Palliative Care Flashcards
Define palliative care
Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.
State some conditions for which palliative care may be appropriate
State some principles of palliative care
- provides relief from pain and other distressing symptoms;
- affirms life and regards dying as a normal process;
- intends neither to hasten nor postpone death;
- integrates the psychological and spiritual aspects of patient care;
- offers a support system to help patients live as actively as possible until death;
- offers a support system to help the family cope during the patients’ illness and in their own bereavement;
- uses a team approach to address the needs of patients and their families, including bereavement counseling, if indicated;
- will enhance quality of life, and may also positively influence the course of illness;
- is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications
State soem aims of general palliative care
- Information for the person and their carers, with ‘signposting’ to relevant services.
- Accurate and holistic assessment of a person’s needs.
- Co-ordination of care teams in and out of hours and across boundaries of care.
- Basic levels of symptom control.
- Psychological, social, spiritual, and practical support.
- Open and sensitive communication with the person, their carers, and professional staff.
Discuss the importance of palliative care in people with advanced illness
- Controlling pain and symptoms
- Allowing person to make most of time left with family by supporting them as best we can
- Allowing them to have a good death
- Helps to support family
Remind yourself what constitues a good death
- To be warned when death is coming & learn what can be expected
- To be able to retain control of what happens
- To be afforded dignity & privacy
- To have control over pain relief & other symptom control
- To have choice & control over where death occurs
- To have access to information & 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
- Have time to say 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
- Avoiding medicalisation
- Avoiding the situation of medical captivity
What is meant by ‘approaching the end of life’
Patients are ‘approaching end of life’ when they are likley to die within the next 12 months. This includes patients whose death is imminent (expected within a few hours or days) and those with:
- Advanced, progressive, incurable conditions
- General frailty and co-existing conditions that mean they are expected to die within 12 months
- Existing conditions if they are at risk of dying from sudden crisis in their condition
- Life threatening acute conditions caused by sudden catastrophic events
There are numerous ways you can identify a pt approaching the end of life; describe some of these approaches
- Pattern recognition: would you be suprised if they were to die soon?
-
Recognising common symptoms in pts with advanced illness e.g.:
- Anorexia
- Weight loss
- Tiredness & fatigue
- Physical weakness
- Pain
- Struggling with self-care
- Loss of continence
- Low mood
- Constipation
- Insomnia
- Exacerbations may worsen and/or become more frequent
State some changes in the final days of life
- Appetite greatly reduced
- Abnormal breathing patterns e.g. becomes shallow and may be long pauses between breaths, Cheyne Stokes breathing etc…
- Drowy & sleepy
- Restless & agitated
- Skin changes:
- Colour: mottled, blue, patchy
- Cold to touch
- Swelling
- Incontinence
Discuss the difference between palliative care and a hospice; consider who can be offered hospice care
- Hospice care for pts who have less than 6 months to live and have ceased all curative treatment.
- Palliative care can be provided for any person with serious illness regardless of whether it is imminently terminal or not.
What does ‘presumption in favour of prolonging life’ mean?
Following established ethical and legal (including human rights) principles, decisions concerning potentially life-prolonging treatment must not be motivated by a desire to bring about the patient’s death, and must start from a presumption in favour of prolonging life. This presumptionusualy requires you to take all reasonable steps to prolong a pts life. However, there is no absolute obligationto prolong life irrespective ofconsequences for pt adn irrespective of pts views.
What does ‘presumption of capacity’ mean?
You must work on the presumptionthat every adult pt has the capacity to make decisionsabout their care and treatment. You must not assume that a pt lacks capacity to make a decision soley because of their age, disability, appearance, behaviour, medical condition, beliefds, apparent inabilit to communicate or becasue they make a decision that others disagree with or consider unwise.
Remind yourself of the definition of the following terms:
- Beneficence
- Non-maleficence
- Autonomy
- Justice
- Beneficence: medical practitioners have a moral duty to promote the course of action that they believe is in the best interests of the patient. Often, it’s simplified to mean that practitioners must do good for their patients
- Non-maleficence: a medical practitioner has a duty to do no harm or allow harm to be caused to a patient through neglect
- Autonomy: expressed as the right of competent adults to make informed decisions about their own medical care
- Justice: the principle that when weighing up if something is ethical or not, we have to think about whether it’s compatible with the law, the patient’s rights, and if it’s fair and balanced. It also means that we must ensure no one is unfairly disadvantaged when it comes to access to healthcare.
Summarise what the GMC says about withdrawing & non-starting a treatment
*NOTE: long paragraph so just summarise the general idea
Difficult decsions in which must way up benefits, burdens and risks of treatments; consider whether treatment is just prolonging death. Ethical and legal considerations.
What is a ReSPECT form?
Recommended Summary Plan for Emergency Care and Treatment
What is the amber care bundle?
The AMBER care bundle aims to improve the quality of care for patients whose recovery is uncertain and who may be approaching the end of their lives despite treatment. It gives our staff a greater opportunity to involve patients and their families in discussions about treatment and future care.
Discuss the GSF’s (Gold Standards Framework) 3 step tool for identifying pts at end of life
