2/18/2020 Disclosure Statement We do not have any relevant financial relationships Why Having a Palliative Care Team Matters: with any commercial interests Benefits of the IDT Approach • Shelly Snow, MDiv, MEd, APBCC 7 th Annual Hospice & Palliative Care Conference • Amy Stuart, RN, CHPN St. Anselm College ~ March 5, 2020 • Marcia Flinkstrom, MSW Shelly Snow, MDiv, MEd, APBCC • Agata Marszalek, MD Amy Stuart, RN, CHPN Marcia Flinkstrom, MSW Agata Marszalek, MD Patient Case Patient Case cont’d Meet Joanne. While in ICU Joanne received a targeted medication for the mutation that her cancer was harboring and within couple of days she felt remarkably better. One 54 y old female with previous history of breast cancer in 2004 and 2010. Treated week later she was home and able to take care of herself, independent. with surgery, chemotherapy and radiation. For 1.5 y our team has been seeing her every month to check on her symptoms: In 2017 Joanne developed difficulty swallowing, she was weak, tired and had a cough, pain, anxiety, fatigue. She was doing well until last spring when her cough for couple of months. cancer started growing again. She came to ED when she could no longer eat. A CT scan showed enlarged lymph nodes in her chest and right lung mass causing partial lung Joanne’s treatment was changed to chemotherapy which was very difficult for collapse. She had a feeding tube placed and biopsy showed lung cancer. her to tolerate. She had severe nausea and vomiting, felt tired all the time. She developed pain in her chest and had shortness of breath. She was very anxious, traumatized from her previous experiences with chemo years ago. A month later her cancer grew so much that she was constantly coughing and was very short of breath. She was in ICU when she met with our team for the first time. She was scared, could not talk, couldn't breathe . We worked very hard to get her comfortable but the cancer was growing fast. Patient Case cont’d Patient Case cont’d After a couple of months on the new medication, Joanne’s disease started to Joanne decided to stop chemo and focus on quality of life, we talked progress. She developed severe cough. Medications were up-titrated, and she about hospice and end of life. She was making plans for the nearest future. was admitted to home hospice. She had a brief admission to a hospice house, and was started on Fentanyl drip. There was one more option for treatment, a pill similar to the one she got at the time of diagnosis, there was no certainty that it will work but she wanted On the morning of November 21 st , she was so short of breath that she came to to give it a try. the WDH ED. Our team evaluated her and provided higher doses of medications. At that time we were seeing her every week because her symptoms were very serious, especially pain, anxiety and nausea. Many medication changes were Joanne was stabilized until the next morning when a sudden change in her made and we worked very hard until she became comfortable. breathing and mentation occurred. Saturations went down to 60-70%, she became severely agitated. ?PE. Multiple medications were given including haloperidol, lorazepam, glycopyrrolate, chlorpromazine, and phenobarbital. The treatment helped. Joanne was able to go on vacation, enjoyed time with Our team made multiple visits to check on her symptoms, until she passed friends and family. She even painted a room in her house. away. 1
2/18/2020 The Role of the Chaplain on the SPC The Role of the Chaplain on the SPC Interdisciplinary Team Interdisciplinary Team The importance of relationship building Chaplains are professional spiritual care providers whose Initial Consult role becomes even more vital as patients and their loved • Met with Joanne and spouse along with Dr. Marszalek ones find their way through serious, life-limiting and life- Initial Spiritual Assessment (FICA) threatening illness. Follow Up Visit • Meaning Making • Independent • Finding Purpose • Met with Joanne in Infusion Center • Storytelling The Role of the Chaplain on the SPC FICA Spiritual Assessment Tool Interdisciplinary Team On again, off again… • Seacoast Cancer Center • Critical Care Unit • ED admission • Final admission The Role of the Nurse on the Benefits of Nurse Role to Interdisciplinary SPC Team Patient and Family • Continuity of care • Emotional support • Consistent point of contact • Liaison between patient and provider Price, C. The Role of a Nurse on an Outpatient Palliative Care Team to Increase Provider Productivity and Improve Communication. Retrieved from http://www.CAPC.org 2
2/18/2020 Benefits of Nurse Role to The Role of the Social Worker Healthcare Team on the SPC Interdisciplinary team • Continuity of care Palliative Care Social Workers help both patients and their families navigate the difficult process of: • Liaison between patient and health care team • Managing the mental, emotional, familial, and monetary stressors of debilitating physical illness • Triage • Understanding their treatment plan and being vocal about their needs • Overcoming crisis situations • • Communication of Plan of Care Connecting to other support services in the area • Planning for end-of-life Introductory Guide to Hospice and Palliative Care Social Work. (2020). Retrieved February 17, 2020, from https://www.onlinemswprograms.com/careers/types-of-social-work/guide-to-hospice-palliative-care-social-work.html The Role of the Social Worker For More Information on the SPC Interdisciplinary team Hospice & Palliative Nurses Association Palliative Care Clinic Consult • https://advancingexpertcare.org/ Advanced Directives • Provider Orders for Life-Sustaining Treatment (POLST) Center to Advance Palliative Care • Psychosocial Support https://www.capc.org/ Final Admission Spiritual Care Association • https://www.spiritualcareassociation.org/ Support • Facilitation of communication • Supportive and active listening with family Questions? Thank you! 3
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