General Principles

Question 1

2 components of prognosis

Answer 1

clinician prediction
model based - data

mixed approach incorporates both

Question 2

where was the surprise question created/validated?

Answer 2

hemodialysis units

Question 3

What is the downfall of model based prognostication

Answer 3

don’t consider social determinants

population used to create model may not be demographically reflective

Question 4

which 3 symptoms are prognostically significant

Answer 4

dyspnea (COPD, cancer)
delirium
anorexia cachexia

Question 5

2 prognostic models for cancer

Answer 5

PaP score
PPI

Question 6

2 prognostic models in CHF

Answer 6

NYHA class
Seattle heart failure score

Question 7

COPD prognostic tool

Answer 7

BODE index

Question 8

ESLD prognostic tools

Answer 8

CPC
MELD (Na, 3.0)

Question 9

Dementia prognostic tools

Answer 9

FAST

ADEPT - advanced dementia prognostic tool

Question 10

2 common clinician biases about patient information preference

Answer 10

overestimate how much they know

underestimate how much they want to know

Question 11

what are 3 broad goals patients with serious illness are generally trying to balance?

Answer 11

prolonging life

improving symptoms

improving function

Question 12

3 key transitions through care trajectory:

Answer 12

curative to palliative

disease modifying therapy no longer effective

function can no longer be improved

Question 13

what is byock’s life cycle model of providing EOLC?

Answer 13

death is a natural end to life course, and has specific developmental tasks associated with it:
- life review
- resolving conflict
- forgiveness
- acceptance
- generativity

Question 14

growth at end of life occurs in which domains?

Answer 14

emotional
spiritual

Question 15

what is palliative rehab?

Answer 15

process of helping a person with progressive and terminal illness reach their best potential physical, social, psychological function in context of the physiological limitations

Question 16

3 types of rehab

Answer 16

preventative
restorative
supportive

Question 17

what are the characteristics of a good surrogate decision maker?

Answer 17

• capacity
• know the patient well (beliefs and values)
• sense of care and concern
• good advocate for patient wishes (in best interest)
• ability to function in emotionally challenging situations

Question 18

key evidence based barriers to advance care planning

Answer 18

• lack of autonomous patient involvement
• lack of patient awareness or readiness
• cognitive and emotional barriers to discussion
• lack of healthcare provider comfort and preparedness

Question 19

when to discuss GOC/ACP around cardiac implant devices

Answer 19

• time of implantation and yearly follow-ups
• at time of device complications
• at time of disease progression / medical complications
• when patient appears to be nearing EOL