25 End of life issues & Palliative care Flashcards
What are the stats of death in Australia?
~150,000 Deaths
~50% of whom will have a warning of their death
~30% of woman are referred to specialist palliative care services
The majority of Australians are not dying the way they would like to
What is the main end of life issues?
- Uncertainty
- Fear of pain and suffering
- Fear of process of dying - not the act itself but the process of the death
- Decision-making: advanced directives
- Carer feelings of inadequacy
- Practical Issues
- Anticipatory grief
What is palliative care?
It is an approach that improves the quality of life of patients and families facing problems associated with life-threatening illnesses, through the prevention and relief of suffering by means of early identification and assessment and treatment of pain and other problems, physical, psychosocial and spiritual (WHO, 2002)
What does palliative care integrate and what does it use?
Integrates psychosocial and spiritual aspects of patient care
Uses a team approach to address patients’ and their families needs
Explain palliative care vs hospice care
All of the hospice is palliative care, but not all of palliative care is a hospice
What are the benefits of early referral to palliative care?
Patients who received palliative care early during treatment had a better quality of life and survived longer compared to patients receiving standard care (Temel et al, 2010)
Patients who received palliative care interventions along with oncology care had higher QOL scores and mood, compared to the patients received only oncology care (Bakista et al, 2009)
Early referral to palliative care minimizes caregiver distress and aggressive measures at the end of life (Cheng et al, 2005)
At what point should referrals be considered in terms of introducing palliative care services?
Referrals should be considered at any time once treatment goal changes from curative to palliative
How should a clinician introduce specialist palliative care services?
- Raise the topic by being honest/open and use term ‘palliative’ explicitly
- Discuss the role of the PC team
- Clarify and correct misconceptions about PC services
- Explain that the patient will still be followed up by the primary health care team and /or specialist where applicable
What is thanatology?
The study of death and dying
What is Bereavement?
The state of having experienced a loss
What is the definition of grief?
The passive and involuntary reaction to the state of bereavement, including affective, cognitive, physical, behavioural, social and spiritual aspects
What is mourning?
The active processes of coping with bereavement and grief => social/public display of ‘grief’ based on cultural, religious, philosophical beliefs
What is grief
A normal and natural process of adjustment to loss. Refers to the responses to the loss and varies based on individuals
=> level of intensity, expression of grief and duration is different for each person
How long does grief last?
Grief is chaotic and unpredictable -> don’t recover from grief - cannot become ‘un-bereaved’. Mourning process never complete (constant triggers/reminders)
Explain the ‘normal or ‘abnormal’ grief reactions?
- Grief affects people in different ways and is overwhelming -> what behaviour is outside “normal” limits?
- It is all relative for the person - whether it is affecting their quality of life or our own discomfort with their reaction
- Danger of labelling people
What are some compounding factors that may affect grief reactions/response?
- Length of time to prepare for death e.g. unresolved issues
- Relationship between bereaved and the deceased e.g. level of significance
- Nature of the relationship e.g. amicable or ambivalence
- Resultant changes in lifestyle e.g. other losses
- Physical and mental health of the bereaved e.g. history of mental illness
- History of loss e.g. significance of other losses
- Religion e.g. fear or guilt for not believing
Describe the results from studies on the “Widower effect”
When one person becomes seriously ill or dies, the risk that the caregiver spouse will also become ill or die significantly increases
Reasons for “healthy” partner’s declining health: Increase in unhealthy behaviour; withdrawal from social networks
The level of risk for the caregiver’s death varies, depending on the type of medical condition of the ill spouse (highest risk: dementia; psychiatric illness)
Describe the early stage theories of grieving
Kubler ross (1967): 5 stage theory of grieving
- Very influential in the field
- Defined the following distinct stages of grief
Distinct stages of grief:
- Denial
- Anger
- Bargaining
- Despair/depression
- Acceptance
State the benefits of stage/task theories
Stage theories useful as therapeutic tools to normalise the experience of individuals
Task theories define specific actions that the bereaved can take to help them cope with the loss
Their simplicity makes them easy to understand
Can explain experiences/feeling during anticipatory grief
State the weaknesses of stage/task theories
Definite number of responses to bereavement - suggesting a time-bound process
Predictive, tend to over-simplify and generalise
Normative, cannot explain gender differences and common experiences may be pathologized
Do not acknowledge the uniqueness of individual experiences of grief - outcome-oriented (“moving on”)
How are current theories of grief changing?
Moved away from ‘linear’ stage models, questioning necessity and goals of “grief work”
Shift away from detachment to maintaining (symbolic) bonds with the deceased
Acknowledge of individual and cultural differences in the grief response
The pathology of “complicated grief” questioned
Development of “growth” needs
What are the typical patterns of grief as described by Bonnanno (2002)?
~90% of partners/spouses could be categorised into one of the following groups:
- Resilience (46%)
- Chronic grief (16%)
- Common grief (11%)
- Depressed improved (10%)
- Chronic depression (8%)
What does it mean by resilience in patterns of grief?
Distress is at low levels all along (46%)
What does it mean by chronic grief in patterns of grief?
Loss brings distress and distress lingers (16%)
