Week 2 - Philosophy and principle of palliative care Flashcards
why are people dying differently than many years ago
- increased life expectancy
- more chronic illness
- life saving interventions
- tech
WHO definition of Palliative care
- approach that improves a QOL of patients and their families facing problems associated with life-limiting illness.
- through the prevention and relief of suffering using early identification and impeccable assessment and treatment of pain and other problems, physical psychological, and spiritual
Goal of palliative care
improve QOL of those who are suffering from severe diseases
theoretical principles of palliative care
Structure
target
task
expertise
goals
Structure (3)
- multidisciplinary team
- 24/7 service
- network: cross setting
Target
- patient population
- timing
- family/relatives
task
control of symptoms
comprehensive care
expertise
knowledge skills and attitudes
goals
prevention and relief of suffering
improvement in Q of L
previous beliefs of palliative care
active treatment, palliative, death
very demarcated
ended when pt died
evolving model of PC
diagnosis- death
-a curative approach aimed at treating the disease or prolonging life
-palliative care is focused on symptom control and quality of life
- ## combination of curative and palliative therapies
another model
included psychosocial and spiritual support
disease-focused care
comfort-focused care
death
follow up
term living well used to
honor the belief that persons are simultaneously living and dying
bow tie model of 21st century
disease management PC
cure rehab
control PC unit or hospice
Symptom management
ACP
_____________________________________> EOL care
survivorship and bereavement added to PC side
palliative care has an aim to
alleviate suffering (physical, emotional, psychological or spiritual) rather than curing
principles of hospice and PC can be
integrated into care early in the dying process
life limiting illness
- acute or chronic, that is likely to shorten or limit a person’s life
- gentler term than terminal illness
- may be more easily accepted word
30% of population ___
33% increase in
2/3 will die with
only 20% will die with a
> 65
deaths from 2004
2 or more chronic diseases after months or years in a state of “vulnerable frailty”
recognizable terminal (palliative) Phase
causes of death in Canada
2.9 % sudden
28.4 terminal illness
33.8 organ failure
29.3 frailty
5.6 other
terminal down will benefit from PC
PC shows improvement in
- pain and other symptoms
- communication with doctors and family members
- emotional and physiological state
- improved QoL
- improved survivor ship
more favorable outcomes (good death)
barriers to accessing palliative care resources
- mistrust of HC system
- Belief of ineligibility
- Insufficient training of HCPs
- Taboos and fears about talking about death and dying
- Lack of a clear prognosis(especially with a non cancer diagnosis)
- Elderly (cognitively aware, hard to know on the trajectory there is nothing left, it is what we expect) children (family not wanting to since it can diminish hope)
- Increasing number of people dying (not enough beds)
- People living with physical and developmental disabilities
- Rural and remote
- Unhoused
- An increasing number of people aging with chronic life-limiting illness will require care for longer periods
- Fewer family caregivers.
moving forward action plan
priorities (3)
- redesign health services to deliver timely coordinated EOL care
- Provide individuals, caregivers and health providers with palliative care information, education tools, and resources
- Strengthen Health System accountability and efficiency
3 triggers for PC approach
- The Surprise Question:
“Would you be surprised if this patient were to die in the next 6-12 months?” - Choice:
The patient with advanced disease makes a choice for comfort care only (example refusing renal transplant or bone marrow transplant) - Clinical Indicators:
Specific to each of the three main end of life groups - cancer, organ failure, elderly frail/dementia
Death trajectories
- cancer = steady decline 1/4
- organ system failure = stuttering, death not as clear
- frailty= long term dependencies, slow death
transitions
“Changes that occur on a continuum from wellness to death, commonly identified in hospice palliative care practice using various palliative performance scales.”
PPS
start on left and move to the right
left is the strongest determinant
key transitions in dying
100-90%
80-70%
60-50%
40-30%
20-10%
0%
- diagnosis
- indicated illness not responding to tx, disease progression
- disease extensive and advanced, cure not possible
- unable to provide self-care, extensive care giving
- less alert and responsive, death is imminent
-death
The patient spends the majority of the day sitting in bed or lying down due to fatigue from advanced disease. She requires considerable assistance to walk even short distances. She is fully conscious. She has a good nutritional intake.
what is PPS? look in one note
50%
The patient is very weak and remains in a chair a couple of hours a day. The rest of the time, he is in bed. He has advance disease and is requiring almost complete assistance with self-care and feeding. He is experiencing decreased food intake, with a few small snacks that remain mostly unfinished. He has adequate fluid intake. The patient is drowsy but not confused.
PPS?
30-40%
4 key elements determine how PC can be used in practice
the approaches
- Decreasing suffering/increasing quality of life
- Implementing holistic care
- Providing person and family centered care
- Providing team based care
how PC upstream approach
Identifying patients early. Meeting the needs of people living the trajectories of chronic life-limiting illnesses.
Requires anticipating, preparing, decision-making, communicating, initiating discussions, advocating, and caring.
Which of the following options are ways to decrease suffering and improve quality of life using a palliative approach? Select all that apply.
- Raise the head of the bed for a person who is struggling to breathe.
- Asking the OT to teach the person how to conserve their energy while attending to their ADLs.
- Ask the person and family how they are managing.
- Manage pain symptoms.
- Tell the person to get their affairs in order.
1,2,3,4
common aspects of holistic care include
Physical
Psychosocial
Spiritual
Financial
Sexual
whose responsibility is it to care for the dying
all nurses and palliative care specialists
what do we strive for (3)
- Equality promotes fairness through equal treatment
- Equity goes a step further by recognizing the diverse needs and starting points of individuals
- Achieving true social justice often requires both principles as they complement each other creating a more inclusive and fairer world.
Prognostication or prediction of need (Screening Tool)
- Gold standard
- Surprise Question embedded
- Tool used to assess any person who is aging, living with a progressive life-limiting illness, entering long-term care, or whose health is suspected to be declining.
- Needs-Based Coding - the right care at the right time
- A person showing any general or specific indicators of decline would benefit from the integration of a palliative approach
Screening Tool to integrate Palliative approach) first step
- identify who is declining and would benefit from a PC approach
- unmet PC needs
identify people with unmet palliative care needs (5)
- Frequent hospital admissions for the same symptom.
- Difficult to manage symptoms.
- Increasingly complex care requirements (e.g., the need for increased assistance with ADLs)
- Added specialty needs
- Decrease appetite and/or involuntary weight loss
domains of care (9)
disease management (primary dx, secondary dx, comorbidities)
physical (pain and other symptoms)
psychological (personality, strengths, depression)
social (relationships, roles, privacy)
spiritual (meaning, value, beliefs)
practical (ADLs)
EOL care/death management
loss/grief
Patient and family in the center
