End of Life Care Flashcards
Define palliative care.
Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness
through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.
Distinguish between the old and newer concepts of end of life care.
OLD CONCEPT
Curative care takes the majority of the care. Once it has been established that nothing can be done (at the very end), palliative care takes over.
NEW CONCEPT
At the beginning of end of life care it’s mainly disease modifying/potentially curative but also a little palliative. As the illness progresses, the use of palliative care increases whilst the use of curative care deceases. Towards the end (before death), bereavement care also begins to prepare the patient for death. Bereavement care continues even after death to help relatives cope.
Refer to slide 6 in lecture on “End of Life Care”
Define end of life.
Those facing imminent death (i.e. less than 12 months) & those with:
– Advanced, progressive, incurable conditions
– General frailty (likely to die in 12 months)
– At risk of dying from sudden crisis of condition
– Life threatening conditions caused by sudden catastrophic events
Give examples of non-cancer diseases which require palliation of symptoms.
End-stage Cardiac failure
End- stage COPD
Motor Neurone disease
Advanced renal disease etc.
What are the aims of palliative care ?
- Treat the person as a whole (as well as care for those that matter to them)
- Address quality of life, including good symptom control
Give examples of principles of good end of life care.
- Open lines of communication
- Anticipating care needs and encouraging discussion
- Effective multidisciplinary team input
- Symptom control – physical and psycho-spiritual
- Preparing for death - patient & family
- Providing support for relatives both before and after death
- An individual plan of care, which includes food and drink, symptom control and psychological, social and spiritual support, is agreed, coordinated and delivered with compassion.
Distinguish between general and specialist end of life care.
GENERAL: Integral part of the routine
care delivered by all health and social care professionals to those living with a progressive and incurable disease, whether at home, in a care home, or in hospital
SPECIALIST: Same principles as general end of life care, but can help people with more complex palliative care needs (patient has preference to die in hospice setting)
Give examples of some of the different roles in the multidisciplinary team in charge of end of life care.
- Specialist nurses (community, hospice, other)
- Palliative care doctors
- GP
- Secondary care (non-palliative teams)
- District nurses
Give examples of adjunct therapies which can be given in addition to actual treatment.
- Music
- Gentle Touch
- Pet
- Aromatherapy
Identify some physical symptoms common to most terminal illnesses.
Pain Dyspnoea Nausea / vomiting Anorexia / weight loss Constipation Fatigue Cough
Explain the role of psycho-spiritual distress in end of life care. What is its role
Exacerbates physical symptoms.
What are possible causes of psycho-social distress in end of life care patients ?
– Uncontrolled physical symptoms
– Alcohol / drug withdrawal
– Depression
– Other medical causes e.g. hyperthyroidism
Define Advance and anticipatory care planning.
Ongoing process of discussion between the patient, those close to themselves and their care providers, focusing on that person’s wishes and preferences for the future. It is perhaps best defined as an umbrella term potentially covering a number of planning processes, including legal, personal, and clinical.
What should be discussed as part of advance and anticipatory care planning ?
- Wishes/preferences/fears about care
- Feelings/beliefs/values that may influence future choices
- Who should be involved in decision making ? (I.e. Who)
- Emergency interventions (e.g. CPR)
- Preferred place of care (i.e. Where)
- Religious/spiritual/other personal support
- May wish to make an Advance & Anticipatory care plan/formalise wishes regarding care
What are different ways to formalize a patients wishes in end of life care ?
1) Advance Statement
2) Advance Direction
3) Power of Attorney
Define advance statement.
A statement that sets down your preferences, wishes, beliefs and values regarding your future care (not legally binding)
Define advance decision.
A decision you can make now to refuse specifics treatments in the future (can be legally binding).