OT 504 Wk12 LG2_End of Life_Brightspace slides

What is the main problem Atul Gawande identifies with modern medicine at the end of life?

Modern medicine often focuses too heavily on extending life through technology instead of understanding what makes life meaningful to the individual patient.

What are examples of goals patients may value near the end of life?

Maintaining cognitive function, avoiding suffering, spending time with family, or completing meaningful life projects.

beWhat is the “paternalistic” model of medical care?

What is the “paternalistic” model of medical care?

In this model, the healthcare provider makes decisions for the patient based on what they believe is in the patient's best interest, often without involving the patient in the decision-making process.

What is death?

The irreversible and permanent cessation of all vital biological functions and processes that sustain life.

What vital functions cease with death?

Circulatory function, Respiratory function, Brain function, including the brainstem.

What are the five classifications of death?

Natural, Accident, Suicide, Homicide, Undetermined/pending.

What is natural death?

A process in which the vital organs progressively decline.

What are common signs during the natural process of dying?

Sporadic, agonal, or shallow breathing; Extended sleeping; Little talking; Hearing remains.

What changes may occur months to weeks before natural death?

Appetite changes, Increased sleep, Acceptance mixed with anger or denial.

What changes may occur weeks to days before death?

Loss of interest in food, Weakness/being bedbound, Reduced bowel and bladder control, Changes in behavior or speech, Eyes may remain half open, May talk to or see people others cannot see.

What changes may occur days to hours before death?

Shallow, quick breathing with long pauses, Coma-like state, Mottling, Decreased muscle tone or rigidity, Restlessness/agitation.

What are Cheyne-Stokes respirations?

A breathing pattern of deep, regular breaths followed by shallow breaths or pauses.

How does fear of death generally change with age?

Anxiety and fear of death tend to decrease with age, but fear of losing control and fear of the dying process remain.

How does culture relate to death and dying?

Death is situated within culture, so death and dying are not experienced the same way across cultures.

What behaviors may occur as people contemplate death?

Renewed interest in spirituality, Searching for meaning in life, Reevaluating relationships, Finding one's “place in the universe.”

Who can receive palliative care?

Anyone with a serious illness.

Who can receive hospice care?

Someone with a serious illness who is believed to have a short time to live, often less than 6 months.

Can someone receive curative treatment while receiving palliative care?

Yes. Curative treatment may continue if the person wishes.

Can someone continue curative treatment while receiving hospice care?

No. Hospice focuses on symptom relief rather than treatment intended to cure the illness.

What is a major similarity between palliative and hospice care?

Both aim to relieve symptoms as much as possible.

Where can palliative care be provided?

Home, Assisted living, Nursing home, Hospital, Palliative care clinic.

Where can hospice care be provided?

Home, Assisted living, Nursing home, Hospice facility, Hospital.

Easy way to remember palliative vs. hospice?

Palliative = serious illness + may still pursue a cure. Hospice = end of life + symptom/comfort focus.

What is an advance directive?

A legally binding outline of a person's healthcare wishes.

What is a living will?

A legal document that typically addresses decisions about things such as: CPR, Feeding, Breathing machines, Tests/surgeries/medications, Transfusions.

What is a durable power of attorney (DPOA)?

A document establishing who is responsible for a person's health or financial decisions.

What is an organ/body donation card?

A document specifying what should be done with the person's body after death.

What is a DNR?

Do Not Resuscitate — a medical document instructing the healthcare team not to perform CPR if the person's heart and/or breathing stops.

What is Five Wishes?

A form that helps a person articulate how they want to be treated if seriously ill, including personal, spiritual, medical, and legal wishes.

What does the California End of Life Option Act allow?

It allows a terminally ill adult California resident who meets specific criteria to request a drug from a physician that will end their life.

What age must a person be to qualify under the CA End of Life Option Act?

18 years or older.

What prognosis is required under the CA End of Life Option Act?

A terminal disease that cannot be cured or reversed and is expected to result in death within 6 months.

What other requirements must be met under the CA End of Life Option Act?

The person must: Be ≥18, Be a California resident, Have a qualifying terminal disease, Have capacity to make medical decisions, Not have impaired judgment due to a mental disorder, Be physically able to take and ingest the medication.

What term does the lecture use instead of "patient" in EOL care?

Care recipient.

What are common emotional needs at end of life?

Coping with: Uncertainty, Fear, Grief, Feeling like a burden.

What are common relational needs at end of life?

Engagement in social roles, Managing living and dying roles, Managing a changing sense of self.

What are occupational needs at end of life?

Engagement in social roles, Engagement in doing, being, becoming, and belonging occupations, Adapting as occupations change, Addressing occupational deprivation.

How may occupations shift near the end of life?

There may be a shift toward more being and belonging occupations rather than doing occupations.

What other needs may care recipients have at end of life?

Informational needs, Symptom management, Spiritual needs.

Why is OT important at end of life?

Loss of independence and roles can contribute to a person's loss of social identity before biological death. OT can help the person adapt functions and roles and maintain self-esteem.

How does traditional OT differ from OT at end of life?

Traditional OT often emphasizes maximizing functional independence and returning to activities, roles, and relationships. EOL OT recognizes progressive disease and permanent functional loss and is not primarily about rehabilitation.

What does OT at end of life address?

The dual states of living and dying.

What is the purpose of meaningful occupation at end of life?

To reinforce the person's sense of being and engage them in occupations that can affirm life and prepare for death.

Where might an OT provide end-of-life services?

Home, Skilled nursing facility (SNF), Long-term care (LTC), Inpatient hospice.

What should OT goals prioritize at end of life?

The client's priorities, Collaboration with the client, care partners, and team, Occupational participation rather than performance.

Why might EOL OT goals look different from traditional rehab goals?

Because the person's condition may progressively decline, so maximizing independence or restoring function may not always be appropriate.

Give an example of an EOL OT goal related to adapting to disease progression.

The client verbalizes two ways they may need to adapt as their condition changes.

Give an example of an EOL goal involving the caregiver.

The client and caregiver verbalize their different priorities regarding maintaining ADLs as the disease progresses.

What are possible OT intervention areas at end of life?

Planning for death, Contacting family, Grief/loss, Autonomy, Meaningful activities, roles, and relationships, Functional independence when appropriate, Symptom control, Calming sensory environment, Communication of EOL preferences, Spiritual support, Life review, Legacy projects, Advocacy, Care partner education/support.

What may many people at end of life desire from their occupations?

A sense of normalcy through basic, everyday activities such as BADLs, eating meals with family, or simply resting.

What is reminiscence as an OT intervention?

Recalling pleasant personal memories to enhance psychological well-being.

What are examples of reminiscence activities?

Old photographs, Familiar tools, Dance/music, Memory boxes.

What is life review therapy?

Opportunities for reexamination and critical reflection that may help a person find meaning and reconciliation in their life.

What is a legacy project?

A gift from one generation to the next that honors the person's life.

What are examples of legacy projects?

Ethical will, Family tree, Memorial garden, Family history recording, Scrapbook, Letters to family, Stuffed animals made from favorite clothing.

What is the Go Wish Card Game used for?

To make EOL conversations easier and help with planning and honoring a person's wishes for their final days.

Is death considered the outcome of OT intervention at end of life?

No.

Is independence in ADLs necessarily the primary outcome of EOL OT?

No. The focus is on the process rather than simply achieving independence.

What questions should an OT consider when evaluating EOL therapy outcomes?

Were the goals met? Were goals reassessed daily? Was the therapy process successful?