Download - What is a Good Death? by Ashley Shreves
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What is a good death?SMACC
June 25, 2015
Ashley Shreves, MDAssistant Professor
Department of Emergency MedicineBrookdale Department of Geriatrics and Palliative Medicine
Icahn School of Medicine at Mt. Sinai
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Which looks like “good” dying?
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What’s most important to patients facing death?
Steinhauser JAMA 2000
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Don’t patients want to live forever?
n = 226Advanced illnesses
Fried N Engl J Med 2002
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What’s most important?
Non-medical >>> medical
Quality of life >>> quantity of life
Outcomes >>> treatments
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Are we good with the non-medical?
Teno JAMA 2005
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Quality vs Quantity?Focused on resuscitation and life-prolongation
Spectacular deaths: exciting and prioritized
“Subtacular” deaths??
Care Poor Forgotten
about
Neglected
Stuck in a corner and left there
A lower class citizen in regards to
EM
Bailey Ann Emerg Med 2010
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Outcomes?Time spent
1 min
Content of conversationDescriptions of CPR
Outcomes?Not mentioned
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Want to do better?
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Palliative Care
Type of care
Improve quality of life/relieve suffering
Serious/advanced illness
Multidisciplinary team approach
Hospice
System of care
Improve quality of life/relieve suffering
Terminal illness
Multidisciplinary team approach
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Mt. Sinai Palliative Care TeamDoctor
Nurse Practition
er
Social Worke
rChaplain
Art therapi
st
Massage
therapist
Yoga therapi
st
Nurse
Patient &
Family
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What do we do?
COMMUNICATION
COMMUNICATION
COMMUNICATION
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What happens?Medical decisions changeQuality of life improvesSymptom management improvesDepression decreasesLife often extended
Costs decrease
Volandes BMJ 2009Temel N Engl J Med 2010
Teno JAMA 2004Connor J Pain Symptom Manage 2007
Morrison Arch Int Med 2008
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When is dying bad?
WHEN IT’S ABOUT YOU
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When is dying good?
WHEN IT’S ABOUT THEM
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How do patients get the good death?
PALLIATIVE CARE & HOSPICE
If not available
LEARN COMMUNICATION SKILLS