E11: End-of-life care

People who are not likely to recover from their stroke receive care at the end of their lives, which takes account of their needs and choices. (Key: e = element | k = knowledge | s = skill)

Knowledge and understanding of…

e11k_1:
End-of-life care strategies, advanced directives, and palliative care tools in relation to stroke
e11k_2:
The implications of the Mental Capacity Act for stroke patients
e11k_3:
Advocates for stroke patients when there is a legal duty to instruct an IMCA, taking account of religious and cultural aspirations
e11k_4:
The range of support groups and services for those affected by stroke with palliative care needs
e11k_5:
The needs and aspirations of those affected by stroke (i.e. patient, carer and family)
e11k_6:
The assessment and management of problems, how they can be controlled and the implications for prognosis: psychological and emotional; social and relationship; cognitive and communication; physiological, physical and functional; neurological, visual and sensory impairments and pain; medical
e11k_7:
Pharmacological and non-pharmacological interventions for end-of-life care after stroke
e11k_8:
The side effects of pharmacological and non-pharmacological interventions for end-of-life care after stroke

Skills and ability to...

e11s_1:
Take and interpret thorough history, including information from carers, relatives and other agencies where possible, and assess mental capacity
e11s_2:
Determine, plan and initiate appropriate assessments/investigations and interventions/treatments; provide information, relevant to individual needs and aspirations (personalise information)
e11s_3:
Communicate and discuss: current event; interventions/treatments and their timeframes; rationale for treatment; possible side effects of treatment; and provide advice and prognosis
e11s_4:
Assess capacity and “best interests” according to the statutory principles
e11s_5:
Provide sufficient information to enable informed choice and decision making by those affected by stroke
e11s_6:
Identify need and when to refer for more specialist or differing treatments where necessary: agree referral
e11s_7:
Recognise and manage symptoms taking account of individual needs and aspirations
e11s_8:
Use palliative care, or other relevant tools, and care pathways
e11s_9:
Identify local services and resources, including waiting times and implications for those affected by stroke
e11s_10:
Use strategies to help with breaking bad news, managing emotions and obtaining information on advanced directives
e11s_11:
Develop mechanisms to support the palliative care team and provide opportunities for debriefing sessions