Week 8 Advanced Directives, Palliative and Hospice Care, End-of-Life Care and Grief Flashcards
Barriers to End-of-Life Care
hospice and palliative care are poorly understood
delayed access to hospice and palliative care services because people do not understand the purpose/benefit
PCPs can be confused on when it’s appropriate to consult palliative care
this delay causes patient and families to not be able to reap the full benefits
Denial of death often prevents from accessing palliative care
Living Will
a directive to healthcare providers that communicates wishes for end-of-life medical care in case a person becomes unable to communicate them. Without documentation expressing those wishes, family members and healthcare providers are left to guess what the patient would prefer, which can often lead to family disputes. Each state has regulations and laws regarding living wills; healthcare providers should know what the requirements are in the state they practice in.
Barrier to ACP
- More than 25% of all adults have given no thought to their end-of-life wishes
- Patient’s don’t want to think about or talk about the subject
- Providers fear increasing patient or family anxiety
Durable Power of Attorney for Healthcare
This document enables older adults to appoint an agent, such as a trusted friend or relative, to handle health decision making. If the patient is no longer able to make decisions for themselves, such as in advanced Alzheimer’s disease or stroke or when a patient is comatose, the person listed as having durable power of attorney is someone who knows and understands the patients’ health and end-of-life wishes and is authorized to speak for the patient.
POLTS Criteria
- it is not a living will or advanced directive
- this document is developed for patients with less than 1 year to live
- outlines appropriate care for the patient, and is a set of orders that is to be followed by emergency workers
- emergency workers are not bound to follow a living will, but are bound to follow orders outlined in a POLST
POLTS Stands For
Physician Orders for Life-Sustaining Treatment
SPIKES Stands For
Setting Perception Invitation Knowledge or information sharing Emotions and empathy Summarize and Strategize
SPIKES is used for:
talking about end-of-life care and advanced directives
Palliative Care is defined as
relieving pain without dealing with the cause of the condition
improves the quality of life of patients and families when they are experiencing life-threatening illnesses
Palliative means
relief
Main goal of palliative care
prevent and relieve suffering and to support the best quality of life possible
Palliative care focuses on
anticipating, preventing, diagnosing, and treating symptoms experienced by patients with serious of life-threatening illness and helping patients and their families make medically important decisions
Goal of palliative care
to prevent and relieve suffering and to support the best possible quality of life for patients and their families, regardless of the stage of the disease or the need for other therapies
TRUE or FALSE: Palliative care can be given with life-prolonging therapies or as the main focus of care.
TRUE
TRUE or FALSE: Hospice care provides care to patients at the end of life and includes palliative care.
TRUE
Palliative care provides:
comfort care and a support system to both the family and patient, integrating the psychological and spiritual aspects of patient care, throughout the trajectory of illness, from the time of diagnosis until death, and encompasses end-of-life care
Eligibility of Palliative Care
- life-threatening diseases/diagnoses (cancer, heart failure, chronic lung disease, end-stage renal disease, Alzheimer’s disease)
- Patients with frequent hospitalizations, admissions prompted by physical or psychological symptoms that are difficult to treat; those with complex care requirements; those with functional decline, feeding intolerance and/or unintended weight loss could indicate the need for palliative care
- Frail elderly with symptom burden, functional limitations, cognitive impairment and lack of family or social support
Services offered by palliative care
Supportive medical, social, emotional and spiritual services to patients and their caregivers to improve patients quality of life
- pain management
- spiritual care
- physical care
- symptom management
Palliative Care Domain 1:
Structure and process of care
- interdisciplinary team
Palliative Care Domain 2:
Physical aspects of care
- pain and other symptom management
Palliative Care Domain 3:
Psychological and psychiatric aspects of care
- psychological and psychiatric issues are assessed and managed: grief and bereavement program is available for patients and families
Palliative Care Domain 4:
Social aspects of care
- interdisciplinary social assessments with appropriate care plan’ referral to appropriate services
Palliative Care Domain 5:
Spiritual, religious and existential aspects of care
- spiritual concerns are assessed and addressed linkages to community and spiritual or religious resources are provided as appropriate
Palliative Care Domain 6:
Cultural aspects of care
- culture-specific needs of patients and families are assessed and addressed; recruitment and hiring practices reflect the cultural diversity of the community
Palliative Care Domain 7:
Care of the imminently dying patients
- signs and symptoms of impending death are recognized and communicated
- hospice referral is recommended when patient is eligible
Palliative Care Domain 8:
Ethical and legal aspects of care
- patient’s goals, preferences, and choices from basis for plan of care
- the team is knowledgeable about relevant federal and state statues and regulation
Hospice care is:
- a team-oriented approach to providing specialized care for people facing a life-limiting illness or injury
- includes expert medical care, pain management, and emotional support for patients and their families
Hospice care uses
principles of palliative care, focusing on quality of life, to support patients and their families through the dying process, including bereavement services
Eligibility of Hospice Care
- must be considered terminal ill and within 6 months of death
- requirements and rules form Medicare
- physician referral required
- patient then chooses to receive hospice care rather than curative treatments
Morphine liquid concentrate treats:
pain and or shortness of breath
Oxygen to treat
hypoxia
Lorazepam liquid concentrate to treat:
restless and anxiety
