Compassionate Care Flashcards
What percentage of patients will die within facilities?
50%
How many patients want to die in their own homes?
80-90%
What percentage of dying patients die in the ICU?
25%
What aids in the increase of patients dying in facilities?
Technology
What are some reasons as to why dying patients are unable to die in their homes?
- devices have to be monitored
- caregivers are working and stressed(canot provided the support needed)
- Caregivers comfort level in providing pain medication
What percentage of people in America have an advanced directive?
26%
What event normally follows the death of a loved one?
PTSD
Name the risks to caregivers when caring for a dying patient?
- Compassion Fatigue
- Burnout
- Depression
- Return of your own grief responses
What is compassion fatigue?
A PTSD experience that occurs after you have lost a patient that has left an impression on you.
Over time, your compassion gradually lessens.
Which type of caregivers experience burnout?
Residents and medical students
What are some danger signs of the risks to caregivers?
When the caregiver shows a lack of emotion or too much emotion to any situation
Who is the best person that the doctor can confide their feelings of loss and grief of a patient with?
Another doctor
What the forms of grief?
Fear Anger Silence Avoidance Depression
What are the four fears of the dying patient?
- “I will be a burden to my family”
- “No one will visit me”.
- “Will I be suffering pain at death?”
- “What will happen to me after death?”
Who are the five members of the hospice team?
Social worker Doctor Nurse Chaplain Volunteer
Why is the volunteer such an integral part of the hospice team?
The volunteer represent the community.
The community needs to support the dying patient
What does the dying patient want?
- To be heard!!!!
- To know what to expect
- Prompt help when they call
- To know that they are not alone
What are three roles of an excellent physician?
Teacher
Healer
Friend
What is the doctor’s role as a healer?
To alleviate all symptoms in every way and as quickly as possible.
Doctors diagnose, treat, and anticipate the prognosis!
In hospice/palliative care, what should be considered if a patient asks for death?
That there is an ongoing symptom that is not controlled
What is the doctor’s role as a teacher?
- To make explanations simple and clear
2. To pay attention to body language
What is the doctor’s role as a friend?
- To listen
2. To give compassionate attention
Name some types of compassionate conversations.
- Family meetings
- Delivering Bad News
- Discussion of advance directives as routine parts of medical care
- Advanced directives
- Code status discussion and questions
Advance directives need to be readdressed time and time again.
True/False
True; as patients evolve in their lives and diseases, the advance directives are prompt to change
What is a code status question ?
Code status question: ask the patient what they want done in case they stop breathing in a primary care setting.
When should a code status discussion take place?
Code status discussion: <30% of pts who are older than 75, have multiple co-morbidities, stage 4 cancer are going to survive to discharge.
With these patients, a discussion is necessary instead of questions.
How should the physician prepare for the conversation?
- Get your mind focused on the patient and family
- Make the room quiet and peaceful
- Consider who should be present
- Consider cultural factors
- Make sure the pt has adequate support present of the conversation
- Make sure you have the facts correct and have discussed it will all involved clinicians
What is the criteria for delivering bad news?
- Be sitting an in a quiet room
- Give a warning shot( “I have bad news)
- Have staff present for you and family
- Be quick and clear
- Prepare for & allow ALL emotional responses
Name the SPIKES
Setting Perception Invitation Knowledge Emotion Summary, next steps
What should be considered during a setting in SPIKES?
Make sure that it is a quiet atmosphere.
What should be considered during the perception in SPIKES?
- Make sure you know what they know and understand about the topic at hand
- You want to undercover denial and defense mechanisms
What should be considered during the Invitation in SPIKES?
It is tricky what patients and family members in the room…Does everyone wants to know?
What is necessary to inform the patient during the invitation portion of SPIKES?
You still have to inform he patient sometimes about their life expectancy, plan, and prognosis
What should be considered during the Knowledge portion in SPIKES?
Be simple, clear, and straight-forward
What should be considered during the emotion portion of SPIKES?
Name the emotion and dealing/empathize with the emotion otherwise you will come across very cold to your patient
What should be considered in the summary portion of SPIKES?
This is a very crucial step; the next steps provide a game-plan for the patient
Under which circumstances will SPIKES be excluded from the conversation?
When a patient has died; avoid using SPIKES with the family and friends
How should you approach having the conversation about a bad news to the patient and the families?
- Find out what the patient and family already know, and what they want to know
- Give a warning shot when delivering bad news
- Redirection must be gentle- use the “I hope, but I fear approach..”
- Answer honestly and clearly in terms your patient and the family can understand
- Use the right words, Do not use euphemisms or platitudes- Keep it simple
- Allow for silence as well as emotions…
What is meant by the world prognosticate?
- Be disease specific information
- If COPD, discuss PFTs, meds, etc. - Functional status
- Ability to be independent(eat, dress self, etc.) - Rate of Change
- How quickly you are changing in functional status - Caregiver support
- Needs to know what is available for the patient and what is not(= nursing home care)
What is the significance of the rate of change while prognosticating?
If you are changing very rapidly, the prognosis may be shorter(days to weeks)
If things are changing on a longer rate, the prognosis may be longer
While prognosticating, specific dates should be used.
True/False
False!!
Use ranges(that is less than you think it’s going to be)
DONT PROMISE ANYTHING!!
