Block 13 - part 2

Question 1

decision analysis

Answer 1

systematic and quantitative way of making healthcare decisions

Question 2

assumptions for decision analysis

Answer 2

decision process is logical and rational, rational decision maker will choose the option to maximise utility

Question 3

utility

Answer 3

the desirability or value attached to a decision outcome

Question 4

5 stages in decision analysis

Answer 4

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

Question 5

square node on decision tree

Answer 5

indicated decision, represents choice between ations

Question 6

circle node on decision tree

Answer 6

indicated chance (probability), represents uncertainty, potential outcomes of each decision

Question 7

calculation for expected utility

Answer 7

utility value x probability

Question 8

sensitive analysis

Answer 8

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

Question 9

preference sensitive

Answer 9

person may feel strongly about the side effects of the treatment

Question 10

probability sensitive

Answer 10

sensitive to changes in the chance of different outcomes

Question 11

benefits of using decision analysis to make decisions

Answer 11

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

Question 12

negatives of using decision anaylsis to make decisions

Answer 12

probability estimates, utility measures

Question 13

probability estimates problems

Answer 13

required data sets to estimate probability may not exist, subjective probability estimates are subject to bias

Question 14

utility measures problems

Answer 14

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

Question 15

ICF model of disability

Answer 15

functioning and disability are multi-dimensional concepts relating to: body functions and structures, activities, participation of people in life, environmental factors

Question 16

palliative care

Answer 16

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

Question 17

goals of palliative care

Answer 17

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

Question 18

who is general palliative care given to

Answer 18

core aspect of care for all patients and their families with advanced disease by all health professionals

Question 19

who is specialised palliative care for

Answer 19

patients (and carers) with unresolved symptoms and complex psychosocial issues, with complec end-of-life and bereavement issues

Question 20

who provides specialised palliative care

Answer 20

NHS - clinical nurse specialist, some consultants, macmillan

voluntary - hospice services, in patient beds, independent charities (marie curie, sue ryder), macmillan

Question 21

what is end of life care

Answer 21

branch of palliative care, ‘end of life care pathway’ - last 48 hours of life

Question 22

challenges for the future of palliative care

Answer 22

inequality of service provision and standards, funding, training, recruitment and retention, maintaining a sense of humanity and comassion

Question 23

total pain

Answer 23

recognises pain as being physical, psychological, social and spiritual

Question 24

different nurses involved in palliative care

Answer 24

district nurse, practise nurse, marie curie nurse, macmillan nurse

Question 25

preferred place of death

Answer 25

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

Question 26

percentage of admission notes which document CPR decisions

Answer 26

10%

Question 27

percentage of in-hospital CPR which is not appropriate

Answer 27

40-50%

Question 28

DNACRP

Answer 28

do not attempt cpr, decision made and recorded in advance, applies to those present if a person subsequently suffers sudden cardiac arrest or dies

Question 29

bowlby’s 4 stages of grief

Answer 29

numbness, yearning/pining and anger, disorganisation and despair, reorganisation

Question 30

symptoms of grief

Answer 30

sadness, anger, guilt, anxiety, loneliness, fatigue, helplessness, shock, yearning, numbness, somatic sensations, etc.

Question 31

worden’s task of mourning

Answer 31

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

Question 32

factors which affect sensitivity of grief

Answer 32

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

Question 33

spirituality

Answer 33

umbrella term that includes religion/faith frameworks, but also includes meaning of life, purpose, sense of personhood

Question 34

effects of religious beliefs on bereavement

Answer 34

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

Question 35

pathological grief

Answer 35

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

Question 36

myth of neutral therapist

Answer 36

idea that psychotherapists will ‘leak’ their personal views regardless of their intention. This will come across in their questioning/direction of questioning