Palliation Assets

·        www.lastacts.org

·        www.hospicemn.org

·        www.minnnesotaparatnership.org   (MN End of Life Commission Report)

·        Minnesota Cancer Pain Initiative

·        Fairview and Allina offer home-based palliative care

·        Medica and BCBS are each developing a palliative benefit

·        "Project decide" - Allina 

·        Mayo does curriculum on end of life care EPEC (ELNEC) nursing curriculum

Palliation Issues

Knowledge issues

·        People do not know what palliative care is

·        Discussion on end of life options should begin early

·        Need to improve family understanding about "what and why" of moving to hospice

·        Need to encourage people to talk about death with for themselves or their family with their family and friends

·        Patients don't know terminology in cancer experience

·        Health careers in schools.  Need to talk about death and dying not just hospice discussion. 

Research Needs

·        How do we do collect data across government programs?

·        Research into outcome for palliative care lacking. Need to get quantitative as well as qualitative data to help decision making

·        Personal stories from people in palliative care may be an imposition on people in it.

Communications

·        Palliation is a new field Public does not know what palliative care is. Not much media attention on process of dying.  Get savvy with media and smarter about getting story out without liking like a failure.  "A good death isn't a failure it's a success."

·        People are missing resources or not aware of them

·        What is most useful for health systems and policymakers?

·        Patient reluctance would be helped with more positive spin on palliative care

Financial or Economic Issues

·        Barriers with insurance system "you have to discharge patient because you're not doing anything"

·        People have to exhaust Medicare room and board before they could access hospice

·        Qualified stay for Medicare and in long term care they cannot turn down benefit and access hospice

·        Need acknowledgement after death prior to getting the bill

Clinical Issues

·        Better to keep some patients in an acute area because of available benefits when palliative care may be better

·        Consistency of care provided varies

·        How to ensure people will get best level of care

·        People will go elsewhere for miracle cure

·        See patients in in-between stages e.g. Parker Hughes.  Language 1 staying "Therapy" means will get over it to patients misunderstanding about language and meaning of tests.

·        What areas of pain management need to be addressed?

·        Mechanisms of pain - little is known; Clinically relevant pain is just starting to be studied

·        Need palliative care teams in all areas of hospitals

·        PC serving Patients in hospital but majority of care is on an outpatient basis.

Collaboration

·        Need for partnering

 Palliation Assets and Issues.pdf