Tutorial 1

Question 1

What is meant by a life-limiting/palliative illness?

Answer 1

Illnesses where it is expected that death will be a direct consequence of the specified illness

Question 2

What are the psychological, social, medical (and ethical) issues that palliative illnesses pose?

Answer 2

Psychological
- grief, anger, denial, blame

Social
- impact on family, care, finances, property, relationships

Medical
- pain/symptomatic relief, dying at preferred place

Ethical
- euthanasia

Question 3

What is the impact of a life-limiting/palliative illness on the patient, the relatives and the medical/nursing staff?

Answer 3

Patient

• pain/symptoms
• anxiety
• reduced functioning
• reduced social contact
• may impact quality of life

Relatives

• anxiety over care and patients suffering
• financial burden
• decline in own health
• increase in responsibilities
• guilt

Staff

• care management
• holistic approach
• enabling patient

Question 4

What support is available to the patient, their relatives and the medical/nursing staff, particularly in the community?

Answer 4

Macmillan nurses
GP
District nurse
OT
Pharmacist 
Dietician
Carers 
Care managers

Question 5

What is the role of palliative care and the roles of the multiple healthcare professionals in care of the dying?

Answer 5

The role of palliative care is to improve the quality of life of patients and families who face life threatening illness

The MDT are involved in providing pain and symptom relief, spiritual and psychosocial support

Question 6

Why is a holistic approach important in caring for these patients at the end of their life?

Answer 6

Allows patient to life actively until death, allows help for family to cope, affirms life and provides relief from pain and other distressing symptoms

Question 7

What factors may indicate that a patient may be suitable for/require palliative care?

Answer 7

Can use the supportive and palliative care indicators tool.

Factors

1. Is it a surprise if they die in next 6-12 months?
2. General clinical indicators (>=2) of poor performance status, weight loss, unplanned admissions, multi morbidity, needs advanced care
3. Disease related indicators
4. Assess patient and family. Review treatment/medication. Plan care. Consider for GP palliative care register.

Question 8

What is the palliative performance scale?

Answer 8

Used to measure the progression of a palliative illness in a patient. It has five dimensions: ambulation, activity and evidence of disease, self care, intake, conscious level. Score given as a percentage.

Question 9

What are the stages of grief in relation to diagnosis of a life-limiting disease and/or bereavement?

Answer 9

Denial, anger, bargaining, depression, acceptance

Bowlby & Parkes

1. Shock & numbness
2. Yearning & searching
3. Despair & disorganisation
4. Reorganisation & recovery