PALLIATIVE CARE

Question 1

WHY IS IT IMPORTANT THAT PATIENTS ARE AWARE OF THEIR PROGNOSIS IN PALLIATIVE CARE?

Answer 1

BECAUSE PATIENTS UNAWARE OF THEIR PROGNOSIS:

• ARE MORE LIKELY TO PREFER AGGRESSIVE CARE
• ARE MORE LIKELY TO RECEIVE AGGRESSIVE CARE
• HAVE A WORSE QUALITY OF LIFE
• ARE LESS LIKELY TO COMPLETE ADVANCE DIRECTIVES
• ARE LESS LIKELY TO RECEIVE CARE CONSISTENT WITH THEIR PREFERENCES
• ARE LESS LIKELY TO RECEIVE HOSPICE SERVICES

Question 2

PREDICTION OF DEATH IN PALLIATIVE PATIENTS?

Answer 2

• PROGNOSTICATION ESTIMATES WILL NEVER BE ACCURATE
• THEY ARE DEVELOPING WAYS TO BE ‘GOOD ENOUGH’ (E.G. THE ‘PiPS PROGNOSTICATOR’)
• KEY IS TO COMMUNICATE UNCERTAINTY!!!!!!!!!!!!!!!!

Question 3

PiPS PROGNOSTICATOR

Answer 3

The PiPS prognostic scores and risk categories have been developed and validated for use in patients with advanced incurable cancer who have recently been referred to palliative care services.

Question 4

SOCIAL DEATH?

Answer 4

• A CONCEPT THAT HELPS US DRAW ATTENTION TO WHOSE LIFE IS VALUED (AND HOW)
• DISTINGUISHED FROM BIOLOGICAL OR PHYSICAL DEATH
• CAN OCCUR BEFORE OR AFTER PHYSICAL DEATH
• CHARACTERISED BY DISCONNECT FROM SOCIAL LIFE THROUGH E.G. LOSS OF SOCIAL IDENTITY, LOSS OF SOCIAL CONNECTEDNESS, LOSSES ASSOCIATED WITH BODILY DISINTEGRATION, LOSS OF TAKING PART IN DAILY ACTIVITES. LOSSES OF SOCIAL RELATIONSHIPS, LOSS OF MORAL ENTITLEMENT….
• ‘SOME PEOPLE BECOME REGARDED AS LESS THAN HUMAN OR NO LONGER A PERSON’

Question 5

MARMOT ET AL (2021), 4 REASONS WHY UK DEATH TOLL IS SO HIGH AND UNEQUAL

Answer 5

1) GOVERNANCE AND POLITICAL CULTURE (DAMAGED SOCIAL INCLUDION AND COHESIVENESS, UNDERMINED TRUST, DE-EMPHASISED THE IMPORTANCE OF COMMON GOOD..)
2) WIDENING INEQUALITIES IN POWER, MONEY AND RESOURCES
3) GOVERNMENT POLICIES OF AUSTERITY (difficult economic conditions created by government measures to reduce public expenditure)
4) HEALTH HAD STOPPED IMPROVING (HIGHER PREVALENCE OF HEALTH CONDITIONS IN LOWER SOCIO-ECONOMIC GROUPS THAT INCREASED FATALITY RATES FROM COVID) –> those with ‘pre-existing conditions’ deaths devalued?

Question 6

WHEN WAS PALLIATIVE CARE RECOGNISED AS MEDICAL SPECIALISM?

Answer 6

IN 1987

Question 7

THE RISE AND IMPORTANCE OF PALLIATIVE CARE?

Answer 7

• A RELATIVELY NEW MEDICAL SPECIALISM (RECOGNISED IN 1987)
• A RADICALLY NEW APPROACH TO CONCEPTUALISING PAIN
• INCLUDES PHYSICAL SYMPTOMS AND MENTAL DISTRESS, SOCIAL PROBLEMS, EMOTIONAL DIFFICULTIES, AND SPIRITUAL ISSUES
• PAIN AS A PROBLEM ‘ON THE LEVEL OF MEANING’

Question 8

CONTEMPORARY CRITIQUE OF PALLIATIVE CARE?

Answer 8

• OVERLY MEDICALISED
• INCREASED HEALTHCARE SPENDING, DEPENDENCE ON DRUGS
• BRINGING MORE ASPECTS OF THE HUMAN BODY AND BEHAVIOUR INTO MEDICAL PRACTICE AND DISCOURSE (NOT EVERYTHING CAN/SHOULD BE MEDICALISED)
• LOCATION CENTRIC PROVISION (E.G. IN HOSPICES)
• EMPHASIS ROLE OF DOCTORS

‘DYING HAS BECOME A MEDICAL EVENT, RATHER THAN A NATURAL PROCESS IN WHICH MEDICINE HAS A PART’
‘HYPER-PROFESSIONALISATION OF DYING’ –. PALLIATIVE CARE HAS BEEN FOCUSED ON INCREASING ITS PROFESSIONAL CAPACITY

Question 9

PUBLIC HEALTH APPROACH TO DYING?

Answer 9

• ORGANISATION AND MANIPULATION OF SOCIETY (COMMUNITIES) RESOURCES AND CONDITIONS TO BENEFIT THE PUBLIC

a variety of approaches that involve working with communities to improve people’s experience of death, dying and bereavement

Question 10

COMPASSIONATE COMMUNITIES?

Answer 10

Compassionate Communities is a local initiative which aims to facilitate support for the dying and bereaved, people living with long term health conditions and people who are socially isolated from within the community itself.

Service to provide:
support for clients in the last year of life and their carers
support for clients in the last days of life and their carers
support for the bereaved relatives after their loved one has died
support for people living with a long term health condition
support for people who are socially isolated

• A NETWORK-CENTRED APPROACH
• AIMS TO MOBILISE LOCAL SOCIAL NETWORKS OF THE DYING PERSON, RATHER THAN IMPOSE OR FUNNEL THOSE NEEDS THROUGH PROFESSIONAL PALLIATIVE CARE
• LOOKS TO ADRESS ‘NETWORK POVERY’ I.E. THOSE WHO DO NOT HAVE SOCIAL OR RELATIONAL SUPPORT AT THE END OF LIFE
• CONTRAST TO MEDICAL MODELS WHERE THOSE WITH GREATEST SOCIAL CAPITAL MORE FREQUENTLY GAIN ACCESS TO AND SUPPORT FROM PALLIATIVE CARE