Term
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Definition
| interdisciplinary care that focuses on relief of suffering and improvement in quality of life |
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Term
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Definition
| palliative care that is delivered when the goals of care are predominantly palliative that is delivered to the patient and the family and that extends into bereavement |
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Term
| Describe hospice philosophy and medicare requirements |
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Definition
Phil: to provide the total care of patients who have life limiting illnesses
interdisciplinary
Medicare requirments: physician certification of limited life expectancy - 6 months or less if disease runs usual course |
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Term
| Physicians role in the interrelationships between goals of care |
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Definition
| communicate with patient and family, clarify goals, and priorities, develop plan of care |
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Term
| Things involved in negotiating goals of care |
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Definition
- cultural differences must be factored into communications
- family meetings may be an option when there is no single spokes person
- ensure continuity
-clarify priotities |
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Term
| What happens when physician cannot support patient's or family member's choice? |
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Definition
- acknowledge conflict
- set limits
- try to find alternative solutions |
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Term
Physiologic futility
qualitative futility |
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Definition
physiologic: most objective standard
qualitative: more subjective standard |
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Term
| What do if patient lacks capacity |
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Definition
- first see if proxy made
- second determine whether patient has give advanced directives
- information on patient's desires, patient's verbal statement, general values and beliefs, how patient lived her life, as well as determinations of what is in the patient's best interests CAN be relied upon
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Term
| reasons why physicians do not say goodbye |
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Definition
acknowledging we will not the patient again makes it clear to the patient they are dying and it may make them too sad
-physicians worry patient will feel abandoned
- prognostic uncertainty - physician may see patient again even after they have said their goobyes
emotional barriers - physician unprepared to deal with her emotions or those of the patient
physician feels expressing emotion is unprofessional
biomedical model emphasizes cures- noone likes to be reminded that medicine is frequently less than curative |
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Term
| Why goodbyes are worthwhile for patients |
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Definition
physician can acknowledge the end of the relationship, underscoring its importance, leaving patient with sense of being valued
- a goodbye can help patient feel she will be missed and remembered
- saying goodbye gives the patient an opportunity to say thank you and to reflect over the course of the relationship |
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Term
| Describe the randomness about the physician's perspective to dying patients |
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Definition
patient deaths have substantial impact on docs
- the longer the duration of the relationship the stronger the physician's emotional reaction to the patient's death
- the less prepared one is for a patient's death, the greater the risk for complicated grief |
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Term
| Why saying goodbyes are good for docs |
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Definition
- acknowleging the end of the visits can bring the relationship to a close on an authentic note
- you are first and foremost a human being in the presence of another human being who is about to die
-engaging in the reality is doing grief work to process the loss
saying goodbye creates and opening to hear and receive teh patients deep appreciation
saying goodbye gives physicians a chance to reflect on their work in a way that may enhance their resilience |
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