Week 12 Clinical Practice

Question 1

Define palliative care

Answer 1

• A branch of medicine that deals with life-threatening stuff
• Does this through prevention/relief of symptoms
• Helps people die well

Question 2

Which staff are involved in palliative care team?

Answer 2

• Doctors
• Nurses (inpatient/community care)
• Social workers (inpatient/community/bereavement)
• Allied health
• Pharmacists
• Psychologists

Question 3

Why is it bad to share too much/little info when discussing sensitive topics?

Answer 3

• Too little: leaves patient in the dark (uncertainty = fear)
• Too much: doesn’t allow denial, too little tact etc

Question 4

Strategies to help patients wrap their heads around

Answer 4

• Distinguish between controllable/uncontrollable problems
• Find patient-specific coping mechanisms/supports
• Always create a plan (future-focus = momentum)
• Use plain language
• Focus on patient’s priorities

Question 5

Common pitfalls when discussing sensitive topics

Answer 5

• Sharing bad news on accident

Question 6

How to navigate tricky questions (how long will I live?) etc in pall care?

Answer 6

• Acknowledge uncertainty
• Better to underestimate than overestimate
• Use generalities (e.g. 60% 5 year survival rate)
• ALWAYS EXPLORE THE QUESTION BEHIND THE QUESTION

“maybe months rather than years/weeks rather than months”

Question 7

Outline four different ?common trajectories of daily life

Answer 7

1. Sudden death (high to zero; sudden)
2. Cancer (from high, smooth decline down)
3. Chronic (decreased, up and down, death)
4. Frailty/aged (low, up and down, death)

Question 8

What are the implications of varying death trajectories?

Answer 8

• Prognosis discussions
• Goals of care based on how events unfold
• Future planning

Question 9

What are some different aspects of future planning (such as ACDs and everything else) in end-of-life care?

Answer 9

• Financial (take care of family; will, centrelink, early super access for the patient themselves)
• Practical planning (don’t want to be a burden; home care, counselling, specialist pall care in hospital)
• Personal (coming to terms with death/legacy)

Question 10

Clinical fx (not exam findings) that suggest someone’s in their last ~wk of life

Answer 10

• Profound weakness (requiring significant help w/ all care)
• Reduced cognition/drowsiness
• REduced intake of food/fluids, ↓ swallowing meds

Question 11

Physical exam findings in last few days of life

Answer 11

• Altered respiration (e.g. cheyne-stokes)
• Audible secretions (death rattle)
• Cyanosis/mottling/coolness of peripheries
• Pulseless radial artery
• Reduced renal output (remember endpoints?)

Question 12

Medical definition(s) of death

Answer 12

1. Loss of all circulatory/resp functions (heart death)
2. Loss of all brain function/brainstem reflexes (brain death)

Question 13

Common reactions of patients/families to death

Answer 13

• Shock
• Disbelief
• Overwhelmed
• Anger/blaming messenger
• Guilt
• Depression
• Seeking confirmation

Question 14

What are the five stages of grief?

Answer 14

• Denial
• Anger
• Bargaining
• Depression
• Acceptance

Question 15

Strategies for doctors to stay in good shape while caring for dying people

Answer 15

• Strong social network (friends/family esp non medical)
• Medical network (GP +/- psych etc)
• Hobbies/strategies timetabled in (music, sport, anything that requires thinking about different topics)