Ethics/Psych Flashcards
What is most common cause of death in bereaved pts?
Cancer and CV disease
Jehovah’s Witness may accept what blood product?
Albumin
True/False
75% of hospice pts are at least 85 y/o?
AA are more likely to enroll in hospice compared to whites?
1/3 of hospice pt dies at in-pt facility?
Majority of hospice pts die at home?
False. 40%
False
True
False, majority die in-pt or SNF.
True/False.
Pts with continuous home hospice care were equally likely to die in home regardless of socioeconomic status.
True.
What are preferences of lower socioeconomic pts?
Less likely to receive palliative care, more likely to have aggressive end of life care/admit to ICU, more likely to die in hospital, more likely to have physician directed care.
What 2 cancers are most commonly associated with anxiety?
Lung and melanoma
True/False.
Most families will agree to an autopsy if asked.
True.
True/False.
Most pts want to know about their diagnosis but few want to know details of their diagnosis.
True.
Can parents withhold life/limb saving interventions for their minor children?
No, physician does not consent from parents to treat. Minors are legally incompetent.
What is 1st line treatment for complicated grief?
Targeted CBT. NO studies to support antidepressants as tx of complicated grief without underlying psychiatric disease.
Name 5 risk factors for complicated grief?
- Premature/unexpected death
- Hx of psychiatric disorders
- Nature of relationship to deceased
- Dysfunctional families
- Poor support system.
What disorder involves grandiosity, need for admiration, superficial relationships, and lack of empathy?
Narcissistic disorder
Histrionic does not have the extreme grandiosity and wants approval/attention of others.
What is treatment for complicated grief?
Cognitive Behavioral Therapy
In cancer SURVIVOR pts, what % experience anxiety and what are the greatest risk factors?
20%, Younger age (<60), female.
True/False. Artificial hydration can prolong dying process?
False, no evidence to support this. Controversial topic in hospice.
True/False? Over half of grieving pts w/hx of mental illness will experience psychiatric illness, suicide, during first year of loss of loved one?
False, 1/3 not half.
Muslim preference at end of life?
Needs to be cleaned of bodily fluids prior to praying
What is true about Buddhist belief?
Buddhists may avoid meds with animal byproducts.
What is % incidence of anxiety in cancer pts?
10%
What is countertransference?
When a provider transfers their personal thoughts onto a patient.
In Catholic pts, what is important at EOL?
Holy rites, viaticum before death.
True/False.
Pacemaker will not prevent death?
Disabling pacemaker will lead to swift death?
It is possible to disable a defibrillator without disabling pacemaker?
True.
False.
True.
True/False. About half of Medicare decedents are enrolled in hospice?
True
How do preschool children view death?
How about elementary children (5-9 y/o)?
Preschool = death is reversible Elementary = death is permanent
What is 1st line tx for insomnia in bereaved pts?
Cognitive Behavioral therapy
Difference between complicated grief and PTSD?
PTSD has fears, anxiety, and avoidance of trigger of event.
What is determined quantitative futility?
Less than 1% chance of successful intervention.
What is Judaism views in regards to end of life?
Life should be preserved however dying process should not be prolonged.
True/False. Less than 1/4 of Americans are in enrolled in hospice at time of death.
False, About 45 % enrolled in hospice.
Hospice requires bereavement counseling to families fora minimum of how long?
1 year.
When informing family of a death, how long into a conversation should you bring up that pt has died?
Within 30 seconds to 2 mins.
Sikhs preference at end of life?
Many like to say prayers immediately upon passing from family members, need to involve them at end of life. Prefer cremation over burial
What % of pts with advanced cancer meet psychiatric disorder? What is most common disorder?
50%, Adjustment disorder
What is distinctive feature of acute grief reactions?
Difference between complicated grief?
Intense thoughts and focus on memory of loss.
Complicated grief has disabling effects.
Acute grief is NOT a mental disorder
What is most common type of delirium?
Mixed.
Which group of pts have the highest risk of suicide, mental illness, and self-harm?
Pt’s who have lost a child
True/False? POLST form is part of AD?
False
What is 1st line tx for borderline personality disorder?
Psychotherapy, dialectal behavioral therapy.
What phobia is greater in cancer pts compared to general population?
Agoraphobia.
What do advanced directives consist of?
POA and living will.
Hindu preference at end of life?
Prefer male caregivers, involve many family members, gifs are common, value purity.
In cancer survivor pts, what risk factors are associated with fear of recurrence?
Frequent doctor visits (5 per year), poor social support, young, female with children, hx of recurrence.
What pt pop is higher risk of suicide in bereaved pts?
Risk of suicide is higher in non-caucasians, male, death of loved one by suicide, poor support, or hx of psychiatric disorder.
What psychiatric condition is most common in HIV and substance abuse population?
Major Depression.
True/False.
Majority of hospice pts transferred out of house before dying were transferred to ED.
False. Most transferred to in-pt hospice facility at death.
Which race has the lowest utilization of hospice?
Asians/Pacific Islanders.
What is one way to differentiate major depression from anticipatory grief?
Major depression has persistent thoughts of suicide. Cannot use anorexia, fatigue, insomnia, anger as depression in cancer its because overlap syndromes.
What tool can be used to screen for cultural preferences? What does it stand for?
ABCD.
Attitude, beliefs, context, decision making
According to USPSTF, what is % prevalence of elder abuse/neglect?
10%
What tool can be used to screen for elder abuse?
EASI
elder abuse suspicion index
In COPD/CHF pts, what % develop anxiety?
50%
