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Sunday, May 19, 2013

When should palliative team be involved in your care?


48 year old male got admitted to our hospital for stage 4 gastric cancer. He was previously followed in another facility. However, he was told that his choices were limited and hospice program was introduced.  He did not like the idea of withdrawing care and as such he came to our hospital for exploring other options.

End of life issues are difficult subjects for patients, family members and physicians.

Objectives:
1. When should palliative team be involved in your care?
2. How to improve communication with patients who want "everything"


1. When should palliative team be involved in your care?
  • Declining ability to complete activities of daily living
  • Weight loss
  • Multiple hospitalizations
  • Patient, family or physician uncertainty regarding goals of care
  • DNR order conflicts
  • Use of tube feeding or TPN in cognitively impaired or seriously ill patients
  • Patient or family psychological or spiritual distress
  • Admission from a nursing home in the setting of one or more chronic life-limiting conditions (e.g., dementia)
  • Two or more ICU admissions within the same hospitalization
  • Prolonged or difficult ventilator withdrawal
  • Metastatic cancer
  • Anoxic encephalopathy
  • Consideration of patient transfer to a long-term ventilator facility
  • Family distress impairing surrogate decision making

2. How to improve communication with patients who want "everything"
  • Family Meeting: where and who should be there
  • Pain Control
  • Risk and benefits of chemotherapy and radiation therapy - Should financial burden be part of decision making
  • Is hospice a happy ending
  • How to interpret studies on new chemotherapeutic medications.
  • What are risks and harms of hospice; Does hospice facilitate Death?
  • Do you screen for depression before hospice agreement? Do family members ever regret the decision of hospice?

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