Module 4 Flashcards
(52 cards)
1
Q
Hidden or implicit standards of care
A
- These aren’t always whats best
- We don’t talk about this often but it’s what we expect
- Serves the institution and not the family
- Could look like
- Quiet and uneventful
- Few people present
- Leave taking behaviour is minimal
- No technical errors are made
- Staff says we did everything we can
- Etc.
2
Q
Kastenbaum’s recommendations for end-of-life care
A
- Patients, family, and staff all have legitimate needs and interests that need to weighed
- The dying person’s own preferences and lifestyle must be taken into account
3
Q
Palliative care
A
- Supports people who are living with life threatening illness/conditions
- Treats the person and their families, not just the disease
4
Q
Clinical practice guidelines for quality palliative care
A
- Patient centered
- Holistic approach
5
Q
Who uses palliative care
A
- About 62% to 89% of those who die could benefit from palliative care, which is essentially anyone who does not die unexpectedly
- 15% of Canadians who die received publicly funded palliative home care in their last year of life
- 62% of Canadians who received palliative care did so in an acute care hospital in their last month of life
- 80% of the time, palliative care was provided during admission was unplanned or through an emergency department
6
Q
How are palliative care savings achieved
A
- Reducing the overall length of hospital stay
- Moving patients from hospital to home or to hospice facilities, at a lower cost per day than acute care
- Reducing the number of ICU admissions
- Reducing unnecessary diagnostic testing
- Reducing inappropriate disease targeting interventions
7
Q
The last three day of life : from the patients’ perspective
A
- Patients were asked how they would like to spend their last three days
- They said
- They want certain people to be here with me
- I want to physically be able to do things
- I want to feel at peace
- I want to be free from pain
- I want the last three days of my life to be like any other days
8
Q
Primary source of strength for hospice patients
A
- Family and friends
- Religion
- Being needed
- Confidence in self
- Satisfied with the help received
9
Q
Hospices 10 philosophy and principles
A
- Hospice is a philosophy; not a facility - one whose primary focus is end of life care
- Affirms life not death
- Strives to maximize present quality in living
- Offers care to the patient and family unit
- Holistic care
- Continues to provide support to family after death
- Combines professional skills and human presence through interdisciplinary teamwork
- 24/7 services
- Support for staff and volunteers
- Can be applied to a variety of individuals and their family members who are coping with life threatening conditions, death, or bereavement
10
Q
Advance care planning
A
- Encourages individuals to communicate their health care wished for the future
- Should consider potential health scenarios, care needs, available choices, and future decisions
- Can help our decision maker make decisions
- Can provide consent for certain care
- Can help with our goals for care
11
Q
MAiD Background in Canada
A
- Became legal to Canadians in 2016
- At its onset things we’re challenging, but things have gotten better
- There are still challenges
- People’s views on death are changing so we see MAiD with a more positive light
12
Q
What is Medical assistance in dying
A
- Legal exception to the criminal code (june 2016)
- Person (patient) driven
- Written request
- Two physician or NP assessments
- MAID is always an active process
- Wants to provide autonomy and choice to the individual in the end of life
- Two physicians needed to start the process of MAID
13
Q
Difference between MAID and euthanasia
A
- Euthanasia is the act of ending a life without consent
- There is active consent with MAID
14
Q
Two options for the administration of MAID
A
- Clinician administered: Physician or nurse practitioner administers a lethal substance
- Self-administered MAID: Person takes the prescribed substance to end their own life
- The vast majority of people use the clinician option
15
Q
Rodriguez 1993 case for MAID
A
- Big activist for MAID
- Ended her life with MAID “illegally”
16
Q
Latimer 1994 case for MAID
A
- Killed his kid because he couldn’t get any MAID help for her
17
Q
Carter 2015 case for MAID in Canada
A
- She couldn’t do anything for herself like she wanted to
- Said it was against her rights to not be able to do it
- This time the argument was heard and the process of legalization started
18
Q
MAID Track 1
A
- How it was seen originally
- Life limiting terminal illnesses who were probably going to die in less than a year ish and who wanted MAID could get it
- This was seen as unconstitutional because more people wanted it, so they made track 2 an option as well
19
Q
Track 2 of MAID
A
- You need to request MAID on your own
- Must have a valid health card for the province
- Need to make sure there’s no outside pressures to your decision, like burden
- Basically for people who will die but their death is not necessarily foreseeable
20
Q
Requirements that must be met to be eligible for MAID
A
- Be eligible for health services in the province, territory, or federal gov
- Be at least 18 and be able to make your own healthcare decisions
- Have a grievous and irremediable medical condition
- Make a voluntary request for MAID, free of outside pressure or influence
- Provide informed consent to receive a medically
- Experience unbearable physical or mental suffering that cannot be relieved under conditions they consider acceptable
21
Q
Grievous and irremediable medical conditions according to the law
A
- A serious and incurable illness, disease or disability
- Is in an advanced state of decline in function that cannot be reversed
- Has unbearable physical or psychological suffering from the illness, disease, disability, or decline that cannot be relieved in a way the persons finds acceptable
- The illness, disease, or disability does not need to be fatal or terminal, but there are different procedural safeguards that must be met depending if the person’s natural death is reasonably foreseeable, or not
- We may try other treatments and wait 90 days before
22
Q
Kathy and friend’s research
A
Phase 1
- Trying to understand what it was like to start the process
Phase 2
- Interviewed people who helped loved ones get MAID
Phrase 3
- Interviews health care workers providing MAID
23
Q
Digital story telling
A
- A short, first person, video narrative created by combining recorded voice, still and moving images, sounds and music
- Can be transformational in the process and the product
24
Q
Kimberly Robertson’s digital story
A
- Her husband did MAID
- He tried different treatments but nothing worked so he went away and did it
- Three days before he was told he “didn’t have bad parkinsons”
- Spent his last full day at home and then went to the hospital the next morning and waited for the meds to come surrounded by family
25
How did they go about making the digital stories
- Two workshops
- One they talked about the process
- Second they did a one to one workshop going over their videos
26
Amy Tsai's digital story
- She told her dad about MAID
- It was hard because her culture has a taboo against death
- She felt like she had to put her emotions aide and tell him about the option and he agreed then and there
- There was a lot of push back from her family but she was confident in her decision
27
Cynthia Clark's Digital story
- Trying to figure out how to talk to kids about MAID
- Four years after her husband did MAID, her dad asked for it
- The dad felt well when he got accepted so he felt like he had control
- Highlights all the emotions of grief like sadness, anger, etc.
28
Dave Byrnes' digital story
- He talks about the struggles of care giving
- She died at home and her husband helped administer the pain drugs before the doctor came
- She died on the couch where she wanted to
29
Controversies and Ethical considerations
- Autonomy vs vulnerability
- When people are denied their request
- Safeguards
- Expansion of eligibility to mental illness and mature minors
- Societal impact on people with disabilities
- Advance requests
30
What are psychedelics
- Classic ones include LSD and psilocybin (magic mushrooms)
- Seen as drugs that may offer the user an experience of self-reflection through exposure to personal existential issues
- MDMA is thought to provide a state of improved insights and aid a greater exploration memories
- Thought to facilitate a deeper access to repressed parts of the psyche
31
History of psychedelics
- Research exploring the use of hallucinogens to treat existential anxiety, despair, and isolation began in 1950s
- These studies suggested how critically ill individuals treated with hallucinogens experienced sustained mood and anxiety improvements as well as diminished need for pain medication
- The war on drugs stopped this research
32
Early studies on psychedelics: Kast et al.
- Completed in the first half of the 1960s
- Looked at LSD in patients with terminal cancer
- Low dose LSD brought greater relief than pain medication
- Low dose LSD also lasted for several days vs several hours like normal pain meds
- Significant reduction of fear of death and reduction of depressive symptoms
33
Early studies on psychedelics: Pahnke et al.
- Completed between 1965 and early 1970s
- LSD assisted psychotherapy on patients with terminal cancer
- Focused on trasnpersonal experiences
- 2/3rds of LSD treated cancer patients had reductions in pain, depression, and fear of death
34
Early studies on psychedelics: Grof et al.
- Completed in 1973 on 60 patients with terminal cancer
- Examined levels of anxeity, depression, and amount of narcotics before and after the LSD treatment
- Most patients showed improvement in all measured parameters
- 29% of patients showed dramatic improvements in emotional well-being and distress
- 41.9% showed moderate improvements
- 22.6% remained unchanged
6.4% showed a decrement
35
Objectives and procedures in Grob et al. 2011
- To examine the safety and efficacy of shrooms in the treatment of psychological distress associated with the existential crisis of terminal disease
- 12 patients with advanced stage cancer and DSM diagnosis of stress or anxiety due to the cancer
- Within-subjet, double blind , and placebo controlled study
- They had to lie in bed wearing eye shades for the first few hours, listen to music, and left undisturbed. After 6 hours the participants discussed the subjective aesthetic, cognitive, affective, and psychospirital experiences they had
- Various self-report inventories and questionnaires were administered prior to the first treatment and up to 6 months following the second treatment
36
States measured in Grob et al. 2011
- Oceanic boundlessness (depersonalization, mood changes, etc.)
- Visionary destructuralization (hallucinations, etc.)
- Anxious ego dissolution (ego disintegration, etc.)
- Auditory alterations (acoustic alternations or experiences, etc.)
- Reduced vigilance (drowsiness, reduced alertness, etc.)
37
Grob et al. 2011 findings
- POMS: declined after administration of shrooms in 11/12 people
- STAI: reduction in anxiety at 1- and 3-months post treatment
- BDI: Improved mood at 6-month follow up
38
Psychedelic-Assited psychotherapy
- May help in treating death anxiety with terminal illness because they provide you a non-physical being experience
- They have to undergo special prep and have supervision when it happens
- We see a rapid clinical improvement with anxiety and depression surrounding dying
- They become more spiritual and philosophical
- Better integrated with their families and dealing with unresolved conflicts and preparing for their death
- They live more in the present and are less concerned with the past and future
- The effects don't necessarily come from the drug but from the spiritual experience they provide
39
Near death experiences (NDEs)
- Profound, often mystical or transcendental events that occur during life threatening situations, where individuals may feel detached from their bodies and experience euphoria or altered perceptions of time and space
- They typically involved a sense of survival despite imminent death and may include elements like dissociation, spiritual insights, and a perceived journey beyond physical existence
- May be in life-threatening or threatening medical situation
40
The Greyson Scale 1983
- Identifies 16 features of NDEs, grouped into four main categories
- Cognitive features: Altered perceptions time, rapid thought processes, and life reviews
- Paranormal features: Involve vivid sensory experiences, extrasensory perception, precognition, and out-of-body experiences
- Affective features: Emotional, often described as feelings of peace, joy, and a sense of unity with the universe or a divine light
- Transcendental features: Involve experiences of otherworldly realms, encounters with mystical beings or spirits, and reaching a boundary that feels like a point of no return
41
Out of body experiences
- Experienced in 37-99% of NDEs
- A feeling of being detached from the body, which can include autoscopy (where you can see yourself)
42
The Tunnel and The Light
- Experienced by around 25% of people with NDEs
- May include the sensation of movement of one's own body (forward vection, flying, falling, etc.)
- May be associated with the presence of severe medical conditions (cardiac arrest, drowning, etc.)
43
NDE Life Review
- Occurs in 13-30% of NDEs
- The perception of unusually vivid, almost instantaneous visual images of either the person's whole life or a few selected highlights of it
- Especially frequent during drowning, found less in children or in suicide attempts
44
NDE and meeting spirits
- Around 50% of people often report seeing or feeling different entities or people during NDEs
- These can be known or unknown people or spiritual entities
45
Positive and negative emotions and NDE
- Feelings of peace, joy, calm, ecstasy occur in more than 50% of NDEs which may be related to loss of pain sensations
- Feelings of absolute love, all-encompassing acceptance, often by a supreme entity, and associated with radiant light
- NDEs may also be associate with negative emotions, with "hell" like features, encounters with tormentors or frightfully devoid of any meaning
- Similar experiences through cultures and ages
46
Psychological Accounts of NDE
- It has been argued that NDEs reflect depersonalization/denial of death
- Quantitative approaches can be used:
- Examine psychological differences between people who experience NDEs and those who do not
- no clear psychopathological features
- People with NDEs report "paranormal experiences" prior to their NDE more often, as well as out of body experiences, feelings of being united with the universe, feeling the presence of God and other worldly entities, or having past-life memories
- Openness/magical thinking
47
After NDEs
- Decreased fear of death
- Increased appreciation of life
- Increased spirituality and concern for others
- Decreased materialism and competitiveness
48
Teno et al. 2011: Association between advance directives and quality of end-of-life care study
Objectives
- Evaluate how advanced care directives (ADs) influenced end-of-life care a decade after the Patient Self-Determination act was implemented
Design
- A mortality follow-back survey, meaning data was collected from family members after the patients death
- People who died in nursing homes, hospitals, or at home
- Phone interviews assessed us of ADs, life-sustaining treatments, and quality of care, including symptom relief, respect, decision-making, care coordination, and family support
Conclusions
- ADs were associated with better communication and hospice use, but significant gaps in end-of-life care quality remain
49
Buote et al. 2022 MAID in Canada study
- Wanted to examine the impact of MAID legalization on psychologists in Canada
- They reviewed MAID's history, current guidelines, and its implication for psychological practice
- Concluded that psychologists need to understand MAID due to its growing relevance and associated ethical and emotional challenges
50
Compassionate communities
- Grounded in a public health approach to end of life care
- A community that becomes a place of support and care for people and their families who are dying or living with loss
- The goal is the opportunity for all of us to live well within our communities to the very end of our lives
51
Yaden et al. 2022 The Potential of Psychedelics for End of Life and Palliative Care
- They aimed to explore the potential of psychedelics as a treatment option in end-of-life and palliative care
- They reviewed recent clinical research on psychedelic use in patients with life-threatening illnesses
- Psychedelics may offer a promising new treatment to help address psychological challenges in palliative care
52
People are turning to psilocybin, ketamine and other treatments for palliative care article
- Psychedelics ease end-of-life distress, offering emotional relief and reduced fear of death
- Early results are promising, but more research and regulations are needed
- Patients report deep personal healing and improve quality of life
