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Providing Palliative Care in General Practice – All the “Ws”!! Dr Laurence Dorman - Chair RCGPNIWhy Me? Southern Area Hospice Services, NewrMourne Family Surgery, Kilkeel.Why the GP?Which Books are Good?Why do it well? • https://www.nejm.org/doi/f ull/10.1056/NEJMoa1000678 • Patients who receive early palliative care have a better LONGER! of life and LIVEWisdom? We need good training to do it well! • Good symptom control needs a clinician to establish causation • Why is this patient breathless/vomiting/in pain? • History, Examination, Investigation • Metastatic disease, metabolic issues, undiagnosed pleural effusion, superimposed infection, CCFWe have a unique opportunity A Personal Story • RCGPNI GP of the year award 2018: • “Dr A understands that my husband David has cognitive functioning issues, and during appointments will explain things as clearly as possible for his benefit. Dr A has started the difficult conversation around palliative care for David and I know that if I have any questions, I will receive informed answers and guidance. Throughout the last 9 months, Dr A has acted with compassion, urgency, professionalism and understanding. He has placed David’s wellbeing at the centre of all our interactions.” We use much more than just drugs and deal with more complexity than just cancer! • Malignant disease: position, fan, opioids, sedatives, tap, XRT • Watch and prepare for emergencies: SVC obstruction, stridor, haematemesis • CCF: loop diuretics, morphine, oxygen • Pulmonary Fibrosis: opioids, oxygen, ACP • End Stage COPD: oxygen, mucolytics, nebulisers We are always trying to ensure best home care! Just in case box.Advance Care Planning • ReSPECT Form due soon • Will replace DNCPR • Goal to allow all HCPs to do • Can operate between locations • Not legally bindingHow? Useful resources: • https://www.palliativedrugs.com/download/LGGbreath.pdf • https://www.palliativecareguidelines.scot.nhs.uk/guidelines/symptom- control/breathlessness.aspx • https://www.macmillan.org.uk/cancer-information-and-support/impacts-of- cancer/breathlessness/managing-and-treating-breathlessness • https://www.macmillan.org.uk/cancer-information-and-support/lung-cancer/controlling- symptoms-of-lung-cancer • https://www.macmillan.org.uk/_images/ten-tips-lung-cancer_tcm9-356701.pdf • https://cks.nice.org.uk/topics/breathlessness/ • Regional Palliative Medicine Group NI. https://bit.ly/2QYJPUqWe is always better than I !! Use and respect your entire MDT!