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SW Intro to PPC

Zooming in at concurrent care
by

Maggie Root

on 6 September 2016

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Transcript of SW Intro to PPC

Helping children Live
as well as possible
for as long as possible
Reflect
Evidence
Plan
Describe benefits
to a colleague
Barriers
Pediatric Palliative Care
Define
Objectives
Describe
Identify Barriers
Hope and prognosis
Timing of palliative care
avoiding failure
takes time
uncertain prognosis
giving up hope
no love from colleagues
hospice care
No disclosures
No conflict of interest
No discussion of off-label drug use
Resources
acknowledgments
Joanne Wolfe, MD, MPH
Mary Ersek, PhD, RN, FAAN, FPCN
Robin Kramer, MS, RN, PNP
Introduce concurrent
palliative care
to a family
Recognize perceived barriers
Have a Plan
Begins at diagnosis
Relieves suffering
physical, emotional, spiritual, existential
Enhances quality of life
Family-centered care
Provided by interdisciplinary team
Focuses on communication
Facilitates care coordination
Occurs together with disease directed treatment
Integrated Pediatric Pain and Palliative Care Team
M-F 0900-1600, x25434 on VOALTE
Rounding M/W/F, as needed on Tu/Th
24/7 Backup by IP3 Pain Pediatrician (443-6100)

getpalliativecare.org

Partners for Children (CCS Palliative Care Waiver)
http://www.dhcs.ca.gov/services/ppc/Pages/default.aspx

National Institute of Nursing Research: Conversations Matter
Tenets of PPC
Good communication by MD
Increased Hope
Boston Children's
Published 2007
Children in 1st year of cancer therapy
194 parents surveyed
Looked at hope, trust, emotional distress
Primary objective: Examine relationship between provider communication regarding prognosis and parental hope
J. Mack et al.
Disclosure of prognosis regardless of likelihood of cure
Temel, et al.
151 new diagnosis non-small cell lung cancer patients
Terminal diagnosis
Randomized to standard treatment vs. standard treatment + palliative care
Intervention= at least monthly visits with palliative care clinician, phone consult access
Results
Reported better quality of life
Fewer depressive symptoms
Lived longer
11.6 vs 8.9 months
Current patient
who might
benefit
Identify patients
Use "palliative care" appropriately
More Fun
Friedrichsdorf, et al.
More likely to have fun
Increased meaning to life
Results
Children with cancer
Home based palliative care
Improved communication
Kassam et al.
Team provides interdisciplinary support and integrates a palliative care approach

Clinical --> more complex care
Education --> enhance knowledge, skills, behaviors and attitudes
Research --> advancing the field
Advocacy --> system-wide changes
Primary & Sub-specialty
UCSF BCH SF
Inpatient Consult Service
M/W/F
Tu/Th
Staff
Hospice & Palliative Medicine BC/BE MD
Pediatric Palliative Care NP
Grief/Loss Counselor

Outpatient Services
Presently limited
Consultation for active patients; kids receiving hospice
Coordination with Hospice by the Bay/By the Bay Kids

Education
New Grad RNs, Nursing Units, Fellows College

Research
Partners for Children
i.e. CCS Palliative Care Waiver
Concurrent Palliative Care
Eligibility
Full financial eligibility for CCS
<21 years old
Qualifying Diagnosis
Live in participating county
No cost to family
Not presently on another waiver
Initial Consult
Tell us about your child...
What can you tell us about your child's medical conditions?
What gives you strength during these hard times?
What are you hoping for?
What are you worried about?
The practicalities
Full transcript