Last Days of Life (PDQ) (2 credit hours)

Program Summary:  This course explores care considerations for the last days of life and includes a discussion of forgoing potentially life saving treatments, withdrawing care, palliative sedation, requests for a hastened death, and no further escalation of care.    Ethical principles and dilemmas are identified including patient autonomy, clinician perceived futility, and the principle of double effect.  This course is intended as a resource to help clinicians provide the highest quality end of life care.  Grief, bereavement, and challenges to the professional caregiver are also explored.

This course is recommended for social workers and appropriate for beginning and intermediate levels of practice.  This course is not recommended for NBCC ethics credit.

“Book  Open the Course Reading Here.

Publisher:  The National Cancer Institute

Course Objectives: To enhance professional practice, values, skills, and knowledge by identifying key issues related to end of life care considerations and decision-making.

Learning Objectives:  Identify care decisions in the final weeks, days, and hours of life.  Describe the ethical principles of patient autonomy and double effect.  Describe when an ethics consult may be necessary.  Identify criteria to consider when deliberating the possibility of forgoing a potential life saving treatment.  Describe strategies for preventing further escalation of care.

Review our pre-reading study guide.

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1: Which of the following is an 11-point scale describing a patient's level of ambulation, level of activity, evidence of disease, ability to perform self-care, nutritional intake, and level of consciousness?
2: Impending death, or actively dying, refers to the process in which patients who are expected to die within _________ exhibit a constellation of symptoms.
3: The ability to diagnose impending death with confidence is of utmost importance to clinicians because it could
4: The Investigating the Process of Dying study identified _______________ in the last weeks and days of life.
5: In the final days to hours of life, patients may have limited, transitory moments of lucidity-
6: Which of the following is a patient-completed measure of the severity of nine symptoms (anxiety, lack of appetite, depression, drowsiness, nausea, pain, shortness of breath, tiredness, and well-being)?
7: In dying patients, a poorly understood phenomenon that appears to be distinct from delirium is the experience of
8: The average intensity of pain often _____________ as patients approach the final days.
9: For patients who experience dysphagia in the last days of life, which of the following is usually recommended?
10: Which of the following describes myoclonus?
11: Patients with advanced cancer who receive hospice care appear to experience
12: Which of the following was associated with short hospice stays?
13: The Medicare hospice benefit requires that physicians certify patients' life expectancies shorter than 6 months and that patients forgo
14: In multivariable analysis, which of the following factors correlated with a lesser likelihood of dying at home?
15: Which of the following patients may be less likely to prefer to die at home?
16: A negative right to be free from the interference of others or, in health care, to refuse a recommended treatment or intervention best describes
17: There are limits to the principle of patient autonomy.
18: Which of the following is a consideration for artificial nutrition at the end of life?
19: Which of the following describes the strategy of no further escalation of care?
20: A number of studies have reported strong _____________ between patients' and caregivers' emotional states.
21: Which ethical principle states that the intended effect may justify the foreseeable but unintended consequence if the intended (positive) outcome is of greater value than the unintended (negative) outcome.
22: The intent of palliative sedation is
23: Reasons for requests for hastened death are multiple and complex and include which of the following:

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Free State Social Work, LLC, provider #1235, is approved as an ACE provider to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Regulatory boards are the final authority on courses accepted for continuing education credit. ACE provider approval period: 9/6/2021 - 9/6/2024. Social workers completing this course receive 2 continuing education credits.

Free State Social Work has been approved by NBCC as an Approved Continuing Education Provider, ACEP NO. 6605. Programs that do not qualify for NBCC credit are clearly identified. Free State Social Work is solely responsible for all aspects of the programs.

G.M. Rydberg-Cox, MSW, LSCSW is the Continuing Education Director at Free State Social Work and responsible for the development of this course.  She received her Masters of Social Work in 1996 from the Jane Addams School of Social Work at the University of Illinois-Chicago and she has over 20 years of experience.  She has lived and worked as a social worker in Chicago, Boston, and Kansas City. She has practiced for many years in the area of hospital/medical social work.  The reading materials for this course were developed by another organization.