- Email: [email protected]
Communication Skills for Transitions in Goals of Care (P3)
444
Schedule with Abstracts
Objectives 1. Describe the ethical issues to consider with withdrawal of life-sustaining therapies (LSTs). 2. Describe the cultural influences and implications when considering withdrawal of LST. 3. Describe communication techniques that are helpful for discussion of withdrawal of LST. 4. Identify clinical management of withdrawal of the following LSTs: r $13 r BSUJàDJBMOVUSJUJPOBOEIZESBUJPO r SFOBMEJBMZTJT r DBSEJBDEFWJDFT r BSUJàDJBMWFOUJMBUJPO r CMPPEQSPEVDUT 5. Describe the moral distress that may be experienced when participating in withdrawal of LST and possible interventions to manage/reduce the distress. As life-sustaining therapies have emerged, so have clinical, ethical, and legal concerns about the appropriate use of these treatments at the end of life. The therapies of artificial hydration and nutrition, mechanical ventilation, renal dialysis, cardiac devices and life-supporting medications, as well as blood products, will all be discussed. Each topic will be presented as case vignettes to highlight the current evidence of benefits and burdens of the therapy, the ethical and legal considerations, and the clinical management of symptoms at the time of withdrawal. Cultural and pediatric implications will be addressed, as will the moral distress of the clinicians who are part of the process.
Vol. 37 No.3 March 2009
Domains Ethical and Legal Aspects of Care; Structure and Processes of Care; Cultural Aspects of Care; Care of the Imminently Dying Patient
Objectives 1. Discuss the pathophysiology associated with wounds for various etiologies (eg, pressure, malignant). 2. Effectively assess, prepare, and dress wounds of various etiologies. 3. Manage associated symptoms (eg, bleeding, exudate, odor, pain). 4. Implement strategies to prevent and/or stabilize wounds. Pressure ulcers and malignant and other chronic wounds have a relatively high prevalence in patients with advanced life-threatening illnesses. Both the wound and the sense of being “wounded” can cause considerable suffering for patients, families, caregivers, and members of the healthcare team. During this interactive, hands-on workshop, the presenters will discuss recent prevalence data from our hospice population of approximately 900 patients per year who experience wounds. We will guide participants though the underlying pathophysiology of chronic healable and nonhealable wounds. We will use clinical cases to discuss effective approaches to wound assessment and management, including debridement, cleansing, and moist interactive wound dressings for both healable and nonhealable wounds based on the state-of-the-art wound-care literature. Exudate, odor, and pain are distressing symptoms associated with wounds that can be incapacitating and may lead to abandonment of the patient. The workshop will include discussions of the underlying pathophysiology of each of these symptoms and case-based approaches to their assessment and management, including the use of both systemic and topical antibiotics, analgesics, and anesthetics.
8 am–Noon
Domain Physical Aspects of Care
AAHPM Preconference Workshops Practical Approaches to Palliative Wound Care (P2) Frank D. Ferris, MD, San Diego Hospice and The Institute for Palliative Medicine, San Diego, CA; Rosene D. Pirrello, RPh, San Diego Hospice and The Institute for Palliative Medicine, San Diego, CA (All speakers for this session have disclosed no relevant financial relationships; all speakers will discuss off-label uses.)
Communication Skills for Transitions in Goals of Care (P3) Anthony L. Back, MD, University of Washington, Seattle, WA; Robert M. Arnold, MD, University of Pittsburgh, Pittsburgh, PA; James A. Tulsky, MD, Duke University Medical Center, Durham, NC; Walter Baile, MD, MD Anderson Cancer Center, Houston, TX; Wendy Anderson, MD MS, University of California–San Francisco, San Francisco, CA; Lynn Bunch, MD, Hertzberg Palliative Care Institute, New York, NY; Lisa Marr,
Schedule with Abstracts
Objectives 1. Describe the ethical issues to consider with withdrawal of life-sustaining therapies (LSTs). 2. Describe the cultural influences and implications when considering withdrawal of LST. 3. Describe communication techniques that are helpful for discussion of withdrawal of LST. 4. Identify clinical management of withdrawal of the following LSTs: r $13 r BSUJàDJBMOVUSJUJPOBOEIZESBUJPO r SFOBMEJBMZTJT r DBSEJBDEFWJDFT r BSUJàDJBMWFOUJMBUJPO r CMPPEQSPEVDUT 5. Describe the moral distress that may be experienced when participating in withdrawal of LST and possible interventions to manage/reduce the distress. As life-sustaining therapies have emerged, so have clinical, ethical, and legal concerns about the appropriate use of these treatments at the end of life. The therapies of artificial hydration and nutrition, mechanical ventilation, renal dialysis, cardiac devices and life-supporting medications, as well as blood products, will all be discussed. Each topic will be presented as case vignettes to highlight the current evidence of benefits and burdens of the therapy, the ethical and legal considerations, and the clinical management of symptoms at the time of withdrawal. Cultural and pediatric implications will be addressed, as will the moral distress of the clinicians who are part of the process.
Vol. 37 No.3 March 2009
Domains Ethical and Legal Aspects of Care; Structure and Processes of Care; Cultural Aspects of Care; Care of the Imminently Dying Patient
Objectives 1. Discuss the pathophysiology associated with wounds for various etiologies (eg, pressure, malignant). 2. Effectively assess, prepare, and dress wounds of various etiologies. 3. Manage associated symptoms (eg, bleeding, exudate, odor, pain). 4. Implement strategies to prevent and/or stabilize wounds. Pressure ulcers and malignant and other chronic wounds have a relatively high prevalence in patients with advanced life-threatening illnesses. Both the wound and the sense of being “wounded” can cause considerable suffering for patients, families, caregivers, and members of the healthcare team. During this interactive, hands-on workshop, the presenters will discuss recent prevalence data from our hospice population of approximately 900 patients per year who experience wounds. We will guide participants though the underlying pathophysiology of chronic healable and nonhealable wounds. We will use clinical cases to discuss effective approaches to wound assessment and management, including debridement, cleansing, and moist interactive wound dressings for both healable and nonhealable wounds based on the state-of-the-art wound-care literature. Exudate, odor, and pain are distressing symptoms associated with wounds that can be incapacitating and may lead to abandonment of the patient. The workshop will include discussions of the underlying pathophysiology of each of these symptoms and case-based approaches to their assessment and management, including the use of both systemic and topical antibiotics, analgesics, and anesthetics.
8 am–Noon
Domain Physical Aspects of Care
AAHPM Preconference Workshops Practical Approaches to Palliative Wound Care (P2) Frank D. Ferris, MD, San Diego Hospice and The Institute for Palliative Medicine, San Diego, CA; Rosene D. Pirrello, RPh, San Diego Hospice and The Institute for Palliative Medicine, San Diego, CA (All speakers for this session have disclosed no relevant financial relationships; all speakers will discuss off-label uses.)
Communication Skills for Transitions in Goals of Care (P3) Anthony L. Back, MD, University of Washington, Seattle, WA; Robert M. Arnold, MD, University of Pittsburgh, Pittsburgh, PA; James A. Tulsky, MD, Duke University Medical Center, Durham, NC; Walter Baile, MD, MD Anderson Cancer Center, Houston, TX; Wendy Anderson, MD MS, University of California–San Francisco, San Francisco, CA; Lynn Bunch, MD, Hertzberg Palliative Care Institute, New York, NY; Lisa Marr,