year three - end of life care

Question 1

When is palliative care put in place?

Answer 1

Palliative care put in place when no curative options- symptomatic control, holistic care

Question 2

What is the Difference between end of life care in hospital vs community?

Answer 2

• Continuity • Knowledge of patient and family • Allows time for conversations and planning

Question 3

Why do people die today?

Answer 3

o Most common causes of death are cancer and ischaemic heart disease

Question 4

How do young people die today?

Answer 4

Mostly via accidents - 23% girls - 38% boys

Question 5

What is the main cause of death in young men aged 15-34?

Answer 5

Suicide

Question 6

By how much as life expectancy in scotland increased by since 1861?

Answer 6

by 32.3yrs for men and 34.1yrs for women

Question 7

What are the consequences of unexpected death?

Answer 7

• Causes a profound sense of shock • No chance to say goodbye, or take back hasty words • Accidents might be compounded by multiple deaths, legal involvement or even press coverage • Deaths of children carry an even more profound sense of shock. SIDS has no definite diagnosis and may carry the stigma of parental blame • Terminal care is the last phase of care when a patients condition is deteriorating and death is close • It is often misleadingly only associated with cancer

Question 8

What does WHO state about palliative care?

Answer 8

: palliative care improves the quality of life of patients and families who face life-threatening illness, by providing pain and symptom relief, spiritual and psychosocial support from diagnosis to the end of life and bereavement

Question 9

4 bullet points

What does the Scottish Governments Living and Dying Well (2008) state about palliative care?

Answer 9

Palliative Care:

• not just about care in the last months, days or hours of a persons life
• should ensure quality of life for patients and families from diagnosis onwards
• should focus on the person, not the disease
• use a hollistic approach to meet the physical, functional, practical, social, emotional and spiritual needs of patients and carers facing progressive illness and bereavement

Question 10

What is the role of the GP in palliative care?

Answer 10

To act as a companion

Question 11

What was the perinatal mortality rate of the 1850s?

Answer 11

>150/1000 live births

Question 12

What was the highest cause of death in the mid 19th century?

Answer 12

infectious disease - accounted for 1/3 deaths

Question 13

How do you know when patients need palliative care?

Answer 13

When patient is getting more ill with a chronic condition or they have a life limiting condition

Doctors can use the Supportive and Palliative Care Indicator tool to help in assessment

Question 14

What should be considered in anticipatory care planning?

Answer 14

o Where do they want to be cared for? o Do they want to be resuscitated in the event of cardiac arrest? o Do they want to die naturally? o Who do they want to be informed of their care and any changes in their condition? o Are they fully aware of their prognosis? o Is their family aware of their prognosis?

Question 15

What occurs after the patient is put on the palliative care register?

Answer 15

The patients wishes should be sent to the out of hours service so everyone involved in the patient care is aware of the patients plan

Question 16

What can be used to evaluate how quickly a palliative patients situation is changing?

Answer 16

The palliative performance scale

Question 17

What symptoms are associated with palliation ?

Answer 17

Pain, anxiety, insomnia, nausea

Question 18

What must palliative care achieve for patients according to the WHO?

Answer 18

• Provides relief from pain and other distressing symptoms
• Affirms life and regards dying as a normal process
• Intends neither to hasten nor postpone death
• Integrated the psychological and spiritual aspects of patient care
• Offers a support system to help patients live as actively as possible until death
• Offers a support system to help the family cope during the patients illness and in their own bereavement
• Uses a team approach to address the needs of patients and their families, including bereavement counselling if indicated

Question 19

Who is involved in palliative care?

Answer 19

Macmillan nurses: practical advice, support, financial benefits

• CLAN
• Marie Curie nurses: can come and sit with family and support and give evening care
• Religious or cultural groups
• District nurses
• Occupational therapists: supply equipment and assess patient functionally- hospital bed, commode, air mattress
• Community nurses – evening + all night
• Care manager: organise personal care

Question 20

What is the DS1500 form?

Answer 20

document stating patient is at the end of their life- opens up available financial support

Question 21

What is the patients perspective of a good death?

Answer 21

• Pain free death
• Open acknowledgement of the imminence of death
• Death at home surrounded by family and friends
• Aware of death, in which personal conflicts and unfinished business are resolved
• Death as personal growth
• Death according to personal preference and in a manner that resonates with the persons individuality

Question 22

How should one break bad news?

Answer 22

• Listen • Set the scene • Find out what the patient understands • Find out how much the patient wants to know • Share information using a common language • Review and summarise • Allow opportunities for questions • Agree follow up and support

WHAT NOT TO SAY - “You have cancer.” *gets up and leaves* **cough cough meiklejohn**

Question 23

What are the reactions to bad news?

Answer 23

• Shock • Anger • Denial • Bargaining • Relief • Sadness • Fear • Guilt • Anxiety • Distress

Question 24

What are the four stages of grief and loss according to Parkes?

Answer 24

Shock and Numbness

Yearning and Searching

Disorganisation and Despair

Reorganisation and Recovery:

Question 25

What must be considered with grief?

Answer 25

• Is an individual experience
• Is a process that may take months or years
• Patients may need to be reassured that they are normal
• Abnormal or distorted reactions may need more help
• Bereavement is associated with morbidity and mortality

Question 26

How many deaths occur in hospices?

Answer 26

15-20%

Question 27

What is voluntary euthanasia?

Answer 27

The deliberate ending of a persons life with their request

Question 28

What is non voluntary euthanasia ?

Answer 28

The deliberate ending of a persons life without their request

Question 29

What is physician assisted suicide?

Answer 29

Physician provides the means and advice for suicide It is illegal in the UK

Question 30

How many people in the UK ask to die?

Answer 30

3-8% Usually due to unrelieved symptoms or the dread of further suffering

Question 31

What should be your response if a patient wants to be euthanised?

Answer 31

• Listen • Acknowledge the issue • Explore the reasons for the request • Explore ways of giving more control to the patient • Look for treatable problems • Remember spiritual issues • Admit powerlessness

Question 32

What are the Just In Case medicines?

Answer 32

• Morphine: pain + breathlessness • Midazolam: agitation • Hyoscine: excess secretions • Levomepromazine: nausea

Question 33

What is a syringe driver used for ?

Answer 33

Usually initiated when patient struggling to take oral medicine • Mixture of drugs- most commonly morphine + midazolam • 24hrs flow of drugs Subcutaneously • No set maximum dose of morphine- patient given as much as they need

Question 34

Palliative performance scale

Answer 34

Question 35

Disease trajectory scale

Answer 35

Question 36

Old vs New Palliative Care Models

Answer 36