hospice basics: palliative care vs. curative care
TRANSCRIPT
Hospice Basics:Palliative Care vs. Curative Care
Goal
• To educate health care professional about hospice, specifically palliative care as compared to curative care in order to provide more appropriate and quality hospice care for terminally ill patients and their families.
Objectives
• Describe the history and philosophy of the hospice movement.
• Identify the difference between palliative and curative care.
• List the benefits of palliative care in the terminally ill patient.
• List some therapies that are
palliative but may be consider curative.
A Bit of History
• Dying in the 19th Century
– 3% of America’s population was >65.
– Life expectancy was 45-50 years.
– Most people died at home.
…And Then Today
• Dying in the United States
– 13% of the population is > 65 years.
– Approximately 75% of Americans die in health care facilities.
• 57% die in hospitals.
• 17% die in
long term care facilities.
Hospice
• The origin of the word hospice was used to describe a “shelter or haven for the weary traveler”
• The term has come to be
associated with support
and care
• Shelter from discomfort is provided to enable dying patients to approach death in a peaceful way
History of Hospice
• 1905 St. Joseph’s
• 1967 St. Christopher’s in London
• 1969 Elizabeth Kubler-Ross– “On Death and Dying”
• 1974 New Haven Hospice of CT– First hospice in the US
Oxford’s Textbook of Palliative Medicine
What is Palliative Care?
“The study and management of patients with active, progressive, far-advanced disease for whom the prognosis is limited and the focus of care is quality of life.”
World Health Organization
Palliative Care
• Affirms life.
• Regards dying as a normal process.
• Neither hastens nor postpones death.
• Provides relief from pain & other symptoms.
• Integrates the psychological & spiritual aspects of care.
• Provides support for patient and family.
Hospice defines Palliative Care
• The aggressive treatment of physical and emotional pain & symptoms
• An active treatment plan,
but not intended to
cure the patient’s
underlying disease
• All palliative treatments focus on enhancing a resident’s comfort & overall quality of life
The Goal of Palliative Care
• The goal of palliative care is helping
patients to achieve and maintain
maximum physical, emotional, spiritual, vocational and social potential,
despite the progression
of their terminal illness.
Palliative Care Realized
This goal is fully realized when the patient experiences the following:
• Relief from pain
• Psychological and spiritual care
• A support system which assists the patient to be as actively as he or she wishes
• A support system to sustain the patient’s family
End of Life Physical Symptoms
Pain and symptom management are the first priority in palliative care
• Unrelieved pain• Shortness of breath• Nausea & Vomiting• Confusion• Restlessness• Itching• Disturbed bladder and
bowel function• Disrupted sleep• Cachexia
Psychosocial / Spiritual Symptoms
Psychosocial and spiritual symptoms that are part of the dying process are addressed
• Psychosocial– Depression– Anxiety– Ineffective Coping– Ineffective Communication– Life Role Transition– Caregiver Distress
• Spiritual– Despair / Hopelessness– Powerlessness– Loneliness – Need for Reconciliation
Palliative Care vs. Curative Care
Curative Care– Disease driven
– Curing the disease is foremost
– Doctor in charge
– Disease process is primary
– Few choices
Palliative Care–Symptom driven
–Comfort & quality of life
–Patient is in charge
–Disease process is secondary to person
–Many choices
Freedom to Choose
• Palliative Care redirects energy
• Patients and Families drive the Plan of Care
• Patients and Families choose what is important to accomplish
• Physical,
Psychosocial or
Spiritual
Palliative Care Misconceptions
• Hospice / palliative care means “doing nothing”
• All treatments are discontinued
• All invasive interventions
such as chemotherapy or
radiation are stopped
Misconceptions
Hospice / palliative care means “doing nothing”
FACT:• The goal is to assist the patient to achieve
quality of life
– Patient drives the Plan of Care
– All decisions are weighed
– More choices give to patient and family
Another Misconception
“All treatments are discontinued”
FACT:• All decisions about treatments (to initiate
or discontinue) are
weighed against the
goal of palliative care.
Misconceptions about Invasive Interventions
All invasive interventions such as chemotherapy or radiation are stopped
FACT:• Yes, there are such things
as palliative chemotherapy
and palliative radiation
therapy
Principles for use of Invasive Palliative Interventions
• What does the patient want?
• What is the life expectancy of the patient?
• What is the patient’s baseline level of function?
• What is the goal or expected outcome of the proposed intervention?
Weinreb N. Twenty Common Problems in End of Life Care, 2001
Patient Wishes
• What does the patient want?
• Is what the patient wants medically indicated?
• What is the physician’s
obligation?
Weinreb N. Twenty Common Problems in End of Life Care, 2001
Patient Prognosis
• Will the patient live long
enough to complete the
treatment?
• Will the patient live long
enough to benefit from the
treatment?
Weinreb N. Twenty Common Problems in End of Life Care, 2001
Patient’s Functional Status
• Ability of patient to tolerate treatment
• Potential for improvement in quality of life
• Potential complications
• Discomfort to patient
• Inconvenience to patient
• Potential toxicities and side effects
Weinreb N. Twenty Common Problems in End of Life Care, 2001
Palliative Chemotherapy
Clinical Benefit Response to Chemotherapy
• Sustained Improvement in Pain– Decreased pain with no change in analgesia– Same level of pain with less analgesia
• Improvement in
Performance Status
• Stabilization or gain in weight
Weinreb N. Twenty Common Problems in End of Life Care, 2001
Indications for Palliative Radiation
• Bone pain secondary to metastases
• Neurological deficits associated with brain metastases
• Malignant dysphagia due to tumor obstruction
• Painful hepatomegaly
• Pulmonary symptoms
• Pelvic masses associated
with pain or obstructionWeinreb N. Twenty Common Problems in End of Life Care, 2001
Palliative Radiation Therapy
• Pain, bleeding, and obstruction may be relieved
• Radionuclides and hemibody radiation for systemic pain
• Key issue relates to dosing– Short or single fractionation schemes are
preferred – An increased risk of long term toxicity should not
be an issue in patients near the end of life
Weinreb N. Twenty Common Problems in End of Life Care, 2001
In Conclusion
• Palliative Care affirms life and attempts to relieved pain and suffering
• Palliative Care is symptom driven with the patient in charge
• Every treatment or intervention must be questioned
• Some treatments and therapies normally viewed as curative can be and are palliative– Chemotherapy– Radiation
In every sufferer,Let me see the Human Being-Maimonides
Hospice Basics:Palliative Care vs. Curative Care