ABA Palliative Care cheat sheet

Hospice eligibility under US Medicare: prognosis of 6 months or less if the disease runs its normal course, certified by two physicians.

Palliative care is appropriate at any disease stage and can be delivered alongside curative-intent treatment; hospice requires foregoing curative-intent treatment for the terminal diagnosis.

Total pain model: physical, psychological, social, and spiritual/existential dimensions must each be assessed and treated.

Opioid conversion: oral morphine 30 mg ≈ oral oxycodone 20 mg ≈ oral hydromorphone 7.5 mg ≈ IV morphine 10 mg (approximate equianalgesic ratios).

When rotating opioids, reduce the calculated equianalgesic dose by 25–50% to account for incomplete cross-tolerance.

Naloxone reverses opioid-induced respiratory depression but not opioid-induced constipation; methylnaltrexone or naloxegol treat the latter.

Dyspnea in advanced disease is treated with low-dose opioids; oxygen benefits only patients with documented hypoxemia.

Delirium at end of life is managed by treating reversible causes, reducing anticholinergics/opioids where possible, and using low-dose antipsychotics for agitation.

Prognosis tools include the Palliative Performance Scale, ECOG performance status, and the Surprise Question ("Would I be surprised if this patient died within a year?").

Advance care planning documents: living will (treatment preferences), durable power of attorney for health care (surrogate decision-maker), and POLST/MOLST (actionable medical orders for seriously ill patients).

Decision-making hierarchy: patient with capacity → court-appointed guardian → health care agent → default surrogate per state law; substituted judgment standard applies.

Withdrawal of life-sustaining treatment is ethically and legally equivalent to withholding it; both are permissible when consistent with patient values.

Palliative sedation to unconsciousness for refractory symptoms is distinct from euthanasia and physician-assisted death; intent is symptom relief, not death.

Terminal restlessness and death rattle: repositioning, anticholinergics (glycopyrrolate, scopolamine), and reducing fluid intake are first-line; suctioning is generally avoided.

Grief and bereavement: normal grief is not a disorder; prolonged grief disorder requires persistent, disabling yearning ≥12 months after death in adults.

Hospice interdisciplinary team core members: physician, nurse, social worker, chaplain, aide, volunteer coordinator, and bereavement counselor.

Spiritual assessment tools include FICA (Faith, Importance, Community, Address in care) and HOPE; chaplain involvement is a core hospice service.