INTRODUCTION

Question 1

What is palliative medicine?

Answer 1

The active holistic care that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual
I.e. relief of symptoms or problems associated with an illness without necessarily curing the disease process or attempting to prolong life

Question 2

Principles of palliative care?

Answer 2

Provides relief from pain and other distressing symptoms.
Affirms life and regards dying as a normal process.
Intends neither to hasten nor postpone death.
Integrates the psychological and spiritual aspects of patient care.
Offers a support system to help patients live as actively as possible until death.
Offers a support system to help the family cope during the patient’s illness and in their own bereavement.
Uses a team approach to address the needs of patients and their families, including bereavement counselling, if indicated.
Will enhance quality of life, and may also positively influence the course of illness.
Is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications.
It doesnt stop when someone dies; it includes care of the bereaved
Its not just about dying, its also about living

Question 3

What is the thanatophobia scale?

Answer 3

A scale that measures feelings associated with thanatophobia which is the fear of death

Question 4

Why do we consider most deaths to be predictable to some extent?

Answer 4

As at least 12% of hopsital inpatients have a prognosis of <3 months
86% of all deaths follow a period of illness or frailty

Question 5

Aims of general palliative care?

Answer 5

Provide information for persons and carers with signposting to relevant services
Accurate and holluistic assessment of a persons needs
Coordinate care teams in and out of hours and across boundaries of care
Provide basic levels of symptoms control
Provide psychological social, spiritual and practical support
Have open and sensitive communication with the person, their carers and professional staff

Question 6

What is specialist palliative care?

Answer 6

These are services that manage complex palliative care problems that cannot be dealt with by generalist services
Under direction of a consultant physician in palliative medicine
They include multidisciplinary specialist palliative care teams to provide assessment, advice, and care to people with advanced cancer in all locations. They also include specialist in-patient facilities and bereavement support services

Question 7

What is general palliative care?

Answer 7

Palliative care that can be provided in any location, using a palliative care approach by HCPs who have had additional training and experience of palliative care principles

Question 8

What is the palliative care approach?

Answer 8

This aims to promote birth physical and psychosocial well being
Its a vital and integral part of all clinical practice whatever the illness or stage and is informed by knowledge and practice of palliative care principles

Question 9

When should you refer someone to palliative care?

Answer 9

When a pt presents with complex care needs or is diagnosed with a life limiting condition
Think about asking yourself questions like “Would you be surprised if this person died in the next 6 months?”

Question 10

Physical needs of patients in palliative care?

Answer 10

Symptoms - pain, SOB, cough, n&v, constipation, poor appetite, fatigue, insomnia
Changes in functional ability may also create physical needs e.g. need for help with mobilising or ADLs

Question 11

Psychological needs of patients in palliative care?

Answer 11

Low mood, anxiety, irritability, tearfulness, guilt, apprehension, a germ fear, hopelessness, isolation
Anticipation of symptoms such as pain can be as problematic as the pain itself
Psychological needs may result from relationship or communication problems, difficlty coping or adjusting, or dealing with loss and grief

Question 12

Spiritual needs of patients in palliative care?

Answer 12

Religious needs
But also may include the need for meaning and purpose in life, the need for love and harmonious relationships and for forgivemenes, the need for a source of hope and strength, the need for trust, for expression of personal believes and values and for spiritual practices and the need to find meaning in suffering

Question 13

Social needs of patients in palliative care?

Answer 13

Practical
Financial
Legal
Supportive

Social workers are often involved with counselling, psychotherapy, psychosocial education to patients and family, palliative care philosophy, planning for discharge, facilitating advance care panning, advocating for patients, linking them with resources

Question 14

What is a hospice?

Answer 14

Inpatient unit where specialist palliative care services are provided

Involves inpatient beds, daycare facilities, outpatient facilities
Integrated with all other healthcare services i.e. the care follows the patient

Question 15

what % of NHS budget is spent on patients in their last uyear of life?

Answer 15

20%

Question 16

What wad the Liverpool care pathway?

Answer 16

A care pathway that covered palliative care options for patients in their final hours/days of life
Enveloped during late 1990s at the Royal Liverpool University Hospital
It was developed to help doctors and nurses provide quality end-of-life care

Question 17

Criticism of the Liverpool Care pathway?

Answer 17

Concerns that the use of LCP hastened peoples deaths though over-prescription of painkillers and the withdrawal of hydration & nutrition
Concerns around the diffiuclty of diagnosing when someone is actually going to die

Question 18

What happens in place of the Liverpool Care Plan?

Answer 18

One Chance to Get it Right came in June 2014

Question 19

What is One Chance to Get it Right report?

Answer 19

A report that sets out the approach to caring for dying people that health and care organisations and staff caring for dying people should adopt
It doesnt set out a protocol or process but instead details the ways in which care for people who are dying should be responsive to the overall needs and wishes of individuals and their families

Question 20

What are the 5 priorities of care in One Chance to Get it Right?

Answer 20

The possibility that a person may die in the next few hours/days is recognised and communicated clearly, decisions made and actions taken in accordance with the persons needs and wishes, and these are regularly reviewed and decisions revised accordingly

Sensitive, regular, clear, honest communication takes place between staff and the person who is dying and those identified as important to them

The dying person and those identified as important to them are involved in decisions about treatment and care to the extent that the dying person wants to

The needs of families and others identified as important to the dying person are actively explored, respected and met as far as possible

An individual plan of care, including food and drink, symptom control, psychological, social and spiritual support is agreed, coordinated and delivered with compassion

Question 21

What is advance care planing?

Answer 21

A voluntary process of discussion and review to help an individual who has capacity to anticipate how their condition may affect them in the future and, if they wish, to set on record: choices about their care and treatment, advance decisions to refuse a treatment in specific circumstances, so that these can be referred to by those responsible for their care or treatment in the event they lose capacity to decide once their illness progresses

Question 22

What is an advance decision to refuse treatment?

Answer 22

This is a decision to refuse specified treatment made in advance by a person who has capacity to
do so.
This decision only applies at a future time when that person lacks capacity to consent to, or
refuse, the specified treatmen

Question 23

What is an independant Mental Capacity Advocate?

Answer 23

If a person who lacks capacity has no close family or friends and has not recorded any choices about their care and treatment or made an advance decision to refuse treatment in advance of losing capacity, then an IMCA should be instructed and
consulted regarding decision making about serious medical treatment or about placement in hospital for longer than 28 days or a care home for longer than 8 weeks.

Question 24

What is a lasting power of attorney?

Answer 24

An LPA is a statutory form of power of attorney created by the Mental Capacity Act 2005.
Anyone who has the capacity to do so may choose a person (an ‘attorney’) to take decisions on their behalf if they subsequently lose capacity.
There are two types of LPAs: (a) for
health and welfare; (b) for property and affairs.

Question 25

what % of people die in hospital

Answer 25

About 50%

Question 26

What is the Edmonton Symptom Assessment System,?

Answer 26

A tool designed to assist in the assessment of 9 symptoms common in cancer patients: pain, fatigue, nausea, depression, anxiety, drowsiness, appetite, wellbeing, SOB
Its a pt opinion on the severity of symptoms

Considered gold standard for symptom assessment

Question 27

What was the End of Life Care Strategy?

Answer 27

focuses on the care of people who are approaching the end of their life which means they are likely to die within the next 12 months. This includes care of both the patient and their loved ones when death is imminent and is expected within a few hours or days.

Question 28

Radical vs adjuvant vs palliative oncological interventions?

Answer 28

Radical treatments are aimed at eliminating or eradicating the cancer completely e.g. surgery or radiotherapy

Adjuvant treatments are used in addition to the primary or main treatment (such as surgery) to reduce the risk of cancer recurrence e.g. chemotherapy

Palliative treatments focus on improving the quality of life for individuals with advanced or metastatic cancer, rather than aiming for a cure.

Question 29

Marie curie v Macmillan nurses ?

Answer 29

Macmillan nurses care for people with cancer, from when they’re first diagnosed. They generally spend up to an hour in someone’s home, providing advice on managing pain and controlling symptoms, as well as emotional support.

Marie Curie Nurses care for people with all terminal illnesses, including terminal cancer, towards the end of their lives. They generally spend several hours at a time in your home providing care and support, usually overnight.