Week 7 - Palliative, Hospice, Advanced Care Planning, Death and Dying

Question 1

Palliative care

Answer 1

healthcare for people with serious illness which focuses on relief from symptoms and stress, and improving quality of life and comfort for the patient and their family.

Question 2

Functions of palliative care

Answer 2

1. Symptom assessment and treatment
2. Assistance with decision making
3. Help with establishing goals of care
4. Collaborative transitions in care

Question 3

When to refer to palliative care

Answer 3

1. Needs cannot be met with existing resources
2. Refractory symptoms
3. Difficulty with decision making
4. Healthcare team burnout
5. Patient/family distress

Question 4

Hospice

Answer 4

Offered once lift prolonging treatments are no longer appropriate.

• Optimize symptom management and psychosocial support while not prolonging life

Question 5

Advanced Directives

Answer 5

1. Durable power of attorney for healthcare
2. Medical orders for life sustaining treatment

Question 6

POLST form

Answer 6

Physician orders for life-sustaining treatment (POLST)

1. Orders directing how care should be provided in event of acute injury or illness
2. Patient’s goals for treatment (aggressive, limited, comfort focused), CPR, hospitalization, antibiotics, hydration, nutrition

Question 7

SPIKES protocol

Answer 7

Strategy for communicating sensitive information about Advanced Care Plan while focusing on patient emotions

1. Setting
2. Perception – what the patient already knows
3. Invitation – clarify information preferences
4. Knowledge – Give the information
5. Empathy – respond to emotion
6. Summary – next steps and follow up

Question 8

Kübler-Ross’s stages of death and dying

Answer 8

1. Denial
2. Anger
3. Bargaining
4. Depression
5. Acceptance

Question 9

Types of grief

Answer 9

1. Normal
2. Anticipatory
3. Disenfranchised
4. Prolonged

Question 10

Normal grief

Answer 10

Sadness, guilt, loneliness, crying, sleep changes, lack of energy, appetite changes, temp withdrawal from normal activities

Question 11

Anticipatory grief

Answer 11

Response to an expected loss occurs before the actual death

Question 12

Disenfranchised grief

Answer 12

Loss cannot be socially acknowledged – no recognition by others (miscarriage)

Question 13

Prolonged grief

Answer 13

Grief symptoms like sadness, anger, bitterness, and guilt, are disabling, limiting day-to-day functioning.
Prolonged grief may involve difficulty accepting the reality of a loss, self-destructive behavior, or suicidal thoughts.