End Of Life Care- Tutorial 1 Flashcards
(32 cards)
Most common causes of death today
Cancer and IHD
Main cause of death in the young
Accidents
Main cause of death in men aged 15-34
Suicide
What’s the increase in life expectancy for both men and women since 1861?
- 3 for men
34. 1 for women
What can unexpected death cause?
A profound sense of shock as there’s no chance to say goodbye, or take back hasty words
What might accompany death by accidents? (3)
Multiple deaths
Legal involvement
Press coverage
What’s SIDS and what may accompany it?
Sudden Infant Death Syndrome
It’s the unexplained death of a seemingly healthy baby of less than a year old
Parental blame may accompany it
What’s terminal care and how does it differ to palliative care?
Terminal care=the last phase of care when a Px’s condition is deteriorating and death is close. Not only associated with cancer
Palliative care is the management before the terminal phase is reached
How has the concept of palliative care changed? (4)
Now identifying who might need PC earlier
Discussing their wishes with them re PC
Using palliative care alongside their medical Tx
As time progresses PC becomes more dominant rather than a sudden change to PC
Where is PC provided?
Majority in primary care with support from specialist practitioners and specialist palliative care units (hospices)
What does the national action plan developed in 2008 (living and dying well) state about PC? (3)
PC isn’t just about care in the last few months
It’s about ensuring QOL at all stages of the disease but remaining focussed on the person, not the disease
Applies a holistic approach to both Px and carers
What does WHO have to say about PC? (4)
It aims to provide relief from pain and distressing S
Not to hasten or postpone death
Acts as a supportive system via a team approach for Px and their families
What’re the important aspects of PC are? (2)
Recognising early on that someone is dying and communicate that
Taking time to find out the wishes and concerns of the Px and family
How do you know if a Px is at the palliative stage?
The supportive and palliative care indicators tool=a guide for docs to consider their patients with a life limiting condition and highlight if they’re at a stage where supportive and palliative care should take place
What’s the palliative performance scale?
Used for assessing and reviewing functional changes in palliative Px
Lower score @ initial assessment=poorer prognosis
Don’t choose half fit values (eg 45%)-always use 10% increments
What does the disease trajectory look like for a malignancy?
Steady but rapid decline from a high function to low function
Most weight loss, reduction in performance and impaired ability occurs in the last few months
There is generally time to anticipate PC and plans for end of life care
What’s the disease trajectory like for organ failure (eg COPD)
Px unwell for months/years
Acute severe exacerbations cause dips in trajectory
Each exacerbation could cause death so timing of death is uncertain
Looks a bit like a declining mountain range
What does a the disease trajectory look like for dementia or a generalised frailty?
Progressive disability so starts with a low baseline function
Straightish steady declining line
Trajectory can be cut off prematurely by an acute illness (eg pneumonia)
What happens once a Px has been identified as being at a palliative stage of care? (4)
Placed on the practice’s palliative care register to coordinate ongoing care
The plan for the Px should be sent to out of hours service
Discuss with MDT
Use PPS
Name 3 significant and distressing symptoms that may be encountered in PC
Anxiety
Insomnia
Nausea
Who may be involved in PC?
Health and social care partnership team Macmillan nurses CLAN Marie nurses Religious or cultural groups
How many people want to die at home? How many actual do?
65%, but only 26% do
Which framework offers the tools to enable primary care to provide palliative care at home?
The Gold Standards Framework
What tools does the Gold Standards Framework contain?
Setting up a cancer register
Reviewing these patients
Reflective practice
