Palliative

Question 1

What is palliative care?

What is the goal?

Answer 1

Care for those with serious illnesses that is aimed at relief of symptoms and stress

The goal is to improve quality of life

Question 2

Who palliative care appropriate for?

Answer 2

It is appropriate at any age and stage with a serious illness

Question 3

T/F

Palliative care cannot be provided with other medical treatment

Answer 3

False. You can receive palliative care and still receive medical treatment for your disease.

Question 4

What are 3 things that make something a serious illness?

Answer 4

1) Impacts Activities of Daily Living
2) Has effect on quality of life
3) It affects the time someone has to live

Question 5

Top 5 leadings causes of death

And explain the stats

Answer 5

1) heart disease
2) cancer
3) unintentional injuries ; notice this one isn’t chronic
4) chronic lower respiratory disease
5) cerebrovascular disease

About 60% of adults live with one of these.
Then 40% have two or more.

Question 6

“Medical advances have led to culture of cure”.
What does this mean?

What is the truth?

Answer 6

It means people expect to be cured due to all the new medicine and technology we have.
Patients do not die.. they code.

The truth is we don’t have a cure for everything. What we have is a lot of ways to prolong life with these illnesses.

Question 7

What is an accurate way for practitioners/patients to decide if palliative care should be considered?

Answer 7

Whether or not they would be surprised if the patient died in the next year.

Question 8

Main four trajectories of dying?

Answer 8

1) Sudden death
2) Terminal Illnesses
3) Organ Failure
4) Frailty

Question 9

Examples of sudden death

Answer 9

Care accident
- the point is, we don’t expect this one.

10%

Question 10

Examples of organ failure
What is the nature and how is this a problem?

Where do these people usually stay for their care?

Answer 10

HF, COPD, ESRD, etc.
Very common. The nature is that they have exacerbations and each time, they slowly move closer to death. This can be confusing for family bc they will never recover & they think they’ll continue to survive but this isn’t possible.

Those with organ failure are often found in nursing homes

• but the cost is an issue
• they can still end up in the hospital

Question 11

When does palliative care want to get involved with organ failure cases?

Answer 11

For organ failure, palliative care wants to begin way back on the start of the exacerbations. Because remember, you can still be on palliative care and get treatment. Their focus is building that relationship.

Question 12

Example of terminal illness trajectory

Answer 12

Pancreatic cancer for example. The outcome is pretty certain upon diagnosis and is predictable.

Question 13

Example of frailty trajectory

Answer 13

Dementia… When elderly just survive long enough to die of being frail/age.

Question 14

Burden of serious/chronic illnesses

Answer 14

• Multiple co-morbidities are often present
• Patient’s symptoms cause discomfort
• It ruins quality of life
• It becomes hard for family and caregiver to provide
• It is expensive

Question 15

Patient quality care checklist?

Answer 15

A sense of control
Spiritual peace
Finances & affairs in order
Strong relationships with loved ones
Believing their life has meaning

Question 16

Healthcare team quality checklist?

Answer 16

Symptom management

Emotional comfort

Question 17

What aspect of nursing causes higher patient satisfaction?

Answer 17

When they believe the nurse did everything to help

Question 18

What are ALL of the jobs of palliative care?

Answer 18

Manage symptoms and pain
Communicate about goals of care
Advance care planning
Provide support 
Assist with coordinating and transitioning care

Question 19

T/F

Palliative care is more expensive

Answer 19

False. Decreased hospital visits, ICU admissions, and ED visits

Question 20

T/F

Unfortunately with palliative care, patients have decreased length of life

Answer 20

False.

Patients actually live longer

Question 21

Who needs palliative care?

Answer 21

Frequent hospital admissions
Symptoms that are hard to manage
Complex care
Decline in function or weight
Uncertainty about care
How long they have left to live

Question 22

How are hospice and palliative care related?

Answer 22

All hospice is palliative but not all palliative care is hospice

Question 23

When is do we switch over to hospice?

Answer 23

Switch to hospice with there’s no point in doing curative treatments. With palliative care, you can simultaneously do curative therapies.
- To do this, the physician and patient need to be on the same page. If you stop care, then you really do stop (unless there’s a good reason)

Question 24

Prognosis for hospice?

Answer 24

6 months or less

• continuous evaluation is done to make sure they meet standards.
• sometimes they can graduate

Question 25

How is hospice paid for?

Answer 25

Medicare
Medicaid
Third party insurance

Question 26

Avg length of stay on hospice?

Answer 26

2 weeks - the point is people tend to wait till the last minute

Question 27

What was the old model like when it came to end of life care?

Answer 27

The medical team tx the issue for as long as possible and then dumped them on hospice/end of life care.

• Now, we want to introduce that end of life care earlier so there’s no feeling of abandonment.
• “REFCOCUS”

Question 28

What is a TPOPP form?

What are the sections?

Answer 28

TPOPP stands for Transportation Physicians Orders for Patient Preferences
- it is a document that states the patients wishes and moves with the patient throughout health care

Sections:

• Resuscitation (DNR or full code)
• Medical Interventional (still has a pulse but has rapid health deterioration)
• Nutrition
• Signatures