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Cancer care (Y4) > 15- Palliative care > Flashcards

15- Palliative care Flashcards

1
Q

Palliative care

A

Palliative care is the active, total care of patients who disease is progressive and not responsive to curative treatment, control of pain, other symptoms and of social, psychological and spiritual problems is paramount
- For non-curative and progressive disease
- Holistic approach
- Symptoms management

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2
Q

Aims of palliative care:

A
  • To affirm life but regard dying as a normal process.
  • To provide relief from pain and other distressing symptoms.
  • To neither hasten nor postpone death.
  • To integrate psychological and spiritual aspects into mainstream patient care.
  • To provide support to enable patients to live as actively as possible until death.
  • To offer support to the family during the patient’s illness and in their bereavement.
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3
Q

Examples of diseases which use palliative care

A
  • Cancer
  • Dementia
  • Frailty
  • Pain management
  • Ischaemic heart disease
  • COPD/ PF
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4
Q

who provides palliative care

A

Doctors
- Generalists e.g. GP, hospital
- Specialist- hospice and specialist palliative care team
Nurses
Health care assistants
Family
OT/PT

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5
Q

Where do people die?

A
  • Hospital- 46.9
  • Home- 23.5
  • Nursing home- 23.5
  • Hospice- 5.7%
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6
Q

Hospices

A
  • Most people who use will not die there
  • People are referred to a hospice when they require specialist palliative care
  • Vast majority die elsewhere
  • Majority of hospice care (84%) is provided in the community
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7
Q

tools used to indicate supportive. andpalliative care may be indicated for a patient

A
  • SPICT tool - supportive and palliative care indication tool
  • Clinical Frailty scale
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8
Q

SPICT tool

A
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9
Q

clinical frailty score

A
  • Score >7 at high risk of dying in the next year
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10
Q

General indicators of decline

A
  • Unplanned hospital admission
  • Performance status is poor or deteriorating
  • Dependent on others for care
  • Carer needs help and support
  • Significant weight loss
  • Persistent symptoms despite optimal treatment
  • A decision to reduce, stop or not have treatment
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11
Q

an subjective tool to consider if patient is close to death?

A

Would you be surprised if this person died within the next 12 months?

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12
Q

recognising the dying phase

A

Recognising dying phase
- Reduced thirst and appetite
- Sleeping more
- Cold peripheries
- Breathing changes
e.g. Cheyne-stoke breathing
e.g. Shallow breathing
- Increased respiratory secretions - death rattle
- Skin colour changes
- Agitation/restlessness

Common symptoms at the end of life
- Pain
- SoB
- Agitation
- N+V

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13
Q

Palliative vs Best supportive vs End of life care: palliative

A
  • For patients who’s condition cannot be cured
  • Aims to reduced pain and distressing symptoms and prolong best quality life
  • May receive palliative care alongside other therapies for treatment aiming for cure
  • Does encompass end of life care – but is so much more
    o Aim is to ensure opitnal quality of life
  • Involves holistic approach
    o Symptom management
    o Psychological
    o Social
    o Spiritual support
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14
Q

Palliative vs Best supportive vs End of life care: Best supportive

A
  • ‘prevention and management of the adverse effects of cancer and its treatments’
  • Includes management of physical and psychological symptosm and side effects across the cancer experience from diagnosis through treatment and post treatment
  • Involves
    o Enhancing rehab
    o Secondary cancer prevention
    o End of life care
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15
Q

Palliative vs Best supportive vs End of life care: End of life care

A
  • People are considered to be approaching the end of life when they are likely to die within the next 12 months
  • A portion of palliative care directed towards the care of a person nearing end of life
  • End of life difficult to predict
    o Includes patients whose death is imminent (expected within a few hours and days)
  • Focus is on maintaining quality of life while offering services for legal matters
  • Aim: patient dies with dignity
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16
Q

common symptoms at the end of life

A
  • Pain
  • Breathlessness
  • Restlessness/agitation
  • Respiratory secretions (death rattle)
  • N+V

People breath really really noisily

17
Q

what can be used to help palliate common symptoms at the end of life

A

Anticipatory prescribing:
5- key ‘just in case meds’

18
Q

anticipatory prescribing for pain

A
  • Morphine 2.5-5mg SC PRN
  • If already on opiates -> calc titration
19
Q

anticipatory prescribing for breathlessness

A

Morphine 2.5-5mg

20
Q

anticipatory prescribing for restlessness and agitation

A
  • Midazolam 2.5-5mg SC PRN
  • Levomepromazine 6.25-12.5mg SC PRN
21
Q

Anticipatory prescribing for N+V

A

Levomepromazine 2.5-5mg SC PRN

or cyclizine, dexamethason, metoclopramide, ondansetron

22
Q

Anticipatory prescribing for respiratory secretions (death rattle)

A

Glycopyrronium bromide 200-400mcg SC PRN

23
Q

summary of anticipatory prescribing for end of life symptoms

A
24
Q

Syringe driver

A

Indication for use
- Intractable vomiting
- Severe dysphagia
- Decrease conscious level
- Poor alimentary absorption (rare)
- If person requires more than 2 disease of an anticipatory medication in 24 hours- should be added to a syringe driver

25
Q

Food and drink

A
  • The patient should be supported to eat and drink as long as they wish to do so: discuss the risks of aspiration if a concern
  • Food and drink/nutrition can be a very emotive concern with many patients experiencing a loss of appetite, loss of interest in eating or drinking or limited ability to eat or drink
26
Q

Hydration

A
  • Offer good mouth care
  • Assess daily re hydration status
  • Discuss risks and benefits of ‘clinically assisted hydration’ (CAH); may relieve symptoms secondary to dehydration, but may cause other problems
  • Share uncertainty around whether CAH will prolong life or extend dying process
  • No clear evidence that not giving CAH hastens death
27
Q

palliative and end of life care summary

A
28
Q

anticipatory medication summary

A
29
Q

Ethical issues in end-of-life care

A

Most challenging decisions are about withdrawing or not starting treatment when it has the potential to prolong life
- E.g. giving antibiotics
- CPR
- Renal dialysis
- Artificial nutrition and hydration
- Mechanical ventilation

In some cases these interventions may only prolong dying and cause unnecessary distress

30
Q

key principles of end-of-life-care

A

1) Equalities and human rights

2) Presumption in favour of prolonging life
- Decisions concerning potentially life-prolonging treatment must not be motivated by a desire to bring about pt death i.e. take all reasonable steps to prolong life

3) Treat end-of-life patients with the same quality of care as other patients
- Dignity
- Respect
- Compassion

4) Work on the presumption that every adult has capacity to make decisions
- If pt lacks capacity then decisions must be made in the best interest of the patient i.e. maximising capacity

5)Overall benefit

31
Q

4 key principles of medical ethics

A
32
Q

Capacity 4 key tests

A
  • Understand information given to them about a particular decision
  • Retain that information long enough to be able to make the decision
  • Weigh up the information available to make the decision
  • Communicate their decision.
33
Q

principles of capacity

A
  • Capacity is decision specific and is for that decision alone and in that point of time
  • Capacity can be fluctuant- time specific
34
Q

Patients who have capacity

A
  • The doctor and patient assess the situation
  • The doctor identifies treatments that are likely to be of overall benefit to the patient
  • The doctor explains the options to the patient, and may recommend an option
  • The patient decides whether to accept
  • The doctor should not put pressure on the patient to accept a particular option
  • The doctor does not have to provide a treatment that they believes will not be of benefit
  • Patients cannot demand treatment, but can refuse it
35
Q

If an adult patient lacks capacity

A
  • The decisions to be made must be based on whether treatment would be of overall benefit to the patient
  • Identify which option (including the option not to treat) would be least restrictive of the patient’s future choices
  • The medical team must consult with those close to the patient who lacks capacity, to help them reach a view but the family should not make the decision
36
Q

Advance care-planning

A

is important because it can inform healthcare decisions such that a patents goals based on their personal values, beliefs and wishes are respected. Improves pt and family interaction. Important ACP discussion is early in pt disease as patients may need time to process information and still has capacity

37
Q

ReSPECT process

A

Recommended Summary Plan for Emergency Care and Treatment

  • A process of discussion between patients, families/carers and professionals, which allows a decision to be made in an emergency situation where they do not have capacity / communication to make that decision.
  • Discussion use to develop a sharded understanding of a patients’ conditions, circumstances and future outlook
  • Also exploring preferences for care and treatment
  • From these agreed clinical references are agreed and documented on the ReSPECT form
  • Explore patients preferences

Who is it for?
- adults, paediatrics and neonates
- specifically useful for people who are at risk of emergency treatment
Not legally binding
- ReSPECT is not a DNAR
- guide to provide a recommendation for immediate decision making

38
Q

ReSPECT form

A
39
Q

Lasting power of attorney

A

Lasting power of attnorney

A lasting power of attorney (LPA) is a legal document. It lets you choose (appoint) someone to make decisions for you if you become unable to make decisions yourself. The person you appoint is called your attorney. The power you give them can be long or short term.
Setting up a power of attorney can give you more control over what happens to you if you cannot make your own decisions, or if you become unable to tell people about them.
In England and Wales, there are two types of LPA. You can make one of them or both:
An LPA for financial decisions This includes things like paying bills or selling your home. It can be used when you are still able to make your own decisions. Or you can set it up to start once you become unable to make decisions for yourself.

An LPA for health and welfare decisions This includes things like giving consent for treatment, care, medication and where you live. This LPA can only be used if you become unable to make decisions for yourself. Some people also make an advance decision to refuse treatment (advance directive). Talk to your solicitor about which is most suitable for you.

Cancer care (Y4) (30 decks)

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