ABEM HPM flashcards

33 cards. Read the term and the definition here. The deck at the top of this page is optional.

Palliative care definition

Interdisciplinary care for people with serious illness that focuses on quality of life, symptom relief, and goals aligned with values; it can be provided alongside curative treatment.

Surprise question

A prognostic prompt asking whether the clinician would be surprised if the patient died within 12 months; it has limited accuracy and should not be used alone.

Hospice Medicare prognosis

US Medicare hospice eligibility generally requires a prognosis of six months or less if the terminal illness follows its expected course, along with election of the hospice benefit.

Palliative Performance Scale

A functional scale from 0% to 100% based on ambulation, activity, self-care, intake, and consciousness; lower scores are associated with shorter survival.

Goals-of-care conversation

A discussion that explores illness understanding, values, acceptable functional states, and tradeoffs before recommending and documenting a treatment plan with the patient or surrogate.

Breakthrough pain dose

For episodic pain, an as-needed opioid dose often equals 10% to 20% of the total daily opioid dose, adjusted for the patient's prior response and safety.

Equianalgesic conversion

Calculation of an approximately equivalent opioid dose when switching drugs or routes; because cross-tolerance is incomplete, reduce the calculated dose by about 25% to 50%.

Opioid-induced constipation

Constipation caused by opioid receptor activation in the gut; tolerance does not develop, so most patients starting regular opioids need a prophylactic bowel regimen.

Neuropathic pain adjuvants

Gabapentinoids, serotonin-norepinephrine reuptake inhibitors, and tricyclic antidepressants can reduce neuropathic pain; titrate slowly and monitor sedation, renal function, and cardiac effects.

Dyspnea in advanced illness

Refractory breathlessness is often treated with low-dose opioids; supplemental oxygen is indicated mainly for hypoxemia, while fans and positioning may provide nonpharmacologic relief.

Delirium screening

The Confusion Assessment Method identifies delirium through acute onset, inattention, disorganized thinking, and altered consciousness; reversible causes and nonpharmacologic measures are first-line.

Malignant bowel obstruction

A complication often managed with antisecretory therapy such as octreotide, corticosteroids, antiemetics, and symptom control; surgery is considered for selected patients.

Terminal secretions

Noisy breathing near death from pooled oral secretions; repositioning, mouth care, and anticholinergics are used, although evidence for drug benefit is limited.

SPIKES protocol

A six-step framework for breaking bad news: setting, perception, invitation, knowledge, emotions, and strategy or summary; it supports clear, empathetic communication.

NURSE statements

A communication mnemonic for responding to emotion: naming, understanding, respecting, supporting, and exploring the patient's feeling; it helps patients feel heard.

Decision-making capacity

A clinical determination that the patient can understand relevant information, appreciate consequences, reason about options, and communicate a choice; it is decision-specific.

POLST form

A portable medical order for seriously ill patients that records preferences for resuscitation, ventilation, and artificial nutrition; it is not a substitute for an advance directive.

Prolonged grief disorder

Persistent, impairing grief with yearning or preoccupation that continues beyond expected norms, generally at least 12 months in adults and 6 months in children.

Caregiver burden

The physical, emotional, financial, and social strain experienced by family or friends caring for an ill person; screening and respite support can reduce distress.

Spiritual distress

Suffering related to loss of meaning, purpose, hope, or connection and to religious or existential conflict; it is associated with worse quality of life and deserves chaplain or counselor involvement.

Kleinman explanatory model

A set of questions about what the patient calls the illness, its cause, how it affects life, and expected treatment; it elicits culturally shaped beliefs and improves communication.

Signs of active dying

Somnolence, reduced intake, dysphagia, mottled skin, cool extremities, irregular breathing, and decreased urine output often signal the final days to hours of life.

Terminal agitation

Restlessness or agitation near death; assess for pain, urinary retention, constipation, and delirium before using antipsychotics or benzodiazepines for distressing symptoms.

Palliative sedation

Intentional reduction of consciousness to relieve refractory severe suffering near the end of life; it requires informed consent, proportional dosing, and careful documentation.

Hospice bereavement benefit

US Medicare hospice programs must provide bereavement counseling and support to the family for at least 13 months after the patient's death.

Double effect

A principle holding that an action with a good intended effect, such as pain relief, may be permissible even if a foreseeable harmful effect, such as respiratory depression, occurs.

Withdrawing treatment

Stopping a life-sustaining intervention such as dialysis or ventilation; ethically it is generally treated the same as withholding treatment when consistent with patient values.

Informed consent elements

Disclosure of diagnosis, risks, benefits, and alternatives; patient understanding; decisional capacity; and voluntary choice without coercion.

Futility dispute

A conflict between clinicians and family about treatments judged to offer no meaningful benefit; resolution uses ethics consultation, institutional policy, and sometimes legal processes.

Medicare hospice periods

The US Medicare hospice benefit has two 90-day periods followed by unlimited 60-day periods; recertification is required, with face-to-face encounters before later periods.

Hospice levels of care

Routine home care, continuous home care, general inpatient care, and inpatient respite care; each has specific eligibility, intensity, and payment rules.

Advance care planning CPT

CPT 99497 covers the first 30 minutes of advance care planning discussion and 99498 each additional 30 minutes; documentation must support the time and content.

PDSA cycle

Plan-Do-Study-Act is a rapid quality-improvement method that tests a small change, reviews results, and refines the intervention before broader implementation.