Issues Relating to Death & Dying in America Flashcards

1
Q

the view of advanced Illness and the care that is involved

A
  • Freq emergency Rm visits
  • Increase in In-Patient Admiss
  • Futile care (taking care of patient where there is no benefit like a person with cancer)
  • Promote suffering
  • Increased risk of depression and anxiety
  • Promote complicated bereavement for family/caregivers
  • Tx continued near death may prevent/delay hospice services
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2
Q

what constitutes good quality care at end of like for healthcare team?

A

providing symptom management and discussing emotional aspects of the disease

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3
Q

what constitutes good quality care at end of like for patients

A

achieving a sense of control, attaining spiritual peace, succeeding in having finances in order, strengthening relationships with loved ones, believing their life had meaning

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4
Q

what was the focus of medicine in early 1990’s

A

comfort

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5
Q

what was the cause of death in the early 1990’s

A

infectious diseases and communicable diseases

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6
Q

what was the death rate in the early 1990’s

A

1720 per 100,000

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7
Q

what was the average life expectancy in early 1990’s

A

50 years old

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8
Q

who was the caregiver in the early 1990’s

A

Family

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9
Q

what was the disease/dying trajectory in the early 1990’s

A

relatively short

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10
Q

what is the current focus in medicine

A

cure

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11
Q

what is the current cause of death

A

chronic illnesses

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12
Q

what is the current death rate

A

800.8 per 100,000

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13
Q

what is the current life expectancy

A

77.8

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14
Q

who are the current care givers

A

strangers/ healthcare providers

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15
Q

where is the current site of death

A

institutions

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16
Q

what is the current disease/dying trajectory?

A

prolonged

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17
Q

what is the Toll of death and dying on patients & family/caregivers

A
  • Pt fears they will be a physical burden
  • If nothing more can be done will healthcare providers abandon them
  • How do families and caregivers adjust to role changes
  • may drain life savings and or go bankrupt to cover medical costs
  • older adults may be cared for by an aged spouse who is also ill
  • older children caring for a parent may also have acute or chronic illness
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18
Q

how many adults provide unpaid care to sick/disabled adults?

A

44 million

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19
Q

how many hours do caregivers spend on taking care of pts

A

average of 21 hours

20
Q

what makes up most of the caregivers

A

most are women in their mid 40’s working full time

21
Q

what is the cost of uncompensated care?

A

257 billion/year

22
Q

what percent of veterans die in a non-VA hospital

A

96%

23
Q

how many US vertrans are there

A

23,442,000

24
Q

how many WWII vets die a day

A

900

25
Q

what percent of all US deaths do veteran account for?

A

28%

26
Q

where do most veterans live?

A

rural communities

27
Q

how many veterans are with out shelter or healthcare

A

121,000

28
Q

what is the national consensus project for quality palliative care (NCP)

A

promotes evidence based practices to optimize palliative care programs

29
Q

what did the National Quality Forum (NQF) do?

A

develops quantifiable quality indicators

30
Q

what is the Joint commission

A

advanced palliative care

31
Q

what are the NCP and NQF 8 domains of palliative care?

A
  1. structure and process of care
  2. physical aspects of care
  3. psychosocial/psychiatric aspect of care
  4. social aspects of care
  5. cultural aspects of care
  6. spiritual, religious, and existential aspects of care
  7. care of the immediately dying
  8. ethical and legal aspects of care
32
Q

palliative care compliments national aim to improve quality of care at what level

A

local, state, national level

33
Q

what are barriers to quality of care at the end of life

A

failure to acknowledge the limits of medicine
lack of training for healthcare providers
hospice/palliative care services are poorly understood
rule and regulations
denial of death

34
Q

hospice definition

A

care is a type of care and philosophy of care that focuses on the palliation of a chronically ill, terminally ill or seriously ill patient’s pain and symptoms, and attending to their emotional and spiritual needs during end of life

35
Q

palliative care definition

A

Palliative care is treatment of the discomfort, symptoms, and stress of serious illness.

36
Q

hospice medicare benefit eligibility criteria

A

-The patient’s doctor and the hospice medical director use their best clinical judgment to certify that the patient is terminally ill with life expectancy of six months or less, if the disease runs its normal course

37
Q

payment for hospice care

A

medicare
medicaid
most private insurers

38
Q

payment for palliative care

A

philanthropy
fee for service
direct hospital support

39
Q

what are the 4 categories of quality of life model?

A

Physical
psychological
social
spiritual

40
Q

what are the assessment tools for palliative care

A
physical symptoms
emotional symptoms
spirituality
quality of life
caregiver outcomes
41
Q

what are the 2 parts of prognostication

A

foreseeing (estimate prognosis)

foretelling (discussing prognosis)

42
Q

Karnofsky performance status

A

ECOG poor predictors, multiple symptoms, biological markers

43
Q

Kay, a 68-year-old woman with heart failure
Dyspnea at rest
On ACE inhibitors and beta blockers
Ejection fraction (EF)

A

MAYBE
Here lies the problem with prognostication and determining the “6-months-or-less hospice rule.”
With these symptoms, current guidelines/literature indicate that predicting a 6- or 12-month prognosis would only promote a 50% accuracy rate

So how does one make a clinical judgment about a patient like Kay?
#1:  What are Kay’s goals of care?
#2:  What is Kay’s New York Heart Association (NYHA) Functional Classification?
44
Q

role in improving palliative care

A

somethings cannot be fixed
use of therapeutic presence
maintaining a realistic perspective

45
Q

Extending palliative care across setting

A

Nurses as the constant
Expanding the concept of healing
Becoming educated
Joint commission Accreditation Healthcare organization (JCAHO) Advanced Certification in Palliative Care