Patient Experience in the Cancer Care System Elizabeth (Lib) - PowerPoint PPT Presentation

Patient Experience in the Cancer Care System Elizabeth (Lib) Cooper RN November 5, 2016

Presentation Agenda Overview of Treatments and 1 Services at cancer agency Definition of Palliative 2 Approach to Care Overview Pain and Symptom 3 Palliative Care Program

Centre for the North Sindi Ahluwalia Hawkins Centre For the Southern Interior Abbotsford Centre Vancouver Fraser Valley Island Centre Vancouver Centre Centre

What do They Feel?

First Visit • Meet with oncologist and nurse • History and Physical • Need more information • Tests will be ordered

First Visit cont’d. • Treatments explained • May be referred to medical oncology, radiation oncology, surgery, pain and symptom management

Confused Questions?

❑ 55 Year old female ❑ Severe Pain right chest wall, ribs ❑ Anxiety++++ ❑ Referred to pain and symptom nurse by surgical suite nurse (bronchoscopy) for severe right sided chest pain ❑ Substance abuse (actively using)

Patient Nurse Pain and Symptom Patient and Nutrition Oncologist Manageme Family nt/Palliative Counseling Care Clinic

❑ Respiratory Therapy ❑ General Practitioner ❑ Nurse Practitioner ❑ Homecare Team ❑ Secretaries and Unit Clerks

Nurses Available in…. Patient Radiation Surgical Chemo Clinics Therapy Phone Line Suite Room Area

• Surgery • Radiation Therapy Radiation Therapy

• Surgery • Radiation Therapy Surgery

• Surgery • Radiation Therapy Chemo- therapy

• Surgery • Radiation Therapy Hormonal Therapy

• Surgery • Radiation Therapy Targeted Therapies

Personalized CUTTING Oncogenetic EDGE Genome

POG Study Identify Looks at the Drivers Block individual Growth cancer cells. Reduce Tumours

POG Case Study ❑ Female 68 years old ❑ Metastatic colon cancer ❑ Chemotherapy ❑ Referred to pain and symptom management palliative care clinic

POG Case Study ❑ Disease Recurred ❑ Identified Protein as driver Result? ❑

POG Case Study ❑ Identified BP medication ❑ Known to Block Pathways to Protein Disease is barely detectable!

Pain and Symptom Management/Palliative Care Helps improve quality of life for patient and caregivers For cancer related symptoms Pain, nausea, shortness of breath

Pain and Symptom Management/Palliative Care For those with symptoms anywhere along trajectory Help with emotional and social concerns Assist with transitions, advanced care planning

Pain and Symptom Management Team Doctor with specialty in pain and symptom management/palliative care Nurse with specialty in pain and symptom management/palliative care Pharmacist, Counsellor

Palliative Approach to Care 1 Many People are Cured of their Cancer 2 For Others becomes Chronic Disease 3 Integrate Palliative Care Earlier

WHO Definition of Palliative Care “Palliative care is an approach that improves the quality of life of patients

and their families facing the problem associated with life- threatening illness

through the prevention and relief of suffering by means of early identification

and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.”

“…..is applicable early in the course of illness, in conjunction with other therapies that are intended to

prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications.”

• Palliative Care DOES NOT just mean End of Life care • The illness does not need to be incurable in order for a person to receive a palliative approach to care

The Bowtie Model of 21 st Century Palliative Care Management Cure Survivorship Palliative Disease Care Symptom Management and Supportive Care Control Hospice Dr.Pippa Hawley, January 2014

Cycle repeats Management Cure Survivorship Palliative Disease Care Symptom Management and Supportive Care Control Hospice

“Palliative Care is for Living Well” Survivorship Management Cure Rehabilitation Palliative Disease Care Control Hospice Bereavement

“We need to look after the disease and the rest of you” Expectation: Physio and Exercise Cure Cure Management f o n Survivorship o Palliative Disease i t c r e u s o e m R u Adjuvant chemoradiation t t s Care a e r b Pain and Symptom Tamoxifen Management Nutrition Information Counselling Control Hospice

Expectation Cure ❑ Breast cancer ❑ Post mastectomy neuropathic pain ❑ Referred to Pain and Symptom Clinic

“We will always be part of your care team” Expectation: Cure Unlikely Management Surgery Survivorship Palliative Disease Chemotherapy Counselling Care Pain and Symptom Clinical Trial? Nutrition Management Hormone Rx Palliative Procedures Radiotherapy Hospice

What Does this Mean for you, the PeriAnesthesia Nurse? ➢ Inform your patients that there is always something that can be done. ➢ Educate yourselves and your colleagues about the palliative approach to care.

What Does this Mean for you, the PeriAnesthesia Nurse? ➢ Refer early. ➢ Anyone can refer.

What Does this Mean for you, the PeriAnesthesia Nurse? ➢ All cancer centres have chemotherapy, targeted therapies, radiation therapy, clinical trials, and pain and symptom management/ palliative care clinics