Palliative Part 1 Flashcards
What is a hospice?
- Primarily a ‘concept’ of care - not always a specific place of care, but often combined
- E.g. specific philosophy of and/or approach to care rather than merely a type of building, service or both
What is palliative care?
- Approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness
- Prevention/relief of suffering by means of early identification, assessment, tx of pain and other physical, psycho-social and spiritual problems
- Guided by principles of primary healthcare
What are the principles of primary health care?
Accessible, participatory, inter-professional, health promoting, uses appropriate technology/skills
What does the Canadian Hospice Palliative Care Association consider palliative care to be?
- Affirms life, regards dying as a normal process
- Neither hastens nor postpones death
- Provides relief from pain/other symptoms
- Integrates psychological/spiritual aspects of care
- Offers ongoing support systems to dying pt’s and family members
What has brought forth the issue of palliative care as a human right?
An aging population, growing incidence and prevalence of cancer, and a growing HIV/AIDS epidemic, have all increased attention to palliative care as a public health issue and a human right
Describe the difference between curative focus and palliative focus:
CURATIVE: disease-specific, treatments
PALLIATIVE: comfort/supportive treatments
What is the focus of curative?
- Dx of disease and related symptoms
- Curing/tx of disease
- Alleviation of symptoms
What is the focus of palliative?
- Pt/family identify unique end-of-life goals
- Assess how symptoms, issues are helping/hindering reaching goals
- Interventions to assist in reaching end-of-life goals
- Quality of life closure
What are the ten guiding principles of hospice palliative care?
1) Person/family centered
2) Ethical
3) High quality
4) Team-based
5) Safe and effective
6) Accessible
7) Adequately resourced
8) Collaborative
9) Advocacy-based
10) Evidence-informed/knowledge-based
What are the goals of palliative care?
- Assure pt receives excellent pain control/other symptom/comfort measures
- Give pt information needed to participate in care decisions
- Offer ongoing emotional/spiritual support
- Obtain expert help in planning care outside the hospital (e.g. discharge planning)
What is evidence-based practice?
- The conscious decision to use current evidence in making decisions about the care of individual pt’s
- Those working in palliative care must use existing research through systematic reviews to maximize the value of data yielded in caring for pt’s/families
- Outcome and quality of life measures need to be sensitive to wider aspects of palliative care (not merely mortality, function, etc.)
- More difficult to measure quality of life and altered outcomes in pt’s/families whose illness or frailty make it difficult to collect data
What physical affects influence quality of life?
- Functional ability
- Strength/fatigue
- Sleep/rest
- n/v
- Appetite
- constipation
- pain
What psychological affects influence quality of life?
- Anxiety/depression
- Enjoyment/leisure
- Pain distress
- Happiness
- Fear
- Cognition/attention
What social affects influence quality of life?
- Financial burden
- Caregiver burden
- Roles/relationships
- Affection/sexual function
- Appearance
What spiritual affects influence quality of life?
- Hope
- Suffering
- Meaning of pain
- Religiosity
- Transcendence
What is bereavement?
- Time we spend adjusting to loss
- No standard time limit, no right/wrong way to feel - everyone must learn to cope in their own way
- Time spent in bereavement may depend on how attached the person was to the person who died, and how much time was spent anticipating the loss
- Bereavement counseling can offer an understanding of the mourning process, explore areas that could potentially prevent you from moving on
What are the 7 C’s of quality hospice palliative care?
1) Competence
2) Consistency
3) Coordination
4) Climate
5) Cooperation
6) Communication
7) Compassion
What is the constant factor extending across hospice palliative care in different settings?
Nurses!
What is the six dimensions of the supportive care model?
Valuing:
1) Connecting
2) Empowering
3) Doing for (what can I do for the family?)
4) Finding meaning
5) Preserving integrity
6) Self-care
What is involved in life closure?
- Completion with worldly affairs
- Completion of community relationships
- Meaning about one’s individual life
- Love of self
- Love of others
Which clients are served by palliative services?
- Pt’s and families with a life threatening illness or facing end of life issues
- Anticipated prognosis of weeks or months rather than years
- Primary intent of tx is improved quality of life, not curative
- Pt/family agree to the referral or to consultative support
- DNR/”no code” status will be required for admission to hospice unit, but not for program
What services are available to patients in palliative settings?
- Visits by home care nurse
- Community HCP’s
- Support from consult team for managing symptoms such as pain/nausea
- Family conferences
- Grief/bereavement counseling
- Hospice volunteer visits
- Access to hospice facility/specialized hospital beds in acute care
- Equipment/supplies
What is the role of the community palliative team?
- Education and support to care providers, the community, individuals and families
- Consultation around pain and symptom management, discharge planning
- Coordination and planning of care
- Participation in case conferences
- Services in residential care, acute care, and in the community
Why should HCP’s consult community palliative teams?
- pain & symptom management
- psycho-social issues
- ineffective family or caregiver coping
- care planning
- end of life issues
- assessment re: need for hospice, acute or tertiary palliative care bed
What settings will a consultation team might appear?
- Home care
- Palliative care unit
- Residential care
- Hospice
- Acute care hospital
In what family/pt situations is it appropriate to refer to tertiary units?
- difficult pain syndromes
- complex physical symptom assessment/management
- complex psychological/spiritual/social issues
- significant family /caregiver distress
- extensive support required to improve QOL
- complex care planning exceeding resources at present community site
Why might an acute care bed be utilized?
- Short stay beds for pt’s requiring diagnostic tests and treatments
- Consult from hospice palliative team can occur in acute care
What is the admission criteria for hospice?
- End-stage, length of stay (LOS) maximum 3 months with average expected to be 16-22 days
- Symptom management plan in place
- DNR (Do Not Resuscitate) must be written
- Patient may be admitted under family physician
- Family physician involves consultation team
- FH resident with patient placement as close to own community as possible.
What is the most common entry point to identifying the need for hospice palliative care support?
Home Care referral
What does the BC Palliative Care Benefits program provide?
Medications, equipment and supplies
When is residential care utilized?
- People with many months to live who cannot remain at home can be cared for in long-term care facilities
- Palliative care teams can be consulted to provide support to patients in a residential facility
