2/18/2020 1
Why Having a Palliative Care Team Matters: Benefits of the IDT Approach
7th Annual Hospice & Palliative Care Conference
- St. Anselm College ~ March 5, 2020
Shelly Snow, MDiv, MEd, APBCC Amy Stuart, RN, CHPN Marcia Flinkstrom, MSW Agata Marszalek, MD
Disclosure Statement
We do not have any relevant financial relationships with any commercial interests
- Shelly Snow, MDiv, MEd, APBCC
- Amy Stuart, RN, CHPN
- Marcia Flinkstrom, MSW
- Agata Marszalek, MD
Patient Case
Meet Joanne. 54 y old female with previous history of breast cancer in 2004 and 2010. Treated with surgery, chemotherapy and radiation. In 2017 Joanne developed difficulty swallowing, she was weak, tired and had a cough for couple of months. 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
- collapse. She had a feeding tube placed and biopsy showed lung cancer.
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.
Patient Case cont’d
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 week later she was home and able to take care of herself, independent. For 1.5 y our team has been seeing her every month to check on her symptoms: cough, pain, anxiety, fatigue. She was doing well until last spring when her cancer started growing again. Joanne’s treatment was changed to chemotherapy which was very difficult for 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. We worked very hard to get her comfortable but the cancer was growing fast.
Patient Case cont’d
Joanne decided to stop chemo and focus on quality of life, we talked about hospice and end of life. She was making plans for the nearest future. 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 to give it a try. At that time we were seeing her every week because her symptoms were very serious, especially pain, anxiety and nausea. Many medication changes were made and we worked very hard until she became comfortable. The treatment helped. Joanne was able to go on vacation, enjoyed time with friends and family. She even painted a room in her house.
Patient Case cont’d
After a couple of months on the new medication, Joanne’s disease started to
- progress. She developed severe cough. Medications were up-titrated, and she
was admitted to home hospice. She had a brief admission to a hospice house, and was started on Fentanyl drip. On the morning of November 21st, she was so short of breath that she came to the WDH ED. Our team evaluated her and provided higher doses of medications. Joanne was stabilized until the next morning when a sudden change in her 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. Our team made multiple visits to check on her symptoms, until she passed away.