End of Life Care Flashcards
What is “care of the dying” refered to as?
End of life care or palliative care
What is the aim of end of life care?
Quality of life and to respect patients wishes
What is the most common cause of death?
In the far past, most death was caused by infection, now most common causes are cancer and IHD:
- Cancer is the leading cause
- In the young, accidents account for 38% of deaths in boys and 23% in girls
- In men age 15-34 suicide is the leading cause
What care occurs after palliative care?
Terminal care is last phase of care when patient’s condition is deteriorating and death is close:
- Palliative care occurs before terminal care
Where is most palliative care provided?
Most provided in primary care with support from specialist practitioners and specialist palliative care units (or hospices)
What is the WHO key points of palliative care?
- Relief from pain and other symptoms
- Affirms life and regards dying as normal process
- Doesn’t 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
- Support for families
- MDT
Why is it important to recognise that someone is dying early?
Recognising that someone is dying early and communicating that allows time to find out wishes and concerns of patient and family:
- Problems can be pre-empted rather than reacted to such as symptom control, aids at home, care staff, night nurse
What are different ways to recognise that someone is dying?
- MDT team will tell you
- Patient themselves or family might tell you
- Clinical skills and experience
- Knowledge of patient over time
- Useful tools
- Supportive and palliative care indicators tool (SPICT)
- Palliative performance scale
- Useful for reviewing functional changes in palliative patients
- Lower scores at initial assessment indicated poorer diagnosis
- Falling score is increased risk of death
What does SPICT stand for?
Supportive and palliative care indicator tools
What is the palliative performance scale?
- Useful for reviewing functional changes in palliative patients
- Lower scores at initial assessment indicated poorer diagnosis
- Falling score is increased risk of death
In the palliative performance scale, what does a falling score mean?
- Lower scores at initial assessment indicated poorer diagnosis
- Falling score is increased risk of death
Describe the disease trajectories of:
- malignant
- organ failure
- dementia/frailty
- Malignant
- Most weight loss, reduction in performance status in last few months, usually time to anticipate palliative needs
- Organ failure
- Patient unwell for long time with exacerbations, determinations associated with hospital admission, each one may result in death so timing of death remains uncertain
- Dementia/frailty
- Progressive disability from an already low baseline, decline can be cut short by acute illness such as pneumonia
Understanding disease trajectory allows for what?
- Discussion with patients about illness progress
- Early planning for care near death
What are some limitations of disease trajectory models?
- Patients may not follow it as concurrent illness may affect outcome
- Some illnesses don’t fit well such as stroke or renal failure
- Does not map for psychological or spiritual distress
What is the first thing that you should do once you identify a patient needing palliative care?
Starts with “Anticipatory Care Planning”, which is planning future care:
- Where do they want to be cared for
- Resuscitation or die naturally
- Who do they want to be informed about care or any changes to condition
- Are they or their family fully aware of prognosis
- Symptoms
- Worries
- Religious beliefs
What does anticipatory care planning consider?
- Where do they want to be cared for
- Resuscitation or die naturally
- Who do they want to be informed about care or any changes to condition
- Are they or their family fully aware of prognosis
- Symptoms
- Worries
- Religious beliefs
What things should be done once a patient is identified as being in need of palliative care?
- Anticipatory care planning
- Patient placed on palliative care register
- Plan sent to OOH service and practice has regular palliative care meetings to discuss people on register
- Patient reviewed regularly
- Palliative performance scale sued to evaluate how quickly situation is changing
Who is in the MDT involved in palliative care?
- Health and Social Care Partnership team
- Macmillan nurses
- CLAN
- Marie Curie nurses
- Religious or cultural groups
- Support networks
What is the preferred place of care for most people?
Most people want to die at home, but only 26% of those who want to get to
Gold Standards Framework offers tools to enable primary care to provide palliative care at home, includes:
- Setting up cancer register
- Reviewing patients and reflective practice
15-20% of deaths occur in hospices, which form part of MDT
Describe a ‘good death’?
- Pain free
- Open acknowledgement of the imminence of death
- Surrounded by family and friends
- Resolved unfinished business
- Death as personal growth
- Death according to preferred preference
Describe how you should 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 are examples of different reactions to bad news?
- Shock
- Anger
- Denial
- Bargaining
- Relief
- Sadness
- Fear
- Guilt
- Anxiety
- Distress
How long does the grieving process take? What is it associated with?
Family, friends and healthcare professionals are bereaved after a patients death
Individual experience, process may take months or years
Abnormal reactions may need help
Associated with morbidity and mortality
What is euthanasia?
Euthanasia = the deliberate ending of a person’s life with or without their request
What are the different kinds of euthanasia?
- Voluntary euthanasia
- Patients request
- Non-voluntary euthanasia
- No request
- Physician assisted suicide
- Physician provides the means and the advice for suicide
What is the legal status of euthanasia in the UK?
Illegal in the UK
Why do people request euthanasia?
- Unrelieved symptoms
- Dread of further suffering
- Depression
Describe how you should respond to a euthanasia request?
- Listen
- Acknowledge the issue
- Explore the reasons for the request
- Explore ways of giving more control to the patient
- Look for treatable problems
- Remember spiritual issues
- Admit powerlessness
