Week 3 - Palliative and End-of-life care Flashcards
End of life care in which the intent of treatment has shifted from a curative POV to one of comfort.
palliative care
When does palliative care start?
At the moment of Dx of incurable disease
Affirms life and regards dying as a normal process; intends neither to hasten nor postpone death
Palliative care
When does palliative care begin?
From Dx to end of life care (however extent will differ as time goes on)
What are some drugs that might be considered to be dropped when a person is at the end of life?
diabetic meds, heart meds (unless necessary), cholesterol meds - i.e. meds in which the complications would take long to manifest
What is the most important attribute of a good death?
Autonomy - give as much choice as possible - i.e. where they die, when they die, choice of treatmetns
What are attributes of a good death?
comfortable surrounded by loved ones peaceful chance to say goodbye autonomy reconciliation
What are the goals of communication at EOL?
Person first; patient second
share accurate information
Empathy and support
Encourage/sustain hope
Describe how hope changes through the palliative journey.
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
What is the WAIT acronym?
Why am I talking?
- we don’t need to know the answer, but know to ask open ended questions, listen, etc.
if the person is lethargic, what is the best way to phrase questions?
Ask if they are better, worse or the same as the day before.
What are some common mistakes in communicating with palliative clients?
using jargon
using “why”
using euphemisms - e.g. tumour, growth, mass
“I know what you’re going through/feeling…”
Describe the common myth of “starving to death”.
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
Describe the misconception between palliative care and euthanasia.
Intent of palliative care is to support the natural journey, not speed up their death
Describe how a HCP can determine if someone is in pain when they aren’t talking/are sedated.
Furrowed brows - if the skin can move - just wrinkles - if tension, probably in pain/discomfort
How do you respond to:
“My son in Halifax is asking whether to come; what should I tell him?”
• 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
What is the last sensation to go?
hearing
The dose is adjusted to help address the symptom, it is not chosen with intent to end the person’s life
Last dose phenomenon
Can we withhold medications with fear that the dose will end their life when they are palliative?
No, we may get charged
we are covered legally, ethically and professionally to provide the dose
Describe prognoses in cancer patients.
often over-optimistic
What are the different disease trajectories?
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
What percentage of the population has a sudden death?
15%
What are the 5 functional dimensions of the palliative performance scale?
Ambulation, activity level and evidence of disease, self care, oral intake, level of consciousness
What is the greatest indicator of life expectancy in the palliative performance scale?
ambulation ability
Once a person is bed bound, what dictates the level of care for a person on the palliative performance scale?
Oral intake
Describe the relationship between the PPS and survival probability.
lower PPS, lower survival odds
