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Transforming Our Understanding of Hospice Palliative Care

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Title: Transforming Our Understanding of Hospice Palliative Care


1
Transforming Our Understanding of Hospice
Palliative Care
2
Acknowledgements This slideshow is a compilation
of information/slides from a number of experts in
hospice palliative care
  • the Palliative Pain and Symptom Management
    Consultants Cathy Joy, Janet Noble, Marie
    Palmer, Diane Reid, Chris Sherwood, and Marsha
    Wolowich
  • Canadian Hospice Palliative Care Association and
    the Pallium Project

3
Agenda
  • View Dying For Care Towards Quality End-of-life
    Care (16 minutes)
  • Review of CHPCA Model to Guide HPC
  • Debrief about common myths, barriers and issues
    impeding quality care

4
View Dying For Care
  • A compilation of insights with Hospice Palliative
    Care leaders conducted in late 2005
  • Reflects perspectives from a cross-section of
    professions and leaders from coast-to-coast.
  • Provides insights into some of the things that
    might impede our abilities to work effectively
    with health care professionals in Hospice
    Palliative Care work.

5
Prior to Antibiotics
Slide compliments of Dr. Frank Ferris Oct 2005
High
  • Sudden, Unexpected
  • infections
  • accidents
  • adults lived into their 60s

Health Status
Death
Low
Time
6
1940s 1980s
Slide compliments of Dr. Frank Ferris Oct 2005
High
Decline
  • Prolonged Dying
  • predictable decline

Health Status
Death
Low
Time
7
Disease, Aging in 2006
  • Sometimes cured
  • Most often controlled
  • Life expectancy 10 - 20 yr.
  • Canada 80 yr.
  • USA 78 yr.
  • India 64

Frank Ferris Oct 2005
8
Hospice Palliative Care in Non Cancer Illness
  • Few of us will die acute deaths
  • 90 of us will die with one or more chronic
    illnesses
  • 29 of us will die of cancer
  • 36 will die of heart or vascular disease
  • By age 85, 47 of us will suffer from dementia
  • 2004 Dr. Larry Librach

9
Exacerbations and Sudden Dying
High
Mostly Chronic Heart and Lung Failure
Function
Death
Low
Time
10
Prolonged Dwindling
High
Frailty and Dementia
Function
Death
Low
Time
11
Traditional Model
 
 
Curative
Palliative
Death
Active
Terminal
Earliest Model of Palliative Care developed Dame
Cicely Saunders 1960s 1970s
12
Current Model
Frank Ferris Oct 2005
End-of-lifeCare
Therapies tomodify disease
Hospice Palliative Care
Presentation
Death
Therapies to relieve suffering and / orimprove
quality of life
BereavementCare
13
Hospice Palliative Care
  • Hospice Palliative care is not
  • A person/resident/patient
  • A place
  • A program

C. Sherwood, PPSMC, 2004
14
Hospice Palliative Care
  • Hospice Palliative care is
  • provided to a person/resident/patient
  • provided in a place
  • provided by health care practitioners, program,
    service etc.

C. Sherwood, PPSMC, 2004
15
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16
Hospice Palliative Care (HPC)
  • A philosophy of care and range of active,
    supportive services provided across several
    settings of care (home, hospital, hospice, LTC/CC
    and settings of marginalization) to enhance the
    quality of living, dying and surviving.
  • Appropriate for any patient and/or family living
    with, or at risk of developing, a
    life-threatening illness due to any diagnosis,
    with any prognosis, regardless of age, and at any
    time they have unmet expectations and/or needs,
    and are prepared to accept care.

17
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18
Start with the end in mind
  • What are we trying to achieve?
  • Canadians should be able to live well and die as
    free of pain and suffering as possible in the
    setting of their choice, surrounded by loved
    ones.
  • Adapted from Quality End of Life
    Coalition of Canada Care

19
Rethinking Palliation
  • Need to broaden our understanding of palliation.
  • Hospice Palliative Care (HPC) as introduced in
    2002 Model provides a pathway for improving care
    which addresses Chronic Progressive Illness.
  • HPC as a philosophy/model of care is broader than
    the earlier palliative care services provision
    model.
  • Each dying process/death event impacts at least 8
    others directly considerable hidden health
    risks/costs.
  • Emerging opportunities to provide different
    supports at the community-level (e.g., practical/
    advanced care planning transportation
    bereavement support).

20
A Growing Need
  • Around 250,000 Canadians will die this year as
    many as 165,000 could use hospice palliative care
    services.
  • Not just about cancer, but other major causes of
    expected death including
  • End-stage organ failure (e.g., heart, lung,
    renal)
  • Neurological illness (e.g., Alzheimers, ALS, MS)
  • Immunological illness (e.g., HIV/AIDS)
  • Many people are living much longer with illnesses
    which will lead to an expected death, often with
    pain/suffering.
  • At present less than 15 of Canadians have access
    to hospice palliative care services in Canada.
    Rural and remote Canada is generally doing much
    worse than most cities.

21
The Current Reality
  • Canadians are living longer, Baby Boomers are
    aging if we arent meeting the needs today what
    will we do in 20 years?
  • 33 more deaths by 2020
  • Most Canadians say they would like to die at home
    or stay at home as long as possible yet 75 die
    in acute care beds or long term care homes(2000)
  • Increased use of acute beds, unnecessary pain and
    suffering, and misuse/overuse of health delivery
    system when families are not supported with
    quality services.

22
Specific Things We Can Do
  • Recognize that living well until death is not
    black and white it is often many shades of
    grey involving complex care and needs provided by
    many.
  • Recognize that many health care professionals
    might find these issues difficult
  • Learn to reframe hope for the long-view.
  • As Family Council members????

23
A Starting Point for Resources
  • HNHB Hospice Palliative Care Network
  • http//www.hnhbhpc.net/
  • Canadian Hospice Palliative Care Association
    (CHPCA)
  • www.chpca.net (see CHPCA Marketplace link)

24
Thank You
  • Diane Reid, Palliative Care Consultant Niagara
  • Diane.reid_at_hospiceniagara.ca
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