Intro to Palliative Care Slide Deck Trainer

1、Introduction to Palliative CareIntro to Palliative Care v4 7.14.20202Welcome!House Keepinghttps:/www.gend.co/blog/best-practice-tips-for-using-zoomVirtual EtiquetteMeeting participation:If youre connecting on your computer, close-down all other apps and browser windows to eliminate notificationsWe w

2、ill be using the raise your hand feature by clicking on the little blue handWe will be using the chat functionWhen we are taking breaks be sure not to leave the meeting but rather mute your audio and videoEnvironment:Be aware of your backgrounds to not be distracting.Position yourself in the light.

3、Intro to Palliative Care v4 7.14.20203ExpectationsWhat do you want to get out of this training?Intro to Palliative Care v4 7.14.20204Learning ObjectivesDefine palliative careDifferentiate palliative care from hospice care Explain why palliative care is integral to primary careDescribe the domains of

4、 palliative careDiscuss social aspects of careRecognize members of the multidisciplinary care teamIdentify palliative care assessment tools that may be used in primary care settings Intro to Palliative Care v4 7.14.20205Palliative Care: YOU Are a BridgeIntro to Palliative Care v4 7.14.20206/watch?v=

5、lDHhg76tMHcPalliative Care and Hospice CareA Population Health ApproachIntro to Palliative Care v4 7.14.20207Intro to Palliative Care v4 7.14.20208Definition of Palliative Care/“Palliative care is an approach that improves the quality of life of patients and their families facing the problems associ

6、ated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.”Comparing Palliative Care and Hospice CareIntro to Palliative Care v4 7.14.202

7、09/wp-content/uploads/2019/04/PalliativeCare_VS_Hospice.pdfPalliative CarePhysical and psychosocial reliefFocus on quality of lifeMultidisciplinary Team ApproachAny stage of diseaseMay be concurrent with curative treatment Hospice CarePhysical and psychosocial reliefFocus on quality of lifeMultidisc

8、iplinary Team ApproachPrognosis 6 months or lessExcludes curative treatmentVSPalliative Care is a Primary Care IssueIntro to Palliative Care v4 7.14.202010Palliative Care Now and the FutureIntro to Palliative Care v4 7.14.202011Hospitals with palliative care programsHospitals that do not currently o

9、ffer palliative carePercentage of Hospitals with a Palliative Care Program by Geographic TypeUrbanSuburbanRural3.0 certified prescribing palliative care providers (MD or APRNs) per 100,000 residents20887260Certified MDCertified NP or CNSCertified RN or Pediatric RNConcentration of spending in high-r

10、isk patient populationsIntro to Palliative Care v4 7.14.202012The sickest 10% of the U.S. population.Accounts for 65% of all health expenditures.Last 12 months of lifeShort term high $Persistent high $Top 5% of Health Care SpendingPatients who live with serious illness and chronic conditions over ye

11、ars are likely to fall under the category of persistent high-cost patients.When this patient population receives palliative care, quality of life increases, crises are prevented and, as a consequence, medical costs decrease.Palliative Care Reduces Avoidable Spending and Utilization in All SettingsIn

12、tro to Palliative Care v4 7.14.202013Source Centers to Advance Palliative Care48%Readmissions28%Cost/Day50%Admissions35%ED Visits43%Hospital/ED Transfers36%Total Costs INPATIENT OUTPATIENT SKILLED NURSING HOME-BASEDPalliative Care Improves Quality of LifeIntro to Palliative Care v4 7.14.202014Center

13、 to Advance Palliative Care, 2018 Retrieved from /tools-for-making-the-case/downloadable-tools/Debbie: Regaining a Quality of LifeIntro to Palliative Care v4 7.14.202015/watch?v=5M-b1c2spPEDebbies quality of life changed with the addition of palliative careIntro to Palliative Care v4 7.14.202016Brea

14、kIntro to Palliative Care v4 7.14.202017/watch?v=5M-b1c2spPEPersonal Perceptions of Palliative CareGroup ActivityIntro to Palliative Care v4 7.14.202018“We are trained to see disease, we are not trained to see suffering”Intro to Palliative Care v4 7.14.202019/watch?v=WKSS9E2qy8A Domains of Palliativ

15、e CareIntro to Palliative Care v4 7.14.202020Domains of Palliative CareStructure and Processes of CarePhysical Aspects of CarePsychological Aspects of CareSocial Aspects of CareSpiritual Aspects of CareCultural Aspects of CareCare of Imminently DyingEthical & Legal Aspects of CareIntro to Palliative

16、 Care v4 7.14.202021Derived from the Clinical Practice Guidelines for Quality Palliative Care, 4th editionStructure and Process of CareBegins with a comprehensive assessment and a care plan that is consistent with a patients values and goalsAdvance Care Planning: patient and family treatment goals a

17、re clearly documentedThe primary non-medical needs expressed most frequently include: a need to express emotional pain, a need to explore spiritual pain, and a need for practical financial and legal help.Intro to Palliative Care v4 7.14.202022Physical Aspects of CareAssessment should focus on reliev

18、ing symptoms, improving/maintaining quality of life and functional statusSymptoms may include pain, shortness of breath, fatigue, nausea, constipation, etc.Lack of assessment is the most common cause of unrelieved painCare is delivered in a manner that is patient centered as defined by the patients

19、wishesIntro to Palliative Care v4 7.14.202023Psychological and Psychiatric Aspects of CarePsychological status needs to be assessed and managedWatch for signs of family members struggling with psychological issuesPrograms and resources should be available to patients and families based on assessed n

20、eed for servicesProcess for appropriate referrals:DirectlyThrough ConsultationSpecialist ReferralIntro to Palliative Care v4 7.14.202024Social Aspects of CareSocial assessment should address environmental and social factors, including, but not limited to:Social support networkFinancial barriersAcces

21、s to care (e.g. transportation, medications)Family Meeting: powerful clinical tool for completing the comprehensive assessment and planning processWarm handoffs and referrals to local/community service providersIntro to Palliative Care v4 7.14.202025Spiritual, Religious, and Existential Aspects of C

22、areSpirituality is a multifaceted, multidimensional human experience that includes religious and nonreligious factorsCare Team members must acknowledge their own spiritualityOffer support of spiritual counselor: priest, pastor, chaplain, rabbi, imam, or other religious leaderFaith, Importance, and I

23、nfluence, Community and Application (FICA) assessmentIntro to Palliative Care v4 7.14.202026CognitiveExperientialBehavioralhttps:/articles/jfmdp/journal-of-family-medicine-and-disease-prevention-jfmdp-3-056.php?jid=jfmdp Cultural Aspects of CareRacial and ethnic minorities experience persistent heal

24、th care disparitiesCultural origins influence the way patients and health care providers think about palliative and end of life careRespect values, beliefs, and traditions related to health, illness, family caregiver roles and decision makingIncorporate culturally sensitive resources and strategies

25、into the plan of careRemove barriers to communication by ensuring that linguistic needs are metIntro to Palliative Care v4 7.14.202027Care of Imminently DyingWhenever possible, early access to hospice care should be facilitatedPlace particular emphasis on days leading up to and just after death of t

26、he patient Ensure patient receives adequate management of pain and other symptomsAvoid inappropriate prolongation of dying Address spiritual and cultural needsSigns and symptoms of impending death are recognized and communicated to patients and familiesProvide support and education to the family Ass

27、ist in making critical decisionsRelieve possible burdens imposed on loved onesDevelop post-death care and bereavement follow up planIntro to Palliative Care v4 7.14.202028Ethical and Legal Aspects of CareAddress guardianship and goals of careIdentify the health proxyHonor patient preferences or thos

28、e made by legal proxies or surrogate decision makersMaintain professional boundariesRemain knowledgeable of organizational policiesCommunicate prognosis essential for informed decision makingIntro to Palliative Care v4 7.14.202029Identify Members of the Multidisciplinary Care TeamIntro to Palliative

29、 Care v4 7.14.202030What patients do you think would benefit?Intro to Palliative Care v4 7.14.202031Who do you think would benefit?High-risk patientsSocially vulnerableExhausted family caregiversPatients with:Cognitive impairmentMultiple comorbiditiesFrailtyFunctional dependencyPalliative care can h

30、elp with illnesses other than cancer:Advanced lung, heart, kidney and liver diseaseAIDSAlzheimersdisease and dementiaCystic FibrosisDisabling stroke and other neurological diseasesMotor Neuron Disease and multiple sclerosisIntro to Palliative Care v4 7.14.202032Who provides palliative care?Intro to

31、Palliative Care v4 7.14.202033Who Provides Palliative Care?Dietitian/NutritionistPatientFamily Member or other Loved OnesSpiritual AdvisorCommunity Health WorkerFront Office StaffIntro to Palliative Care v4 7.14.202034Physician Advanced Practice ProviderRegistered NurseSocial WorkerPharmacistMedical

32、 AssistantAspens Palliative Care ExperienceIntro to Palliative Care v4 7.14.202035/watch?v=OgWdwsNYY3QPatient Focused ApproachesDecisions are driven by the patients goals of care and wishesProvide support to patient to express wishesProvide support to family and caregivers so that patients may reali

33、ze goals of careNavigate, coordinate a complex/confusing healthcare system, understand the plan of careIntro to Palliative Care v4 7.14.202036Family: Members of the Care TeamCentral to the delivery of care are family members and/or caregivers:Provide insights into progression, improvement, and quali

34、ty of lifeMay advocate for patient needs, wishes and desiresSource of emotional support and reliability for patients in ever-changing circumstancesProvide long-term, 24 hour care with minimal emotional and psychological supportFamily members benefit from the support of the palliative care team:Exper

35、ience physical, emotional, and mental stress caring for family member or friendProne to social isolation and caregiver burdenBenefit from support of the overall palliative care team in the form of information, counselling, or practical assistance and trainingIntro to Palliative Care v4 7.14.202037Fa

36、mily Related ChallengesFamily FunctioningMay have less than optimal relationshipsIncongruent patient and family member needsCommunication process barriersImpaired concentrationTiming and amount of informationFamily members not wanting to bother the health care teamFamily members rejection of support

37、Cultural issues and provider comfort levelIntro to Palliative Care v4 7.14.202038Family Meeting When possible, the patient should determine who they would like to be presentIdentify the health proxyHelpful to have members of the care team available to the patient to aid in decision makingEnsure an e

38、nvironment where patients and families feel comfortable sharing informationIntro to Palliative Care v4 7.14.202039Shared Decision Making/shared-decision-makingEngages patients and families in decisions about their care Increases their involvement and satisfactionHelps patients and families clearly c

39、ommunicate their goals and needsNo “one right way” to interveneIntro to Palliative Care v4 7.14.202040Integrating Palliative Care into the Primary Care SettingIntro to Palliative Care v4 7.14.202041Challenges and OpportunitiesGroup ActivityIntro to Palliative Care v4 7.14.202042Challenges and Opport

40、unitiesChallengesOpportunitiesShortage of palliative care specialistsLack of knowledge of palliative care still exists with some providersRegional, socioeconomic, racial and ethnic groups influence access to palliative careCare team members may be reluctant to discuss palliative care; fear patients

41、will lose hopeMany patients are unaware of palliative care servicesDevelop communication strategies to help patients through the decision making processLeverage EHR and HIE technology to facilitate appropriate referralsEducate all providers and staff about palliative careIncrease patient satisfactio

42、n, while reducing provider burnout Increase access to primary palliative careIntro to Palliative Care v4 7.14.202043International association for hospice and palliative careValue of Palliative Care in Primary CareIncreased primary care involvement in the care of seriously ill individuals is associat

43、ed with:Improved quality of lifeReduced inpatient and ED utilization for seriously ill patientsImproved quality measure outcomes near the end of lifeClear guidelines and indications for subspecialty referrals exist for hospitalized patients; these should be adapted for the outpatient setting as well

44、PCPs responsible for care managementSpecialists available for patients with complex needs Intro to Palliative Care v4 7.14.202044How and Where of Palliative CareGaining Access to Palliative CareReferral from PCPReferral from specialistReferral from care team memberHospitalizationSelf-referralHospice

45、Locations for Palliative CarePatients homeNursing homeAssisted livingHospitalAmbulatory practice/clinic (Primary Care and Specialty Care)Community-based facilityIntro to Palliative Care v4 7.14.202045Medicare Cost SharingEliminate beneficiary cost sharing for patient-centered servicesAdvance Care Pl

46、anningChronic Care ManagementCreate and expand existing Medicare alternative payment modelsImproved quality of careQuality of lifeHealth outcomes in patients with serious illnessEnsure that all models allow concurrent palliative care and disease treatmentIntro to Palliative Care v4 7.14.202046Pallia

47、tive Care Enhanced Care ModelIntro to Palliative Care v4 7.14.202047Disease ManagementPalliative CareRehabilitationHospice End of Life CareCureControlPain & Symptom ManagementSurvivorshipBereavementHawley, P,H. (2014). The Bow Tie Model of 21st Century Palliative Care. Journal of Pain and Symptom Ma

48、nagement. Retrieved from /10.1016/j.jpainsymman.2013.10.009Value of Assessment ToolsPatient assessment is a critical step in identifying palliative care needsPCPs need to consider the palliative care needs of all patients with life-limiting illnesses including metastatic cancer, end stage organ fail

49、ure and advanced degenerative neurological conditionsAssessment should address prognosis, current and anticipated symptoms, distress, and the availability and support needs of family and caregiversIntro to Palliative Care v4 7.14.202048/home/ Examples of Tools Useful in Palliative CarePhysical Aspec

50、ts of CareEdmonton Symptom Assessment Scale (ESAS)Frailty ScorePsychological and Psychiatric Aspects of CarePHQ9GAD7Social Aspects of CareSDoH screeningSpiritual, Religious, and Existential Aspects of CareFICA Spiritual AssessmentEthical and Legal Aspects of CareAdvance DirectivesGeneral Assessment

51、ToolsKarnofsky Performance Scale (KPS)Palliative Performance Scale (PPS)PEPSI-COLA ChecklistIntro to Palliative Care v4 7.14.202049QuestionsIntro to Palliative Care v4 7.14.202050You will have (5) business days to complete the post-test.Criteria for Successful Completion of Introduction to Palliativ

52、e CareAttend Introduction to Palliative course, in-person or virtualIf the Learner misses 30 minutes; the course will not be counted as “completed” and the learner will need to retake the course. If the Learner misses 30 minutes; the course will be counted as “completed”. The Learner will need to re

53、view the missed course content located here: /training If course is virtual must attend by audio and video/internetComplete the Michigan Institute for Care Management and Transformation (MICMT) Introduction to Palliative Care post-test and evaluationAchieve a passing score on the post-test of 80% or

54、 greater. If needed, participants may retake the post-testIntro to Palliative Care v4 7.14.202051Development TeamIntro to Palliative Care v4 7.14.202052Curriculum developed in partnership with:Alicia MajcherMichigan Institute for Care Management and Transformation (MICMT)Ruth ClarkIntegrated Health

55、PartnersKim HarrisonPriority HealthSharon KimBlue Cross Blue Shield of Michigan (BCBSM)Ewa MatuszewskiMedical Network One / Practice Transformation InstituteMichael SmithMichigan MedicineMichigan Institute for Care Management and Transformation (MICMT)Partnership between University of Michigan and B

56、CBSM Physician Group Incentive Program (PGIP)To help expand the adoption of and access to multidisciplinary care teams providing care management to populations served by the physician community in order to improve care coordination and outcomes for patients with complex illness, emerging risk, and t

57、ransitions of care.Who We AreGoal of MICMTIntro to Palliative Care v4 7.14.202053Introduction to Palliative Care Curriculum DevelopmentPlease provide the following as an appropriate reference if you use this material:“Material based on the Introduction to Palliative Care course developed through a c

58、ollaborative effort by the following Michigan organizations: MICMT, PTI, IHP, Priority Health, BCBSM, and Michigan Medicine.”Questions about using or replicating this curriculum should be sent to: micmt-requests Please follow this link to apply to become an approved trainer for this curriculum: Intr

59、o to Palliative Care v4 7.14.202054AppendixIntro to Palliative Care v4 7.14.202055ResourcesVideosPalliative Care, a Different Voice in Healthcare Introducing the Palliative Care TeamReadingsPalliative Care Clinical Practice Guidelines (2018)Implementation Tools and ResourcesAdvanced Care PlanningAwd

60、ish, R. (2018). In Shock: My Journey from Death to Recovery and the Redemptive Power of HopeFerrell, B.R., Twaddle, M.L., Melnick, A., and Meier, D. (2018). National Consensus Project Clinical Practice Guidelines for Quality Palliative Care Guidelines, 4th Edition. Journal of Palliative Medicine, Vo