Defining a Good Death - Oxford 2.4 Flashcards

1
Q

List 8 features of a “good death”

A
  • Multidimensionality
  • Importance of role
  • Importance of culture
  • IMportance of timing
  • Developmental stage
  • Importance of diagnosis
  • Location of death
  • Opportunity for growth
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2
Q

Multidimensionality

A
  • Physical experience
    • pain and symptom management
    • functional status
  • Psychological experience
  • social experience
  • spiritual or existential experience
    • religious, connection to nature, meaning and purpose in life
  • Nature of health care
    • appropriateness of level of intervention
    • relationship to provider, communication with health care provider
  • life closure and death preparation
    • many patients now want to know what to expect
    • personal affairs in order
    • prepare families for future
    • life review, resolving conflicts, legacy work, personal reflection, etc
  • circumstances of death
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3
Q

Importance of role

A
  • patients experience their illness living a variety of roles and inter relationships that need to be sustained as part of whole person care.
  • families and patient may rate being at peace and freedom as important as pain control
  • mental alertness important.
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4
Q

Importance of culture

A
  • much of the empirical work defining “good death” is based on Western English speaking populations
  • Social construction of the meaning of death is varied and often in direct opposition to the palliative care’s normative views of grief and loss.
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5
Q

Importance of timing

A
  • no consense on what constitutes “end of life”
  • Timeframe and preparation varies:
    • new diagnosis: preparation may be possible courses of treatment, getting back to work, social roles
    • As illness progresses: preparation may include increasing palliative approaches, hospice, issues of completion
    • As dying is imminent : prepartion may include expectations of care, location of care, education about very end of life.
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6
Q

Developmental Stage

A
  • adult vs peds
  • peds:
    • Same domains as adults plus:
    • importance of addressing total population in need:
    • Children born with expectation of imminent death, acquired illness, trauma / sudden death
    • IMportance of collaborative decision making with families
    • Involving children to extent to which they are developmentally capable and desiring
    • Often peds death seen as untimely–> leads to complex grief.
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7
Q

Importance of diagnosis

A
  • early palliative care all cancer
  • limited generalizations to broader end of life populations : COPD, CHF, ESRD, Dementia, frailty
  • uncertain prognosis and increased possibility of sudden death
    • challenges conventional palliative care concepts of open awareness, autonomy, individuality
  • cardiologist’s view “living with heart failure” vs palliative care’s “dying with heart failure”
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8
Q

Location of death

A
  • majority of care in dying trajectory occurs in community
  • must have continuity between community and hospital.
  • Advanced cancer patients value supportive services, emergency contacts, case management
  • death in long term care settings:
    • adequacy of staff, facility environment, bonds with staff, improved communication
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9
Q

Opportunity for Growth

A
  • Life Cycle Model vs Medical Model
  • Medical model generates a problem list first
    • Less like to help patients experience improvement or growth in non physical domains
    • predicts and manages only decline
  • Life Cycle Model
    • natural end to life course
    • expected developmental tasks at this phase :
    • life review, conflict resolution, forgiveness, acceptance, generativity
    • allows one to conceptualize end of life as holding opportunity for growth rather than only decline
    • Growth in emotion and spiritual domains
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10
Q

Clinical implications of the term “Good Death”

A
  • Zeal driving early movement of “good death”
  • Risks imposing judgment of the “right way to die”
  • “Right way to die” includes free of pain, surrounded by family, free of conflict, acceptance of death, stopping curative treatment, being at peace and at home.
  • Unintended paternalism
  • So much more nuance and variation to patient preference
  • Some “good death” may include medically non-beneficial treatment at end of life
    • emotional distress or deeply rooted vitalist traditions
    • May need to respect and honour these preferences
    • ethics consults prn
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11
Q

Types of outcomes in QI research?

A
  • outcome measures
  • process measures
  • balancing measures : unintended consequences
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12
Q

Analysis structure for QI goal setting?

A
  • SEPTEE
  • Safe
  • Effective
  • Patient centred
  • Timely
  • Efficicent
  • Equitable
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13
Q

Team members of QI project?

A
  • technical expert
  • clinical leader
  • admin
  • IT
  • key stakeholders
  • patient family representative
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