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 over recovery and is performed by a multidisciplinary team.
How does the World Health Organisation define palliative care? (5)
Palliative care improves:
- the quality of life of patients and their families who face life threatening illness,
by providing:
- pain and symptom relief
- spiritual support
- and psycho-social support
- from diagnosis to end of life and bereavement
What is the benefit of identifying early which patients would benefit from palliative planning?
Can begin the discussion of patient’s care plan as to respect their wishes and to accommodate their personal needs/
i.e. where they want to be treated and in a way that they want to be treated
What is used to know if a patient is at a palliative stage? (3)
Supportive and palliative care indicators tool:
- Ask: would it be a surprise if this patient died in the next 6-12 months?
- Look for 2 or more general CLINICAL indicators
- Look for 2 or more DISEASE RELATED indicators
Give 6 examples of general clinical indicators suggesting palliative care might be needed:
- Performance status poor or deteriorating e.g. limited self care.
- Progressive weight loss >10% over past 6 months
- Two or more unplanned admissions in past 6 months
- 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.
List 4 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? (2)
- Health and social care partnership team
- Macmillian/CLAN/Marie Curie nurses
What is a good death? (5)
- 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
What percentage of people achieve a home death?
26%
What framework offers tools to enable primary care to provide palliative care at home?
The Gold Standards Framework
Examples of reaction to bad news or grief include (8)
- Shock
- Anger
- Denial
- Relief
- Sadness
- Fear
- Guilt
- Anxiety
What are the main steps of breaking bad news?
6
1) Set the scene and consent.
2) Explore ICE - Find out what the patient understands, and how much they want to know.
3) Share information using a common language.
4) Review and summarise.
5) Allow opportunities for questions.
6) 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)? (4)
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
Healthcare System implications of ageing population (3)
- Increased need for geriatricians/care of elderly specialists
- Increased need for elderly healthcare facilities
- Shift of care of long term conditions from secondary to primary care
Social implications of ageing population (4)
- Become increasingly dependent on families and carers
- Demand for home carers and nursing homes rise
- Role of elderly people as carers is likely to change
- Housing demands change
Economic implications of ageing population (4)
- 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 (2)
- Elderly group have power to influence political decision making, as there are so many of them. (THINK BREXIT)
- 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 & 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 reviewed
What questions can be asked for an anticipatory care plan to be formulated? (4)
- DNR?
- WHERE do they want to be cared for?
- WHO is to be informed about their care and changes in their condition?
- INFORM: are they and their family fully aware of their prognosis?
What should happen after a discussion about an Anticipatory Care Plan 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.
