CT End-of-Life Care & Support 2 — Questions and Answers
Question 1: Which principle of palliative care specifically addresses the importance of treating the patient as a whole person rather than focusing solely on the disease?
- Disease-centered care
- Holistic care (Correct answer)
- Curative care
- Symptomatic care
Correct answer: Holistic care
Holistic care in palliative settings addresses the physical, emotional, social, and spiritual dimensions of a patient's experience.
Question 2: A patient with terminal cancer asks their thanatologist, 'Why is this happening to me?' This question most likely reflects which dimension of suffering?
- Physical suffering
- Financial suffering
- Existential or spiritual suffering (Correct answer)
- Social suffering
Correct answer: Existential or spiritual suffering
Questions about the meaning and reason for suffering are hallmarks of existential or spiritual distress common near end of life.
Question 3: When a dying patient's family requests that the patient not be told their prognosis, the thanatologist's primary ethical obligation is to:
- Honor the family's wishes without question
- Immediately disclose the prognosis to the patient
- Explore the patient's own wishes regarding information disclosure (Correct answer)
- Defer entirely to the attending physician
Correct answer: Explore the patient's own wishes regarding information disclosure
Patient autonomy requires first assessing what the patient wants to know, rather than defaulting to family or physician preferences.
Question 4: The 'good death' concept in thanatology most commonly includes which of the following elements?
- Death occurring in a hospital setting
- Absence of any pain medication to maintain consciousness
- Dying with a sense of meaning, comfort, and dignity (Correct answer)
- Prolonging life as long as medically possible
Correct answer: Dying with a sense of meaning, comfort, and dignity
A 'good death' is widely understood to involve comfort, dignity, meaningful relationships, and a sense of personal control.
Question 5: Which tool is most commonly used by hospice teams to assess and communicate a dying patient's symptom burden across multiple domains?
- Beck Depression Inventory
- Edmonton Symptom Assessment System (ESAS) (Correct answer)
- Mini-Mental State Examination
- Glasgow Coma Scale
Correct answer: Edmonton Symptom Assessment System (ESAS)
The ESAS is a widely used validated tool in palliative care for rating the severity of nine common symptoms in seriously ill patients.
Question 6: In the context of end-of-life care, 'total pain' is a concept introduced by Dame Cicely Saunders that encompasses:
- Only the physical pain of terminal illness
- Physical, emotional, social, and spiritual components of suffering (Correct answer)
- Pain that does not respond to opioid medications
- The cumulative pain experienced by family caregivers
Correct answer: Physical, emotional, social, and spiritual components of suffering
Saunders' concept of total pain recognizes that suffering at end of life is multidimensional, encompassing physical, psychological, social, and spiritual distress.
Question 7: A hospice patient suddenly becomes agitated, confused, and experiences hallucinations in the final days of life. This cluster of symptoms is most consistent with:
- Opioid-induced neurotoxicity only
- Terminal delirium (terminal restlessness) (Correct answer)
- A new psychiatric diagnosis
- Medication non-compliance
Correct answer: Terminal delirium (terminal restlessness)
Terminal delirium is a common and distressing syndrome in the last hours to days of life, characterized by agitation, confusion, and altered consciousness.
CT End-of-Life Care & Support 2
Which principle of palliative care specifically addresses the importance of treating the patient as a whole person rather than focusing solely on the disease?