Palliative Care

Question 1

Identify what patients want during the last stages of a terminal illness

Answer 1

• Pain and symptom control
• Avoid inappropriate prolongation of the dying process
• Achieve a sense of control
• Relieve burdens on family
• Strengthen relationships with loved ones

Question 2

Provide a definition of palliative care.

Answer 2

• Palliative care is specialized medical care for people with serious illnesses. It is focused on providing patients with relief from the symptoms, pain, and stress of a serious illness – whatever the diagnosis. The goal is to improve quality of life for both the patient and the family
• Palliative care is provided by a team of doctors, nurses, and other specialists who work together with a patient’s other doctors to provide an extra layer of support. It is appropriate at any stage in a serious illness and can be provided along with curative treatment.

Question 3

List the seven major skills needed when delivering palliative care.

Answer 3

• Communication
• Decision making
• Management of disease-related complications
• Symptom control
• Psychological and spiritual care
• Care of the dying
• Coordination of care of continuity

Question 4

List the information needs of palliative care patients.

Answer 4

• Understanding of their illness and treatment options
• Unrealistic expectations
• Help making priorities for the future
• Care for themselves
• Participation in treatment decisions
• A sense of autonomy and control as a way of coping with serious illness

Question 5

State the potential barriers to communication about serious illness care goals.

Answer 5

• Patient factors
• Physician factors
• System factors

Question 6

Patient factors that can be a barrier to communication

Answer 6

o Patient emotions

o Patient expectations

Question 7

Physician factors that can be a barrier to communication

Answer 7

o Lack of serious illness conversation training
o Timing of conversations
o Uncertainty about prognostic accuracy
o Uncertainty of how to address patient’s and family’s psychosocial concerns

Question 8

System factors that can be a barrier to communication

Answer 8

o Ambiguity about who is responsible
o Life-sustaining treatment is a default approach
o Lack of a systematic approach to serious illness care planning
o Variation in location and quality of documentation in electronic health records

Question 9

Identify the questions that should be asked of or the information that should be shared with patients and their family during a conversation about serious illness

Answer 9

• Understanding: What is your understanding now of where you are with your illness?
• Information preferences: How much information about what is likely to be ahead with your illness would you like from me?
• Prognosis: Share prognosis as a range, tailored to information preferences
• Goals: If your health situation worsens, what are your most important goals?
• Fears/Worries: What are your biggest fears and worries about the future with your health?
• Function: What abilities are so critical to your life that you can’t imagine living without them?
• Trade-offs: If you become sicker, how much are you willing to go through for the possibility of gaining more time?
• Family: How much does your family know about your priorities and wishes?

Question 10

State how using the “wish/worry/wonder” framework allows providers to connect with patients during a conversation about serious illness

Answer 10

• “I wish . . .” statements allow for aligning with the patients hope
• “I worry . . .” statements allow for being truthful while sensitive
• “I wonder . . .” statements are a subtle way to make a recommendation

Question 11

Provide a definition of shared decision-making.

Answer 11

Collaboration in which the physician shares with the patient medical knowledge and opinion, and the patient shares with the physician values and preferences