Palliative Care

Question 1

Define palliative care

Answer 1

An approach that aims to relieve suffering and improve quality of living AND dying in patients diagnosed with life threatening/ limiting illnesses

Question 2

What age range does palliative care apply to?

Answer 2

All

Question 3

Who can palliative care be provided by?

Answer 3

Primary, secondary, and tertiary providers

Question 4

In terms of illness trajectory, when can palliative care begin?

Answer 4

Ideally will start early, can start as soon as you know someone has an incurable illness.

Hospice palliative care typically runs late into the illness until patient’s death.

Question 5

When does palliative care end?

Answer 5

Does not end with patient’s death; helps family through the course of bereavement.

Question 6

Outline the approach (principles) of palliative care

Answer 6

• Quality of life (defined by the individual)
• Preserving dignity
• Symptom management
• Advanced care planning and treatment decisions; discussing and preparing for end-of-life
• Exploring wishes, values, personhood
• Ethical and moral problem-solving
• Assessing & managing grief
• Care for the caregiver

Question 7

Geriatric and palliative care, together, are considered to be __________ specialities.

Answer 7

Complementary (work together to provide comprehensive care for OA entering the later stage of their lives, and their families)

Question 8

What does advanced care planning involve?

What does it is ACP not?

Answer 8

Involves:

• reflecting & communicating values and wishes for the future
• identifying a substitute decision maker if one lacks the capacity to make decisions for oneself

It is NOT:

• one single conversation
• synonymous with a CODE discussion
• set in stone

Question 9

What questions should the nurse ask when establishing goals of care?

Answer 9

• “What would be important to you if you had an advanced, incurable illness?”
• “What goals do you have for the time you have left?”
• Questions about priorities (comfort vs life prolongation)

Question 10

Goals of care discussions are ______ and (ideally) should occur when individuals are _____________.

Answer 10

Ongoing

Well enough to articulate their wishes

Question 11

POA

Answer 11

Power of attorney

Question 12

SDM

Answer 12

Substitute decision maker

Question 13

DNR

Answer 13

Do not resuscitate

Question 14

EDITH

Answer 14

Expected death in the home

Question 15

CMO

Answer 15

Comfort measures only

Question 16

SMK

Answer 16

Symptom management kit

Question 17

FTC

Answer 17

Failure to cope

Question 18

“FTC” is often written on a patient’s chart when they actually need ______

Answer 18

High quality palliative care.

Question 19

AND

Answer 19

Allow natural death (proposed alternative to a DNR)

Question 20

Why has the term AND been proposed as an alternative to DNR?

Answer 20

“DNR” is often understood as “do not treat,” which is not right

Patients still want surgery, treatment (chemo, etc). AND is a new term to clear up the misconception.

Question 21

Cancer prognosis is generally (more/less) predictable compared to other diseases

Answer 21

More

Question 22

What does prognosis depend on?

Answer 22

Diagnosis and existing comorbidities

Question 23

Describe the illness trajectories of:

Cancer (diagnosis to death)
Organ system failure
Frailty/dementia

Answer 23

Cancer:
Start out very high functioning, stay that way for most of onset, sharp decline

Organ system failure:
Function starts out mid-level, begin to use hospital often, self-care becomes difficult, declines in function then increases (overall trend declines).
Every time they leave the hospital they are weaker than before.

Frailty/dementia:
Mid-level function to begin, slow gradual decline

Question 24

The undermining of a patient’s dignity is strongly associated with

Answer 24

Depression
Anxiety
Hopelessness
Loss of will to live
Desire for death
Feeling of being a burden to others
Lower quality of life