Palliative care: Chronic or End-of-life Respiratory Disease

Question 1

What is the main role of palliative care in chronic conditions?

Answer 1

Focuses on relieving symptoms and stress of the condition and its treatment

Improves overall quality of life and is appropriate at any stage of the condition.

Question 2

Name three chronic respiratory conditions that benefit from palliative care interventions.

Answer 2

• Lung cancer
• COPD
• CF
• IPF

CF refers to Cystic Fibrosis, and IPF refers to Idiopathic Pulmonary Fibrosis.

Question 3

How can decreased appetite be managed in palliative care?

Answer 3

• Nutritional plans high in calories and protein
• Appetite stimulant drugs (e.g., Megestrol acetate, medroxyprogesterone acetate)

These interventions aim to improve nutritional intake and overall health.

Question 4

What are two strategies for managing fatigue in palliative care?

Answer 4

• Modifying activity and rest patterns
• Steroids (e.g., Dexamethasone)

Psycho-stimulants like Methylphenidate can also be used for chronic fatigue syndrome.

Question 5

List four methods for dyspnea management.

Answer 5

• Supplemental oxygen
• Short-burst or long-term oxygen therapy
• Keeping the patient in a sitting position with a fan
• Medications (e.g., opioids, benzodiazepines, corticosteroids, bronchodilators)

Dyspnea management is crucial for improving patient comfort.

Question 6

What types of drugs are used for nausea management?

Answer 6

• Antiemetic drugs (e.g., Cyclizine, haloperidol)
• Prokinetic drugs (e.g., metoclopramide)

These drugs help alleviate nausea symptoms in patients.

Question 7

What is a common treatment for coughing in palliative care?

Answer 7

Opioid cough suppressants (e.g., Codeine linctus, morphine)

These medications help control persistent coughing.

Question 8

How can sputum/expectoration be managed?

Answer 8

• Prescribing nebulised saline solution
• Mucolytics

These methods encourage expectoration and improve airway clearance.

Question 9

What are two approaches to managing anxiety in patients?

Answer 9

• Psychotherapies (e.g., CBT, dignity therapy)
• Assessment of lifestyle factors (e.g., smoking, alcohol, exercise)

Medications like benzodiazepines and SSRIs may also be used.

Question 10

Fill in the blank: Palliative care is appropriate at any _______ of the condition.

Answer 10

stage

This highlights the flexibility of palliative care in different phases of illness.

Question 11

What is end-of-life care in respiratory conditions?

Answer 11

Symptom relief still managed by palliative care but patient must now have advanced care planning and advance decisions.

Question 12

What is advance care planning?

Answer 12

Discussion about future care and support needs which includes 5 main points:
→ Patient understanding of prognosis
→ Patients preferred place of care
→ Who to call for help in crisis or acute exacerbations
→ Emergency interventions and interventions that patient doesn’t want
→ Whether resuscitation should be attempted if they have a life-threatening deterioration.

Question 13

Where should copies of advance care planning be available?

Answer 13

Copies available in patient’s home, care home, hospice, hospital.

Question 14

What are advance decisions?

Answer 14

Patient can state how their preferred treatment before/if they lose capacity.

Question 15

What types of advance decisions can patients make?

Answer 15

Advance refusals of treatment and advance requests for specific treatment.

Question 16

How can advance decisions be documented?

Answer 16

They can be witnessed oral statements, written documents, signed printed cards, smart cards, discussion recorded in patient notes.