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FOPC > End of life care > Flashcards

End of life care Flashcards

1
Q

Care of the Dying is..

A

one of the fundamental tasks of a good doctor

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2
Q

Today, what are the most common causes of death?

A

cancer and IHD
men aged 15-34 = suicide
accidents = 38% in young boys and 23% in girls

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3
Q

Describe features of an unexpected death (3)

A

Causes a profound sense of shock. No chance to say goodbye, or take back hasty words.

Accidents might be compounded by multiple deaths, legal involvement or even press coverage.
Deaths of children carry an even more profound sense of shock. SIDS has no definite diagnosis and may carry the stigma of parental blame

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4
Q

Describe features of an expected death (2)

A

Terminal care is the last phase of care when a patients condition is deteriorating and death is close.

It is often misleadingly only associated with cancer.

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5
Q

Palliative care is a more helpful term for the management of conditions until ?

A

the terminal phase is reached.

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6
Q

What does palliative care encompass?

A

end of life care regardless of cause of illness, and as doctors we are encouraged to consider which of our patients would benefit from palliative planning and treatment from early on in their illness.

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7
Q

identifying patients early that require palliative care allows?

A

discussions of the 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.

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8
Q

What is palliative care alongside?

A

the medical management of their condition and as time and their condition progresses the balance between managing the condition and managing the process of dying change to focus more on supportive and palliative care.

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9
Q

Palliative care main aim?

A

to improve the quality of life of a patient

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10
Q

Where is most palliative care provided?

A

primary care with support from specialist practitioners and specialist palliative care units (or hospices).

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11
Q

What is the WHO description of palliative care?

A

‘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.

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12
Q

What is stated in the Scottish governments living and dying well plan?

A

WHO definition followed by:
- 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.’ 2

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13
Q

WHO - Palliative care features (7)

A
  • Provides relief from pain and other distressing symptoms
  • Affirms life and regards dying as a normal process
  • Intends neither to hasten nor postpone death
  • Integrates the psychological and spiritual aspects of patient care
  • Offers a support system to help patients live as actively as possible until death
  • Offers a support system to help the family cope during the patients illness and in their own bereavement.
  • Uses a team approach to address the needs of patients and their families, including bereavement counselling if indicated.
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14
Q

Ways of pre-emptying problems?

A

symptom control, aids in the home, care staff, night nurses

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15
Q

Discussions should happen early between?

A

Patient, specialist, family, MDT team, OOH’S

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16
Q

How do we recognise that someone is in need of palliative care or that someone is dying? (3)

A

Often the MDT team will tell you
The patient themselves or their family might tell you
Clinical skill and experience – knowledge of the patient over time

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17
Q

How do you know if a patient is at a Palliative Stage?

A

The ‘Supportive and Palliative Care Indicators Tool’ - guide for doctors to consider patient’s with a life-limiting diagnosis e.g. cancer or worsening chronic e.g. COPD - highlights if they are at a stage palliative care should take place

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18
Q

Use of the palliative performance scale? - what does a lower PPS score mean?

A

low- at initial assessment indicated poorer prognosis

19
Q

What does a falling PPS score cause?

A

increased the risk of death compared with patients whose PPS scores remained static or improved.

20
Q

PPS scores are determined by?

A

reading horizontally at each level to find a ‘best fit’ for the patient who is then assigned as the PPS % score.

21
Q

Why may a PPS score be used? (3)

A
  • excellent communication tool for quickly describing a patient’s current functional level.
  • may have value in criteria for workload assessment or other measurements and comparisons
  • has prognostic value
22
Q

Trajectory of cancer?

A

Most weight loss, reduction in performance status and impaired ability occurs in the last few months - often time to put palliative care plans in place - may need resources eg hospice bed or marie curie nurses.

23
Q

Trajectory of heart failure or COPD?

A

Patients unwell for months or years with acute, often severe, exacerbations. Deteriorations often associated with hospital admissions and intensive treatment and lead to an overall gradual deterioration in health - each exacerbation may result in DEATH.

24
Q

Trajectory of dementia/frailty

A

Progressive disability from an already low baseline of cognitive or physical functioning. Combination of declining reserves and other events that in themselves may seem trivial (e.g. minor illness, falls, or just the difficulty of continuing with daily tasks) lead to death. The trajectory can be cut short by an acute event such as pneumonia or a fractured neck of femur which results in the patient dying sooner than expected.

25
Q

Understanding a disease trajectory allows for? (3)

A
  1. Discussion with the patient about how their illness will progress – help them gain control over their illness
  2. Early planning for care when nearing death including discussion regarding where they wish to die, DNR directives.
  3. Significant challenges particularly in managing patients with the second trajectory.
26
Q

Limitations of disease trajectory? (3)

A
  1. Patients may not follow it as concurrent illness or change in circumstances affect outcome
  2. Some illnesses don’t fit well e.g. stroke (depends on severity of stroke) or renal failure (steady decline determined by underlying condition)
  3. Does not map well for psychological or spiritual distress
27
Q

planning with the patient and their Carers what they want for their future care is called?

A

‘Anticipatory Care Planning’

28
Q

Once discussions have taken place and a patient is diagnosed as at a palliative state of care, what happens next?

A

practice’s Palliative Care Register - coordinates and enables ongoing care

29
Q

Once a patient is on the palliative care register, what happens next?

A

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 Multi- disciplinary team present, to ensure that everyone is aware of how the patient is.
Patient will be reviewed regularly.

30
Q

Palliative Care in Primary Care (4)

A

Practices have a register of palliative patients.
The practice team meet regularly to discuss the cases.
Enhances communication between team members.
OOH also notified of palliative cases.

31
Q

Symptoms and palliative care? (4)

A

Pain is often feared by patients.
No symptoms should be ignored.
For example anxiety, insomnia, and nausea may all be significant and distressing symptoms.
It is important to respond globally to the patient and his or her family.

32
Q

The team involved in palliative care? (5-6)

A

In addition to the Health and Social Care Partnership Team:

Macmillan Nurses, CLAN, Marie Curie Nurses, Religious or Cultural Groups amongst other support networks.

33
Q

Most palliative patients request?

A

home death 65% - only 26% actually achieve this

34
Q

The Gold standards framework offers tools to enable? - what does this include setting up? (3)

A

enable primary care to provide palliative care at home.

  • cancer register, reviewing these patients and reflective practice (eg SEA’s)
35
Q

% of deaths that occur in hospices?

A

15-20%

36
Q

What makes a ‘good death’ - the aim

A

working together with the multidisciplinary team and planning with the patient and carers is to achieve a ‘good death’ for our patients and their families based on their perspective.

37
Q

What makes a ‘good death’ - the principles (

A
  1. Pain-free death
  2. Death at home surrounded by family and friends
  3. To know when death is coming, and to understand what can be expected
  4. To be able to retain control of what happens
  5. To be afforded dignity and privacy
  6. To have control over pain relief and other symptom control
  7. To have choice and control over where death occurs (at home or elsewhere)
  8. To have access to any spiritual or emotional support required
38
Q

Breaking bad news to a patient about a diagnosis? (8)

A 
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
39
Q

What are the main patient reactions to bad news?

A 
Shock
Anger 
Denial
Bargaining
Relief 
Sadness
Fear
Guilt
Anxiety
Distress

Over time = ACCEPTANCE

40
Q

After Death - support?

A

the Health and Social Care Partnership Team is also there to support the bereaved.

41
Q

Describe some of the features of Grief? (5)

A
  1. Is an individual experience
  2. Is a process that may take months or years
  3. Patients may need to be reassured that they are normal
  4. Abnormal or distorted reactions may need more help
  5. Bereavement is associated with morbidity and mortality
42
Q

What is euthanasia and the 3 different types?

A

Means ‘gentle’ or ‘easy’ death

Voluntary Euthanasia – patients request
Non Voluntary Euthanasia – no request
Physician assisted suicide – Physician provides the means and the advice for suicide.

43
Q

Why do people request euthanasia? (3)

A
  • often those with an advanced disease
  • unrelieved symptoms or the dread of further suffering.
  • Some studies indicate that 60% of patients requesting euthanasia are depressed.
44
Q

Exploring euthanasia - responses? (7)

A 
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

FOPC (5 decks)

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