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):
1

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

2

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.
-

3

The goal of palliative care

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

4

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

5

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

6

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)

7

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

8

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

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

9

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

10

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

11

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)

12

Palliative care services

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

13

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

14

How do hospital-based palliative care programs work?

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

15

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.

16

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

17

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

18

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