Overview of end of life care

Question 1

Why is the quality of life during the dying process poor?

Answer 1

Inadequate treatment of distress, fragmented care, strains on family etc

Question 2

Deaths in the us occur most often in the elderly, and are marked by what characteristics? (2)

Answer 2

1. Slow

2. Increased dependency

Question 3

What are the three trajectories of illness?

Answer 3

Fall off a cliff
Slow decline with periodic crises
Prolonged dwindle

Question 4

True or false: acute care and palliative care can occur simultaneously

Answer 4

True

Question 5

What are the “three legs of the medicine stool”?

Answer 5

Diagnosis
Prognosis
Theraputics

Question 6

What is the goal of life prolonging care? Palliative care?

Answer 6

Life prolonging = lengthen life at any cost

Palliative = no bad symptoms

Question 7

Which is a board certified sub specialty–hospice care or palliative medicine?

Answer 7

Palliative medicine

Question 8

What is the payment source of hospice?

Answer 8

Medicare

Question 9

Where is the locus of care for hospice and palliative med?

Answer 9

Hospice - where home is

Palliative med = anywhere

Question 10

True or false: there are more inclusive services in palliative medicine compared to hospice?

Answer 10

False–other way around

Question 11

What is the difference in time frame for palliative vs hospice care?

Answer 11

Palliative = all stages of disease trajectory
Hospice = less than 6 months

Question 12

True or false: hospice is a place to die

Answer 12

False-where they can live well

Question 13

True or false: a pt has to have a DNR in order to be accepted into hospice

Answer 13

False

Question 14

True or false: many pts who enroll in hospice actually starve to death

Answer 14

False

Question 15

How much longer do patient who get transferred to hospice live compared to those who do not?

Answer 15

29 days longer

Question 16

True or false: one of the benefits of transferring a pt to hospice is knowing that the hospice will pay for all of the pts meds

Answer 16

True, but only for the meds that are involved in hospice placement

Question 17

True or false: in order to be transferred into hospice, pts must transfer their care to the hospice physician

Answer 17

False

Question 18

True or false: a good death is free from pain and suffering

Answer 18

False

Question 19

True or false: In order to refer a pt to hospice, the attending physician must certify that the patient will die in the next six months

Answer 19

False

Question 20

True or false: Good pain management alway includes measurable aspects of the patient’s pain

Answer 20

True

Question 21

True or false: Hospice has bereavement support for 13 months following a pts death

Answer 21

True

Question 22

True or false: the majority of hospice pts receive care at an in patient facility

Answer 22

False–often at home

Question 23

What are the four usual obstacles to hospice?

Answer 23

1. limited access
2. Lack of family support
3. LATE REFERRAL
4. Difficulties in determining prognosis

Question 24

What is the most common obstacle to hospice care?

Answer 24

Late referral

Question 25

How accurate are physicians' prognoses?

Answer 25

3-5 times longer than what it actually is

Question 26

What is the goal of palliative medicine?

Answer 26

Improve QOL of pts and family with serious illness

Question 27

When is palliative medicine appropriate?

Answer 27

At any age or stage of a serious illness

Question 28

What is the rationale for palliative medicine?

Answer 28

Relieves family burden

Question 29

What are the three key palliative care services?

Answer 29

1. Establish goals 2. Treat symptoms 3. Psychosocial support

Question 30

What are the two main barriers to palliative care?

Answer 30

Awareness of service | Tendency of clinicians to equate palliative care = end of life

Question 31

What are the four major concerns of drs in palliative care?

Answer 31

1. Introducing palliative care will interfere with treatment 2. Inadequate resources 3. Reimbursement 4. Shortage of palliative care drs.

Question 32

Why is it important to offer palliative services?

Answer 32

You are the gatekeeper (and the keymaster!)

Question 33

If a doctor knows a patient better, are they more likely to overestimate or underestimate the amount of time they have left

Answer 33

Overestimate, even more than usual