Prognosis: palliative care

Question 1

A core competency for hospitalists is the assistance in decision making for patients w serious and life threatening illness. This requires: (4)

Answer 1

• knowledge about functional status and disease state
• communication w collaborating providers
• shared and informed understanding about pt prognosis
• expploration of pt/family understanding about illness/goals/fears/wishes

Question 1

define prognosis

Answer 1

a prediction of the probable course and outcome of disease

or

the likelihood of recovery from disease

Question 2

One useful and quick clinical tool for prognostication is the () question. which asks: ()

Answer 2

surprise question

“would ou be surprised if this patient died in the next year”

Question 3

A () is a clinical tool that quantifies the contributions that various components of the history, physical exam, and laboratory findings make toward a diagnosis, prognosis, or likely response to treatment.

Answer 3

prognostic index

Question 4

Providers can use () to lend confidence to their judgments about prognosis and these indices provide an objective measure to support clinical intuition.

Answer 4

prognostic indices

Question 5

What are some different names for prognostic indices

Answer 5

• clinical prediction rules
• decision rules
• staging systems
• see below

Question 6

Pretty sure this is just an example but what are the 4 NYHA classifications

Answer 6

Question 7

what is the Walter index

Answer 7

an accurate and easy-to-use index to stratify older adults into groups by their risk for 1-year mortality after hospital discharge.

Question 8

what does functional status reflect

Answer 8

the severity and end result of many different illnesses and psychosocial features

Question 9

Critically ill hospitalized patients with prehospitalization disability have been shown to have a () fold increase in the risk of death

Answer 9

2 to 3

Question 10

The simplest method to assess functional ability is to ask patients: …..

what does their response mean for prognosis?

Answer 10

• “How do you spend your time? How much time do you spend in bed or lying down?”
• If the response is >50% of the time and this is increasing, estimate the ill patients’ prognosis at 3 months or less.

Question 11

this is probs just FYI but feel free to look

Answer 11

Question 12

this is probs just FYI but feel free to look

Answer 12

Question 13

Palliative care focuses on (), and integrates () care by considering a patient’s and family’s needs, preferences, values, beliefs, and culture.

Answer 13

• effective management of pain and other distressing symptoms
• psychosocial and spiritual

Question 14

The palliative care approach works to improve quality of life for the patient and family by … (3)

Answer 14

• Reducing a patient’s symptom burden
• Providing clear communication about what to expect in the future
• Aligning realistic treatment options with patient- and family-determined goals of care.

Question 15

I feel like this slide is common sense but also idk ill probs forget it.

Answer 15

Question 16

I feel like this slide is common sense but also idk ill probs forget it.

Answer 16

Question 17

Examples of palliative care

Answer 17

Question 18

Unlike hospice, which requires that a physician endorse a 6-month prognosis in order for a patient to qualify for hospice services, palliative care (sometime referred to as supportive care), is provided in conjunction with ()

Answer 18

curative treatment at any point in the disease trajectory from the time of diagnosis.

Question 19

Palliative treatment options may become a greater focus for the patient and the care team when (), or when ().

Answer 19

• the burden of curative treatment outweighs the benefits
• there are no longer effective disease-modifying treatments

Question 20

what are the 3 core components of primary palliative care

Answer 20

1. skills in sympotm assessment and management
2. skills in effective and empathetic communication
3. skills in interdisciplinary teamwork

Question 21

Patients with complex needs may require a referral to a()

Answer 21

specialized palliative care team

Can provide assistance with difficult-to-control symptoms and conflict resolution regarding goals and treatments with families, between staff and families, and among treatment teams.

Question 22

To address the fear that a palliative care consultation may signal to the patient that the hospital team is ‘giving up,” hospitalists could state:

lol good luck w this speech cuz its loooonggg

Answer 22

“We want to make sure we are doing everything possible to help you feel as best as you possibly can. We will be asking the palliative care team to visit and provide an extra layer of support for you and your family. They will help us make sure that your symptoms are well controlled, and we will continue to be your primary doctors during this hospitalization.”

Question 23

The key aspects of palliative care are divided into eight domains, including:

Answer 23

1. Structure and Processes of Care
2. Physical Aspects of Care
3. Psychological and Psychiatric Aspects of Care
4. Social Aspects of Care, Spiritual, Religious and 5. Existential Aspects of Care
5. Cultural Aspects of Care
6. Care of the Patient at the End of Life
7. Ethical and Legal Aspects of Care