End of life care Flashcards
What are some reasons why unexpected death so hard to deal with?
Profound sense of shock
No chance to say goodbye
No chance to take back hasty words
Which factors may compound the damage of an accidental death?
Multiple deaths
Legal involvement
Press coverage
What is terminal care?
Last phase of care when a patient’s condition is worsening and death is close
What is palliative care?
Management of conditions until the terminal phase is reached
Where does palliative care take place?
Mostly in primary care with support from specialist practitioners and specialist palliative care unit or hospices
What is the purpose of palliative care?
Provides relief from pain and other distressing symptoms
Dying is a normal process, not hastened or delayed
Integrates psychological and spiritual aspects of care
Supports active living until death
Support for family
How may we be informed that a patient is in need of palliative care?
MDT may tell you
Patient or patient’s family may tell you
Your own knowledge of the patient over time
Support and Palliative Care Indicators Tool (SPICT)
Describe the possible disease trajectory of cancer.
Most reduction in weight and performance status occurs in the last few months
Generally time to anticipate care needs
Chance to concentrate more care on the last months of life
Describe the possible disease of trajectory of conditions like heart failure and COPD.
Unwell for months or years with acute exacerbations
Deteriorations often associated with hospital admissions/intensive treatment
Each exacerbation may result in death so timing of death is uncertain
Described the disease trajectory of dementia or generalised frailty.
Progressive disability from an already low baseline
Decline in reserves along with small events such as minor illness or falls lead to death
Trajectory can be cut short by an acute event such as pneumonia or a fracture
What are some key points in a palliative anticipatory care plan?
Where they wish to be cared for If, in the event of cardiac arrest, they wish to be resuscitated Are they fully aware of the prognosis Present symptoms Any particular worries from the patients Religious beliefs
What proportion of cancer/organ failure trajectories want to die at home?
65%
What proportion of deaths occur in hospices?
15-20%
Depends on the area
Describe some important factors in breaking bad news.
Listen Set the scene Establish patient's knowledge Review and summarise Allow opportunity for questions Agree follow up and support
What are Parkes’ stages of adjustment in grief?
Shock/immobilisation Denial Anger Bargaining Depression Testing Acceptance
