General Principles Flashcards
2 components of prognosis
clinician prediction
model based - data
mixed approach incorporates both
where was the surprise question created/validated?
hemodialysis units
What is the downfall of model based prognostication
don’t consider social determinants
population used to create model may not be demographically reflective
which 3 symptoms are prognostically significant
dyspnea (COPD, cancer)
delirium
anorexia cachexia
2 prognostic models for cancer
PaP score
PPI
2 prognostic models in CHF
NYHA class
Seattle heart failure score
COPD prognostic tool
BODE index
ESLD prognostic tools
CPC
MELD (Na, 3.0)
Dementia prognostic tools
FAST
ADEPT - advanced dementia prognostic tool
2 common clinician biases about patient information preference
overestimate how much they know
underestimate how much they want to know
what are 3 broad goals patients with serious illness are generally trying to balance?
prolonging life
improving symptoms
improving function
3 key transitions through care trajectory:
curative to palliative
disease modifying therapy no longer effective
function can no longer be improved
what is byock’s life cycle model of providing EOLC?
death is a natural end to life course, and has specific developmental tasks associated with it:
- life review
- resolving conflict
- forgiveness
- acceptance
- generativity
growth at end of life occurs in which domains?
emotional
spiritual
what is palliative rehab?
process of helping a person with progressive and terminal illness reach their best potential physical, social, psychological function in context of the physiological limitations
3 types of rehab
preventative
restorative
supportive
what are the characteristics of a good surrogate decision maker?
- 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
key evidence based barriers to advance care planning
- lack of autonomous patient involvement
- lack of patient awareness or readiness
- cognitive and emotional barriers to discussion
- lack of healthcare provider comfort and preparedness
when to discuss GOC/ACP around cardiac implant devices
- 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
