end of life care

Question 1

What does palliative care involve?

Answer 1

• relief from pain and other distressing symptoms
• regards dying as a normal process
• intends neither to hasten nor postpone death
• psychological and spiritual aspects of patient care
• offers support system to help patients live as actively as possible until death
• offers support system for family to help them cope with patient’s illness and their own bereavement
• team approach to address needs of patient
• enhance quality of life
• used in conjunction with other therapies (e.g. chemo) in order to possibly prolong life and manage clinical complications of illness as early stage.

Question 2

define end of life care.

Answer 2

the supportive and palliative care of a patient and their family through the last phase of their life and into bereavement. (it’s basically palliative care)

Question 3

define supportive care.

Answer 3

the care that helps the patient and their family cope with their condition and treatment from pre-diagnosis all the way up to bereavement.

Question 4

define palliative care.

Answer 4

the active total care of patients (and their families!) whose disease is unresponsive to curative treatment. It involves control of pain and other symptoms as well as support to manage psychological, social and other problems. It aims to achieve the best QUALITY OF LIFE for patients and their families.

Question 5

what are the four aspects of care identified in the holistic approach to care?

Answer 5

• physical
• psychological
• social
• spiritual

Question 6

can palliative care be provided at the same time as other treatments?

Answer 6

yes - patients can receive palliative alongside other treatments such as chemotherapy, radiotherapy, physiotherapy, surgery, nutritional support etc. >makes the care more holistic

Question 7

describe the pattern of patient function/capability with time, until death, for the following scenarios:
sudden death, terminal illness, organ failure, frailty

Answer 7

sudden death - person has consistent high function until death where all function suddenly goes with no gradual deterioration

terminal illness - the patient has a steady gradual decline of function over time from start of illness to death

organ failure - person has a gradual deterioration of function over time although this fluctuates with some points the patient improving in function and other times the patient deteriorating again until eventually the patient loses all function and dies.

frailty - person has general lower function which slowly deteriorates towards death.

Question 8

describe the ‘spectacular’ trajectory (path) of end-of-life-care in the emergency department.

Answer 8

• sudden, traumatic loss of life
• care is prioritised to patients in this category
• consumes most of the attention of emergency staff
• generally a death associated with ED
• problems may be fixed by rapid intervention
• e.g. road traffic accident victims

Question 9

describe the ‘subtacular’ trajectory (path) of end-of-life-care in the emergency department.

Answer 9

• care often neglected in favour of the spectacular trajectory patients
• lower attention received
• generally attend ED for symptom management as the underlying condition deteriorates or they experience a periodic crisis in their illness
• ranked as low status work

Question 10

What are some of the concerns over care for patients in end of life care? (4)

Answer 10

• lack of attention - sometimes due to lack of staffing and prioritisation
• poor communication - patient is left feeling lost about condition and anxious about what is going to happen
• lack of recognition of expert family - the family know what’s going on with the patient better than anyone else but often neglected
• lack of continuity of care - as soon as patients start to get better, in some cases there can be a lack of monitoring

Question 11

what is the NHS EOL Care Programme (DOH, 2006)?

Answer 11

strategy to offer choice at EOL and provide training for healthcare staff to help care for people at the end of their lives.

Question 12

when was the NHS EOL Strategy formed?

Answer 12

2008

Question 13

What are the aims of the NHS EOL Strategy? (3)

Answer 13

• changing quality of care for people approaching end of life
• to enhance choice at end of life
• to deliver government’s manifesto commitment to double investment in palliative care

*the strategy covers all conditions and all healthcare settings - home, hospital, community, hospice, prison, care home, etc.

Question 14

What is the Liverpool Care Pathway (LCP)?

Answer 14

• was a care plan for patients facing end of life
• involved daily assessment of patient by healthcare professionals and symptom management etc.
• helped doctors and nurses to provide better end of life care for these patients
• there was a general concern over the LCP that patients put on the plan were basically be left to die and would be neglected
• people called it the ‘death pathway’
• there were some incidents of patients put on LCP not receiving adequate assessment and care as they were believed to be beyond help i.e. they can’t be cured so there is nothing we can do for them, just leave them and deal with other patients
• this is however not true! and not everyone on the LCP necessarily is going to die - assessment to see if there is a chance they can improve
• the LCP was discontinued and replaced with a similar plan called the Individual End of Life care plan
• similar approaches but not the stigma