Terminal Care (terminal + care)

Distribution by Scientific Domains

Selected Abstracts


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]

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

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]

Announcement from The Japan Geriatrics Society Ethics Committee: the terminal care of the elderly

Article first published online: 30 MAR 200
First page of article [source]

A concept analysis of renal supportive care: the changing world of nephrology

Helen Noble
Abstract Title.,A concept analysis of renal supportive care: the changing world of nephrology Aim., This paper is a report of a concept analysis of renal supportive care. Background., Approximately 15 million people worldwide are kept alive by renal dialysis. As services are required to support patients who decide not to start or to withdraw from dialysis, the term renal supportive care is emerging. Being similar to the terms palliative care, end-of-life care, terminal care and conservative management, there is a need for conceptual clarity. Method., Rodgers' evolutionary method was used as the organizing framework for this concept analysis. Data were collected from a review of CINAHL, Medline, PsycINFO, British Nursing Index, International Bibliography of the Social Sciences and ASSIA (1806,2006) using, ,renal' and ,supportive care' as keywords. All articles with an abstract were considered. The World Wide Web was also searched in English utilizing the phrase ,renal supportive care'. Results., Five attributes of renal supportive care were identified: available from diagnosis to death with an emphasis on honesty regarding prognosis and impact of disease; interdisciplinary approach to care; restorative care; family and carer support and effective, lucid communication to ensure informed choice and clear lines of decision-making. Conclusion., Renal supportive care is a dynamic and emerging concept relevant, but not limited to, the end phase of life. It suggests a central philosophy underpinning renal service development that allows patients, carers and the multidisciplinary team time to work together to realize complex goals. It has relevance for the renal community and is likely to be integrated increasingly into everyday nephrology practice. [source]

A concept analysis of palliative care in the United States

Salimah H. Meghani RN MSN CRNP
Purpose., The purpose of this analysis is to trace the evolution of the concept of palliative in the United States, explicate its meanings, and draw comparisons with other related concepts such as hospice care and terminal care. Methods., Rodgers' evolutionary method was used as an organizing framework for the concept analysis. Data were collected from a review of CINAHL, MEDLINE, CANCERLIT, PsycINFO and Sociological Abstracts databases using ,palliative care' and ,United States' as keywords. Articles written in the English language, with an abstract, published between 1965 and 2003 were considered. Data were synthesized to identify attributes, antecedents and consequences of palliative care. Findings., There has been a significant evolution in understanding of the palliative care concept in the United States over the last few decades, which has resulted in the emergence of new models of palliative care. Four attributes of the current palliative care concept were identified: (1) total, active and individualized patient care, (2) support for the family, (3) interdisciplinary teamwork and (4) effective communication. Results reinforce that cure and palliation are not mutually exclusive categories. Conclusions., The scope of palliative care has evolved to include a wide range of patient populations who may not be appropriately termed ,dying' but for whom alleviation of suffering and improvement of quality of life may be very relevant goals. The ultimate success of the new models of palliative care will eventually rest upon the commitment of health professionals to recognize and integrate the changing concept of palliative care into everyday practice. [source]

Perspectives of Elderly People on Advance Directives in Japan

Miho Matsui
Purpose: To examine perspectives of Japanese elderly people on advance directives (ADs) and factors related to positive attitudes toward ADs. Method: The data were collected by a structured questionnaire from 313 of 565 older adult members of senior citizens' centers in two cities in Japan. Survey items pertained to demographic characteristics, terminal care preferences, and personal values, including autonomy, family function, and religious piety. Findings: Of the 313 elderly people who completed questionnaires, 72.9% had positive preferences for executing living wills. With regard to durable power of attorney for health care, 62.2% approved of it. The supporters of ADs were more likely to have had discussions about terminal care with family members or physicians, experience of a family member hospitalized for terminal illness or injury, preferences for life-sustaining treatments that were self-determined, and personal values such as religious piety. The relationship between positive preferences toward durable power of attorney for health care and sex, marital status, and living arrangements were significant. Conclusions: Most Japanese older adults in this study approved of ADs, and family structure was important to the acceptance of designating a proxy. Discussion about end-of-life care and respect for life-sustaining treatment preferences are important decisions, about the end of life. [source]

Analysis of the circumstances at the end of life in children with cancer: Symptoms, suffering and acceptance

AbstractBackground: In an effort to improve the quality of life of children with cancer, this study analyzes the signs and symptoms at the end of life in such children. It is hoped that these data will contribute to the development of appropriate programs to address the challenges faced by these children. Procedure: Between 1994 and 2000, 28 children died after treatment for cancer at Hamamatsu University Hospital, Japan. The circumstances, signs and symptoms at the end of life of these children were analyzed through their medical records. Results: Of the 28 children, the underlying diseases were leukemia/lymphoma (LL group; n=11), brain tumors (BT group; n=7), and other solid tumors (OST group; n=10). Records showed poor appetite (100%), dyspnea (82.1%), pain (75.0%), fatigue (71.4%), nausea/vomiting (57.1%), constipation (46.4%) and diarrhea (21.4%) among these children. Anxiety was reported in 53.6% of the entire group of 28 children; however, no child in the BT group manifested anxiety. However, disturbance of consciousness was reported in all children in the BT group, which was significantly greater than in the other groups. Awareness, fear or acceptance of the imminence of his/her own death as indicated by verbal expression was reported in nine children (32.1%). Conclusions: Using the data obtained in the present study, we describe situations faced in the terminal care of children. It is important to address the problems revealed by this analysis in order to achieve improvements in both the physical and psychological care of children with terminal cancer. [source]

A shift to ambulatory medical education in Israel

Khaled Karkabi
Summary Background:, The Council for Higher Education in Israel published an extensive report in 2007, calling for a significant increase of undergraduate medical education in Israel in ambulatory care settings. The objective of this article is to propose an action plan aimed at shifting undergraduate medical education in Israel towards ambulatory education. Context:, The main barriers to increasing ambulatory education in Israel are lack of academic recognition for teaching and excellence, conflict between patient care, income and teaching, lack of an adequate educational infrastructure and faculty in ambulatory care, and insufficient support and involvement of the health organisations. However, there is great potential for developing ambulatory education in Israel based on existing resources: Israel has a well-established primary care network, has chronic disease management programmes, community-based preventive medicine and health promotion activities, and an emerging structure for home, palliative and terminal care in the community. Innovation:, The proposed action plan presents a framework for enhancing ambulatory education in undergraduate medical education in Israel, and allows site-specific adjustments according to the preferences, resources and capabilities of each of the four medical schools. Implications:, A national shift to ambulatory education in Israel can be implemented through the existing coordination mechanism of the four medical schools. A government funding policy that encourages the collaboration between four medical schools will be beneficial both in terms of resource utilisation and the engagement of other stakeholders. The recognition of community services and educational excellence can be advanced by establishing academies of teaching scholars. [source]

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

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]