Block 13 - part 2 Flashcards
decision analysis
systematic and quantitative way of making healthcare decisions
assumptions for decision analysis
decision process is logical and rational, rational decision maker will choose the option to maximise utility
utility
the desirability or value attached to a decision outcome
5 stages in decision analysis
structure problem as a decision tree,
assess probability (chance) of every choice branch,
asses (numerically) the utility of every outcome,
identify the option that maximised expected utility,
(possibly) conduct a sensitive analysis to explore effect of varying judgements
square node on decision tree
indicated decision, represents choice between ations
circle node on decision tree
indicated chance (probability), represents uncertainty, potential outcomes of each decision
calculation for expected utility
utility value x probability
sensitive analysis
explores what would happen if probability or utility values were slightly different to the ones you are using - calculate effect of uncertainty on a decision
preference sensitive
person may feel strongly about the side effects of the treatment
probability sensitive
sensitive to changes in the chance of different outcomes
benefits of using decision analysis to make decisions
makes all assumptions in a decision explicit, allows examination of the process of making a decision, integrates research evidence into the decision process, insight gained during process may be more important than the generated numbers, can be used for individual decisions, population level decisions and for cost effectiveness analysis
negatives of using decision anaylsis to make decisions
probability estimates, utility measures
probability estimates problems
required data sets to estimate probability may not exist, subjective probability estimates are subject to bias
utility measures problems
individual may be asked to rate a state of health that they have not experienced, different techniques will result in different numbers, subject to presentation framing effects, approach is reductionist
ICF model of disability
functioning and disability are multi-dimensional concepts relating to: body functions and structures, activities, participation of people in life, environmental factors
palliative care
active holistic care of patients with advanced progressive illness, aims to treat or manage pain and other physical symptoms and will also help with any psychological, social or spiritual needs
goals of palliative care
improves quality of life, pain/symptom relief, supports life, regards death as normal process, doesn’t quicken/postpone death, combines psychological and spiritual aspects of care, offers support system for individual and family, uses MDT approach to address person’s needs
who is general palliative care given to
core aspect of care for all patients and their families with advanced disease by all health professionals
who is specialised palliative care for
patients (and carers) with unresolved symptoms and complex psychosocial issues, with complec end-of-life and bereavement issues
who provides specialised palliative care
NHS - clinical nurse specialist, some consultants, macmillan
voluntary - hospice services, in patient beds, independent charities (marie curie, sue ryder), macmillan
what is end of life care
branch of palliative care, ‘end of life care pathway’ - last 48 hours of life
challenges for the future of palliative care
inequality of service provision and standards, funding, training, recruitment and retention, maintaining a sense of humanity and comassion
total pain
recognises pain as being physical, psychological, social and spiritual
different nurses involved in palliative care
district nurse, practise nurse, marie curie nurse, macmillan nurse
preferred place of death
most people wish to die at home, few wish to die in hospital, most die in hospital, hard to plan as don’t know when will happen
percentage of admission notes which document CPR decisions
10%
percentage of in-hospital CPR which is not appropriate
40-50%
DNACRP
do not attempt cpr, decision made and recorded in advance, applies to those present if a person subsequently suffers sudden cardiac arrest or dies
bowlby’s 4 stages of grief
numbness, yearning/pining and anger, disorganisation and despair, reorganisation
symptoms of grief
sadness, anger, guilt, anxiety, loneliness, fatigue, helplessness, shock, yearning, numbness, somatic sensations, etc.
worden’s task of mourning
accepting reality of the loss, work through pain of grief, adjust to environment in which the deceased is missing, emotionally relocate the deceased and move on with life
factors which affect sensitivity of grief
closeness of relationship, meaningfulness of relationship, nature of relationship prior to death, expectedness and manner of death, age and development stage of griever, social support
spirituality
umbrella term that includes religion/faith frameworks, but also includes meaning of life, purpose, sense of personhood
effects of religious beliefs on bereavement
belief in afterlife, continued attachment (prayer as means of continuing connection), defence against fear of personal death, religious funeral rituals that aid and progress the grief progress, religious funeral rituals which recruit social support
pathological grief
extended grief reactions, can be in denial for an extended period of time - exhibit mummification e.g. not changing things in dead person’s room, major depressive disorders >2 months after loss
myth of neutral therapist
idea that psychotherapists will ‘leak’ their personal views regardless of their intention. This will come across in their questioning/direction of questioning
