(W0) Intro

Question 1

When is one terminally ill?

Answer 1

Life expectancy of <6 months

Question 2

What is the main goal of care in palliative?

Answer 2

Comfort at the final moments of illness trajectory

Question 3

What are the 4 illness trajectories?

Answer 3

1) Sudden death —-|
2) Terminal illness —-\
3) Organ failure /\/\/\/\
4) Frailty ~~~\

Question 4

What is the ECOG score?

Answer 4

• Eastern Cooperative Oncology Group
• Scale to assess performance status of px and to determine future treatment options
• 0: Fully active
• 1: Restricted in physically strenuous activity but can do light work
• 2: Capable of all self-care and ambulatory 50% of time, but no work activities
• 3: Limited self-care, confined to bed >50% of time
• 4: Completely disabled, no self-care and totally confined to bed
• 5: Dead

Question 5

When does one determine if a patient should receive curative or palliative care?

Answer 5

• ECOG score just remains low or deteriorates further
  ~ Shows that treatments are not working anymore
• Severe symptoms + Px wishes + Prognosis + Limited ADLs

Question 6

Why is palliative care and curative care given at the same time?

Answer 6

• Need to look at the patient holistically (beyond just meds and disease needs)

Question 7

What is assessed upon referral to the palliative team?

Answer 7

• Illness trajectory
• Functional performance / ECOG score
• Total pain

Question 8

What are the 6 main palliative and hospice care services available in Singapore?

Answer 8

1) Hospital
2) Subacute
3) Inpatient hospice
4) Palliative day care
5) Home hospice
6) Caregiver services

Question 9

What do Hospital pall. services provide?

Answer 9

• Symptoms control
• EOL care
• Psychosocial, spiritual support

Question 10

What do Subacute pall. care services provide?

Answer 10

• Px w/ life-limiting illnesses that need subacute care
• Eg YCH, AMK THK Hospital

Question 11

What do Inpatient hospice services provide?

Answer 11

• Px w/ prognosis of < 3 months
• Care at home is difficult
• Pain and symptom control
• Psychosocial, spiritual support
• Respite care
• EOL care

Question 12

What do Palliative day care services provide?

Answer 12

• Px w/ life-limiting illnesses, stable but slowly deteriorating
• PT< OT, art/music therapy, recreational activities
• Pain and symptom control
• Psychosocial and spiritual support
• Respite care

Question 13

What do Home hospice services provide?

Answer 13

• Px w/ life-limiting illnesses but have caregivers at home
• Home visits conducted by multidisciplinary team
• Pain and symptom control
• CGT
• Equipment loan

Question 14

What do caregiver services provide?

Answer 14

• CGT
• Grants
• Counselling
• Bereavement support

Question 15

What are the main concepts of palliative and EOL care?

Answer 15

• Interdisciplinary involvement
• Symptom control
• Disease management
• Psychosocial and spiritual care
• Respecting px’s goals, preferences and wishes
  ~ ACP