The Role Of Palliative Care Flashcards
Is death normal cycle event?
Yes normal in the very old and in the chronically ill with declining function
But not normal in the young and healthy
What are the major causes of death in USA?
Chronic disorders- heart disease, cancer, stroke
Acute conditions- infections, trauma, homicide/ suicide
Where are the most sites people die?
Hospital- half of the time
Nursing home-30%
Home-20%
Where do people want to die at?
Home
Hospital
Nursing home- never
What are the forces in the healthcare system pushing for aggressive treatment until shortly before death?
Physician forces
Patient and family forces- not accepting facts
System forces- financial incentives to fill up hospital beds
What is the trajectory of illness?
Depends on the type of illness
2 major ones: cancer and non cancer
Cancer trajectory is more predictable.Typically death within 3-4 months after loss of 70% of function
Non cancer is less predictable. May have a lower functionality that cancer but decline is slower and can have multiple events
When is a patient dying?
Chronic life limiting illness and
Progressive loss of function and/or weight despite medical therapy
Increase use of medical resources with mo improvement in quality of life
Patient request of no further measures to reverse current or future medical problems
What are the signs and symptoms of syndrome of imminent death?
Time course is typically 1-14 days but can’t prognosticate with precision Loss of mobility- bed bound Decreased cognition Decreased oral intake Loss of swallowing reflex Pain Fever Skin color changes
What are the key aspects of care during the dying process?
Pain and symptoms control- morphine, lorazepam Meds to dry secretions- atropine Skin and oral care Family and spiritual care Death planning
What is the physician role in the care of the dying?
Symptoms management
Communication- share decision making to establish goals of care
Support
Presence
What is hospice?
A model of care for the dying patients and their families
It is not place but rather a program
It is a specialized form of home care
What are the focus of hospice?
Assessment of patient’s goals and wishes
Control distressing physical symptoms
Psychological and spiritual support for patient and family
Bereavement care
What is the eligibility criteria for hospice?
Physician certified prognosis of less than 6 months assuming the terminal illness runs its usual course
Treatment goals are palliative or comfort based rather than curative
A physician is willing to be the physician of record
DNR cannot be used as a criteria for eligibility
What are the required services that must be available to all patients under the medicare hospice benefit(MHB)?
Skilled nursing visits as needed Physician medical director Home health and service for a limited period of time each week (not full time) Psychological counseling Preparation for death Bereavement program
