Advanced Care Planning

Question 1

What are anticipatory meds?

Answer 1

Anticipatory medications are prescribed medications intended to manage symptoms that a patient is likely to experience as they approach the end of life, often as part of palliative or hospice care. E.g. analgesia for pain relief, SOB, antisickness, agitation, reducing secretions.

Question 2

What is meant by symptom control in end of life care?

Answer 2

Treating other symptoms such as nausea, breathlessness, anxiety, or aggitation to enhance the patient’s quality of life.

Rather than treating the cause which may prolong unnecessary suffering.

Question 3

Suggest some symptoms typically experience towards the end of life.

Answer 3

1. Pain
2. Shortness of breath
3. Nausea & vomiting
4. Agitatation
5. Excess secretions

Question 4

Name some anticipatory medications and thier use.

Answer 4

1. Morphine for pain relief
   2.Clyclazine, Ondansetron for antisickness
   3.Benzodiazepines like lorazepam or midazolam for anxiety or agitation
   4.Ipratropium bromide for SOB
   5.Anticholinergics for secretions

Question 5

What is end of life care?

Answer 5

End-of-life care encompasses the support and medical care provided to individuals in the final stages of life, with a focus on comfort, dignity, and quality of life rather than curative treatment.

Question 6

Suggest 5 features end of life care considers.

Answer 6

1. Goals of End-of-Life Care e.g. symptom control vs treatment

2.** Advance Directives and Legal Considerations:** e.g. legal documents that outline a patient’s wishes regarding medical treatment in case they become unable to make decisions for themselves.

3.Care Settings: e.g. where does the patient wish to spend their final few days.

4. Support Services: e.g Offer psychological support and counseling to help the patient and family cope with the emotional aspects of dying and bereavement.

5. Cultural and personal preferences. e.gBe aware of and respect the cultural, religious, and personal preferences of the patient and their family. This includes respecting rituals, beliefs about death, and preferences for care and treatment.

Question 7

What is meant by ‘ceiling of care’?

Answer 7

Ceiling of carerefers to the limits or boundaries of medical care that can be provided to a patient, often due to constraints such as resource availability, medical limitations, ethical considerations, and patient preferences.

Question 8

What is meant by ageism in healthcare?

Answer 8

Ageism in healthcare refers to the prejudices or discriminatory practices against individuals based on their age, often leading to inequities in the quality of care provided to older adults.

Question 9

Give 3 examples of ageism in healthcare?

Answer 9

1. Underdiagnosis: Older adults may experience underdiagnosis or misdiagnosis of conditions because symptoms might be attributed to normal aging rather than underlying health issues. For instance, cognitive decline might be mistaken for normal aging instead of an early sign of dementia.

**2. Neglect of Preventive Measures: ** Preventive care measures, such as screenings and vaccinations, might be less frequently offered to older adults. This neglect can lead to missed opportunities for early intervention and disease prevention.

3. Lack of Patient Involvement: Older patients might be excluded from decision-making processes regarding their care based on the belief that they are incapable of understanding complex medical information.

Question 10

How can ageism in healthcare be avoided?

Answer 10

1. Education and Training
2. Patient-Centred Care
3. Improving access to care

Question 11

What is a ‘ReSPECT’ form and when is it used?

Answer 11

What:Recommended Summary Plan for Emergency Care and Treatment, a process that creates individual recommendations for a person’s clinical care in emergency situations, including cardiorespiratory arrest. T

**Who: ** For people who have complex health needs, people who are likely to be nearing the end of their lives, and people who are at risk of sudden deterioration or cardiac arrest.

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Question 12

What is a DNACPR?

Answer 12

DNACPR stands for do not attempt cardiopulmonary resuscitation.

It means that if a person has a cardiac arrest or dies suddenly, there will be guidance on what action should or shouldn’t be taken by a healthcare professional, including not performing CPR on the person.

Question 13

Suggest 3 ethical issues raised when making end of life decisions e.g. DNAR?

Answer 13

1. Autonomy- Respect for Patient’s Wishes: which means honoring their preferences and values regarding their own care.

2. Balancing Benefits and Harms: Healthcare providers must balance the potential benefits of resuscitation with the likelihood of success and the potential harm of prolonged suffering or a reduced quality of life. In some cases, resuscitation may only prolong the dying process rather than providing meaningful recovery.

3.Respecting Beliefs: Different cultures and religions have varying beliefs about end-of-life care, including views on resuscitation and the appropriate approach to death. It’s important to respect and integrate these beliefs into care planning while maintaining ethical standards.

Question 14

What is a lasting power of attorney (LPA)?

Answer 14

A lasting power of attorney ( LPA ) is a legal document that lets you (the ‘donor’) appoint one or more people (known as ‘attorneys’) to help you make decisions or to make decisions on your behalf when you are no longer able to.

Question 15

What are the 2 types of LPA?

Answer 15

1.One for managing finances
2.One for health and care

Question 16

When does a LPA get a say regarding financial decisions?

Answer 16

You decide when you want this type of LPA to start. This might be while you still have mental capacity, or it might be if and when you lose mental capacity.

Question 17

When does a LPA get a say regarding health and care decisions?

Answer 17

Unlike an LPA for financial decisions, your attorney can only use this LPA if you no longer have mental capacity.

Question 18

Define mental capacity.

Answer 18

Mental capacity is the ability to make an informed decision based on understanding a situation, the options available, and the consequences of the decision

Question 19

Mental capacity is time and decision specific.
What is meant by this.

Answer 19

This means you should assess a patient’s ability to make a specific decision at the time the decision needs to be made

Decision:
Mental capacity can vary depending on the complexity and nature of the decision. For example, an individual may be able to make simple, everyday decisions (like what to eat for breakfast) but might struggle with more complex decisions (such as financial investments or end-of-life care choices).

Time:
Mental capacity can fluctuate over time due to factors such as illness, medication, emotional state, or cognitive changes. A person might have the capacity to make decisions at one point but not at another. For instance, someone experiencing acute confusion due to a temporary illness may lack capacity at that time but regain it once their condition improves.

Question 20

What are the 4 criteria for capacity?

Answer 20

1. Understand the information given to them
2. Retain that information long enough to be able to make the decision
3. Weigh up the information available to make the decision
4. Communicate their decision – this could be by talking, using sign language or even simple muscle movements such as blinking an eye or squeezing a hand.