Hospice and Palliative Medicine Flashcards
(47 cards)
Define Hospice
The study of and care for patients with active, progressive, far-advanced disease whose prognosis is limited, and thus the focus becomes quality of life
Define Palliative Care
- The “relieving or soothing the symptoms of a disease or disorder.”
- Means specialized medical care for people with serious illnesses. This type of care is focused on providing patients with relief from the symptoms, pain and stress of serious illness, whatever the diagnosis.
Who can receive Palliative care?
- Palliative care is for people of any age, and at any stage in an illness, whether that illness is curable, chronic, or life-threatening. In fact, palliative care may actually help patients recover from illness by relieving symptoms like pain, anxiety, or loss of appetite, as they undergo sometimes-difficult medical treatments or procedures, such as surgery or chemotherapy. 1
- Palliative care is appropriate at any age and at any stage in a serious illness and can be provided together with curative treatment. The goals to improve quality of life for both the patient and the family.
Synonyms for Palliative Care
“comfort care” and “supportive care”
False Belief about palliative care
Many people mistakenly believe this means patients receive palliative care only when they can’t be cured. Actually, palliative medicine can be provided by one doctor while other doctors work with you to try to cure the illness.
Hospice is a _____ and not a ____.
Hospice is a service and a philosophy,not a place
What to consider for end of life preparation and advanced directives
- Families/medical durable power of attorney (May be in conflict with the patients wishes)
- DNR, Intent for CPR, DNAR
- POLST/MOST (Physician orders for life sustaining treatment, medical orders of sustaining treatment)
- Five Wish
- Artificial nutrition and hydration
- Organ/tissue donation
- Risk-benefit ratio
4 recognized ethical priciples and their meanings
- Autonomy - Patient self-determination
- Beneficence -Serving the patient’s well-being
- Nonmaleficence - Do no harm
- Justice - Fairness
Competence vs. Capacity
Capacity is the medical decision you make at the bed side; Competence is the legal preceding side
Best way to understand treatment Goals?
- Talk to the patients/families
- most conflicts are communication issues and misunderstandings
When to have end of life discussions?
When pt is first diagnosed with disease
Risk - benefit ratio
does the greater good outweigh what we are doing?
What is futility?
- Every one has their own definitions
- Justice Stewart - “ I don’t know how to define it, but I know what it is when I see it”
Treatment Goals and Ethical Dilemmas
- Talk to the pts and families
- *Treatments are ETHICALLY NEURAL
- *There is no ethical distinction between withholding and withdrawing life sustaining treatment
- Find out what the patient wants to know and who they may want to be in charge of their decision making, in whole or in part.
What is the double effect?
The doctrine (principle) of double effect is often invoked to explain the permissibility of an action that causes a serious harm, such as the death of a human being, as a side effect of promoting some good end
Ethical Dilemma of the double effect?
This theory is based upon the caregiver’s intent which is problematic
Primum non nocere
- First do no harm
- requires risk-benefit ratio
Hospice Requires a ___
- Interdisciplinary Team
- Must consist of a physician, nurse case manager, dietary counselor, medical social worker, and bereavement counselor
Define Physician Assisted Suicide/Physician Assisted Death
“The deliberate action taken by the physician to help a patient commit suicide.”
Define Euthanasia
“The act of ending a patient’s life when carried out by the physician personally.”
Most common reason pts ask to end their lives?
The reasons that patients ask to end their lives are a sense of hopelessness, loss of control, or an unmet symptom control (pain).
What is required to asses symptom management?
- A complete History and Physical
- Almost always the answer to “what to do next”
Pain assessment
- Pain must be continually reassessed, including patient and care-giver compliance with a prescribed program.
- Patient self reporting of pain is the single most reliable method of evaluating pain
What is “total pain”? What is the meaning of pain to the patient?
- The recognition of pain that is beyond the just the physical.
- Patients often suffer from spiritual/existential, emotional/psychological and social/interpersonal pain.
- meaning? Some patients believe that this is something that they must endure.
