Week 2 - Philosophy and principle of palliative care

Question 1

why are people dying differently than many years ago

Answer 1

• increased life expectancy
• more chronic illness
• life saving interventions
• tech

Question 2

WHO definition of Palliative care

Answer 2

• approach that improves a QOL of patients and their families facing problems associated with life-limiting illness.
• through the prevention and relief of suffering using early identification and impeccable assessment and treatment of pain and other problems, physical psychological, and spiritual

Question 3

Goal of palliative care

Answer 3

improve QOL of those who are suffering from severe diseases

Question 4

theoretical principles of palliative care

Answer 4

Structure
target
task
expertise

goals

Question 5

Structure (3)

Answer 5

• multidisciplinary team
• 24/7 service
• network: cross setting

Question 6

Target

Answer 6

• patient population
• timing
• family/relatives

Question 7

task

Answer 7

control of symptoms
comprehensive care

Question 8

expertise

Answer 8

knowledge skills and attitudes

Question 9

goals

Answer 9

prevention and relief of suffering
improvement in Q of L

Question 10

previous beliefs of palliative care

Answer 10

active treatment, palliative, death
very demarcated
ended when pt died

Question 11

evolving model of PC

Answer 11

diagnosis- death
-a curative approach aimed at treating the disease or prolonging life
-palliative care is focused on symptom control and quality of life

• ## combination of curative and palliative therapies

Question 12

another model

Answer 12

included psychosocial and spiritual support

disease-focused care
comfort-focused care
death
follow up

Question 13

term living well used to

Answer 13

honor the belief that persons are simultaneously living and dying

Question 14

bow tie model of 21st century

Answer 14

disease management PC

cure rehab
control PC unit or hospice
Symptom management
ACP
_____________________________________> EOL care

survivorship and bereavement added to PC side

Question 15

palliative care has an aim to

Answer 15

alleviate suffering (physical, emotional, psychological or spiritual) rather than curing

Question 16

principles of hospice and PC can be

Answer 16

integrated into care early in the dying process

Question 17

life limiting illness

Answer 17

• acute or chronic, that is likely to shorten or limit a person’s life
• gentler term than terminal illness
• may be more easily accepted word

Question 18

30% of population ___
33% increase in
2/3 will die with
only 20% will die with a

Answer 18

> 65
deaths from 2004
2 or more chronic diseases after months or years in a state of “vulnerable frailty”
recognizable terminal (palliative) Phase

Question 19

causes of death in Canada

Answer 19

2.9 % sudden
28.4 terminal illness
33.8 organ failure
29.3 frailty
5.6 other

terminal down will benefit from PC

Question 20

PC shows improvement in

Answer 20

• pain and other symptoms
• communication with doctors and family members
• emotional and physiological state
• improved QoL
• improved survivor ship
  more favorable outcomes (good death)

Question 21

barriers to accessing palliative care resources

Answer 21

• mistrust of HC system
• Belief of ineligibility
• Insufficient training of HCPs
• Taboos and fears about talking about death and dying
• Lack of a clear prognosis(especially with a non cancer diagnosis)
• Elderly (cognitively aware, hard to know on the trajectory there is nothing left, it is what we expect) children (family not wanting to since it can diminish hope)
• Increasing number of people dying (not enough beds)
• People living with physical and developmental disabilities
• Rural and remote
• Unhoused
• An increasing number of people aging with chronic life-limiting illness will require care for longer periods
• Fewer family caregivers.

Question 22

moving forward action plan
priorities (3)

Answer 22

1. redesign health services to deliver timely coordinated EOL care
2. Provide individuals, caregivers and health providers with palliative care information, education tools, and resources
3. Strengthen Health System accountability and efficiency

Question 23

3 triggers for PC approach

Answer 23

1. The Surprise Question:
   “Would you be surprised if this patient were to die in the next 6-12 months?”
2. Choice:
   The patient with advanced disease makes a choice for comfort care only (example refusing renal transplant or bone marrow transplant)
3. Clinical Indicators:
   Specific to each of the three main end of life groups - cancer, organ failure, elderly frail/dementia

Question 24

Death trajectories

Answer 24

1. cancer = steady decline 1/4
2. organ system failure = stuttering, death not as clear
3. frailty= long term dependencies, slow death

Question 25

transitions

Answer 25

“Changes that occur on a continuum from wellness to death, commonly identified in hospice palliative care practice using various palliative performance scales.”

Question 26

PPS

Answer 26

start on left and move to the right left is the strongest determinant

Question 27

key transitions in dying 100-90% 80-70% 60-50% 40-30% 20-10% 0%

Answer 27

- diagnosis - indicated illness not responding to tx, disease progression - disease extensive and advanced, cure not possible - unable to provide self-care, extensive care giving - less alert and responsive, death is imminent -death

Question 28

The patient spends the majority of the day sitting in bed or lying down due to fatigue from advanced disease. She requires considerable assistance to walk even short distances. She is fully conscious. She has a good nutritional intake. what is PPS? look in one note

Answer 28

50%

Question 29

The patient is very weak and remains in a chair a couple of hours a day. The rest of the time, he is in bed. He has advance disease and is requiring almost complete assistance with self-care and feeding. He is experiencing decreased food intake, with a few small snacks that remain mostly unfinished. He has adequate fluid intake. The patient is drowsy but not confused. PPS?

Answer 29

30-40%

Question 30

4 key elements determine how PC can be used in practice | the approaches

Answer 30

- Decreasing suffering/increasing quality of life - Implementing holistic care - Providing person and family centered care - Providing team based care

Question 31

how PC upstream approach

Answer 31

Identifying patients early. Meeting the needs of people living the trajectories of chronic life-limiting illnesses. Requires anticipating, preparing, decision-making, communicating, initiating discussions, advocating, and caring.

Question 32

Which of the following options are ways to decrease suffering and improve quality of life using a palliative approach? Select all that apply. - Raise the head of the bed for a person who is struggling to breathe. - Asking the OT to teach the person how to conserve their energy while attending to their ADLs. - Ask the person and family how they are managing. - Manage pain symptoms. - Tell the person to get their affairs in order.

Answer 32

1,2,3,4

Question 33

common aspects of holistic care include

Answer 33

Physical Psychosocial Spiritual Financial Sexual

Question 34

whose responsibility is it to care for the dying

Answer 34

all nurses and palliative care specialists

Question 35

what do we strive for (3)

Answer 35

- Equality promotes fairness through equal treatment - Equity goes a step further by recognizing the diverse needs and starting points of individuals - Achieving true social justice often requires both principles as they complement each other creating a more inclusive and fairer world.

Question 36

Prognostication or prediction of need (Screening Tool)

Answer 36

- Gold standard - Surprise Question embedded - Tool used to assess any person who is aging, living with a progressive life-limiting illness, entering long-term care, or whose health is suspected to be declining. - Needs-Based Coding - the right care at the right time - A person showing any general or specific indicators of decline would benefit from the integration of a palliative approach

Question 37

Screening Tool to integrate Palliative approach) first step

Answer 37

- identify who is declining and would benefit from a PC approach - unmet PC needs

Question 38

identify people with unmet palliative care needs (5)

Answer 38

- Frequent hospital admissions for the same symptom. - Difficult to manage symptoms. - Increasingly complex care requirements (e.g., the need for increased assistance with ADLs) - Added specialty needs - Decrease appetite and/or involuntary weight loss

Question 39

domains of care (9)

Answer 39

disease management (primary dx, secondary dx, comorbidities) physical (pain and other symptoms) psychological (personality, strengths, depression) social (relationships, roles, privacy) spiritual (meaning, value, beliefs) practical (ADLs) EOL care/death management loss/grief Patient and family in the center