Palliative Care Flashcards
Define palliative care
Active holistic care of patients with advanced, progressive illness
Goal of palliative care
Best QOL for patients and familities
Aims of palliative care
regard dying as normal process, relief from symptoms, integrate psychological/spiritual aspects, ensure live as fulfilled as possible until death, bereavement service
What does palliative care involve
self help, information giving, psych/social support, symptom control, bereavement care
Difference between end of life care and end of life care pathway
end of life care (last year)
end of life care pathway: last 48h of life
2 provisions of palliative care services
voluntary sector (marie curie, macmillan) hospices (day unit, hospice at home)
4 types of nurses
District nurse: community based, generic skills, hands on
Practice nurse: practice based, general palliative care
Marie curie: community based, district nurse for palliative care/ terminal illness
Macmillan: community/hospital, cancer.
General criteria for referral to specialist palliative care team
Incurable disease or refused treatment if competent to do so
Prognosis < year
Indications for palliative care where prognosis might be more than 1 year
> year but have complex needs
need support around dx of incurable disease (may be longer than a year)
6 general indicators for palliative care
- progressive deterioration
- dependence in >/=3 of ADL
- multiple comorbidities
- symptoms cannot be alleviated
- malnutrition signs (cachexia/ < albumin)
- severe progression of illness over recent month
3 inappropriate referrals for palliative care
- chronic stable disease or disability with life expectancy of several years
- chronic pain not with progressive terminal disease
- problems are psychological
Gold standard framework for palliative care
Tasks: communicate, coordinate, control symptoms, continuity, continue learning, carer support, care in dying phase.
Helps primary care, care homes, end of life support.
10 points from the end of life care strategy 2008
Raising the profile (engage with local communities)
Strategic commissioning (equality impact assessments for changes in service)
Identifying people approaching end of life
Care planning (needs assessed, wishes etc)
Coordination of care
Rapid access to care if condition changes
Last days of life and care after death
Involving carers
Measurement and research
Funding
9 principles from the WHO Palliative Care
FANS (family, activity, natural death, symptom relief) Symptom relief Affirm life and regard dying as normal process Natural death (doesn’t hasten/ prolong) Spiritual Actively as possible until death Family through illness and bereavement Team approach to patient and family Quality of life and course of illness
3 Gold standard framework for the provision of palliative care
Improve quality of care
Improve coordination and collaboration
Improve outcomes that matter to people (unwanted crises, choosing placing of death)
7 signs/symptoms a person exhibits in the last days of life
agitation, Cheyne-Stokes breathing, deterioration in consciousness, mottling skin, weight loss, fatigue
Psychosocial needs in the last few days of life
Persons goals and wishes
Views of those important to the person about future care
What do you need to communicate with the family? (3)
- Needs and expectations
- Discuss prognosis
- Shared decision making
What do you need to take into account when treating the dying?
take into account culture/ spiritual/ religious beliefs and advance directive
3 things when maintaining hydration
- swallowing difficulties
- risk of pulmonary oedema
- monitor every 12h for changes in symptoms
Treatment of anxiety, delirium and agitation
explore cause (reversible causes e.g. electrolyte disturbance)
- non-pharmacological
- trial BZD for anxiety/ agitation
- antipsychotics for delirium or agitation
What do you need to assess when anticipatory prescribing?
Assess what they may need in last days of life (anxiety, breathless, N+V, pain) account for:
- likelihood of symptoms occurring
- benefits: harms, risk of deterioration
- monitor for benefits and side effects daily
Define bad news
Any news that drastically and negatively alters patients or their relatives views of his/ her future. Causes cognitive, behavioral, emotional deficit in person receiving the news that persists some time after news ins received.
8 difficulties when breaking bad news
Personality types Gender Culture Upsetting someone Burden of responsibility Uncertain of patients expectations/ hope Own inadequacy Embarrassment for too optimistic picture for patient
Define SPIKES
Setting up (time, privacy, no interruptions, mentally rehearse)
Perception (understanding situation)
Invitation (permission/ ask in advance about sensitive topic)
Knowledge (what you want to convey)
Emotions (empathy)
Strategy and summary
Stages in Colin Murray Parkes’ four pahses of grief
numbness, yearning/anger, disorganization/despair, re-organization
Warden’s tasks of mourning
accept reality of loss, work through pain of grief, adjust to environment where deceased is missing, emotionally relocate deceased to move on with life
5 reasons for pathological grief
extended grief reaction stuck mummification denial major depressive > 2 months after loss
6 factors affecting grief sensitivity
Obvious: meaningfulness of relationship, manner of death, age of griever
Non-obvious: individual resilience, attachment and dependency, religious beliefs
3 impacts of religious beliefs on bereavement
Afterlife (possibility of meeting up again)
Continued attachment (prayer as means of continuing connection)
Religious funeral rituals that aid and progress the grief process/ recruit social support
