Palliative Care (Respiratory) Flashcards
What is palliative care?
The active total care of patients whose disease is not responsive to curative treatment.
What does palliative care practically involve?
Good symptom control whilst attending to patient and family needs including physical, social, psychological and spiritual.
When should palliative care begin?
When we can recognise that patients are reaching the end of their life.
Where do most people die and what does that mean for that location?
In a hospital, acute hospitals have palliative and end of life care as part of their core business.
Describe the prognostication (disease trajectories) of people with organ failure and frailty.
Organ failure: lose function with every exacerbation, eventually one of these exacerbations will cause them to die. Frailty: people dwindle in function over time.
In what sort of patients is a home death more likely?
Cancer, young patients, people who live with someone and people with professional support.
What should the priorities be if someone is dying and what is required to speak to them about it?
Symptom control, ceiling of care and advanced care planning. Effective communication required.
What do people want at the end of their life?
To be with loved ones, avoid life prolonging treatments and interventions, to put their affairs in order, to have good symptom control (just a guide, every patient will be different).
What are 2 barriers to achieving good end of life care?
Prognostic paralysis (people are unsure whether someone is dying or not) and uncoordinated care/communication between primary and secondary care.
Why do people not want to have the discussion about palliative care with their patients?
Concern that the conversation removes hope, medical perception that death is a failure, lack of skills in symptom control and communication skills.
What are common physical symptoms in incurable disease?
Pain, nausea and vomiting, fatigue, anorexia, breathlessness (dyspnoea), itch, drowsiness, constipation/diarrhoea, psychological symptoms.
What are the benefits of effective communication and the drawbacks of poor communication?
Effective: influences rate of recovery, can improve pain control and satisfaction with services. Poor: leave people feeling anxious, uncertain and dissatisfied with their care.
If people have a poor performance status, do they have a good chance of surviving cardiac arrest?
No (2% of leaving hospital if performance status 50%).
What domains should be assessed in the last days of life?
Physical, psychological, spiritual and social.
