End of Life Care

Question 1

What are the most common causes of death?

Answer 1

Cancer

Ischaemic Heart Disease

Question 2

What is the is the most common cause of death in the young?

Answer 2

Accidents

Question 3

What are the most com on causes of death in men?

Answer 3

Suicide

Question 4

What do unexpected deaths lead to?

Answer 4

Shock
Multiple deaths or legal/press involvement
Guilt/Sorrow as no chance to say bye or take back last words

Question 5

When you expect a death, what types of care can be provided?

Answer 5

Terminal Care - last phase of care when patients condition is deteriorating
Palliative Care - management of conditions until terminal phase is reached.

Question 6

According to WHO, what is palliative care?

Answer 6

Emphasises on the improvement of QoL of patients and families who face life threatening illnesses by providing a symptoms of relief, spiritual and psychosocial support, from diagnosis to end of life and bereavement.
It is performed by MDT.

Question 7

What does palliative care not take into account?

Answer 7

The disease/cause of the illness. It just wants to ensure patients wishes are met.

Question 8

To the patients and carers, palliative care applies a holistic approach to the following needs: (6)

Answer 8

1. Emotional
2. Functional
3. Physical
4. Practical
5. Spiritual
6. Social

Question 9

An approach that improves QoL of patients and families facing a life-threatening illness through prevention and relief of suffering are by:

Answer 9

1. Early identification
2. Impeccable assessment
3. Treatment of pain and other problems (physical, psychological and spiritual)

Question 10

What do you use to assess whether a patient is at a palliative stage and what does it involve?

Answer 10

Supportive and Palliative Care Indicators Tool (SPICT)

Involves anticipatory care planning

Question 11

What is SPICT?

Answer 11

Supportive and Palliative Care Indicators Tool - Guide for doctors if patient has life limiting diagnosis and worsening chronic disease e.g. caner, COPD and highlights if they are at that stage for palliative care

Question 12

What questions does the anticipatory care plan answer?

Answer 12

1. Where do they want to be cared for?
2. Do they want to be resuscitated in event of cardiac arrest? Or die naturally?
3. Who do they want to be informed about their condition/ changes to condition?
4. Are they fully aware of their prognosis?
5. Is family aware of prognosis?

Question 13

What register should the patient be placed once having the discussions with them?

Answer 13

Palliative Care Register

- they inform out of hours services involved in patient’s care of their wishes

Question 14

What is used to evaluate how quickly a situation is changing for the patient and see if care needs to be evaluated?

Answer 14

Palliative Care Performance Scale

Question 15

Who is the Palliative Care register used by?

Answer 15

The practice to meet regularly to discuss cases (enhanced MDT). Out of hours services are also notified

Question 16

Give some examples of symptoms addressed by the palliative care plan?

Answer 16

e.g.s include:
nausea,
insomnia, anxiety/depression/distress

Bottom line, no symptom should be ignored!

Question 17

What are the WHOs goals of palliative care? (7)

Answer 17

1. Provides relief from pain and other symptoms
2. Affirms life and regards dying as normal process
3. Neither hasten/hurry nor postpone death
4. Integrates psychological and spiritual aspects of patient care
5. Offers support system to help PATIENT live as actively as possible until death
6. Offers support system to help FAMILY cope during patient’s illness and bereavement
7. Uses team approach to address patient needs and families including counselling

Question 18

Who makes up the palliative care team?

Answer 18

Macmillian nurses
CLAN
Marie Curie nurses
Religious or cultural groups

Question 19

What are the six key aspects of a ‘good death’?

Answer 19

1. Pain-free
2. Open acknowledgement/proximity of death
3. Death at home surrounded by friends and family
4. An aware death where personal conflicts and unfinished business has been resolved
5. Death as personal growth
6. Death according to personal preference and in a manner that resonates with person’s individuality

Question 20

what % of deaths occur in hospices?

Answer 20

15-20%

Question 21

What are the 8 stages of breaking bad news?

Answer 21

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 common language
6. Review and summarise
7. Allow opportunities for questions
8. Agree follow up and support

Question 22

What are some examples of reactions to receiving bad news?

Answer 22

shock
anger
denial
bargaining
relief 
sadness
fear 
guilt 
anxiety 
distress

Question 23

Stages to bad news/acceptance cycle?

Similar to examples, just in order!!

Answer 23

SIDAB DTA

Stability
Immobilisation
Denial
Anger
Bargaining

Depression
Testing
Acceptance

Question 24

How long can a person grieve for?

Answer 24

Individual experience - Can take months-years and patient needs to be reassured that it’s normal

Question 25

What is bereavement associated with?

Answer 25

Morbidity and mortality

Question 26

Define Euthanasia

Answer 26

Deliberate ending of person’s life with or without their request; gentle or ‘easy’ death
ILLEGAL IN UK

Question 27

What are the types of Euthanasia?

Answer 27

1. Voluntary Euthanasia - patients request
2. Involuntary Euthanasia - without patient’s request/patient unable to give informed consent
3. Physician assisted suicide - physician provides means and advice for suicide

Question 28

What is the most common reason for Euthanasia?

Answer 28

Unrelieved symptoms or dead of further suffering

Question 29

What are the response stages to Euthanasia?

Answer 29

1. Listen
2. Acknowledge the issue
3. Explore reasons for the request
4. Explore ways of giving more control to the patient
5. Look for treatable problems
6. Remember spiritual issues
7. Admit powerless