Lecture 7- End of Life Care Flashcards Preview

Geriatrics Exam 2 > Lecture 7- End of Life Care > Flashcards

Flashcards in Lecture 7- End of Life Care Deck (18):

Who provides palliative care?

- A team of doctors, nurses, and other specialists who work together to provide an extra layer of support. It is appropriate at ANY age and at ANY state in a serious illness and can be provided along with curative treatment


Palliative care definition

- specialized medical care for patients with serious illnesses
- provides patients with relief from the symptoms, pain, and stress of a serious illness- whatever the diagnosis.


The goal of palliative care

To improve the quality of life for both the patient and the family


Growth of palliative care growth in the last 15 years

- Rapidly rising trend!
- Sees the person beyond the disease
- Represents a major paradigm shift in health care delivery


What do palliative care teams treat?

People living with serious, complex, and chronic illnesses-
- ex. cancer, CHF, COPD, Renal failure, Dementia, Parkinson's, ALS etc...
- At ANY stage of their illness
- Palliative care considered a KEY COMPONENT of medical care along with all other appropriate treatments


Palliative care teams provide what to improve quality and support to the primary physician, patient, and family?

- Time to devote to intensive family meetings and patient/family communication
- Communication and support for resolving family/patient/physician questions concerning goals of care
- Expertise managing complex physical and emotional symptmos (pain, dyspnea, depression, nausea)


PC teams help improve....

- Patient and family satisfaction with overall medical treatment, physicians and the health care team
- HCAHPS- standards by contributing to reduced readmissions and hospital mortality


Palliative care takes care of the ___ ______ while the specialists take care of the ______ ________

- "whole person"
- " Patient's Disease"


Rationale for Palliative care

- reach adequate control of pain and other symptoms
- Achieve a sense of control
- Relieve burden on family members and strengthen relationship
- gain realistic understanding of the nature of the illness
- Understanding pros and cons of available treatment alternatives
- Name decision makers in case of loss of decisional capacity
- Have financial affairs in order


When does palliative care occur?

- NOT just when they are about to die
- Should potentially begin immediately upon diagnosis- will likely increase as the disease progresses


3 trajectories of serious illness

- Steady decline- short terminal phase (ex. pancreatic, lung cancer)
- Slow decline, periodic crises, then sudden death (ex. CHF, COPD)
- Prolonged dwindling (ex. General frailty, Dementia)


Palliative care services

- Establish goals of care (ESSENTIAL)
- Treatment of symptoms- pain and non-pain
- Psychosocial support/spiritual care


Treatment Options for serious illness/end of life

1. Life prolonging care- maximize length of survival, even if some compromise of other values- quantity of life is more important than quality of life
2. Limited medical care- Use of selected medical interventions, often while determining the balance between benefit and burden
3. Comfort care- Maximize pain and symptom relief, even if life is somewhat foreshortened- quality of life is greater than quantity of life


How do hospital-based palliative care programs work?

- consultation services
- Inpatient palliative care unit for inpatients
- Co-management in the ED and ICU


Physician concerns about incorporating palliative care

- Concern that introducing it could interfere with therapy directed at extending life as long as possible
- Inadequate patient resources
- Issues related to reimbursement
- Shortage of palliative care physicians and services.


Barriers to referrals for palliative care

- 2 main barriers
1. Lack of awareness of the palliative care services among patients and their families
2. Tendency of clinicians to equate palliative care with end of life care- do not offer/discourage consultation with Palliative care


Why the health care provider is the gate keeper to Palliative care

- Patients/families will not frequently ask for it
- If the HCP recommends it, they will readily accept it
- If the patient/family requests palliative care, they may be discouraged from receiving it


Compare and Contrast Palliative medicine and Hospice care

Palliative care
- All stages of disease trajectory
- can be provided along with acute care
- payment sources- various
- locus of care- anywhere
- Providers are physicians/nurses primarily
- Treatment focus- comfort

Hospice Care
- Typically defined by the medicare hospice benefit- primarily the last 6 months of life
- Usually patient foregoes concurrent acute care
- Payment source- Medicare/medicaid
- Locus of care- in site patient identifies as "home"
- Providers- More inclusive services than palliative medicine
- Treatment focus- comfort