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CARING WITHOUT CURING – IT’S OK TO DIE. Palliative Care Institute of Southeast Louisiana Hospice of St. Tammany. Objectives. Communicate better with patients and families about death and dying Come to grips with personal issues about death

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caring without curing it s ok to die
CARING WITHOUT CURING – IT’S OK TO DIE
  • Palliative Care Institute of Southeast Louisiana
  • Hospice of St. Tammany
objectives
Objectives
  • Communicate better with patients and families about death and dying
  • Come to grips with personal issues about death
  • Appreciate the value of the interdisciplinary team approach used in palliative care and hospice
  • Overcome the barriers to optimum opioid use at the end-of-life
  • Treat more effectively the distressing symptoms in the dying or suffering patient
slide3
The EPEC project, Education for Physicians on End-of-Life Care was developed by the American Medical Association and by the Northwestern University Medical School
  • We present now the trigger-tape from Plenary 1, “Gaps in End-of-life Care”
ethical principles
Ethical Principles

Autonomy: respect for patient’s choice

Beneficence: do good

Non-maleficence: don’t harm

Justice: fair use of resources

part one concerns at the end of life

Part One - Concerns at the End-of-life

Some needs expressed by patients:

talk to me and my family
“Talk to me and my family”
  • Communication is essential!
  • Keep the chain of communication simple
  • Remember cultural differences
  • 90+% of patients want to know if they have a life-threatening condition
talk to me and my family9
“Talk to me and my family”
  • Breaking Bad News:
  • Set the stage
  • What does the patient and family know?
  • What do they want to know?
  • Give the news, pause, await the reaction
  • Establish a plan of action
  • Answer questions , pledge support
talk to me and my family10
“Talk to me and my family”
  • Keeping the patient and family informed enhances a stronger doctor-patient relationship
  • Stay involved- be the patient’s advocate
respect my wishes
“Respect My Wishes”
  • Advance directives simplify the lives of everyone (patients, families, healthcare professionals)
  • Planning ahead allows the patient to select a proxy to act for him/her
  • Listen and keep documentation of decisions
respect my wishes12
“Respect my wishes”
  • Every person has an idea of how they want to live and how they want to die
  • Remember that patients have the right to participate in planning their care, including the right to refuse or withdraw from treatment
don t abandon me
“Don’t Abandon Me”
  • “There’s nothing more we can do” is often perceived by patients, rightly or wrongly, as abandonment
  • This is a time of great vulnerability
  • Knowing that someone they trust and rely on will be there for them, whether for aggressive or for palliative care is crucial
non abandonment
Non-abandonment

Slowly, I learn about the importance of powerlessness. I experience it in my own life and I live with it in my work.

“The secret is not to be afraid of it – not to run away. The dying know we are not God.

“All they ask is that we do not desert them”

Shelia Cassidy, MD

help relieve my suffering
“Help Relieve My Suffering”
  • Much of suffering has to do with pain. Pain has 4 dimensions,and elements of each contribute to the complexity of the patient’s care
  • Physical pain
  • Emotional pain
  • Socio-economic pain
  • Spiritual pain
components of suffering
Components of Suffering
  • Physical symptoms.
  • Psychological symptoms
  • Complications of illness
  • Side effects of treatments
  • Effect of illness on life roles
  • Functional status
components of suffering17
Components of Suffering
  • Context/meaning of illness
  • Past experience with illness
  • Relationship with doctors, nurses
  • Healthcare system
  • Financial stresses
  • Spiritual and existential concerns.
spiritual aspects of suffering
Spiritual Aspects of Suffering
  • Uncertainty about timing and manner of death.
  • Guilt and anger
  • Fatigue of caregiver and community support may lead to increased sense of isolation and abandonment.
  • Addressed by improved symptom control and reconnection with community.
help relieve my suffering19
“Help relieve my suffering”
  • In today’s world, it is unrealistic to expect the doctor to address all aspects of suffering
  • A team of healthcare professionals does the best job, much like the “stroke team” does
  • The patient’s doctor should be a member of that palliative care team
summary part one
Summary- Part one
  • Personal physicians are the first to be called when illness strikes
  • Patients expect their doctor to be with them until the end
  • Though cure may not be possible, much can and should be done to provide comfort and support