Death And Dying

Question 1

What are the rankings of places people would most want to die?

Answer 1

70% would prefer to die at home
- most reported

However most people die in acute care hospitals (60%)

Question 2

How did hospice begin?

Answer 2

1974 was when the first hospice care centered opened
- created from a 1972 senate plea

The JCAHO develops standards for hospice accreditation in 1980

Question 3

What does the sandwich generation refer to?

Answer 3

People caring for both their own kids and their adult parents at the same time

Question 4

Caregiver strain

Answer 4

While caring for people, caregivers often become burnt out due to some of the following reasons:
1) often times caring for long term (3 or more years)

2) 65% of adults with long-term care needs rely on exclusively on family and friends to provide assistance
3) heath care prices continue to increase
4) social security dependence is super high (90%)

Question 5

Most common symptoms for dying patients

Answer 5

Fatigue
- is the most common and under-reported symptom in hospice/palliative care

Anorexia
- reversible weight loss caused by not wanting to eat

Cachexia
- irreversible weight loss caused by aging or pathogenesis

Dysphasia
- reduces quality of life and often causes anorexia

Nausea/vomiting

• reduces quality of life
• caused by many different reasons and often assocaited with treatments

Pain
- most common symptoms during the dying process

Dyspnea
- very common in cancer patients

Anxiety/depression

Question 6

How to treat dyspnea non pharmacologically and pharmacologically

Answer 6

Non pharmacological:

1) Oxygen therapy
2) Energy preservation

Pharmacological

1) bronchodilator
2) opioids
3) benzodiazepines
4) corticosteroids

note these are not rankings in order to use

Question 7

anti-Nausea medication

Answer 7

Serotonin antagonists

Steroids

Dopamine antagonists

Antacids

Cannabinoids

can also treat nausea w/ gastric decompression and laxatives/stool softeners

Question 8

How many people actually die at home?

Answer 8

20%

This is due to the baby boomers dieing off later and their children are the sand which generation

Question 9

Advance care planning

Answer 9

Must be person centered and not one ACP fits all

Is usually individualized to a persons stage of illness

Often integrate cultural and religious values/beliefs into planning

Question 9

Who is responsible for advance care planning?

Answer 9

Health care providers

Patients

Community

Question 9

What are barriers to informed decision making?

Answer 9

Provider time, training and reimbursement

Patient health care literacy

Explaining EVERYTHING to patients and the treatments

Question 10

What are the common EOL preferences of people in Idaho

Answer 10

Many want to die at home

Many are worried about finances

Don’t want to be burdens to loved ones

Really want to be involved in making decisions about their death

Question 11

What are the top ranked options as it pertains to whom patients trust to provide information about EOL?

Answer 11

1) Physicians
2) Family
3) Spouse/partner

Question 12

What’s the steps to providing a serious illness conversation

Answer 12

1) set up the conversation
- introduce purpose
- ask permission
- prepare the future

2) assess understand/preferences of each individual

3) share the prognosis
- decide the “frame” of the statement
- allow silence and explore emotion

4) explore key topics that the patients wants to talk about
- common ones are goals, fears, sources of strength, critical abilities, traders and family

5) close the conversation
- summarize
- make recommendations
- affirm commitment

6) document the conversation
7) communicate with key clinicians related to the patient care