The True Benefit of Palliative Care: Talking to Patients About Their Goals and Wishes
May 05, 2021
Email US
Click to Email Us
Recent articles inAnnals of the American Thoracic Societyhighlight whygoals-of-care (GOC) conversationsandadvance care planning (ACP) sessionsshould be common in primary practices, specialty clinics, hospitals, and care facilities for patients facing the challenges of advanced lung disease and other advanced illnesses.
Suggesting a goals-of-care conversation should be as commonplace in a clinicians daily routine as taking vital signs.
We want our healthcare colleagues to know that we are prepared at any time to step in and help facilitate these conversations on their behalf, and to follow up by providing expert end-of-life care in patients preferred settings so that they receive thecomfort-focused modalities and supportthey want and deserve.
Engaging in and completing these conversations delivers measurable, high-impact results for all parties involved.
Where to Start a Goals-of-Care Conversation: 5 Questions
First, palliative care discussions identify key parameters for a patients care moving forward. Here are 5 questions you can ask your patient with advanced illness to help guide their care:
What do you understand about your disease?
What are your fears and concerns about your worsening health?
What is important to you?
What do you want your medical care to look like moving forward?
Are you ready to put your wishes and goals for care in writing so that you, your family, and your medical care team know your preferences?
For patients, GOC conversations result in better outcomes and greater satisfaction with care. For healthcare providers, they result in goal-concordant care that delivers measurable cost savings for patients who have incurable diseases likeadvanced chronic obstructive pulmonary disease (COPD)or lung cancer.
Data cited in this quarters perspective (Ruggiero, R. and Reinke, L.), in fact, notes that the inclusion of palliative carewhich is built around GOC conversations and advance care planningsaves an average of $3,237 per patient over the course of a hospital stay, compared with patients who do not receive palliative care.
Sooner Is Better
Our message to our non-hospice, non-palliative care healthcare colleagues is that the sooner these conversations take place, the better it is for everyone involved.Many patients with advanced lung disease, in fact, are eligible for hospice carelong before these conversations occur.
Follow along with an example of an advance care planning conversation:
If physicians or specialists do not feel comfortable with these difficult-but-rewarding conversations, trained VITAS facilitators are always available to meet with patients and familieswherever they are and whenever they are ready to decide the course of their care as their health declines.
VITAS Can Help You Educate Your Patients
Just as we can help physicians overcome their unease or perceived lack of training to engage in goals-of-care conversations, we can help patients overcome their concerns about the transition to hospice care, by:
reassuring patients that hospice care does not mean giving up the medications or treatments (e.g., inhalers, access to arespiratory therapist) that currently provide comfort and symptom management
explaining the value of theinterdisciplinary hospice teamto address physical, emotional, and spiritual needs
offering an individualized care plan and one offour levels of hospice careto meet their individual needs and goals
adjusting medication delivery seamlessly as their symptoms worsen to maintain comfort (e.g., switch from inhaled medication to nebulized versions in the home)
delivering the necessary equipment, medications, and suppliesdirectly to them, wherever they prefer to receive care, usually at a cost saving
easing the concerns of anxious family members and caregivers through regular team visits, training, educational materials, and 24/7 availability of VITAS clinicians to manage crises and keep their loved one comfortable
Goals-of-Care Conversations Should Be Commonplace
Our goal is to support our healthcare partners in private practices, specialty practices, hospitals, and care facilities. We want them to embrace a 360-degree view of advanced disease so that they know when its time to call VITAS for a goals-of-care conversation. Ideally, suggesting a GOC conversation should be as commonplace in a clinicians daily routine as taking vital signs, interpreting laboratory findings, and exploring treatment options, particularly for those with advanced illness.
What are signs ofhospice eligibility in a patient with advanced lung disease?
A no answer to the surprise question: Would you be surprised if this patient were to die in the next year?
Shortness of breath at rest or with minimal exertion
More than 50% of waking hours spent sitting or resting (Palliative Performance Scaleof about 50%)
More dependence for activities of daily living
Functional decline over time
We know that talking with patients about their disease and wishes is one of the hardestand most importantactivities that healthcare professionals can undertake, especially for patients with advanced illness.
Other Articles You May Like
Discovery Senior Living Launches First-of-Its-Kind The Disappearing Mind Podcast Addressing Need for Trusted Brain Health & Dementia Resources
Project Update - Immokalee Complete Streets
PROJECT UPDATE IMOKALEE COMPLETE STREETS TIGER GRANT DESIGN-BUILD PROJECT JUNE 2025PROJECT UPDATEThe Immokalee Complete Streets Project is finished and includes new sidewalks and drainage along miles of local streets. In addition to the sidewalks, the project included reconstruction of many existing residential driveways and improvements to the drainage swale along your property line within the Collier County Right-of-Way (ROW).We need to work together to keep these new sidewalks and drainage improvements in good condition. Please do your part to help maintain the improvements by complying with the existing codes which require property owners to assume all maintenance and repair responsibilities within the Collier County ROW. These responsibilities include mowing the grass and protecting the sidewalk and driveway from damage.We are requesting your help to maintain these improvements including: Drainage cutting the grass within the swale is very important because it will allow the drainage system to function. Picking up the litter before you mow will also keep the community clean. Pedestrian Safety do not park on the sidewalks, it is against the law and blocks the safe passage of children and adults. Heavy trucks and equipment can damage the sidewalk. The construction of sidewalks is expensive, and your help is needed to maintain them. Please remember it is illegal to park on a sidewalk. Both the Collier County Sheriffs Office and the Collier County Code Enforcement Division are monitoring to encourage voluntary compliance. Citations will be issued if the law is broken. It is the property owners responsibility to assure that all your visitors, tenants, and family members obey the law. You, as the property owner, are responsible for maintaining the driveway and ROW.If you rent your property, please inform your tenants of this information. As a landlord, you are responsible for providing your tenants with this information.We hope you enjoy the improvements along the county roadways and please continue to assist your neighbors as we work to improve the health and safety of our community.For more information about the project, please contact: CHRISTIE BETANCOURT ASSISTANT DIVISION DIRECTOR COMMUNITY REDEVELOPMENT AGENCY (CRA) Email: Christie.Betancourt@colliercountyfl.gov Phone: (239) 867-0028 IMMOKALEE CRA Collier County Community Redevelopment Agency
June is Alzheimers & Brain Awareness Month
This June during Alzheimers & Brain Awareness Month, the Alzheimers Association is encouraging all Americans to take charge of their brain health. Today, there are more than 7 million Americans living with Alzheimers. Two-thirds of Americans have at least one major potential risk factor for dementia. The brain changes that cause Alzheimers are thought to begin 20 years or more before symptoms start, which suggests that there may be a substantial window of time in which we can intervene in the progression of the disease. Experts believe there isnt a single cause of Alzheimers. Its likely the disease develops as a result of multiple factors. While not a direct cause of Alzheimers, the greatest known risk factor is advancing age. Although some risk factors like age cant be changed, as many as 45% of dementia cases may be attributable to modifiable risk factors, such as high blood pressure and lack of physical activity. Research shows that adopting healthy behaviors like getting exercise and good quality sleep can improve your brain health and reduce the risk of cognitive decline. Based on mounting scientific evidence, the Alzheimers Association encourages individuals to incorporate these 10 Healthy Habits such as challenging your mind and eating healthier foods to help protect brain health. Be Proactive in Addressing Brain Changes Only half of those with Alzheimers disease ever receive a diagnosis, delaying needed care and potentially putting them at risk. Another important way to take charge of your health is to know the early warning signs of Alzheimers and other dementia and be proactive in addressing them. Early detection and diagnosis of Alzheimers is more important than ever. Early detection offers significant benefits for the person diagnosed and their loved ones, including greater access to treatment options and the ability to plan for the future. There are now treatments that can slow disease progression for people in the early stage of Alzheimers, making a timely diagnosis critically important. If you or someone you know is experiencing memory or thinking problems, its important to get it checked. Talk to your doctor so you can make an informed decision on available treatments to determine if they are right for you. Join the Fight to End Alzheimers During Alzheimers & Brain Awareness Month, the Alzheimers Association invites everyone to join us in the fight to end Alzheimers and all other dementia. Heres what you can do: Adopt the 10 Healthy Habits: It is never too early or too late to start taking positive actions for your brain. Visit alz.org/healthyhabits to learn more! Go purple: Throughout the month of June, go purple the color of the Alzheimers movement to raise awareness of the disease. Dress in purple and share your story on social media using the hashtag #ENDALZ. Join the fight: Advance the care, support and research efforts of the Alzheimers Association by participating in our fundraising events Walk to End Alzheimers, The Longest Day and Ride to End ALZ. Visit alz.org/fundraisingevents. Get information and support: Access education programs and dementia care resources. Visit alz.org/educationalprograms. Volunteer with us: As an Alzheimers Association volunteer, you can help people in your community take steps to reduce their dementia risk and recognize the signs of Alzheimers. Visit alz.org/volunteer. Advocate: Raise your voice tell Congress to act today. Visit alz.org/congressconnects. Accelerate research: It takes everyone to advance Alzheimers and dementia research. Alzheimers Association TrialMatch is a free, easy-to-use service that connects individuals living with cognitive impairment, Alzheimers disease or another dementia, caregivers and healthy participants with current research studies. Visit alz.org/trialmatch. Donate: Empower people at every age and stage of life to take charge of their brain health support the Alzheimers Association! Visit alz.org/donate. We are proud to partner with the Alzheimers Association in the fight against Alzheimers and other dementia. To learn more visit alz.org/abam.