出诊对话:姑息治疗

今天的姑息治疗

Palliative care is the interdisciplinary pursuit of quality of life in the setting of serious illness (credit: Dr. BJ米勒). It’s an approach in which we explore with seriously ill people what matters most to them 而且 what causes them suffering. We responsibly guide them through complex decision making regarding their care choices. Then we nurture whatever creates meaning while ameliorating sources of suffering.

具有里程碑意义的以病人为中心的焦点

L而且mark is a medical group that takes a patient-centered perspective on providing care. Our multidisciplinary team explores what matters to the people we care for—how they feel 而且 what they need—而且 then designs a care plan that reflects those priorities 而且 adjusts as those priorities change. We do this by being in the home—getting to know our patients, their family, 而且 their pets. We make sure our patients have the correct medications 而且 access to healthy food. 当他们生病时，lg游戏照顾他们——即使是在晚上和周末. We work closely with patients 而且 family to help them underst而且 when to call us at the beginning signs of a medical need which allows us to intervene—preventing hospitalization. 如果需要住院治疗, we check in frequently 而且 visit as soon as they’re back home to ensure they underst而且 their discharge instructions.

When our patients develop the kind of serious illness for which palliative care is most important, lg游戏特别关注姑息治疗的核心原则. 例如:

• lg游戏花更多的时间来探索病人的目标和恐惧.
• We aid patients 而且 families in decision making aligned with the patient’s wishes.
• lg游戏分享关于未来的知识.
• lg游戏为患者的家庭和护理人员提供支持.
• lg游戏协助护理机构的过渡.
• lg游戏帮助确保病人的症状得到控制.

与病人和家属的重要讨论

L而且mark clinicians are trained to explore 目标 而且 discuss prognosis with patients 而且 families. We focus on patient well-being, in addition to conventional disease treatment. We use the Serious Illness Conversation Guide (SICG) as our framework for these discussions. The SICG is the centerpiece of 阿里阿德涅的实验室’ Serious Illness Program, 哪一种已经被证明会导致更多的结果, 早些时候, 以及病人和医生之间更好的对话. 这可以减少情绪上的痛苦、焦虑和抑郁. (信贷: 阿里阿德涅的实验室)

对话发生在病人之间, 医疗服务提供者, 家人或护理人员关心病人最关心的是什么, 他们如何定义生活质量, 他们未来的希望, 目标, 恐惧, 当病人不能自理时，谁能为他辩护.

The documents that emerge from the conversation are important but secondary to The Conversation itself.

Each community that L而且mark serves has at least one Palliative Care Lead who is a provider, 护士, 或社会工作者. The Palliative Care Lead has additional training or experience in palliative care 而且 serves as a local resource for the interdisciplinary care team 而且 their patients.

针对以舒适为导向的患者 而且 limited life expectancy, L而且mark discusses with the patient 而且 family how hospice may help. We continue our relationship with the patient through the transition to hospice 而且 intermittently thereafter.

“非常感谢你和我病人的儿子讨论临终关怀. I agree completely that she is ready 而且 will put in the referral right away.” -Dr. 富勒

 地标的姑息治疗模式有何不同

Some health plans offer dedicated community-based palliative programs that focus exclusively on patients with a limited prognosis. These programs usually focus on nursing 而且/or social work support at home.

L而且mark的模式不同. 同时lg游戏提供护理和社会工作支持, lg游戏大多数的家访都是由医生来做的, NPs或不是. This allows us to manage medical crises in the home more aggressively, 急诊次数减少39%，住院次数减少28%.¹

“Thank you so much for seeing my patient, the impact you have had on him has been great.” -Dr. 克努森

姑息治疗对社区提供者的影响

通过合作, L而且mark supports community providers by reinforcing their care plan in the patient’s home. 许多地标医疗服务提供者都来自初级保健背景. We recognize the challenge of managing medically complex patients 而且 initiating difficult conversations during short office visits. We partner with community primary care providers to make their office visits more efficient 而且 productive, lg游戏告诉他们lg游戏在病人家里学到的东西.

作为一个身患重病的病人走向生命的尽头, we provide compassionate care alongside community providers who have been integral in the patient’s wellness for decades.

“Thank you for your wonderful care of my patient 而且 her family at the end of her life.” -Dr. Ozaydin

Dr. Jill Denny is Medical Director of Palliative Care at L而且mark Health. Board certified in Internal Medicine 而且 Hospice 而且 Palliative Medicine, Dr. Denny has worked as an ER physician, hospitalist, hospice physician, 而且 palliative care physician.

引用:
1. For L而且mark patients in the first six months of engagement compared to the trend in utilization for statistically matched non-engaged patients. 楚,Lihao. A House-Call program that reduces unnecessary variation in utilization 而且 spending among patients with poly chronic conditions. 学院 健康年度研究会议，2018年6月25日，西雅图，西澳大利亚州. 未发表的会议论文. 具有里程碑意义的健康,有限责任公司，亨廷顿海滩，2018年. 打印.