Palliative and Hospice Care Lecture Notes

why is palliative and hospice care so important

Dehumanization during dying process

Serious, chronic, or terminal illnesses

Battle against the “evil” of death

Unrelieved discomfort

Unnecessary suffering

Disability = social isolation

What does palliative Interventions do?

Medical treatments focused on relieving pain and suffering and improving quality of life without providing a cure, not end of life just yet

Palliative Care Timing

Ideally begins at the time of diagnosis of a life-threatening illness and continues through cure or until death and into the family's bereavement period.

movement of improved hospice and palliative care

Humanize End-of-Life experience

Palliative Interventions

Changes in end of life care- discuss death / encompass body / mind / spirit

what impact does palliative care do?

Holistic care

Interdisciplinary team cares for the whole patient and family unit

Physical, emotional, spiritual needs are addressed

Palliative Care Symptom Focus

Emphasis on relief from undesirable symptoms, such as pain, shortness of breath, fatigue, anorexia, and nausea and vomiting.

Difficult conversations

Identify other decision makers

Assess understanding of prognosis

Define patient’s goals for care

Reframe goals

Identify needs for care

Summarize and link goals with care needs

Introduce Hospice

Reinforce commitment to care

How should you approach hard conversations

Responding to Emotions

• Acknowledge response

• Legitimize reaction

• Empathize

• Explore concerns

• Explain hospice goals

• Reassure

Interdisciplinary Team (IDT) in Holistic Care

A team of care providers that collaborates to address physical, emotional, and spiritual domains of suffering for the whole patient and family unit.

Hospice Care Eligibility

Serves anyone with a life-limiting illness who has a prognosis of $6\,\text{months}$ or less, elects a course of comfort care, and whose care does not conflict with other benefits such as dialysis.

Focus of Hospice Care

Specialized care at the end of life that focuses on care, comfort, quality of life, dignity, and grief and counseling services rather than curative treatment.

Hospice Care Coverage

Covers all medications, supplies, and equipment related to the hospice diagnosis, physician visits, and treatments or hospital stays precertified by the hospice.

Hospice Median Length of Stay

The median length of stay for hospice nationwide is $24\,\text{days}$, compared to the ideal length of $3\,\text{to}\,6\,\text{months}$.

End-of-Life Tasks

Tasks completed near the end of life categorized into Financial (will, estate planning)

Emotional (relationship closure),

Spiritual (search for meaning).

Time-Limited Trial

An option elected by a hospice patient when a treatment outcome is uncertain, allowing them to evaluate whether the intervention successfully relieves symptoms.

Can a patient on hospice call 911

yes

CAN A PATIENT RECEIVE HOSPICE SERVICES AND STILL REMAIN A FULL CODE?

grey area of what th patient really wants

Hospice Revocation

The voluntary discharge from hospice care due to improvement in condition, desire to undergo curative treatment, or no longer wanting services, with the option to re-admit at any time.

Symptom Management Treatments in Hospice

Interventions utilized on a case-by-case basis intended solely to relieve symptoms rather than cure illness, including blood transfusions, radiation therapy, and thoracentesis/paracentesis.

Responding to Emotions Protocol

A communication approach used during difficult conversations: Acknowledge response, Legitimize reaction, Empathize, Explore concerns, Explain hospice goals, and Reassure.

Who pays for hospice and palliative care?

Funding sources for hospice and palliative care including Medicare, Medicaid, private and employer-sponsored insurance, and some non-profit agencies.

Palliative Care vs. Hospice Care (Treatment Concurrent)

Palliative care can be provided concurrently with disease-directed and curative treatments, while hospice care requires stopping curative treatment because it is final stages of life, less than 6 months of life

Both provide symptoms reliefand improve quality of life

when does pallaitive care begin

at diagnosis

Where can hospice be provided

anywhere the patient is

A nurse is caring for a client recently diagnosed with stage IV lung cancer. The client is beginning chemotherapy and reports severe pain, fatigue, and anxiety. The client's spouse asks, "Is there any service that can help us manage all of this while treatment continues?

"Palliative care can help manage symptoms and provide support while the client continues treatment."

A client with end-stage heart failure has been hospitalized four times in the past 6 months. During a family meeting, the client states, "I don't want any more hospitalizations. I want to focus on being comfortable at home with my family.”

Discuss hospice services and assess the client's goals of care

A nurse is caring for a client receiving hospice services for advanced pancreatic cancer. The client's daughter states, "I don't understand why Mom is taking pain medication. Shouldn't the doctors be trying to cure the cancer instead?”

Hospice care focuses on comfort and quality of life rather than curing the disease.

A nurse is discussing palliative care with a client newly diagnosed with advanced ALS. Which statements by the nurse accurately describe palliative care?

"Palliative care can help manage symptoms such as pain and shortness of breath."

"Palliative care supports emotional, social, and spiritual needs."

"Palliative care can be provided while you continue disease-directed treatments."

"Palliative care can help you and your family make healthcare decisions."