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
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
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.
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.
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.
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.
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”
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
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
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
11
Q
Types of outcomes in QI research?
A
- outcome measures
- process measures
- balancing measures : unintended consequences
12
Q
Analysis structure for QI goal setting?
A
- SEPTEE
- Safe
- Effective
- Patient centred
- Timely
- Efficicent
- Equitable
13
Q
Team members of QI project?
A
- technical expert
- clinical leader
- admin
- IT
- key stakeholders
- patient family representative