End of Life Care Flashcards
Unexpected death
profound shock
unable to say goodbye/reconcile
accidents may be compounded by multiple deaths, legal involvement, press coverage
deaths of children carry even more shock e.g. SIDS has no definite diagnosis + may carry stigma of parental blame
Expected death
terminal care = last phase of care when pt. condition s deteriorating + death is close
palliative care = management of conditions until terminal phase reached
Palliative care
philosophy of care - emphasises quality of life for those who face life-threatening conditions by providing pain + symptoms relief, spiritual + psychosocial support - holistic as covers many domains imp. to pt. + carers
performed by MDT - communication bwtn members is key (macmillan nurses, CLAN, marie curie nurses, religious/cultural groups amongst other support networks)
most provided in primary care w/ support from specialist practitioners + specialist palliative care units/hospices
encompasses end of life care regardless of cause of illness - identify pt. likely to need it early so that their wishes can be discusses to set up care the way they want
Identifying pt. for palliative care
supportive and palliative care indicators tool - for pt. who have life-limiting diagnosis, worsening chronic condition - starts w/ anticipatory care planning (planning w/ pt. + their carers what they want for their future care)
Where do they want to be cared for? Do they want to be resuscitated in the event of cardiac arrest? Or do they want to be allowed to die naturally? Who do they want to be informed of their care and any changes in their condition? Are they fully aware of their prognosis? Is their family aware of their prognosis?
once diagnosed as at palliative stage + discussions made = pt. placed on practice’s palliative care register - then plan for pt. should be sent to out of hours service (so anyone involved in pt. care aware of wishes)
practice has regular palliative care meeting to discuss pt. on palliative care register - w/ MDT present + pt. reviewed regularly + palliative performance scale used to evaluate how quickly pt. situation is changing + if care needs to be re-evaluated
Symptoms
pt. often fear pain
no symptoms should be ignored e.g. anxiety, insomnia, nausea can all be sig. + distressing
respond globally to pt. + their family
WHO palliative care
Provides relief from pain + other distressing symptoms
Affirms life + regards dying as normal process
Intends neither to hasten nor postpone death
Integrates psychological + spiritual aspects of patient care
Offers support system to help patients live as actively as poss. until death
Offers support system to help family cope during pt. illness + in own bereavement
Uses team approach to address needs of patients + families, incl. bereavement counselling if indicated
Good death
Pain-free death
Open acknowledgement of the imminence of death
Death at home surrounded by family and friends
An ‘aware’ death, in which personal conflicts and unfinished business are resolved
Death as personal growth
Death according to personal preference and in a manner that resonates with the person’s individuality
Preferred place of care
most want to die at home
gold standards framework offers tools to enable primary care to provide palliative care at home incl. setting up cancer register, reviewing pt. + reflective practice
Breaking bad news
Listen
Set the Scene
Find out what the patient understands
Find out how much the patient wants to know
Share information using a common language
Review and summarise
Allow opportunities for questions
Agree follow up and support
Reactions to bad news
Shock Anger Denial Bargaining Relief Sadness Fear Guilt Anxiety Distress
after death - following death of loved one, health and social care partnership team also there to support bereaved
Grief
Is an individual experience
Is a process that may take months or years
Patients may need to be reassured that they are normal
Abnormal or distorted reactions may need more help
Bereavement is associated with morbidity and mortality
Stages of grief: stability, immobilisation, denial, anger, bargaining, depression, testing, acceptance
Hospices
form part of MDT, generally underfunded
Euthanasia
deliberate ending on person’s life w/ or w/o their request
voluntary euthanasia - pt. request
non-voluntary - no request
physician assisted suicide - physician provides means + advice for suicide
illegal in UK
pt. may ask because of unrelieved symptoms/dread of further suffering/depression
Response to those asking for euthanasia
Listen
Acknowledge the issue
Explore the reasons for the request
Explore ways of giving more control to the patient
Look for treatable problems
Remember spiritual issues
Admit powerlessness
