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Palliative Care

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by

Zack Smith

on 31 August 2016

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Transcript of Palliative Care

So what is Palliative Care?


Most illnesses (in youth) are temporary.

Chronic illnesses usually present much later in life.
"It's not about killing Granny; it's about keeping Granny alive as long as possible - with the best quality of life." Diane Meier, NYTimes
Myths about palliative care:
Palliative care = Giving up, losing hope
Palliative care = no more care/treatment
Palliative care = continuous morphine only = CMO
The Palliative Care Team:
A place?
A philosophy?
For patients who are ready to die?
from Second City
"A good physician treats the disease; a great physician treats the patient who has the disease" - William Osler
Impacting Outcomes in Louisiana
Dr. Benjamin Li and
Becky Majdoch
January 28, 2012
Objectives
Increase awareness of cancer’s impact in Louisiana
Increase knowledge of American Cancer Society programs and services
Statewide
Community-level
Increase understanding of how ACS programs and services affect cancer outcomes
Cancer Incidence in Louisiana
Cancer Incidence
Source: Cancer Control Planet, Data Accessed August 2011.
.
All Sites (Invasive) – Incidence Rates
By Year of Diagnosis – All Races, Males and Females
2015 Goal 383.0
1992 Baseline 510.7
Incidence and mortality rates per 100,000 and age-adjusted to 2000 US standard population
SEER Cancer Statistics Review 1975-2007.
2008 U.S. Rate
2015 Goal – 25% Reduction from Baseline
2015 Projected Rate – 444.3
2008 LA Rate
Source: American Cancer Society and Cancer Control Planet. Accessed August 2011.
.
Cancer Incidence - By County
Source: Cancer Control Planet, Data Accessed August 2011.
.
Cancer Mortality in Louisiana
Cancer Mortality
Source: Cancer Control Planet, Data Accessed August 2011.
.
All Sites (Invasive) – Incidence Rates
By Year of Diagnosis – All Races, Males and Females
2015 Goal 383.0
1992 Baseline 510.7
Incidence and mortality rates per 100,000 and age-adjusted to 2000 US standard population
SEER Cancer Statistics Review 1975-2007.
2008 U.S. Rate
2015 Goal – 25% Reduction from Baseline
2015 Projected Rate – 444.3
2008 LA Rate
Source: American Cancer Society and Cancer Control Planet. Accessed August 2011.
.
Cancer Incidence - By County
Source: Cancer Control Planet, Data Accessed August 2011.
.
Cancer Incidence - By Type
Source: American Cancer Society , 2011 Cancer Facts & Figures
.
Cancer Mortality in Louisiana
Cancer Mortality
Source: Cancer Control Planet, Data Accessed August 2011.
.
Cancer Mortality - By County
Source: Cancer Control Planet, Data Accessed August 2011.
.
How We Can Make a Difference?
Polyp as Seen on Colonoscopy
Peritoneal Carcinomatosis
Locally Advanced Breast Cancer
Early Breast Cancer and Breast Conservation Therapy
2012 Mid-South Division Board Outcomes
Board Outcomes – Early Detection
Eliminate mammography screening disparity between Medicare-eligible African-American and Caucasian women
Increase colorectal screening rates in the 50+ population from 50% to 60%
Decrease colorectal screening disparity between Medicare-eligible African-Americans and Caucasians from 7.5% to 4%
Board Outcomes – Quality of Life
Increase use of ACS services by cancer patients and caregivers
Increase number of underserved cancer patients receiving services
Increase number of newly diagnosed cancer patients receiving services
Board Outcomes - Advocacy
Increase tobacco excise tax by at least $0.50 in 2 Mid-South States
Remove exemptions to LA’s Statewide Smoke-Free Act
Increase funding for the Breast and Cervical Cancer Early Detection Program to cover 30% of the eligible population
Secure funding for programs that provide access to colorectal cancer screening for the uninsured and underinsured
Bringing Outcomes Alive in Your Community
Becky Majdoch, MPH
American Cancer Society
Health Initiatives Director, Louisiana
Information & Patient Programs
24
Patient Service Center
Employs skilled, specialized patient service center staff with comprehensive training.
Provides coverage of telephones during all working hours, with fewer abandoned calls and an ability to monitor progress.
Maintains consistent and timely follow-up on patient requests; eliminating obstacles created by staff vacancies or extended absences seen in the current decentralized system.
Allows staff to expand and promote patients programs and invest more time in volunteer efforts.
Helps to identify volunteer opportunities in patient programs.
Reinforces and safeguards patient data by standardizing and centralizing data in a more secure environment.
Ensures that consistent policies, procedures and criteria are used throughout the Division to deliver high quality patient services.
Hope Lodge
26
Community Health Advisor
27
Health Systems – Prevention/Early Detection, Quality of Life, & Advocacy
Any Questions?
Goals of today's discussion:

1. Have an understanding of palliative and hospice care

2. Know when to involve palliative principles in patient care

3. Understand the benefits of palliative care to the patient

4. Understand why there is a financial incentive to facilities to develop a palliative care program
Regardless of where you are now -

#1. You will have a life-changing event

#2. If you survive - you will still eventually
die.

How our culture sees "illness".
In a Nutshell -

It is the care you want to receive so that you can do the things you want to do.
So.......Now that you are going to Live awhile-


What do you want?

What makes life living?
POP Quiz!!
Excluding Annual Exams,
How many of us see MDs
Traditional Continuum of Care
Optimal Continuum of Care
POP Quiz!!
What Are Hospitals Good At?
Acute Illness
Medical Errors
And What?
We are aging as a nation.
By the year 2030, according to the Administration on Aging (AoA), there will be more than 72.1 million Americans over age 65 in the U.S. (1 out of 5), and more than twice the number in 2000.
Why Do We Fail with Chronic Disease?
What is
Palliative Care?

Zack Smith
Director - Radiation Oncology
Baton Rouge General Pennington Cancer Center

Psychologist
Vascular MD
GI MDs
Urologists
Cardiologist
Pulmonologist
Optomitrist
Endocrine MD
OB/GYN
Rheumatology
When is it used?
Does it differ from Hospice?
Palliative Care is specialized Medical Care focused on providing relief from the symptoms, pain, and stress of serious (life-limiting) illness - whatever the diagnosis.
It is appropriate at any stage of an illness and can be provided with curative treatment.
The goal is to improve the quality of life for the patient and family.
What is the Number One Diagnosis Referred to Palliative and Supportive Care?
- Stroke
- Cancer
- CHF
- ESRD
- CHF
Haven't Heard of
Palliative Care?
Complex Chronic Conditions:
Diabetes
Hypertension
Coronary Artery Disease
Heart Failure
Lung Failure (Asthma/COPD)
Vascular Disease
Arthritis
Cancer
Dementia
Chronic Renal Disease
Depression
Degenerative Neurological Disorders
Bipolar/Schizophrenia
Aging Statistics, The Administration on Aging (AoA) website, www.aoa.gov, last accessed 10/5/2012.
when
we feel
Well
?
Remember: Age = Chance of Chronic Condition
Mentality:

- Patients will take treatments that have almost no chance
Access to Medical Care:
- ~47 Million Americans don't have medical insurance

- What % of Americans DO have insurance?
55%
65%
75%
85%
85%
Recent Studies on People with Serious Illness:
- experience medically inadequate treatment
- fragmented care
- poorly controlled symptoms
- poor communication with MDs
- strain on family caregivers
State-by-State Report Card 2011, Center for the Advancement of Palliative Care, www.capc.org, last accessed 10/12/2012
Birth
Death
Death
Birth
Confusion about Supportive
and End of Life Care
- Doctors will give treatments that have almost no chance
Specialized MDs
RNs
Social Workers
Chaplains
Patient Treated According to "Systems"
Of the 1.5M Americans with Chronic Conditions who die each year.....
more than 70% are admitted to the hospital during the last 6 months of life.
FACT
Dartmouth Atlas of Care
Special Thanks to:

Suzana Makowski
Dr. Charles Mason
Angela Cunningham

For their time, expertise, input, and ideas.

Palliative Care
Hospice
Care
Benefits of Palliative Care:
- Better symptom control
- Coordinated care
- Increased survival*
- Less utilization
In a survey on end-of-life:

80% responded they wanted to die at home
Benefits to Hospital:
- Lower mortality rates
- Lower readmission rates
- Increased patient satisfaction rates
- Decreased cost per admission
In Summary
Palliative Care
Hospice Care
End of Life
Not defined by life expectancy
Specialized Team
Specialized Team
Stop curative focus
Concurrent to curative treatments
Medicare Benefit
Not Medicare benefit*
Home or Inpatient
Any patient setting*
Questions?
Thank you.
Don't be surprised
zack.smith@brgeneral.org
zack.smith@brgeneral.org
Full transcript