9/25/2017 I have nothing to disclose Elizabet h Y oung, MD Kaiser - PDF document

9/25/2017  I have nothing to disclose Elizabet h Y oung, MD Kaiser S F , Palliative Care October 6, 2017  Defining palliat ive care  Identifying appropriate patient populations and st art ing t he conversat ion  Common misconceptions  Cultural Beliefs/ Attitudes w/ case studies 1

9/25/2017  Metastatic cancer  Palliat ive Care (PC) = Hospice Care  Chronic/ Degenerat ive Disease w/ mult iple  PC = you are dying hospitalizations in past year  PC = bad news t hat no ot her provider has  Frail shared yet  PC = “ giving up” or no t reat ment  “ SURPRISE QUESTION” - Would you be  PC team will put patient on a morphine drip surprised if t his pat ient died in t he next unt il t hey die year?  Brief t he int erpret er, set expect at ions, cultural guide  Many t erms can be t ranslat ed a number of different ways, some wit h very negat ive connotation  For medical update: Use short phrases, simple language, “ teach- back” key element s 2

9/25/2017  Doctors as Authority Figure  “ Y es Doctor” complex  Ext ra layer of support t o care for t hose wit h  Identifying a healthcare proxy may seem difficult serious/ life-limiting illness  Death may be a taboo topic  1) Symptom management : Physical and Emotional  Filial Piety “ Hsiao”  2) Communication: Medical team, Patient  Children have the duty to protect their parent s’ and Family health, safety, and well-being  3) Planning: Decision Making, Preparedness,  Children may advocat e for Goals of Care, Advanced Directive, POLST aggressive treatment  The FOCUS is on LIFE , how to live well, how t o make every day a bet t er day  70y/ o male met nasopharyngeal ca -> brain, on home hospice  Familial hierarchy  Admitted for dyspnea, F , AMS -> bacteremic,  Family based vs. personal autonomy severe sepsis  Speaking to wrong family member  Son told primary team over t he phone, “ Do  Y ounger (more “ westernized” ) generation everyt hing!”  Gender-determined roles  Family meet ing wit h int erpret er, wife, son, and daught er  Wife acknowledged t hat her husband was dying and asked to stop aggressive treatment 3

9/25/2017  41y/ o male w/ metastatic lung cancer  Escalating pain that was difficult to control,  Limited emotional expressiveness; stoicism asked for physician assisted suicide  Downplay the severity of symptoms  Parent s refused to talk about EOL  May not acknowledge depression or  Admitted to hospital at the end of his life for anxiety comfort care  Cont ribute to total body pain  Pragmat ic, hard t o have generalized/ broad GOC discussion  Be specific in achievable goals; consider finances, home support , medicat ion management Bell CL, Kuriya M, Fischberg D. Hospice Referrals and Code St at us: Out comes of  Inpat ient Palliat ive Care Consult at ions Among Asian Americans and Pacific Islanders wit h Cancer. J Pain Sympt om Manage 2011; 42(4): 557-564  Fernandes R, Braun KL, Ozawa J, et al. Home-Based Palliat ive Care Services for Underserved Populat ions. J Palliat Med 2010; 13(4): 413-419  Mondia S, Hichenberg S, Kerr E, et al. The Impact of Asian American Value Syst ems on Palliat ive Care: Illust rat ive Cases From t he Family-Focused Grief Therapy t rial. Am J Hosp Palliat Med 2012; 29(6): 443-448  Palliative Care = I’ m worried about you and I  Schenker Y , Smit h AK, Arnold RM, Fernandez A. ‘‘ Her Husband Doesn’ t Speak Much English’’ : Conduct ing a Family Meet ing wit h an Int erpret er. J Palliat Med 2012; would like to give you extra help 15(4): 494-498 Wang J, Kearney JA. The experience of Chinese American parent s of children wit h  life-limit ing illness: a comprehensive review. Int l J Palliat Nursing 2013; 19(7): 347- 354  Chinese-American Out reach Guide. Available online at www.caringinfo.org under ‘ communit y’  www.caccc-usa.org  ht t p:/ / coalitionccc.org 4