What is a Good Death? by Ashley Shreves

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This document discusses what constitutes a good death according to patients facing end of life. It notes that patients rate non-medical factors like quality of life and personal priorities as most important, rather than medical treatments or prolonging life. However, current end of life care is often focused on resuscitation and life-prolonging measures instead of quality of life. Palliative care aims to improve quality of life and relieve suffering for patients with serious illnesses through a multidisciplinary approach. When utilized, palliative care can lead to improved medical decisions and outcomes like better symptom management, less depression, extended life, and lower costs. The key to a good death is focusing on the patient's priorities and values rather than the priorities of doctors

Gesundheit & Medizin

What is a good death?
SMACC
June 25, 2015
Ashley Shreves, MD
Assistant Professor
Department of Emergency Medicine
Brookdale Department of Geriatrics and Palliative Medicine
Icahn School of Medicine at Mt. Sinai

What’s most important to
patients facing death?
Steinhauser JAMA 2000

Don’t patients want to live
forever?
n = 226
Advanced illnesses
Fried N Engl J Med 2002

What’s most important?
Non-medical >>> medical
Quality of life >>> quantity of life
Outcomes >>> treatments

Are we good with the non-medical?
Teno JAMA 2005

Quality vs Quantity?
Focused on resuscitation and life-prolongation
Spectacular deaths: exciting and prioritized
“Subtacular” deaths??
Care Poor Forgotten
about
Neglected
Stuck in a
corner and
left there
A lower class
citizen in
regards to EM
Bailey Ann Emerg Med 2010

Outcomes?
Time spent
1 min
Content of conversation
Descriptions of CPR
Outcomes?
Not mentioned

Palliative Care
Type of care
Improve quality of
life/relieve suffering
Serious/advanced
illness
Multidisciplinary team
approach
Hospice
System of care
Improve quality of
life/relieve suffering
Terminal illness
Multidisciplinary team
approach

Mt. Sinai Palliative Care Team
Doctor
Nurse
Practitione
r
Social
Worker
Chaplain
Art
therapist
Massag
e
therapist
Yoga
therapis
t
Nurse
Patient
&
Family

What do we do?
COMMUNICATION
COMMUNICATION
COMMUNICATION

What happens?
Medical decisions change
Quality of life improves
Symptom management improves
Depression decreases
Life often extended
Costs decrease
Volandes BMJ 2009
Temel N Engl J Med 2010
Teno JAMA 2004
Connor J Pain Symptom Manage 2007
Morrison Arch Int Med 2008

When is dying good?
WHEN IT’S ABOUT THEM

How do patients get the good death?
PALLIATIVE CARE & HOSPICE
If not available
LEARN COMMUNICATION SKILLS

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