ABFM Palliative Care flashcards

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

Palliative care

Interdisciplinary care for people with serious illness that relieves symptoms, supports goals and values, and improves quality of life; it is appropriate at any stage and can accompany curative treatment.

Surprise question

A prognostic prompt asking whether the clinician would be surprised if the patient died within the next 12 months; a 'no' answer warrants palliative assessment and goals discussion.

Karnofsky Performance Status

A 0-100 scale in 10-point steps describing functional status, from fully active to dead; lower scores predict shorter survival and support hospice eligibility.

Palliative Performance Scale

A 0-100% functional scale in 10% steps scoring ambulation, activity, self-care, oral intake, and consciousness; it correlates with survival and is used in hospice eligibility.

Total pain

Cicely Saunders' concept that pain in serious illness has physical, psychological, social, and spiritual components, so assessment and treatment must address all four domains.

Equianalgesic morphine anchor

Morphine 30 mg by mouth equals morphine 10 mg intravenously, oxycodone 20 mg by mouth, hydromorphone 7.5 mg by mouth, or hydromorphone 1.5 mg intravenously.

Fentanyl transdermal patch

A long-acting opioid for severe chronic pain in opioid-tolerant patients; it is contraindicated in opioid-naive patients and reaches steady state after 12 to 24 hours.

Neuropathic pain adjuvants

Gabapentinoids, duloxetine, tricyclic antidepressants, and topical lidocaine treat neuropathic pain; corticosteroids help malignant bone pain and nerve compression, while opioids alone are often insufficient.

Breakthrough pain dosing

A short-acting opioid at 10-20% of the total 24-hour opioid requirement given as needed; repeated need suggests the scheduled baseline regimen should be increased.

Methadone precautions

Methadone is a mu agonist and NMDA antagonist with variable half-life and QTc prolongation; conversions are complex, so start low, titrate slowly, and seek specialist guidance.

Dyspnea first-line treatment

Systemic opioids such as morphine reduce air hunger in advanced illness; oxygen is reserved for documented hypoxemia and benzodiazepines are not first-line for breathlessness.

Terminal secretions

Pooled oral secretions from loss of swallow and cough; treat with anticholinergics such as glycopyrrolate or hyoscine butylbromide, repositioning, and gentle rather than deep suctioning.

Hyperactive delirium management

Nonpharmacologic measures come first; haloperidol 0.5-2 mg is typical. Benzodiazepines are avoided except in alcohol or benzodiazepine withdrawal because they can worsen delirium.

SPIKES protocol

Six steps for breaking bad news: Setting up the conversation, assessing Perception, obtaining Invitation, giving Knowledge, responding to Emotions with empathy, and summarizing Strategy.

NURSE empathy statements

A framework for responding to emotion: Naming, Understanding, Respecting, Supporting, and Exploring what the patient is feeling.

Decisional capacity

A clinical determination that the patient can communicate a choice, understand relevant information, appreciate how it applies to them, and reason about the alternatives.

Time-limited trial

An agreed course of treatment with explicit goals, a defined duration, and stopping criteria, after which the decision is revisited using new information.

FICA spiritual history

A brief screening tool covering Faith or belief, Importance of spirituality, spiritual Community, and how care should Address these issues.

Cultural humility at end of life

Approaching each patient as an individual, asking about cultural preferences rather than assuming, using trained interpreters, and negotiating care with the LEARN model.

Rule of double effect

When an action has a good and a harmful foreseen effect, it is permissible if the intent is good, the harm is unintended and not the means, and benefit is proportionate.

Palliative sedation

Lowering consciousness with medication to relieve refractory suffering near end of life; the intent is symptom relief with doses titrated to comfort, distinguishing it from euthanasia.

POLST form

A portable medical order documenting preferences for CPR, ventilation, and hospitalization for seriously ill patients; unlike an advance directive, it is actionable across care settings.

Signs of imminent death

Mottled skin, cool extremities, Cheyne-Stokes breathing, oliguria, terminal secretions, and decreasing consciousness typically mark the last days to hours of life.

Medicare hospice benefit periods

Two 90-day periods followed by unlimited 60-day periods; recertification is required at each boundary, with a face-to-face encounter before the third period.

Terminal agitation

Restlessness near death; rule out pain, urinary retention, fecal impaction, and hypoxia before treating with haloperidol, midazolam, or lorazepam.

Hospice levels of care

Routine home care, continuous home care for crisis, general inpatient care for uncontrolled symptoms, and respite care capped at 5 days per benefit period.

Hospice interdisciplinary team

Core members are a physician, nurse, social worker, chaplain, home health aide, and trained volunteers; they coordinate an individualized plan and meet at least every 15 days.

Palliative care consult triggers

Metastatic cancer, ICU stay beyond about 7 days, multiple recent hospitalizations, advanced dementia, and severe heart failure commonly prompt inpatient palliative care consultation.

Pediatric pain assessment

Use NIPS or PIPP for neonates, FLACC or Wong-Baker FACES for young children, and numeric rating scales for older children and adolescents.

Concurrent hospice care for children

Under Medicaid concurrent care, children enrolled in hospice may continue disease-directed therapy at the same time, unlike the adult hospice requirement to forgo curative treatment.

Prolonged grief disorder

DSM-5-TR diagnosis requiring intense longing or preoccupation with the deceased plus associated symptoms and impairment, persisting beyond 12 months in adults and 6 months in children.

Anticipatory grief

Grief experienced before an expected death; it can coexist with caregiving strain and does not necessarily reduce the intensity of grief after the death.