Palliative Care Flashcards
Why is a philosophy of care needed?
For instruction on the management of dying patients
To facilitate “to love until they die”
Special care required for the dying
What makes facilitating a good death difficult?
Death is a ‘taboo subject’ - rare for people to see a dead body, dying has been medicalised
‘Lost art of dying’ - dying has been medicalised, professionalised and sanitised to such an extent that it is now aliens to many people’s daily lives.
What are the challenges to achieving a ‘good death’?
Truthfulness with patients
Enabling informed consent
Allowing time to prepare
Avoiding isolation
Overcoming a wall of silence
Maintaining hope by accompanying them on the journey.
How do decide when to move to palliative care?
There is a dilemma - at what point does the transition occur from cure to palliation?
Futility - when curative treatment is continued where these is not prospect of success - prolongation of life
Negotiate a management plan - informed consent - a smooth transition.
Caring when cure is no longer possible.
What are the 5 stages of anticipatory grief?
Anger Denial Bargaining Depression Acceptance. (Or resignation?)
But, not convinced anybody can accept dying
What is spiritual pain?
Being informed, resolving conflicts, letting go, saying goodbye
How do you do ‘Good dying’?
Avoid medicalisation and thus prolongation of the dying process
Avoid the situation of ‘medical captivity’ of being a frightened patient. Enable their release from ‘captivity’.
An agreed care plan is required avoiding ‘managed states’
Ability to die one’s own death
Adequate symptom control
What do say to the informal career?
Often unintentionally neglected by the professional careers
A lot of support and input required
Opportunities for respite care
Grief before and after death
Ensure they do not feel guilty that they have ‘failed’ their loved one in any way.
What if there is suffering?
Suffering can be equated in inadequate palliative care.
If there is suffering the provision of palliative care to an individual requires urgent review by a specialist.
Any thought of euthanasia, is not a provision of ‘good dying’ but a failure of communication and palliative care.
What are the principles of a ‘good death’?
To be warned when death is coming and learn what can be expected.
To be able to retain control of what happens.
To be afforded dignity and privacy.
To have control over pain relief and other symptom control.
To have choice and control over where death occurs (at home or elsewhere).
To have access to information and expertise of whatever kind is necessary.
To have access to any spiritual or emotional support required.
To have access to hospice care.
To have control over who is present and who shares the end.
To be able to issue advance directives which ensure wishes are respected.
To have time today goodbye and control over other aspects of timing.
To be able to leave when it is time to go and not have life prolonged pointlessly.
What about the future?
Sustainable if basic paradigm shift for a change from biomedical to bio-psycho-spiritual model
From a disease centres approach to person-centred care,
From ‘doing-care’ to ‘being care’
From prolongation of survival to enhancement of meaningfulness in the last journey.
The cultural and person specific concept of a ‘good-death’ should be better understood.
Caregivers play contemporary roles crucial for effective home care.
Family coping skills, good symptom control and appropriate emotional support help to transform this burdensome journey into one that is rewarding and fulfilling.
Avoiding futile life-sustaining treatment where quality of life is reduced.
