54 Questions
What is the main purpose of an Advance Directive?
To allow patients to appoint someone to make healthcare decisions for them if they become incapacitated
Which of the following is a key benefit of advance care planning for hospital patients?
Greater likelihood of end of life care wishes being fulfilled
What is a key challenge in implementing effective advance care planning?
Patients often have insufficient capacity to engage in the process
What is the primary goal of an anticipatory care plan in the context of advance care planning?
To outline a patient's wishes for palliative care and hospice referral
What is a key benefit of advance care planning for patients with terminal cancer?
Earlier hospice referral and better bereavement experiences for family members
What is a key benefit of motivating general practitioners to engage in advance care planning discussions?
Substantial uptake of advance care planning and better representation of non-cancer patients
What is the primary goal of Advance Care Planning (ACP)?
Facilitating discussion and documentation of personal wishes
Which of the following is a key feature of Advance Care Planning?
Exploration of beliefs and expectations
What distinguishes Anticipatory Care Planning from Advance Care Planning?
It involves a 'thinking ahead' philosophy of care
What role does the interdisciplinary team play in Advance Care Planning?
Enhancing communication and coordination among different healthcare professionals
What is a common misconception associated with Advance Care Planning?
It restricts patients' choices and preferences
Why is facilitating choice an essential component of Advance Care Planning?
To ensure patient autonomy and respect their preferences
What percentage of community patients identified for palliative care due to dementia or frailty were referred to specialist palliative care?
10%
In Scotland in 2016, what was the second most common place of death for all causes?
Care home
What has the potential to help address major challenges facing palliative care according to the text?
Advance Care Planning
Which article discusses residents' and relatives' views on advance care planning, end-of-life care, and decision-making in nursing homes?
Bollig, Gjengedal, and Rosland (2016)
Which professional group is NOT typically involved in interdisciplinary team care for palliative patients?
Accountants
What has been identified as an idea that has the potential to help work with patients and their families according to the text?
Advance Care Planning
Advance Care Planning is primarily focused on educating patients and families about end-of-life care options.
True
Advance Care Planning is more effective at improving quality of life for patients with terminal cancer compared to patients with organ failure or dementia.
True
The main purpose of an Advance Directive is to facilitate choice and control for patients over their future healthcare decisions.
True
One of the key challenges in implementing effective Advance Care Planning is overcoming patient and family members' misconceptions about the process.
True
Anticipatory Care Planning focuses on discussing and planning for future healthcare decisions, while Advance Care Planning is primarily concerned with end-of-life care preferences.
False
Interdisciplinary team care for palliative patients typically involves nurses, social workers, and chaplains, but not general practitioners.
False
In Advance Care Planning (ACP), patients can appoint a trusted individual to make healthcare decisions on their behalf if they become incapacitated.
True
Advance Care Planning (ACP) should be initiated only when a patient is diagnosed with a terminal illness.
False
Research has shown that Advance Care Planning (ACP) can result in higher rates of aggressive interventions for patients with terminal cancer.
False
An Anticipatory Care Plan is a legal document that allows patients to outline their healthcare wishes in writing.
False
Engaging general practitioners in Advance Care Planning (ACP) discussions can lead to better representation of non-cancer patients and earlier access to palliative care.
True
Advance Care Planning (ACP) has been shown to increase depression and anxiety levels in patients with terminal illnesses.
False
Advance Care Planning (ACP) is solely focused on end-of-life decisions and does not involve ongoing discussions.
False
Anticipatory Care Planning is primarily used for patients with long-term conditions to plan for expected changes in their health or social status.
True
The goal of Advance Care Planning is to facilitate discussions and document personal wishes, including preferred place of care in the last days of life, even when the patient no longer has decision-making capacity.
True
Educating patients and families about Advance Care Planning is unnecessary, as the clinicians and wider team can make decisions without involving them.
False
$\frac{1}{3}$ of patients with terminal cancer who engage in Advance Care Planning discussions are more likely to receive aggressive, life-prolonging care contrary to their wishes.
False
Advance Care Planning discussions should be avoided for patients with dementia or frailty, as they may lack decision-making capacity.
False
What is the main focus of the Burden model when conceptualizing support needs of family carers?
Overburdening family carers
According to the Stress and coping model, what is the primary focus when assessing family carers' support needs?
Emotion-focused coping
In the context of conceptualizing family carers' needs, which model focuses on caregiving within social relationships?
Social relationship model
What does the Stress and coping model primarily measure when assessing family carers' support needs?
Emotion-focused and problem-focused coping
When examining support needs of family carers, which model focuses on promoting coping mechanisms and 'fixing' problems?
Stress and coping model
Which theoretical position emphasizes that family carers should be viewed within the realm of social relationships?
'Social relationship model'
Which of the following is a recommendation for supporting family carers?
Providing staff training on understanding diverse cultural norms and expectations
Which group of family carers is highlighted as having special needs that require consideration?
Family carers of patients with dementia or prolonged caregiving periods
What should be embedded in practice to support family carers?
Regular assessment of family carers' needs
Which group is identified in the text as also experiencing problems during palliative care and having needs that must be addressed?
Families, including children, close friends, and neighbors
What is a recommendation for improving transitions between care settings for patients and family carers?
Improve transitions to reduce disruption and distress
What role do volunteers potentially have in supporting family carers?
There may be a greater role for volunteers in supporting family carers
Which of the following is NOT considered a supportive activity for family carers according to the text?
Prescribing medication for the patient
Which of the following interventions is NOT typically available to support family carers?
Providing the family carer with a caregiver allowance
Which of the following is a key characteristic of interventions to support family carers, as described in the text?
They should be tailored to the individual family carer's needs
What is a key challenge in providing effective support for family carers?
The brief window of opportunity for carers to access support
What is a key focus of the 'Preparedness for caregiving intervention' mentioned in the text?
Assessing and addressing the overall needs of family carers
Which of the following is NOT identified in the text as a type of therapeutic activity available to support family carers?
Cooking classes for the family carer
Study Notes
Advance Care Planning (ACP)
- ACP is an approach to facilitate discussion and documentation of personal wishes, including preferred place of care, in the last days of life.
- It can be used to anticipate needs that may arise when the person concerned no longer has the capacity to make decisions about their own care.
- Features of ACP include:
- Ongoing discussion
- Involvement of patient, clinician/wider team, and family member(s)
- Explores context, including beliefs, understandings, hopes, and expectations
- Addresses patient-related information needs
- Usually covers care at the end of life
- Usually results in a document
- Founded on a good therapeutic relationship
Anticipatory Care Planning
- Described as adopting a 'thinking ahead' philosophy of care that allows practitioners and their teams to work with people and those close to them to set and achieve common goals.
- Commonly applied to support those living with a long-term condition to plan for an expected change in health or social status.
- It incorporates health improvement and staying well.
Advance Directives
- Legal documents that allow patients to put their healthcare wishes in writing, or to appoint someone they trust to make decisions for them, if they become incapacitated.
- Examples include:
- Advance Directive (or Decision) to Refuse Treatment (ADRT)
- Living Will
- Enduring Power of Attorney
Research on ACP
- ACP in elderly hospital patients can deliver:
- Greater likelihood of end of life care wishes being fulfilled
- Lower levels of stress and higher levels of satisfaction among family members
- ACP in out-patients with terminal cancer can result in:
- No increases in depression or anxiety
- Lower rates of aggressive interventions
- Earlier hospice referral
- Better bereavement experiences for family members
- A concerted approach among hospital patients can deliver:
- Substantial uptake of ACP
- Motivating General Practitioners around ACP can result in:
- Substantial uptake of ACP
- Better representation of non-cancer patients
- Earlier access to palliation
Good Practice in ACP
- Start as early as possible, while the person is well enough and has sufficient capacity to fully engage.
- Good practice in ACP results in:
- Greater likelihood of end of life care wishes being fulfilled
- Lower levels of stress and higher levels of satisfaction among family members
Demographic Changes
- Increasing longevity, especially among people over 85 years
- Changing women's role in society, with increasing employment outside the home, later childbearing, and fewer children
- Changing marital relationship patterns, including single parenting and step parenting
Support Needs of Family Carers
- Can be conceptualized using three theoretical positions:
- Burden model
- Stress and coping model
- Social relationship model
- Evidence suggests that family carers have a range of support needs, including:
- Information and education
- Supportive activities
- Therapeutic activities
- Strategies for safe moving and handling of the patient
Interventions to Support Family Carers
- There is little robust evidence on which interventions are best
- A menu of options may be most effective
- Interventions should be timely, accessible, affordable, and appropriate
- Examples of interventions include:
- Information and education
- Supportive activities
- Therapeutic activities
- Strategies for safe moving and handling of the patient
- Access to welfare or benefits advice
- Complementary therapies
- Psychotherapy
Implications and Recommendations
- There may be a greater role for volunteers in supporting family carers
- Staff need training in understanding different cultures, norms, and expectations of families
- Consideration should be given to the special needs of family carers of those with dementia or more prolonged caregiving periods
- Regular assessment of family carers' needs should be embedded in practice
- Improve transitions between care settings to reduce disruption and distress for patients and family carers
Explore the concept of Advance Care Planning (ACP) which involves discussing and documenting personal wishes for end-of-life care. Learn about the definitions, benefits, and key components of ACP, including anticipatory care planning and advance directives.
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