IDENTIFICATION OF DYING

Question 1

Why is it important to identify dying?

Answer 1

So that we can plan - advance care planning finances, treatment, seeing family, bucket list etc

Question 2

Prognostic tools?

Answer 2

SPICT tool (supportive and palliative care indicators tool)
GSF tool
RCP tool

Question 3

Questions you should ask yourself to determine if someone may be dying?

Answer 3

Do they have an advanced, progressive incurable condition?
Are they generally frail and have many coexisting conditions?
Would you be surprised if they died in the next 12 months?
Do they have existing conditions where they are at risk of dying from sudden acute crisis?
Do they have life-threatening acute conditions caused by sudden catastrophic events?

Question 4

What % of patients die after a chronic illness rather than a sudden event?

Answer 4

85%

Question 5

What % of patients find themselves not in a position to make own decisions when close to death?

Answer 5

50%

Question 6

Why is advanced care planning important?

Answer 6

Improves symptom control
Better end of life decision making around withholding and withdrawing Tx
Decisions to reduce active treatments and resuscitation even if deemed medically appropaira e
Discussions around place of care and death
Its personalised, patient orientated
Right care in the right place at the right time!

Question 7

What is the AMBER care bundle?

Answer 7

A bundle that aims to improve the quality of care for people whose recovery is uncertain and who may be approaching the end of their life
It helps doctors and nurses recognise when pt may not respond as well as they hoped to medical treatment and so their condition may deteriorate further
It improves decision making and communication between pt and their families. It provides the opportunity for pt to be actively involved with dusicussions about their treatments.

Question 8

What does AMBER stand for?

Answer 8

Assessment
Management
Best practice
Engagement
Recovery uncertain

Question 9

What are the 4 factors that affect our prognosis estimate?

Answer 9

What the diagnosis is
Pt preferences about what they want for treatment e.g. do they want Tx or do they want palliative care
Physiological parameters e.g. if they have HF do they have resistant oedema? Could be a poor prognostic indicator
Estimated trajectory of the disease