ACHPN key terms

A working group of clinicians from different disciplines-medicine, nursing, social work, chaplaincy, pharmacy, therapy, and volunteers-who share one coordinated plan and meet regularly to review the patient's and family's changing needs.

The written, regularly revised document listing the patient's problems, measurable goals, the specific interventions each discipline will provide, and who is accountable, serving as the shared blueprint the whole team follows.

Care that relieves symptoms and stress caused by serious illness and improves quality of life for patients and families; it is offered alongside disease-directed treatment and is appropriate at any stage, not only at the end of life.

The outcomes a patient values most-such as staying at home, living as long as possible, or being free of pain-which are used to choose which treatments to pursue and which to decline.

An ongoing conversation in which a person considers and tells others what care they would want if they became unable to decide, and records preferences and a chosen spokesperson before a crisis occurs.

A legal document, such as a living will, that states a person's treatment preferences for a future time when they cannot speak for themselves; it guides care but does not by itself create medical orders.

A clinician-completed, portable order set that turns the treatment preferences of a seriously ill person-regarding CPR, ventilation, antibiotics, and artificial nutrition-into immediately actionable orders that travel across care settings.

A six-step framework for delivering serious news: Setting up the conversation, assessing the patient's Perception, obtaining an Invitation, giving Knowledge clearly, responding with Empathy, and Summarizing with a plan.

The idea that pain has physical, emotional, social, and spiritual dimensions, so assessment and relief require attention to all four; treating only the body often leaves suffering unrelieved.

A self-report pain measure in which the patient chooses a number from 0 (no pain) to 10 (worst imaginable), useful for adults who can understand and communicate the scale.

A five-item observational tool scoring breathing, negative vocalization, facial expression, body language, and consolability to estimate pain in people with advanced dementia who cannot report it.

A short, severe flare of pain that occurs even though baseline pain is otherwise controlled; it is usually treated with a short-acting opioid dosed as needed, plus attention to the trigger.

A reference table giving doses of different opioids, and of different routes, that produce similar analgesia; because conversions are approximate and cross-tolerance is incomplete, clinicians usually reduce the calculated dose for safety.

A predictable need for larger opioid doses to produce an effect previously achieved at a lower dose after repeated exposure; it is a pharmacologic phenomenon, not addiction, and should not by itself limit comfort-focused dosing.

A medication whose main purpose is something other than pain-such as an anticonvulsant, antidepressant, corticosteroid, or bisphosphonate-used alongside opioids to relieve particular pain types such as nerve or bone pain.

A short-acting opioid antagonist that reverses opioid-induced respiratory depression; in palliative care it is titrated carefully so breathing recovers without causing abrupt, severe pain or withdrawal.

The uncomfortable, subjective awareness of difficult breathing, which may not match oxygen saturation or breathing rate; opioids, a fan, positioning, and treating reversible causes relieve the sensation.

Involuntary appetite loss with weight and muscle loss driven by inflammation and altered metabolism in advanced illness; it does not reverse with forced feeding, so care focuses on comfort and reassuring families.

Bowel blockage caused by tumor, adhesions, or both, producing nausea, vomiting, cramping, and no bowel movements; it is often managed medically with decompression, antisecretory drugs, steroids, and antiemetics rather than surgery.

An acute, fluctuating change in attention, awareness, and thinking that is common in serious illness and often triggered by drugs, infection, dehydration, or organ failure; the cause is sought while non-drug measures calm the patient.

An ongoing, self-reflective stance in which clinicians recognize their own cultural assumptions, remain open to learning from each patient, and adapt care to the family's values, language, and traditions rather than applying a stereotype.

A short bedside tool exploring Faith or belief, the Importance of that belief, the person's faith Community, and how they want Address in care, used to understand what gives the patient meaning and support.

Practices that protect a person's sense of worth near the end of life, such as respecting privacy, maintaining roles, preserving hope, and responding to spiritual and cultural needs.

Deliberately stopping a therapy such as a ventilator, dialysis, or vasopressors after concluding its burdens outweigh benefits; it is ethically and legally treated the same as never starting that therapy.

The proportional use of sedating medication to relieve refractory, intolerable symptoms in a dying patient, intending to relieve suffering rather than to cause death; it requires informed consent, expert consultation, and careful documentation.

Noisy, gurgling breathing in the last days of life caused by saliva pooling where cough and swallow have weakened; it is usually not distressing to the patient, so care targets repositioning and family reassurance.

Restlessness, picking, moaning, and unsettled behavior in the final hours or days; the team searches for treatable causes such as pain, a full bladder, or delirium and uses calm presence and, if needed, medication.

What the team does after death: confirming and documenting death, preparing the body respectfully, honoring religious and cultural rituals, supporting the family's time with the deceased, and notifying the right people.

The sorrow, worry, and rehearsal of loss that family members experience before the death occurs; it is normal and can be eased by honest information, involvement in care, and acknowledgment.

A recognized condition in which intense longing for the deceased, preoccupation, and impaired functioning persist well beyond expected cultural norms-about a year for adults-and warrant targeted treatment.

Grief that society does not openly recognize or support, such as that of an unmarried partner, a former spouse, a colleague, or a pet owner, leaving the mourner with little permission or ritual to mourn.

A structured look at factors that raise the chance of poor bereavement outcomes-such as dependency, prior mental illness, sudden death, or limited support-used to target follow-up to those most vulnerable.

A Medicare coverage in which a person with a prognosis of six months or less elects comfort-focused care; it pays for an interdisciplinary team, medications and equipment related to the terminal diagnosis, and bereavement support.

The person a patient names in advance, usually in a durable power of attorney for health care, to make medical decisions if the patient loses capacity; the proxy follows the patient's known wishes.

Someone who decides for a patient without capacity when no proxy was named, usually following state law's default order of relatives; decisions rest on what the patient would have wanted, or failing that, the patient's best interests.

A clinician's bedside determination that a patient can understand the information, appreciate how it applies to them, reason through options, and state a consistent choice; it is decision-specific and may change.

A judgment that a treatment cannot achieve its physiologic goal or give the patient meaningful benefit; it can justify limiting or stopping treatment but is contested, so teams usually use a fair process and policy.

A small, rapid quality-improvement cycle: plan a change, try it, study the results, then act to adopt, adapt, or abandon it before the next cycle.

The cumulative emotional and physical exhaustion that can follow prolonged exposure to others' suffering, producing detachment or diminished empathy; it is distinct from burnout and is addressed through workload, support, and self-care.

Clinical decisions that combine the best available research with clinician expertise and the patient's values and preferences, rather than relying on habit or tradition alone.