Module 4 Palliative Care Flashcards
1
Q
Palliative Care Definition
A
- An approach that improves the QUALITY OF LIFE of patients and families facing problems associated w/ a SERIOUS life-threatening illness
- Prevention and relief of suffering
- Impeccable assessment and treatment of pain and other problems
- Physical, psychosocial and spiritual needs - Multidisciplinary approach that focuses on the whole patient and family
2
Q
What does Hospice Cover?
A
- Cost of all meds related to terminal illness
- Durable medical equipment
- Physician services
- Visiting nurse services
- Home attendants
- Ambulance/transportation
- Short term inpatient stays for mgmt of acute conditions/Sx’s
- Respite care limited to 5 days maximum
- Bereavement support
- Use of a multidisciplinary team
3
Q
Why Don’t more Pt’s use Hospice?
A
- Cultural denial regarding death on part of patients and health care
- Lack of awareness of Medicare hospice benefit
- Pt’s and families hesitation to transition from curative care to palliative care
- Physicians apprehension about accurately predicting prognosis**
4
Q
Prognosticating Errors?
A
- Most all providers regardless of specialty overestimate life expectancy
- The better a provider knows the patient, the more likely he/she will err in determining prognosis
- Experienced providers are more likely to make accurate predictions
5
Q
How much longer do I have left?
A
- If a patient is making “changes”month by month, they generally have months to live
- If a patient is making “changes”week by week (day by day, hour by hour) they generally have weeks (days, hours) to live
6
Q
Engage your Patients EARLY for End of Life
A
- Name surrogate decision maker
- Complete an advance directive
- Conversation about goals of care
- Offer POLST
- EOL decision making
7
Q
My Wishes 5 Categories “Legal Document”
A
- A person that I want to make health care decisions for me when I can’t make them for myself
- My wish for the kind of medical treatment that I want or don’t want
- My wish for how comfortably I want to be
- My wish for how I want people to treat me
- My wish for what I want my loved ones to know
8
Q
Ask-Tell-Ask**
A
Based on notion that education requires knowing what the learner already knows and building on that knowledge
- ASK the patient to describe their understanding of issue (disease, prognosis)
- TELL the patient what you need to tell them — Be straightforward, avoid medical jargon
- ASK the patient if they understand what you said — Ask them to repeat it back or summarize
9
Q
“Tell me more”
A
- Great to use when you get stuck
- Tell me more about what information you need at this point
- Tell me more about how you are feeling about this news
- Tell me what this means for you and your life
10
Q
Breaking Bad News? SPIKES
A
- S: Set — Set up the situation, plan for emotions and be prepared
- P: Perception — What is the patient’s perception of the situation
- I: Invitation — How much does patient want to know
- K: Knowledge — Give a warning and use simple language — “I am afraid I have some serious news” Be straight forward
- E: Empathize — Use empathetic statements, don’t speak over the emotions
- S: Summarize and Strategize — Assess understanding, make plans for the next step
11
Q
Responding to Emotion: NURSE
A
- N: Name — Name the emotion “It sounds like you are frustrated”
- U: Understand — Understand the emotion “It must be hard to see your wife like this”
- R: Respect — Respect the patient “I am so impressed by how well you have taken care of you mother at home”
- S: Support — Support the patient “I will be here to support you through your chemo treatments”
- E: Explore — Explore the emotion “Tell me more about how this pain has been affecting your life”
12
Q
How to Conduct a Family Meeting?
A
- Decide who the “Key players” will be in the meeting — Patient, family, caregivers, clinicians, consultants
- Pre-meet if necessary
- Meet in a quiet and comfortably place
- Make introductions — explain everyone’s role
- Explain purpose of the meeting (set rules if needed)
- Ask about patient/family goals and expectations for meeting
- Ask patient or family what their understanding is of pt’s illness (ASK-TELL-ASK)
- Fill in the gaps in pt/family knowledge, describe clinical situation
