Nancy Joyner – Nearing the End of Life: Dare to Care

Outline

• An Inexact Art & Science
  • Illness and dying trajectories
  • Frailty
  • Dementia
  • Prognostication and prognostic scales
  • When to refer to palliative care or hospice (disease specific)
• Essentials of Care: Comfort, Communication, Choices, Control
  • Comfort Always
    • Morphine: Still the gold standard?
    • Pain during the final hours of life
    • Drug misuse: How to avoid it
    • Opioids for dyspnea
    • Thirst vs. xerostomia
    • Medical marijuana
  • Complementary and alternative therapies
    • Emotional distress interventions
    • The role of spirituality
    • Palliative sedation
    • Communication: Everyone is Involved
    • Advance care planning: More than just a form
    • The terminology matters
    • Your role in these critical conversations
    • How much can we share?
    • Truth vs. hope
    • Code status discussions
    • DNR does not mean do not treat
    • Addressing concerns and needs of the family
    • Thanatophobia: Is it fear of dying or fear of death?
    • Premortem surge
    • Near death awareness
    • The dying process
  • Choices: Shared Decision-Making
    • Nutrition & hydration choices
    • Voluntarily Stopping Eating and Drinking (VSED): Benefits & burdens
    • Life-sustaining treatment
    • Non-beneficial treatment choices
    • Faith-based influences
    • Ventilator support
    • Dialysis or renal palliative care
    • Devices to extend life
    • Hastened death request: Why not humanely euthanize?
  • Allowing Control: Patient-Centered Care
    • Reframing hope
    • What do family members want you to consider
    • Who makes the decision
    • What about family dysfunction…
    • Is the focus quality or quantity?
    • Decision to withhold or withdraw care
    • Challenging decisions: Honoring patients’ wishes
  • Cultivating Moral Resiliency
    • Moral resilience–preserving/restoring integrity
    • Personal vs. professional grieving
    • Enabling character and honorable action
    • Ethical Competency