FOPC3 - End of life care

Question 1

What is the most common cause of death?

Answer 1

IHD and cancer
Accidents in young
Suicide in males aged 15-34

Question 2

What does palliative care focus on?

Answer 2

Management. of conditions until terminal phase reached
Quality of life
MDT approach
Most from primary care with palliative specialist support

Question 3

What are the. 4 step guidelines for identifying palliative care patients?

Answer 3

Ask
General clinical indicators
Two or more disease related indicators
Ask patient and family for supportive care needs

Question 4

What is the Palliative Performance Scale based on?

Answer 4

Activity
Evidence of disease 
Self-care 
Intake
Conscious level 
Ambulation

Question 5

What is palliative care according to WHO?

Answer 5

Relief from pain and other distressing symptoms
Affirms life and regards dying as normal process
Doesn’t hasten or postpone death
Integrates psychological and spiritual aspects
Offers support for patient and family
Team approach

Question 6

Who are part of the palliative care team?

Answer 6

GP
District nurse
Pharmacist 
Receptionist 
Care manager 
Palliative specialist 
Religious support e.g Chaplain 
3rd sector: MacMillan, CLAN, Marie Curie

Question 7

What is considered a “good death” in the Western World?

Answer 7

Pain free
Open acknowledgement 
At home with family 
'Aware death' - resolve conflicts and unfinished business
According to personal preference
See death as personal growth

Question 8

What is SPICT?

Answer 8

Supportive and Palliative Care Indicator Tool - identifies those at risk of deteriorating health and dying

Looks for two or more general indicators of deteriorating health and look for clinical indicators of one or more advance conditions.

Question 9

What are signs of late stage heart disease where supportive and palliative care should take place?

Answer 9

NYHA Class III/IV HF
SBP<100
HR >100
eGFR<30
2 or more acute episodes needing I therapy in past 6 months 
SOB/chest pain on minimal exertion

Question 10

What is the function of the palliative performance scale?

Answer 10

Assess and monitor change in condition

Question 11

Draw the disease trajectory graph.

Answer 11

…

Question 12

What is the Gold Standards Framework?

Answer 12

Offers tools to provide palliative care at home

Question 13

What is important when breaking bad news?

Answer 13

Listen 
Set the scene
Find out what patient knows and how much they want to know
Use common language
Review and summarise
Allow opportunity for Qs
Agree follow-up and support

Question 14

What does successful ageing depend on?

Answer 14

Individual and socio-cultural factors

Question 15

What are the 5 stages of grief?

Answer 15

1. Denial
2. Anger
3. Bargaining
4. Depression
5. Acceptance

Question 16

What is the difference for family members between sudden and expected loss?

Answer 16

Sudden = more difficult to adjust to

Question 17

What is the DS1500 form?

Answer 17

Used for benefit claims for last 6-12 months of life (jump list for housing, access to benefits etc)

Question 18

What medications should be prescribed in terminal phase?

Answer 18

For:

1. Pain (opioids e.g morphine, fentanyl patches, NSAIDs)
2. Agitation (benzodiazepines e.g midazolam)
3. Respiratory secretions (anticholinergic drugs e.g hyoscine butyl bromide)
4. Nausea (Anti-emetic e.g haloperidol, cyclizine, metoclopramide, levomepromazine)
5. Breathlessness (positioning, fan, cool environment, oxygen, benzodiazepines, opioids)

*Administer via subcutaneous bolus or continuous subcutaneous infusion over 24hrs or via syringe pump.

Question 19

What comfort measures are taken in last days of life?

Answer 19

Review meds
Reduce medical intervention to a minimal
Symptom control drugs
Regular oral care
Skin care
Bladder and bowel care
Always consider possible sources of stress other than pain

Question 20

What is required for good care of the dying patient?

Answer 20

Recognition 
Care objectives
Resuscitation status clarification 
Good communication 
Consider place of care
Multiprofessional care
Drugs

Question 21

How do you recognise a patient is dying?

Answer 21

Daily continuous deterioration 
Profound weakness and drowsiness
Difficulty taking things by mouth 
Poor concentration 
Disorientation 
Reduce peripheral perfusion with changes in skin colour and temperature
Breathing pattern may change 
PPS is 10%