CFPC CAC Palliative Care flashcards

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

Definition of palliative care

An approach improving quality of life for patients and families facing life-threatening illness, through early identification and impeccable assessment and treatment of pain and other physical, psychosocial, and spiritual problems.

Total pain concept

Cicely Saunders' model holding that suffering has physical, psychological, social, and spiritual dimensions; relief requires assessing and treating all four, not just nociception.

Edmonton Symptom Assessment System

A validated bedside tool where patients rate nine symptoms, including pain, tiredness, nausea, depression, anxiety, drowsiness, appetite, wellbeing, and dyspnea, from 0 to 10.

Palliative Performance Scale

A functional score from 100% to 0% based on ambulation, activity, self-care, oral intake, and level of consciousness; lower scores correlate with shorter survival.

Surprise question

A prognostic prompt asking whether the clinician would be surprised if the patient died within twelve months; a negative answer identifies patients who may benefit from palliative assessment.

SPIKES protocol

A six-step framework for breaking bad news: Setting, Perception, Invitation, Knowledge, Emotions with empathy, and Strategy with summary; address emotion before further information.

Capacity assessment elements

To have decision-making capacity the patient must understand relevant information, appreciate the consequences, reason about options, and communicate a choice; capacity is task-specific.

Advance care planning

An ongoing process of reflection and discussion about values, goals, and wishes for future care, ideally documented and shared with substitute decision-makers before incapacity occurs.

Substitute decision-maker hierarchy

A legally defined order of people who may decide for an incapable patient, usually starting with a court-appointed or named representative, then spouse, then relatives, guided by prior wishes.

MAiD eligibility in Canada

Requires a capable adult with a grievous and irremediable condition, informed consent, and two independent assessments; non-terminal track adds a ninety-day assessment period.

Withholding versus withdrawing

Ethically equivalent acts; both allow the underlying disease to take its course and require a documented rationale, symptom plan, and clear communication with family.

Prolonged grief disorder

Persistent disabling yearning or preoccupation with the deceased beyond twelve months in adults, or six months in children, causing significant functional impairment.

Delirium at end of life

An acute fluctuating disturbance of attention and cognition common in terminal illness; screen with the Confusion Assessment Method and search for reversible causes before sedating.

Palliative Performance Scale threshold

A score of 30% or less, indicating mainly bedbound status with minimal intake, is often used to signal eligibility for hospice-level palliative programs.

Last-days medication review

Stop non-essential drugs such as statins, antihypertensives, anticoagulants, hypoglycemics, and vitamins; continue analgesics, anxiolytics, and antisecretory agents with anticipatory prescriptions.

Family conference purpose

A structured meeting to align understanding of illness and goals, resolve conflict, and document a plan; the capable patient should be included whenever possible.

Cancer pain ladder

A three-step World Health Organization approach: non-opioid for mild pain, weak opioid for moderate pain, strong opioid for severe pain, with adjuvants added at any step.

Equianalgesic oral morphine ratio

Oral morphine 10 mg equals oral oxycodone 5 mg and oral hydromorphone 1 to 2 mg; reduce the calculated dose by 25 to 50% when rotating for cross-tolerance.

Breakthrough pain dosing

Prescribe an immediate-release opioid dose equal to roughly 10% of the total daily opioid dose, given every hour as needed, and reassess after several episodes.

Opioid-naive starting doses

Oral immediate-release morphine 5 to 10 mg every four hours, oxycodone 2.5 to 5 mg, or hydromorphone 0.5 to 1 mg, plus a breakthrough dose.

Fentanyl patch indication

Reserved for opioid-tolerant patients, usually taking at least 60 mg oral morphine equivalent daily; patches are changed every 72 hours and are unsuitable for unstable pain.

Opioid-induced constipation

Universal and non-tachyphylactic; prescribe a stimulant laxative such as senna prophylactically rather than waiting for symptoms, and reassess bowel function regularly.

Opioid respiratory depression

Rare when opioids are titrated; it is preceded by increasing sedation and falling respiratory rate, so monitor sedation level rather than relying on rate alone.

Dyspnea opioid dosing

Low-dose morphine, such as 2.5 to 5 mg orally or 1 to 2 mg subcutaneously in opioid-naive patients, relieves air hunger; oxygen helps only when the patient is hypoxemic.

Antiemetic selection by cause

Metoclopramide or domperidone for gastric stasis, haloperidol or methotrimeprazine for metabolic causes, ondansetron for serotonin-mediated nausea, dexamethasone for raised intracranial pressure.

Malignant bowel obstruction

Treat with dexamethasone and metoclopramide if incomplete; if complete, stop prokinetics and use octreotide or anticholinergics plus analgesia, reserving nasogastric tubes for intractable vomiting.

Terminal secretions management

Reposition the patient and reassure family; if distress persists, use anticholinergics such as glycopyrrolate or scopolamine, since suctioning gives only brief benefit and may cause discomfort.

Palliative sedation principles

Reserved for refractory symptoms after aggressive measures fail; obtain consent where possible, start with proportional sedation, and document intent to relieve suffering rather than hasten death.

Hypercalcemia of malignancy

A common reversible cause of delirium, constipation, and nausea in advanced cancer; treat with intravenous fluids plus bisphosphonates, and monitor calcium and renal function.

Neuropathic pain adjuvants

Gabapentinoids, tricyclic antidepressants, and serotonin-norepinephrine reuptake inhibitors are first-line adjuvants; corticosteroids help with nerve compression and raised intracranial pressure.

Cultural safety in dying

Ask about preferred decision-making roles, trained interpreter needs, truth-telling preferences, and death rituals, recognizing that family-centered models are common and valid.

Clinician moral distress

The experience of knowing the right action but being constrained from taking it; addressed through peer debriefing, ethics consultation, and institutional support rather than individual resilience alone.