Outline

Disease Prognostication: An Inexact Art & Science

• Illness and Dying Trajectory
• Performance Scales
• Prognosis Tools
• Determining Palliative Care vs. Hospice
• National Consensus Project: Eight Domains for Quality Practice
• Crucial Conversations

Heart Failure

• Stages
• Treatment options
• Devices to Extend Life
• Symptom Burden/Management
• Prognostic Models
• Living better – or prolonging suffering?

Advanced Cancer/ Neoplastic conditions

• Staging Cancer
• Spiritual needs
• Complications and interventions
  • Spinal cord compression
  • Superior vena cava syndrome
  • Bowel obstruction
  • Hypercalcemia
  • Fungating wound care
  • Signs of impending death

Pulmonary Disease

• Staging the disease
• Spirometry: a required test
• The MMRC Breathlessness Scale
• Treating dyspnea: The pain of non-malignant disease
• The medical toolbox: oxygen, bronchodilators, opioids & steroids

Amyotrophic Lateral Sclerosis

• Diagnostic tests
• Post-polio syndrome: An ALS mimic
• Advance directives and life support decisions: nutrition & gastrostomy, non-invasive ventilation or invasive?
• Table of useful medications

Advanced Dementia

• Stages
• Ethical issues: feeding, medications
• Ensuring comfort
• Delirium & dementia
• Interventions for agitation and aggression

Renal Disease

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

Liver Disease

• Prognostic Determination
• Ethical issues
• Signs of ‘end stage’

Challenging Decisions

• What do People Want at the End of Life?
• Honoring Patients Wishes
• Delirium vs near death experience
• Dying Signs, symptoms and needs – is hydration needed?
• Mental health needs of the dying
• Managing pain as death nears
• Palliative sedation therapy: for intractable symptoms

Moral Distress

• Ethical dilemmas
• Medication errors
• Conflicted consciences
• Giving the last dose
• Attending the first death
• Strategies for diminishing death discomfort
• Personal versus professional grieving