pathways to palliative care: comforting congregants with...
TRANSCRIPT
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Pathways to Palliative Care: Comforting
Congregants with Life-Limiting Illnesses
Jerry Johnson, M.D.
Professor of Medicine
Tara Hayden, MHSA
University of Pennsylvania
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Objectives
Raise awareness of the challenges of
communicating with patients and families
about life limiting illnesses
Increase knowledge of resources and care
options
Illustrate examples of church and academic
research partnerships
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Case of JM
55 yo Christian woman with breast cancer
Presentation
Swelling all over, weak, breathless, confused.
Admitted to a hosp. with cancer in liver and
lungs, low platelets, low oxygen level
Management
She elected and received chemotherapy.
She also said she wanted to be “comfortable.”
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Case of JM
Friends visited, sat with her and prayed with
her
No church visitors for unclear reasons
Spouse commented on how “strong” JM
was.
Her sister became the decision-maker by
default.
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Case of JM
Over three days, not eating, breathing
rapidly, and unable to converse;
chemotherapy was stopped.
A social worker recommended a move to a
hospice unit.
The sister sought info about hospice care.
The patient died in the hospital two days
later.
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What might have been different?
Was death avoidable?
Was this a good death?
Could her symptoms have been reduced?
What did she want to achieve by going into
the hospital, and 2) receiving chemotherapy?
How might a church prepare its members to
minister to persons in this state?
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What do you need to know?
Symptoms are predictable and often can be
ameliorated: pain, breathlessness, weakness,
nausea and vomiting, anorexia.
Family stress and turmoil is common.
Tradeoffs of treatment vs Potential harm:
Forced feeding, natural or artificial
Resuscitation attempts.
Other stress and harm.
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Critical Questions
What is advance care planning?
What is palliative care?
What is hospice?
Who is the decision-maker?
Whose interest is the decision-maker
representing?
What is meant by goals of care?
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Providing Comfort : A Church-
based Research Model
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Project Goal and Aims
Create a model to engage AA churches as
active participants in reducing the stress of
individuals with life limiting illnesses
Partner with four churches
Educate the entire congregation and the
leadership
Evaluate outcomes
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Focus Groups: Planning and
Implementation
Focus Groups- 7 groups in 2 churches (n=51)
Selection of attendees
Church leadership-pastors, deacons and
deaconesses
Members of health ministries
Comfort and bereavement ministries
Other church members
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Our Focus Group Findings
Consensus that support needed in 5 areas
Faith aspects of death and dying
Emotional Issues
Family dynamics
Myths About palliative care and hospice
Mis-communication with health
professionals and within families
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Faith Issues
“No matter what happens, God is going to take of
me.”
“Everything is in God’s hands.”
“When it was time for her to go, she knew it. She
said to me, I am going home to be with Jesus. Do
not worry about me at all. I am ready.
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Emotional Issues
Fear: burden, guilt, anger
“It is just like they feel as though maybe it will
go away. If I do not bother it, it will be all
right.”
“It is like I remember a pastor saying one time
everybody wants to get to heaven but nobody
wants to buy the ticket.”
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Family Issues
Need for a family navigator, decision-maker
“And the last thing that always, that resonated with me
from my father was I know it was very important to
him that his family be together, but we were not all
at the same place.”
“A lot of folks – the sick family member wants to have
their dignity and the family may want this and this and
the dignity piece is often overlooked.”
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Variable Knowledge and Perceptions
of Palliative Care/Hospice
“When I hear somebody is in hospice, it is
almost like somebody just slapped me in
the face.”
“I know if they have the right hospice
program; it is a wonderful, wonderful,
wonderful way to end life.. it so much less
painful because they are truly there…”
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Academic and Church Based
Research Partnerships
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Principles of CBPR
Community as unit of identity
Builds on strengths within the
community
Facilitates a collaborative
partnership: leadership,
control
Fosters co-learning and
capacity building
Integrates and achieves a
balance between research
and benefit
Focuses on the local
relevance
Applies a systems approach
to the partnership
Disseminates results
Commitment to sustainability
Minkler and Wallerstein, 2008
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Church involvement in comfort care
Circles of Care in NC
Lay advisors often unprepared to assist with
communication.
Harlem Palliative Care Network
engaged support of churches to inform and recruit; J Pall
Med 2002
Others involved in surveys
Reese
Johnson
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Our Approach
Adhere to principles of CBPR
Shared leadership
Participation in research decisions
Meaningful deliverables
Interprofessional research team
Geriatrician physician, anthropologist, public health,
palliative care specialist physician, communications
specialist, chaplain, pastor, other church members
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Examples with Churches
Palliative Care Research
Physical Activity Research
Stress Reduction Research
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Conclusions
Church-based palliative care programs offer
opportunities to minister to congregants
Church and academic research partnerships
are effective venues for improve the health of
congregants and communities.
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Research Literature on AA church, and Care for the
Seriously ill
Wicher,C.P. What Influences African American End-
of-life Preferences? J Health Care Poor
Underserved, 2012. 23(1): p. 28-58
Hanson, LC. Circes of Care: development and initial
evaluation of a peer support model for Affricna Amerivans
with advanced cancer. Health Educ Behav 2013. 40 (5) : p
536-43.