Primary Care Provider ’ s Role
Studies show a clear benefit when patients are given a chance to discuss end-of-life issues and are more likely to die at home or in a comfortable setting instead of a hospital intensive care unit . Survivors are able to cope better with death and experience less anxiety and stress later .
1 . Timing of end-of-life conversations should begin well before a person becomes ill as these discussions can be very difficult for patients and their families once a health crisis occurs . Advanced care planning should be an integral part of a primary care providers routine adult medical care prior to declines in health .
2 . Periodic end-of-life planning should be revisited as a disease progresses and before a risky procedure or surgery . If a diagnosis of a terminal disease has been made the patient and their families need to understand the prognosis and make decisions regarding what treatment they want and plan priorities for the life that remains .
3 . Determine patient ' s wishes for interventions at time of crisis . This should be accomplished through written advanced directives or direct conversations with the patient with key family members or their power of attorney present addressing general values and specific management choices . Spiritual , cultural and social and economic are key components of end-of-life discussions . Aspects pertaining to the disease or illness treatment related to cure and expectations should be discussed . Determining if length of life or quality of the remaining time is priority .
4 . Functional status is a strong indicator of a patient ' s prognosis . Eliciting information about the patient ' s ability to perform activities of daily living can help predict survival . When the patient is not able to spend time out of bed , has reduced appetite or reduced caloric intake and cannot dress or bathe without assistance the patient is likely to be in the last months of life . These patients should be eligible for Medicare hospice benefits . This is the time to involve specialty palliative care consultation .
5 . Primary care providers or hospitalists caring for patients could provide palliative care services including management of basic pain , depression or anxiety and conducting initial or revisited discussions pertaining to advanced care planning , clarifying prognosis of chronic debilitating illnesses and establishing goals of treatment options as well as determining or confirming CODE STATUS .
Suggested Questions to Start a Conversation
· Thinking about your death , what do you value most about your life ?
· If you were diagnosed with a terminal illness , would you want to pursue every possible cure ?
· Do you imagine wanting to stop curative efforts if they were unsuccessful ?
· Do you want to die at home ?
· How do you feel about an extended hospitalization ?
· How much pain is acceptable to you ?
· Do you want to be with your family when you die ?
· What decisions regarding care do you want to entrust to others ?
· What does good death look like to you ?
Community Palliative Resources
· Mount Carmel Palliative Care and Hospice Website : http :// libguides . mccn . edu / palliativecare
· State of Ohio Living Will and Power of Attorney Packet : http :// recorder . franklincountyohio . gov / services / living-wills . cfm
· Ohio Department of Health DNR forms : http :// www . odh . ohio . gov / pdf / forms / dnrfrm . pdf
· Center to Advance Palliative Care ( capc ): https :// www . capc . org /
· National Hospice and Palliative Care Organization : http :// www . nhpco . org /
· American Academy of Hospice and Palliative medicine : http :// aahpm . org /
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