Source / episode info

• **Episode:**228
• **Title:**Divine Intervention Episode 228 – USMLE Nov 2020 Changes Series 1: Palliative Care 1.
• **Published:**2020-04-07
• Source:Episode page

One-liner

This episode covers the principles of palliative care, emphasizing that it should be initiated early for chronic illness; it details advanced care planning barriers and outlines the structured communication protocol (SPIKES) for breaking bad news.

High-yield summary

• Early Initiation: Palliative care is not reserved only for the dying; it must be considered as part of comprehensive care for any patient with a serious or chronic illness.
• ACP Goals: The primary goal of ACP discussions is to maintain patient autonomy and ensure that the patient has a say in their own care, even if they become incapacitated.
• Communication Protocol (SPIKES): When delivering bad news, use the structured mnemonic: Setting up the environment, Preparing for the discussion, assessing what the patient/family understand, providing Information (asking how much detail is desired), giving Knowledge with empathy, acknowledging Emotional responses (pausing), and Sharing next steps/plan of care.
• Legal Directives: A Living Will provides specific instructions for care while the patient is coherent; a Healthcare Proxy (or Durable Power of Attorney) designates a person to make decisions when the patient cannot. If both conflict, the patient must decide which takes precedence.
• Screening Tools: Use the PHQ-9 questionnaire for screening depression and the GAD-7 questionnaire for generalized anxiety disorder in terminal patients.

Learning objectives

• Understand the scope of palliative care: it is comprehensive supportive care for chronic illness, not just end-of-life care.
• Identify key barriers to initiating Advanced Care Planning (ACP) discussions in primary care settings.
• Master the sequential steps and components of the SPIKES protocol when delivering bad news.
• Differentiate between a Living Will and a Healthcare Proxy/Durable Power of Attorney, including conflict resolution guidelines.
• Recognize appropriate screening tools for common mental health issues (PHQ-9, GAD-7) in chronically ill patients.

Board exam buzzwords