“grave” lessons in end of life care
DESCRIPTION
“Grave” Lessons in End of Life Care. Hector López , DO Council on Minority Health Issues. EOL Learning Objectives. Enjoy light-hearted vignettes about “Grave” EOL issues. - PowerPoint PPT PresentationTRANSCRIPT
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HECTOR LÓPEZ, DO
COUNCIL ON MINORITY HEALTH
ISSUES
“Grave” Lessons in End of Life Care
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EOL Learning Objectives
1. Enjoy light-hearted vignettes about “Grave” EOL issues.2. Participants will learn how to initiate and conduct a patient-
centered EOL discussion with diverse minority patients and their families.
3. Participants will discover the importance of discussing a DPAHC (Durable Power of Attorney for Health Care).
4. Participants will learn to dispel myths and misinformation about a multiplicity of EOL issues.
5. Participants will learn how to discuss medical treatments that ease dying rather than those that prolong suffering and death.
6. Participants will learn to perceptively discuss CPR and DNR status of patients with different cultural background than their own.
7. Participants will be better able to provide cultural competent care to diverse minority groups.
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First Video clip
MODERN DAY REAPER
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Patient’s values, desires & needs
Uneasy with our own mortality/training
DO must ease death process, not prolong it
Get big picture from patient
Base on patients’ concept of death/EOL issues
What concerns patient the most?
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Patient’s values, desires…
Emotions and desires of family/patient
Ethnicity/culture versus patient’s goals
Patient’s spiritual beliefs/rituals/unresolved issues
Limit medical jargon: procedure/prognosis/diagnosis/resuscitation/
Resuscitation and DNR discussion with patient.
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☺Second video clip☻
Wrong way to explain CPR
& Resusitation
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Just D.O. it
Studies: 95% patients want DO to discuss EOL care.
Kaiser: Drs. brief, gave few numerical CPR outcomes*
Address fears, beliefs & frame talk based on outcomes
Avoid euphemisms “restart your heart” Emanuel LL, Barry MJ, Stoeckle JD, et al. Advance directives for medical care—a case for greater use. N Engl J Med 1991;324(13):889-95 . *Grave Words video Dr. Bernard Lo
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Just D.O. it
Only 1-12% survive CPR, patients think 90% do.
Potential versus Imminent death.
Negotiate with pt and family. May need different terms
Ensure a “good” dignified & peaceful death.
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Cultural Competent Care
Don’t stereotype all patients of one culture
Seek each patient’s individual wishes
Is patient able to grasp grim diagnosis?
Confirm understanding, maybe pts “didn’t See what they Heard”
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Cultural Competent Care
Note cultural pain differences
Discuss advance directives, only 10-15% have AD.
If no AD form, document in chart, or NOT VALID!
Cost savings with AD. Blacks, Latinos cost more at EOL *
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Cultural Competent Care
Engage patient, family, other Decision Makers. Initiate discussions as scenarios that affected other patients Monitor non-verbal cues In some cultures, discussing death directly is taboo Use qualified interpreters.
Don’t apply the Golden rule.
*Arch of IM vol 169 #5, 3/9/09
Wilner, A, Pain Management Across Cultures. 10/14/2008, Medscape Neurology & Neurosurgery
Green CR, Ndao-Brumblay SK, West B, et al Differences in prescription opioid analgesic availability: comparing minority and white pharmacies across MI. J Pain. 2005;6:689-699
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Patients & EOL Discussion
Experienced a greater sense of trust and well-being.
Believe treatments and technology will be geared to their goals and wishes.
No adverse patient effects seen by having these EOL discussions.
Virmani J, et al. Relationship of ADs to physcian-patient communication. AIMed.1994;154:154:909-913.
Smucker WD, Ditto PH, et al. Elderly outpatients respond favorably to a physician-initiated irective discussion. J Am Board Fam Pract
1993;6(5):473-82.
Tierney WM, Dexter PR, et al. The effect of discussions about advance directives on patients' satisfaction with primary care. J Gen Intern Med 2001;16:32-40
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Third video clip….
A Sensitive Caring D.O.
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EOL Cultural Competency Resources
http://www.fanlight.com/catalog/films/456_hyb.php http://www.fanlight.com/downloads/HoldYourBreath.pdf http://medethicsfilms.stanford.edu/holdyourbreath/howto.html http://www.aahpm.org/about/index.html http://ajh.sagepub.com/cgi/content/refs/23/5/404 http://goliath.ecnext.com/coms2/gi_0199-6837217/Cultural-
competency-key-in-end.html http://cat.inist.fr/?aModele=afficheN&cpsidt=21884256 http://www.amazon.com/Cultural-Issues-Life-Decision-Making/dp/
0761912177 http://www.ncbi.nlm.nih.gov/pubmed/12442876 The American Academy of Hospice and Palliative Medicine ( Cultural
competence group )
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A minority patient’s verbal statement about their live support views is not considered valid unless documented
in an advance directive.
Tru
e
Fal
se
0%0%
1. True2. Fals
e
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Approximately 42% of people in the USA have completed a Durable Power of Attorney for Health Care.
Tru
e
Fal
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0%0%
1. True2. False
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The racial and ethnic health care disparities in the USA are pervasive until the time minority patients die.
Tru
e
Fal
se
0%0%
1. True2. False
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Research shows that most minority patients find discussions about life support and end of life planning
disturbing or upsetting.
Tru
e
Fal
se
0%0%
1. True2. False
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Doctors and family members usually make decisions for incompetent patients that reflect the patient’s own wishes
as opposed to their own values.
Tru
e
Fal
se
0%0%
1. True2. False
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The survival to discharge outcomes of CPR in general in-patient wards is usually >35%.
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0%0%
1. True2. False