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M&SIII > Palliative Care > Flashcards

Palliative Care Flashcards

1
Q

Palliative Care

A

focuses on maximizing qualitly of life for patients to live as actively as possible with serius illness until death by:

addressing physical, spiritual, and psychosocial disress

Optimizing clinician-patient communication

assisting in advanced care planning and coordination of care

using an interdisciplinary approach

(early identification, impeccable assesment, and tratment of pain and other problems, physical, psychosocial, and spiritual)

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2
Q

What is hospice?

A

Hospice is a part of palliative but not every in palliative care goes to hospice

  • Provide 24/7 palliative care to terminally ill patients and services to their families
  • can be inpatient or outpatient
  • Medicare hospice benefit
    • 65 or older
    • Physician estimates prognosis of 6 mo or less
    • goals of care must be palliative not curative
  • Most other insurances also cover hospice
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3
Q

Hospice Services

A
  • hospice physician medical director
  • skilled nurse
  • home health aide
  • Social worker
  • Chaplain
  • Volunterr program director
  • Bereavement program coordinator
  • The medicare jospice Benefit does not provide 24 hour custodial care
  • Nurse and home health aid visits regularly
  • 24hr/day acess to advice by telephone
  • Visits any time of day for uncontrolled symptoms
  • All drugs related to the terminal ilnes
  • All durable medical equitemtn (bed, commonde, etc
  • Any ordered physical therapy, dietart counseling
  • Payment for other medical sevices approved by the hospice reman such as: paliative radiation, parenteral hydration, etc
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4
Q

History of Palliative Care

A

Death in the 20th Centrury

  • Conquering of illness
    • penecillin, polio vaccine, cancer chemotherapy
    • shift in focus of medicine towards curing illness and prolonging life
  • Institutionalization of medicine
    • care moved from home to hospital and clinics
    • most deaths now occur outside of the home
  • Change in popular experience of death
    • no longer commonplace
    • fear of the unfamiliar
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5
Q

Philosophy of palliative care

A
  • Modern medicine often falls short in the care of patients at the end of life
  • active care for patients and theri loved ones should not end when illness is no longer curables
  • by focusing on the treating the whole patient and his or her loved ones, we can improve quality of life at the end of life
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6
Q

Who opened St. Christopher’s Hospin in London and When?

A

Cicely Saunders

This was done in 1967

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7
Q

When did the hospice unit come to the united states

A

early home based programs came in 1974

medicare created hospice benefit in 1982

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8
Q

When was the first palliative care unti created and where?

A

1975

Montreal

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9
Q

History of Palliative care continued . . .

A

Palliative care in US teaching hospitals in 1990s

AAHPM board certification for fellowship training in 2008

ACGME accredidation for fellowship in 2008

Fellowship training program expansion from academic centers to community too

IOM dying in America report in 2014

WHO first global resolution on palliative care in 2014

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10
Q

Who should recieve palliative care?

A

Patients with life threatning illness who

  • have distressing symptoms or problems related to their illness
  • have spiritual or existential distress
  • need assistance discussing goals of care and code status
  • need assistance with coordination of care
  • have loved ones who need support
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11
Q

When should palliative care start?

A

Traditional model: closer to death

Optimal model of care: Onset of disease. Hospice comes in when patient is near death a dn care is given after death (bereavement)

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12
Q

Who provides palliative care?

A

Interdisciplinary team approach to care

Better suited to trat total patient (mind, bosy and spirit)

Allow for collaboration in problem solving

Alllows ofr suppof those involved in caring for patient

  • Physician
  • Nurse practioner
  • Physician assistant
  • social workers
  • Bereavement counselors Psychologust Chaplains
  • Nurses
  • Aides
  • Music/Art Therapist
  • Integrative medicine practioners
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13
Q

Where is palliative care delivered?

A
  • Acute care hospitals
    • Consult service, dedicated unit
  • Outpatient clinic
  • Extended care facility
  • Rehab facility
  • Palliative home care
  • Hospice
    • home (50%)
    • Facility (nursing facility, hospice unit, hospital)

Focus on treating the total patient and their loved ones

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14
Q

What are the four main aspects of care?

A
  • assessment and treatment of symptoms
  • Clinicain-patient communication
  • care coordination
  • Psychosocial, spiritaul, and Bereavement support
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15
Q

Assesment and treatment of symptoms

A

Pain

fatugue

depression

anxiety

insomnia

SOB

Nausea

Constipation

Anorexia

Delirium

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16
Q

Provide therapy with attention to

A
  • underlying cause of sxs
  • Pt Hx of past effective therapies
  • Mode of Delivery of medication
  • Side-effect profile
  • Availability and cost
  • patient prognosis and personal goals
17
Q

Help patients and families work through decision by:

A
  • Help them understand the medical situation
  • Respond to intense emotions
  • Clarify values and goals
  • weigh benifits and burdens of treatment
  • Document decisions and coordinate care
18
Q

Care coordination

A

Help patient and families navigate the health care system

  • Involves
    • Address and readdress goals of care
    • referral to hospice, palliative care or other disciplinary care services
    • address finacnial planning
    • arrange support for loved ones and encourage or facilitate their visits
19
Q

Psychosocial support

A
  • determine patient and family coping
  • Assess support systems
  • offer assistance from a social worker or phsycologist
20
Q

Spiritual support

A

address spiritual or existential concerns

offer support from a chaplain or other spiritual advisor

adress death and dying (allow the patient to talk about death)

provide anticipatory guidance

answer questions about what to expect

21
Q

Bereavement support

A

is an avenue for continued care of loved ones after the patient has died

  • organized beareavement programs through hospice or palliative care program
  • personal cards, letters or phone calls
  • attend a funeral or memorial service
22
Q

African AMerican Attitudes about EOL Care

A
  • African Americans were less satisfied with the quality of end-of-life care and more often reported concerns about provider communication
  • greater preference for life sustaing therapies regarless of prognosis among African Americans and hispancis compared to white individuals
23
Q

Hospice is used at lower rate in non-white population

disenrollment rates higher among african american

why?

A

Mistrust of the health care system due to history of bias and injustices

Spiritual and religious beliefs may conflict with the goals of palliative care

M&SIII (10 decks)

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