General Flashcards
What is the definition of palliative care?
“Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual” - WHO (2002)
What are some key principles of palliative care?
Focused on achieving best QoL for patients + their formal caregivers + families/friends
Manages pain and other physical symptoms e.g. nausea, but also psychosocial and spiritual issues
For any patient with advanced progressive disease (COPD, heart failure, MND, dementia, cancer etc.)
Practised by a range of professionals in different settings (hospitals, community, hospice etc.)
How does palliative care differ from end of life care?
End of life care:
Care that patients, and their families, receive when the patient is likely to die within the next 12 months (is a part of palliative care)
When does palliative care start?
May begin from the time of diagnosis, alongside other formal therapeutic/disease modifying treatments e.g. chemo - palliative role will increase over time as life extending measures are exhausted/achieve all they can
Palliative care also includes bereavement care
What is ‘bad news’?
Any news that changes the perceptions of or direction of an individuals life
A positive pregnancy test might be good news to someone and bad to another - its intimately personal
How should you prepare the setting for delivering bad news?
When breaking bad news relating to end of life, privacy is one of the most crucial aspects to consider - find a room in advance and book this if possible
Depending on the nature of the bad news, the patient or family members may have many questions and issues to discuss - try to book a room without any time restrictions
Ensure that there is enough seating for patients. family and staff
Provide tissues and water
Ensure that an interpreter is available if necessary
Minimise disturbances as much as possible e.g. switch phones off and avoid using rooms near any building work that may be taking place
How should you prepare the patient for bad news?
Give as much detail regarding the meeting as possible e.g.
- Time and duration of meeting
- Location
- Map and directions
- Parking facilities and cost
- Contact details if they need to cancel or re-arrange
- A reminder letter a few days before the meeting
- Letting them know that they can bring someone with them for support
How should you prepare yourself for delivering bad news?
You need to find out all the relevant information about the patient prior to delivering any news e.g. past medical history and any previous test results.
You need to find out and become familiar with all the relevant information about the news you are about to deliver e.g. causes, consequences, side-effects and after-care.
Make sure you have all this information to hand.
Try to mentally rehearse the dialogue you will deliver.
Try to anticipate the questions likely to be asked and to rehearse your answers.
Listen attentively to the patient and respond appropriately to cues - patient may not behave in the way you had predicted or ask the questions you had anticipated – be prepared.
Consider the steps you will break the information down into.
What model can you use when breaking bad news?
Baile’s SPIKES:
Setting:
- Not at bedside, pre-booked private room with no interruptions, family present, time for discussion, water/tissues etc.
Perception:
- What does the patient think about what is happening? Already know? Fears? Can be done before news is broken, in order to set the scene/pitch at the right level
Invitation:
- Getting the patients permission to discuss the bad news, as they may not want to know everything about what is happening - “how much information would you like to know about your diagnosis and treatment?”
Knowledge:
- Warning shot - “I’ve got your test results and im very sorry to tell you…”
- Chunk and check in with patient understanding; ask if they have questions
- Ensure your knowledge is accurate/up to date, don’t be afraid to say you dont know
Emotion + empathetic response:
- “this is obviously very upsetting for you…” , “can i check in with how you’re feeling?” etc.
Strategy + summary:
- formulating F/U, discussing availability + format of further support
- summarising what has been discussed
How should you follow up a patient after delivering bad news?
No set rules about when is best to follow up - but plan should be made in the same session that the bad news is delivered in
The means by which followup is conducted can vary too - can be by phone or clinic appointment etc. - whatever is preferable to the patient
At the followup:
- patient understanding should be checked
- any concerns (from the professional or patient) should be explored
Successful followup helps patients feel less abandoned and better supported throughout a difficult time
What are the 5 priorities of care for the dying person?
Recognise that the person may die in the next few days/hours
Communicate sensitively with the patient (if able) and to those who are important to the patient those important to the patient that you believe they are dying
Involve the patient (where possible) and those important to the patient in care and treatment decisions
Support those important to the patient by exploring, respecting, and meeting their needs as far as possible
Create an individualised care plan
