The Principles of palliative and End of Life Care

Question 1

What is palliative care?

Answer 1

The active total care of patients whose disease is not responsive to curative treatment

Question 2

What factors does palliative care address?

Answer 2

• Symptom control
• Physical
• Psychological
• Spiritual needs

Question 3

What is end of life care?

Answer 3

Focuses on the dying phase (last few weeks or days of life)

Question 4

Is all palliative care end of of life care?

Answer 4

No, can go on for years

Question 5

Who is palliative car provided by?

Answer 5

All professionals working in healthcare

Question 6

What is the purpose of palliative care?

Answer 6

Offers a support system to help patients live as actively as possible with a good quality of life until death

Question 7

What are examples of patients who receive palliative care?

Answer 7

Those who have…

• Cancer
• Cardiac failure
• Respiratory failure
• Renal failure
• Neuroglocal disease e.g. MND, MS
• HIV
• Stroke
• Dementia

Question 8

When should a palliative approach begin?

Answer 8

• Old concept - at end of life phase

* New concept - palliative care delivered at the same time as active treatment

Question 9

Why is it difficult to determine when patients may be in the last year of their lives?

Answer 9

Due to an ageing population with complex co-morbities and poor functional status

Question 10

Where do people want to die?

Answer 10

63% of UK population wish to die at home

Question 11

Where to people actually die?

Answer 11

54.8% of UK population dies in a hospital

Question 12

Why is COPD important in terms of palliative care?

Answer 12

• 5th leading cause of death in the UK

* Commonest single cause of hospital admission and readmission

Question 13

What do people want at the end of their lives?

Answer 13

• To be with loved ones
• To avoid life prolonging treatments and interventions
• To put their affairs in order
• To have good symptom control

Question 14

What are barriers to achieving good end of life care?

Answer 14

• Unclear prognosis
• Uncoordinated care/communication between primary and secondary care
• Concern that conversation removes hope
• Medical perception that death is a failure
• Lack of skills in symptom control and communication skills

Question 15

What is a palliative approach?

Answer 15

• Patient and family centred – not disease centred
• Listening and empathic support
• Assessment – attention to detail
• Treatment – reversing what is reversible
• Recognising when a patient is reaching last months of life
• Having courageous conversations

Question 16

What are physical symptoms in incurable disease?

Answer 16

• Pain
• Nausea and vomiting
• Fatigue
• Anorexia
• Breathlessness (dyspnoea)
• Itch
• Drowsiness
• Constipation / Diarrhoea
• Psychological symptoms

Question 17

What does effective communication influence?

Answer 17

• Can increase rate of recovery
• Can improve pain control
• Improve satisfaction with services

Question 18

What can poor communication result in?

Answer 18

Patients feeling anxious, uncertain and dissatisfied with their care

Question 19

What does anticipatory care planning involve?

Answer 19

An honest conversation to help provide patient centred care, based on an informed patient making their wishes known about their future priorities for care

Question 20

What is the chance of survival after CPR?

Answer 20

• 10% in community

* Up to 17% in hospital

Question 21

In what domains are patients assessed during end of life care?

Answer 21

• Physical
• Psychological
• Spiritual
• Social