Palliative Care Flashcards
Explain the difference between grief and depression
Grief: - freq. crying - extreme sadness - changes in appetite - fatigue - insomnia - generally improves with time - Feelings of grief are common in the palliative patient Grieving for: The loss of independence The loss of being able to engage in activities The important events they will miss
Depression:
-Symptoms as noted for grief with the addition of:
Abandoning or losing interest in hobbies or other joyful activities
Ongoing social isolation
Weight loss
Loss of feelings of self worth
Increased use of alcohol or other drugs
Fixation on death, suicidal thoughts or attempts
- Generally does not improve with time
Identify the stages of grief
- denial and isolation
- anger
- bargaining
- depression
- acceptance
explain palliative care
maintaining QOL
relieving suffering
offering support
discuss psychological problems faced by patients with newly diagnosed cancer
Recent researches and clinical practice indicate that about third to half of oncology patients hvae different psychiatric/psychological comorbidity disorders. There are many predispone factors for psychiatric disorders among oncology patients such as nature of disease, reduced fertility, different organic factors, prior stress and psychiatric disorders, communication with family etc.
Anxiety associated with cancer amplifies feelings of pain, interferes with sleep habits, causes nausea and vomiting, and negatively affects on patients quality of life.
The experience of life threatening disease, as cancer, can lead to development of PTSD. Some of the risk factors for PTSD occurrence after cancer include past experience of stress life events, history of psychological disorders, high level of distress prior to cancer diagnosis, coping through avoidance, poor social support and worse physical functioning.
There is strong evidence of cancer-depression association, with depression prevalence from 20 to 50 % at substantial tumours.
explain how to discuss advanced directive planning with patients and families
Advance care planning (ACP) is an ongoing process in which patients, their families, and their healthcare providers reflect on the patient’s goals, values, and beliefs, discuss how they should inform current and future medical care, and ultimately, use this information to accurately document their future health care choices, ideally after an exploration of the patient and caregiver’s knowledge, fears, hopes, and needs. The timing and nature of ACP may vary depending on whether the person is healthy, has mild to moderate chronic illness, or if they have an advanced, life-threatening illness and are thought likely to die within the next 12 months. Regardless of the clinical scenario, ACP should be proactive, appropriately timed, and integrated into routine care. In addition, ACP should be revisited every time a person’s medical condition changes.
Advance care planning (ACP) helps patients prepare for future decisions about their medical treatment and place of care. ACP is a process where a patient’s current condition and prognosis are reviewed, likely medical dilemmas are presented, and options discussed [8]. In an ideal ACP discussion, clinicians, the patient, and his or her loved ones think through particular approaches to follow if (or when) the patient’s health declines. This process is iterative and typically occurs longitudinally within the context of an existing and continuing medical relationship.
Unfortunately, many patients face medical decision-making at a time they lack the capacity to make decisions for themselves [9]. In such cases, surrogates must step in to make decisions that they feel are in the best interest of the patient. ACP also helps patients clarify their choice of surrogate and prepares that surrogate for decision-making on behalf of the patient.
ACP can include completion of an advance directive (AD) if patients wish to document their wishes for medical care and surrogate decision maker. There are various kinds of ADs, but the types typically recognized by State law in the United States are the Living Will (LW) and the Durable Power of Attorney for Health Care (DPAHC). LWs document patient preferences for life sustaining treatments and resuscitation. DPAHCs (also known as “Healthcare Proxy Designations”) document his/her choice of a surrogate decision maker. The major limitation of the LW is that it may not be applicable to every decisional dilemma the patient will actually face. For that reason, the designation of a surrogate decision maker is especially important; surrogate decision makers can provide guidance to medical teams in cases where patients are incapacitated and the LW does not apply.
Advance directives (Ads; will/power of attorney) are the documents a person completes while still in possession of decisional capacity about how treatment decisions should be made on her or his behalf in the event she or he loses the capacity to make such decisions. They are legal tools meant to direct treatment decision-making and/or appoint surrogate decision makers. Although a component of advance care planning (ACP), an AD does not imply that ACP occurred, and thorough ACP does not always yield ADs (eg, if the patient does not voice any choices, or declines to have their choices recorded).
It is important to remember that ADs are not to be followed unless the patient has lost the ability to make decisions for himself. It is also important to remember that ADs can be revoked orally by the patient at any time (so long as he has maintained decisional capacity).
http://www.uptodate.com/contents/advance-care-planning-and-advance-directives
discuss the role of a palliative care team
- palliative care physician: specially trained in palliative care; may provide care through hospital, hospice program or both
- hospice care: specific type of palliative care for people in which a cure is no longer possible and who likely have 6 months or less to live; hospice care can be provided at a home, hospice facility, hospital, or nursing home
identify ways to help patients and families transition from active treatment to palliative care
When you are thinking about whether your family member’s current care is appropriate for his or her condition, here are some questions to ask:
- What is the prognosis – the expected course – of my family member’s illness?
- What are the goals for care? For instance, is the goal to cure the disease or to provide comfort and improve the quality of my family member’s life?
The transition to palliative care becomes smooth when the doctors communicate the disease status and prognosis, the questions and emotions of patients and families are adequately answered, and a discussion about palliative care is done. For an improved patient-physician relationship, the values and wishes of a terminal-stage patient (and relatives) should be adequately evaluated by the medical team.
There are several barriers to the medical community’s effective implementation of a transition from curative to palliative care:
- physician’s inability to evaluate the futility of aggressive therapy
- patient or relative does not want to stop anti-cancer treatment
- a reluctance to communicate the real situation of incurable stage
- unavailability of palliative care facility and/or right drugs
- Cultural, linguistic and religious differences
identify techniques for caring for self when caring for cancer patients
Processing grief in physicians:
- Name the feeling
- Accept the normalcy of the feeling
- Reflect on the emotion and its possible consequences
- Consult a trusted colleague
Saying goodbye to patients:
Choose an appropriate time & place
Acknowledge the end of your routine contact
Invite the patient to respond
Frame the goodbye as an appreciation
Give space for the patient to reciprocate
Articulate an ongoing commitment to the patient’s care
Later reflect on your work with the patient
explain the AHCPR guidelines to assess pain in cancer patients
The Agency for Health Care Policy and Research (AHCPR) was established in December 1989 under Public Law 101-239 (Omnibus Budget Reconciliation Act of 1989) to enhance the quality, appropriateness, and effectiveness of health care services and access to these services.
Recommendations:
1. Clinicians should reassure patients and their families that most pain can be relieved safely and effectively. (A)
- Clinicians should assess patients and, if pain is present, provide optimal relief throughout the course of illness. (Panel Consensus)
- Curricula for health professionals should include sufficient content on pain to prepare clinicians to assess and manage pain effectively. (Panel Consensus)
- Clinicians should include patient and family education about pain and its management in the treatment plan and encourage patients to be active participants in pain management. (A)
- Federal, State, and local laws and regulatory polices should not hamper the appropriate use of opioid analgesics for cancer pain. (Panel Consensus)
- Clinicians should collaborate with patients and families, taking costs of drugs and technologies into account in selecting pain management strategies. (Panel Consensus)
http: //www.hospicepatients.org/clinicalpracticeguidelines1994.html
common issues arising in palliative care?
weakness & fatigue pain depressed immunity xerostomia (dry mouth) dyspnea pressure ulcers muscle cramps dehydration renal insufficiency cardiac dysfunction depression & grief terminal agitation decreased consciousness
aetiologies of weakness & fatigue in palliative care?
inflammatory cytokines deconditioning & loss of muscle mass chronic pain malnutrition anemia depression side effects of medications
L-carnitine is often found to be deficient in populations with chronic illness. Does supplementing with L-carnitine improve fatigue in patients with cancer?
Nope
According to TCM theory, pain is typically the result of? (dx)
internal accumulation of heat toxins
phlegm-damp
qi and/or blood stagnation
qi and/or blood deficiency
how are excessive secretions treated?
anticholinergics/antimuscarinics
i. e. scopolamine, atropine, hyoscyamine sulfate, glycopyrrolate
- will lead to drying of mucus membranes
- may cause additive CNS depression
- may induce toxic megacolon
acupuncture points for excessive secretions?
Lu 1 Lu 2 Lu 8 UB 13 UB 42 ST 40 SP 3
