Palliative Care Across the Continuum of Illness
Jean Endryck, FNP-BC, ACHPN, NE-BCDirector of Palliative Care
St. Peter’s Health Partners/Seton HealthTroy, New YorkJuly 23, 2013
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I, Jean Endryck, do not have any relevant financial interests or other relationshipswith a commercial entity producing healthcare-related products and/or services.
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Learning Objectives
Identify the principles of Palliative Care
Understand how Palliative Care applies across the continuum of illness
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OLD LANGUAGE
Palliative care is the medical specialty focused onimproving the quality of life of people facing seriousillness.
Emphasis is placed on pain and symptom management,communication and coordinated care.
Palliative care is appropriate from the time of diagnosisand can be provided along with curative treatment.
Source: 2011 Public Opinion Research on Palliative Care: CAPC
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NEW YORK STATE LAW
Palliative care, as defined by the law, is “health care treatment, including interdisciplinary end-of-life care, and consultation with patients and family members, to prevent or relieve pain and suffering and to enhance the patient’s quality of life, including hospice care” PHL §§2997-c and 2997-d
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Palliative care is specialized medical care for people with serious illnesses. This type of care is focused on providing patientswith relief from the symptoms, pain, and stress of a serious illness – whatever the diagnosis.
The goal is to improve quality of life for both the patient and the family. Palliative care is provided by a team of doctors, nurses,and other specialists who work with a patient’s other doctorsto provide an extra layer of support.
Palliative care is appropriate at any AGE and at any STAGE in a serious illness, and can be provided together with CURATIVE TREATMENT.
Source: 2011 Public Opinion Research on Palliative Care by CAPC
NEW LANGUAGE
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Patient Focused, Family Centered Medical Care
Achieving Sense of Control
Achieving Closure Respect and Compassion
Spirituality/ Transcendence
Attends to Caregiver
Focus on the Individual
Shared Decision-Making
Physical and Emotional Comfort
Personal Closure
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NATIONAL CONSENSUS PROJECTThird Edition, 2013
Developed clinical practice guidelines for quality Palliative Care which are:1.Define the essential elements of palliative care
2.Drive development and improvement in clinical programs
3.Help clinicians incorporate palliative care into routine practice
4.Promote quality, consistency and reliability of services
5.Foster access to palliative care across the continuum of health care services
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NATIONAL CONSENSUS PROJECTDOMAIN 1: Structure and Processes of Care
DOMAIN 2: Physical Aspects of Care
DOMAIN 3: Psychological and Psychiatric Aspects
DOMAIN 4: Social Aspects of Care
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NATIONAL CONSENSUS PROJECT (continued)
DOMAIN 5: Spiritual, Religious, and Existential Aspects of Care
DOMAIN 6: Cultural Aspect of Care
DOMAIN 7: Care of the Patient at the End-of-Life
DOMAIN 8: Ethical and Legal Aspects of Care
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NATIONAL QUALITY FORUM (NQF)
2012 report identified a framework and set of NQF endorsed™ preferred practices that focus on improving palliative care acrossthe Institute of Medicine’s six dimensions of quality-safe, effective,timely, patient-centered, efficient, and equitable
The preferred practices mark a crucial step in the standardization of palliative care and hospice
There are 38 preferred practices
Source: www.qualityforum.org
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PALLIATIVE CARE VS HOSPICEAll of hospice is
palliative care,
but not all of
Palliative care is
hospice
Palliative Care
Hospice
ASCENSION HEALTH MODEL
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The Joint Commission Advanced Certification Program for Palliative Care
Started in 2011
Signifies that hospitals are committed to patient and family centered care
Certification based on clinical practice guidelines through the National Quality Forum Consensus Report
NQF has identified 38 preferred practices that focus on improving palliative care and hospice care across the IOM six dimensions of quality, safe, effective, timely, patient centered, efficient, and equitable
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15Modified from Diane Meier, MD CAPC
CLINICAL INTERSECTIONS
CONTINUUM OF ILLNESS
FACT: Approximately 90 million Americans live with at least one chronic disease.
FACT: In New York City, the average person with a serious illness receives care from 12 specialists, with no one coordinating care
Source: Dartmouth Atlas of Health Care
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Continuum of Illness: Adult and Pediatric
Hospital Palliative Care Teams:
Emergency Department: IPAL-EM
Intensive Care Units: IPAL-ICU
Medical Floors
Outpatient: IPAL-OP covering clinic, home based
Assisted Living Homes
Nursing Homes, Skilled Nursing Facilities
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CONTINUUM OF ILLNESS
Pulmonary
Heart Failure
Dementia
Hepatic
HIV/AIDS
Neurological Diseases and Trauma
Renal
Cancer
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EVIDENCE OF SUCCESS
2010 NEJM research study showed that patients with metastatic non-small cell lung cancer who received early palliative care along with standard treatment lived on average THREE MONTHS LONGER (11.6 months vs. 8.9 months)
Pain and symptoms were well managed resulting in less admissions to the ED or inpatient
Patients in the study experience less depression and improved QOL
Chose less “aggressive” care at EOL
Source: Temel, J.S., et.al. (2010). Early Palliative Care for Patients with Metastatic Non-Small cell lung cancer. NEJM(363), 733-742.
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CONCLUSION
DON’T delay Palliative care for a patient with serious illness who has physical, psychological, social, or spiritual distress because they are pursuing disease directed treatment
Numerous studies including randomized trials provide evidence that palliative care improves pain and symptom control, improves family satisfaction with care, and reduces costs
Palliative care does not accelerate death and may prolong life in selected population
Source: Five things Physicians and Patients should question in hospice and palliative medicine. Choosing Wisely; an initiative of the ABIM Foundation. Aahpm.org/choosingwisely
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QUESTIONS?
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RESOURCES
Center to Advance Palliative Care: www.capc.org
American Academy of Hospice and Palliative Medicine: www.aahpm.org
Hospice and Palliative Nurses Association: www.hpna.org
National Consensus Project for Quality Palliative Care: www.nationalconsensusproject.org
National Quality Forum (NQF) Consensus Report: www.qualityforum.org
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RESOURCES
Education in Palliative and End of Life Education: www.epec.net
ELNEC: www.aacn.nche.edu/elned
EPERC: www.eperc.mcw.edu
Get Palliative care resource for families at www.getpalliativecare.org
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REFERENCES2011 Public Opinion Research on Palliative Care accessed www.capc.com
New York State Palliative care act accessed
www.health.ny.gov/professionals/patients/patient_rights/palliativecare/practitioners/resources.htm#prognosis
National Consensus Project (NCP) Third Edition, 2013 accessed www.nationalconsensusproject.org
National Quality Forum (NQF) 2012 accessed www.qualtiyforum.org
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REFERENCES
Dartmouth Atlas of Health Care accessed www.dartmouthatlasofhealthcare
Temel, J.S., et.al.(2010). Early Palliative care for patients with metastatic non-small cell lung cancer. NEJM (363), 733-742.
Choosing wisely; an initiative of the ABIM Foundation accessed www.aahpm.org/choosingwisely
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