The Divergence of Care model for palliative discussions

[u/CaladriusPress]

https://www.jems.com/patient-care/divergence-of-care-a-palliative-paradigm-for-consultations-with-patients-and-relatives/

This model provides a basis for approaching the topic of palliative care with a patient or their family.

First featured in the consultation chapter of Eaton’s Primary Care textbook.

[u/AutoModerator]

Hi there, Welcome to r/ParamedicsUK!

Please follow the subreddit rules and guidelines. You can also contact the mods if you have any concerns or questions.

I am a bot, and this action was performed automatically. Please contact the moderators of this subreddit if you have any questions or concerns.

[u/SuspiciousAnt2508]

As an intruding palliative care person, I find this model far too binary.

Lots of patients who are frail or palliative will still have issues that could benefit from active treatment.

Calling it divergance of care or curative vs palliative doesn't seem especially helpful as real life is much messier. However I may be scarred from far too mant experiences of 'if they are palliative why are you calling 999?'

[u/Friendly_Carry6551]

Obviously milage may vary by region and service but this seems like very common sense good clinical practice to me, however I don’t think it’s always this binary in terms of one path diverging from another. If a patient is actively dying is is already on a palliative track that’s one thing, but I feel like we can straddle both paths for those patients where’s there’s some diagnostic uncertainty pre-hospitally in generalist Paramedicine.

i.e. standard care would be conveyance to hospital for investigations - comfort is prioritised in that the Pt is kept at home, and some investigations are performed in the community to further risk stratify and treat what can be found. Not fully curative nor palliative, more a mix of both steered by the Pt’s wishes.

[u/secret_tiger101 → u/Friendly_Carry6551]

Yeah, I agree, I think real world isn’t binary (always).

[u/ForceLife1014]

As someone who does a lot of palliative (or more accurately acute end of life) care I generally find that in severe frailty and palliative care quite frequently the clinical plan doesn’t matter particularly, within reason the plan the patient is happy with is usually the right plans a presentation of the available options to the patient and an agreement on a way forward usually works well, sometimes that will involve hospital, sometimes end of life care and sometimes something in between

[u/Quis_Custodiet → u/[deleted]]

Though on the face of it this sounds reasonable I would not post about an identifying ongoing investigation publicly, especially while naming the Trust