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Jan 2015 Webinar: Palliative Care
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Transcript of Jan 2015 Webinar: Palliative Care
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Palliative CareResearch Advocacy Training and Support Program
Our webinar will begin shortly.
WELCOME!
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• Speaker(s): Jean S. Kutner, MD, MSPH
• Archived Webinars: FightColorectalCancer.org/Webinars
• AFTER THE WEBINAR: Expect an email with links to the material & a survey. If you fill it out, we’ll send you a Blue Star pin.
• Ask a question in the panel on the RIGHT SIDE of your screen
• Follow along via Twitter – use the hashtag #CRCWebinar
Today’s Webinar:
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What is a RESEARCH ADVOCATE? A research advocate brings a patient viewpoint to the research process and communicates a collective patient perspective
Fight CRC’s Research Advocacy Training and Support (RATS) Program: • Goal is to improve the ability of research
advocates to effectively participate in the research process.
• In person meetings, online trainings, and webinars.
• Continued education and ongoing training and support
Brought to you by RATS:
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Resources:
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Disclaimer:
The information and services provided by Fight Colorectal Cancer are for general informational purposes only. The information and services are not intended to be substitutes for professional medical advice, diagnoses or treatment.
If you are ill, or suspect that you are ill, see a doctor immediately. In an emergency, call 911 or go to the nearest emergency room.
Fight Colorectal Cancer never recommends or endorses any specific physicians, products or treatments for any condition.
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Speaker:Dr. Kutner is a tenured Professor of Medicine in the Divisions of General Internal Medicine (GIM), Geriatric Medicine, and Health Care Policy and Research at the University of Colorado School of Medicine (UC SOM). She is Board Certified in internal medicine, geriatric medicine and hospice and palliative medicine and cares for patients on the palliative care service and in general internal medicine clinic.
Her research focuses on improving symptoms and quality of life for hospice and palliative care patients and their family caregivers. On July 1, 2014, Dr. Kutner became the inaugural Chief Medical Officer of University of Colorado Hospital and Associate Dean for Clinical Affairs, UC SOM.
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Palliative Care
Fight Colorectal Cancer WebinarJanuary 29, 2016
Jean S. Kutner, MD, MSPHProfessor of Medicine, University of Colorado School of Medicine
Chief Medical Officer, University of Colorado Hospital
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Palliative Care
When is the “right” time?What are its benefits?
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LT’s story• LT – 43 year old woman, previously healthy• Worsening hip pain – thought to be a running injury• Diagnosed with metastatic cancer by MRI• Confirmed as colorectal cancer• Sources of suffering:
– Pain– Sudden serious illness diagnosis– Uncertain future– Decision making about treatments
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What is Palliative Care?• Specialized medical care for people with serious illness and
their families– Focused on improving quality of life as defined by patients and
families.– Provided by an interdisciplinary team that works with patients,
families, and other healthcare professionals to provide an added layer of support.
– Appropriate at any age, for any diagnosis, at any stage in a serious illness, and provided together with disease treatments.
Definition from public opinion survey conducted by ACS CAN and CAPC http://www.capc.org/tools-for-palliative-care-programs/marketing/public-opinion-research/2011-public-opinion-research-on-palliative-care.pdf
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Palliative Care Components
Hospice CarePalliative Care
Advance Directives
ImproveCommunication
Pain &
Symptom Management
Goals of Care
Difficult Decisions
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Palliative Care: Concurrent with Disease-Directed Therapies
Medicare Hospice Benefit
Life Prolonging Care Not this
Palliative Care
Bereavement
Hospice CareLife ProlongingCare
But this
Dx Death
13
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Hospice• focus is on pain and
symptom management • patient has a terminal
diagnosis with life expectancy of less than six months
• not seeking curative treatment
Palliative Care• focus is on pain and
symptom management • patient does not have to be
terminal • may still be seeking
disease-directed treatment• is not linked to
reimbursement
Hospice vs. Palliative Care
HospicePalliative Care
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Have serious or advanced illness and:• Bothersome or difficult to control psychological or
physical symptoms• Desire for more information about what the future
holds, wanting to make informed decisions• Frequent hospitalizations or ER visits• Progressive inability to care for self• Caregiver distress• Long hospitalization without evidence of progress• In ICU setting with poor prognosis
Who Might Consider Palliative Care?
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Palliative Care: Key Components• Multidimensional assessment
– Sources of distress– Unmet needs
• Physical symptoms• Psychological issues• Social concerns• Family difficulties• Spiritual distress
• Treatment to improve sources of distress– Skills in pain and symptom control– Ability to have conversations about tough issues
• Know about referral resources and be willing to refer for additional specialist palliative care
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• Managing symptoms that cause suffering• Communication
Exploring values and patient-centered goals Helping patients assess risk, benefit, burdens Creating care plans (and back-ups) to meet
goals
Palliative Care Integrates with Disease-focused Treatments
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Palliative Care as a Specialty
Medicine: American Board of Medical Specialities and American Osteopathic
Association Board of Specialities formally recognized Hospice and Palliative Medicine as a new specialty in 2006 (www.abms.org)
First board exam October 2008. First ACGME fellowship certification 2009
Nursing: National Board for Certification of Hospice and Palliative Nurses
(www.nbchpn.org) Social work
Advanced Certified Hospice and Palliative Social Worker (www.socialworkers.org)
Chaplaincy BCC-HPCC (board certified chaplain - hospice/palliative care certified)
(http://bcci.professionalchaplains.org/palliative)
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• Clarification of care goals• Pain and other symptom management• Emotional, social, and spiritual support• Coordination of care
Common Reasons for Palliative Care Consultation
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EXISTING EVIDENCE – BRIEF SUMMARY
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Palliative Care = Quality Care
Research shows that palliative care:
• Relieves pain and distressing symptoms• Clarifies goals of care and supports decision-making• Improves quality of life• Increases patient and family satisfaction with care • Eases burden on providers and caregivers• Helps patients complete life prolonging treatments• Enhances the value of health care
Bakitas: JAMA 2009; Gade: JPM 2008.
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Palliative Care Improves Quality, Reduces CostRCT of palliative care vs. usual home care for heart failure, chronic
obstructive pulmonary disease, or cancer patients (1999–2000)
13.211.1
2.3
9.4
4.6
35.0
5.3
0.9 2.4 0.90
10
20
30
40
Home healthvisits
Physicianoffice visits
ER visits Hospital days SNF days
Usual Medicare home care Palliative care intervention
Brumley, R.D. et al. JAGS 2007
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Concurrent palliative care
Randomized trial: simultaneous standard cancer care with palliative care co-management from diagnosis vs standard cancer care only (non small cell lung cancer):
– Improved quality of life – Reduced major depression – Reduced ‘aggressiveness’ (less chemo < 14d before death,
more likely to get hospice, less likely to be hospitalized in last month)
– Improved survival (11.6 mos. vs. 8.9 mos., p<0.02) Temel et al. Early palliative care for patients with non-small-cell lung cancer NEJM. 2010;363:733-42
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Temel et al. Early palliative care for patients with non-small-cell lung cancer NEJM2010;363:733-42.
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Kaplan-Meier estimates of 1-year survival by treatment group.
Marie A. Bakitas et al. JCO doi:10.1200/JCO.2014.58.6362
©2015 by American Society of Clinical Oncology
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Benefits of Outpatient Palliative Care
Four well-designed randomized interventions as well as a growing body of nonrandomized studies indicate that outpatient palliative care services can:1) improve patient satisfaction2) improve symptom control and quality of life3) reduce health care utilization, and4) lengthen survival in a population of lung cancer patients.
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Morrison, R. S. et al. Arch Intern Med 2008;168:1783-1790.
Mean direct costs per day for palliative care patients who were discharged alive (A) or died (B) before and after palliative care consultation
Died:Adjusted net savings = $4908 direct costs/admission; $374 direct costs/day
Discharged alive:Adjusted net savings = $1696 direct costs/ admission;$279 direct costs/day
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Consultation within 6 days reduced costs by -$1,312 (95% CI, -$2,568 to -$56; P .04) = 14% reduction in cost of hospital stay.
Consultation within 2 days reduced costs by -$2,280 (95% CI, -$3,438 to -$1,122; P .001) = 24% reduction in cost of hospital stay.
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Palliative Care Improves Value
Quality improves– Symptoms– Quality of life– Length of life– Family satisfaction– Family bereavement
outcomes– MD satisfaction
Costs reduced– Hospital cost/day – Use of hospital, ICU,
ED – 30 day readmissions – Hospitality mortality – Labs, imaging,
pharmaceuticals
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RECOMMENDATIONS AND GUIDELINES
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Palliative care is essential to quality
8 Relevant IOM Reports:
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IOM Report: Delivering High-Quality Cancer Care
To read the report online: www.iom.edu/qualitycancercare
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Cancer Care Continuum
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IOM Report: “Dying in America”
iom.edu/endoflife
Released 9/17/14
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Key Areas for Findings and Recommendations
• Delivery of person-centered, family-oriented care• Clinician-patient communication and advance care
planning• Professional education and development• Policies and payment systems• Public education and engagement
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American Society of Clinical Oncology (ASCO)
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STANDARD 2.4 Palliative Care Services Palliative care services are available to patients either on-site or by referral.
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COMMUNICATION IN THE SETTING OF SERIOUS ILLNESS
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https://www.ariadnelabs.org/wp-content/uploads/sites/2/2015/12/Serious-Illness-Conversation-Guide-10.30.15.pdf
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AVAILABILITY OF PALLIATIVE CARE IN US
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Hospital Setting:• Palliative care consultation• Palliative care unit• In-hospital hospice beds
Community-based Setting:• Home-based palliative care• Clinic-based palliative care• Nursing home-based palliative care• Hospice (at home, dedicated facility, nursing home,
assisted living)
Where Can I Get Palliative Care?
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State-by-State Rating (2015)
Center to Advance Palliative Care (https://reportcard.capc.org/)
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2015 Report Card On Access To Palliative Care At US Hospitals
Center to Advance Palliative Care (https://reportcard.capc.org/)
2008 2011 2015
A
B
C
D
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Access differs by hospital characteristics
►100% of the U.S. News 2014 – 2015 Honor Roll Hospitals Have a Palliative Care Team►100% of the U.S. News 2014 – 2015 Honor Roll Children’s Hospitals Have Palliative Care Teams
Center to Advance Palliative Care (https://reportcard.capc.org/)
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Where Can I Get More Information?
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Treating the person beyond the disease.
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www.ariadnelabs.org
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getpalliativecare.org
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LT’s story• Began seeing palliative care before oncologist
• Over course of the next 11 months, LT cared for by both palliative care and oncologist– Palliative care: symptoms, support, decision making– Oncology: CRC treatment
• Partnership between palliative care and oncology allowed LT to participate in first, second and third line treatments
• Palliative care supported LT and her family in her final weeks when she decided that the burdens of cancer treatment were outweighing the potential benefits– Allowed her to achieve important goals and spend meaningful time with her
family
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“A life ended with much unfinished business
or uncontrolled suffering has not been met with due
respect, and does not leave good
memories.” Dame Cecily Saunders
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QUESTIONS AND DISCUSSION
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Question & Answer:
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