Death and Dying

Question 1

Tasks of grief for those who experience loss:

Answer 1

Accept the reality
Experience the pain of the loss
Adjust to the environment without the deceased
Emotionally relocate the deceased and move on with life

Question 2

Stages of grief:

Answer 2

DABDA

Denial
Anger
Bargaining
Depression
Acceptance

Question 3

Types of complicated grief and a description.

Answer 3

CEMD

Chronic - occurs longer than 6 months

Exaggerated - characterized by risk behaviors and disabling symptoms

Masked - symptoms of grief absent or only apparent due to unrelated factors

Delayed - grief appears years after loss

Question 4

Risk factors that can complicate grief: (6 things)

Answer 4

1. The specifics of the loss and who deceased (i.e. Loss of a child)
2. Nature of the attachment (i.e. Dependent partner)
3. Mode of loss or death (i.e. Sudden death)
4. Historical antecedents and personality variables (i.e. Psychiatric illness, Several losses)
5. Social Factors (i.e. Estrangement and geographical separation)
6. Concurrent stressors (i.e. Economic reversals)

Question 5

The _____% of Medicare patients with _______ chronic conditions account for _____% of all Medicare spending.

Answer 5

23%; > 4; 68%

Question 6

What did the SUPPORT trial show?

Answer 6

A significant number of patients don’t have their wishes known, don’t have their wishes implemented, and experience pain. Many did not want to be coded but this information was unknown by doctors.

Question 7

Consequences to family members of patients that die in the ICU.

Answer 7

1. Increased risk of MI or sudden cardiac death
2. Increased risk of death due to emotional strain for caregivers
3. ICU care of patient was associated with a 5X family risk of PTSD
4. Hospital care associated with 8.8 X family risk of prolonged grief disorder

Question 8

Barriers to communication due to the patient and family:

Answer 8

1. Cultural beliefs on disclosure of information
2. Unrealistic expectations of the healthcare system especially in a culture which “denies death”
3. Societal values on the dying process
4. Trust
5. Lack of advanced directives and burden of decision making on families

Question 9

What is the burn out rate in palliative care?

Answer 9

61%

Question 10

What is the burnout rate in general medicine?

Answer 10

45%

Question 11

______% of all Medicare spending is for the _____% of patients who are in their final year of life

Answer 11

25%; 5%

Question 12

Caregivers are _______ more likely to suffer major depression 6 months after a patient’s death in the ICU.

Answer 12

3X

Question 13

Describe findings of the Aetna experiments.

Answer 13

Aetna understood that many terminally ill patients wanted to maintain curative treatment, so they gave them the option to maintain treatment and receive hospice services. Patient enrollment in the concurrent care program jumped from 26 - 70%. Additionally, ER visits dropped, hospital and ICU use dropped by two-thirds, and costs fell by 25%. They figured these changes were due to patient access to a knowledgeable individual to speak with about daily needs.

Question 14

Two most common symptoms of depression and anxiety.

Answer 14

Dyspnea and pain

Question 15

RULE for motivational interviewing.

Answer 15

Resist righting
understand
listen
empower

Question 16

Empathetic component of interviewing, NURSE

Answer 16

Name
Understand
Respect
Support
Explore

Question 17

SPIKE during the interview.

Answer 17

1) Setting up the interview
2) Assessing the patient’s Perception
3) Obtaining the Patient’s Invitation
4) Give the Knowledge to the patient
5) Addressing the patient’s Emotions with Empathetic responses