Care Planning Flashcards
What percentage of deaths in the community can be roughly predicted?
Around 80% - definitely the majority.
What tool can we use to help recognise deterioration and the need for advance care planning?
SPICT - Supportive and palliative care indicators tool.
What is good about the SPICT?
It can be disease specific as well as generally assessing the pt.
Allows for advance care planning.
What is advance care planning?
Process that allows patients to express their wishes for the future, for a time when they are unable to make and/or communicte their wishes.
What general indicators are there on the SPICT for general indicators of poor/deteriorating health?
- Unplanned hospital admission
- Poor performance staus or recent change
- Dependancy on others for ADLs/care
- Significant weight loss/underweight
- Symptoms despite Rx
- Pt or family asks for palliation
Which conditions/groups of conditions does the SPICT tool allow for?
Cancer Dementia/frailty Neurological disease Heart/vascular disease Respiratory disease Kidney disease Liver disease
What are the 5 recommended stages of forming/initiating an advance care plan?
- Check pts understanding of condition and trajectory
- Explore what it important to the pt
- Suggest future scenarios and how they would like them to be managed
- Take pts wishes into account while being realistic
- Record planning clearly for pt and providers.
What kind of trajectory can we expect for a cancer pt?
Fairly steady, perhaps with small decline over time, then sudden decline that usually leads to death.
What kind of trajectory can we expect for an organ failure pt?
Steady decline over time with exaccerbations of their condition after which they never fully recover to their baseline, ending in death usually due to an exacerbation of their condition.
What kind of trajectory can we expect for a dementia pt or frailty pt?
Low starting point with slow fairly steady decline over many years, with periods of small exacerbations and recovery.
How could you start a conversation about advance care planning with a patient?
- Tell me what you understand about your condition, about how your illness is progressing.
- Has anyone talked to you about what is likely to happen during the course of your illness?
- You haven’t manage to recover as much as we would hope, have you thought about what this means for your future?
- We would like to talk to you about your future care and management, is that ok?
Basically be open and gentle and don’t scare the patient, but bring this important issue up.
What might be important to the pt?
Family - involved, protected, informed etc. Pets Home and housing Where they want to be managed/die Finances/work Religion Hobbies May be concerned about symptoms and discomfort
What kind of scenarios can be discussed with a pt to help develop an advance care plan?
Infection Head injury Acute SoB Acute chest pain Swallowing difficulties
A pt has an advance care plan. How should this be used in an acute setting if the pt:
a) still has capacity
b) has lost capacity
a) can be used to help the pt not panic in a situation, but they still have the right to change their mind.
b) to advise HCPs of the pts wishes so this can be used to help formulate a plan that is in the pts best interest
What are the 5 recognised priorities for end of life care?
- Recognising dying
- Sensitive communication
- Involving the pt
- Involving family/carers and address their needs for support etc
- Addressing the pts individual priorities (food, drink, symptoms mx etc)
