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Flashcards in Overview of end of life care Deck (33):
1

Why is the quality of life during the dying process poor?

Inadequate treatment of distress, fragmented care, strains on family etc

2

Deaths in the us occur most often in the elderly, and are marked by what characteristics? (2)

1. Slow
2. Increased dependency

3

What are the three trajectories of illness?

Fall off a cliff
Slow decline with periodic crises
Prolonged dwindle

4

True or false: acute care and palliative care can occur simultaneously

True

5

What are the "three legs of the medicine stool"?

Diagnosis
Prognosis
Theraputics

6

What is the goal of life prolonging care? Palliative care?

Life prolonging = lengthen life at any cost
Palliative = no bad symptoms

7

Which is a board certified sub specialty--hospice care or palliative medicine?

Palliative medicine

8

What is the payment source of hospice?

Medicare

9

Where is the locus of care for hospice and palliative med?

Hospice - where home is
Palliative med = anywhere

10

True or false: there are more inclusive services in palliative medicine compared to hospice?

False--other way around

11

What is the difference in time frame for palliative vs hospice care?

Palliative = all stages of disease trajectory
Hospice = less than 6 months

12

True or false: hospice is a place to die

False-where they can live well

13

True or false: a pt has to have a DNR in order to be accepted into hospice

False

14

True or false: many pts who enroll in hospice actually starve to death

False

15

How much longer do patient who get transferred to hospice live compared to those who do not?

29 days longer

16

True or false: one of the benefits of transferring a pt to hospice is knowing that the hospice will pay for all of the pts meds

True, but only for the meds that are involved in hospice placement

17

True or false: in order to be transferred into hospice, pts must transfer their care to the hospice physician

False

18

True or false: a good death is free from pain and suffering

False

19

True or false: In order to refer a pt to hospice, the attending physician must certify that the patient will die in the next six months

False

20

True or false: Good pain management alway includes measurable aspects of the patient's pain

True

21

True or false: Hospice has bereavement support for 13 months following a pts death

True

22

True or false: the majority of hospice pts receive care at an in patient facility

False--often at home

23

What are the four usual obstacles to hospice?

1. limited access
2. Lack of family support
3. LATE REFERRAL
4. Difficulties in determining prognosis

24

What is the most common obstacle to hospice care?

Late referral

25

How accurate are physicians' prognoses?

3-5 times longer than what it actually is

26

What is the goal of palliative medicine?

Improve QOL of pts and family with serious illness

27

When is palliative medicine appropriate?

At any age or stage of a serious illness

28

What is the rationale for palliative medicine?

Relieves family burden

29

What are the three key palliative care services?

1. Establish goals
2. Treat symptoms
3. Psychosocial support

30

What are the two main barriers to palliative care?

Awareness of service
Tendency of clinicians to equate palliative care = end of life

31

What are the four major concerns of drs in palliative care?

1. Introducing palliative care will interfere with treatment
2. Inadequate resources
3. Reimbursement
4. Shortage of palliative care drs.

32

Why is it important to offer palliative services?

You are the gatekeeper (and the keymaster!)

33

If a doctor knows a patient better, are they more likely to overestimate or underestimate the amount of time they have left

Overestimate, even more than usual