death and dying Flashcards
What are some of the key stats around death in the uk?
500,000 people die in england each year
will rise to 590,000 in the next 20 yrs
1/4 people will die of cancer
increasing ageing pop = majority of people will be living with a number of conditions (e.g. 30% of peope over 85 yrs with cancer also have dementia).
Why is it important to recognise a patient approaching the end of their life?
- may allow for opportunities of shared decision making
- prevent unnecessary interventions
- ensure dying persons expressed wishes are considered
- avoids misunderstandings and unnecessary distress
- Good communication of dying persons prognosis –> improves end of life care and improved bereavement exp of those important to them
What are the 6 ambitions for palliative and end of life care?
- each person is seen as an individual
- each person gets fair access to care
- maximising comfort and wellbeing
- care is coordinated
- all staff prepared to care
- each community prepared to help
What are some of the main concerns highlighted by age UK end of life review?
- dying in pain
- dying alone
- being told that they are dying
- dying in hospital
- going bankrupt
- divorce/ end of relationship
- losing their job
Why may it be difficult to recognise that a person is reaching the end of their life?
- we want to save lives
- acceptance only when interventions fail/ run out of options
- pressure to provide medically futile tx (by pt family social)
- tendency to shy away from dying and or inability to acknowledge dying
- feelings of failure, lack of experience or eductation/ training
- inadequate communication skills
What signs help us to recognise someone is entering last days of life?
- signs getting worse day by day/ hour by hour
- reduced mobility or bedbound
- extreme tiredness and weakenss
- little interest in food/ drink
- difficulty swallowing oral medication
- sleepiness and drowsiness
- reduced urine output
- changes in breathing
- new incontinence
- increased restlessness, confusion +/- agitation
- no reversible cause for deterioration
What are some of the performance scales that can be used in palliative care?
- Australian modified karnofsky scale – >from 100 (normal no evidence of disease) to becoming bedbound to death
- ECOG scale –> from 0 fully actuve able to carry on predisease performance, to 3 limited selfcare, confined to bed/ chair more than 50% hours, to 0 death
What are the 5 phases of illness?
- stable
- unstable
- deteriorating
- terminal
- bereavement
(high complex dying) or (low complex dying) used for 4/5 sometimes.
Who should diagnose dying?
- MDT diagnosis
- listen to the patient
- listen to the family/ carer
- listen to instinct and experience
- you will not always get it right
What is the importance of communication in the dying patient?
- Earlier is better
- important to ascertain patients level of involvement in decisions and amount of information
- more likely to lead to advance care planning discussions –> patient wishes
- preferred place of care and death
- what is important to you?
- escalation of care and DNAR discussion
- important to do whilst a patient has capacity (not every pt will lost capacity).
What is the importance of documentation in palliative care?
what tools are there available?
- again, the earlier the better
- needs to be shared with all involved in that patients care –> need to d/w patient
- needs to be regularly reviewed
- needs to be available to all healthcare professionals to avoid repetition
- patient held documentation
- important to share documentation and communication:
- respect process (recommended summary plan for emergency care and tx).
- castle – >care and support towards life’s end (advanced care planning resource and documents).
What are key aspects of end of life management?
- symptom control
- app. medications only –> correct dose and route
- stop inapp. interventions
- rationalise medications
- consider anticipatory drugs
What are some of the anticipatory drugs that may be used in end of life care?
- Pain management –> first line morphine s/c
- nausea and vomiting – >levomepromazine s/c
- agitation -> midazolam s/c ( or levo can be used)
- secretions –> hyoscine butylbromide s/c
- different agreement for “just in case” medications in different areas (prescribed just in case of need. )
- authorisation to administer form (district nurse can administer drugs at home)
