Week 12: EOL Flashcards
What is advanced care planning?
Advance care planning is the process of thinking about, sharing (with family, or any other people you wish involved), and writing down, your beliefs, values & wishes for future health care treatment, in the event you become incapable of deciding for yourself.
What is a representation agreement?
Naming and instructing someone to make health and personal care decisions if/when you become incapable
What is an advance directive?
Provides instructions for health care that are given to your health care provider, which they must follow directly when it speaks to the care the individual needs at the time they become incapable.
What is an enduring power of attorney?
Appoints someone to make decisions about financial affairs, business and property. The enduring POA means that the designated person can continue to manage financial affairs even after an individual loses the capacity to direct them.
What is a MOST?
“Medical Orders for Scope of Treatment” is used in primary care and acute care to guide treatment decisions. This can be used in conjunction with other Advance Care planning documents
What is palliative care?
-Pain/ symptom management to improve QOL in those with life threatening illness; prevention and relief of suffering. Intends neither to hasten or postpone death
-Palliative care should be seen as interdisciplinary care focused on improving the quality of life for patients living with serious illness, as well as for their caregivers
-Palliation can be given along with treatments meant to cure or treat the disease and can continue from diagnosis through to the end of life.
-It should include symptom assessment and treatment, help to determine possible benefits and burdens of therapy, goals of care, as well as supportive transitions when care needs mean a move from home to hospital or hospice
What is Plan P
-BC Palliative Care Benefits Program
-For BC residents who have reached end stage (6 mo life expectancy) of life threatening disease and wish to receive palliative care wherever they are living (own home, supported/ assisted living, hospice, LTC)
-Covers 100% of prescribed and OTC palliative medications in Plan P (Palliative Care) formulary AND medical supplies/ equipment through local health authortiy
4 eligibility criteria for BC Palliative Care benefits:
-They are diagnosed with a life-threatening illness or condition
-They wish to receive palliative care at home (defined on p. 3)
-They consent to a focus on palliative care rather than treatment toward a cure
-Their life expectancy is up to 6 months
What is hospice care?
Hospice palliative care aims to relieve suffering and improve the quality of living and dying.
Hospice palliative care strives to help patients and families address:
* physical, psychological, social, spiritual and practical issues, and their associated expectations, needs, hopes and fears
* prepare for and manage self-determined life closure and the dying process
* cope with loss and grief during the illness and bereavement
What is the difference between palliative care and hospice care?
Palliative- management of symptoms, regardless of intent to cure or not
Hospice- focus on care/ comfort/ qol at EOL. No intent to cure.
From textbook:
hospice- generally offered once life prolonging tx are no longer appropriate
palliative care- offered simultaneously with disease modifying, life prolonging, and even potentially curative tx for patients with serious illness
What is the palliative performance scale? (PPS)
-measures progressive decline of palliative resident
-prognostic tool in palliative care patients
-useful for identifying/ tracking potential care needs of palliative patients, especially as they change with disease progression
-assigns a PPS level (% of 100) based on ambulation, activity & evidence of disease, self care, intake, and consciousness level
You are caring for a patient with metastatic Ca. When should you consider referral to home care nursing, based on their PPS?
-When PPS is transitioning from 70% to 60% or lower (BC Guidelines)
-In this PPS, ambulation is reduced, pt is moving towards not being about to do hobbies or housework, they need occasional assistance with self care, they may be confused at times.
Estimating prognosis in life limiting illness allows optimal use of limited time for patients and families. Rapid change in clinical condition is an understandable and helpful sign (BC Guidelines). Although prognoses can only be estimated, list some poor prognostic factors.
-progressive weight loss (esp. >10% over 6 mo)
-rapidly declining level on PPS
-dyspnea
-dysphagia
-cognitive impairment
(BC Guidelines)
True or false: The single most important predictive factor in cancer is stage of cancer and patient age.
False.
The single most important predictive factor in cancer is performance status and functional ability (BC Guidelines)
True or false: If patients are spending more than 50% of time in bed/ lying down, prognosis is likely to be about 3 months or less.
True
When might you refer a patient to a tertiary palliative care unit?
Referral is indicated for control of pain or other symptoms when these cannot be met in the community, and for support of severe psychological, spiritual, or social distress (BC Guidelines)
