End of Life Care Flashcards
Curing
The alleviation of symptoms or the termination or suppression of a disease process through surgical, chemical, or mechanical intervention
Healing
May be spontaneous, but more of it is a gradual awakening to a deeper sense of self (and of the self in relationship to others) in a way that effects profound change. Healing comes from within and is consistent with a person’s OWN readiness to grow and to change
What percentage of Americans die in in a hospital or nursing home?
70% (39% in hospital; 31% in nursing home)
Half of conscious patients had moderate to severe pain at least ___ before death
1/2 the time
__% of patients did not wish to have CPR… BUT physicians of more than half were NOT aware of DNR order preference
31
Nearly ___ of DNR orders were written within 2 days of patient death
half
__% of the patients spent at least 10 days in the ICU
40%
TENO Study: 1/4 of people who died did not receive enough pain medication and sometimes received none at all. Inadequate pain management was 1.6 times more likely to be a concern where vs where?
In a nursing home vs a home with hospice care
TENO Study: 1/2 of patients did not receive enough emotional support. This was 1.3 times more likely to be the case where?
In an institution
What is the biggest concern when considering yesterday’s solutions as today’s problems?
- Cost*
e. g. Mechanical ventilation, Renal dialysis, Pacemakers/defibrillators, Organ transplantation
What are the major medical issues at the end of life?
- Withholding and Withdrawing Care (e.g. Invasive Nutrition, Resuscitation (DNR), Antibiotics)
- Medical Futility
- Assistance in Dying
What is the first question that should be answered when dealing with end of life care?
What is/are the PATIENT’S goal(s)?
***Ask this before “what else can we do here?” or “What else can we offer this patient?”
What is the object of all clinical decision-making?
First, to secure the health, well-being, or good dying of the patient and to do this in a manner that respects the integrity of all participants in the decision-making process.
What is the moral valance of technology?
Technology is NEUTRAL. How it is used gives it its moral valance.
In what context is there a huge difference between withholding and withdrawing treatment?
Emotionally
There is no difference morally, ethically, medically, legally, or religiously
What is the goal of withholding and withdrawing artificial nutrition and hydration?
Restoration/cure, stabilization, preparation for death
What is the process for withholding and withdrawing artificial nutrition and hydration?
After listening carefully to patient/surrogate decision-maker, MAKE A MEDICAL RECOMMENDATION (NOT a question) consistent with patient’s goals of care
Recommendations: Feeding Tubes in Advanced [End Stage] Dementia
Percutaneous feeding tubes are not recommended in patients with advanced dementia; rather, oral-assisted feeding is recommended
What are the 3 signals that indicate desire to refuse food?
Pursing lips, blocking with hand, and saying “No”
What is 6-6-6-6?
What was your mother like 6 months ago, 6 weeks ago, 6 days ago, 6 hours ago?
Helps family members see that patient has been changing
What does this mean to you?
What is involved in a “Goals of Care” conversation?
- Review the clinical situation
- Assess the decision maker’s understanding (6-6-6-6; what does this mean to you?)
- Establish patient’s Goals of Care
- Present options to manage clinical issues
- Weigh risks and benefits with values and preferences
- Measure effects the decision has on family and loved ones
- Offer additional sources of decisional support
- Provide ongoing support and recognize the need to revisit the decision
Euthanasia
Clinician performs lethal intervention
Note: includes the intention that death is the result
Not legal anywhere in the US
Physician Assisted Suicide
Clinician provides the means; patient acts
Legal in Oregon, Washington, and Montana; Vermont and New Jersey with restrictions
Voluntary Euthanasia
Requested; Killed
