Palliative Care Flashcards
What is palliative care?
An approach which improves the quality of life for the patient and their family facing a life-threatening illness, through shifting the focus of treatment to relieving symptoms rather than prolonging life.
Focuses on physical, psychological, social support
Why is a palliative care approach so important?
Improve the quality of life Provide support for patient and family Help with the grieving process Puts patient's desires and goals first Provides pain and symptom control
Quality measures for a “good death”?
Patient preference / choice on where they want treatment e.g., at home, hospice, hospital
With or without family members
Ensuring free of symptoms
Ensuring the patient is comfortable
What are the challenges associated with palliative care?
Reframing hope - patient or family may think you’re giving up
Bereavement and medicines disposal
Lack of awareness
Unaware of the prognosis of the patient
Sensitive subject - difficult to communicate
What is anticipatory medicine?
Advance planning - just in case medicines - to treat the most common symptoms experienced by the individual approaching end-of-life, to avoid distress or discomfort of the patient and their family or the nurses if the drugs are unavailable / it is OOH / if the pharmacy or GP are closed. (times where access to medicine)
Formulation of anticipatory medicines?
Sub-cut
Common symptoms associated with the end of life?
Pain
Nasuea/Vomiting
Restlessness/Agitation
Increased respiratory secretions
Treatment for these symptoms?
Morphine or Diamorphine – Pain
Cyclizine, Haloperidol, Levomepromazine – Nausea and Vomiting
Midazolam, Haloperidol – Restlessness, Anxiety, Agitation
Hyoscine Hydrobromide, Glcopyrronium bromide – Secretions, ‘Death Rattle’
Key elements of a palliative care approach
Each person is seen as an individual
Each person gets fair access to care
Maximising comfort and wellbeing
Care is coordinated
All staff are prepared to care
Each community is prepared to help
Advanced care planning
What are the most important things for the patient right now?
Is the patient talking with their family?
Place of care?
Power of attorney?
Place of death?
Do Not Attempt Cardiopulmondary Resuscitation?
Why do we need to supply anticipatory medicines?
Avoid distress for patient and family
Avoid discomfort for the patient
Avoid distress for nurses / pharmacy when a drug is unavailable
Improve symptom control
What is a TTO?
To Take Out medicine
Needs to be completed for all patients being discharged from the hospital
(ensures changes correspond correctly - summarises hospital stay to GP or pharmacy and acts as a Rx for the drugs they need to take home with them)
Controlled drug prescription requirements
Name of drug Form of drug Strength (where appropriate) Clearly defines dose Quantity in words and figures
What general circumstances should be considered before deprescribing in a palliative care patient?
What is the patient’s life expectancy?
What is the treatment target?
- slow disease progression
- Prevent decline
- symptom control and comfort
How long does it take to see a benefit from a drug?
Barriers to deprescribing
Not knowing who’s job it is
Patient is unwilling
Unaware of risk vs benefit
Hesitant to deprescribe anything prescribed by a specialist
Limited time available
Seen as “giving up” hope
Concern over drug withdrawal or possible worsening of symtpoms
