SM_271b: Principles of Palliative Care

Question 1

Describe palliative care

Answer 1

Palliative care

• Provides relief from pain
• Affirms life and regards dying as a normal process
• Intends to neither hasten or postpone death
• Integrates psychological and spiritual aspects of patient care
• Offers a support system to help the family hope
• Uses a team approach to address needs of patients and families
• Is applicable early in course of illness in conjunction with other therapies that are intended to prolong life

Question 2

Hospice occurs when ___

Answer 2

Hospice occurs when patient is close to death

Question 3

Describe elements of hospice

Answer 3

Hospice

• Expected prognosis of 6 months or less: challenges are prognosticating and discussing
• Capitated / managed system: challenge is that more expensive therapies may be harder for individual hospices to provide
• Focus on comofrt and not cure: challenge is that it is hard to make the distinction

Question 4

Hospice is most often used for ___

Answer 4

Hospice is most often used for cancer

• Even the heart disease is largest cause of death

Question 5

Overall data for impact of palliative care are in ___ and ___

Answer 5

Overall data for impact of palliative care are in symptom control and quality of life

• No difference in mortality
• Earlier hospice referrals, lower rates of ventilation / ICU admission / rescucitation, not associated with more depression or more worry
• Lower costs of care
• Helpful for family

Question 6

Describe effects of palliative care in RCT

Answer 6

Palliative care in RCT: early palliative care associated with

• Lower depression
• Better quality of life
• Improved survival

Question 7

Summarize effects of palliative care

Answer 7

Palliative care

• Patients with metastatic non-small cell lung cancer: early palliative care led to significant improvements in quality of life and mood
• Early palliative care led to less aggressive care at end of life but longer survival

Question 8

Describe conceptual challenges of palliative care

Answer 8

Conceptual challenges of palliative care

• Caring vs curing: what is caring not curing? and what is comfort care?
• We like to win: the perspective that hospice is for losers is problematic, actual outcomes are worse than on TV
• We are poor prognosticators
  
  • Inaccuracy: usually optimistic
  • Ambivalence: usually significant
  • Hesitance: usually warranted, often problematic

Question 9

Describe steps in extubating a patient

Answer 9

Steps in extubating a patient

1. Making a decision to do so
2. Steps of extubating itself: who is there, what does each person do
3. Supporting patient and family during and after extubation: symptom control, emotional support

Question 10

Palliative care requires consideration of the ___

Answer 10

Palliative care requires consideration of the ethics of a team

• Differential diagnosis: what are potential reasons for conflict?
• Management: what are you going to do about the conflict?