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

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Elizabet h Y

• ung, MD

Kaiser S F , Palliative Care October 6, 2017  I have nothing to disclose  Defining palliat ive care  Identifying appropriate patient populations

and st art ing t he conversat ion

 Common misconceptions  Cultural Beliefs/ Attitudes w/ case studies

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 Metastatic cancer  Chronic/ Degenerat ive Disease w/ mult iple

hospitalizations in past year

 Frail  “ SURPRISE QUESTION” - Would you be

surprised if t his pat ient died in t he next year?

 Palliat ive Care (PC) = Hospice Care  PC = you are dying  PC = bad news t hat no ot her provider has

shared yet

 PC = “ giving up” or no t reat ment  PC team will put patient on a morphine drip

unt il t hey die

 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

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 Ext ra layer of support t o care for t hose wit h

serious/ life-limiting illness

 1) Symptom management : Physical and

Emotional

 2) Communication: Medical team, Patient

and Family

 3) Planning: Decision Making, Preparedness,

Goals of Care, Advanced Directive, POLST

 The FOCUS is on LIFE, how to live well,

how t o make every day a bet t er day

 Doctors as Authority Figure  “ Y

es Doctor” complex

 Identifying a healthcare proxy may seem difficult  Death may be a taboo topic  Filial Piety “ Hsiao”  Children have the duty to protect their parent s’

health, safety, and well-being

 Children may advocat e for

aggressive treatment

 70y/ o male met nasopharyngeal ca -> brain,

• n home hospice

 Admitted for dyspnea, F

, AMS -> bacteremic, severe sepsis

 Son told primary team over t he phone, “ Do

everyt hing!”

 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

 Familial hierarchy  Family based vs. personal autonomy  Speaking to wrong family member  Y

• unger (more “ westernized” ) generation

 Gender-determined roles

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 41y/ o male w/ metastatic lung cancer  Escalating pain that was difficult to control,

asked for physician assisted suicide

 Parent s refused to talk about EOL  Admitted to hospital at the end of his life for

comfort care

 Limited emotional expressiveness; stoicism  Downplay the severity of symptoms  May not acknowledge depression or

anxiety

 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

 Palliative Care = I’ m worried about you and I

would like to give you extra help



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

• n 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



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; 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

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ht t p:/ / coalitionccc.org