Foundations in Palliative Care

Question 1

What is palliative care?

Answer 1

An approach that improves the quality of life for patients and their families

Question 2

What is double intent?

Answer 2

Intends neither to hasten or postpone death

Question 3

What are the three parts of palliative care?

Answer 3

1) Team approach
2) Enhance quality of life
3) Applicable early in the course of illness

Question 4

What is the integrated model?

Answer 4

Introduce palliative care early in life-prolonging/curative therapy

Question 5

Is hospice a component of palliative care?

Answer 5

Yes

Question 6

Who is hospice for?

Answer 6

Patients with a life expectancy of 6 months

Question 7

What do hospice teams provide patients and their families?

Answer 7

Expert medical care
Emotional and spiritual support
Focused on improving patient and family quality of life

Question 8

Does hospice care include bereavement in the integrated model?

Answer 8

Yes

Question 9

Does hospice care include bereavement in the traditional model?

Answer 9

No

Question 10

What are the three palliative care outcomes?

Answer 10

1) Improve quality of life
2) Reduce needs for hospitalizations
3) Prolonged life

Question 11

Is palliative care appropriate at any age and at any stage in a serious illness?

Answer 11

Yes

Question 12

What are the physician roles for goals of care?

Answer 12

1) Communicate (transparent communication, patient oriented)
2) Assess (multiple aspects of a patient’s journey)
3) Treat (realistic interventions that promote quality of life and relief of symptoms)

Question 13

What are the potential goals of care?

Answer 13

Cure of disease
Avoidance of premature death
Maintenance of improvement of function
Prolongation of life
Relief of suffering
Quality of life
Staying in control
A good death
Support for families and loved ones

Question 14

What are the aspects of negotiating goals of care?

Answer 14

1) Assess (patient’s disease process, illness expectations, family dynamics, desired outcomes)
2) Explore (realistic goals, relief of symptoms, quality of life, belief system)
3) Create (open and honest communication, non-judgmental climate, patient-focused support)
4) Plan (preservation of patient dignity and autonomy, realistic care plans, multi-disciplinary support)
5) Review (ongoing changes, disease trajectories, QOL, patient/family welfare)

Question 15

What are the four aspects of QOL?

Answer 15

Pain (musculoskeletal, myofascial, emotional)
Breathlessness (dypnea, orthopnea, hypoxemia)
Fatigue (multi-factorial, greatest effect on QOL)
General (nausea/vomiting, diarrhea/constipation, weight loss)

Question 16

What is prognostication?

Answer 16

Aspect of clinical practice that serves to predict illness trajectories

Question 17

What are examples of short period of decline?

Answer 17

Trauma

Sudden cardiac death

Question 18

What are examples of chronic illness with exacerbations?

Answer 18

Heart failure
COPD
ESRD

Question 19

What is an example of prolonged dwindling?

Answer 19

Dementia

Question 20

What are examples of sudden neurologic impairment?

Answer 20

Hemorrhagic
Stroke
Neuro trauma

Question 21

How do you evaluate prognosis?

Answer 21

Validated tools
Clinical experience
Evidence-base medicine

Question 22

What are the benefits of accurate prognostication?

Answer 22

Gives a good framework in making informed decisions
Provides opportunity for life-care planning
Spiritual
Financial
Psychosocial
Opportunity to say “goodbye”
Life closure and legacy giving

Question 23

Are the majority of physicians comfortable giving a prognosis?

Answer 23

No

Question 24

What are the aspects of medical frailty?

Answer 24

1) Unintentional weight loss (loss of muscle mass)
2) Weakness in grip strength (impaired cognition)
3) Self-reported exhaustion (underweight)
4) Low physical activity (depression)
5) Slowed gait speed (decreased ADLs)

Question 25

What does quantifying the degree of medical frailty allow for?

Answer 25

Physicians to identify futile interventions that will not alleviate symptoms and could worsen cognitive and function

Question 26

Any intervention should aim to what?

Answer 26

Minimize symptoms and morbid conditions

Question 27

What are the services covered by hospice under medicare?

Answer 27

Physician services
Nursing care
Medical supples and equipment
Prescription drugs for symptom control and pain relief
Nutritional counseling
Medicare hospice aide (certain circumstances)
Short-term inpatient care
Short-term respite care
Other Medicare-covered services to manage pain

Question 28

What is a service NOT covered by hospice under Medicare?

Answer 28

Custodial care (living arrangements, facility placement for dependent care)

Question 29

What are the aspects of Medicare hospice benefit?

Answer 29

1) Must be eligible for Medicare Part A
2) Medical certification of terminal illness with most 6 months survivability if the illness were to run its usual course
3) Patients can withdraw from Medicare hospice and return to normal Medicare coverage
4) Medicare hospice benefit requires the patient have designated health care proxy
5) There are other covered benefits that may continue to apply
6) Hospice care must come from a Medicare-approved hospice program