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Questions and Answers
What is the primary focus of hospice care?
What is the primary focus of hospice care?
Which of the following best describes palliative care?
Which of the following best describes palliative care?
A patient is receiving treatment for cancer, but also wants to improve their pain management and address existential concerns. Which type of care is most appropriate?
A patient is receiving treatment for cancer, but also wants to improve their pain management and address existential concerns. Which type of care is most appropriate?
What is a key difference between hospice and palliative care, based on the goals of care?
What is a key difference between hospice and palliative care, based on the goals of care?
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Which of these is a primary objective of the content?
Which of these is a primary objective of the content?
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What is a key criterion for hospice eligibility, as determined by most providers?
What is a key criterion for hospice eligibility, as determined by most providers?
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Which of the following best describes a typical hospice setting for patients who prefer to be with their loved ones, but are not in need of inpatient care?
Which of the following best describes a typical hospice setting for patients who prefer to be with their loved ones, but are not in need of inpatient care?
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In a palliative care setting, what is the typical focus of conversations during an inpatient visit?
In a palliative care setting, what is the typical focus of conversations during an inpatient visit?
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What is a required member of a hospice team?
What is a required member of a hospice team?
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Which of the options is the best description of a setting for patients whose symptoms can no longer be managed at home, but do not need inpatient treatment?
Which of the options is the best description of a setting for patients whose symptoms can no longer be managed at home, but do not need inpatient treatment?
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What is the role of the Medicare LCD guidelines in hospice care?
What is the role of the Medicare LCD guidelines in hospice care?
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What is the primary focus of discussions during an outpatient palliative care visit?
What is the primary focus of discussions during an outpatient palliative care visit?
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Which healthcare professional is NOT consistently part of a palliative care team, especially in outpatient settings?
Which healthcare professional is NOT consistently part of a palliative care team, especially in outpatient settings?
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Which core element distinguishes hospice care from palliative care?
Which core element distinguishes hospice care from palliative care?
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In which situation would palliative care be the most suitable approach?
In which situation would palliative care be the most suitable approach?
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Considering the objectives of care, what is the main distinction in goals between palliative and hospice approaches?
Considering the objectives of care, what is the main distinction in goals between palliative and hospice approaches?
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What is a critical understanding required for a health care professional referring a patient to hospice care?
What is a critical understanding required for a health care professional referring a patient to hospice care?
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What is the primary purpose of defining and distinguishing between palliative and hospice care?
What is the primary purpose of defining and distinguishing between palliative and hospice care?
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What is the typical duration of prognosis, agreed upon by two providers, for a patient to be eligible for hospice care under Medicare?
What is the typical duration of prognosis, agreed upon by two providers, for a patient to be eligible for hospice care under Medicare?
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Which of these is a least likely setting for a patient receiving palliative care?
Which of these is a least likely setting for a patient receiving palliative care?
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A patient’s symptoms are poorly managed at home, but they don’t require inpatient hospitalization, which setting is most appropriate for their hospice care?
A patient’s symptoms are poorly managed at home, but they don’t require inpatient hospitalization, which setting is most appropriate for their hospice care?
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Which member of the care team is specifically required to be a volunteer in every hospice program?
Which member of the care team is specifically required to be a volunteer in every hospice program?
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Which of the following is primarily responsible for assisting hospice patients with their daily activities such as bathing and dressing?
Which of the following is primarily responsible for assisting hospice patients with their daily activities such as bathing and dressing?
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In many palliative care programs, when is a chaplain most likely to be involved?
In many palliative care programs, when is a chaplain most likely to be involved?
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Who is responsible for establishing medical direction within a hospice program?
Who is responsible for establishing medical direction within a hospice program?
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For a patient admitted to the hospital with another diagnosis, which approach is most typical for addressing palliative care needs?
For a patient admitted to the hospital with another diagnosis, which approach is most typical for addressing palliative care needs?
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Study Notes
Hospice and Palliative Care Objectives
- Identify factors impacting life expectancy estimations.
- Locate resources aiding prognostication for older adults.
- Differentiate between palliative and curative care.
- List hospice care benefits and barriers.
- Describe hospice funding mechanisms.
- Explain patient referrals and hospice admission criteria.
- Discuss roles within interprofessional end-of-life care teams.
- Evaluate prognostication concepts.
- Apply prognostication components in end-of-life care.
- Evaluate prognostication's impact on patients, caregivers, and providers.
Definitions
- Hospice care: A comprehensive comfort-focused system for those expected to live ≤6 months. Its sole focus is comfort and relief of suffering for individuals at life's end.
- Palliative care: Interdisciplinary care aiming for suffering relief, improved quality of life, and decision support for individuals with advanced illnesses.
Goals of Care
- Palliative Care: Alleviates uncontrolled symptoms (pain, existential). Can be combined with curative or comfort care.
- Hospice Care: Provides comfort at end-of-life; not curative.
Hospice Criteria
- Life expectancy of less than six months, agreed upon by two providers (usually the referring provider and hospice director).
- Some hospices require patients no longer pursue life-extending interventions (though some do not, and the VA does not).
- Clinical documentation validating the criteria is essential.
- Medicare LCD guidelines offer disease-specific criteria for hospice eligibility.
Hospice Settings
- Home: Ideal for remaining at home with loved ones.
- Facility: Assisted living or nursing homes (if family unable to manage symptoms at home; no inpatient needs).
- Inpatient: For severe, uncontrolled symptoms not manageable at home, or if inpatient safety concerns exist.
Hospice Team
- Physician (medical director).
- Registered nurses.
- CNAs (for ADLs).
- Social workers.
- Volunteers.
- Bereavement specialist.
- Chaplain (often a bereavement specialist; and may not always be a bereavement specialist).
Palliative Settings
- Outpatient: Clinic-based, for discussions on end-of-life/symptom management (pain, nausea, constipation, etc.). Repeated clinic visits are common.
- Inpatient: Hospital-based, addressing current circumstances (with follow-up in outpatient setting if appropriate). Discussions often centered on current symptoms and conditions.
Palliative Team
- Physicians/advanced practice providers (APPS).
- Registered nurses.
- Medical assistants (MAs).
- Social workers (often).
- Chaplains (often, especially inpatient).
Hospice: Medicare Benefit
- Six-month prognosis, certified by two physicians; patients can revoke.
- Regular recertification for hospice eligibility, essential with clear documentation; this must show life expectancy of less than 6 months.
- Patients forgo curative treatments, and the care plan is managed by hospice.
- Treatment continuation may be allowed in some hospices ('open access').
Bereavement
- Hospice benefit includes bereavement care.
- Support continues for at least one year after the patient's death, typically past first anniversary plus one month; support varies, often including follow-ups, office visits, home visits, and support groups.
Palliative Medicine (End-of-Life)
- Extended visits to discuss disease progression, prognosis, and grief management (symptom control for comfort).
- Can be given alongside hospice care.
- Inpatient discussions with families and the care team focus on impending death and associated symptoms.
Palliative Care (Hard Decisions)
- Inpatient consultations for complex decision-making (e.g., surgery vs. medical treatment, curative vs. comfort care, code status).
- Including decisions on end-of-life options (VCE&D, medical aid in dying).
Palliative Care (Symptom Control)
- Symptom management when other therapies fail to achieve benefit (pain, nausea, constipation, diarrhea, side effects, breathlessness, fatigue).
Existential Dread
- Psychological turmoil facing imminent death.
- Impacts physical, personal, relational, spiritual, and religious well-being.
- Can exacerbate physical/psychological symptoms.
Summary
- Hospice eligibility criteria, funding, and settings.
- Palliative care approaches and goals.
- Teams and their functions in both hospice and palliative care.
- Ethical considerations (prognosis, difficult decisions, etc.).
Prognostication
- Importance of accurate discussions (no negative impact on hope and coping)
- Practitioners' challenges in prognostication (uncertainty, potential errors, bias).
Prognostication Tools
- Palliative Performance Scale: Assessing self-care and function.
- Eprognosis: Validated prognostic indices for clinical use.
- Hospice in a minute: Smartphone app for hospice criteria.
- Clinical judgment also vital: (e.g., aneurysm, cardiac arrest).
- Specific tools are for various illnesses and should be used appropriately.
Prognostication for Normal Life Expectancy
- Data tables illustrating how life expectancy varies by age/gender quartile.
Clinical Choices
- Deciding whether to continue screening/monitoring based on 10-year life expectancy.
Delivering Bad News, Strategies
- Start by inquiring about patient/family understanding of situation.
- Use a "warning shot" approach.
- Consider patient/family emotional needs.
- Answer questions & address any emotional needs/mood disorders that may arise. Use native language for effective communication.
Asking Before Giving
- Consider asking how the patient prefers to receive information.
- Allow for possible involvement of loved ones—but check with patient first.
Family Dynamics
- Importance of assessing family involvement in care decisions.
- Addressing any potential conflicts about support roles for the patient.
Follow-up
- Planning for follow-up visits, addressing concerns, and coordinating care.
- Including referrals, tests, and/or support resources. (Follow-up may not always be about end-of-life decisions.)
Having Talks about End-of-Life
- Initiating conversations when decisions aren't urgent for better planning.
- Focusing on the patient’s priorities and what a "good death" means to them.
Advanced Care Planning
- POLST: Physician Orders for Life-Sustaining Treatment – guiding medical choices across settings.
- Research suggests that POLST use reduces unwanted hospitalizations.
- Alternative end-of-life options: Medical Aid in Dying (may involve medication to end life sooner if prognosis is less than 6 months) and is legal in 10 states including NM and Washington DC. Competent patients can make a decision to end their lives. Physicians, advanced practice providers, (PA/NP), can prescribe the medication.
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Description
This quiz focuses on key objectives within hospice and palliative care, including prognostication, care differentiation, and interprofessional team roles. Participants will explore factors influencing life expectancy and understand the benefits and barriers of hospice care. Enhance your knowledge to better support patients and caregivers in end-of-life scenarios.
