Palliative Care

1
Palliative Care

• Debra Wertheimer, M.D.

2
Too Many Die in Pain

• 40 of elderly cancer patients in nursing homes
  have pain
• 50 of those seriously ill in hospitals have
  significant pain in the last days of their lives
• Only 20 of Americans die in Hospice Care
• Minorities, women and the elderly are
  disproportionately under-treated for pain!

3
Sites of Death

• Hospitals 56
• Nursing Homes 19
• Home 21
• Other 4

4
The Hard Discussions

• Are there Advanced Directives and if not now is
  the time to address these issues!
• Is this a terminal illness?
• What are the risk and benefits to the therapeutic
  maneuvers being proposed?
• What are the wishes of the patient and the family?

5
Mrs. C.

• 55 yo woman with diagnosis of Pancreatic Ca
• Life long smoker
• Some SOB on exertion
• Saw an Oncologic Surgeon and was offered a
  Whipple
• Did not see a Medical Oncologist
• Multiple complications including sepsis, failure
  to wean from ventilator, wound dehiscense

6
The Hard Discussions

• Are there Advanced Directives and if not now is
  the time to address these issues!
• Is this a terminal illness?
• What are the risk and benefits to the therapeutic
  maneuvers being proposed?
• What are the wishes of the patient and the family?

7
Advanced Directives

• Durable Power of Attorney
• Surrogate Decision Makers
• Guardians

8
Palliative Medicine

• Is 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.

9
Hospice

• Is a philosophy of care where the focus is placed
  on