3- Palliative Care & End of Life

Question 1

What is palliative care?

Answer 1

Specialized care for serious illnesses, provides sx relief a/w chronic medical conditions

(historically- alleviate a problem (pain) without addressing underlying cause)

Question 2

What is the goal of palliative care?

Answer 2

Improve QOL for patient and family

(consider big picture and goals/ wishes of patient)

Question 3

What are the principles of effective pain management?

(introduced by Saunders 1918-2005)

Answer 3

Do not need to wait for pain meds to wear off before next dose

Controlling pain = less fear/ anxiety

Opiate addiction in dying is NOT a concern

Question 4

What is encompassed by the concept of “total pain”?

(introduced by St. Christopher’s hospice 1967)

Answer 4

Phyiscal, emotional, social, spiritual dimensions of distress

Question 5

Besides the concept of “total pain”, what else was introduced by St. Christopher’s hospice ~ 1967?

Answer 5

Dying deserve dignity, respect, compassion, to be treated as individuals

Curing is not always the goal and death is not failure

Question 6

What are the 5 emotional stages of dying?

Answer 6

1. Denial-isolation
2. Anger
3. Bargaining
4. Depression
5. Acceptance

Question 7

What is defined as the final stages of care initiated by the palliative care team as the pt completes their journey from serious illness to terminal condition?

Answer 7

Hospice care

(more intense focus on alleviating fear, anxiety, physical sxs, emotional/ spiritual distress)

Question 8

With the additional of medical advances (information technology, imaging, therapies, meds), life expectancy has increased from 68 yrs to 78 yrs in the last 40 years and what is the general perception regarding death?

Answer 8

Death is not an inevitable outcome of illness

Question 9

How do HCPs typically estimate prognosis?

Answer 9

Over estimate by 3-5x

(difficulty imparting bad news, avoid dashing hope)

Question 10

Who should palliative care be considered for?

Answer 10

Anyone with a progressive chronic illness

Question 11

What is considered when evaluating need for tests, procedures, etc in a pt with an incurable condition?

Answer 11

Difference in how the pt is cared for

Improved QOL

Question 12

According to Medicare, Hospice is considered when pt has how long left to live?

Answer 12

< 6 months

Question 13

Who is a part of the palliative team? (7)

Answer 13

Social worker

Psychologist

Pharmacist

Nursing

Clergy

Recreation therapist

Medical providers

Question 14

A pts understanding of their condition, their goals/ fears, critical abilites the pt can’t imaging living without, what they are willing to tolerate for further txs, and hope (always present but meaning changes) are all considered as goals of care conversations. How is this conversation approached? (SPIKES)

Answer 14

Set up conversation

Perception (what does the pt know)

Invitation to discuss

Knowledge (inform pt)

Emotional response > empathy, silence

Strategy, support, summary

Question 15

How should prognosis be given in a terminal/ serious illness conversation?

Answer 15

As a range

Question 16

A recommendation for a palliative care pt should be based on what?

Answer 16

Medical situation, treatment options, goals/ values

Question 17

Aside from documenting any end of life conversation, what is also important?

Answer 17

Insure follow up

Question 18

What should be avoided in communication of serious illness? (6)

Answer 18

Talk > half the time

Use medical jargon

Fear silence

Overly optimistic prognosis

Facts in response to strong emotions

Focus on medical procedures, past failures, erroneous/ unfulfilled promises

Question 19

Although majority of end of life pts proclaim the desire to die at home with family support, what is the reality?

Answer 19

Die in hospital > die in nursing home > die at home