End of life care (3)

Question 1

What is terminal care (expected death)

Answer 1

The last phase of care when a patient’s condition is deteriorating and death is close

Question 2

What is palliative care

Answer 2

A philosophy of care that emphasises quality of life and is performed by a multidisciplinary team

Question 3

WHO definition of palliative care

Answer 3

‘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 end of life and bereavement’

Question 4

What is the benefit of identifying early which patients would benefit from palliative planning?

Answer 4

We can then discuss patient’s wishes with them and try where possible to care for them where they want to be treated and in a way that they want to be

Question 5

What is used to know if a patient is at a palliative stage?

Answer 5

Supportive and palliative care indicators tool

1. Ask - would it be a surprise if this patient died in the next 6-12 mths?
2. Look for two or more general clinical indicators
3. Look for two or more disease related indicators

Question 6

Examples of general clinical indicators suggesting palliative care might be needed

Answer 6

• Performance status poor or deteriorating eg limited self care
• Progressive weight loss >10% over past 6mths
• Two or more unplanned admissions in past 6mths
• New diagnosis of a progressive, life threatening illness
• Two or more advanced or complex conditions (multi-morbidity)
• Patient is in a nursing care home or NHS continuing care unit

Question 7

Positive aspects of palliative care

Answer 7

• Provides relief from pain and other distressing symptoms
• Affirms life and regards dying as a normal process
• Intends neither to hasten nor postpone death
• Offers a support system to help patients live as actively as possible until death, and to help the family cope

Question 8

What professionals might be involved in palliative care situations

Answer 8

• Health and social care partnership team

- Macmillian/CLAN/Marie Curie nurses

Question 9

What is a good death?

Answer 9

• Pain free
• Openly acknowledged
• Surrounded by family and friends
• Resolving of unfinished business/personal conflicts
• In a manner that resonates with the person’s individuality

Question 10

How many people achieve a home death?

Answer 10

26%

Question 11

What framework offers tools to enable primary care to provide palliative care at home?

Answer 11

The Gold Standards Framework

Question 12

Reactions to bad news or grief include

Answer 12

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

Question 13

Give some important elements of breaking bad news

Answer 13

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

Question 14

Give the 3 types of euthanasia

Answer 14

• Voluntary: patient’s request
• Non voluntary: no request
• Physician assisted suicide: physician provides the means and the advice for suicide

Question 15

What must you do if a patient requests euthanasia (in the UK)?

Answer 15

ADMIT POWERLESSNESS!

• Listen and acknowledge the issue
• Explore reasons for the request, and ways of giving more control to the patient
• Look for treatable problems

Question 16

Health implications of ageing population

Answer 16

• Increased need for geriatricians/care of elderly
• Increased need for elderly healthcare facilities
• Shift of care of long term conditions from secondary to primary care

Question 17

Social implications of ageing population

Answer 17

• Become increasingly dependent on families and carers
• Demand for home carers and nursing home places goes up
• Role of elderly as carers is likely to change
• Housing demands change

Question 18

Economic implications of ageing population

Answer 18

• Retirement/pension age will increase
• Finding employment might become harder for young people
• Less people paying into tax and pension funds
• Increasing cost of free personal care for the elderly policy in Scotland

Question 19

Political implications of ageing population

Answer 19

• Elderly group have power to influence political decision making, as there are so many of them
• Current decision making and workforce planning must take into account the ageing population

Question 20

Define multi-morbidity

Answer 20

The co-existence of 2 or more long term conditions in an individual

Question 21

What is an anticipatory care plan?

Answer 21

Involves discussing an individual’s goals and wishes, and recording these decisions so that in the event of a gradual or sudden decline , those providing care have clear guidance on what that person would wish to happen

Question 22

When should an anticipatory care plan be made?

Answer 22

• At any time in life that seems appropriate

- Continuously

Question 23

What questions can be asked for an ACP to be formulated?

Answer 23

• DNR?
• Where do they want to be cared for?
• Who is to be informed about their care and changes in their condition?
• Are they and their family fully aware of their prognosis?

Question 24

What should happen after a discussion about an ACP has taken place?

Answer 24

Patient should be placed on the practice’s palliative care register

Question 25

What tool can be used to evaluate how quickly the situation is changing for the patient and to see of their care needs need to be re-evaluated?

Answer 25

Palliative performance scale