End of Life Care

Question 1

What are the most common causes of death nowadays?

Answer 1

cancer and IHD (more cancer now)

Question 2

What is a common cause of death in the young?

Answer 2

accidents

Question 3

What is the main cause of death in men 15-34?

Answer 3

suicide

Question 4

Has life expectancy increased or decreased since years ago?

Answer 4

increased

Question 5

What is the last phase of care when a patients condition is deteriorating and death is close?

Answer 5

terminal care (expected death)
(often misleadingly assc with cancer)

Question 6

What is a more helpful term for the management of conditions until terminal phase is reached?

Answer 6

palliative care (end of life care)

Question 7

What are the concepts of palliative care?

Answer 7

• 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

Question 8

What does palliative care encompass?

Answer 8

QoL

Question 9

Where is most palliative care provided?

Answer 9

primary care with support from specialist practiotioners and specialist palliative care units (or hospices). GPs can act as companions for these patients

Question 10

What is “living well and dying well”?

Answer 10

Scotland’s national action plan for palliative and end of life care

Question 11

What does “Living well and dying well state”?

Answer 11

‘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.’

Question 12

What does WHO define palliative care as?

Answer 12

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.

Question 13

Who do you recognise that someone is in need of palliative care or that someone is dying?

Answer 13

• 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

Question 14

What is the Supportive and Paliative Indicators Tool?

Answer 14

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.

Question 15

What is the Palliative Performance Scale?

look to PP to see it

Answer 15

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

Question 16

Describe disease trajectories?

Answer 16

LOOK TO PP to see the different disease trajectories for eg malignancy, organ failure, dementia/frailty.

Question 17

If you have identified your patient needs palliative care, what happens next?

Answer 17

• 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.

Question 18

Who else can be involved in palliative care situations?

Answer 18

(as well as health and social care partnership team)

• macmillan nurses
• CLAN
• Marie curie nurses
• religious or cultural groups
• other support networks etc
• hospices

Question 19

What offers tools to enable primary care to provide palliative care at home?

Answer 19

The Gold Standards Framework

these tools include setting up. a cancer register, reviewing these patients and reflective practice

Question 20

What can constitute a “good death”?

Answer 20

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

Question 21

How do you break bad news?

Answer 21

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

Question 22

What does euthanasia mean?

Answer 22

the deliberate ending of a persons life with or without their request

Question 23

What are the different types of euthanasia?

Answer 23

• voluntary = patients request
• non voluntary = no request
• • physicican assisted suicide = physicican provides the means and advice for suicide.

Question 24

Is euthanasia legal?

Answer 24

no it is illegal

Question 25

What do studies indicate about 60% of patients who request euthanasia?

Answer 25

they are depressed