Hospice and Palliative Care Flashcards
Palliative Care =
patient and family-centered care
optimizes quality of life by anticipating, preventing, and treating suffering
Palliative care throughout the continuum of illness involves addressing the physical, intellectual, emotional, social and spiritual needs and to facilitate patient autonomy, access to information, and choice
General Principles of Palliative and Hospice Care
Client and family as unit of care
Attention to physical, psychological, social and spiritual needs
Interdisciplinary team approach
Education and support of client and family
Extends across illnesses and settings
Bereavement support
Hospice Care =
Ideally a patient living with chronic, debilitating or progressive disease receives palliative care throughout the course of the disease, and as death approaches, services are seamlessly increased to meet the patient’s individual needs
A diagnosis of six months or less to live
A desire to pursue comfort care over curative treatment
Goal is symptom management
Hospice Eligibility- highly regulated to qualify for reimbursement of services
Life-limiting condition with a prognosis of six months or less if their disease runs its normal course
Frequent hospitalizations in the past six months
Progressive weight loss (taking into consideration edema weight)
Increasing weakness, fatigue, and somnolence
A change in cognitive and functional abilities
Compromised Activities of Daily Living (ADLs)
Deteriorating mental abilities
Recurrent Infections
Skin breakdown
Specific decline in condition
Palliative Care vs. Hospice Care
Palliative Care- continue with life prolonging therapies/treatments.
Hospice Care- comfort care; no longer therapies/treatments to prolong life.
Curative and Palliative Approaches to Care
Palliative Focus
Client/Family identify unique end of life goals
Assess how symptoms, issues are helping/hindering reaching goals
Interventions to promote comfort
Curative treatment still indicated if desired
Quality of life closure
Principles of Hospice Care
All principles of palliative care apply
Difference is the shift is made to comfort care rather than curative care
No longer curative treatments
Symptom control
Attention to psychological, social and spiritual needs
Palliative Care and Hospice Care
Expert symptom relief
Suffering can be decreased
Allows for client and family to attend to issues
Patient and Family- unit of care
Relationship repair/enhancement as indicated
Goals of Care
Patient/Family Goals of Care
Goal directed care
Quality of Life- paramount
Role of Physical Therapy
Assist the patient in maintaining functional abilities for as long as they possibly can.
Reduce the burden of care for caregivers involved, including friends and family members.
Assist in pain control.
Active interprofessional team member.
PT Interventions
Pain management and relief
Positioning to prevent pressure sores, lessen pain, prevent contractures, and help with breathing and digestion
Endurance training and energy-conservation techniques
Gait training, transfers, safety instruction, stair climbing
Therapeutic exercises
Management of edema, a condition characterized by an excess of water in the body
Equipment recommendations, training and modification
Home modifications
Prognostication
Is poor for many non-cancer diagnoses
Referral is often made when death is imminent
Autonomy
Person’s right to self-determination, unrestricted by the control of others, even when it contradicts clinician’s recommendation
Hospice philosophy strongly supports client choice
Greatest fears
> being abandoned
> pain
Informed DECISIONS
Built on ethical principle of veracity or truth telling.
Truth telling is essence of open, trusting relationship.
Sense of knowing often relieves burden of the unknown
Patient Autonomy
Dignity and Respect
Accept patients and families “where they are”
