Hospice and Palliative Care

Question 1

***What is palliative care?

Answer 1

• INTERDISCIPLINARY care that aims to relieve suffering and improve quality of life for patients with advanced illness and their families.
• Address symptom management.
• It is offered simultaneously w/ all other appropriate medical treatment.
• Requires a team → shorter length of stay

Question 2

***What is required to become a palliative and hospice specialist?

Answer 2

1 year fellowship in addition to family med or internal med residency.

Question 3

Does palliative care for the terminally ill include hospice care?

Answer 3

YES!

Question 4

***What are the requirements for hospice care?

Answer 4

#1=Prognosis < 6 months (needs 2 doctors to certify terminal illness)
#2=Covers all medical needs assoc. w/ terminal diagnosis
-Are allowed full medical treatment in the sense of what is rational for their diagnosis
#3=Is a “Part A” benefit
#4=Inter-disciplinary team (IDT)

Question 5

***What does POLST stand for? Why should you use it? Who needs to certify it?

Answer 5

Physician Orders for Life Sustaining Treatment
Why use POLST:
• Patient wishes often are not known
• Allows individuals to choose medical treatments they want to receive and identify those they don’t want.
• Allows healthcare providers to know and honor wishes during serious illness.
• Don’t need a witness; just patient and doctor need to sign it.

Question 6

***If you have a pt on an opioid w/ new onset abdominal distention and pain, what should you assume the problem is and what should you do?

Answer 6

Assume an obstruction and give a laxative (not a stool softener).

Question 7

***What is the #1 side effect of opioids?

Answer 7

Gastric dysmotility

Question 8

***If an elderly pt is exhibiting psychosis, what should you rule out? What is a common cause?

Answer 8

Rule out all secondary causes (meds) before determining a primary cause.
BENZOS are a major risk factor for delusional behavior in the elderly.

Question 9

What should you know about supplements for Hospice and Palliative Care Patients?

Answer 9

• Feeding tubes cause increased complications and skin wounds in dementia patients.
• Don’t improve pressure ulcer healing