Other bits Flashcards
What are the 2 scales used for WHO performance status
Zubrod
Karnofsky
Describe the Zubrod scale
0 - Normal activity
1 - Symptomatic and ambulatory, cares for self
2 - Ambulatory >50% of time, occasional assistance
3 - Ambulatory <50% of time, req. nursing care
4 - Bedridden
Describe Karnofsky’s scale
100 - Normal, no evidence of disease
90 - Able to perform normal activities, minor symptoms
80 - Normal activity with effort, some symptoms
70 - Able to care for self but unable to do normal activities
60 - Req. occasional assistance, care for most needs
50 - Req. considerable assistance
40 - Req. special assistance, Disabled
30 - Severely disabled
20 - Very sick, req. active supportive treatment
10 - Moribund
What are the benefits of being managed by an MDT?
Accurate diagnosis and staging
Choice of treatments from group of experts, not just 1 doctor
Better co-ordination and continuity of care
Treated in line with local policies/guidelines
Appropriate and consistent information
Psychological and social needs considered
What are the disadvantages to being managed by an MDT?
Difficult to maintain adequate communication
Risk to patient confidentiality
Burdening patients - need to meet more professionals
Patient not involved in MDT
What emotions may someone experience having survived cancer?
Relief that it is over
Fear that it may come back
Guilt for having survive when others haven’t
Worry about finances, job etc
Frustration surrounding physical and sexual health
How would you describe palliative vs end of life care to a patient?
Palliative is for anyone where cure in no longer an option. Treatment does not aim to hasten nor postpone death
End of life is a branch of palliative care for people in their last year of life
What are the advantages and disadvantages of CPR
- prolonged stay in ICU on ventilators
- injuries such as broken ribs
- poor post CPR quality of life
+ gives time to put affairs in order
+ it sometimes works
+ family feel everything has been tried
What is advanced care planning and what is an advanced decision to refuse treatment?
Care planning: not legally binding but sets out the persons wishes on any aspect of future care
ADRT: legally binding if valid and applicable. It states which treatments under which circumstances a person does not wish to have
What is screening?
a systematic approach to detect unrecognised condition. It distinguished between well people who probably do and probably don’t have a disease
What is lead time bias?
Cancer picked up early so although screening appears to prolong life, life is not prolonged just time with cancer is longer
What is length time bias?
Screening picks up slow growing cancers that the person may never have noticed or been harmed by. Screening appears to prolong life of those found +ve whereas actually it may never have harmed them
What is selection bias?
Healthy people are more likely to go for screening and also look after their health in other ways too
What must a screening programme be to be approved?
CONDITION: serious and frequent
TEST: simple, safe, agreed cut off level for treatment
INTERVENTION: intervening before symptoms must be beneficial
OTHER: cost effective, adequate staffing, benefit>harm
