End of Life Care Flashcards
What provides palliative care?
MDT
What Scottish government document provides the national action plan for palliative and end of life care?
“Living and Dying Well” - Produced in 2008
In Living and Dying Well, what needs of the patient are addressed (6)?
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 is a major benefit of identifying patients who will likely require palliative care?
Allows us to discuss the patient’s wishes with them and try, where possible, to care for them where they want to be treated and, in a way they want to be treated for
Draw a graph w/ function on the Y axis and time on the X axis, comparing the progression of malignancy, organ failure and dementia/frailty.
- Malignancy slowly progresses towards a rapid decline
- Organ failure has a relapsing and remitting course
- Dementia/frailty has a progressive decline
List 4 common symptoms experiences by palliative care patients
- Pain is often feared by patients
- Anxiety
- Insomnia
- Nausea
What is SPCIT and when may it be used?
- Supportive and Palliative Care Indicators Tool:
- A guide for doctors to consider their patients who have a life-limiting diagnosis (e.g. cancer), or a progressive chronic condition (e.g. COPD), to assess if they are at a stage where supportive and palliative care should be initiated
What is the first step of SPCIT?
- Anticipatory care planning:
- Carried out with the patient and their carers to decide what they want for their future care
What things are addressed in an ACP (6)?
- Where do they want to be cared for?
- Do they want to be resuscitated in the event of a cardiac arrest?
- 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 fully aware of their prognosis?
Once a patient has been diagnosed as at palliative stage of care, and once an ACP has been carried out, what should you do?
Place the patient on the practice’s Palliative Care Register
What things shoulde happen once the patient has been placed on the register (3)?
- The plan for the patient should be sent to the out of hours service so that anyone who may be involved in the patient’s care is aware of the patient’s wishes
- The practice will have regular palliative care meetings to discuss the patients on the palliative care register, with the MDT present to ensure that everyone is aware of the patient’s status
- The patient will be reviewed regularly
What can be used to evaluate how quickly the situation is changing for the patient and to assess whether their care requires re-evaulation?
The Palliative Performance Scale
Give 3 benefits of the PPS
- It is a useful communication tool for describing the patient’s current functional level
- It may have a value in criteria for workload assessment or other measurements and comparisons
- It appears to have prognostic value
How does the PPS work?
What are the 5 categories assessed?
How is the score given?
What would you do if all the columns were giving you a different score?
- The % score is determined by reading horizontally at each level to find a ‘best fit’ for the patient
- You will begin at the left column and work your way down until you reach the appropriate description for level of ambulation
- You will then do the same with the next column and so forth
- The column to the left of any specific column takes precedence in terms of the scoring
- If each column is giving you a different score, use the leftward precedence and clinical judgement to determine the score
What are consideref to be elements of “good death” in Western Culture (4 main)?
- Pain free
- 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
