Integrating Principles and Practice of Palliative Medicine in Emergency Care

2016 ◽  
Author(s):  
Patricia J. O’Malley
Keyword(s):  
Palliative Care ◽  
Medical Specialty ◽  
Family Satisfaction ◽  
Emergency Setting ◽  
Advanced Illness ◽  
Patient Centered ◽  
Serious Illness ◽  
Breaking Bad ◽  
Communication Competencies ◽  
Aggressive Interventions

Trajectories of serious illness and dying have changed in the last century; people now live longer, often with prolonged debility in advanced stages of illness. With more options for aggressive interventions at the end of life, patients and families face increasingly complex medical decisions. Many of these patients will present repeatedly to the emergency department (ED) before their death, and emerging evidence suggests that integrating palliative care into the treatment of advanced illness, including in the emergency setting, can improve outcomes. This review covers changing trajectories of illness and death, palliative care as a medical specialty, emerging models of integration, essential palliative care competencies for the ED clinician, and managing the actively dying patient in the ED. Figures show palliative care through the trajectory of serious illness, theoretical trajectories of disease, life expectancies for women and men, and patient-centered communication. Tables list philosophy of palliative care, domains of suffering addressed by palliative care, palliative performance scale, NURSE mnemonic for accepting and responding to emotion, palliative care communication competencies in the intensive care unit: effect on clinical outcomes and family satisfaction, and SPIKES mnemonic for breaking bad news.   This review contains 4 highly rendered figures, 6 tables, and 113 references

Principles and Practice of Palliative Care

2013 ◽  
Author(s):  
Kristen G Schaefer ◽  
Rachelle E Bernacki
Keyword(s):  
Palliative Care ◽  
Life Support ◽  
Advanced Life Support ◽  
Family Satisfaction ◽  
Terminal Phase ◽  
Survival Times ◽  
Advanced Illness ◽  
Post Discharge ◽  
Patient Centered ◽  
Serious Illness

The trajectories of serious illness and dying have changed in the last century; in the past, patients lived shorter lives and often died quickly of infectious disease, whereas patients in the 21st century live longer and often with prolonged debility in the advanced stages of illness. As a result, patients with serious illness can suffer undertreated symptoms and often feel poorly prepared for the final stages of disease. With more options for advanced life support and other aggressive interventions at the end of life, patients and families face increasingly complex medical decisions in the terminal phase of illness, and the treatments they receive do not always align with their goals and values. Emerging evidence suggests that integrating palliative care into the treatment of advanced illness can improve outcomes, decrease costs, and improve both patient and family satisfaction. Consequently, patient access to high-quality specialty-level palliative care is becoming standard of care at most academic cancer centers and more available in the community. This chapter describes the practice and principles of specialty-level palliative care and outlines specific "generalist" palliative care competencies essential for all physicians caring for patients with serious illness, including prognostication, patient-centered communication, and the navigation of ethical dilemmas in the field of palliative care. Tables outline the philosophy of palliative care, domains of suffering, location of death of hospice patients, the palliative performance scale, median survival times for cancer syndromes, indicators associated with a poorer prognosis in congestive heart failure, the NURSE mnemonic for accepting and responding to emotion, palliative care communication competencies in the intensive care unit, and the SPIKES mnemonic for breaking bad news. Figures depict causes of death in 1900 versus 2010, palliative care through the trajectory of serious illness, theoretical trajectories of disease, life expectancies for women and men, mortality at 1 year post discharge, and a model for patient-centered communication. This review contains 6 highly rendered figures, 9 tables, and 169 references.

Principles and Practice of Palliative Care

2013 ◽  
Author(s):  
Kristen G Schaefer ◽  
Rachelle E Bernacki
Keyword(s):  
Palliative Care ◽  
Life Support ◽  
Advanced Life Support ◽  
Family Satisfaction ◽  
Terminal Phase ◽  
Survival Times ◽  
Advanced Illness ◽  
Post Discharge ◽  
Patient Centered ◽  
Serious Illness

The trajectories of serious illness and dying have changed in the last century; in the past, patients lived shorter lives and often died quickly of infectious disease, whereas patients in the 21st century live longer and often with prolonged debility in the advanced stages of illness. As a result, patients with serious illness can suffer undertreated symptoms and often feel poorly prepared for the final stages of disease. With more options for advanced life support and other aggressive interventions at the end of life, patients and families face increasingly complex medical decisions in the terminal phase of illness, and the treatments they receive do not always align with their goals and values. Emerging evidence suggests that integrating palliative care into the treatment of advanced illness can improve outcomes, decrease costs, and improve both patient and family satisfaction. Consequently, patient access to high-quality specialty-level palliative care is becoming standard of care at most academic cancer centers and more available in the community. This chapter describes the practice and principles of specialty-level palliative care and outlines specific "generalist" palliative care competencies essential for all physicians caring for patients with serious illness, including prognostication, patient-centered communication, and the navigation of ethical dilemmas in the field of palliative care. Tables outline the philosophy of palliative care, domains of suffering, location of death of hospice patients, the palliative performance scale, median survival times for cancer syndromes, indicators associated with a poorer prognosis in congestive heart failure, the NURSE mnemonic for accepting and responding to emotion, palliative care communication competencies in the intensive care unit, and the SPIKES mnemonic for breaking bad news. Figures depict causes of death in 1900 versus 2010, palliative care through the trajectory of serious illness, theoretical trajectories of disease, life expectancies for women and men, mortality at 1 year post discharge, and a model for patient-centered communication.  This chapter contains 6 highly rendered figures, 9 tables, 169 references, 1 teaching slide set, and 5 MCQs.

Principles and Practice of Palliative Care

2013 ◽  
Author(s):  
Kristen G Schaefer ◽  
Rachelle E Bernacki
Keyword(s):  
Palliative Care ◽  
Life Support ◽  
Advanced Life Support ◽  
Family Satisfaction ◽  
Terminal Phase ◽  
Survival Times ◽  
Advanced Illness ◽  
Post Discharge ◽  
Patient Centered ◽  
Serious Illness

The trajectories of serious illness and dying have changed in the last century; in the past, patients lived shorter lives and often died quickly of infectious disease, whereas patients in the 21st century live longer and often with prolonged debility in the advanced stages of illness. As a result, patients with serious illness can suffer undertreated symptoms and often feel poorly prepared for the final stages of disease. With more options for advanced life support and other aggressive interventions at the end of life, patients and families face increasingly complex medical decisions in the terminal phase of illness, and the treatments they receive do not always align with their goals and values. Emerging evidence suggests that integrating palliative care into the treatment of advanced illness can improve outcomes, decrease costs, and improve both patient and family satisfaction. Consequently, patient access to high-quality specialty-level palliative care is becoming standard of care at most academic cancer centers and more available in the community. This chapter describes the practice and principles of specialty-level palliative care and outlines specific "generalist" palliative care competencies essential for all physicians caring for patients with serious illness, including prognostication, patient-centered communication, and the navigation of ethical dilemmas in the field of palliative care. Tables outline the philosophy of palliative care, domains of suffering, location of death of hospice patients, the palliative performance scale, median survival times for cancer syndromes, indicators associated with a poorer prognosis in congestive heart failure, the NURSE mnemonic for accepting and responding to emotion, palliative care communication competencies in the intensive care unit, and the SPIKES mnemonic for breaking bad news. Figures depict causes of death in 1900 versus 2010, palliative care through the trajectory of serious illness, theoretical trajectories of disease, life expectancies for women and men, mortality at 1 year post discharge, and a model for patient-centered communication. This review contains 6 highly rendered figures, 9 tables, and 169 references.

Principles and Practice of Palliative Care

2013 ◽  
Author(s):  
Kristen G Schaefer ◽  
Rachelle E Bernacki
Keyword(s):  
Palliative Care ◽  
Life Support ◽  
Advanced Life Support ◽  
Family Satisfaction ◽  
Terminal Phase ◽  
Survival Times ◽  
Advanced Illness ◽  
Post Discharge ◽  
Patient Centered ◽  
Serious Illness

The trajectories of serious illness and dying have changed in the last century; in the past, patients lived shorter lives and often died quickly of infectious disease, whereas patients in the 21st century live longer and often with prolonged debility in the advanced stages of illness. As a result, patients with serious illness can suffer undertreated symptoms and often feel poorly prepared for the final stages of disease. With more options for advanced life support and other aggressive interventions at the end of life, patients and families face increasingly complex medical decisions in the terminal phase of illness, and the treatments they receive do not always align with their goals and values. Emerging evidence suggests that integrating palliative care into the treatment of advanced illness can improve outcomes, decrease costs, and improve both patient and family satisfaction. Consequently, patient access to high-quality specialty-level palliative care is becoming standard of care at most academic cancer centers and more available in the community. This chapter describes the practice and principles of specialty-level palliative care and outlines specific "generalist" palliative care competencies essential for all physicians caring for patients with serious illness, including prognostication, patient-centered communication, and the navigation of ethical dilemmas in the field of palliative care. Tables outline the philosophy of palliative care, domains of suffering, location of death of hospice patients, the palliative performance scale, median survival times for cancer syndromes, indicators associated with a poorer prognosis in congestive heart failure, the NURSE mnemonic for accepting and responding to emotion, palliative care communication competencies in the intensive care unit, and the SPIKES mnemonic for breaking bad news. Figures depict causes of death in 1900 versus 2010, palliative care through the trajectory of serious illness, theoretical trajectories of disease, life expectancies for women and men, mortality at 1 year post discharge, and a model for patient-centered communication.  This chapter contains 6 highly rendered figures, 9 tables, 169 references, 1 teaching slide set, and 5 MCQs.

Palliative and Serious Illness Patient Management for Physician Assistants

2021 ◽  
Keyword(s):  
Palliative Care ◽  
Healthcare Professionals ◽  
Healthcare Providers ◽  
Medical Specialty ◽  
Physician Assistants ◽  
Medical Providers ◽  
Patient Centered ◽  
Serious Illness ◽  
Comprehensive Management ◽  
Centered Care

There are still medical providers who believe palliative care medicine is limited to care of the dying. It is actually devoted to relief of suffering at every stage of life. Comprehensive management of patients with serious illness, including the relief of their symptoms, impacts their lives and those of their families, significant others, and caregivers, including healthcare providers. The knowledge and skills inherent in this medical specialty enables them all to grow and fosters resilience in their lives. Patient centered care is the best model that incorporates team practice with physicians and other healthcare professionals, and this is a cornerstone of palliative care medicine. Furthermore, PAs are compassionate listeners who provide comprehensive diagnosis and treatment of vulnerable patient populations across the life span and in all healthcare settings. Among medical providers involved in palliative care medicine, PAs are the only group whose accreditation requirements incorporate this knowledge and training. This text represents a new resource for PAs, clinicians, researchers, and educators of the profession to further facilitate its expansion into palliative and serious illness care. PAs are thereby poised to reduce the workforce shortage of healthcare professionals in palliative care medicine.

scholarly journals Incorporating reflective writing & art therapy in my palliative care practice

2021 ◽  
Vol 31 (2) ◽  
pp. 205-212
Author(s):  
Kalliopi Stilos ◽  
Katherine Burgoyne
Keyword(s):  
Palliative Care ◽  
Emotional Health ◽  
Psychosocial Care ◽  
Family Satisfaction ◽  
Care Practice ◽  
Continuous Exposure ◽  
Spiritual Support ◽  
Advanced Illness ◽  
Complex Needs ◽  
Dying Patients

The specialty of palliative care routinely focuses on the complex needs of patients living with incurable illness and their families’ emotional and psychosocial concerns. Healthcare professionals who work with patients with advanced illness sometimes suffer from frustration and anxiety when they return home from caring for dying patients. The psychosocial care that increases patient and family satisfaction is sometimes lost when nurses are suffering (Pendry, 2007; Freeman, 2013). Continuous exposure to such difficult situations and the accumulation of unrecognized feelings and attitudes can lead to physical and psychological challenges (Pereira et al., 2011). As such, nurses have a duty to maintain their health to the best of their ability. To encourage nurses in promoting emotional health, Freeman’s (2013) CARES tool (Comfort, Airway management, Restlessness and delirium, Emotional and spiritual support, and Self-care) was integrated into our organization’s Comfort Measures Order Set for imminently dying patients (prognosis <72 hours) (Stilos, Wynntchuk et al., 2016).

Principles of Surgical Palliative Care

2019 ◽  
pp. 13-18
Author(s):  
Anne C. Mosenthal
Keyword(s):  
Palliative Care ◽  
Quality Care ◽  
Surgical Care ◽  
Shared Decision ◽  
Life Care ◽  
Patient Centered ◽  
Serious Illness ◽  
The Core ◽  
Relief Of Suffering

The principles of surgical palliative care, an emerging field, represent the integration of surgical care and palliative care and their ethics, drawing on both disciplines to yield a more patient-centered approach to quality care. The core principle focuses on improving quality of life for those patients with serious illness and surgical disease or under the care of surgeons. Surgical palliative care addresses relief of suffering and shared decision-making across the life span, regardless of prognosis, and thus goes beyond end-of-life care and hospice. The chapter defines the principles of surgical palliative care, their ethical foundation, and their application in practice.

Patient-Centered Care and Autonomy: Shared Decision-Making in Practice and a Suggestion for Practical Application in the Critically Ill

2019 ◽  
Vol 35 (11) ◽  
pp. 1352-1355
Author(s):  
Marianna V. Mapes ◽  
Peter A. DePergola ◽  
William T. McGee
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Critically Ill ◽  
Care Service ◽  
Clinical Care ◽  
Patient Centered Care ◽  
Practical Application ◽  
Patient Centeredness ◽  
Patient Centered ◽  
Centered Care

Decision-making for the hospitalized dying and critically ill is often characterized by an understanding of autonomy that leads to clinical care and outcomes that are antithetical to patients’ preferences around suffering and quality of life. A better understanding of autonomy will facilitate the ultimate goal of a patient-centered approach and ensure compassionate, high-quality care that respects our patients’ values. We reviewed the medical literature and our experiences through the ethics service, palliative care service, and critical care service of a large community teaching hospital. The cumulative experience of a senior intensivist was filtered through the lens of a medical ethicist and the palliative care team. The practical application of patient-centered care was discerned from these interactions. We determined that a clearer understanding of patient-centeredness would improve the experience and outcomes of care for our patients as well as our adherence to ethical practice. The practical applications of autonomy and patient-centered care were evaluated by the authors through clinical interactions on the wards to ascertain problems in understanding their meaning. Clarification of autonomy and patient-centeredness is provided using specific examples to enhance understanding and application of these principles in patient-centered care.

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