End Of Life Care- Tutorial 1

Question 1

Most common causes of death today

Answer 1

Cancer and IHD

Question 2

Main cause of death in the young

Answer 2

Accidents

Question 3

Main cause of death in men aged 15-34

Answer 3

Suicide

Question 4

What’s the increase in life expectancy for both men and women since 1861?

Answer 4

32. 3 for men

34. 1 for women

Question 5

What can unexpected death cause?

Answer 5

A profound sense of shock as there’s no chance to say goodbye, or take back hasty words

Question 6

What might accompany death by accidents? (3)

Answer 6

Multiple deaths
Legal involvement
Press coverage

Question 7

What’s SIDS and what may accompany it?

Answer 7

Sudden Infant Death Syndrome
It’s the unexplained death of a seemingly healthy baby of less than a year old
Parental blame may accompany it

Question 8

What’s terminal care and how does it differ to palliative care?

Answer 8

Terminal care=the last phase of care when a Px’s condition is deteriorating and death is close. Not only associated with cancer

Palliative care is the management before the terminal phase is reached

Question 9

How has the concept of palliative care changed? (4)

Answer 9

Now identifying who might need PC earlier
Discussing their wishes with them re PC
Using palliative care alongside their medical Tx
As time progresses PC becomes more dominant rather than a sudden change to PC

Question 10

Where is PC provided?

Answer 10

Majority in primary care with support from specialist practitioners and specialist palliative care units (hospices)

Question 11

What does the national action plan developed in 2008 (living and dying well) state about PC? (3)

Answer 11

PC isn’t just about care in the last few months
It’s about ensuring QOL at all stages of the disease but remaining focussed on the person, not the disease
Applies a holistic approach to both Px and carers

Question 12

What does WHO have to say about PC? (4)

Answer 12

It aims to provide relief from pain and distressing S
Not to hasten or postpone death
Acts as a supportive system via a team approach for Px and their families

Question 13

What’re the important aspects of PC are? (2)

Answer 13

Recognising early on that someone is dying and communicate that
Taking time to find out the wishes and concerns of the Px and family

Question 14

How do you know if a Px is at the palliative stage?

Answer 14

The supportive and palliative care indicators tool=a guide for docs to consider their patients with a life limiting condition and highlight if they’re at a stage where supportive and palliative care should take place

Question 15

What’s the palliative performance scale?

Answer 15

Used for assessing and reviewing functional changes in palliative Px
Lower score @ initial assessment=poorer prognosis
Don’t choose half fit values (eg 45%)-always use 10% increments

Question 16

What does the disease trajectory look like for a malignancy?

Answer 16

Steady but rapid decline from a high function to low function
Most weight loss, reduction in performance and impaired ability occurs in the last few months
There is generally time to anticipate PC and plans for end of life care

Question 17

What’s the disease trajectory like for organ failure (eg COPD)

Answer 17

Px unwell for months/years
Acute severe exacerbations cause dips in trajectory
Each exacerbation could cause death so timing of death is uncertain
Looks a bit like a declining mountain range

Question 18

What does a the disease trajectory look like for dementia or a generalised frailty?

Answer 18

Progressive disability so starts with a low baseline function
Straightish steady declining line
Trajectory can be cut off prematurely by an acute illness (eg pneumonia)

Question 19

What happens once a Px has been identified as being at a palliative stage of care? (4)

Answer 19

Placed on the practice’s palliative care register to coordinate ongoing care
The plan for the Px should be sent to out of hours service
Discuss with MDT
Use PPS

Question 20

Name 3 significant and distressing symptoms that may be encountered in PC

Answer 20

Anxiety
Insomnia
Nausea

Question 21

Who may be involved in PC?

Answer 21

Health and social care partnership team 
Macmillan nurses 
CLAN
Marie nurses 
Religious or cultural groups

Question 22

How many people want to die at home? How many actual do?

Answer 22

65%, but only 26% do

Question 23

Which framework offers the tools to enable primary care to provide palliative care at home?

Answer 23

The Gold Standards Framework

Question 24

What tools does the Gold Standards Framework contain?

Answer 24

Setting up a cancer register
Reviewing these patients
Reflective practice

Question 25

Are hospices part of the MDT?

Answer 25

Yes

Question 26

How many deaths occur in hospices?

Answer 26

15-20%

Question 27

What’re the general principles of a good death?

Answer 27

A pain free one
Open 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 in their personal preference

Question 28

What’re the principles when breaking bad news? (8)

Answer 28

Listen 
Set the scene
Find out what the Px’s understands 
Find out what they want to know
Share info using a common language 
Review and summarise 
Allow opportunities for Qs
Agree follow up and support

Question 29

What’re the stages of reactions to bad news?

Answer 29

Stability 
Immobilisation 
Denial
Anger
Bargaining 
Depression
Testing 
Acceptance

Question 30

How long may grief last for?

Answer 30

Months or years

Question 31

What do voluntary euthanasia, non-voluntary euthanasia and physician assisted suicide mean?

Answer 31

VE=patient’s request
NVE=no request
Physician associated suicide=physician provides the means and advice for suicide

Question 32

What’re the principles of a response for euthanasia/PAS? (&)

Answer 32

Listen 
Acknowledge the issue
Explore the reasons for the request
Explore more ways of giving control to the Px
Look for treatable issues
Remember spiritual issues
Admit powerlessness