What does palliative mean?
Compassion, dignity, quality of life. It can be associated with death by families/pt/healthcare professionals which is a misconception.
What is palliative care?
Approach to care that improves quality of life of pt/fam facing life threatening/life limiting illnesses. Aimed to relieve suffering, used when cure isn’t possible, and should be initiated early in illness trajectory. It can be intimated alongside treatments to control disease (like chemo)
What can early palliative care lead to?
Decreases depression/anxiety, better symptom control, better quality of life, and they can live longer (up to 3 months in a study).
MAID and PC?
MAID is excluded in palliative care because PC is not about death
PC approach?
Term was coined in Australia to differentiate primary level PC from specialist level PC. 4 elements that are involved are identify, assess, plan, and manage.
Identify, assess, plan, and manage meanings?
- Identity the pt who would benefit from PC early
- Assess pt/fam understanding of illness/symptoms, quality of life, values/wishes, and their needs
- Plan (care plans, goals of care discussions)
- Manage (pay attention to symptoms and manage them, manage psychosocial and spiritual needs, manage essential discussions).
What is the surprise question?
It’s a screening tool for PC: Would I be surprised if the patient died in the next 6-12 months. It does not predict life expectancy. If the answer is no then considering initiating PCA (including the 4 elements of PCA).
PPS (palliative performance scale)?
Assess functional status across 5 domains- ambulating, activity/evidence of disease, self care, intake, consciousness level. It’s not a prognostic tool but it provides a snapshot of functional status at a point in time.
3 approaches to deal with stigma according to Nathan Cherry?
- Gettin over it- stick to term but educate them about it as well, this may take longer
- Living with it- add on another term to palliative like supportive/palliative care, this can lead to people not being educated about what PC is really about
- Getting around it- Replace with another term, like pain/symptom management, this fails to educate and important conversations can be avoided
How to change culture around PC?
Change the way we talk (avoid saying pt is palliative or do you want PC), use phrases like do you have a pt who would benefit from PCA?
What is golds standard framework?
UK initiative to improve PC in primary care. It Adopted the surprise question and pairs it with general/disease specific indicators of decline.
