End of life care (3) Flashcards
What is terminal care (expected death)
The last phase of care when a patient’s condition is deteriorating and death is close
What is palliative care
A philosophy of care that emphasises quality of life and is performed by a multidisciplinary team
WHO definition of palliative care
‘Palliative care improves the quality of life of patients and families who face life threatening illness, by providing pain and symptom relief, spiritual and psychosocial support from diagnosis to end of life and bereavement’
What is the benefit of identifying early which patients would benefit from palliative planning?
We can then discuss patient’s wishes with them and try where possible to care for them where they want to be treated and in a way that they want to be
What is used to know if a patient is at a palliative stage?
Supportive and palliative care indicators tool
- Ask - would it be a surprise if this patient died in the next 6-12 mths?
- Look for two or more general clinical indicators
- Look for two or more disease related indicators
Examples of general clinical indicators suggesting palliative care might be needed
- Performance status poor or deteriorating eg limited self care
- Progressive weight loss >10% over past 6mths
- Two or more unplanned admissions in past 6mths
- New diagnosis of a progressive, life threatening illness
- Two or more advanced or complex conditions (multi-morbidity)
- Patient is in a nursing care home or NHS continuing care unit
Positive aspects of palliative care
- Provides relief from pain and other distressing symptoms
- Affirms life and regards dying as a normal process
- Intends neither to hasten nor postpone death
- Offers a support system to help patients live as actively as possible until death, and to help the family cope
What professionals might be involved in palliative care situations
- Health and social care partnership team
- Macmillian/CLAN/Marie Curie nurses
What is a good death?
- Pain free
- Openly acknowledged
- Surrounded by family and friends
- Resolving of unfinished business/personal conflicts
- In a manner that resonates with the person’s individuality
How many people achieve a home death?
26%
What framework offers tools to enable primary care to provide palliative care at home?
The Gold Standards Framework
Reactions to bad news or grief include
- Shock
- Anger
- Denial
- Relief
- Sadness
- Fear
- Guilt
- Anxiety
Give some important elements of breaking bad news
- Set the scene
- Find out what the patient understands, and how much they want to know
- Share information using a common language
- Review and summarise
- Allow opportunities for questions
- Agree follow up and support
Give the 3 types of euthanasia
- Voluntary: patient’s request
- Non voluntary: no request
- Physician assisted suicide: physician provides the means and the advice for suicide
What must you do if a patient requests euthanasia (in the UK)?
ADMIT POWERLESSNESS!
- Listen and acknowledge the issue
- Explore reasons for the request, and ways of giving more control to the patient
- Look for treatable problems
Health implications of ageing population
- Increased need for geriatricians/care of elderly
- Increased need for elderly healthcare facilities
- Shift of care of long term conditions from secondary to primary care
Social implications of ageing population
- Become increasingly dependent on families and carers
- Demand for home carers and nursing home places goes up
- Role of elderly as carers is likely to change
- Housing demands change
Economic implications of ageing population
- Retirement/pension age will increase
- Finding employment might become harder for young people
- Less people paying into tax and pension funds
- Increasing cost of free personal care for the elderly policy in Scotland
Political implications of ageing population
- Elderly group have power to influence political decision making, as there are so many of them
- Current decision making and workforce planning must take into account the ageing population
Define multi-morbidity
The co-existence of 2 or more long term conditions in an individual
What is an anticipatory care plan?
Involves discussing an individual’s goals and wishes, and recording these decisions so that in the event of a gradual or sudden decline , those providing care have clear guidance on what that person would wish to happen
When should an anticipatory care plan be made?
- At any time in life that seems appropriate
- Continuously
What questions can be asked for an ACP to be formulated?
- DNR?
- Where do they want to be cared for?
- Who is to be informed about their care and changes in their condition?
- Are they and their family fully aware of their prognosis?
What should happen after a discussion about an ACP has taken place?
Patient should be placed on the practice’s palliative care register
What tool can be used to evaluate how quickly the situation is changing for the patient and to see of their care needs need to be re-evaluated?
Palliative performance scale
