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Oncology Exam 1
Frei Palliative Care
| Question | Answer |
|---|---|
| 3 different courses in death are? | sudden death; steady decline; slow decline |
| Sudden death is least common out of the 3 courses in death. % is? | 10% (MI, stroke, accident and pass away before they get to the ER) *unexpected cause |
| Steady decline is more common and is more so known as a ____ _____ ____. Example would be? (think of a cancer one, like a fast aggressive one) | short terminal phase; pancreatic cancer (not found till the progression is advanced; |
| Most common way pts in the US die is a periodic ____ ______ Examples would be? | slow decline followed with periodic crisis and sudden death; HF, CKD |
| Which of the following conditions involves a slow decline, perioidc crisis, sudden death? A. Motor vehicular Trauma B. Massive myocardial infarction C. CKD D. Pancreatic Cancer | CKD |
| So how does Death and dying work in America? | disparity exist between the way people die/the way they want to die. -realities of life limiting diseases (family generations, need to work) -lack of adequate training of professionals -delayed access to hospice/palliative care **NEED for Palliative care |
| Key Question on exam--> tell me what is the difference b/w | palliative care and hospice care |
| Palliative care is all about focusing on the goals of the family, how to assess symptoms, make them comfortable with palliative care, ____ | interventions to get them to their end of life goals and quality of life and closure *its about meeting their needs and making sire they fell good or feel comfortable to where they want to be |
| Palliative does not have a ______ focus | curative (not trying to diagnose and cure them. |
| Palliative care is about controlling the symptoms and getting them comfortable and prepared at the ____ ____ ____ | end of life |
| Palliative care is not just the patient, its also the ______ that take care of the pt and also their family. Palliative care includes? | caregivers; Medication management, social support, spiritual care, better QoL, and symptom management |
| What are the general principles of palliative care? | Patient and family, as defined by the patient, as unit of care • Attention to physical, psychological, social and spiritual needs • Interdisciplinary team approach • Education and support of patient and family • Extends across illnesses and settings |
| What is the model of QoL | Physical Well Being • Psychological Well Being • Social Well Being • Spiritual Well Being |
| In the Ideal model: Continuum of care--> Palliative care extends through both the ____ of the illness and to the point where you've decived its hospice time | treatment |
| Hospice, your not giving curative therapy. | specialized care focused on quality of life at the end of life, disease modifying treatment has stopped, and expected less than 6 months left |
| T/F: Palliative cure includes the curative phase (tx) and the non-curative phase (hospice) | True *non-curative (hospice) no longer through to cure, just doing sx control (palliative care) *symptom management and support of the pt. |
| What is bereavement support? | support for family and care givers after pt dies (part of hospice) (1-yr anniversary) |
| palliative care can be used along side curative (chemo) and? | life-prolonging measures |
| Hospice occurs when you have a 6 month or less predicted ______ | survival and no longer going to give cure. |
| Hospice or Palliative care? Provides care for the terminally ill; most often introduced in last 6 months of life; focused on improving quality and comfort of remaining life | Hospice *end of life |
| Hospice or Palliative care? can be used alongside curative and life-prolonging measures; given to those with terminal and non-terminal illness; can begin at any stage of the disease | Palliative care *sx focused |
| Eligibility for hospice: | loved ones must be certified as terminally ill; loved one must agree to not pursue curative measures; loved one must elect to pursue hospice care with a specific hospice organization |
| Eligibility for palliative care: | loved one must request palliative care referral from physician |
| What are the 3 big predictors of access to palliative care? | 1. Geography 2. Size of hospital 3. Type of hospital |
| Major takeaway from the hospice length of stay by profit status is that? | the length of stay in hospice is relatively short for all pts enrolled *aka not 6 months, more like 3 weeks *peoley dont get that help until its almost till the end |
| What are the top diagnosis's for hospice? | Cancer (30.1%); Circulatory/Heart (17.6%); Dementia (15.6%); Respiratory (11%); CKD (9.4%) |
| Pts with palliative care have better outcomes, why? | bc of the study known as early palliative care intervention *palliative care pts lived 3 months longer vs just receiving standard tx meaning a survival advantage |
| Palliative care is appropriate for any individual with a serious illness, at any age and at any stage, from the point of _____ and alongside curative tx | diagnosis |
| People living with serious illness are at risk for: | symptom crisis, caregiver exhaustion, difficult decision-making, and out-of-pocket medical costs-all of which cause suffering and reduce QoL |
| The equitable provision of quality palliative care improves: Palliative care benefits? | QoL, prevents crisis, and helps align care with pt's goals and values; pts, caregivers, clinicians, and healthcare organizations |
| all clinicians can apply the principles of palliative care to improve? | QoL for their pts with serious illness |
| What is de-prescribing? | discontinuing meds (Rx, OTC, cam) when risks outweigh the potential benefits *stopping, reducing, or slowly withdrawing medications that are inappropriate, unsafe, or ineffective |
| What is poly-pharmacy? | use of 5 or more rx's concurrently for the tx of one or more co-existing diseases |
| Reasons for de-prescribing in palliative care: | Reducing the associated cost; Reducing potential adverse effects; Reducing the burden of polypharmacy in last months of life; Improve QoL***; Could improve adherence to other medications |
| What are common medications de-prescribed during in palliative care? | Antihypertensives; Dyslipidemia agents; CAMs (complementary alternative medicines); Aspirin/anticoagulants (if for primary prevention); Osteoporosis medications; Diabetes medications; PPIs (questionable area) |
| What are some considerations for de-prescribing? | Is tapering needed?; Monitoring; Follow-up; Shared decision making; How would de-prescribing affect the patient and family? |
| What are the approaches to safe de-prescribing? | Establish life expectancy--> ID goals--> Assess time to benefit--> Tx targets; Accurate med list--> Assess--> adjust--> Follow up and repeat *we only drop ONE DRUG AT A TIME |
| What are barriers to de-prescribing? | Reluctance to cease medications prescribed by specialists; Perception of inability to change patients’ attitudes; Belief there was a strong indication for a medication |
| What is euthanasia? | an act, undertaken only by a physician, that intentionally ends the life of a person at his or her request **ILLEGAL in ALL STATES |
| Physician-assisted suicide (PAS) is? | a person self-administers a lethal substance prescribed by a physician *legal in many states |
| Physician-Assisted Suicide is legal in what states? | California, Colorado, Hawaii, Maine, Montana (unclear), NM (unclear), NJ, Oregon, Vermont, Washington, Washington D.C |
| Is Euthanasia legal in the US? | No, its not legal |
| Qualifications for Physician-Assisted Suicide inlcude? | need to be an adult (18 and older), need to be a resident of that state, need to have at least an expected time until death of 6 months or less, and need to ask for Physician assisted suicide on 2 occasions |
| For Physician-assisted suicide, you need to ask for 2 _____ requests (at least ___ days apart) and ONE written | ORAL; 15 *legal term says its a sustained interest for PAS) |
| What are the legal issues with PAS (Physician-Assisted suicide)? | Voluntary, well-considered, informed, and persistent over time; The requesting person must provide explicit written consent and must be competent at the time the request is made; Different b/w states (may involve 2 oral (at least 15 days apart) requests and one written request) *CA is only state that has explicit protection for pharmacist dispensing |
| NCCN (oncology guidelines on Hastened death) when it comes to pt requests for PAS includes? | Response (intensify palliative care, get information from the pt such as what's going on; address the request explicitly; evaluate the reasoning behind the request and ask why now? -assess symptom control; -assess psychological/psychiatric issues; -ask about relationships, values and personal views, discuss fears of caregiver burden and abandonment |
| NCCN (oncology guidelines on Hastened death) cont'd: | -Consult ethics committee; -Discuss alternatives to PAS; -Withdrawal of life sustaining treatment; -Voluntary cessation of eating or drinking; -Sedation for refractory symptoms; -Clarify care plan |
| Conclusion on palliative care: | is important as our population ages; Lack of clinical trials in palliative care but early palliative care can improve median survival; Pharmacists can be involved in palliative care (esp de-prescribing of PIMs and managing symptoms at end-of-life); Pharmacists can become palliative care specialists through residencies or traineeships; PAS is not supported by healthcare organizations |
Created by:
Xander635
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