Palliative Care Flashcards
What is palliative care?
NICE CKS definition:
Active holisitic care of people with advanced, progressive illness.
Management of pain and other symptoms and provision of psychological, social and spiritual support are paramount
Why is palliative care important in care of people with advanced illness?
- It is a main part of people centred health service.
- Relieving serious health-related suffering is a global ethical responsibility
- Prevents and relieves suffering - for patient and family
- Provides a dignified, good death
Main definition of a pt ‘approaching the end of life’?
Pt is likely to die within the next 12 months
Give examples of conditions that deteriorate, and may require palliative care?
Pt with respiratory condition (COPD) becoming more breathless
Pt with brain tumour who has an increase in seizures
Pt with liver failure developing ascites.
Symptoms of advanced illness (so needing palliative care)?
Loss of appetite Reduced food and fluid intake Weight loss Tired and fatigued Physically weak Pain Struggle with self care Loss of continence Low mood Constipation Insomnia
How to recognise a patient approaching the end of life?
Pattern recognition
Underlying condition deteriorates
Show symptoms of advanced illness
Exacerbations may worsen or become more frequent
Define the term: presumption in favour of prolonging life
Decision regarding life-prolonging treatment must NOT be motivated by desire to bring about patient death.
Decisions must start in favour of prolonging life.
Take all reasonable steps to prolong life.
Define the term: presumption of capacity
Work presuming that every adult patient has capacity to make decisions about care and treatment
Do not assume pt has a lack of capacity based on age, disability, appearance, behaviour, conditions, beliefs, inability to communicate.
Define the term: beneficence
Balancing benefits of treatment against the risks and costs
Act in a way that benefits the patient
Define the term: Non-maleficence
Avoid causing harm to patient.
Most treatment involves some harm - but harm should not be disproportionate/higher weighting than the benefits of the treatment.
Define the term: autonomy
Respect the decision making capacities of autonomous person. Allow pt to make reasoned, informed choices
Define the term: Justice
Distribution of a fair share of benefits (e.g. distributing health resources fairly)
Legally - doing what the law says
Rights based - human rights and legal rights
What is involved in the ReSPECT process form?
Summary of information for plan - diagnosis, communication needs, reasons for certain preferences, wishes of organ donation.
Personal preferences to guide plan (when person has capacity) - prioritise sustaining life or prioritise comfort?
Clinical recommendations for emergency care and treatment - includes clinical guidance on specific interventions. Includes whether CPR is recommended.
Capacity and representation at time of completion - states whether pt has capacity.
Emergency contacts - needs to be listed.
Who is the ReSPECT form for?
The ReSPECT process can be for anyone but will have increasing relevance for:
- people who have complex health needs
- people who are likely to be nearing the end of their lives
- people who are at risk of sudden deterioration or cardiac arrest.
Some people will want to record their care and treatment preferences for other reasons.
Who are the core members of the MDT team in palliative care?
Patient and his/her family Physician, Advanced practice nurse (APN), Nurse Social worker, Chaplain, Pharmacist, Allied health clinician Complementary therapist.
