Palliative Care

Question 1

Nausea

Constipation

Prognostic curves

Horizontal leadership

Question 2

Describe the NURSE mnemonic of exploring difficult emotions with patients.

Answer 2

Name the emotion (e.g., “you must be feeling frustrated” - if you get it wrong, they will correct you and provide the proper description);

offer understanding (e.g., “I can’t imaging what you are experiencing”);

offer respect and support;

explore the emotion (e.g., “what’s on your mind right now?”)

Question 3

List the steps of the SPIKES mnemonic of sharing bad news.

Answer 3

Prepare the Setting

Assess patient Perception

Obtain patient Invitation

Knowledge sharing

Emotions/Empathy

Summary and strategy

Question 4

What is Dr. Malhotra’s simplified version of the SPIKES mnemonic?

Answer 4

“Ask-Tell-Ask”

Ask - set the scene and get the patient’s perception/invitation

Tell - provide knowledge and emotional support

Ask - summarize/strategize according to the patient’s goals

Question 5

What is the ‘Rule of 3s’ in patient communication?

Answer 5

Speak at a 3rd-grade level

Provide ≤ 3 items of information

Let the patient speak ~3/4 of the time

Take 3-second pauses for patient to absorb information

Question 6

What is Dr. Malhotra’s “R³” mnemonic of effective patient-physician interactions?

Answer 6

Make rapport

Build a relationship

Provide recommendations

Question 7

What feedback did Dr. Basquez give me in regards to bettering my body language when communicating with patients?

Answer 7

• Don’t force eyecontact; if a patient avoids eye contact, look at their shoulder until they make eye contact, then look up. If they seem to just want to watch TV, watch TV with them while you talk.
• Mirror; mimic the patient’s body position.

Question 8

What feedback did Dr. Basquez give me in regards to bettering my empathetic interactions with patients?

Answer 8

Don’y apologize so much for the patient’s situation.

(Sometimes things suck; acknowledge difficult moments, and then move on towards more productive conversations.)

Question 9

Name three categories of medications often used in managing neuropathic pain.

Answer 9

1. Gabapentin and pregabalin

2. SNRIs (duoloxetine and venlafaxine)

3. TCAs (amitriptyline and nortriptyline)

Question 10

What is Dr. Malhotra’s method of in-patient constipation management in very sick patients?

Answer 10

17 g Miralax b.i.d. and 17.2 mg Senna b.i.d.

(decrease to q.d. following first bowel movement)

Question 11

What is the simple difference between cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT)?

Answer 11

CBT - helps patients reframe issues

DBT - helps patients cope with issues

Question 12

Name some of the mediators of cancer inflammation.

Answer 12

TNF-alpha

IL-1, IL-6

Substance P

Prostaglandins

CRP

Other cytokines

Question 13

What is the VOMIT mnemonic of patient nausea/vomiting etiologies?

Answer 13

• Vestibular causes
• Obstructions
• Medications
• Inflammation
• Toxins

Question 14

How should prognostic timelines be communicated to patients?

Answer 14

In time ranges

(I.e.,

“minutes to hours,”

“hours to days,”

“days to weeks,”

“weeks to months,”

“months to years”)