End of Life Care Flashcards
What is Palliative Care?
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
How does the GMC define ‘end of life’?
‘Approaching the end of life’
* Likely to die within the next 12 months
Indicatiors
* Advanced, progressive or incurable conditions
* General frailty
* At risk of sudden crisis of condition
* Life threatening condition from sudden catastrophic events
What are some non-cancer diseases that requre palliation of symptoms?
- Motor Neurone Disease
- End-stage Cardiac failure
- End-stage COPD
- Advanced renal disease
What are the aims of palliative care?
Whole person approach
* Focus on quality of life - good symptom control
* Care covers person with life threatening illness AND those that matter to them
What are some principles of good end of life care?
- Open lines of communication
- Anticipating care needs and encouraging discussion
- Effective multidisciplinary team input
- Symptom control - physical and psycho-spiritual
- Preparing for death - patient and family
- Providing support for relatives both before and after death
Describe Psycho-spiritual distress
Exacerbates physical symptoms
Multifactorial
Have to consider:
* Uncontrolled physical symptoms
* Alcohol/Drug withdrawal
* Depression
* Other medical causes - hyperthyroidism
What is an Advance Statement?
A statement that sets down your preferences, wishes, beliefs and values regarding your future care
Provides guidance if patient loses capacity to make decisions or to communicate them
Requests will be given weight BUT future decisions can’t be bound by statement - treatment must still be of overall benefit to the patient
What is an Advance Decision
A decision you can make to refuse specific treatments in the future
Can be refered to as
* Advance Directive to Refuse Treatment
* Advance Refusal of Treatment
* Living Will
May concern life sustaining treatment - DNACPR
Validity and applicability need to be considered
How do you determine if an advance decision is valid?
- Is it clearly applicable?
- When was it made
- Did the patient have capacity when it was made?
- Was it an informed decision
- Where there any undue influences when made?
- Has the decision been withdrawn?
What are the 5 Priorities for the care of dying people?
- Possibility of death within the next few hours or days is recognised and communicated
- Sensitive communication between staff and dying person
- Ensure that the dying person and persons they care about are involved in decisions about treatment
- Needs of those identified as important are explored, respected and met as far as possible
- An individual care plan is agreed and coordinated
What are the steps of the Cancer pain ladder?
- Non-opioid - e.g. aspirin
- Weak opioid - e.g. codeine
- Strong opioid - e.g. morphine
All may be taken with adjuvant, non-opioids may be taken alongside opioids. Delivery should be oral and regular
What support exists for families after death?
- Chaplain
- Counsellors
- Family workers
- Healthcare professionals
How is death recognised in a clinical setting?
The simulataneous and irreversible onset of apnoea and unconciousness in the absence of circulation. Observed and confirmed for a minimum of 5 minutes
What should be performed if death is suspected after 5 minutes?
Check for:
* Absence of pupillary responses to light
* Absence of corneal reflexes
* Absence of any motor response to supra-orbital pressure
