Palliative Care (palliative + care)

Distribution by Scientific Domains
Distribution within Medical Sciences

Terms modified by Palliative Care

  • palliative care nurse
  • palliative care patient
  • palliative care services
  • palliative care unit

  • Selected Abstracts


    PALLIATIVE CARE, PUBLIC HEALTH AND JUSTICE: SETTING PRIORITIES IN RESOURCE POOR COUNTRIES

    DEVELOPING WORLD BIOETHICS, Issue 3 2009
    CRAIG BLINDERMAN
    ABSTRACT Many countries have not considered palliative care a public health problem. With limited resources, disease-oriented therapies and prevention measures take priority. In this paper, I intend to describe the moral framework for considering palliative care as a public health priority in resource-poor countries. A distributive theory of justice for health care should consider integrative palliative care as morally required as it contributes to improving normal functioning and preserving opportunities for the individual. For patients requiring terminal care, we are guided less by principles of justice and more by the duty to relieve suffering and society's commitment to protecting the professional's obligation to uphold principles of beneficence, compassion and non-abandonment. A fair deliberation process is necessary to allow these strong moral commitments to serve as reasons when setting priorities in resource poor countries. [source]


    Patient Participation in Palliative Care: A Voice for the Voiceless

    EUROPEAN JOURNAL OF CANCER CARE, Issue 2 2005
    DEBRA P. OLIVER msw
    No abstract is available for this article. [source]


    Palliative Care in Neurology

    JOURNAL OF ADVANCED NURSING, Issue 5 2005
    Patricia K.T. Pothier PhD
    No abstract is available for this article. [source]


    Teaching Palliative Care in the Nursing Home

    JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 1 2004
    Eileen R. Chichin PhD
    No abstract is available for this article. [source]


    Palliative Care and Pain Medicine Come Together to Optimally Treat Cancer Pain: What We Can Learn from the British Pain Society

    PAIN MEDICINE, Issue 5 2010
    Allen W. Burton MD
    No abstract is available for this article. [source]


    Educating Medical Students in Pain Medicine and Palliative Care

    PAIN MEDICINE, Issue 3 2002
    Hui-Ming Chang MD
    No abstract is available for this article. [source]


    A Decision Analysis Model to Justify and Approve Off-Label Drug Use in Pain and Palliative Care

    PAIN PRACTICE, Issue 3 2008
    Dr P.H., James H. Diaz MD
    No abstract is available for this article. [source]


    Stepping into Palliative Care 2: Care and Practice (2nd edn).

    PSYCHO-ONCOLOGY, Issue 1 2008
    Edited by Jo Cooper.
    No abstract is available for this article. [source]


    The Politics of Palliative Care and the Ethical Boundaries of Medicine: Gonzales v. Oregon as a Cautionary Tale

    THE JOURNAL OF LAW, MEDICINE & ETHICS, Issue 1 2007
    Bryan HilliardArticle first published online: 2 MAR 200
    The U.S.Supreme Court's 6-decision in Gonzales v. Oregon is the latest defeat for the Bush administration in its sustained attack on Oregon's physician-assisted suicide law. Both the majority opinion and the major dissent in Oregon provide an opportunity to assess the dangers inherent in allowing a political agenda that emphasizes the sanctity of life and minimizes professional ethical obligations to overshadow quality patient care at the end of life. [source]


    Advanced Heart Failure: Prognosis, Uncertainty, and Decision Making

    CONGESTIVE HEART FAILURE, Issue 5 2007
    Jane G. Zapka ScD
    Heart failure is a serious clinical management challenge for both patients and primary care physicians. The authors studied the perceptions and practices of internal medicine residents and faculty at an academic medical center in the Southeast to guide design of strategies to improve heart failure care. Data were collected via a self-administered survey. Eighty-nine faculty and resident physicians in general internal medicine and geriatrics participated (74% response rate). Items measured perceived skills and barriers, adherence to guidelines, and physician understanding of patient prognosis. Case studies explored practice approaches. Clinical knowledge and related scales were generally good and comparable between physician groups. Palliative care and prognostic skills were self-rated with wide variance. Physicians rated patient noncompliance and low lifestyle change motivation as major barriers. Given the complexities of caring for elderly persons with heart failure and comorbid conditions, there are significant opportunities for improving physician skills in decision making, patient-centered counseling, and palliative care. [source]


    Palliative care in haematology

    INTERNAL MEDICINE JOURNAL, Issue 9 2007
    D. Joske
    No abstract is available for this article. [source]


    Palliative care and pain management 2

    ANAESTHESIA, Issue 6 2002
    M. Dobb
    No abstract is available for this article. [source]


    Palliative care in aged care facilities for residents with a non-cancer disease: results of a survey of aged care facilities in South Australia

    AUSTRALASIAN JOURNAL ON AGEING, Issue 2 2005
    Carol Grbich
    Objectives:,This study reports the results of a cross-sectional study of residential aged care facilities in South Australia which sought to quantify the extent of specialist palliative care involvement in residential aged care facilities as well as identifying the current need for palliative care. Method:,A questionnaire was completed by 51 Directors of Care from 51 of 90 facilities targeted, representing a response rate of 57% and representing 20% of the total number of South Australian licensed beds. Facilities responding were representative of residential aged care facilities in South Australia for location, type of funding and level of care. Results:,Thirty facilities (59%) used specialist palliative care services during 2001 with the average number of residents consulted being four. There were 627 deaths recorded in the 2785 licensed beds, a death rate of 23%. The majority of these deaths were from non-cancer diseases (83%) and up to two-thirds of all deaths occurred away from low care facilities, usually in an acute care setting. Main reasons for transfer away from the facility were; an acute care episode requiring other expertise, rapid deterioration of the resident, care needs beyond the facility, or the general practitioner or family requested a transfer. Care Directors estimated that 7% of their current residents would be considered palliative and the majority of these had non-cancer diseases (78%). Conclusion:,These findings indicate that palliative care is an important aspect of care in residential aged care facilities for clients with a non-cancer diagnosis. [source]


    Do the learning needs of rural and urban general practitioners differ?

    AUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 6 2005
    James A. Allan
    Abstract Introduction:,The challenges of rural general practice have given rise to a separate rural training stream and a separate rural professional body. The differences are characterised by the nature of the work undertaken by rural GPs and reflected in the continuing medical education topic choices made when surveyed. Methods:,In 2001 a survey was designed and distributed by the Royal Australian College of General Practitioners and Divisions of General Practice in South Australia and Northern Territory. The survey utilised a list of 104 topics. The topic choices of rural and urban GPs were compared. Results:,The survey was distributed to approximately 1762 GPs and yielded 578 responses (33%). Rural GPs were more likely to select the following topics: Anaesthetics, Aboriginal Torres Strait Islander health, Population Health, Renal medicine, Cardiology, Teaching skills, Obstetrics, Neonates, Arrhythmias, Fracture management, Tropical medicine and Therapeutics. Urban GPs were more likely to select Menopause, Travel medicine and Palliative care (P < 0.05). Discussion:,Many of the areas of difference reflected aspects of rural general practice. There were also many similarities in topic choices between these two groups. [source]


    Palliative care in the hinterlands: A description of existing services and doctors' attitudes

    AUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 6 2005
    Glenn J. Pereira
    Abstract Objective:,To describe palliative care services as they exist in the hinterlands (towns away from regional centres) of Midwest New South Wales, including an estimation of the numbers of cases treated by local doctors, and the service they provide to their patients. Generalist doctors' attitudes to palliative care are also explored, as this information is lacking in the literature but is important for service provision. Design:,Descriptive survey. Setting:,Rural primary care and district hospitals. Participants:,Generalist doctors in hinterland areas. Results:,In total, 38% (19/50) of surveys were returned. ,Visiting rights' to the district hospital were held by 78.9% of local doctors, and patients are admitted under the care of their own doctor for symptom control and terminal care, 94.1% and 76.5% of the time, respectively. All doctors surveyed perform home visits for terminally ill patients, and 68.4% make themselves routinely available after hours. Doctors surveyed estimated that they managed a mean of 8.4 deaths due to chronic illness in the past 12 months. Most (78.9%) said that they would continue to manage dying patients even if they had a choice, and they feel between moderately and very satisfied that they provide quality care. However, only 21.1% considered their undergraduate training in palliative medicine to be adequate, and all said that they would refer to a specialist service if it were available. Conclusions:,Generalist rural doctors not only treat many dying patients, but also provide a continuity of care that is rarely seen in other settings. Proposals of models for ,rural' palliative care should, therefore, take this unique setting into account. One such suggestion is given in this article. [source]


    Palliative care by nurses in rural and remote practice

    AUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 4 2004
    John P. Rosenberg
    Abstract Objective:,To evaluate the experiences of a group of rural and remote nurses in providing palliative care and to discuss the implications of this evaluation for the development and implementation of professional support strategies. Design:,Semi-structured survey comprising 23 items measuring perceptions of the nature of rural and remote practice, the provision of palliative care in these settings and the appropriateness of various professional development strategies; as well as 12 open-ended questions to obtain qualitative descriptions relating to key concepts in rural and remote practice. Setting:,Rural and remote communities in the Southern zone of Queensland Health. Subjects:,Thirty-one registered and enrolled nurses, all female, who attended a two-day professional development workshop. Main outcome measures:,Identification of characteristics of, barriers against and strategies to support the practice of palliative care in rural and remote communities. Results:,High levels of agreement with key statements relating to issues evident in contemporary literature regarding rural and remote nursing practice; qualitative descriptions show congruence with key statements. Conclusions:,This evaluation demonstrated congruence between the challenges faced by this group of nurses and those reported in the literature. These nurses identified the importance of peer networking as an integral part of their work, which enhanced their potential as rural and remote palliative care providers. What is already known:,The issues faced by nurses in rural and remote communities have been described in previous studies. For the most part, these had not specifically targeted the practice of palliative care in this setting. It was not clear whether the practice of palliative care brought distinct challenges to nurses. What this paper adds:,This paper adds to the growing body of knowledge about the professional development needs of nurses in rural and remote communities in relation to the practice of palliative care. It suggests that the nurses surveyed in this study share many challenges in common with nurses practising rural and remote settings. Palliative care is understood to be an integral part of practice, despite the infrequency of palliative care clients and the diverse roles they carry out. Barriers to professional development related to geographical and professional isolation are shared in common. An imperative emerges to identify professional development strategies that are directly relevant to rural and remote settings, to improve access to professional development resources and to promote sustainable peer support networks. [source]


    Advanced Heart Failure: Prognosis, Uncertainty, and Decision Making

    CONGESTIVE HEART FAILURE, Issue 5 2007
    Jane G. Zapka ScD
    Heart failure is a serious clinical management challenge for both patients and primary care physicians. The authors studied the perceptions and practices of internal medicine residents and faculty at an academic medical center in the Southeast to guide design of strategies to improve heart failure care. Data were collected via a self-administered survey. Eighty-nine faculty and resident physicians in general internal medicine and geriatrics participated (74% response rate). Items measured perceived skills and barriers, adherence to guidelines, and physician understanding of patient prognosis. Case studies explored practice approaches. Clinical knowledge and related scales were generally good and comparable between physician groups. Palliative care and prognostic skills were self-rated with wide variance. Physicians rated patient noncompliance and low lifestyle change motivation as major barriers. Given the complexities of caring for elderly persons with heart failure and comorbid conditions, there are significant opportunities for improving physician skills in decision making, patient-centered counseling, and palliative care. [source]


    The relationship between quality of life and levels of hopelessness and depression in palliative care

    DEPRESSION AND ANXIETY, Issue 9 2008
    Kyriaki Mystakidou M.D., Ph.D.
    Abstract There is growing interest in the psychological distress and quality of life of cancer patients. The aim of this study was to compare the responses of 102 advanced cancer patients on a quality of life scale (as measured by the SF12) with the Beck Depression Inventory (BDI) and the Beck Hopelessness Scale (BHS), as well as the impact of depression and hopelessness on quality of life. Significant associations were found between gender (P=.027), performance status (P=.003), opioids (P=.002), depression (P<.0005), and hopelessness (P<.0005) with the SF12-Mental Component Score (MCS). Gender (P=.07), metastasis (P=.001), opioids (P=.0005), and education (P=.045) correlated significantly with SF12-Physical Component Score (PCS). In the prediction of MCS, the dimensions of age, hopelessness, gender, and performance status were statistically significantly high (P<.0005), explaining 48% of variance. For PCS, the predictor variables were education, metastasis, and opioids (25% of variance). Quality of life, in this patient population, was predicted by the level of hopelessness and patients' demographic and clinical characteristics. Depression and Anxiety. 2007 Wiley-Liss, Inc. [source]


    PALLIATIVE CARE, PUBLIC HEALTH AND JUSTICE: SETTING PRIORITIES IN RESOURCE POOR COUNTRIES

    DEVELOPING WORLD BIOETHICS, Issue 3 2009
    CRAIG BLINDERMAN
    ABSTRACT Many countries have not considered palliative care a public health problem. With limited resources, disease-oriented therapies and prevention measures take priority. In this paper, I intend to describe the moral framework for considering palliative care as a public health priority in resource-poor countries. A distributive theory of justice for health care should consider integrative palliative care as morally required as it contributes to improving normal functioning and preserving opportunities for the individual. For patients requiring terminal care, we are guided less by principles of justice and more by the duty to relieve suffering and society's commitment to protecting the professional's obligation to uphold principles of beneficence, compassion and non-abandonment. A fair deliberation process is necessary to allow these strong moral commitments to serve as reasons when setting priorities in resource poor countries. [source]


    A retrospective audit exploring the use of relaxation as an intervention in oncology and palliative care

    EUROPEAN JOURNAL OF CANCER CARE, Issue 5 2008
    J. MILLER
    The benefits of relaxation in cancer care have been well documented within the literature, with the majority of research being undertaken by nursing professionals. However, evidence of the effectiveness of relaxation interventions by occupational therapists is lacking. Occupational therapists are in an ideal situation to provide information and practical relaxation sessions. Athough in numerical terms, the outcome of relaxation interventions is small, functional outcome related to quality of life and independence in activities of daily living is immeasurable. This article reports the findings of a retrospective audit exploring relaxation-specific referrals to occupational therapy, and identifies effectiveness of a variety of different techniques currently employed within this specific programme. Patients with a primary diagnosis of breast cancer were the most frequently seen, and this prevalence is reflected in current national statistics. Similarly, those between 50 and 59 years of age comprised the largest group. Guided visualization was the most commonly used technique, although there appeared to be very little change in perceived tension between all the techniques. Further study of the impact relaxation has on occupational performance would be worthwhile. [source]


    Practice development , Part 1: developing a practice initiative in oncology and palliative care

    EUROPEAN JOURNAL OF CANCER CARE, Issue 2 2007
    G.G. DARK mbbs, iltm
    No abstract is available for this article. [source]


    Special considerations for haematology patients in relation to end-of-life care: Australian findings

    EUROPEAN JOURNAL OF CANCER CARE, Issue 2 2007
    P. MCGRATH bsocwk, senior research fellow
    Recent haematology clinical guidelines recommend that palliative care specialists should have central roles in haemato-oncology teams. However, the available research evidence indicates there are presently significant obstacles to the integration of palliative care in haematology. The following discussion presents findings from an Australian study designed to address the problems associated with lack of referral of haematology patients to the palliative system through the development of a best-practice model for end-of-life care for these diagnostic groups. The preliminary step in the development of such a model is to document the factors that denote the special characteristics of the end-of-life stage of haematological conditions and their treatments. This article presents the list of special considerations from a nursing perspective, including issues associated with the high-tech nature of treatments, the speed of change to a terminal event, the need for blood products and possibility of catastrophic bleeds, the therapeutic optimism based on a myriad of treatment options and the clinical indices of the terminal trajectory. The nursing insights provide an important foundation for building a practical, patient-centred model for terminal care in haematology. [source]


    Research sensitivities to palliative care patients

    EUROPEAN JOURNAL OF CANCER CARE, Issue 3 2002
    J. Addington-Hall phd
    Research sensitivities to palliative care patients This paper considers the methodological challenges of researching the health care experiences of palliative care patients and their families. Difficulties in defining a ,palliative care patient' are highlighted, and the question of whether there are specific ethical issues when researching palliative care explored. Methodological issues are discussed, including the negotiation of access via health professionals, the choice of appropriate data collection methods and tools, the consequences of high attrition rates and the use of retrospective surveys of bereaved relatives. Key areas for research are identified. These include patients' and families' experiences of research participation, the impact of being approached on those who decline, how the characteristics of those who participate differ from those who do not and the likely impact of this on findings. Research is also needed into patient and family motivations for participation, and whether and how these change as the disease progresses. To ensure that the voices of palliative care patients and their families are heard by both service providers and policy-makers, research in this area needs to address the methodological challenges raised in this paper, as well as continuing to explore users' views. [source]


    Non-medical palliative care and education to improve end-of-life care at geriatric health services facilities: A nationwide questionnaire survey of chief nurses

    GERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 3 2007
    Yoshihisa Hirakawa
    Background: Geriatric health services facilities (GHSF) are expected to assume a growing role in caring for the dying elderly. However, research in this area has so far been scant. The purpose of the present study is to reveal the status of non-medical palliative care and staff education aiming at improving and enhancing end-of-life care at GHSF. Methods: The subjects were 2876 chief nurses of GHSF. Data was collected through a mailed questionnaire in 2003. The questionnaire covered the following: (i) staff perception of end-of-life care policies; (ii) staff education; and (iii) available non-medical care. To evaluate the factors correlated with end-of-life care policies at GHSF, we divided the facilities into two groups. Results: We analyzed the answers collected from 313 facilities with a progressive policy toward end-of-life care (PP group) and 818 with a regressive policy toward it (RP group). It was found that staff training was conducted more frequently among PP facilities. Generally, nurses in the PP facilities were more confident that they could provide comprehensive on-site end-of-life care and grieving support, but did not feel so sure about their ability to provide better end-of-life environments for dying residents and family by organizing outside support from voluntary and/or governmental organizations and religious organization for healing and to pursue appropriately a written follow-up communication with the bereaved family. Conclusions: Our results suggest that providing GHSF staff with education about end-of-life issues or setting up collaboration with the outside is an important factor to enhance overall end-of-life care at these facilities. [source]


    Haematology and palliative care: blood, sweat and tears

    INTERNAL MEDICINE JOURNAL, Issue 12 2003
    S. Newton
    No abstract is available for this article. [source]


    Ethical foundations of palliative care for Alzheimer patients.

    INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 8 2006
    Edited by Ruth B. Purtilo, Henk A.M.J. ten Have.
    No abstract is available for this article. [source]


    The communication challenges faced in adopting a palliative care approach in advanced dementia

    INTERNATIONAL JOURNAL OF NURSING PRACTICE, Issue 5 2009
    Amanda Johnson RN DipT(Ng) MHScEd
    This paper discusses one aspect from the findings of an Australian study aimed at understanding the needs of people with advanced dementia. Specifically, this paper focuses on the communication issues that might potentially inhibit the implementation of a palliative care approach for a person with advanced dementia in a residential aged care facility (RACF). Six focus groups consisting of 34 participants and 24 semistructured interviews were conducted. Participants were drawn from palliative care specialty staff, palliative care volunteers, designated aged or dementia specialist staff from an area health service, general practitioners, RACF staff and family carers. The findings show communication issues identified by the participants were a significant factor impacting on their capacity to adopt a palliative care approach in caring for people with advanced dementia. The findings support the need for education, skill development and networking to occur among the key providers of care in RACFs to ensure the provision of ,best practice' palliative care to residents with advanced dementia and their families. [source]


    Palliative Ultrasound for Home Care Hospice Patients

    ACADEMIC EMERGENCY MEDICINE, Issue 3 2010
    Peter J. Mariani MD
    Abstract The evolving relationship between emergency and palliative medicine is expected to benefit patients of each. Two collaborative care encounters involving home hospice patients are discussed. Portable bedside ultrasound was performed in the home to diagnose ascites and to guide palliative paracentesis. Specific interventions and outcomes are reported. The interface of emergency and palliative care and the use of paracentesis in cancer palliation are briefly reviewed. It is concluded that home-performed ultrasound and ultrasound-guided procedures are promising palliative modalities for care at the end of life. ACADEMIC EMERGENCY MEDICINE 2010; 17:293,296 2010 by the Society for Academic Emergency Medicine [source]


    Factors associated with lower quality of life among patients receiving palliative care

    JOURNAL OF ADVANCED NURSING, Issue 9 2009
    Ying Yu Chui
    Abstract Title.,Factors associated with lower quality of life among patients receiving palliative care. Aim., This paper is a report of a study conducted to (1) assess the quality of life (QoL) and physical functioning status of patients diagnosed with advanced cancer and receiving palliative care; (2) determine if there was a statistically significant relationship between their physical functioning and QoL and (3) identify the demographic and disease-related variables related to their QoL. Background., Achieving the best possible QoL is a major goal in palliative care. However, research findings about the relationship between QoL and demographic variables have been inconsistent. Method., Three hundred patients with advanced cancer were recruited from four district hospitals in Hong Kong between February 2005 and July 2006. Their QoL and physical functioning status were assessed by face-to-face interview, using the McGill Quality of Life Questionnaire (Hong Kong version) and the Palliative Performance Scale respectively. Results., Participants reported reduced ambulation, inability to perform hobbies or housework, and the need for occasional assistance in self-care (mean: 646 out of 100, sd: 193, range: 20,100). QoL was fair (mean: 62 out of 10, sd: 15, range: 09,10). There was a weak positive association between physical functioning and QoL scores. Multiple regression analysis showed that patients who were older, female, had ever been married, or had higher physical functioning tended to have better QoL. Conclusion., More could be done in symptom and psychosocial management to improve patients' QoL, in particular for those who are younger, male or single, or who have lower physical functioning. [source]


    Decision-making for acutely ill nursing home residents: nurses in the middle

    JOURNAL OF ADVANCED NURSING, Issue 5 2009
    Ruth Palan Lopez
    Abstract Title.,Decision-making for acutely ill nursing home residents: nurses in the middle. Aim., This paper is a report of a study to generate a model of nursing behaviours and social processes inherent in decision-making for acutely ill nursing home residents. Background., Most research concerning clinical decision-making in nursing homes focuses on the perspectives of doctors. Much less is known about the perspectives and actions of nurses with regard to decision-making, despite the centrality of their roles in nursing homes. Method., Grounded theory was used. Data were collected in 2004 in four nursing homes in the United States of America using in-depth, semi-structured interviews, 74 hours of non-participant observation and informal conversational interviews with key nursing staff involved in decision-making. Findings., Nurses strive to create a plan of care acceptable to family members and doctors, consistent with wishes of residents and most comfortable for residents. A unifying theme of satisfying all sides emerged as representative of the negotiation strategies used by nurses to address these competing points of view. Four phases in this negotiation occurred: weighing the significance; notifying the family; feeling it out; and playing the middleman. The outcome was either a decision for life-prolongation or for palliative care. Conclusion., Decisions for nursing home residents are complex and involve weighing and balancing the interests and preferences of many concerned participants, including residents, families and doctors. This process requires skill in clinical judgment, communication and collaboration. [source]