Midterm Flashcards
Palliative care
Improves QOL for patients and families facing life-threatening illness
4 components of palliative care
Prevention and relief of suffering
Early identification
Assesment
Pain treatment
6 principles of palliative care
Patient and family are a unit systematic assessment of physical and emotional needs Communciation and support throughout Releive symptoms promptly Plan ahead and prevent problems Team approach
Hospice
Patient centred holistic care focusing on QOL and extending support to families
EOLC
Focus on last 6 months of life
% of HIV patients in developing countries
98%
% of opioids consumed in western countries
90%
Developing world resources
5% of cancer resources but 2/3 patients
% of hospital beds taken by EOL patients who dont want it
20%
% of people who die in hospitals
60%
Increase in elderly pop
2-3x
People that can benefit from palliative care but dont get it
100 million
Support and Palliative care indicators tool
Used identify advanced illness and those in need of palliative care
6 steps to palliative care
Discussion about end of life Assesment, care planning and review Coordination of care Delivery of high quality services in different settings Care in the last days of life After detah--> bereavemnt
Palliative care areas to imporve
Recognition of those who are dying
Out of working hoiurs service
Patients without cancer
Greater cultural consideration
7 Cs Gold standrad of PC
Communication Coordination Control of symptoms Conitnuity out of hours Continued learning Carer supports Care in the dying phase
5 rights of patients
Confidentiality Pain control setting of death Degree of carer involvement Deny illness
% who think of EOL issues
74%
% that support palliative care
96%
% that prefer to die at home
75%
hours of caregiving required ot die at home
54 hrs/week
Canadas ranking for quality of death
11/80
% who suffer from chronic illness
32%–> 74% of seniors have more than one
% of deaths from chronic illness
70%
Dementia prevalance
8% 65 and up
1/3 over 85
Amount saved with hospital based PC
2.1 billion–> 50% savings
% who feel they cant care give for family
65%
$ from informal care giving
25 billion
Informal care giver
54% women
44% aged 45-64
28% are raisign children
4 major conditons requiring care
Aging (28%)
Cancer (11%)
CVD (9%)
Mental illness (7%)
% of PC doctors who focus on palliative care, and who are specialists
12% focus on PC
5% are specialists
% of PC docs that do home visits
68% for Canada
75% in ontario
44% in Quebec
Symptoms of dying
Fatigue
Respiratory secretions
Mouth care
Restlessness and agitation
4 things needed to die at home
Family or care givers
Adequate nursing care
Night sitting service
Access to specialist palliative care
4 quality outcomes of terminal care
Preffered place of death
successful symptom management
Spiritual care
Good experience for care givers
4 psychosocial needs
fear
guilt
anger
uncertainty
DNACPR
do not attempt cardiopulmonary resuscitation . Order discussed and kept with patient
4 components of general care at EOL
Positioning and pressure care
Mouth and eye care
Bladder and bowel care
Fluid and nutrition
Death anxiety
Thought by Freud and sociologists to bind and preserve social groups
4 factors in a death system
Exposure to detah
life expectancy
Percieved control over forces of nature
Perception on what it means to be human
3 levels in evealution of spirituality
Routine asessmenrt –> all patients
Multidiscliplinary assessment
Specialist assessment
Kubler Ross stages
Denial Anger Bargaining Depression Acceptance
Total pain
Includes emotional, social and spiritual suffering as well as physical
Frued
Reality of death is repeatedly tested until attachment from deceased is withdrawn
Bowlby 4 stages of bereavemrnt
numbing
yearning and searching
disorganization and despair
Reorganisation
Wordens tasks of bereavement
Accept reality of loss
Work through pain and grief
Adjust to environment which person is missing
Emotionally relocate desceased and move on
Strobe and Schut Dual process theory of coping
Oscillate betwen loss and restoration
Klass. et al
No breaking down of bonds, just create a new healthy attachment that is compatible with existing relationships
Range of response to loss
Overwhelmed–> immediate response
Controlled: Emotions are avoided
Vulnerability: Can persist in those with limited capacity
Resilience: Growing inner strength
Adult attitude to grief scale
Assess level of vulnerability to pathologic bereavement
3 complicated bereavement reatcions
Absent
Delayed
Chronic
Lindeman 5 subgroups of grief symptoms
Somatic distress preoccupation with images Guilt Hostility Meaningless activity
7 Key transition points in holistic assesment of cancer patinets
diagnosis beginning of treatment completion of primary treatment Each new episode of disease Recognition of incurability Beginning of end of life Dying is imminent
emotional thermometer
Distress, anxiety, depression , anger and help wanted
6 sources for bereavement management
Written info Primary care team Specialist bereavement services Hospital based services Funeral directors Volunteers
Fiduciary
Professional relationship built on trust
Double effect doctrine
Recognition that bad consequences are possible in doing good –>
Original action is good
Sole intention of the act is good
Good effect is not produced as a consequence of bad effect
Required outcome is significant enough to warrant risk
4 prima facie principles
Autonomy
Beneficence
non- maleficence
justice
Distributive justice
Fair spread of scarce resources
Deontology
Good means doing the right thing regardless of outcome. Duty ethics–> some acts are just wrong
Consequentialism
Cost-benefit analysis of likely outcome. Good action produces best result for the most people, produces the most benefit despite intentions
Morality
Absolute values vs moral relativism
Kolva study amount of people who were seriously impaired in at least one capacity
1/3
highest rates in understanding and reasoning
MacCat capacity
Significantly associated with cognitive funstion and education, not with anxiety or depression
% who have not heard of ACP
86%
Fowler and Hammer results
10-15% treated in ICU during final admission
12% wanted life prolonging tretaments
48% had an ACP
