Tutorial 5 - Living With Dying

Question 1

What are the 2 most common causes of death in the western world?

Answer 1

cancer and IHD

Question 2

What is a terminal illness?

Answer 2

an incurable ailment leading to death

Question 3

What are some psychological effects of diagnosis with terminal illness?

Answer 3

• anxiety about death

- depression about hopeless situation

Question 4

What are some social effects of diagnosis with terminal illness?

Answer 4

• social isolation - maybe immune system not up to having certain visitors
• financial worries
• employment -continue to work or not?
• dependence on family members for care
• consider will and legal matters

Question 5

What are some medical effects of diagnosis with a terminal illness?

Answer 5

• change in medical treatment
• decision about advanced care directives, DNRs etc
• change of care environment? e.g. from hospital to home?

Question 6

What is palliative care?

Answer 6

• a philosophy of care that emphasises quality of life
• performed by a MDT
• mostly provided in primary care with support
• improves QoL of patients and families who face life-threatening illness, by providing pain and symptom relief, spiritual and psychosocial support

Question 7

What is the main purpose of palliative care?

Answer 7

to ensure that patients have autonomy and dignity in the final stages of their illness until death - this means making sure their wishes about where, when and how they are cared for is listened to and put in to action

Question 8

What tool can be used to know if a patient is at a palliative stage?

Answer 8

the ‘Supportive and Palliative Care Indicators Tool’

Question 9

How does the palliative care process begin?

Answer 9

by producing an ‘Anticipatory Care Plan’

Question 10

What questions are asked for an Anticipatory Care Plan to be formulated?

Answer 10

• Where do they want to be cared for?
• DNR?
• Who is to be informed about their care and changes in their condition?
• Are they fully aware of their prognosis?
• Is their family aware of their prognosis?

Question 11

What should happen after a discussion about an anticipatory care plan has taken place?

Answer 11

patient should be placed on the practice’s Palliative Care Register

Question 12

What tool can be used to evaluate how quickly the situation is changing for the patient and to see of their care needs need to be re-evaluated?

Answer 12

Palliative Performance Scale

Question 13

What are 3 purposes of the Palliative Performance Scale?

Answer 13

• good communication tool for quickly describing a patient’s current functioning level
• appears to have prognostic value
• may have value for workload assessment or other measurements and comparisons

Question 14

Why is it important to have palliative care in primary care?

Answer 14

• part of the quality and outcomes framework
• ensures practices have a register of palliative patients
• ensures that the team meet regularly to discuss the cases
• enhances communication between team members
• out of hours also notified of palliative cases

Question 15

What does the WHO view as positives for palliative care?

Answer 15

• provides relief from pain and other distressing symptoms
• affirms life and regards dying as a normal process
• intends neither to hasten nor postpone death
• integrates the psychosocial and spiritual aspects of patient care
• offers a support system to help patients live as actively as possible until death
• offers support system to help family cope during the patient’s illness and in their own bereavement
• uses a team approach to address the needs of the patient and their families, including bereavement counselling if indicated

Question 16

Other than primary care, what other healthcare professionals are involved in palliative care?

Answer 16

• Macmillan nurses
• CLAN
• Marie Curie Nurses
• Religious/cultural groups
• other support networks e.g. websites
• third sector organisations

Question 17

What are markers of a ‘good’ death?

Answer 17

• pain free
• open acknowledgement of the imminence of death
• death at home surrounded by family and friends
• an ‘aware’ death, in which personal conflicts and unfinished business are resolved
• death as a personal growth
• death according to personal preference and in a manner that resonates with the person’s individuality
• without excessive medical intervention e.g. respirators etc

Question 18

What are the 8 principles of breaking bad news?

Answer 18

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

Question 19

What are possible reactions to bad news? (also stages of grief)

Answer 19

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

Question 20

How can you respond well to a patient’s reaction to bad news?

Answer 20

• listen
• acknowledge the issue
• explore the reasons for the request
• explore ways of giving more control to the patient
• look for treatable problems
• remember spiritual issues
• admit powerlessness

Question 21

What is grief?

Answer 21

a primary emotional reaction to the loss of a loved one

Question 22

What are the 5 stages of grief?

Answer 22

• denial
• anger
• bargaining
• depression
• acceptance

Question 23

What are the 4 Parke’s stages of adjustment in grief?

Answer 23

• numbness
• pining/searching/ yearning
• depression/ disorganisation/despair
• recovery/ reorganisation

Question 24

What is euthanasia?

Answer 24

deliberate ending of a person’s life with or without their request

Question 25

What role does the GP principal or Partner have?

Answer 25

• run the practice

- sometime there is only one GP partner, but normally it is a group

Question 26

What is a sessional/salaried GP?

Answer 26

employed by the practice and receives salary for a fixed number of hours worked

Question 27

What is a GP locum?

Answer 27

• freelance GP
• employed to cover leave or sickness and to back-fill a practice GP attending a meeting or activity outside of the practice

Question 28

What does a GP do?

Answer 28

• acute treatment
• chronic management
• transfer of hospital work
• paperwork
• meetings, training and education
• shift work for out of hours
• special interest

Question 29

When is communication important to a GP?

Answer 29

• electronic lab results
• telephone
• email
• interprofessional meetings
• communication across organisations
• communication with other industries
• with hospitals

Question 30

What is the Quality and Outcome Framework?

Answer 30

• annual reward and incentive programme detailing GP practice achievement results
• rewards GPs for how well they care for their patients, and ca be viewed as a set of clinical standards

Question 31

What does the Quality and Outcome Framework award surgeries achievement points for?

Answer 31

• managing some of the most common chronic diseases e.g. asthma, diabetes
• implementing preventative measures e.g. regular BP checks
• extra services offered e.g. maternity services
• the quality and productivity of the service, including the avoidance of emergency admissions to hospital
• compliance with the minimum time a GP should spend with each patient at each appointment