Palliative Care

AHA/ASA Policy Statement: Palliative care is an essential health benefit that is central to high-quality overall care. Integrating palliative care in the management of patients with advanced CVD and stroke may provide the following benefits:• Improved patient and caregiver

understanding of disease, treatment, and prognosis

• Improved treatment of symptoms and relief of suffering

• Shared decision making based on patient values, preferences, and goals

• Enhanced patient-clinician communication• Individual advance care planning based on

benefits, risks, and burdens of care• Improved patient and caregiver outcomes• Improved preparation for end-of-life and

associated care• Bereavement support

Palliative Care

Symptom Management of Life Limiting Illness

End-of-Life Care / HospiceSymptom Management

and Comfort Care

Circulation. 2016;134:e198–e225Rosenberg, M et al, Clin Geriatr Med 2013; 29:1–29

Palliative Care Models

Hierarchy of Well-Being Total Symptom Model

AH Maslow, Theory of Human MotivationCurr Opin Support Palliat Care. 2008; 2(2):110-3J Palliat Med., 14(10):1167–72, 2011

Carle Palliative Medicine Referral Criteria

General Referral Criteria1

Presence of a serious illness and one or more of the following:

• New diagnosis of life-limiting illness for symptom control, patient/family support

• Declining ability to complete activities of daily living

• Weight loss

• Progressive metastatic cancer

• Admission from long-term care facility (nursing home or assisted living)

• Two or more hospitalizations for illness within three months

• Difficult-to-control physical or emotional symptoms

• Patient, family or physician uncertainty regarding prognosis

• Patient, family or physician uncertainty regarding appropriateness of treatment options

• Patient or family requests for futile care

• DNR order conflicts

• Conflicts or uncertainty regarding the use of non-oral feeding/hydration in cognitively impaired, seriously ill, or dying patients

• Limited social support in setting of a serious illness (e.g., homeless, no family or friends, chronic mental illness, overwhelmed family caregivers)

• Patient, family or physician request for information regarding hospice appropriateness

• Patient or family psychological or spiritual/existential distress

Heart Failure2

• Symptoms

• NYHA class III/IV symptoms

• Frequent heart failure readmissions

• Recurrent ICD shocks

• Refractory angina

• Anxiety or depression adversely affecting patient's quality of life or ability to best manage illness

•Milestones

• Referral

• VAD

• Transplant

• TAVR

• Home inotropic therapy

•Caregiver distress.

1 www.capc.org2 www.acc.org/latest-in-cardiology/articles/2016/02/11/08/02/palliative-care-for-patients-with-heart-failure#sthash.ddHLsX9W.dpuf

Communicating About Palliative Care

What NOT to say!

• “There’s nothing left to do…let’s have palliative care see you.”

There is always something to do for the patient even if there

is nothing left to treat the disease.

What to say!• “Palliative care works with me, your

cardiologist, to better manage your [pain, shortness of breath or other symptom (anxiety, fatigue, nausea)]. They are experts in looking at this holistically and make a comprehensive plan for how best to relieve your [symptom].

• They can answer some of the questions you may have about what to expect in future as your [disease] worsens.

• They help me formulate a treatment plan that is based on what is important to you and what is going on with your family.

• There is support staff at the clinic who works with the palliative care providers to help you and your family cope with these changes and plan for the future”

J Palliat Med, 11(6):823–828, 2008.