Week 3 - Palliative and End-of-life care

Question 1

End of life care in which the intent of treatment has shifted from a curative POV to one of comfort.

Answer 1

palliative care

Question 2

When does palliative care start?

Answer 2

At the moment of Dx of incurable disease

Question 3

Affirms life and regards dying as a normal process; intends neither to hasten nor postpone death

Answer 3

Palliative care

Question 4

When does palliative care begin?

Answer 4

From Dx to end of life care (however extent will differ as time goes on)

Question 5

What are some drugs that might be considered to be dropped when a person is at the end of life?

Answer 5

diabetic meds, heart meds (unless necessary), cholesterol meds - i.e. meds in which the complications would take long to manifest

Question 6

What is the most important attribute of a good death?

Answer 6

Autonomy - give as much choice as possible - i.e. where they die, when they die, choice of treatmetns

Question 7

What are attributes of a good death?

Answer 7

comfortable
surrounded by loved ones
peaceful
chance to say goodbye
autonomy
reconciliation

Question 8

What are the goals of communication at EOL?

Answer 8

Person first; patient second
share accurate information
Empathy and support
Encourage/sustain hope

Question 9

Describe how hope changes through the palliative journey.

Answer 9

At the start, hope may be for a cure
Later on, may be symptom management
Finally, may be hoping to have everything in place to make the future as secure for kids as possible
Final days - hope for excellent symptom relief and a good death

Question 10

What is the WAIT acronym?

Answer 10

Why am I talking?

- we don’t need to know the answer, but know to ask open ended questions, listen, etc.

Question 11

if the person is lethargic, what is the best way to phrase questions?

Answer 11

Ask if they are better, worse or the same as the day before.

Question 12

What are some common mistakes in communicating with palliative clients?

Answer 12

using jargon
using “why”
using euphemisms - e.g. tumour, growth, mass
“I know what you’re going through/feeling…”

Question 13

Describe the common myth of “starving to death”.

Answer 13

At the end of life, no matter the route, people will develop a decreased appetite as the body start to shut down
- solids will go first
very important to consider mouth care

Question 14

Describe the misconception between palliative care and euthanasia.

Answer 14

Intent of palliative care is to support the natural journey, not speed up their death

Question 15

Describe how a HCP can determine if someone is in pain when they aren’t talking/are sedated.

Answer 15

Furrowed brows - if the skin can move - just wrinkles - if tension, probably in pain/discomfort

Question 16

How do you respond to:

“My son in Halifax is asking whether to come; what should I tell him?”

Answer 16

• I can’t imagine how hard it must be, but we don’t have a concrete timeline; tell the kid an update and leave it up to him to decide

Question 17

What is the last sensation to go?

Answer 17

hearing

Question 18

The dose is adjusted to help address the symptom, it is not chosen with intent to end the person’s life

Answer 18

Last dose phenomenon

Question 19

Can we withhold medications with fear that the dose will end their life when they are palliative?

Answer 19

No, we may get charged

we are covered legally, ethically and professionally to provide the dose

Question 20

Describe prognoses in cancer patients.

Answer 20

often over-optimistic

Question 21

What are the different disease trajectories?

Answer 21

high function then rapid death
High function then continued decline to death - e.g. terminal
Function that has peaks and troughs as function descends - e.g. CHF
Low function that progressively gets worse, over a long time - e.g. dementia

Question 22

What percentage of the population has a sudden death?

Answer 22

15%

Question 23

What are the 5 functional dimensions of the palliative performance scale?

Answer 23

Ambulation, activity level and evidence of disease, self care, oral intake, level of consciousness

Question 24

What is the greatest indicator of life expectancy in the palliative performance scale?

Answer 24

ambulation ability

Question 25

Once a person is bed bound, what dictates the level of care for a person on the palliative performance scale?

Answer 25

Oral intake

Question 26

Describe the relationship between the PPS and survival probability.

Answer 26

lower PPS, lower survival odds