End of Life Care Flashcards
In the 1850s what was a huge contributor to dying?
Perinatal mortality with 150 death per 1000 births
In the mid 19th century how many death were a result of infectious disease?
1 in 3 deaths
In 1918-1919 what resulted in 21, 000, 000 deaths?
Influenza pandemic
Overall, what are the most common causes of death in modern day?
Cancer and ischaemic heart disease
Since 1995 cancer has outstripped IHD
What are one of the most common causes of death in the young within modern day?
In the young, accidents account for 38% of deaths in boys and 23% in girls.
What are is the most common causes of death in men between 15-34 within modern day?
In men age 15-34 suicide is the main cause.
Since 1861 how much has the life expectancy increased in Scotland?
> 32.3 years for men
> 34.1 years for women
What is associated with unexpected death?
Profound sense of shock
What is meant by terminal care?
Terminal care is the last phase of care when a patients condition is deteriorating and death is close.
What is used prior to terminal care?
Palliative care is a more helpful term for the management of conditions until the terminal phase (When death is close) is reached.
What does the WHO state about palliative care?
‘Palliative care improves the quality of life of patients and families who face life- threatening illness, by providing pain and symptom relief, spiritual and psychosocial support… from diagnosis to the end of life and bereavement.”
What is palliative care?
A philosophy of care that emphasises quality of life.
Is performed by a multi disciplinary team.
Communication between members is essential.
Most provided in primary care with support from specialist practitioners and specialist palliative care units (or hospices).
GP’s can act as companions on a journey for patients undergoing palliative care.
In 2008 the Scottish Government developed a national action plan for palliative and end of life care, ‘Living and Dying Well’, what does it state?
‘Palliative care is not just about care in the last months, days and hours of a person’s life, but about ensuring quality of life for both patients and families at every stage of the disease process from diagnosis onwards…. Palliative care focuses on the person, not the disease, and applies a holistic approach to meeting the physical, practical, functional, social, emotional and spiritual needs of patients and carers facing progressive illness and bereavement.’
What modern concepts are applied in palliative care?
By identifying early which patients are likely to need palliative care we can discuss patient’s wishes with them and try where possible to care for them where they want to be treated and in a way that they want to be.
This allows planning and treatment from early on in their illness.
What is the supportive and palliative care indicators tool?
It is a guide for doctors to consider their patients who have a life-limiting diagnosis (eg. Cancer), or a worsening chronic condition (e.g. COPD), and highlight if they are at a stage where supportive and palliative care should take place. This starts with ‘Anticipatory Care Planning’, planning with the patient and their Carers what they want for their future care.
It encompasses:
1) Asking whether the patient is likely to die within the next 6-12 months
2) Looks for 2 or more general clinical indicator:
- Performance status poor
- Progressive weight loss over 6 months
- Two or more unplanned admission within 6 months
- A new diagnosis of a progressive, life limiting illness
- Patient is in a nursing car home or NHScontinuing care unit or needs care at home
3) Two or more disease related indicators:
- Heart disease
- Respiratory disease
- Kidney disease
- Liver disease
- Neurological disease
- Dementia
- Cancer
4) Asess patient and family for supportive and palliative care needs. Review treatment/medication. Plan care
What is the palliative performance scale?
Uses:
- Ambulation
- Activity and evidence of disease
- Self-care
- Intake
- Conscious level
to determine someones palliative care status and needs
Concepts of palliative care WHO?
1) Provides relief from pain and other distressing symptoms
2) Affirms life and regards dying as a normal process
3) Intends neither to hasten nor postpone death
4) Integrates the psychological and spiritual aspects of patient care
5) Offers a support system to help patients live as actively as possible until death
6) Offers a support system to help the family cope during the patients illness and in their own bereavement.
7) Uses a team approach to address the needs of patients and their families, including bereavement counselling if indicated.
Team Involved in palliative care?
In addition to the Health and Social Care Partnership Team discussed previously, there are several professionals that may be involved in palliative care situations.
These could include Macmillan Nurses, CLAN, Marie Curie Nurses, Religious or Cultural Groups amongst other support networks.
What is considered a “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
What is the preferred place of care?
Most people express the preference for a home death.
Only 26% achieve this.
Most of the final year is spent at home however.
The Gold Standards Framework offers tools to enable primary care to provide palliative care at home.
These include setting up a cancer register, reviewing these patients and reflective practice (eg SEA’s)
Concepts around breaking bad news?
1) Listen
2) Set the Scene
3) Find out what the patient understands
4) Find out how much the patient wants to know
5) Share information using a common language
6) Review and summarise
7) Allow opportunities for questions
8) Agree follow up and support
Reaction to bad news time scale?
1) Stable (Active)
2) Immobilisation (Passive)
3) Denial
4) Anger (Active)
5) Bargaining
6) Depression
7) Testing
8) Acceptance
Emotions:
- Shock
- Anger
- Denial
- Bargaining
- Relief
- Sadness
- Fear
- Guilt
- Anxiety
- Distress
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
Hospices?
15-20% of deaths occur here depending on the area.
Form part of the multidisciplinary care team.
Are generally underfunded.
Euthanisa?
Means ‘gentle’ or ‘easy’ death
Has now come to mean the deliberate ending of a persons life with or without their request
Illegal in the UK, Ongoing national debate
In the Netherlands the law changed in the late 1990’s to allow euthanasia under certain circumstances
Voluntary Euthanasia?
Voluntary Euthanasia – patients request
Non-voluntary euthanasia?
Non Voluntary Euthanasia – no request
Physician assisted suicide?
Physician assisted suicide – Physician provides the means and the advice for suicide.
Why do people request Euthanasia?
Less researched than the ethical arguments for and against.
Perhaps 3-8% of patients with advanced disease will ask to die.
The most common reasons are unrelieved symptoms or the dread of further suffering.
Some studies indicate that 60% of patients requesting euthanasia are depressed.
How should you respond if someone requests 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
