Tutorial 1 - End of Life Care

Question 1

what is terminal care (expected death)

Answer 1

the last phase of care when a patient’s condition is deteriorating and close to death

Question 2

most common cause of death in men age 15-34

Answer 2

suicide

Question 3

what accounts for 38% of deaths in boys and 23% in girls

Answer 3

accidents

Question 4

most common causes of death

Answer 4

cancer and IHD

Question 5

what is palliative care

Answer 5

a philosophy of care that emphasises quality of life and is performed by a MDT

Question 6

what guide is used to consider if a patient is at a palliatie stage

Answer 6

Supportive and Palliative Care Indicators Tool

Question 7

what is a Palliative Care Register

Answer 7

a practice’s list of patients at a palliative stage of care

Question 8

what is the supportive and pallaitive care indicators tool based on

Answer 8

would it be a surprise if they died in the next 6-12 months
2 or more general indicators of declining health
2 or more disease related indicators

Question 9

scale used in palliative care assessment

Answer 9

Palliative Performance Scale (PPS) in %

Question 10

how is a PPS assigned for a patient

Answer 10

start at left and go down until you reach the ambulation level which is most appropriate, then activity and evidence of disease, self-care, intake and conscious level

Question 11

cut off levels for PPS ambulation

Answer 11

100% - full
70% - reduced
50% - mainly sit
40% - mainly bed
30% - bed bound

Question 12

pros of PPS

Answer 12

excellent communication tool
value in other measurements and comparisons
prognostic value

Question 13

WHO principles of palliative care

Answer 13

• relief from pain and distressing symptoms
• affirms life and views dying as normal process
• doesn’t hasten or postpone death
• integrates pyschologicala dn spiritual aspects of primary care
• support system to help patient life actively till death
• support system to help family cope
• uses team approach to addressing patient and family needs

Question 14

examples of team members involved in palliative care

Answer 14

HSCP team, Macmillian nurses, CLAN, Marie Curie nurses, religious or cultural groups

Question 15

principles of a ‘good death’

Answer 15

• pain-free death
• open acknowledgement of imminence of death
• at home surrounded by family and friends
• ‘aware’ death in which personal conflicts and unfinished business are resolved
• death as personal growth
• according to personal preference and in a manner that resonated with the person’s individuality

Question 16

where do most people prefer to die

Answer 16

at home - 26% of people do

Question 17

what tools enable primary care to provide palliative care at home

Answer 17

Gold Standards Framework

Question 18

WHO definition of palliatve care

Answer 18

palliative care improves the quality of life of patient and families who face life-threatening illness, by providing pain and symptom relief, spiritual and psychosocial support… from diagnosis to the end of life and bereavement

Question 19

8 reactions to bad news and grief described by Parkes

Answer 19

• shock
• anger
• denial
• relief
• sadness
• fear
• guilt
• anxiety

Question 20

principles of breaking bad news

Answer 20

• listen
• set the scene
• find out what the patients understands
• find out how much they want to know
• share information using common language
• review and summarise
• allow opportunities for questions
• agree follow up and support

Question 21

3 types of euthanasia

Answer 21

voluntary - at patien’t request
non-voluntary - no request
physician assisted suicide

Question 22

what proportion of deaths take place in hospices

Answer 22

15-20%

Question 23

why do people ask for euthanasia

Answer 23

unrelieved symptoms or dread of further suffering

Question 24

how do respond to a request for euthanasia

Answer 24

• acknowldge the issue
• explore reasons for request
• exlore ways of giving patient more control
• look for treatable problems
• consider spiritual issues
• admit powerlessness