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YEAR 4 CANCER CARE > Palliative care And End Of Life > Flashcards

Palliative care And End Of Life Flashcards

1
Q

What are three parts of palliative care?

A
  • enhanced suportive care
  • palliative care
  • end of life care

not soley concerned with dying

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2
Q

What is palliative care?

A

Palliative care is the active, total care of the patients whose disease is not responsive to curative treatment. Control of pain, of other symptoms, and
of social, psychological and spiritual problems is paramount.

European Association for Palliative Care (2010)

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3
Q

What is end of life care?

A

Patients are ‘approaching the end of life’ when they are likely to die
within the next 12 months.

GMC: Treatment and Care towards the end of Life: Decision Making 2010

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4
Q

What is is enhanced supportive care?

from LOROS day

A

From LOROS day:
* Care where no more treatment or surgery can be done
* is conservative

From NHS care guide: Usually for patients with incurable cancer.

  • Supportive care in cancer is the prevention and management of the adverse effects of cancer and its treatment.
  • Includes management of physical and
    psychological symptoms and side effects across the continuum of the cancer experience from diagnosis, through anticancer treatment, to post-treatment care.
  • Enhancing rehabilitation, secondary cancer prevention, survivorship and end of life
    care are all integral to Supportive Care.
    [https://www.england.nhs.uk/wp-content/uploads/2016/03/ca1-enhncd-supprtv-care-guid.pdf]
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5
Q

palliative care

What are barriers to recognising deterioration?

A
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6
Q

What is SPICT?
Why is it important?

A
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7
Q

In palliative care, what are general indicators of decline?

A
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8
Q

palliative care

What are factors that may indicate that dying is imminent?

A
  • Bedbound
  • Drowsiness, impaired cognition
  • Difficulty taking oral medications
  • Reduced food and fluid intake
  • Increasing symptom burden
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9
Q

What are 5 priorities identified for care of the dying person (in The Leadership Alliance for the Care of Dying People)?

A
  1. possibility of death is recognised and communicated
  2. sensitive communication
  3. person is invoved in decisions about treatment and care to the extent that they want
  4. needs of families and others identified as important as important are respected and met
  5. individual plan of care - which includes food and drink, symptom control and
    psychological, social and spiritual support, is agreed, co-ordinated and delivered
    with compassion.
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10
Q

palliative care

What are features that may present in the dying phase?

A
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11
Q

What are 5 common symptoms experienced at the end of life

A
  1. nausea and vomiting
  2. pain
  3. breathlessness/dyspnoea
  4. agitation and restlessness
  5. respiratory tract secretions
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12
Q

palliative

For these common symptoms, what drugs are used (as anticipatory prescribing)?

A
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13
Q

What is benefit of using levopromazine in end of life N+V?

A

It targets all chemoreceptors - D2 (CTZ), 5HT2 (VC), Ach and H1 (VC VIII)

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14
Q

How do you manage food and drink in palliative care?

A
  • support patient to eat and drink as long as they wish to do so. Discuss risk of aspiration
  • can be an emotive concern losing an appetite/loss of interest in food ot drink - be aware of this when talking to them and families
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15
Q

How do you manage hydration in palliative care?

A
  • Offer good mouth care
  • Assess daily re hydration status
  • Discuss risks and benefits of CAH - (clinically assessed hydration); may relieve symptoms
    secondary to dehydration, but may cause other problems.
  • Share uncertainty around whether CAH will prolong life or
    extend the dying process.
  • No clear evidence that not giving CAH hastens death
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16
Q

For medication in palliative care, what should you remember when prescribing?

A
  • Use lowest effective dose
  • Reduce opiate dose or reduce frequency of dose in ESRF patients, v frail patients or if they have a low weight
  • consider increasing PRN doses in patients taking regular opiates
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17
Q

What structure can you use when communicating bad news?

A
18
Q

What are anticipatory medications?

A

Medications prescribed before they are needed, in the anticiption of symptoms in end of life

19
Q

What two groups of medications are given in end of life

general terms

A

Anticipatory end of life medication
Syringe drivers = allow a continuous subcutanoeus infusion of drugs - avoiding repeated cannulation and injection when the oral route is no longer feasible.

20
Q

What are some examples of drugs that can be given via syringe driver?

A
21
Q

In planning for death, what aspects do you need to discuss with the patient, family and the MDT?

oxford handbook

A
  • Ensure that a ‘Do not attempt resuscitation’ or ‘Allow natural death’, order has been made.
  • Discuss this with the patient (where appropriate), their family, and/or others of importance to them.
  • Document everything clearly.
  • Do they want to die at home? This can usually be arranged at very short notice with help from district nursing teams and community palliative care.
  • Discuss transfer to a hospice or nursing home if appropriate.
22
Q

What is advanced care planning? (ACP)

A
  • a process of discussion between an individual and their care provider irrespective of discipline.
  • the process of ACP is to make clear a person’s wishes
  • will usually take place in the context of an anticipated deterioration of the individual’s condition
  • recommened to be documented, regularly reviewed and communicated to the persons involved in their care
23
Q

What are key elelments of ACP
(advanced care planning)
1. is it involuntary or voluntary?
2. what is required re capacity?
3. is it legally binding?
4. does this include advance decisions to refuse treatments (ADRT)?
5. what happens if there is no record of an ACP or ADRT?

A
  1. it is voluntary and should not be a result of external pressure
  2. ACP requires that the individual has the capacity to discuss and understand the options available to them and agree on what is then planned
  3. ACP is not leagally binding but should be taken into account when professionals are required to make a decision on a person’s behalf
  4. no - it does not include this - the individual will need to complete an Advance Decision to Refuse Treatment according to the Mental Capacity Act.
  5. Decisions will be made in a persons Best Interest
24
Q

Who provides palliative care?

A

Specialists:
* hospice and specialists in palliative care
Generalists
* primary care
* care homes
* hospital
* domicillary care
Lay people - general public
* public awareness
* community care
* carers support

25
Q

What percentage of deaths occur in hospital?

A

50% of all deaths.

26
Q

What do patients want with regard to end of life care?

A
27
Q

Patients having end of life care include patients….?
(there are 5 groups of patients who may recieve end of life care - what are they?)

A

Patients…
1. who may die in the coming hours or days
2. with advance, progressive, incurable conditions
3. with general frailty and coexisting conditions which mean they are expected to die within 12 months
4. at risk of dying from an acute crisis
5. with a life-threatening acute condition caused by sudden events

28
Q

In BMJ article ‘a good death’, what are prinicples of a good death?

A
29
Q

What are underlying principles of MCA?

A
  1. a presumption of capacity - everyone has capacity until proven otherwise
  2. individuals should be supported where possible so that they can make their own decisions (capacity is decision specific)
  3. people have the right to make unwise decisions
  4. in a person lacking capacity, decisions will be made in their best interest
  5. decisions should be made that are the least restrictive of a person’s rights or freedom of action
30
Q

What is an advance decision to refuse treatment?

A
  • A decision you can make to refuse a specific medical treatment in whatever circumstances you specify.
  • This can include thechoice to refuse treatment even if doing so might put yourlife at risk.
  • The advance decision to refuse treatment will not be used if you are able to make your own choices at
  • the time that the treatment is needed and offered.
31
Q

What are benefits and implictions of making an advance decision to refuse treatment?

A
  • better contrl over what happens in the future if there is a treatment you don’t want to have
  • lets people know what is important to you about future care and treatment
  • help healthcare teams and families discuss your care if you can no longer communicate or express yourself
  • ADRT only apply in circumstances that you specify - so requires a lot of thought
32
Q

What is a lasting power of attorney?

A
  • An LPA covers decisions about your financial affairs, or your health and care.
  • It comes into effect if you lose mental capacity, or if you no longer want to make decisions for yourself.
  • You would set up an LPA if you want to make sure you’re covered in the future.

LPA must be registerd. It is a legal document.

33
Q

How is mental capacity assessed?

A

The MCA sets out a 2-stage test of capacity:

1) Does the person have an impairment of their mind or brain, whether as a result of an illness, or external factors such as alcohol or drug use?

2) Does the impairment mean the person is unable to make a specific decision when they need to? People can lack capacity to make some decisions, but have capacity to make others. Mental capacity can also fluctuate with time – someone may lack capacity at one point in time, but may be able to make the same decision at a later point in time.

34
Q

The MCA says a person is unable to make a decision if they cannot WHAT?

A
  • understand the information relevant to the decision
  • retain that information
  • use or weigh up that information as part of the process of making the decision
35
Q

The MCA sets out a checklist to consider when deciding what’s in a person’s best interests.
What does it say you should do as a HCP?

A
  • encourage participation – do whatever’s possible to permit or encourage the person to take part
  • identify all relevant circumstances – try to identify the things the individual lacking capacity would take into account if they were making the decision themselves
  • find out the person’s views – including their past and present wishes and feelings, and any beliefs or values
  • avoid discrimination – do not make assumptions on the basis of age, appearance, condition or behaviour
  • assess whether the person might regain capacity – if they might, could the decision be postponed?
36
Q

What do you check for in the death certification process?

A

Check that the pupils are fixed and dilated
No response to pain
No breath or heart sounds after 1 min of auscultation

37
Q

Who writes the death certificate?

A

A doctor that has cared for the patient within the last 14 days

38
Q

How does the death certificate outline the cause of death?

A

1a- Cause of death
1b- Condition leading to cause of death
1c- Additional condition leading to 1b
2- Any contributing factors or conditions

39
Q

What is the process for cremation paperwork?

A

Completed by 2 independent doctors.
* Part 1- completed by doctor who knows the patient.
* Part 2- by an independent doctor 2 years post registration, seeking confirmation of the cause of death from a variety of sources.

40
Q

When should a death be reported to the coroner?

A

When a doctor knows or has reasonable cause to suspect that the death occurred due to:

Poisoning, use of controlled drug, medicinal product or toxic chemical
Trauma, violence or physical injury
Related to any treatment or medical procedure
Self harm
Injury or disease attributed to patients work
notifiable accident, poisoning or disease
neglect
otherwise unnatural

41
Q

Aside from certain causes of death, when should the death be reported to coroner?

A

Occurred in custody or in state detention

No attending practitioner attended the deceased at any time in the 14 days prior to death or no attending practitioner is available within a reasonable period to prepare an MCCD

Identity of deceased is unknown

42
Q

What is the coroners role?

A

To determine who died, where they died and how they died.
They do not comment on care but do have powers to insisit on further local investigation.
Coroners can decide to hold an inquest to ascertain the answers to the questions above.

YEAR 4 CANCER CARE (22 decks)

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