Palliative and EoL Care

Question 1

Palliative Care
- Definition

Answer 1

Palliative Care definition

1. Active total care
   i) Pain
   ii) Symptoms
   iii) Social
   iv) Psychological
   v) Spiritual
2. Disease not responsive to curative treatment

Question 2

EoL Care
- Definition

Answer 2

EoL Care Definition

1. Approaching the end of life
2. Likely to die within 12 months
   - “would you be surprised if…”

Question 3

Palliative care
- Scope

Answer 3

Palliative care - scope

1. • EoL Care
2. • Enhanced Supportive Care
3. Palliative care

Question 4

EoL
- Seven choices

Answer 4

EoL Choices

1. Location of care
2. Staff training
3. Services available
   …
4. Wholistic support
   …
5. Involvement in decisions
6. Disclosing wishes
7. Involving kin

Question 5

Recognising deterioration
- Barriers

Answer 5

Barriers to recognising deterioration

1. Medicine
   - Diagnosis
   - Prognosis
   - Complex
   …
2. Provider competence
   - Knowledge/skill
   - Confidence
3. Provider focus
   - Disease not patient
   - Specific results not big picture
   - Scientific principles
4. Provider fears
   - Difficult questions
   - Loss of hope
   - ‘Giving up’
   - Death anxiety

Question 6

SPICT
- Purpose

Answer 6

SPICT

1. Supportive and Palliative Care Indicators Tool
2. Identify patient risk
   - Deteriorating
   - Dying
   - One or more conditions
   - Progressive/life-limiting

Question 7

SPICT
- Life-limiting diseases

Answer 7

SPICT Diseases

1. Cancer
   …
2. Frailty/dementia
3. Neurological disease
   …
4. CVS
5. Respiratory
   …
6. Kidney disease
7. Liver disease

Question 8

SPICT
- General Indicators

Answer 8

Supportive and palliative care indicator tools

1. Unplanned admission
2. Performance status with limited reversibility
   …
3. Depends on others with increasing needs
   - Carer needs more help
   …
4. Significant weight loss or remains underweight
5. Persistent symptoms despite optimal treatment
   …
6. Asks for palliative care/quality of life

Question 9

Clinical frailty
- 9 Scores

Answer 9

Clinical frailty

1-2
Very fit - Well

3-4
Managing well - Vulnerable

5-6
Mildly frail - Moderately frail

7-9
Severely frail - Very severely frail - Terminally ill

Question 10

CFS
- Mildly frail

Answer 10

Mildly Frail

1. Evident slowing
2. High order IADLs
3. Impaired
   - Shopping
   - Walking alone
   - Meal prep and housework

Question 11

CFS
- Moderately frail

Answer 11

Moderately frail CFS

1. All outside activities require help
2. Help with keeping house
3. Stairs and bathing

Question 12

CFS
- Severely frail

Answer 12

CFS Severely Frail

1. Completely dependent for personal care
   - Physical
   - Cognitive
2. Even if stable

Question 13

CFS
- Very severely frail

Answer 13

Very severely frail CFS

1. Completely dependent
2. Approaching EoL
3. Could not recover from minor illness

Question 14

CFS
- Terminally ill

Answer 14

Terminally ill CFS

1. Approaching EoL
2. Life expectancy <6 months
3. Not otherwise evidently frail