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Author: Richard Dupee, M.D.
Palliative Care Palliative Care
Case 1 Case 1
Palliative Care: Slide 3 Palliative Care: Slide 3
Palliative Care: Slide 4 Palliative Care: Slide 4
Case 2 Case 2
Palliative Care: Slide 6 Palliative Care: Slide 6
Palliative Care: Slide 7 Palliative Care: Slide 7
Goals of Care in Geriatrics Goals of Care in Geriatrics
Death in the Elderly Death in the Elderly
Death in the Elderly (2) Death in the Elderly (2)
Death in the Elderly (3) Death in the Elderly (3)
Care versus Cure Care versus Cure
The Experience of Dying The Experience of Dying
Forced Choices Forced Choices
Palliative Care Palliative Care
Palliative Care (cont’d) Palliative Care (cont’d)
Hospice Hospice
Medicare Covered Hospice Services Medicare Covered Hospice Services
Hospice and Medicare Hospice and Medicare
Hospice Hospice
Hospice (cont’d) Hospice (cont’d)
Communicating Bad News Communicating Bad News
Communicating Bad News (2) Communicating Bad News (2)
Step 1: Preparation Step 1: Preparation
Step 2: Establishing the Patient’s Understanding Step 2: Establishing the Patient’s Understanding
Step 3: What the Patient Wants to Know Step 3: What the Patient Wants to Know
Step 4: Telling the Patient Step 4: Telling the Patient
Step 4: Telling the Patient (cont’d) Step 4: Telling the Patient (cont’d)
Step 5: The Prognosis Step 5: The Prognosis
Step 6: Responding to Feelings Step 6: Responding to Feelings
Step 7: Follow-up Step 7: Follow-up
Pain Management Pain Management
Pain and Aging Pain and Aging
Altered Pain Perception in Aging Altered Pain Perception in Aging
The Reality The Reality
Adverse Psychological Effects of Untreated Pain Adverse Psychological Effects of Untreated Pain
Undertreatment of Cancer Pain Undertreatment of Cancer Pain
Barriers to Cancer Pain Management Barriers to Cancer Pain Management
Barriers to Cancer Pain Management Barriers to Cancer Pain Management
National Hospice Study National Hospice Study
Why is Pain Undertreated? Physician Issues Why is Pain Undertreated? Physician Issues
Why is Pain Undertreated? Patient Issues Why is Pain Undertreated? Patient Issues
Assessment Assessment
Perception Perception
Non-communicative patient pain behaviors Non-communicative patient pain behaviors
Goal Goal
What Really Happens? What Really Happens?
Propoxyphene Propoxyphene
Inadequate Pain Treatment Inadequate Pain Treatment
Advances In Pain Management Advances In Pain Management
AGS Guidelines AGS Guidelines
New AGS Guidelines New AGS Guidelines
New AGS Guidelines (2) New AGS Guidelines (2)
New AGS Guidelines (3) New AGS Guidelines (3)
What Should Happen What Should Happen
No Patient... No Patient...
Palliative Care: Slide 57 Palliative Care: Slide 57
Palliative Care: Slide 58 Palliative Care: Slide 58
Palliative Care: Slide 59 Palliative Care: Slide 59
Palliative Care: Slide 60 Palliative Care: Slide 60
Palliative Care: Slide 61 Palliative Care: Slide 61
Palliative Care: Slide 62 Palliative Care: Slide 62
Pathophysiologic Classification of Chronic Pain Pathophysiologic Classification of Chronic Pain
Nociceptive Pain Nociceptive Pain
Neuropathic Pain Neuropathic Pain
Mixed or Undetermined Pathophysiology Mixed or Undetermined Pathophysiology
Psychologically-based Pain Syndromes Psychologically-based Pain Syndromes
Myth Myth
Long Acting Opioids Long Acting Opioids
Long Acting Opioids Long Acting Opioids
Long Acting Opioids Primarily Used in the U.S. Long Acting Opioids Primarily Used in the U.S.
Patient Concerns About Taking Opioids Patient Concerns About Taking Opioids
Physiology v. Psychology Physiology v. Psychology
Pseudo-addiction Pseudo-addiction
Larger opioid doses Larger opioid doses
The Good Side of Opioid Tolerance The Good Side of Opioid Tolerance
Acetaminophen Acetaminophen
NSAIDs NSAIDs
TCA’s TCA’s
Anticonvulsants Anticonvulsants
Tramadol Tramadol
Meperidine Meperidine