Dying patients can have needs that differ from those of other patients. So that their needs can be met, dying patients must first be identified. Before death, patients tend to follow 1 of 3 general trajectories of functional decline: A limited period of steadily progressive functional decline eg, typical of progressive cancer A prolonged indefinite period of severe dysfunction that may not be steadily progressive eg, typical of severe dementia, disabling stroke, and severe frailty Function that decreases irregularly, caused by periodic and sometimes unpredictable acute exacerbations of the underlying disorder eg, typical of heart failure or COPD With the first trajectory eg, in progressive cancerthe course of disease and time of death tend to be more predictable than with the other trajectories.
End of life - Ideas for practice: Case study End of life care - Holistic palliative care Kate is a 51 year old woman with late stage ovarian cancer. She is a single mother with five children aged 24, 23, 17, 15 and She is also guardian for her 13 year-old grandson.
Kate first became known to the palliative care team before her diagnosis two years ago when her daughter was at the hospice dying from ovarian cancer. They met briefly with a member of the team following her death for assistance with practical concerns such as arranging a funeral.
Kate spoke of having had bad experiences with social services in the past.
This made it very difficult for the social work team at the hospice to engage with her and shortly after this meeting Kate cut all contact with the team. Initially she agreed to see only the nurse specialist.
However, after a few months some finance and legal issues arose concerning the children so Kate agreed to see a palliative care social worker.
Palliative care social workers are usually non-statutory so are less likely to be pressurised to complete a piece of work and close the case. The social worker involved was therefore able to phone weekly over a period of time to check how the family were and if they needed anything.
Slowly, Kate agreed to the social worker visiting and she gradually built a relationship with Kate and her eldest daughter Louise, her main carer and, increasingly, carer for her younger siblings. Kate introduced the social worker to the younger children and the worker was able to support Kate in discussions about her illness, death and dying and the future.
Louise was offered separate support as a carer but declined this. However, she began to talk a little to the social worker and the district nurse. The weekly calls and regular visits continued for nearly a year.
Kate deteriorated gradually and became frailer, however she remained determined to be there for her children and to make sure they would be looked after once she was gone.
Kate was assisted to complete a statement confirming that she wanted Louise to have guardianship for all the children including her grandson when she died. After much persuasion, Kate agreed to a referral on the condition that the palliative care social worker continued to be involved. Due to Louise caring for all the children, a full family assessment was needed alongside allocation to a kinship social worker to assist with the handover of guardianship.
The palliative care social worker was able to explain the roles of all involved to the family and although they were still worried, the first visit went well. After one more visit the assessment officer closed the case reporting that the children were well cared for and Louise would be the most appropriate person to care for them in the future.
This work meant that Kate did not have to worry about who would look after her children and whether they would have a roof over their heads after her death.
Kate wanted to be at home for as long as possible but wanted to go to the hospice for her last few days as she did not want to die at home in front of her children.
This was recorded in her advance decision. Kate recently phoned the team saying she felt very unwell and tired and that she would like to come into the hospice as she thought she might be dying.End of Life Care Case Study # 2 1. Instructions for Completing Case StudyReview all slides in lausannecongress2018.comte all required reading, including links to external lausannecongress2018.com questions and answers included throughout the case lausannecongress2018.com finished, click on the ‘CE Form’ link located at the end of the study.
Palliative care, and the medical sub-specialty of palliative medicine, is specialized medical care for people with serious illnesses. It focuses on providing relief from the symptoms and stress of a serious illness with the goal of improving quality of life.
Palliative care should be provided from the moment of diagnosis to ensure adequate symptom management and to ensure that treatments are aligned with the patient’s preferences and values. Definitions of palliative careThe World Health Organisation () stated that the goal of palliative care is to control patient's pain and other symptoms associated with the whole person, being their body, soul and mind, whilst enabling patient's and their families to maintain a quality of life.4/5(2).
Essential Palliative Care Skills for Every Clinician Tools to Support Seriously Ill Patients in a Primary Care Practice. This is a comprehensive series of courses designed to provide foundational palliative care skills to any physician, osteopathic physician, nurse practitioner, or physician assistant, and to demonstrate how those services can be seamlessly integrated into a primary care .
End of Life care is one of the themes of CQC inspection and UK practices are expected to have a palliative care register, regular palliative care meetings and a plan as to how they are finding their 1%, and to be aware of the Five Priorities of Care and show how they apply them.