Episode 7: Palliative care with Jessica McFarlin (part 1)

The podcast episode centers on navigating complex end-of-life decisions for a 75-year-old patient with a severe intracerebral hemorrhage. Dr. Jessica McFarlin, a stroke neurologist, neurocritical care, and palliative care physician, joins the hosts to discuss a case scenario. Key considerations include balancing aggressive treatment with the patient's pre-existing cognitive decline and expressed wishes against being kept alive artificially. The discussion emphasizes the importance of early, honest communication with families, framing prognosis, and understanding their values and fears. Dr. McFarlin highlights using scenario planning—best case, worst case, and most likely outcomes—to guide decision-making and aligning medical recommendations with the patient's goals.

Outlines

Part 1: Introduction, Case Presentation

Part 2: Communication, Goals of Care

Part 3: Decision-Making, Clinical Trials

Part 4: End-of-Life, Recommendations

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Critical Care Scenarios

Part 1: Introduction, Case Presentation

Introduction to Critical Care Scenarios: Stroke, Neurology, and Palliative Care

Initial Assessment of a 75-Year-Old Stroke Patient with Intracerebral Hemorrhage

Part 2: Communication, Goals of Care

Family Communication and Goals of Care in Acute Stroke Management

Addressing Family Concerns and Prognosis in Severe Intracerebral Hemorrhage

Balancing Prognosis, Patient Wishes, and Aggressiveness of Care

Part 3: Decision-Making, Clinical Trials

Time-Limited Trials and Honest Prognostication in Critical Care Decisions

Family Meetings and Surrogate Decision-Making in Neurocritical Care

Part 4: End-of-Life, Recommendations

Addressing Fears and Providing Recommendations in End-of-Life Discussions

Seamless Recommendations and Aligning Goals with Medical Realities

Conclusion of Part 1

Episode 7: Palliative care with Jessica McFarlin (part 1)

Critical Care Scenarios

Part 1: Introduction, Case Presentation

00:05Introduction to Critical Care Scenarios: Stroke, Neurology, and Palliative Care

Introduction to Critical Care Scenarios: Stroke, Neurology, and Palliative Care

01:14Initial Assessment of a 75-Year-Old Stroke Patient with Intracerebral Hemorrhage

Initial Assessment of a 75-Year-Old Stroke Patient with Intracerebral Hemorrhage

Part 2: Communication, Goals of Care

04:34Family Communication and Goals of Care in Acute Stroke Management

Family Communication and Goals of Care in Acute Stroke Management

07:02Addressing Family Concerns and Prognosis in Severe Intracerebral Hemorrhage

Addressing Family Concerns and Prognosis in Severe Intracerebral Hemorrhage

10:25Balancing Prognosis, Patient Wishes, and Aggressiveness of Care

Balancing Prognosis, Patient Wishes, and Aggressiveness of Care

Part 3: Decision-Making, Clinical Trials

13:58Time-Limited Trials and Honest Prognostication in Critical Care Decisions

Time-Limited Trials and Honest Prognostication in Critical Care Decisions

17:29Family Meetings and Surrogate Decision-Making in Neurocritical Care

Family Meetings and Surrogate Decision-Making in Neurocritical Care

Part 4: End-of-Life, Recommendations

21:37Addressing Fears and Providing Recommendations in End-of-Life Discussions

Addressing Fears and Providing Recommendations in End-of-Life Discussions

25:21Seamless Recommendations and Aligning Goals with Medical Realities

Seamless Recommendations and Aligning Goals with Medical Realities

29:03Conclusion of Part 1

Conclusion of Part 1