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
