Overview of end of life care Flashcards
Why is the quality of life during the dying process poor?
Inadequate treatment of distress, fragmented care, strains on family etc
Deaths in the us occur most often in the elderly, and are marked by what characteristics? (2)
- Slow
2. Increased dependency
What are the three trajectories of illness?
Fall off a cliff
Slow decline with periodic crises
Prolonged dwindle
True or false: acute care and palliative care can occur simultaneously
True
What are the “three legs of the medicine stool”?
Diagnosis
Prognosis
Theraputics
What is the goal of life prolonging care? Palliative care?
Life prolonging = lengthen life at any cost
Palliative = no bad symptoms
Which is a board certified sub specialty–hospice care or palliative medicine?
Palliative medicine
What is the payment source of hospice?
Medicare
Where is the locus of care for hospice and palliative med?
Hospice - where home is
Palliative med = anywhere
True or false: there are more inclusive services in palliative medicine compared to hospice?
False–other way around
What is the difference in time frame for palliative vs hospice care?
Palliative = all stages of disease trajectory Hospice = less than 6 months
True or false: hospice is a place to die
False-where they can live well
True or false: a pt has to have a DNR in order to be accepted into hospice
False
True or false: many pts who enroll in hospice actually starve to death
False
How much longer do patient who get transferred to hospice live compared to those who do not?
29 days longer
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
True, but only for the meds that are involved in hospice placement
True or false: in order to be transferred into hospice, pts must transfer their care to the hospice physician
False
True or false: a good death is free from pain and suffering
False
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
False
True or false: Good pain management alway includes measurable aspects of the patient’s pain
True
True or false: Hospice has bereavement support for 13 months following a pts death
True
True or false: the majority of hospice pts receive care at an in patient facility
False–often at home
What are the four usual obstacles to hospice?
- limited access
- Lack of family support
- LATE REFERRAL
- Difficulties in determining prognosis
What is the most common obstacle to hospice care?
Late referral
How accurate are physicians’ prognoses?
3-5 times longer than what it actually is
What is the goal of palliative medicine?
Improve QOL of pts and family with serious illness
When is palliative medicine appropriate?
At any age or stage of a serious illness
What is the rationale for palliative medicine?
Relieves family burden
What are the three key palliative care services?
- Establish goals
- Treat symptoms
- Psychosocial support
What are the two main barriers to palliative care?
Awareness of service
Tendency of clinicians to equate palliative care = end of life
What are the four major concerns of drs in palliative care?
- Introducing palliative care will interfere with treatment
- Inadequate resources
- Reimbursement
- Shortage of palliative care drs.
Why is it important to offer palliative services?
You are the gatekeeper (and the keymaster!)
If a doctor knows a patient better, are they more likely to overestimate or underestimate the amount of time they have left
Overestimate, even more than usual
