end of life care

Question 1

most common causes death

Answer 1

cancer

IHD

Question 2

main cause death men 15-34

Answer 2

suicide

Question 3

scottish life expectancy increase since 1881

Answer 3

32. 3yrs for men

34. 1yrs for women

Question 4

unexpected death

Answer 4

causes profound sense of shock, no time to say goodbye

Question 5

terminal care

Answer 5

last phase of care when patient’s care deteriorating and death is close

Question 6

palliative care

Answer 6

management of conditions until terminal phase is reached

emphasises quality of life

Question 7

who provides palliative care

Answer 7

mostly provided by primary care with support from specialist practitioners and specialist palliative care units

GPs can act as companions on journey

Question 8

WHO - palliative care

Answer 8

• relief from pain, other distressing symptoms
• affirms life and regards dying as normal process
• psychological and spiritual aspects
• support system to help patient live as actively as poss
• support system to help families cope
• team approach to address needs of pt and fam

Question 9

important aspects of care

Answer 9

recognising early someone is dying and communicating that
taking time to find out wishes and ocncerns of patient and family
pre-empting problems rather than reacting to them e.g. symptoms control, home aids

Question 10

palliative performance scale

Answer 10

assess and review functional changes in palliative patients

describes patient functional level, prognostic value

Question 11

lower PPS score at initial assessment

Answer 11

indicates poorer prognosis

Question 12

falling PPS score

Answer 12

inc risk of death compared with other patients whose PPS scores remain static/improve

Question 13

disease trajectory 1: typically malignancy

Answer 13

• weight loss, reduced performance, impaired ability over few months
• generally time to anticipate palliative needs and plan end of life care

Question 14

disease trajectory 2: heart failure, COPD

Answer 14

• patients unwell for months or years with acute exacerbations
• deteriorations assoc w hosp admissions, intensive Rx and health deterioration
• each exacerbation may result in death so timing of death uncertain

Question 15

disease trajectory 3: dementia, frailty

Answer 15

• progressive disability from already low baseline of cognitive/physical functioning
• combination of declining reserves and other events (minor illness, falls) lead to death
• trajectory may be cut short by acute event e.g. pneumonia

Question 16

understanding disease trajectory allows for

Answer 16

• discussion with patient about how their illness will progress
• early planning for care when nearing death incl where they want to die

Question 17

palliative care in 1ry care

Answer 17

• register of palliative patients
• practice team meet regular to discuss cases
• OOH also notified of palliative cases

Question 18

a good death

Answer 18

pain free
open acknowledgement of imminence of death
death at home, surrounded by friends, family
aware death - conflicts, unfinished buisness resolved
according to personal preference

Question 19

reactions to bad news

Answer 19

shock 
anger 
denial 
bargaining 
sadness
fear
guilt
anxiety 
distress

Question 20

blood test for heart failure

Answer 20

B-type natriuretic peptide

Question 21

end of life care in community

Answer 21

district nurse - admin medications
OH: assess environment, provision home aids
pharmacist: medication
GP: care, medication
care manager: co-ordinate provision of care

Question 22

care manager

Answer 22

advice re care packages and cost
link with shelter housing, nursing homes

GP or self referral

Question 23

palliative performance scale: areas looked at

Answer 23

ambulation
activity level
evidence of disease
self-care
oral in- take
level of consciousness.