End of Life Care

Question 1

What is palliative care?

Answer 1

Palliative care is an approach that improves the quality of life of patients and their families facing the problem 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

In terms of months, what length of time before predicted death is palliative care prescribed?

Answer 2

12 months

Question 3

What is the main goal of palliative care?

Answer 3

Focus on quality of life

Question 4

List some of the principles of good end of life care?

Answer 4

Communication
Anticipation and discussion
Multidisciplinary team input
Symptom control
Preparation for death
Support before AND after death

Question 5

Who are the members of the multidisciplinary palliative care team?

Answer 5

 Specialist nurses (community, hospice, other)
 Palliative care doctors
 GP
 Secondary care (non-palliative teams)
 District nurses
 Occupational therapists
 Dieticians
 Physiotherapists
 Counsellors
 Chaplain etc...

Question 6

What is generalist palliative care?

Answer 6

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

Question 7

What is specialist palliative care?

Answer 7

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

Question 8

List some physical symptoms a palliative patient might experience.

Answer 8

 Pain
 Dyspnoea
 Nausea / vomiting
 Anorexia / weight loss
 Constipation
 Fatigue
 Cough
 Andmanyothers!
 Medical / surgical emergencies

Question 9

What is advance and anticipatory care planning?

Answer 9

‘…an ongoing process of discussion between the patient, those close to them and their care providers, focusing on that person’s wishes and preferences for their future. It is perhaps best defined as an umbrella term potentially covering a number of component planning processes, legal, personal and clinical’

Question 10

What sort of things should be discussed with palliative care patients?

Answer 10

 Wishes / preferences / fears about care
 Feelings/ beliefs / values that may influence future
choices
 Who should be involved in decision making?
 Emergency interventions e.g. CPR
 Preferred place of care
 Religious / spiritual / other personal support
 May wish to make an Advance & Anticipatory care plan / formalise wishes regarding care

Question 11

What is an advance statement?

Answer 11

Patient preferences regarding future care (note: preferences, therefore no binding obligation)

Question 12

What is an advance decision?

Answer 12

A decision made to refuse something in a future

Question 13

What are two things to bear in mind se advance decisions?

Answer 13

Validity

Applicability

Question 14

How can you test for validity of an advance decision?

Answer 14

 Is it clearly applicable?
 When was it made?
 Did the patient have capacity when it was made?
 Was it an informed decision?
 Were there any undue influences when made?
 Has the decision been withdrawn?
 Are more recent actions / decisions inconsistent?

Question 15

What are the pros of advance statements and decisions?

Answer 15

 Enhances autonomy
 May encourage / improve discussions on end-of-life decisions
 Avoid breaching patient’s personal / religious beliefs
 Death with dignity

Question 16

What are the cons of advance statements and decisions?

Answer 16

 May not be valid
 May not be applicable
 Attitudes may change with onset of serious illness
 May have been advances in medicine since being made

Question 17

What are the 5 priorities listed in the ‘More Care: Less Pathway’?

Answer 17

1. The possibility that a person may die within the next few days or hours is recognised and communicated clearly, decisions made and actions taken in accordance with the person’s needs and wishes, and these are regularly reviewed and decisions revised accordingly.
2. Sensitive communication takes place between staff and the dying person, and those identified as important to them.
3. The dying person, and those identified as important to them, are involved in decisions about treatment and care to the extent that the dying person wants.
4. The needs of families and others identified as important to the dying person are actively explored, respected and met as far as possible.
5. An individual plan of care, which includes food and drink, symptom control and psychological, social and spiritual support, is agreed, coordinated and delivered with compassion.

Question 18

What are the 4 guiding principles of care of people in the lat days or hours of life?

Answer 18

Principle 1: Informative, timely and sensitive communication is an essential component of each individual person’s care

Principle 2: Significant decisions about a person’s care, including diagnosing dying, are made on the basis of multi- disciplinary discussion

Principle 3: Each individual person’s physical, psychological, social and spiritual needs are recognised and addressed as far as is possible

Principle 4: Consideration is given to the wellbeing of relatives or carers attending the person

Question 19

Outline the steps of the WHO analgesic ladder for cancer pain.

Answer 19

Step 1: Non-Opioid
Step 2: Weak opiod
Step 3: Strong opiod

Question 20

What ar the pros of the WHO analgesic ladder for cancer pain?

Answer 20

Effective pain relief in 70-90% of cases
Inexpensive
Oral route
By the clock
Adjuvant drugs (calming of fear and anxiety)