whole person assessment: a physician isn't enough
Post on 07-May-2015
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Whole Person Assessment: A Physician Isn’t Enough
Kyle P. Edmonds, MD
Assistant Clinical Professor
Doris A Howell Palliative Care Consultation Service
UC San Diego Health Sciences
Adapted from the Palliative Care International Curriculum Series Editor, Frank R. Ferris, MD
Objectives
• Discuss the role of assessment as a means to relieve suffering
• Verbalize your clinical role in assessment
• Use a framework to guide assessment
• Discuss how the assessment fits into the process of providing care
Palliative Care IS…• A team that can help your patients and families manage the pain, symptoms, and stress of serious illness.
• Available at any age and at any stage in a serious illness and can be provided along with curative treatment.
• Expert communication for challenging situations.
• Partnering with you for better outcomes by helping your patients tolerate curative treatment.
Palliative Care…improves the quality of life
…through the prevention and relief of suffering
…early identification and
impeccable assessment and treatment
of pain and other problems,
physical, psychosocial and spiritual WHO
2002
Suffering
Old Man in Sorrow
(On the Threshold
Of Eternity)
Vincent van Gogh, 1890
…impeccable assessment…
• Inquiry
• Active listening
• Reflection statements
Why Skill at Assessment is Important
• Patient/family/caregivers expect relief of suffering
• Develops a therapeutic relationship
• Key diagnostic tool
• Foundation for interdisciplinary care
Scope of practice
• Listen, acknowledge, analyze
• Offer information, practical suggestions
• Introduce sources of support
The Broad Perspective
• A narrow focus on physical pain can miss the patient who is depressed,
• or doesn’t have the money for the pain medicines,
• or is afraid that the pain means that she is going to die
10
Tenants of Assessment
• Find Points of Departure
• Be Severity Aware
• Plan before you pry
• Assume nothing
Tenant: Find Points of Departure
1. Be mentally aware
2. Be at peace with God
3. Not a burden to family
4. Be able to help others
5. Pray
6. Have funeral arrangements planned
7. Not be a burden to society
8. Feel one’s life is completeSteinhauser et al., 2000.
12
Tenant: Be Severity Aware
13
Tenant: Plan Before You Pry…
Tenant: Plan Before You Pry
Jacobson et al., 2013.
• Patients will ask
• Fact clubbing
• Decisional preferences
Tenant: Assume Nothing…
Assessment
Pt/Fam
Disease Mgmt
Physical
Psych
SocialSpiritual
Practical
EOL Worries
Disease Mgmt
• Do patient/family verbalize the dx and px
• Primary dx, Secondary dx & Px
• Co-morbidities
• Adverse events
• Symptoms
• Level of consciousness
• What is the patient’s performance status
• Is he or she safe?
• Fluid and nutrition
• Can the patient see or hear well enough
• Wounds
Physical Issues
• How is the patient responding to being ill
• Personality type / Self Image
• Depression / Anxiety
• Emotions or fears expressed
• Need for Control
• Sense of Dignity
• Conflict tolerance
Psychological & Cognitive
Issues
• Cultural values, beliefs and practices
• Relationship and roles with family, friends, church, community
• Routines and rituals
• Legal- advance directives, will, power of attorney for healthcare and business
• Guardianship issues
• Financial resources
Social Issues
• Intrapersonal, Interpersonal & Transpersonal domains
• Meaning and value of this life
• What comes after this life
• Spiritual advisors
• Rites and rituals
Spiritual Issues
• ADLs / iADLs independent or independent
• Plan for assistance when needed
• Assistive devices available / in use
• Care for pets?
• Transportation?
Practical Issues
• Financial resources
• Legacy creation
• Preparing for expected death
• Last hours expectations
• Legal issues (coroner cases)
• Care of the family
End of Life / Death
Management
• Multiple losses experienced during illness
• Grief-emotional response to loss
• Anticipatory / Acute / Chronic
• Common / Complicated
• Mourning-adaptation to loss
• Bereavement- period after loss
Loss & Grief
25
Pt / Fam
Chaplaincy
Clinical Social Work
Nursing
Pharmacy
Physician
Other
Providing Care
Summary
A comprehensive assessment that includes the issues that cause
patients/families/caregivers suffering guides palliative care
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