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Palliative Care
Kenneth Morgan Sauer, MD
Baptist Health Systems
June 3, 2015
Palliative Care
The United States is expected to experience
rapid aging of the population over the next few
decades. By the year 2050, the number of
Americans over age 65 is expected to grow to
88.5 million, up from 40.2 million in 2010--more
than double.
As adults age, their medical conditions become
less responsive to curative treatment, and they
also experience significant physical and cognitive
decline. This is often why they require long-term
care.
• Understand the principles of palliative
Objectives
care and how it differs from traditional
models
• Understand the importance of
establishing and fulfilling goals of care as
a critical element of palliative care
• Describe the common physical and
psychological symptoms at end-of-life
and ways to address them using a
palliative approach
• Describe ways to recognize the final
hours and how best to support the
What is Palliative Care?
The World Health Organization (WHO)
defines palliative care as an “approach
that improves the quality of life of
patients and their families facing the
problems associated with lifethreatening illness through the
prevention and relief of suffering by
means of early identification and
impeccable assessment and treatment
of pain and other problems-- physical,
psychosocial, and spiritual.”
Understanding
Palliative Care
•
Palliative care differs from traditional care
in that it typically does not rely heavily on
invasive tests or procedures or other
diagnostic methods that are aimed at
finding a cause or cure for a certain
symptom or medical condition!
Rather than curing disease, palliative
care focuses on alleviating discomfort.
• It’s all about patient COMFORT!
•
Palliative Care vs.
Hospice Care
Palliative care is similar to hospice
Both share the same philosophy
Palliative care may be utilized at any time
during treatment
Palliative Care vs.
Hospice Care
Hospice usually delivered by a hospice
care team vs. traditional team
Hospice is a
Medicare/Medicaid/private insurance
benefit
Hospice has regulations regarding care
and eligibility.
Palliative Care vs.
Hospice Care
Palliative care does not have regulatory
restrictions
Hospice is a branch of palliative care.
All hospice is palliative care, but palliative
care is much more than just hospice.
Palliative Care
Relief from pain and distress
Regards dying as a normal part of the life
cycle
Does not hasten or postpone death
Uses biopsychosocial model of care
Team approach for pt/family needs
Support for caregiver stress and
bereavement
Who Provides Palliative Care?
Palliative care is not just medical care or
nursing care
All team members play a vital role in
palliative care
All team members must be supportive of
this approach to care.
Palliative Care Team
Nurse- primary provider, caries out most
aspects of care plan. Monitors patient’s
physical condition, symptoms, and
response to interventions
Nurse Assistant- helps identify needs
and response to intervention. Delivers
non-medical palliative interventions
Palliative Care Team
Social Worker- helps patients/families
plan EOL issues: finances, funeral, and
legal arrangements. Provide support,
identify & address emotional needs.
Chaplain- spiritual/emotional support to
patients, families, AND STAFF!!!
Palliative Care Team
PT/OT- therapies and supportive
devices for max comfort. Caregiver
education to assist with care.
MD/DO/APN/PA- orders
interventions, prognostication, medical
diagnoses, directs the team approach
Palliative Care Team
Recreation therapist- helps design
pleasure activities, assist with getting the
most fun out of life
Dietician- assist with meal planning,
shopping instructions
Pharmacist- evaluate medications and
interactions (including diet and OTCs).
Developing The
Palliative Care Plan
Agreed by all team members and
propelled by nursing to address the
following:
Goals of Care
Physical Symptoms
Psychological Symptoms
Family Needs and Concerns
Liberalized Restrictions
Goals of Care
Clarify palliative care does not mean
withdrawing care
Frame a plan to meet goals of care
Revisit plan frequently with team &
caregivers/family
Complete advanced directives
Know various types
Understand the family may be overwhelmed.
Symptoms of End of Life
Pain: Common. May be complex
Respiratory: dyspnea, cough, wheeze
GI: Nausea, constipation, aspiration
Psychological: Depression, anxiety,
hallucinations, delirium, decreased LOC
Spiritual: Crisis of faith
Interventions
Long acting + PRNs vs. PRNs (esp pain)
Oxygen, inhaler vs. nebulizer, diuretics, steroids
Anti-nausea meds, bowel stimulants vs. osmotic
agents
Anti-depressants, anxiolytics
Non-pharmacologic therapies
Addressing Spiritual Needs
Offer religious music, writings, or icons
Arrange for spiritual leader visit
Facilitate rituals
Assist with funeral arrangements
DO NOT WAIT UNTIL THE
LAST MINUTE!!!!!!
Cultural Considerations
Most people have more than one culture
Manifested through values, beliefs,
customs, and behaviors
Affects decision making, views on
death, & many other aspects of care
Race, ethnicity, religion, and lifestyle
contribute to culture
Preserving Dignity
Cleanliness and oder control
Bathing and grooming
Mouth and nail care
Clothing and bedding
Maximize independence
The Final Hours
Pain and noisy breathing
Attending to symptoms and hygeine
Limited food/fluid intake
Maintaining personhood
Talk to resident appropriately
Educate family
Thank You!
Any Questions?