Foundations in Palliative Care Flashcards
What is palliative care?
An approach that improves the quality of life for patients and their families
What is double intent?
Intends neither to hasten or postpone death
What are the three parts of palliative care?
1) Team approach
2) Enhance quality of life
3) Applicable early in the course of illness
What is the integrated model?
Introduce palliative care early in life-prolonging/curative therapy
Is hospice a component of palliative care?
Yes
Who is hospice for?
Patients with a life expectancy of 6 months
What do hospice teams provide patients and their families?
Expert medical care
Emotional and spiritual support
Focused on improving patient and family quality of life
Does hospice care include bereavement in the integrated model?
Yes
Does hospice care include bereavement in the traditional model?
No
What are the three palliative care outcomes?
1) Improve quality of life
2) Reduce needs for hospitalizations
3) Prolonged life
Is palliative care appropriate at any age and at any stage in a serious illness?
Yes
What are the physician roles for goals of care?
1) Communicate (transparent communication, patient oriented)
2) Assess (multiple aspects of a patient’s journey)
3) Treat (realistic interventions that promote quality of life and relief of symptoms)
What are the potential goals of care?
Cure of disease Avoidance of premature death Maintenance of improvement of function Prolongation of life Relief of suffering Quality of life Staying in control A good death Support for families and loved ones
What are the aspects of negotiating goals of care?
1) Assess (patient’s disease process, illness expectations, family dynamics, desired outcomes)
2) Explore (realistic goals, relief of symptoms, quality of life, belief system)
3) Create (open and honest communication, non-judgmental climate, patient-focused support)
4) Plan (preservation of patient dignity and autonomy, realistic care plans, multi-disciplinary support)
5) Review (ongoing changes, disease trajectories, QOL, patient/family welfare)
What are the four aspects of QOL?
Pain (musculoskeletal, myofascial, emotional)
Breathlessness (dypnea, orthopnea, hypoxemia)
Fatigue (multi-factorial, greatest effect on QOL)
General (nausea/vomiting, diarrhea/constipation, weight loss)
What is prognostication?
Aspect of clinical practice that serves to predict illness trajectories
What are examples of short period of decline?
Trauma
Sudden cardiac death
What are examples of chronic illness with exacerbations?
Heart failure
COPD
ESRD
What is an example of prolonged dwindling?
Dementia
What are examples of sudden neurologic impairment?
Hemorrhagic
Stroke
Neuro trauma
How do you evaluate prognosis?
Validated tools
Clinical experience
Evidence-base medicine
What are the benefits of accurate prognostication?
Gives a good framework in making informed decisions
Provides opportunity for life-care planning
Spiritual
Financial
Psychosocial
Opportunity to say “goodbye”
Life closure and legacy giving
Are the majority of physicians comfortable giving a prognosis?
No
What are the aspects of medical frailty?
1) Unintentional weight loss (loss of muscle mass)
2) Weakness in grip strength (impaired cognition)
3) Self-reported exhaustion (underweight)
4) Low physical activity (depression)
5) Slowed gait speed (decreased ADLs)
What does quantifying the degree of medical frailty allow for?
Physicians to identify futile interventions that will not alleviate symptoms and could worsen cognitive and function
Any intervention should aim to what?
Minimize symptoms and morbid conditions
What are the services covered by hospice under medicare?
Physician services
Nursing care
Medical supples and equipment
Prescription drugs for symptom control and pain relief
Nutritional counseling
Medicare hospice aide (certain circumstances)
Short-term inpatient care
Short-term respite care
Other Medicare-covered services to manage pain
What is a service NOT covered by hospice under Medicare?
Custodial care (living arrangements, facility placement for dependent care)
What are the aspects of Medicare hospice benefit?
1) Must be eligible for Medicare Part A
2) Medical certification of terminal illness with most 6 months survivability if the illness were to run its usual course
3) Patients can withdraw from Medicare hospice and return to normal Medicare coverage
4) Medicare hospice benefit requires the patient have designated health care proxy
5) There are other covered benefits that may continue to apply
6) Hospice care must come from a Medicare-approved hospice program
