End Of Life Care

Question 1

Define palliative care?

Answer 1

This i an approach that improves the quality of life of patients and their families facing the problems associated with life threatening illness through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual

Question 2

Defining end of life?

Answer 2

Approaching the end of life = likely to die within the next 12 months

Those facing imminent death and those with:
- advanced, progressive, incurable conditions
- general frailty
- at risk of dying from sudden crisis or condition
- life threatening conditions caused by sudden catastrophic events

Question 3

Other than cancer, what other disease will require palliative care?

Answer 3

• motor neurone disease
• end stage cardiac failure
• end stage COPD
• advanced renal disease

Question 4

Principles of good end of life care?

Answer 4

• open lines of communication
• anticipating care needs
• effective multidisciplinary team inputs
• symptom control
• preparing for death (prepare family and patient)
• provide support for relatives before and after death

Question 5

Other than drugs, what complematary therapies are used for end of life care?

Answer 5

• music
• gentle touch
  Pets
• aroma therapy

Question 6

What sort of physical symptoms are you looking to ameliorate?

Answer 6

• nausea/vomiting
• anorexia
• constipation
• cough
• fatigue

Question 7

What are the 3 aims of palliative care?

Answer 7

1- whole person approach HOLLISTIC

2- focus on QOL
3- care encompassing the person with the life threatening illness and those that matter to them

Question 8

What is generalist palliative care?

Answer 8

Integral part of the routine care delivered by all health professionals to those living with a progressive and incurable disease, whether at home, in a care home,or in a hospital.

Question 9

What is specialist palliative care?

Answer 9

Based on the same principles of palliative care, but can help people with more complex palliative care needs.

Question 10

Who would be part of a multi disciplinary team in palliative care?

Answer 10

Specialist nurse
Palliative care doctors
GP
Secondary care
District nurse
Dieticians
Chaplain …

Question 11

Advance statement?

Advance decision?

Answer 11

Advance statement = a statement that sets down your preferences, wishes, beliefs and values regarding your future care.
- future decisions cannot be bound by this

Advance decision = a decision you can make now to refuse specific treatment in the flute
Eg- will
- there may be issues around life saving treatment
You will always need power of attorney

Question 12

When can death be confirmed/

Answer 12

“The simultaneous and irreversible onset of apnoea and unconsciousness in the absence of the circulation.”

• observed and confirmed for a minimum of 5 minutes
• apnoea = no respiration

Question 13

How do you recognise death in primary care?

Answer 13

The absense of cardiac function will be confirmed by:
- absence of a central pulse
- absence of heart sounds

Question 14

How do you recognise death in hospital?

Answer 14

One or more of the following:
- asystole on a continuous ecg
- a sense of pulsatile flow using direct intra arterial pressure monitoring
- absense of contractile activity on echo

Question 15

After 5 minutes of continued cardio respiratory arrest, what should you do?

Answer 15

• absence of pupillary response to light
• absence of corneal reflexes
• absence of any motor response to supra orbital pressure.

Question 16

How do you know if the advanced decision is valid?

Answer 16

• is it clearly applicable?
• when and who made it?
  Are more recent actions inconsistent?

Mental capacity act 2005 (England and Wales)
Adults with capacity Act 2000 (Scotland)

Question 17

Pros and cons to advanced decision?

Answer 17

Pros=
- enhances autonomy
- avoids breaching patients personals/religious beliefs
- death with dignity

Cons=
- may not be valid
- may not be applicable
- attitudes may change with onset of serious illness
- may have been advances in medicine since the rescission has been made

Question 18

What is the gold standard framework?

Answer 18

“Systematic, evidence based approach to optimising care for all patients approaching the end of life, delivered by generalist frontline care providers”.

• for people with any condition or diagnosis
• for people considered to be at any age in their final years of life
• for people in any setting
• provided by anyone in health or social care
• at any time needed

Question 19

What are the 5 prioritise of care of the dying person?

Answer 19

1- the possibility that the person may die within the next dew days or hours is recognised

2- sensitive communication

3- the dying person and those identified as important to them, are involved in descisions about treatment.

4- the needs of families and others identified as important to the person as explored, respected and met as far as possible.

5- individual care plan.

Question 20

What are the 4 principles of care for people in the last days and hours of life?

Answer 20

Principle 1 = informative, timely and sensitive communication is an essential component of each individual persons care

Principle 2= significant decisions about a persons care, including diagnosing dying, are made on the basis of multi disciplinary discussion

Principle 3= each individual persons physical, psychological, social and spiritual needs are recognised and addressed as far as pssible

Principle 4= consideration is given to the wellbeing of relatives or carers attending the person.

Question 21

3 steps in symptoms control?

Answer 21

Step 1 - non opioid

Step 2- weak opioid

Step 3 - strong opioid

Question 22

What is the WHO pain ladder for?

What are the steps?

Answer 22

The WHO pain ladder is a framework for symptomatic pain relief
Three steps:

1- by mouth = the oral route is preferred for all steps of the pain ladder

2- by the clock = cancer pain is continuous, analgesics should be given at regular intervals, not on demand.

3- adjuvants = to help calm fears and anxiety, adjuvant drugs may be added at any step of the ladder

Question 23

What is the difference between the old and new concept of palliative care?

Answer 23