SLA 19 - Palliative Care Flashcards
What is palliative care?
Care that aims to improve the quality of life for patients and their families, who have life-threatening illnesses.
It prevents and relieves suffering through the early identification, correct assessment and treatment of pain, and takes into account physical, psychosocial and spiritual factors.
Give some diseases which may result in needing palliative care.
- cancer
- Alzheimer’s
- COPD
- frailty
- heart failure
- HIV / AIDS
- chronic kidney disease
- meningitis
What is advanced care planning?
A plan made between a healthcare professional and a patient to inform their future healthcare decisions, based upon the patient’s:
- personal values
- beliefs
- wishes
It helps to relieve family anxiety as decisions are made by the patient early in their disease whilst they still have capacity.
When would patients be considered to be approaching the end of life?
Patients considered to be approaching the end of life if they are likely to die within the next 12 months (including patients who’s deaths are imminent).
Define frailty.
A state of increased vulnerability due to decreased physiological reserve, in which three or more of the following criteria are present:
- unintentional weight loss
- self-reported exhaustion
- slow walking speed
- low physical activity
Note that patients who are frail generally experience sharp declines to a stressor (e.g. illness) due to the lack of physiological reserve.
What is the illness trajectory of the following conditions?
- cancer
- organ failure
- frailty
- dementia
How can a patient who is nearing the end of life be recognised?
- expected to die within the next 12 months
- exacerbations of existing illness becoming worse in character or frequency
- common symptoms of advances illness (e.g. anorexia, loss of weight, tiredness, pain, depression)
Give some terminal signs that can be expected in the weeks leading up to death, which should be explained to the patient and family to help them prepare?
- Death rattle - heard due to the patient being unable to swallow or reabsorb secretions. Give the patient a fan or open the window to help.
- Tiredness - the patient has less energy and so may be more sleepy, however can still hear so continue to speak to them.
- Agitation - the patient may be experiencing hallucinations or be constipated. Try to comfort the patient and let them know you are there with them.
- Skin changes - the patient’s skin may go cold or change colour, and is a normal part of the dying process.
- Loss of continence - clean the patient to help keep them comfortable.
What are some steps that can be taken to help relieve the death rattle?
- lay patient on their side
- oropharyngeal suction
- anticholinergics (e.g. hydroscine butylbromide) to dry secretions.
What is the definition of the following pillars of medical ethics?
a) beneficence
b) non-maleficence
c) autonomy
d) justice
a) promote the patients best interests
b) do no harm
c) respect the patient’s decisions about their own health
d) distribute medical benefits fairly
Describe the following ethical issues that arise when considering end of life care:
a) presumption in favour of prolonging life
b) presumption of capacity
a) decisions concerning potentially life-prolonging treatment must not be motivated by a desire to bring about the patient’s death, and must start from a presumption in favour of prolonging life.
b) every adult patient has the capacity to make decisions about their care and treatment. Doctors are bound to respect a refusal of treatment from a patient who has capacity, and if the doctor themselves have an objection to the refusal, they have a duty to find another doctor who will carry out the patient’s wishes.
List some examples of treatment that are debated as to whether or not to administer when patient’s are at the end of their life.
- treatment for life-threatening infection
- CPR
- renal dialysis
- artificial nutrition and hydration
- mechanic ventilation
What is a ReSPECT form?
The Recommended Summary Plan for Emergency Care and Treatment form.
It is an individualised care plan for the patient, allowing them to decide what steps should be taken in the management of their condition and deterioration.
Note the ReSPECT form is NOT legally binding, and can be regularly reviewed. It is not a DNACPR.
What must be assessed prior to constructing a ReSPECT form with a patient?
The patient must be deemed to have capacity to make decisions about their health.
If the patient lacks capacity, a family member or legal proxy can decide on behalf of the patient.
Give some questions that may be asked during the ReSPECT process.
- what do you understand about your medical condition?
- do you need any further support?
- what is important to you?
- what concerns do you have?
- what treatments would you want or not want?
