End of Life Care Flashcards
What are the most common causes of death?
Cancer
Ischaemic Heart Disease
What is the is the most common cause of death in the young?
Accidents
What are the most com on causes of death in men?
Suicide
What do unexpected deaths lead to?
Shock
Multiple deaths or legal/press involvement
Guilt/Sorrow as no chance to say bye or take back last words
When you expect a death, what types of care can be provided?
Terminal Care - last phase of care when patients condition is deteriorating
Palliative Care - management of conditions until terminal phase is reached.
According to WHO, what is palliative care?
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.
What does palliative care not take into account?
The disease/cause of the illness. It just wants to ensure patients wishes are met.
To the patients and carers, palliative care applies a holistic approach to the following needs: (6)
- Emotional
- Functional
- Physical
- Practical
- Spiritual
- Social
An approach that improves QoL of patients and families facing a life-threatening illness through prevention and relief of suffering are by:
- Early identification
- Impeccable assessment
- Treatment of pain and other problems (physical, psychological and spiritual)
What do you use to assess whether a patient is at a palliative stage and what does it involve?
Supportive and Palliative Care Indicators Tool (SPICT)
Involves anticipatory care planning
What is SPICT?
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
What questions does the anticipatory care plan answer?
- Where do they want to be cared for?
- Do they want to be resuscitated in event of cardiac arrest? Or die naturally?
- Who do they want to be informed about their condition/ changes to condition?
- Are they fully aware of their prognosis?
- Is family aware of prognosis?
What register should the patient be placed once having the discussions with them?
Palliative Care Register
- they inform out of hours services involved in patient’s care of their wishes
What is used to evaluate how quickly a situation is changing for the patient and see if care needs to be evaluated?
Palliative Care Performance Scale
Who is the Palliative Care register used by?
The practice to meet regularly to discuss cases (enhanced MDT). Out of hours services are also notified
Give some examples of symptoms addressed by the palliative care plan?
e.g.s include:
nausea,
insomnia, anxiety/depression/distress
Bottom line, no symptom should be ignored!
What are the WHOs goals of palliative care? (7)
- Provides relief from pain and other symptoms
- Affirms life and regards dying as normal process
- Neither hasten/hurry nor postpone death
- Integrates psychological and spiritual aspects of patient care
- Offers support system to help PATIENT live as actively as possible until death
- Offers support system to help FAMILY cope during patient’s illness and bereavement
- Uses team approach to address patient needs and families including counselling
Who makes up the palliative care team?
Macmillian nurses
CLAN
Marie Curie nurses
Religious or cultural groups
What are the six key aspects of a ‘good death’?
- Pain-free
- Open acknowledgement/proximity of death
- Death at home surrounded by friends and family
- An aware death where personal conflicts and unfinished business has been resolved
- Death as personal growth
- Death according to personal preference and in a manner that resonates with person’s individuality
what % of deaths occur in hospices?
15-20%
What are the 8 stages of 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 common language
- Review and summarise
- Allow opportunities for questions
- Agree follow up and support
What are some examples of reactions to receiving bad news?
shock anger denial bargaining relief sadness fear guilt anxiety distress
Stages to bad news/acceptance cycle?
Similar to examples, just in order!!
SIDAB DTA
Stability Immobilisation Denial Anger Bargaining
Depression
Testing
Acceptance
How long can a person grieve for?
Individual experience - Can take months-years and patient needs to be reassured that it’s normal
What is bereavement associated with?
Morbidity and mortality
Define Euthanasia
Deliberate ending of person’s life with or without their request; gentle or ‘easy’ death
ILLEGAL IN UK
What are the types of Euthanasia?
- Voluntary Euthanasia - patients request
- Involuntary Euthanasia - without patient’s request/patient unable to give informed consent
- Physician assisted suicide - physician provides means and advice for suicide
What is the most common reason for Euthanasia?
Unrelieved symptoms or dead of further suffering
What are the response stages to Euthanasia?
- Listen
- Acknowledge the issue
- Explore reasons for the request
- Explore ways of giving more control to the patient
- Look for treatable problems
- Remember spiritual issues
- Admit powerless
