Palliative Care at the Very End of Life - Dartmouth-Hitchcock

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Barriers to Recognize the Dying Denial-hope Denial hope it gets better No definitive diagnosis Failure to recognize key symptoms Lack of knowledge of death trajectory Pursuing futile interventions Process Poor communication skills Ethical/Legal Concerns about withholding or with drawing treatment of hastening death about CPR Legal issues Cultural/spiritual practices
Overcoming Barriers Recognize key sign and symptoms Skilled communication of prognosis Team approach within your facility Know ethical & legal principles supporting care Appreciate cultural and religious traditions
Page 1 and 2: Palliative Care at the Very End of
Page 3 and 4: Like every birth, every death is un
Page 5 and 6: ...Objectives ... Objectives Descr
Page 7 and 8: Where do people die Hospital-50% H
Page 9 and 10: Dementias Pneumonia Urosepsis En
Page 11 and 12: What Is “Good Good Death” Death
Page 13 and 14: Steinhauser et al. 2000 “…pain
Page 15 and 16: Symptom Frequency in Last 48 Hours
Page 17 and 18: Clinical Assessments and Interventi
Page 19: (Blues & Zerwekh, 1984) From Wilkie
Page 23 and 24: Weakness/Fatigue Decreased ability
Page 25 and 26: Benefits and Burdens of Artificial
Page 27 and 28: Unproven Benefits of Artificial Fee
Page 29 and 30: Benefits and Burdens Burdens of Ar
Page 31 and 32: Summary of Benefits/Burdens Few me
Page 33 and 34: …Decreasing Decreasing Fluid Inta
Page 35 and 36: Neurologic dysfunction Decreasing
Page 37 and 38: …Communication Communication with
Page 39 and 40: Palliative Care Interventions: Seda
Page 41 and 42: Fears …Changes Changes in Respira
Page 43 and 44: Pain Fear of increased pain Asses
Page 45 and 46: As Expected Death Approaches Discu
Page 47 and 48: • Discontinue diagnostic tests
Page 49 and 50: Social Concerns Patient Preference
Page 51 and 52: Spiritual Care Unfinished business
Page 53 and 54: Signs of Death • Cessation of hea
Page 55 and 56: PRONOUNCEMENT OF DEATH When you are
Page 57 and 58: Pronouncing Death and Beyond Know

Palliative Care at the Very End of Life - Dartmouth-Hitchcock

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