End of Life Care Flashcards
What are the most common causes of death nowadays?
cancer and IHD (more cancer now)
What is a common cause of death in the young?
accidents
What is the main cause of death in men 15-34?
suicide
Has life expectancy increased or decreased since years ago?
increased
What is the last phase of care when a patients condition is deteriorating and death is close?
terminal care (expected death) (often misleadingly assc with cancer)
What is a more helpful term for the management of conditions until terminal phase is reached?
palliative care (end of life care)
What are the concepts of palliative care?
- Encompasses end of life care regardless of cause of illness
- doctors encouraged to consider which patients would benefit from palliative planning and treatment from early on in their illness, which is a change in thinking.
-identifying early allows to discuss patient’s wishes and try to fulfill them where possible
-so old concept was just curative or palliative care
where as newer concept involves supportive and palliative care alongisde disease modifying or potentially curative care = early. - this newer concept also more relevant for non cancer related palliative care where may be a less clear distinction between what is curable and what isn’t
What does palliative care encompass?
QoL
Where is most palliative care provided?
primary care with support from specialist practiotioners and specialist palliative care units (or hospices). GPs can act as companions for these patients
What is “living well and dying well”?
Scotland’s national action plan for palliative and end of life care
What does “Living well and dying well state”?
‘Palliative care is not just about care in the last months, days and hours of a person’s life, but about ensuring quality of life for both patients and families at every stage of the disease process from diagnosis onwards…. Palliative care focuses on the person, not the disease, and applies a holistic approach to meeting the physical, practical, functional, social, emotional and spiritual needs of patients and carers facing progressive illness and bereavement.’
What does WHO define palliative care as?
Provides relief from pain and other distressing symptoms
Affirms life and regards dying as a normal process
Intends neither to hasten nor postpone death
Integrates the psychological and spiritual aspects of patient care
Offers a support system to help patients live as actively as possible until death
Offers a support system to help the family cope during the patients illness and in their own bereavement.
Uses a team approach to address the needs of patients and their families, including bereavement counselling if indicated.
Who do you recognise that someone is in need of palliative care or that someone is dying?
- often MDT team tell u
- patient or their family
- clinical skills and experience = knowledge of patient over time
- useful tools = Supportive and Palliative Care Indicators Tool and Palliative Performance Tool
What is the Supportive and Paliative Indicators Tool?
SPICT a guide for doctors to consider their patients who have a life-limiting diagnosis (eg. Cancer), or a worsening chronic condition (e.g. COPD), and highlight if they are at a stage where supportive and palliative care should take place.
What is the Palliative Performance Scale?
look to PP to see it
Study found it to be a useful way of assessing and reviewing functional changes in palliative patients
Lower PPS scores at initial assessment indicated poorer prognosis
Falling PPS scores increased the risk of death compared with patients whose PPS scores remained static or improved.
However, it may not identify the subtle changes in individuals with advanced dementia
Describe disease trajectories?
LOOK TO PP to see the different disease trajectories for eg malignancy, organ failure, dementia/frailty.
If you have identified your patient needs palliative care, what happens next?
- anticipatory care planning with patient and their carers what they want for their future care (eg where, who, fully aware, family aware, worries, thoughts, religious beliefs)
- then once diagnosed at palliative stage of care and discussions taken place = place on practice’s Palliative Care Register (enables and coordinates ongoing care)
- then send the plan for the patient to out of hours service so anyone who may be involved in their care is aware of their wishes
- MDT team discuss regularly and patient reviewed regularly
- Palliative performance scale can be used to evaluate how quickly the situation is changing if their care needs re-evaluated.
Who else can be involved in palliative care situations?
(as well as health and social care partnership team)
- macmillan nurses
- CLAN
- Marie curie nurses
- religious or cultural groups
- other support networks etc
- hospices
What offers tools to enable primary care to provide palliative care at home?
The Gold Standards Framework
these tools include setting up. a cancer register, reviewing these patients and reflective practice
What can constitute a “good death”?
Pain-free death
Open acknowledgement of the imminence of death
Death at home surrounded by family and friends
An ‘aware’ death, in which personal conflicts and unfinished business are resolved
Death as personal growth
Death according to personal preference and in a manner that resonates with the person’s individuality
How do you break bad news?
Listen Set the Scene Find out what the patient understands Find out how much the patient wants to know Share information using a common language Review and summarise Allow opportunities for questions Agree follow up and support
What does euthanasia mean?
the deliberate ending of a persons life with or without their request
What are the different types of euthanasia?
- voluntary = patients request
- non voluntary = no request
- physicican assisted suicide = physicican provides the means and advice for suicide.
Is euthanasia legal?
no it is illegal
What do studies indicate about 60% of patients who request euthanasia?
they are depressed
