Issues Relating to Death & Dying in America Flashcards
the view of advanced Illness and the care that is involved
- 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
what constitutes good quality care at end of like for healthcare team?
providing symptom management and discussing emotional aspects of the disease
what constitutes good quality care at end of like for patients
achieving a sense of control, attaining spiritual peace, succeeding in having finances in order, strengthening relationships with loved ones, believing their life had meaning
what was the focus of medicine in early 1990’s
comfort
what was the cause of death in the early 1990’s
infectious diseases and communicable diseases
what was the death rate in the early 1990’s
1720 per 100,000
what was the average life expectancy in early 1990’s
50 years old
who was the caregiver in the early 1990’s
Family
what was the disease/dying trajectory in the early 1990’s
relatively short
what is the current focus in medicine
cure
what is the current cause of death
chronic illnesses
what is the current death rate
800.8 per 100,000
what is the current life expectancy
77.8
who are the current care givers
strangers/ healthcare providers
where is the current site of death
institutions
what is the current disease/dying trajectory?
prolonged
what is the Toll of death and dying on patients & family/caregivers
- 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
how many adults provide unpaid care to sick/disabled adults?
44 million
how many hours do caregivers spend on taking care of pts
average of 21 hours
what makes up most of the caregivers
most are women in their mid 40’s working full time
what is the cost of uncompensated care?
257 billion/year
what percent of veterans die in a non-VA hospital
96%
how many US vertrans are there
23,442,000
how many WWII vets die a day
900
what percent of all US deaths do veteran account for?
28%
where do most veterans live?
rural communities
how many veterans are with out shelter or healthcare
121,000
what is the national consensus project for quality palliative care (NCP)
promotes evidence based practices to optimize palliative care programs
what did the National Quality Forum (NQF) do?
develops quantifiable quality indicators
what is the Joint commission
advanced palliative care
what are the NCP and NQF 8 domains of palliative care?
- structure and process of care
- physical aspects of care
- psychosocial/psychiatric aspect of care
- social aspects of care
- cultural aspects of care
- spiritual, religious, and existential aspects of care
- care of the immediately dying
- ethical and legal aspects of care
palliative care compliments national aim to improve quality of care at what level
local, state, national level
what are barriers to quality of care at the end of life
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
hospice definition
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
palliative care definition
Palliative care is treatment of the discomfort, symptoms, and stress of serious illness.
hospice medicare benefit eligibility criteria
-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
payment for hospice care
medicare
medicaid
most private insurers
payment for palliative care
philanthropy
fee for service
direct hospital support
what are the 4 categories of quality of life model?
Physical
psychological
social
spiritual
what are the assessment tools for palliative care
physical symptoms emotional symptoms spirituality quality of life caregiver outcomes
what are the 2 parts of prognostication
foreseeing (estimate prognosis)
foretelling (discussing prognosis)
Karnofsky performance status
ECOG poor predictors, multiple symptoms, biological markers
Kay, a 68-year-old woman with heart failure
Dyspnea at rest
On ACE inhibitors and beta blockers
Ejection fraction (EF)
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?
role in improving palliative care
somethings cannot be fixed
use of therapeutic presence
maintaining a realistic perspective
Extending palliative care across setting
Nurses as the constant
Expanding the concept of healing
Becoming educated
Joint commission Accreditation Healthcare organization (JCAHO) Advanced Certification in Palliative Care
