Palliative Care Across the Continuum of Illness

Jean Endryck, FNP-BC, ACHPN, NE-BCDirector of Palliative Care

St. Peter’s Health Partners/Seton HealthTroy, New YorkJuly 23, 2013

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I, Jean Endryck, do not have any relevant financial interests or other relationshipswith a commercial entity producing healthcare-related products and/or services.

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Learning Objectives

Identify the principles of Palliative Care

Understand how Palliative Care applies across the continuum of illness

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OLD LANGUAGE

Palliative care is the medical specialty focused onimproving the quality of life of people facing seriousillness.

Emphasis is placed on pain and symptom management,communication and coordinated care.

Palliative care is appropriate from the time of diagnosisand can be provided along with curative treatment.

Source: 2011 Public Opinion Research on Palliative Care: CAPC

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NEW YORK STATE LAW

Palliative care, as defined by the law, is “health care treatment, including interdisciplinary end-of-life care, and consultation with patients and family members, to prevent or relieve pain and suffering and to enhance the patient’s quality of life, including hospice care” PHL §§2997-c and 2997-d

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Palliative care is specialized medical care for people with serious illnesses. This type of care is focused on providing patientswith relief from the symptoms, pain, and stress of a serious illness – whatever the diagnosis.

The goal is to improve quality of life for both the patient and the family. Palliative care is provided by a team of doctors, nurses,and other specialists who work with a patient’s other doctorsto provide an extra layer of support.

Palliative care is appropriate at any AGE and at any STAGE in a serious illness, and can be provided together with CURATIVE TREATMENT.

Source: 2011 Public Opinion Research on Palliative Care by CAPC

NEW LANGUAGE

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Patient Focused, Family Centered Medical Care

Achieving Sense of Control

Achieving Closure Respect and Compassion

Spirituality/ Transcendence

Attends to Caregiver

Focus on the Individual

Shared Decision-Making

Physical and Emotional Comfort

Personal Closure

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NATIONAL CONSENSUS PROJECTThird Edition, 2013

Developed clinical practice guidelines for quality Palliative Care which are:1.Define the essential elements of palliative care

2.Drive development and improvement in clinical programs

3.Help clinicians incorporate palliative care into routine practice

4.Promote quality, consistency and reliability of services

5.Foster access to palliative care across the continuum of health care services

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NATIONAL CONSENSUS PROJECTDOMAIN 1: Structure and Processes of Care

DOMAIN 2: Physical Aspects of Care

DOMAIN 3: Psychological and Psychiatric Aspects

DOMAIN 4: Social Aspects of Care

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NATIONAL CONSENSUS PROJECT (continued)

DOMAIN 5: Spiritual, Religious, and Existential Aspects of Care

DOMAIN 6: Cultural Aspect of Care

DOMAIN 7: Care of the Patient at the End-of-Life

DOMAIN 8: Ethical and Legal Aspects of Care

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NATIONAL QUALITY FORUM (NQF)

2012 report identified a framework and set of NQF endorsed™ preferred practices that focus on improving palliative care acrossthe Institute of Medicine’s six dimensions of quality-safe, effective,timely, patient-centered, efficient, and equitable

The preferred practices mark a crucial step in the standardization of palliative care and hospice

There are 38 preferred practices

Source: www.qualityforum.org

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PALLIATIVE CARE VS HOSPICEAll of hospice is

palliative care,

but not all of

Palliative care is

hospice

Palliative Care

Hospice

ASCENSION HEALTH MODEL

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The Joint Commission Advanced Certification Program for Palliative Care

Started in 2011

Signifies that hospitals are committed to patient and family centered care

Certification based on clinical practice guidelines through the National Quality Forum Consensus Report

NQF has identified 38 preferred practices that focus on improving palliative care and hospice care across the IOM six dimensions of quality, safe, effective, timely, patient centered, efficient, and equitable

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15Modified from Diane Meier, MD CAPC

CLINICAL INTERSECTIONS

CONTINUUM OF ILLNESS

FACT: Approximately 90 million Americans live with at least one chronic disease.

FACT: In New York City, the average person with a serious illness receives care from 12 specialists, with no one coordinating care

Source: Dartmouth Atlas of Health Care

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Continuum of Illness: Adult and Pediatric

Hospital Palliative Care Teams:

Emergency Department: IPAL-EM

Intensive Care Units: IPAL-ICU

Medical Floors

Outpatient: IPAL-OP covering clinic, home based

Assisted Living Homes

Nursing Homes, Skilled Nursing Facilities

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CONTINUUM OF ILLNESS

Pulmonary

Heart Failure

Dementia

Hepatic

HIV/AIDS

Neurological Diseases and Trauma

Renal

Cancer

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EVIDENCE OF SUCCESS

2010 NEJM research study showed that patients with metastatic non-small cell lung cancer who received early palliative care along with standard treatment lived on average THREE MONTHS LONGER (11.6 months vs. 8.9 months)

Pain and symptoms were well managed resulting in less admissions to the ED or inpatient

Patients in the study experience less depression and improved QOL

Chose less “aggressive” care at EOL

Source: Temel, J.S., et.al. (2010). Early Palliative Care for Patients with Metastatic Non-Small cell lung cancer. NEJM(363), 733-742.

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CONCLUSION

DON’T delay Palliative care for a patient with serious illness who has physical, psychological, social, or spiritual distress because they are pursuing disease directed treatment

Numerous studies including randomized trials provide evidence that palliative care improves pain and symptom control, improves family satisfaction with care, and reduces costs

Palliative care does not accelerate death and may prolong life in selected population

Source: Five things Physicians and Patients should question in hospice and palliative medicine. Choosing Wisely; an initiative of the ABIM Foundation. Aahpm.org/choosingwisely

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QUESTIONS?

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RESOURCES

Center to Advance Palliative Care: www.capc.org

American Academy of Hospice and Palliative Medicine: www.aahpm.org

Hospice and Palliative Nurses Association: www.hpna.org

National Consensus Project for Quality Palliative Care: www.nationalconsensusproject.org

National Quality Forum (NQF) Consensus Report: www.qualityforum.org

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RESOURCES

Education in Palliative and End of Life Education: www.epec.net

ELNEC: www.aacn.nche.edu/elned

EPERC: www.eperc.mcw.edu

Get Palliative care resource for families at www.getpalliativecare.org

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REFERENCES2011 Public Opinion Research on Palliative Care accessed www.capc.com

New York State Palliative care act accessed

www.health.ny.gov/professionals/patients/patient_rights/palliativecare/practitioners/resources.htm#prognosis

National Consensus Project (NCP) Third Edition, 2013 accessed www.nationalconsensusproject.org

National Quality Forum (NQF) 2012 accessed www.qualtiyforum.org

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REFERENCES

Dartmouth Atlas of Health Care accessed www.dartmouthatlasofhealthcare

Temel, J.S., et.al.(2010). Early Palliative care for patients with metastatic non-small cell lung cancer. NEJM (363), 733-742.

Choosing wisely; an initiative of the ABIM Foundation accessed www.aahpm.org/choosingwisely

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