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• Complete advance care planning;
• Know a patient’s preferred surrogate decision maker;
• Learn primary palliative care methods of symptom assessment including pain, dyspnea, and fatigue;
• When appropriate, make sure that hospice referrals are timely; and
• Know when to place a supportive and palliative care referral.
specialist-level palliative care:
• Patient must have an advanced chronic disease such as CHF, COPD, frailty, dementia, AIDS, or cancer;
• High symptom burden such as dyspnea, fatigue, pain, or agitation;
• Frailty with poor functional status;
• Limited social support, psychosocial situation interferes with receiving appropriate treatment, caregiver burden, or lacking decision maker;
• High utilization with multiple admissions/ED visits (four in six months or two in three months);
• Needs help aligning goals of care with treatments, seemingly
REFERENCES
1. Hoover D, Crystal S, Kumar R, et al. Medical expenditures during the last year of life: findings from the 1992-1996 Medicare Current Beneficiary Survey. HSR. 2002;37:1625-1642.
2. Center for Advancement of Palliative Care. 2015. America’s Care of Serious Illness. Available at: https://reportcard.capc.org/wp-content/ uploads/2015/08/CAPC-Report-Card-2015.pdf. Accessed November 1, 2015.
3. Greer J, Pirl W, Temel J, et al. Effect of early palliative care on
patient and family;
• Psychosocial or spiritual support/existential distress;
• Assist in discussing prognosis and what to expect from illness;
• Advance directive completion in complicated cases; and/or
• Patient may not meet criteria for hospice admission, yet still need support.
In conclusion, palliative care does not take away chronic illness, but it can change the experience of the illness. Advance care planning is an important tool for patients so they are sure to get the medical care they want. Both of these initiatives work to provide the right care, at the right time, in the right way for each individual patient. Palliative care is an area of medicine in which we all need basic competencies, and together we can provide the best outcome for each patient.
CONTRIBUTING AUTHORS
■ ROSHNI GUERRY, MD is the Inpatient Medical Director for Supportive and Palliative Care at Christiana Care Health System in Newark, Del.
■ LINSEY D. O’DONNELL, DO is Medical Director for Community-Based Supportive and Palliative Care at Christiana Care Health System in Newark, Del.
4.
5. 6.
chemotherapy use and end-of-life care in patients with metastatic non- small cell lung cancer. J Clin Oncol. 2012;30:394-400.
Moss A, Ganjoo J, Sharma S, et al. Utility of the “surprise” question to identify dialysis patients with high mortality. Clin J Am Soc Nephrol. 2008;3:1379-1384.
Quill T, Abernethy A. Generalist plus specialist palliative care – creating a more sustainable model. NEJM. 2013;386:1173.
VanGunten C. Secondary and tertiary palliative care in US hospitals. JAMA. 2002;287: 875-881.
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