Introduction to Patient Assessment Jillian Gustin MD, FAAHPM, FACP

Introduction to Patient Assessment Jillian Gustin MD, FAAHPM, FACP Lisa Humphrey MD, FAAP Palliative Care Interdisciplinary Curriculum

Objectives Consider the concept of suffering Describe a Domains approach to patient assessment Practice, Practice, Practice

What is suffering ?

The relief of suffering: A human right

Patient assessment

Community Family Patient

Introduction to HPM Domains 1. 2. 3. 4. 5. Structure & Processes of Care Physical Aspects of Care Psychological & Psychiatric Aspects of Care Social Aspects of Care Spiritual, Religious & Existential Aspects of Care 6. Cultural Aspects of Care 7. Care of the Imminently Dying Patient 8. Ethical & Legal Aspects of Care

Assessment by Domains Disease Disease Management Management Diagnosis Diagnosis Prognostication Prognostication Management Management Physical Physical Pain, Pain, dyspnea dyspnea & & other other symptoms symptoms Function, Function, fluids, fluids, nutrition nutrition Loss, Loss, grief grief Emotional Emotional responses responses Bereavement Bereavement End End of of life life // death death management management Last Last hours hours of of living living When When death death occurs occurs Psychological Psychological Anxiety Anxiety Depression Depression Distress Distress Social Social Family Family dynamics dynamics Financial Financial Legal Legal Practical Practical Caregiving Caregiving Teamwork Teamwork Volunteers Volunteers Spiritual Spiritual Hope Hope Meaning, Meaning, value value Existential Existential

Patient & family Demographics Culture Personal values Developmental state, health literacy Disabilities

Capacity for medical decision-making Communicate a choice Understand the relevant information Appreciate the situation and its consequences Reason about treatment options

Disease management Primary diagnosis and prognosis Secondary diagnosis Co-morbidities Adverse effects Allergies

General symptom assessment tools Memorial Symptom Assessment Scale Edmonton Symptom Assessment Scale The James Supportive Care Screening

Specific assessment tools Delirium screen: Confusion Assessment Method - ICU Functional assessments: Karnofsky Performance Scale Eastern Cooperative Oncology Group Palliative Performance Scale Substance abuse screening

Physical Pain and other symptoms Level of consciousness, cognition, delirium Function Fluids & nutrition Wounds Habits

Psychological Personality and behaviors Depression and anxiety Emotions Control Conflict Self-image

Social Cultural values and practices Relationships and roles Isolation Privacy & intimacy Routines & rituals Finances Legal (HPOA, Living well, etc) Guardianship, custody issues

Spiritual Meaning Existential Beliefs & practices Spiritual advisors, rites, rituals Symbols

Practical Activities of daily living Caregiving Dependents (including pets) Transportation Telephone

End of life: Death management Life closure Gift giving Legacy creation Preparation for the unexpected Preparation for last hours of life Rites, rituals Peri-death care of family and body Funeral, celebrations, memorials

Loss & grief Loss Grief Bereavement planning Mourning

Practice, Practice, Practice

Assess the care team Who is involved ? Expertise ? Understanding of illness and GOC ? Limits of care ? Coping ? Anticipated future problems ?

Things Change !

Summary Our goal is to reduce suffering when possible Assess all aspects of the patient & family by using a DOMAINS approach

Gandhi You need to be the change you want to see in the world Kobacker House Columbus, Ohio