Palliative

Question 1

A case study involves a terminally ill patient with amyotrophic lateral sclerosis (ALS) requiring complex symptom management. Explain how the MDT in a community palliative care setting would address the patient’s needs.

Answer 1

The MDT, including palliative care specialists, community nurses, occupational therapists, and speech therapists, would work together to alleviate symptoms such as pain, dyspnoea, and dysphagia, provide assistive devices for mobility and communication, and offer psychological support for the patient and their family.

Question 2

Discuss how the MDT in a nursing home setting would support a patient with end-stage dementia, considering their physical and psychosocial needs.

Answer 2

• The MDT, consisting of nursing staff, a palliative care consultant, psychologists, and dieticians
• Would focus on pain management - Providing sensory stimulation
• Offering emotional support to the patient and their family
• Facilitating advance care planning discussions.

Question 3

Provide an example of how the MDT in a home palliative care setting would address cultural considerations when caring for a terminally ill patient from a minority ethnic group.

Answer 3

• The MDT, including a palliative care nurse, interpreter services, religious leaders, and community support workers
• Would respect and incorporate the patient’s cultural beliefs and practices into their care plan
• Ensuring cultural sensitivity and promoting dignity and respect.

Cultural Assessment: Conducting a cultural assessment to understand the patient’s cultural background, beliefs, practices, and preferences.
Cultural Liaison or Community Health Worker: Involving a cultural liaison or community health worker from the same ethnic background as the patient to provide culturally sensitive support and advocacy.
Tailored Care Plans: Developing individualized care plans that take into account the patient’s cultural and spiritual needs, preferences for end-of-life care, and rituals surrounding death and bereavement.
Cultural Competency Training: Providing ongoing training for MDT members to enhance their cultural competence and sensitivity in caring for patients from diverse cultural backgrounds.

Question 4

Describe the ethical considerations involved in discontinuing life-sustaining treatment for a terminally ill patient with end-stage renal failure.

Answer 4

• Respecting the patient’s autonomy and wishes
• Ensuring beneficence by alleviating suffering
• Balancing the principle of non-maleficence by avoiding harm
• Considering justice in resource allocation and equitable access to palliative care.

Question 5

Explain the role of advance care planning (ACP) in the context of DNAR decisions.

Answer 5

• ACP involves discussions between patients, their families, and healthcare professionals about future healthcare preferences, including preferences regarding resuscitation.
• ACP allows patients to express their wishes regarding resuscitation and empowers them to make informed decisions about their end-of-life care, including whether they want to have a DNAR order in place.

Question 6

What is an Advance Directive, and how does it relate to Advance Life Decisions in the UK?

Answer 6

• An Advance Directive, also known as a living will, is a legal document that allows individuals to specify their preferences for medical treatment in the event that they lose capacity to make decisions for themselves in the future.
• It forms part of Advance Life Decisions, empowering individuals to have control over their healthcare decisions, even when they are unable to communicate them.

Question 7

What specific details must be included in an Advance Directive to ensure its legal validity and enforceability in the UK?

Answer 7

• An Advance Directive must clearly state the individual’s treatment preferences regarding specific medical interventions, such as resuscitation, ventilation, and artificial nutrition and hydration.
• It should be signed and dated by the individual in the presence of witnesses who attest to the individual’s capacity and understanding at the time of signing.

Question 8

Describe the criteria outlined in the Mental Capacity Act 2005 for assessing an individual’s capacity to make decisions about their healthcare, including resuscitation preferences.

Answer 8

• The Mental Capacity Act 2005 specifies that an individual must be able to understand, retain, weigh, and communicate information relevant to the decision at hand.
• This assessment includes evaluating the individual’s ability to comprehend the risks and benefits of resuscitation and express their wishes clearly.

Question 9

Give me examples of agencies involved in palliative care in the community?

Answer 9

Marie Curie
MacMillan Cancer support
Hospice UK
Carers trust
Carers UK
Age UK

Question 10

When are people considered to be approaching the end of life?

Answer 10

When they are likely to die within the next 12 months

Question 11

What does person-centred care mean in palliative care?

Answer 11

This means identifying and meeting a person’s individual physical, psychological, social and spiritual needs.

Question 12

Outline a GP MDT in palliative care?

Answer 12

• GP
• District nurses
• Community matrons
• Hospital teams
• Physiotherapists
• Dietitians
• Palliative care clinical nurse specialists
• Community pharmacists

Question 13

What is the message in a bottle initiative?

Answer 13

• Allows people to store a form with important information about themselves and their condition in a small plastic bottle for emergency services to retrieve.
• This is usually stored in the person’s fridge, as this is where emergency services are trained to find it.

Question 14

What are the daffodil standards?

Answer 14

Set of quality standards developed by Marie Curie
Cover a range of aspects including communication, coordination of care, symptoms management, emotional support and holistic care provision.

Question 15

When can a doctor issue a death certificate?

Answer 15

After the coronavirus act, a doctor who has seen the patient within 28 days of their death can complete the medical certificate of cause of death.

Question 16

What happens if the patient was not seen within 28 days of their death?

Answer 16

The death should be discussed with the coroner.

Question 17

What are the five steps when someone dies?

Answer 17

1. Get a death certificate
2. Register their death
3. Tell others about the death
4. Arrange the funeral, and apply for probate
5. Get bereavement support

Question 18

What is probate?

Answer 18

Probate is a legal process.
It happens after someone dies.
It deals with their property, money, and possessions.
The court checks if the person’s will is valid.
It ensures debts and taxes are paid.
It also makes sure the remaining assets are distributed correctly to beneficiaries.
Probate can take time and involves paperwork.
It’s needed if the person owned property or had significant savings.

Question 19

What is an example of support for bereavement support?

Answer 19

The national bereavement service
Bereavement UK
Samaritans
Memoria
The compassionate friends
The good grief trust

Question 20

What happens if you have been named the executor of a person’s death

Answer 20

If you have been named the executor of the will you might have to deal with the money and property of the person who’s died. You may need to apply for probate, which is a court order required to release the person’s assets.

Question 21

What are some decisions taken into account with advance care planning?

Answer 21

• What treatment might or might not benefit them
• What treatments they would not want
• How and where they would like to be cared for
• Where they would prefer to die

Question 22

What are the 5 pillars of the mental capacity act?

Answer 22

1. Assume capacity
2. Maximize capacity
3. Unwise decisions do not always mean wrong decisions
4. Always act in a person’s best interest
5. Least restrictive option always.

Question 23

What ethical considerations are important when making end-of-life care decisions for non-cancer patients?

Answer 23

Quality of Life Assessment:
Evaluate physical, psychological, social, and spiritual well-being to determine appropriate care interventions.

Autonomy and Informed Consent:
Respect the patient’s right to make decisions about their care by providing comprehensive information about prognosis, treatment options, and potential outcomes.

Cultural and Religious Considerations:
Acknowledge and accommodate diverse beliefs and values regarding death, dying, and end-of-life care practices.

Palliative Care Provision:
Ensure access to multidisciplinary palliative care teams to manage symptoms, alleviate suffering, and enhance quality of life.

Beneficence and Non-Maleficence:
Strive to promote the patient’s well-being while avoiding harm, including unnecessary invasive procedures or treatments.

Question 24

How do ethical issues differ in end-of-life care between cancer and non-cancer patients?

Answer 24

Prognostic Uncertainty:
Non-cancer patients may have less predictable disease trajectories, necessitating ongoing assessment and communication about goals of care.

Timing of End-of-Life Discussions:
Cancer patients often have earlier opportunities to discuss end-of-life preferences due to clearer prognoses, while non-cancer patients may require more frequent reevaluation and adaptation of care plans.

Complexity of Symptom Management:
Non-cancer patients may present with diverse symptom profiles requiring tailored interventions and interdisciplinary collaboration.

Question 25

Question: What are the ethical implications of withholding or withdrawing life-sustaining treatment in end-of-life care?

Answer 25

Patient Autonomy and Informed Decision-Making:
Respect the patient’s right to refuse or discontinue treatments that are burdensome or not aligned with their goals of care.

Shared Decision-Making:
Involve patients, their families, and healthcare teams in discussions about treatment options, weighing potential benefits and burdens.

Comfort-Centered Care:
Prioritize symptom management and comfort measures to alleviate suffering while avoiding futile or overly burdensome interventions.

Communication and Transparency:
Provide clear and honest information about the rationale behind treatment decisions, ensuring patients and families understand the goals of care and potential outcomes.

Question 26

What is the role of Hospice UK?

Answer 26

Provides comprehensive palliative care services, including pain and symptom management, emotional support, and respite care. They work closely with the MDT to ensure coordinated care.

Question 27

What are some cultural preferences about end of life care that may impact end of life decisions?

Answer 27

• In some cultures, enduring pain or suffering is seen as a virtue or a test of faith.
• Some cultures and religions, such as Islam and Judaism, prohibit autopsies because they believe it desecrates the body.
• In many cultures, dying at home surrounded by family is considered important for the patient’s spiritual journey.
• Many religions have specific rituals and prayers that need to be performed at the end of life or immediately after death.