Care When There is No Cure for Patients with End Stage Diseases – Lores Vlaminck

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Preserving a patient’s legacy – Harold’s story…

Harold was a patient with metastatic bowel cancer – he had just months to live. Over his lifetime, he had been instrumental in transforming acres of farmland into the village that he grew to love. This legacy was extremely important to Harold. In an effort to keep this heritage alive, he had large posters made of photos, and he even used his carpentry skills to create an entire model of the town. Upon hospice visits, his only focus was teaching his caregivers about this legacy; he did not want it lost with his death.

His caregivers began videotaping him sharing the story of his village – but that wasn’t enough for Harold. With his permission, a local TV station was brought in, focusing on the model, photos, and the stories behind them. The TV personnel never mentioned that Harold was ill. The video aired on the local station, and Harold was ecstatic – and at peace. He passed away soon after, his legacy preserved.

In this compelling recording, multiple case studies like Harold’s will provide you with examples that you can incorporate when caring for the terminally ill. Caring for patients with end stage disease requires extreme sensitivity, deep compassion, and extraordinary knowledge. In order to deliver expert, holistic care, healthcare professionals need to have a toolbox full of new interventions to promote quality of life.

Each particular end stage disease has unique complexities for the patient, the family, and the healthcare professional – and this recording will cover specific strategies for caring for these patients.

Did you know that a patient seeking a liver transplant can be on hospice care while waiting? We will discuss how this is done.

What can we do for patients with COPD who’s seemingly only solution for an exacerbation is a visit to the ER? We have an intervention for this.

How can we keep costs down without sacrificing patient care? We’ll give you the latest strategies, proven successful in practice.

It’s time to think outside the box.

Walk away from this recording with new tools for quality support – and care when there is no cure.

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1. Summarize the assessment scales that are predictive of poor survival.
2. Explain the importance of prognosis and shared decision-making.
3. Evaluate the benefits of using palliative care principles for patients with end stage disease.
4. Distinguish palliative services vs. hospice services.
5. Choose strategies to help patients overcome the fear of death.
6. Predict challenging end of life symptoms and the best interventions.

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Disease Prognostication: An Inexact Art & Science

• Individualized care: The importance of prognosis (science/art/intuition)
• Determining palliative care vs. hospice care
• Crucial conversations
• The hospice benefit

Congestive Heart Failure: The Broken Heart

• Best practice: The Seattle HF Model
• Medication management strategies
• Symptom management and pain management
• Pacemakers, ICDs & LVADs – Living better or prolonging suffering?

Chronic Obstructive Lung Disease

• Global Obstructive Lung Disease (GOLD) Guidelines
• The COPD Assessment Test (CAT)
• Treating dyspnea: “The Pain of Non-Malignant Disease”
• The medication tool box: Oxygen, bronchodilators, opioids and steroids

Renal Disease

• Appropriate use of dialysis
• Staging disease with Glomerular Filtration Rate
• Hemodialysis mortality predictor
• Symptom burden
• Underutilization of hospice
• Opiods with dialysis

Liver Disease

• Indicators of poor prognosis
• Differentiating when cirrhosis is the cause
• Most useful analgesics for the pain
• Waiting for transplant while on hospice: Use of the MELD tool

Advanced Dementia

• GDS: FAST
• Pain scales
• Feeding tube dilemmas – and outcomes
• Delirium and dementia: Interventions for agitation and aggression
• End state dementia

Amyotrophic Lateral Sclerosis

• Diagnostic tests for ALS
• Advance directives and life support decisions
• Nutrition and gastrostomy
• Non–invasive ventilation
• Table of useful medications and palliative measures

Advanced Cancer

• The value of early palliative care
• Spiritual needs
• Complications and interventions
  • Spinal cord compression
  • Superior vena cava syndrome
  • Bowel obstruction
  • Hypercalcemia
  • Fungating wound/terminal Kennedy ulcer

Eight Signs of Impending Death

Challenging Decisions

• What do people want at the end of life?
• Delirium vs. near death awareness
• Mental health needs of the dying
• Palliative sedation therapy for intractable symptoms
• Does the dying person need hydration? Oxygen? Treatment for rales?

Moral Distress

• Uncomfortable patient/family scenarios
• Ethical dilemmas
• Medication errors
• Conflicted consciences

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