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Sample records for apca african palliative

  1. Outcomes 'out of africa': the selection and implementation of outcome measures for palliative care in Africa

    Directory of Open Access Journals (Sweden)

    Downing Julia

    2012-01-01

    Full Text Available Abstract Background End-of-life care research across Africa is under-resourced and under-developed. A central issue in research in end-of-life care is the measurement of effects and outcomes of care on patients and families. Little is known about the experiences of health professionals' selection and implementation of outcome measures (OM in clinical care, research, audit, or teaching in Africa. Methods An online survey was undertaken of those using outcome measures across the region, as part of the PRISMA project. A questionnaire addressing the use of OMs was developed for a similar survey in Europe and adapted for Africa. Participants were sampled through the contacts database of APCA. Invitation emails were sent out in January 2010 and reminders in February 2010. Results 168/301 invited contacts (56% from 24 countries responded, with 78 respondents having previously used OM (65% in clinical practice, 12% in research and 23% for both. Main reasons for not using OM were a lack of guidance/training on using and analysing OM, with 49% saying that they would use the tools if this was provided. 40% of those using OM in clinical practice used POS, and 80% used them to assess, evaluate and monitor change. The POS was also the main tool used in research, with the principle criteria for use being validation in Africa, access to the tool and time needed to complete it. Challenges to the use of tools were shortage of time and resources, lack of guidance and training for the professionals, poor health status of patients and complexity of OM. Researchers also have problems analysing OM data. The APCA African POS was the most common version of the POS used, and was reported as a valuable tool for measuring outcomes. Respondents indicated the ideal outcome tool should be short, multi-dimensional and easy to use. Conclusion This was the first survey on professionals' views on OM in Africa. It showed that the APCA African POS was the most frequently OM used

  2. [Cultural approach in nursing care of North African Muslims needing palliative care].

    Science.gov (United States)

    Lepain, Catherine

    2003-03-01

    Working in a multi-cultural medical establishment, concerning both patients and nursing staff, calls for deliberations regarding the intercultural as well as palliative approach in nursing care. These deliberations are: 1) intra-personal, in questioning the nursing staff on his/her values, beliefs, convictions, personal culture and identity, as well as opinions regarding health, illness and death. 2) Interpersonal, in recognizing the other person through his/her culture, values, individuality, while taking into account his/her opinions on health, illness and death. The goal of this project is to initiate this intercultural approach by first studying the culture from the perspective of North African Muslims currently hospitalized. It will develop in three steps: The first step to consider consists in training health-care professionals. The second step will lead to the preparation of pedagogical support concerning "nursing care and North African culture". The third step should significantly demonstrate the intercultural approach in clinical nursing procedures. In the future, the project's aim should progress towards a health-care collaboration in which each patient feels implicated regardless of his/her condition, culture, beliefs, education or lifestyle. PMID:12749094

  3. End-of-life experiences and expectations of Africans in Australia: cultural implications for palliative and hospice care.

    Science.gov (United States)

    Hiruy, Kiros; Mwanri, Lillian

    2014-03-01

    The ageing and frail migrants who are at the end of life are an increasing share of migrants living in Australia. However, within such populations, information about end-of-life experiences is limited, particularly among Africans. This article provides some insights into the sociocultural end-of-life experiences of Africans in Australia and their interaction with the health services in general and end-of-life care in particular. It provides points for discussion to consider an ethical framework that include Afro-communitarian ethical principles to enhance the capacity of current health services to provide culturally appropriate and ethical care. This article contributes to our knowledge regarding the provision of culturally appropriate and ethical care to African patients and their families by enabling the learning of health service providers to improve the competence of palliative care systems and professionals in Australia. Additionally, it initiates the discussion to highlight the importance of paying sufficient attention to a diverse range of factors including the migration history when providing palliative and hospice care for patients from African migrant populations.

  4. Palliative care and support for persons with HIV/AIDS in 7 African countries: implementation experience and future priorities.

    Science.gov (United States)

    Alexander, Carla S; Memiah, Peter; Henley, Yvonne B; Kaiza-Kangalawe, Angela; Shumbusho, Anna Joyce; Obiefune, Michael; Enejoh, Victor; Stanis-Ezeobi, Winifred; Eze, Charity; Odion, Ehekhaye; Akpenna, Donald; Effiong, Amana; Miriti, Kenneth; Aduda, Samson; Oko, John; Melaku, Gebremedhin D; Baribwira, Cyprien; Umutesi, Hassina; Shimabale, Mope; Mugisa, Emmanuel; Amoroso, Anthony

    2012-06-01

    To combat morbidity and mortality from the worldwide epidemic of the human immunodeficiency virus (HIV), the United States Congress implemented a President's Emergency Plan for AIDS Relief (PEPFAR) in 30 resource-limited countries to integrate combination antiretroviral therapy (ART) for both prevention and cure. Over 35% of eligible persons have been successfully treated. Initial legislation cited palliative care as an essential aspect of this plan but overall health strengthening became critical to sustainability of programming and funding priorities shifted to assure staffing for care delivery sites; laboratory and pharmaceutical infrastructure; data collection and reporting; and financial management as individual countries are being encouraged to assume control of in-country funding. Given infrastructure requisites, individual care delivery beyond ART management alone has received minimal funding yet care remains necessary for durable viral suppression and overall quality of life for individuals. Technical assistance staff of one implementing partner representing seven African countries met to clarify domains of palliative care compared with the substituted term "care and support" to understand potential gaps in on-going HIV care. They prioritized care needs as: 1) mental health (depression and other mood disorders); 2) communication skills (age-appropriate disclosure of HIV status); 3) support of care-providers (stress management for sustainability of a skilled HIV workforce); 4) Tied Priorities: symptom management in opportunistic infections; end-of-life care; spiritual history-taking; and 5) Tied Priorities: attention to grief-related needs of patients, their families and staff; and management of HIV co-morbidities. This process can inform health policy as funding transitions to new priorities.

  5. Best practices in developing a national palliative care policy in resource limited settings: lessons from five African countries.

    Science.gov (United States)

    Luyirika, Emmanuel Bk; Namisango, Eve; Garanganga, Eunice; Monjane, Lidia; Ginindza, Ntombi; Madonsela, Gugulethu; Kiyange, Fatia

    2016-01-01

    Given the high unmet need for palliative care in Africa and other resource limited settings, it is important that countries embrace the public health approach to increasing access through its integration within existing healthcare systems. To give this approach a strong foundation that would ensure sustainability, the World Health Organisation urges member states to ensure that policy environments are suitable for this intervention. The development, strengthening, and implementation of national palliative care policies is a priority. Given the lack of a critical mass of palliative care professionals in the region and deficiency in documenting and sharing best practices as part of information critical for regional development, policy development becomes a complex process. This article shares experiences with regard to best practices when advocating the national palliative care policies. It also tells about policy development process, the important considerations, and cites examples of policy content outlines in Africa. PMID:27563347

  6. Best practices in developing a national palliative care policy in resource limited settings: lessons from five African countries.

    Science.gov (United States)

    Luyirika, Emmanuel Bk; Namisango, Eve; Garanganga, Eunice; Monjane, Lidia; Ginindza, Ntombi; Madonsela, Gugulethu; Kiyange, Fatia

    2016-01-01

    Given the high unmet need for palliative care in Africa and other resource limited settings, it is important that countries embrace the public health approach to increasing access through its integration within existing healthcare systems. To give this approach a strong foundation that would ensure sustainability, the World Health Organisation urges member states to ensure that policy environments are suitable for this intervention. The development, strengthening, and implementation of national palliative care policies is a priority. Given the lack of a critical mass of palliative care professionals in the region and deficiency in documenting and sharing best practices as part of information critical for regional development, policy development becomes a complex process. This article shares experiences with regard to best practices when advocating the national palliative care policies. It also tells about policy development process, the important considerations, and cites examples of policy content outlines in Africa.

  7. Team networking in palliative care

    Directory of Open Access Journals (Sweden)

    Odette Spruyt

    2011-01-01

    Full Text Available "If you want to travel quickly, go alone. But if you want to travel far, you must go together". African proverb. The delivery of palliative care is often complex and always involves a group of people, the team, gathered around the patient and those who are close to them. Effective communication and functional responsive systems of care are essential if palliative care is to be delivered in a timely and competent way. Creating and fostering an effective team is one of the greatest challenges for providers of palliative care. Teams are organic and can be life giving or life sapping for their members.

  8. Palliative Care

    Science.gov (United States)

    Palliative care is treatment of the discomfort, symptoms, and stress of serious illness. It provides relief from distressing symptoms ... of the medical treatments you're receiving. Hospice care, care at the end of life, always includes ...

  9. Palliative Chemotherapy.

    Science.gov (United States)

    Matzo, Marianne

    2016-06-01

    This article is the first in a series on palliative care developed in collaboration with the Hospice and Palliative Nurses Association (HPNA; http://hpna.advancingexpertcare.org). The HPNA aims to guide nurses in preventing and relieving suffering and in giving the best possible care to patients and families, regardless of the stage of disease or the need for other therapies. The HPNA offers education, certification, advocacy, leadership, and research. PMID:27227867

  10. Symptom Clusters in People Living with HIV Attending Five Palliative Care Facilities in Two Sub-Saharan African Countries: A Hierarchical Cluster Analysis.

    Directory of Open Access Journals (Sweden)

    Katrien Moens

    Full Text Available Symptom research across conditions has historically focused on single symptoms, and the burden of multiple symptoms and their interactions has been relatively neglected especially in people living with HIV. Symptom cluster studies are required to set priorities in treatment planning, and to lessen the total symptom burden. This study aimed to identify and compare symptom clusters among people living with HIV attending five palliative care facilities in two sub-Saharan African countries.Data from cross-sectional self-report of seven-day symptom prevalence on the 32-item Memorial Symptom Assessment Scale-Short Form were used. A hierarchical cluster analysis was conducted using Ward's method applying squared Euclidean Distance as the similarity measure to determine the clusters. Contingency tables, X2 tests and ANOVA were used to compare the clusters by patient specific characteristics and distress scores.Among the sample (N=217 the mean age was 36.5 (SD 9.0, 73.2% were female, and 49.1% were on antiretroviral therapy (ART. The cluster analysis produced five symptom clusters identified as: 1 dermatological; 2 generalised anxiety and elimination; 3 social and image; 4 persistently present; and 5 a gastrointestinal-related symptom cluster. The patients in the first three symptom clusters reported the highest physical and psychological distress scores. Patient characteristics varied significantly across the five clusters by functional status (worst functional physical status in cluster one, p<0.001; being on ART (highest proportions for clusters two and three, p=0.012; global distress (F=26.8, p<0.001, physical distress (F=36.3, p<0.001 and psychological distress subscale (F=21.8, p<0.001 (all subscales worst for cluster one, best for cluster four.The greatest burden is associated with cluster one, and should be prioritised in clinical management. Further symptom cluster research in people living with HIV with longitudinally collected symptom data to

  11. Oncology and palliative care

    OpenAIRE

    Bausewein, Claudia; Hartenstein, R.

    2000-01-01

    Oncology developed as a discipline over the last decades. Treatment is concentrated on cure or palliation of the illness with the help of chemotherapy, radiotherapy or surgery. Palliative care has its origin in the hospice movement that started around 1960 in the UK. Centre of care is the patient and his family. Focus of care has moved from quantity to quality of life. Symptom control, communication, rehabilitation and care for the dying are main areas of palliative care. Palliative care and ...

  12. Pediatric Palliative Care

    OpenAIRE

    Johnston, Donna L.; Hentz, Tracy A.; Friedman, Debra L.

    2005-01-01

    Pediatric palliative care provides benefit to children living with life-threatening or terminal conditions. Palliative care should be available to all seriously ill children. Palliative care includes the treatment of symptoms such as pain, nausea, dyspnea, constipation, anorexia, and sialorrhea. This care can occur in a variety of settings, from home to hospice to hospital, and must include bereavement care and follow up after the death of a child. There are many challenges in pediatric palli...

  13. [Palliative care in neurology].

    Science.gov (United States)

    Provinciali, Leandro; Tarquini, Daniela; De Falco, Fabrizio A; Carlini, Giulia; Zappia, Mario; Toni, Danilo

    2015-07-01

    Palliative care in neurology is characterized by the need of taking into account some distinguishing features which supplement and often differ from the general palliative approach to cancer or to severe organ failures. Such position is emphasized by a new concept of palliative assistance which is not limited to the "end of life" stage, as it was the traditional one, but is applied along the entire course of progressive, life-limiting, and disabling conditions. There are various reasons accounting for a differentiation of palliative care in neurology and for the development of specific expertise; the long duration of the advanced stages of many neurological diseases and the distinguishing features of some clinical problems (cognitive disorders, psychic disorders, etc.), in addition to the deterioration of some general aspects (nutrition, etc.), make the general criteria adopted for cancer, severe respiratory, hepatic or renal failures and heart failure inadequate. The neurological diseases which could benefit from the development of a specific palliative approach are dementia, cerebrovascular diseases, movement disorders, neuromuscular diseases, severe traumatic brain injury, brain cancers and multiple sclerosis, as well as less frequent conditions. The growing literature on palliative care in neurology provides evidence of the neurological community's increasing interest in taking care of the advanced and terminal stages of nervous system diseases, thus encouraging research, training and updating in such direction. This document aims to underline the specific neurological requirements concerning the palliative assistance. PMID:26228722

  14. Future of palliative medicine

    Directory of Open Access Journals (Sweden)

    Sushma Bhatnagar

    2015-01-01

    Full Text Available A ′need-supply′ and ′requirement-distribution mismatch′ along with a continuingneed explosion are the biggest hurdles faced by palliative medicine today. It is the need of the hour to provide an unbiased, equitable and evidence-based palliative care to those in need irrespective of the diagnosis, prognosis, social and economic status or geographical location. Palliative care as a fundamental human right, ensuring provision throughout the illness spectrum, global as well as region-specific capacity building, uniform availability of essential drugs at an affordable price, a multidisciplinary team approachand caregiver-support are some of the achievable goals for the future. This supplanted with a strong political commitment, professional dedication and ′public-private partnerships′ are necessaryto tackle the existing hurdles and the exponentially increasing future need. For effectively going ahead it is of utmost importance to integrate palliative medicine into medical education, healthcare system and societal framework.

  15. What is palliative care?

    Science.gov (United States)

    ... Living Wills: A Guide to Advance Directives, the Health Care Power of Attorney, and Other Key Documents . Cambridge, MA: Harvard Health Publications. 2013. Oxenham D. Palliative care and pain. ...

  16. Center to Advance Palliative Care

    Science.gov (United States)

    ... Catalogue Membership Brochure Join CAPC Central Registry National Palliative Care Registry™ Enter your data to improve performance, prove ... Log In to register Billing for Community-Based Palliative Care Virtual Office Hour Anne E. Monroe, MHA October ...

  17. Palliative care in Enugu, Nigeria: Challenges to a new practice

    Directory of Open Access Journals (Sweden)

    Tonia C Onyeka

    2011-01-01

    Full Text Available Everyone, young and old, male and female, rich and poor, should have access to excellent care during the course of a serious illness and at the end of life. Therefore, a denial of such care becomes an infringement of the individual′s human rights. Because of the efforts of pioneers in this field of Medicine in Africa and beyond, both living and immortalized, we can now say that palliative care in the African context is affordable and achievable. In this article, some of the challenges faced in setting up and running a new palliative care practice in an emerging and developing economy are examined.

  18. Inter-Professional Palliative Care

    DEFF Research Database (Denmark)

    Madsen, Kirsten Halskov; Henriksen, Jette; Meldgaard, Anette

    2013-01-01

    Chapter 11 by Kirsten Halskov Madsen, Anette Meldgaard and Jette Henriksen deals with the development of palliative care programmes aimed at the basic level of palliative care practice. The need to develop educational opportunities at particularly this level – described as ‘the basic inter......-professional level of palliative care’ – has been increasing for many years where palliative care has conventionally and primarily been associated with specialist training. As the authors show – based on a mapping out of existing educational initiatives in a region of Denmark, a reading of the curriculum...... and a description of the organization of palliative care – there is a need for such inter-professional palliative care that raises the level of competences at the basic level and the sharing of knowledge as well as securing the continuous qualifying of healthcare staff working with palliative care....

  19. Palliative care and spirituality

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    Narayanasamy Aru

    2007-01-01

    Full Text Available Critical junctures in patients′ lives such as chronic illnesses and advanced diseases may leave the persons in a state of imbalance or disharmony of body, mind and spirit. With regard to spirituality and healing, there is a consensus in literature about the influence of spirituality on recovery and the ability to cope with and adjust to the varying and demanding states of health and illness. Empirical evidence suggests that spiritual support may act as an adjunct to the palliative care of those facing advanced diseases and end of life. In this article, the author draws from his empirical work on spirituality and culture to develop a discourse on palliative care and spirituality in both secular and non-secular settings. In doing so, this paper offers some understanding into the concept of spirituality, spiritual needs and spiritual care interventions in palliative care in terms of empirical evidence. Responding to spiritual needs could be challenging, but at the same time it could be rewarding to both healthcare practitioner (HCP and patient in that they may experience spiritual growth and development. Patients may derive great health benefits with improvements in their quality of life, resolutions and meaning and purpose in life. It is hoped that the strategies for spiritual support outlined in this paper serve as practical guidelines to HCPs for development of palliative care in South Asia.

  20. Palliation:Hilar cholangiocarcinoma

    Institute of Scientific and Technical Information of China (English)

    Mahesh; Kr; Goenka; Usha; Goenka

    2014-01-01

    Hilar cholangiocarcinomas are common tumors of the bile duct that are often unresectable at presentation. Palliation, therefore, remains the goal in the majority of these patients. Palliative treatment is particularly indicated in the presence of cholangitis and pruritus but is often also offered for high-grade jaundice and abdominal pain. Endoscopic drainage by placing stents at endoscopic retrograde cholangio-pancreatography(ERCP) is usually the preferred modality of palliation. However, for advanced disease, percutaneous stenting has been shown to be superior to endoscopic stenting. Endosonography-guided biliary drainage is emerging as an alternative technique, particularly when ERCP is not possible or fails. Metal stents are usually preferred over plastic stents, both for ERCP and for percutaneous bili-ary drainage. There is no consensus as to whether it is necessary to place multiple stents within advanced hi-lar blocks or whether unilateral stenting would suffice. However, recent data have suggested that, contrary to previous belief, it is useful to drain more than 50% of the liver volume for favorable long-term results. In the presence of cholangitis, it is beneficial to drain all of the obstructed biliary segments. Surgical bypass plays a limited role in palliation and is offered primarily as asegment Ⅲ bypass if, during a laparotomy for resec-tion, the tumor is found to be unresectable. Photody-namic therapy and, more recently, radiofrequency abla-tion have been used as adjuvant therapies to improve the results of biliary stenting. The exact technique to be used for palliation is guided by the extent of the bili-ary involvement(Bismuth class) and the availability of local expertise.

  1. Generalist palliative care in hospital

    DEFF Research Database (Denmark)

    Bergenholtz, Heidi; Jarlbæk, Lene; Hølge-Hazelton, Bibi

    2016-01-01

    Background: It can be challenging to provide generalist palliative care in hospitals, owing to difficulties in integrating disease-orientedtreatment with palliative care and the influences of cultural and organisational conditions. However, knowledge on the interactionsthat occur is sparse. Aim......: To investigate the interactions between organisation and culture as conditions for integrated palliative care in hospital and, ifpossible, to suggest workable solutions for the provision of generalist palliative care. Design: A convergent parallel mixed-methods design was chosen using two independent studies...... hospital with 29 department managements and one hospital management. Results: Two overall themes emerged: (1) ‘generalist palliative care as a priority at the hospital’, suggesting contrasting issues regardingprioritisation of palliative care at different organisational levels, and (2) ‘knowledge and use...

  2. Pediatric palliative care

    OpenAIRE

    Trapanotto Manuela; Spizzichino Marco; Benini Franca; Ferrante Anna

    2008-01-01

    Abstract The WHO defines pediatric palliative care as the active total care of the child's body, mind and spirit, which also involves giving support to the family. Its purpose is to improve the quality of life of young patients and their families, and in the vast majority of cases the home is the best place to provide such care, but for cultural, affective, educational and organizational reasons, pediatric patients rarely benefit from such an approach. In daily practice, it is clear that pedi...

  3. Cancer and the African American Experience

    Science.gov (United States)

    The first plenary of the EPEC-O (Education in Palliative and End-of-Life Care for Oncology) Self-Study: Cultural Considerations When Caring for African Americans explores the many factors that lead to inequalities in cancer care outcomes for African Americans.

  4. Renal palliative care.

    Science.gov (United States)

    Cohen, Lewis M; Moss, Alvin H; Weisbord, Steven D; Germain, Michael J

    2006-08-01

    Patients with chronic kidney disease have a shortened life expectancy and carry a high symptom burden. Clinicians need sophisticated expertise in pain and symptom management and skills in communication to meet the many needs of this population. This article reviews the literature and discusses prognosis, ethical and legal considerations, symptoms, treatment, and end-of-life issues. The field of nephrology is shifting from an exclusive focus on increasing survival to one that provides greater attention to quality of life. There is an opportunity to integrate many of the advances of palliative medicine into the comprehensive treatment of these patients.

  5. Integrating Palliative Care into Primary Care.

    Science.gov (United States)

    Gorman, Rosemary D

    2016-09-01

    Improved quality of life, care consistent with patient goals of care, and decreased health care spending are benefits of palliative care. Palliative care is appropriate for anyone with a serious illness. Advances in technology and pharmaceuticals have resulted in increasing numbers of seriously ill individuals, many with a high symptom burden. The numbers of individuals who could benefit from palliative care far outweighs the number of palliative care specialists. To integrate palliative care into primary care it is essential that resources are available to improve generalist palliative care skills, identify appropriate patients and refer complex patients to specialist palliative care providers.

  6. [Palliative care for glioblastoma].

    Science.gov (United States)

    Dieudonné, Nathalie; De Micheli, Rita; Hottinger, Andreas

    2016-04-27

    Patients with glioblastoma have a limited life expectancy and an impaired quality of life and they should be offered palliative care soon after the diagnosis is established. Still, only a quarter of patients aged over 65 return home or medical institution after completing treatments. Home care must be promoted by coordinating assistance and care, combining disciplines such as physiotherapy and ergotherapy, medical and nursing care and psychosocial support. Patients are at risk of mood, personality and behavioural disorders. Limited awareness of these troubles and their physical limitations alter their capacity of rehabilitation and social relationships. Isolation of relatives, exhaustion and misunderstandings should be prevented. The therapeutic goals should be discussed and determined upstream to anticipate difficulties and questions concerning end of life. PMID:27281945

  7. What is Pediatric Palliative Care?

    Science.gov (United States)

    ... communication and coordination of care. With the close communication that palliative care provides, families are better able to choose options that are in line with their values, traditions and culture. This improves the well-being of the entire ...

  8. Palliative Procedures in Lung Cancer

    OpenAIRE

    Masuda, Emi; Sista, Akhilesh K.; Pua, Bradley B.; Madoff, David C.

    2013-01-01

    Palliative care aims to optimize comfort and function when cure is not possible. Image-guided interventions for palliative treatment of lung cancer is aimed at local control of advanced disease in the affected lung, adjacent mediastinal structures, or distant metastatic sites. These procedures include endovascular therapy for superior vena cava syndrome, bronchial artery embolization for hemoptysis associated with lung cancer, and ablation of osseous metastasis. Pathophysiology, clinical pres...

  9. When palliative treatment achieves more than palliation: Instances of long-term survival after palliative radiotherapy

    Directory of Open Access Journals (Sweden)

    Madhup Rastogi

    2012-01-01

    Full Text Available Context: Palliative radiotherapy aims at symptom alleviation and improvement of quality of life. It may be effective in conferring a reasonable quantum of local control, as well as possibly prolonging survival on the short term. However, there can be rare instances where long-term survival, or even cure, results from palliative radiotherapy, which mostly uses sub-therapeutic doses. Aim: To categorize and characterize the patients with long-term survival and/or cure after palliative radiotherapy. Materials and Methods: This study is a retrospective analysis of hospital records of patients treated with palliative radiotherapy from 2001 to 2006 at the Regional Cancer Centre, Shimla. Results: Of the analyzed 963 patients who received palliative radiotherapy, 2.4% (n = 23 survived at least 5 years, with a large majority of these surviving patients (73.9%, n = 17 being free of disease. Conclusions: In addition to providing valuable symptom relief, palliative radiotherapy utilizing sub-therapeutic doses may, in a small proportion of patients, bestow long-term survival, and possibly cure. Rationally, such a favorable, but rare outcome cannot be expected with supportive care alone.

  10. In vivo Reconstitution of ApcA and CpcA from Synechocystis sp PCC 6803%集胞藻ApcA和CpcA的体内生物重组研究

    Institute of Scientific and Technical Information of China (English)

    刁红丽; 周婷; 赵开弘

    2011-01-01

    利用聚合酶链式反应(PCR)克隆出集胞藻Synechocystis sp.PCC 6803变藻蓝蛋白和藻蓝蛋白α亚基的编码基因apcA和cpcA,将脱辅基蛋白ApcA、CpcA分别与裂合酶CpeSl或CpcE/F以及血红素氧化酶HO1、胆绿素还原酶PcyA在大肠杆茵中共同表达.研究表明:通过大肠杆菌体内重组可以获得具有光学活性的重组色素蛋白PCB-ApcA和PCB-CpcA.吸收光谱、荧光光谱以及锌电泳均表明,藻蓝胆素与脱辅基蛋白形成了正确的共价连接.由此可知,利用大肠杆菌进行集胞藻藻蓝蛋白和变藻蓝蛋白α亚基的体内生物合成是可实现的.同时还时重组色素蛋白的摩尔消光系数和荧光量子产率进行了计算.%Genes of a-subunit of allophycocyanin and phycocyanin (apcA and cpcA) from Synechocystis sp.PCC 6803 were cloned by PCR and expressed in E.coli.ApcA and CpcA were coexpressed in E.coli with heme oxygenase and 3Zphycocyanobilin: ferredoxin oxidoreductase (HO1 and PcyA) and lyase (CpeS1 or CpcE/F) through in vivo reconstitution tests.All results from SDS-PAGE of Zn2+-induced fluorescence,absorption and fluorescence spectra showed that ApcA and CpcA could bind covalently phycocyanobilin (PCB) in E.coli and in vivo biosynthesis of a-subunit of phycocyanin and allophycocyanin from Synechocystis sp.PCC 6803 was practicable.Molar extinction coefficient and fluorescence quantum yield of reconstitution chromoproteins were calculated in the paper.

  11. Pediatric Palliative Care: A Personal Story

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    Full Text Available ... count__/__total__ Find out why Close Pediatric Palliative Care: A Personal Story NINRnews Subscribe Subscribed Unsubscribe 242 ... and her family. The story demonstrates how palliative care can positively influence a patient's and family's experience ...

  12. Pediatric Palliative Care: A Personal Story

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    Full Text Available ... count__/__total__ Find out why Close Pediatric Palliative Care: A Personal Story NINRnews Subscribe Subscribed Unsubscribe 240 ... and her family. The story demonstrates how palliative care can positively influence a patient's and family's experience ...

  13. Pediatric Palliative Care: A Personal Story

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    Full Text Available ... count__/__total__ Find out why Close Pediatric Palliative Care: A Personal Story NINRnews Subscribe Subscribed Unsubscribe 245 ... and her family. The story demonstrates how palliative care can positively influence a patient's and family's experience ...

  14. Palliative Care: What You Should Know

    Science.gov (United States)

    ... Palliative care is provided by a team of doctors, nurses, and other specialists who work together with a ... help you. 3 ? Ask for it! Tell your doctors, nurses, family and caregivers that you want palliative care. ...

  15. Pediatric Palliative Care: A Personal Story

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    Full Text Available ... count__/__total__ Find out why Close Pediatric Palliative Care: A Personal Story NINRnews Subscribe Subscribed Unsubscribe 243 ... and her family. The story demonstrates how palliative care can positively influence a patient's and family's experience ...

  16. Pediatric Palliative Care: A Personal Story

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  17. Pediatric Palliative Care: A Personal Story

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  18. Pediatric Palliative Care: A Personal Story

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  19. Pediatric Palliative Care: A Personal Story

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  20. Pediatric Palliative Care: A Personal Story

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    ... Queue __count__/__total__ Find out why Close Pediatric Palliative Care: A Personal Story NINRnews Subscribe Subscribed Unsubscribe 270 ... patient—and her family. The story demonstrates how palliative care can positively influence a patient's and family's experience ...

  1. Pediatric Palliative Care: A Personal Story

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    Full Text Available ... count__/__total__ Find out why Close Pediatric Palliative Care: A Personal Story NINRnews Subscribe Subscribed Unsubscribe 249 ... and her family. The story demonstrates how palliative care can positively influence a patient's and family's experience ...

  2. Pediatric Palliative Care: A Personal Story

    Medline Plus

    Full Text Available ... count__/__total__ Find out why Close Pediatric Palliative Care: A Personal Story NINRnews Subscribe Subscribed Unsubscribe 241 ... and her family. The story demonstrates how palliative care can positively influence a patient's and family's experience ...

  3. Palliative Care Doula: an innovative model.

    Science.gov (United States)

    Lentz, Judy C

    2014-01-01

    Walking the journey of serious illness is very difficult and stressful for patients and families. A universal principle of palliative care is caring for the patient/ family unit. This article introduces a model for the Palliative Care Doula for experienced and advanced practice palliative care nurses to support patients and families during the traumatic and vulnerable period of end-of-life care.

  4. Pain management: lessons from palliative care.

    Science.gov (United States)

    Langlois, John P

    2013-01-01

    Reducing suffering and helping patients to control their symptoms are key components of palliative care. This commentary will offer a comprehensive definition of palliative care and will present a case history to illustrate how palliative care can benefit patients with chronic pain.

  5. Pediatric palliative care

    Directory of Open Access Journals (Sweden)

    Trapanotto Manuela

    2008-12-01

    Full Text Available Abstract The WHO defines pediatric palliative care as the active total care of the child's body, mind and spirit, which also involves giving support to the family. Its purpose is to improve the quality of life of young patients and their families, and in the vast majority of cases the home is the best place to provide such care, but for cultural, affective, educational and organizational reasons, pediatric patients rarely benefit from such an approach. In daily practice, it is clear that pediatric patients experience all the clinical, psychological, ethical and spiritual problems that severe, irreversible disease and death entail. The international literature indicates a prevalence of incurable disease annually affecting 10/10,000 young people from 0 to 19 years old, with an annual mortality rate of 1/10,000 young people from birth to 17 years old. The needs of this category of patients, recorded in investigations conducted in various parts of the world, reveal much the same picture despite geographical, cultural, organizational and social differences, particularly as concerns their wish to be treated at home and the demand for better communications between the professionals involved in their care and a greater availability of support services. Different patient care models have been tested in Italy and abroad, two of institutional type (with children staying in hospitals for treating acute disease or in pediatric hospices and two based at home (the so-called home-based hospitalization and integrated home-based care programs. Professional expertise, training, research and organization provide the essential foundations for coping with a situation that is all too often underestimated and neglected.

  6. Palliative radiotherapy for multiple myeloma

    International Nuclear Information System (INIS)

    This study reviews the experience of palliative radiotherapy to patients with multiple myeloma to define the optimal dose for pain relief. The records of 31 patients (66 sites) with multiple myeloma irradiated for palliation at Kumamoto University hospital between 1985 and 1994 were reviewed. Total dose ranged from 8 to 50 Gy, with a mean of 32.2 Gy. Symptoms included pain (78.1%), neurological abnormalities (28.1%), and palpable masses (34.3%). Symptomatic remission was obtained in 45 of 46 evaluable sites (97.8%). Complete remission of symptoms were obtained in 28.3%, and partial remission in 69.6%. According to fraction size, there was no significant difference between 3-5 Gy and 1.8-2 Gy. The incidence of complete remission increased when a total dose of more than 20 Gy was given. When the quality of life is considered, hypofractionation was recommended for the palliative radiation therapy of multiple myeloma. (author)

  7. Rawlsian Justice and Palliative Care

    DEFF Research Database (Denmark)

    Knight, Carl; Albertsen, Andreas

    2015-01-01

    Palliative care serves both as an integrated part of treatment and as a last effort to care for those we cannot cure. The extent to which palliative care should be provided and our reasons for doing so have been curiously overlooked in the debate about distributive justice in health and healthcare...... to provide pain relief to those who need it as a supplement to treatment and, without justice-based reasons to provide palliative care to those whose opportunities cannot be restored. We conclude that this makes Daniels' framework much less attractive........ We argue that one prominent approach, the Rawlsian approach developed by Norman Daniels, is unable to provide such reasons and such care. This is because of a central feature in Daniels' account, namely that care should be provided to restore people's opportunities. Daniels' view is both unable...

  8. Palliative medicine and medical oncology.

    Science.gov (United States)

    Maltoni, M; Amadori, D

    2001-04-01

    Traditionally, medical oncology and palliative care have been considered two distinct and separate disciplines, both as regards treatment objectives and delivery times. Palliative care in terminal stages, aimed exclusively at evaluating and improving quality of life, followed antitumor therapies, which concentrated solely on quantitative results (cure, prolongation of life, tumoral mass shrinkage). Over the years, more modern concepts have developed on the subject. Medical oncology, dealing with the skills and strategic co-ordination of oncologic interventions from primary prevention to terminal phases, should also include assessment and treatment of patients' subjective needs. Anticancer therapies should be evaluated in terms of both the quantitative and qualititative impact on patients' lives. Hence, the traditional view of palliative care has to be modified: it constitutes a philosophical and methodological approach to be adopted from the early phases of illness. It is not the evident cultural necessity of integrating medical oncology with palliative medicine that may be a matter of argument, but rather the organizational models needed to put this combined care into practice: should continuous care be guaranteed by a single figure, the medical oncologist, or rather by an interdisciplinary providers' team, including full-time doctors well-equipped for palliative care? In this paper the needs of cancer patients and the part that a complete oncologist should play to deal with such difficult and far-reaching problems are firstly described. Then, as mild provocation, data and critical considerations on the ever increasing needs of palliative care, the present shortcomings in quality of life and pain assessment and management by medical oncologists, and the uncertain efficacy of interventional programmes to change clinical practice are described. Finally, a model of therapeutic continuity is presented. which in our view is realistic and feasible: an Oncologic

  9. [Nutritional problems in palliative medicine].

    Science.gov (United States)

    Ollenschläger, G

    2000-09-01

    Malnutrition is a frequent problem in the palliative care of the seriously ill and dying. Want of appetite and los of weight are direct symptoms of patients with consumptive infectional diseases (AIDS, TBC) as well as cancer or geriatric patients. Severe malnutrition significantly contributes to a loss of quality of life and increases morbidity of palliative patients. The subjective well-being of seriously ill patients is heavily influenced by want of appetite and loss of weight. Patients often find want of appetite and the incapability to eat as pressing as the physical impairment caused by the disease. Therefore the sole aim of palliative dietotherapy has to be to strengthen the general physical and mental condition of the patient. A specific training of home care staff and relatives of seriously ill patients in dealing sensitively with this problem of care is desirable. Above all, in-patient treatment of affected patients for the sole purpose of feeding has to be avoided. Aggressive dietotherapeutic interventions, especially artificial feeding, should be refrained from as far as possible in the terminal phase. Only if the prognosis of a patient in palliative treatment is improving contrary to expectations are strategies of curative dietotherapy valid. PMID:11048342

  10. Analgesic prescribing in palliative care.

    Science.gov (United States)

    Lowe, Emma; Hanchanale, Sarika; Hurlow, Adam

    2014-12-01

    Pain management requires a multimodal approach involving pharmacological and non-pharmacological strategies. It is important to take a detailed history and examine the patient before prescribing any analgesia. This article focuses on assessment and management of pain in palliative care patients.

  11. [Palliative care in heart failure].

    Science.gov (United States)

    Gavazzi, Antonello; Svanoni, Fausto; De Maria, Renata

    2012-12-01

    The natural history of heart failure (HF) is characterized by a progressive decline in functional capacity, punctuated by acute heart destabilization episodes which contribute to a spiraling worsening course. Advanced HF affects one in four patients who are referred to the hospital for the syndrome and has an estimated yearly incidence of 12 000 new cases in Italy. Life expectancy is very limited, and in general less than 50% of advanced HF patients are alive at 1-2 years. Advanced HF patients show a high, not modifiable mortality, severe symptoms and impaired quality of life. Treatment goals should focus on the improvement of symptoms and quality of life, the aims of palliative care. Palliative consultations during hospital admissions reduce the number of interventions and procedures in the last stages of life, the length of stay in the intensive care unit and general ward. HF patients who receive home palliative care are more likely to die at home, in accordance with their expressed will. The research project RF-MAR-2007-67955 aims to analyze, through a prospective observational registry, the palliative care needs of HF patients in Italy, to answer the gaps in knowledge on symptom changes during the terminal stages of the disease, on the quality of communication between healthcare professionals, patients and their families and caregivers' needs.

  12. Cultural Considerations When Caring for African Americans

    Science.gov (United States)

    The EPEC-O (Education in Palliative and End-of-Life Care for Oncology) Self-Study: Cultural Considerations When Caring for African Americans is a free comprehensive multimedia curricula for health professionals caring for persons with cancer and their families.

  13. Undergraduate curricula in palliative medicine: a systematic analysis based on the palliative education assessment tool.

    LENUS (Irish Health Repository)

    Schiessi, C

    2013-01-01

    By law in 2013, palliative medicine will be integrated into the undergraduate curriculum as part of a mandatory training program and examinations at German medical schools. For this reason a national curriculum in palliative medicine has to be developed.

  14. Smartphone applications in palliative homecare

    Directory of Open Access Journals (Sweden)

    Sunil R Dhiliwal

    2015-01-01

    Full Text Available Smartphone applications in healthcare delivery are a novel concept and is rapidly gaining ground in all fields of medicine. The modes of e-communications such as e-mail, short message service (SMS, multimedia messaging service (MMS and WhatsApp in palliative care provides a means for quick tele-consultation, information sharing, cuts the waiting time and facilitates initiation of the treatment at the earliest. It also forms a means of communication with local general practitioner and local health care provider such that continuity of the care is maintained. It also minimizes needless transport of the patient to hospital, prevents needless hospitalization and investigations and minimizes cost and logistics involved in the care process. The two case studies provided highlights the use of smartphone application like WhatsApp in palliative care practice and demonstrates its utility.

  15. Palliative Care and Death Anxiety

    Directory of Open Access Journals (Sweden)

    Figen Inci

    2012-06-01

    Full Text Available Diminishing treatment alternatives, losing hope for a possible recovery, insufficient control of pain and inability to provide the necessary technical support lead palliative care to bring multiple problems with itself. Along with technical and professional challenges, palliative care can put a humanitarian strain on the nurse. Caring for a dying patient is a worrisome experience which causes spiritual pain. An increase in nurses’ death anxiety may cause unwillingness to be together with a dying patient. In terms of the end of life, it is expected that the nurse stands by patient’s family to help them in sustaining their psychosocial wellness. In order to meet this expectation, nurses should get a qualitative training for end of life care along with good interpersonal communication skills and coping strategies.

  16. Smartphone applications in palliative homecare.

    Science.gov (United States)

    Dhiliwal, Sunil R; Salins, Naveen

    2015-01-01

    Smartphone applications in healthcare delivery are a novel concept and is rapidly gaining ground in all fields of medicine. The modes of e-communications such as e-mail, short message service (SMS), multimedia messaging service (MMS) and WhatsApp in palliative care provides a means for quick tele-consultation, information sharing, cuts the waiting time and facilitates initiation of the treatment at the earliest. It also forms a means of communication with local general practitioner and local health care provider such that continuity of the care is maintained. It also minimizes needless transport of the patient to hospital, prevents needless hospitalization and investigations and minimizes cost and logistics involved in the care process. The two case studies provided highlights the use of smartphone application like WhatsApp in palliative care practice and demonstrates its utility.

  17. Palliative Care Doula: an innovative model.

    Science.gov (United States)

    Lentz, Judy C

    2014-01-01

    Walking the journey of serious illness is very difficult and stressful for patients and families. A universal principle of palliative care is caring for the patient/ family unit. This article introduces a model for the Palliative Care Doula for experienced and advanced practice palliative care nurses to support patients and families during the traumatic and vulnerable period of end-of-life care. PMID:25296488

  18. Palliative Care in Lung Cancer.

    Science.gov (United States)

    Shinde, Arvind M; Dashti, Azadeh

    2016-01-01

    Lung cancer is the most common cancer worldwide and is the leading cause of cancer death for both men and women in the USA. Symptom burden in patients with advanced lung cancer is very high and has a negative impact on their quality of life (QOL). Palliative care with its focus on the management of symptoms and addressing physical, psychosocial, spiritual, and existential suffering, as well as medically appropriate goal setting and open communication with patients and families, significantly adds to the quality of care received by advanced lung cancer patients. The Provisional Clinical Opinion (PCO) of American Society of Clinical Oncology (ASCO) as well as the National Cancer Care Network's (NCCN) clinical practice guidelines recommends early integration of palliative care into routine cancer care. In this chapter, we will provide an overview of palliative care in lung cancer and will examine the evidence and recommendations with regard to a comprehensive and interdisciplinary approach to symptom management, as well as discussions of goals of care, advance care planning, and care preferences. PMID:27535397

  19. Palliative Care in Musculoskeletal Oncology.

    Science.gov (United States)

    Gulia, Ashish; Byregowda, Suman; Panda, Pankaj Kumar

    2016-01-01

    Patients in advanced stages of illness trajectories with local and widespread musculoskeletal incurable malignancies, either treatment naive or having recurrence are referred to the palliative care clinic to relieve various disease-related symptoms and to improve the quality of life. Palliative care is a specialized medicine that offers treatment to the disease-specific symptoms, places emphasis on the psychosocial and spiritual aspects of life and help the patients and their family to cope with advance stage cancer in a stronger and reasonable way. The overall outcome of musculoskeletal malignancies has improved with the advent of multidisciplinary management. Even then these tumors do relapse and leads to organ failures and disease-specific deaths in children and young adults in productive age group thus requiring an integrated approach to improve the supportive/palliative care needs in end-stage disease. In this article, we would like to discuss the spectrum of presentation of advanced musculoskeletal malignancies, skeletal metastasis, and their management. PMID:27559251

  20. Working with a palliative care team.

    Science.gov (United States)

    Wiebe, Lauren A; Von Roenn, Jamie H

    2010-01-01

    The interdisciplinary team is fundamental to the successful delivery of quality palliative care. Ideally, the oncologist is an integral part of either the palliative care or hospice team and serves to maintain continuity of care through the end of life. In the United States, barriers can complicate the oncologist's easy integration into the hospice team as patients often remain at home. Also, there may be philosophical or clinical practice differences between oncology and palliative care at first glance. This article focuses on ways to overcome these potential obstacles and use differences in training to strengthen the team's impact. A significant part of oncology practice includes managing difficult symptoms, mitigating suffering, and discussing priorities of care--all elements of palliative medicine that oncologists perform daily. Participating on a palliative care team may be natural for oncologists, and some might elect to provide integrated palliative cancer care for patients throughout the course of their disease and at the end of life. Thus, there is a need to enrich the general oncologist's knowledge of specialized palliative medicine, as recommended by the major cancer organizations, including the American Society of Clinical Oncology and the European Society of Medical Oncology.It is important to know when to incorporate a palliative or hospice care team into the routine management of a cancer patient and what benefits these referrals can provide. Oncologists have an obligation to provide high-quality palliative care to all patients in an integrated fashion, including patients with advanced cancer enrolled in clinical trials for early therapeutics.

  1. Turkish healthcare professionals' views on palliative care.

    Science.gov (United States)

    Turgay, Gulay; Kav, Sultan

    2012-01-01

    The concept of modern palliative care has been disseminating slowly in Turkey and has recently been included in the National Cancer Control Program. The aim of this study was to explore healthcare professionals' knowledge and views of palliative care. It was conducted at three hospitals with a sample of 369 healthcare professionals working in adult clinics. Data were collected via open-ended questions and 16 statements from healthcare professionals on their views of palliative care. Most respondents stated that there was a lack of in-service/continuing education in palliative care, and more than half said they had not received any education in palliative care. A majority stated that the meaning and goal of palliative care is "improving the quality of life of a patient who is in the terminal stage." Lack of awareness of palliative care and a lack of educational resources in that field are the most frequently reported barriers to the development of palliative care in Turkey. Palliative care should be included in curricula for healthcare professionals and in-service education programs should be established. PMID:23413762

  2. Spirituality, religion and palliative care.

    Science.gov (United States)

    Richardson, Patrice

    2014-07-01

    As medical science has evolved, many conditions that once were thought to be "death sentences" have become chronic illness. In some ways, this makes death and dying more complicated, fraught with decisions about what care is appropriate and when to withhold or withdraw care. Studies have shown that most patients faced with life-threatening illness have spiritual needs that are not adequately addressed by their health care providers. The philosophy and practice of palliative care operates upon an understanding of whole person care, reflected in the muli-dimensional approach of the biopsychosocial model. One cannot provide whole-person care without giving consideration to the relevant spiritual needs held by patients with serious illness. As palliative care clinicians, we are uniquely positioned to work with teams/patients/families to explore the many variables that individuals and their families use as the guiding principles when making difficult decisions around end of life. While we are often consulted to manage physical symptoms, that is only part of our work. As we work on building relationships, both with our patients and their care team, we are often able to help facilitate communication that allows for mutually satisfactory goal setting. We are equipped to work with patients within their cultural contexts of which spirituality is a part. It is important to recognize the barriers to providing adequate spiritual care. The National Consensus Project has created clinical practice guidelines to provide a road map for the provision of quality palliative care. These guidelines delineate eight domains that are addressed through the provision of palliative care; the fifth domain gives attention to spiritual, religious and existential aspects of care. Guidelines recommend the use of standardized tools wherever possible to assess spiritual needs; referral to members of the interdisciplinary team who have specialized skills in addressing existential and spiritual

  3. Palliative sedation versus euthanasia: an ethical assessment.

    Science.gov (United States)

    ten Have, Henk; Welie, Jos V M

    2014-01-01

    The aim of this article was to review the ethical debate concerning palliative sedation. Although recent guidelines articulate the differences between palliative sedation and euthanasia, the ethical controversies remain. The dominant view is that euthanasia and palliative sedation are morally distinct practices. However, ambiguous moral experiences and considerable practice variation call this view into question. When heterogeneous sedative practices are all labeled as palliative sedation, there is the risk that palliative sedation is expanded to include practices that are actually intended to bring about the patients' death. This troublesome expansion is fostered by an expansive use of the concept of intention such that this decisive ethical concept is no longer restricted to signify the aim in guiding the action. In this article, it is argued that intention should be used in a restricted way. The significance of intention is related to other ethical parameters to demarcate the practice of palliative sedation: terminality, refractory symptoms, proportionality, and separation from other end-of-life decisions. These additional parameters, although not without ethical and practical problems, together formulate a framework to ethically distinguish a more narrowly defined practice of palliative sedation from practices that are tantamount to euthanasia. Finally, the article raises the question as to what impact palliative sedation might have on the practice of palliative care itself. The increasing interest in palliative sedation may reemphasize characteristics of health care that initially encouraged the emergence of palliative care in the first place: the focus on therapy rather than care, the physical dimension rather than the whole person, the individual rather than the community, and the primacy of intervention rather than receptiveness and presence.

  4. Understanding Models of Palliative Care Delivery in Sub-Saharan Africa: Learning From Programs in Kenya and Malawi.

    Science.gov (United States)

    Downing, Julia; Grant, Liz; Leng, Mhoira; Namukwaya, Elizabeth

    2015-09-01

    The need for palliative care has never been greater. From being significantly present in only five African countries in 2004, palliative care is now delivered in nearly 50% of African countries; however, less than 5% of people in need receive it. To scale-up palliative care, we need greater knowledge about how different models of palliative care work within different health systems. A case study evaluation was undertaken in Kenya and Malawi to define the models used, contextualize them, and identify challenges, best practices, and transferable lessons for scale-up. Visits were made to seven sites and, using an audit tool, data were collected from program staff, hospital staff, and local stakeholders, and care observed as appropriate. Three models of palliative care service delivery were identified, which supports the existing literature, that is, specialist, district hospital level, and community level. However, in looking further, findings show that the major determinants for each model were a set of philosophical questions and assumptions underpinning each and influencing staff and patient decision-making, planning, and allocation of resources. The health system structure and the beliefs about palliative care determined, and were determined most by, referrals, the patient journey, the centeredness of the model, and role definition and training. The models are also closely associated with the physical setting of services. Understanding how the services have developed because of, and indeed despite the geographical setting and the system level, provides us with a different set of indicators of program structure incorporated into the three models. The analysis of models provides pointers to future planning for palliative care. PMID:25936938

  5. Parenting and palliative care in paediatric oncology

    NARCIS (Netherlands)

    Kars, M.C.

    2012-01-01

    Although many children with cancer can be cured, approximately 25 % will die of their disease. These deaths are usually anticipated and preceded by a period of palliative care focused on the end-of-life, usually referred to as the palliative phase. The PRESENCE-study was aimed at a better understand

  6. Pediatric Palliative Care: A Personal Story

    Medline Plus

    Full Text Available ... Reserve 6,185 views 12:07 Portraits of Life, Love and Legacy through Pediatric Palliative Care - Duration: ... havoctrend 4,258,570 views 1:09:38 LIFE Before Death Pediatric Palliative Care - Duration: 5:27. ...

  7. Integrating palliative care into comprehensive cancer care.

    Science.gov (United States)

    Abrahm, Janet L

    2012-10-01

    While there are operational, financial, and workforce barriers to integrating oncology with palliative care, part of the problem lies in ourselves, not in our systems. First, there is oncologists' "learned helplessness" from years of practice without effective medications to manage symptoms or training in how to handle the tough communication challenges every oncologist faces. Unless they and the fellows they train have had the opportunity to work with a palliative care team, they are unlikely to be fully aware of what palliative care has to offer to their patients at the time of diagnosis, during active therapy, or after developing advanced disease, or may believe that, "I already do that." The second barrier to better integration is the compassion fatigue many oncologists develop from caring for so many years for patients who, despite the oncologists' best efforts, suffer and die. The cumulative grief oncologists experience may go unnamed and unacknowledged, contributing to this compassion fatigue and burnout, both of which inhibit the integration of oncology and palliative care. Solutions include training fellows and practicing oncologists in palliative care skills (eg, in symptom management, psychological disorders, communication), preventing and treating compassion fatigue, and enhancing collaboration with palliative care specialists in caring for patients with refractory distress at any stage of disease. As more oncologists develop these skills, process their grief, and recognize the breadth of additional expertise offered by their palliative care colleagues, palliative care will become integrated into comprehensive cancer care. PMID:23054873

  8. Pediatric Palliative Care: A Personal Story

    Medline Plus

    Full Text Available ... Reserve 6,028 views 12:07 Portraits of Life, Love and Legacy through Pediatric Palliative Care - Duration: ... Karen Fauman 1,238 views 1:05:13 LIFE Before Death Pediatric Palliative Care - Duration: 5:27. ...

  9. Pediatric Palliative Care: A Personal Story

    Medline Plus

    Full Text Available ... Palliative Care - Duration: 5:39. Northeast Ohio Medical University (NEOMED) 15,536 views 5:39 Emily's story - ... 4:17. batsonhospital 1,946 views 4:17 Right to Relief: Palliative Care in India - Duration: 3: ...

  10. Palliative care in chronic obstructive pulmonary disease.

    Science.gov (United States)

    Lilly, Evan J; Senderovich, Helen

    2016-10-01

    Chronic obstructive pulmonary disease (COPD) is the only major worldwide cause of mortality that is currently increasing in prevalence. Furthermore, COPD is incurable, and the only therapy that has been shown to increase survival is oxygen therapy in selected patients. Compared to patients with cancer, patients with COPD experience similar levels of pain, breathlessness, fatigue, depression, and anxiety and have a worse quality of life but have comparatively little access to palliative care. When these patients do receive palliative care, they tend to be referred later than patients with cancer. Many disease, patient-, and provider-related factors contribute to this phenomenon, including COPD's unpredictable course, misperceptions of palliative care among patients and physicians, and lack of advance care planning discussions outside of crisis situations. A new paradigm for palliative care would introduce palliative treatments alongside, rather than at the exclusion of disease-modifying interventions. This integrated approach would circumvent the issue of difficult prognostication in COPD, as any patient would receive individualized palliative interventions from the time of diagnosis. These points will be covered in this review, which discusses the challenges in providing palliative care to COPD patients, the strategies to mitigate the challenges, management of common symptoms, and the evidence for integrated palliative care models as well as some suggestions for future development.

  11. Diagnostic radiology in paediatric palliative care

    International Nuclear Information System (INIS)

    Palliative care is an expanding specialty within paediatrics, which has attracted little attention in the paediatric radiological literature. Paediatric patients under a palliative care team will have numerous radiological tests which we traditionally categorise under organ systems rather than under the umbrella of palliative medicine. The prevalence of children with life-limiting illness is significant. It has been estimated to be one per thousand, and this may be an underestimate. In this review, we will focus on our experience at one institution, where radiology has proven to be an invaluable partner to palliative care. We will discuss examples of conditions commonly referred to our palliative care team and delineate the crucial role of diagnostic radiology in determining treatment options. (orig.)

  12. Diagnostic radiology in paediatric palliative care

    Energy Technology Data Exchange (ETDEWEB)

    Patel, Preena; Koh, Michelle; Carr, Lucinda; McHugh, Kieran [Great Ormond Street Hospital, Radiology Department, London (United Kingdom)

    2014-01-15

    Palliative care is an expanding specialty within paediatrics, which has attracted little attention in the paediatric radiological literature. Paediatric patients under a palliative care team will have numerous radiological tests which we traditionally categorise under organ systems rather than under the umbrella of palliative medicine. The prevalence of children with life-limiting illness is significant. It has been estimated to be one per thousand, and this may be an underestimate. In this review, we will focus on our experience at one institution, where radiology has proven to be an invaluable partner to palliative care. We will discuss examples of conditions commonly referred to our palliative care team and delineate the crucial role of diagnostic radiology in determining treatment options. (orig.)

  13. Palliative Care in Rural Minnesota: Findings from Stratis Health's Minnesota Rural Palliative Care Initiative.

    Science.gov (United States)

    McKinley, Deb; Shearer, Janelle; Weng, Karla

    2016-01-01

    Palliative care, which involves managing symptoms, controlling pain and addressing stress caused by a chronic or terminal illness, has been shown to keep patients out of the hospital and allow them to stay home and live more comfortably with their illness. Typically, it is provided by an interdisciplinary team led by a physician trained in palliative medicine. Rural areas have not always had access to such specialists. Yet, today, rural health care organizations are finding ways to create palliative care programs that meet the needs of their chronically ill and aging populations. This article describes a six-year initiative led by Stratis Health to advance palliative care in rural Minnesota. It highlights the work of FirstLight Health System in Mora and describes Stratis Health's Rural Palliative Care Measurement Pilot Project, an effort to develop and test measures for evaluating rural palliative care programs. PMID:26897897

  14. [Introduction to palliative care for the oncologist-history and basic principles of palliative care].

    Science.gov (United States)

    Shima, Yasuo

    2010-10-01

    The basic principle of palliative care has evolved over time and is the historical origin of the modern hospice. WHO proposed the first definition of palliative care in 1989, and the definition was revised in 2002. These definitions have something in common. Both relieve the pain and suffering to improve QOL. Palliative care is also good for any kind of life-threatening disease, regardless of whether it requires short or long term recuperation. That also need to be able to accept equally all the people of the community. The provision of general palliative care is the responsibility of all medical, nursing, and health professionals for the welfare of all patients with life-threatening disease. Specialist palliative care is based on the basic principles of palliative care, intensive clinical training, and systematic acquisition of knowledge and skills training to support palliative care education, clinical research and training provided by the profession. It has been established by nursing and medical experts in palliative care that palliative care can provide expertise in interdisciplinary teams in different settings. It is necessary that the medical system.

  15. Pediatric Palliative Care: A Personal Story

    Medline Plus

    Full Text Available ... of Rachel—a pediatric neuroblastoma patient—and her family. The story demonstrates how palliative care can positively influence a patient's and family's experience with illness. Category Science & Technology License Standard ...

  16. The Island Hospice model of palliative care

    Science.gov (United States)

    Khumalo, Thembelihle; Maasdorp, Valerie

    2016-01-01

    There has been a substantial increase in cancer detections in Africa over years, and it has also been noted that higher number of individuals are affected by the later stages of cancer that lead to death. When it comes to cancer care, Zimbabwe is no exception with its ongoing palliative care related research, though still in its infancy. The need for advanced and more accessible palliative care to assist the vulnerable has been intensified by this increase in cancer prevalence. Island Hospice, which is a centre of excellence in palliative care has varying elements of the models that it employs to engage those most in need of palliative assistance, especially children and financially-challenged individuals.

  17. Growing Pains: Palliative Care Making Gains

    Science.gov (United States)

    An article about the growth of palliative care, a medical subspecialty that has been shown to improve patient outcomes such as symptom management, quality of life, and patient and family satisfaction with care.

  18. Pediatric Palliative Care: A Personal Story

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  19. Pediatric Palliative Care: A Personal Story

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  20. Pediatric Palliative Care: A Personal Story

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  1. Metronomic palliative chemotherapy in maxillary sinus tumor

    OpenAIRE

    Vijay M Patil; Vanita Noronh; Amit Joshi; Ashay Karpe; Vikas Talreja; Arun Chandrasekharan; Sachin Dhumal; Kumar Prabhash

    2016-01-01

    Background: Metronomic chemotherapy consisting of methotrexate and celecoxib recently has shown promising results in multiple studies in head and neck cancers. However, these studies have not included patients with maxillary sinus primaries. Hence, the role of palliative metronomic chemotherapy in patients with maxillary sinus carcinoma that is not amenable to radical therapy is unknown. Methods: This was a retrospective analysis of carcinoma maxillary sinus patients who received palliative m...

  2. Pediatric Palliative Care: A Personal Story

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    Full Text Available ... NEOMED) 15,536 views 5:39 Perinatal Palliative Care - The Zimmer Family Story - Duration: 13:34. UnityPoint Health - Meriter 52,107 views 13:34 A Certain Kind Of Death - Documentary - Duration: 1:09:38. havoctrend 4,265,977 views 1:09:38 ... LIFE Before Death Pediatric Palliative Care - Duration: 5:27. LIFE Before Death 9,986 ...

  3. Kampo medicine for palliative care in Japan

    OpenAIRE

    Okumi, Hirokuni; Koyama, Atsuko

    2014-01-01

    Kampo medicines are currently manufactured under strict quality controls. The Ministry of Health, Labour and Welfare of Japan has approved 148 Kampo formulas. There is increasing evidence for the efficacy of Kampo medicines, and some are used clinically for palliative care in Japan. The specific aim of this review is to evaluate the clinical use of Kampo medicines in palliative care in the treatment of cancer. The conclusions are as follows: Juzentaihoto inhibits the progression of liver tumo...

  4. Pediatric Palliative Care: A Personal Story

    Medline Plus

    Full Text Available ... NEOMED) 15,234 views 5:39 Perinatal Palliative Care - The Zimmer Family Story - Duration: 13:34. UnityPoint Health - Meriter 50,432 views 13:34 A Certain Kind Of Death - Documentary - Duration: 1:09:38. havoctrend 4,213,979 views ... Principles of Pediatric Palliative Care - Duration: 1:05:13. Karen Fauman 1,257 ...

  5. Pediatric Palliative Care: A Personal Story

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    Full Text Available ... Fair 616,862 views 7:46 Perinatal Palliative Care - The Zimmer Family Story - Duration: 13:34. UnityPoint Health - Meriter 50,610 views 13:34 A Certain Kind Of Death - Documentary - Duration: 1:09:38. havoctrend 4,218,518 views ... 59:01 The Human Connection of Palliative Care: Ten Steps for What To Say and Do - ...

  6. Palliative care reimagined: a needed shift.

    Science.gov (United States)

    Abel, Julian; Kellehear, Allan

    2016-03-01

    Palliative care, since its inception over 60 years ago, has set the standard of how to care for people who are dying. Key features among these standards have been the professional development of clinical specialisms such as palliative medicine and palliative nursing; the essential addition of the multidisciplinary team to these two new specialisms that included social, spiritual and allied health workers-an outgrowth of the recognition that routine work with the dying, their carers, and the bereaved required more than solely clinical skills; and the unique partnership with communities that yielded the volunteer movement within palliative care. Professional, evidence-based symptom management and the importance of supportive care in its widest possible sense were and remain the cornerstones of the modern palliative care approach. However, the majority of people with terminal illnesses do not have access to palliative care teams, whose main focus of care remains patients with cancer. In the context outlined above this paper therefore poses two key questions: how can we provide an equitable level of care for all people irrespective of diagnosis and how can we increase the range and quality of non-medical/nursing supportive care in a context of diminishing resources? We argue that an important opportunity and solution can be found by adopting the principles of a public health approach to end-of-life care. PMID:26832803

  7. [Neonatal palliative care and culture].

    Science.gov (United States)

    Bétrémieux, P; Mannoni, C

    2013-09-01

    The period of palliative care is a difficult time for parents and caregivers because they are all weakened by the proximity of death. First of all, because of religious and cultural differences, parents and families cannot easily express their beliefs or the rituals they are required to develop; second, this impossibility results in conflicts between the caregiver team and the family with consequences for both. Caregivers are concerned to allow the expression of religious beliefs and cultural demands because it is assumed that they may promote the work of mourning by relating the dead child to its family and roots. However, caregivers' fear not knowing the cultural context to which the family belongs and having inappropriate words or gestures, as sometimes families dare not, cannot, or do not wish to describe their cultural background. We attempt to differentiate what relates to culture and to religion and attempt to identify areas of potential disagreement between doctors, staff, and family. Everyone has to work with the parents to open a space of freedom that is not limited by cultural and religious assumptions. The appropriation of medical anthropology concepts allows caregivers to understand simply the obligations imposed on parents by their culture and/or their religion and open access to their wishes. Sometimes help from interpreters, mediators, ethnopsychologists, and religious representatives is needed to understand this reality.

  8. Pulmonary medicine and palliative care.

    Science.gov (United States)

    Tucakovic, M; Bascom, R; Bascom, P B

    2001-04-01

    Gynaecological malignancies affect the respiratory system both directly and indirectly. Malignant pleural effusion is a poor prognostic factor: management options include repeated thoracentesis, chemical pleurodesis, symptomatic relief of dyspnoea with oxygen and morphine, and external drainage. Parenchymal metastases are typically multifocal and respond to chemotherapy, with a limited role for pulmonary metastatectomy. Pulmonary tumour embolism is frequently associated with lymphangitic carcinomatosis, and is most common in choriocarcinoma. Thromboembolic disease, associated with the hypercoagulable state of cancer, is treated with anticoagulation. Inferior vena cava filter placement is indicated when anticoagulation cannot be given, or when emboli recur despite adequate anticoagulation. Palliative care has a major role for respiratory symptoms of gynaecological malignancies. Treatable causes of dyspnoea include bronchospasm, fluid overload and retained secretions. Opiates are effective at relieving dyspnoea associated with effusions, metatases, and lymphangitic tumour spread. Non-pharmacological therapies include energy conservation, home redesign, and dyspnoea relief strategies, including pursed lip breathing, relaxation, oxygen, circulation of air with a fan, and attention to spiritual suffering. Identification and treatment of gastroesophageal reflux, sinusitis, and asthma can improve many patients' coughs. Chest wall pain responds to local radiotherapy, nerve blocks or systemic analgesia. Case examples illustrate ways to address quality of life issues. PMID:11358403

  9. Policy analysis: palliative care in Ireland.

    LENUS (Irish Health Repository)

    Larkin, P

    2014-03-01

    Palliative care for patients with advanced illness is a subject of growing importance in health services, policy and research. In 2001 Ireland became one of the first nations to publish a dedicated national palliative care policy. This paper uses the \\'policy analysis triangle\\' as a framework to examine what the policy entailed, where the key ideas originated, why the policy process was activated, who were the key actors, and what were the main consequences. Although palliative care provision expanded following publication, priorities that were unaddressed or not fully embraced on the national policy agenda are identified. The factors underlying areas of non-fulfilment of policy are then discussed. In particular, the analysis highlights that policy initiatives in a relatively new field of healthcare face a trade-off between ambition and feasibility. Key policy goals could not be realised given the large resource commitments required; the competition for resources from other, better-established healthcare sectors; and challenges in expanding workforce and capacity. Additionally, the inherently cross-sectoral nature of palliative care complicated the co-ordination of support for the policy. Policy initiatives in emerging fields such as palliative care should address carefully feasibility and support in their conception and implementation.

  10. Palliative radiotherapy: current status and future directions.

    Science.gov (United States)

    Sharma, Sonam; Hertan, Lauren; Jones, Joshua

    2014-12-01

    For nearly 100 years, palliative radiotherapy has been a time-efficient, effective treatment for patients with metastatic or advanced cancer in any area where local tumors are causing symptoms. Short courses including a single fraction of radiotherapy may be effective for symptom relief with minimal side effects and maximization of convenience for patient and family. With recent advances in imaging, surgery, and other local therapies as well as systemic cancer therapies, palliative radiotherapy has been used frequently in patients who may not yet have symptoms of advanced or metastatic cancer. In this setting, more prolonged radiotherapy courses and advanced radiotherapy techniques including intensity-modulated radiotherapy (IMRT) or stereotactic radiotherapy (SRT) may be useful in obtaining local control and durable palliative responses. This review will explore the use of radiotherapy across the spectrum of patients with advanced and metastatic cancer and delineate an updated, rational approach for the use of palliative radiotherapy that incorporates symptoms, prognosis, and other factors into the delivery of palliative radiotherapy. PMID:25499634

  11. European Association for Palliative Care (EAPC framework for palliative sedation: an ethical discussion

    Directory of Open Access Journals (Sweden)

    Juth Niklas

    2010-09-01

    Full Text Available Abstract Background The aim of this paper is to critically discuss some of the ethically controversial issues regarding continuous deep palliative sedation at the end of life that are addressed in the EAPC recommended framework for the use of sedation in palliative care. Discussion We argue that the EAPC framework would have benefited from taking a clearer stand on the ethically controversial issues regarding intolerable suffering and refractory symptoms and regarding the relation between continuous deep palliative sedation at the end of life and euthanasia. It is unclear what constitutes refractory symptoms and what the relationship is between refractory symptoms and intolerable suffering, which in turn makes it difficult to determine what are necessary and sufficient criteria for palliative sedation at the end of life, and why. As regards the difference between palliative sedation at the end of life and so-called slow euthanasia, the rationale behind stressing the difference is insufficiently demonstrated, e.g. due to an overlooked ambiguity in the concept of intention. It is therefore unclear when palliative sedation at the end of life amounts to abuse and why. Conclusions The EAPC framework would have benefited from taking a clearer stand on some ethically controversial issues regarding intolerable suffering and refractory symptoms and regarding the relation between continuous deep palliative sedation at the end of life and euthanasia. In this text, we identify and discuss these issues in the hope that an ensuing discussion will clarify the EAPC's standpoint.

  12. Palliative care. Some organisational considerations.

    Science.gov (United States)

    Welshman, A

    2005-01-01

    Managing pain effectively is one of the biggest challenges in medicine, let alone when dealing with the dying patient and his family. For palliative care specialists this is a daily challenge. However, ''To cure when possible, to give comfort always'' is an empty credo if physicians don't use every weapon in the medical arsenal to relieve the suffering caused by chronic pain. It's of course the opioids: morphine, heroin, their synthetic derivatives and other narcotics, a class of medications that conjure up visions of drug addiction and narcotic squads. To say that opioids are stigmatised by such allusions is putting it mildly. An unhealthy proportion of doctors and patients alike are afraid to have anything to do with them, even in when facing their final stages of life. This is particularly so in the Mediterranean society. It is here in Italy that an effort must be made to educate both physicians and the general public, an arduous task to change a long standing belief which requires a quick cultural turn around. Those who refuse opioids because they are afraid of addiction, and the doctors who refuse to prescribe them out of fear or pure unwillingness to address an apprehensive attitude on behalf of his patient, need to be better informed. Most misconceptions about opioids have to do with terminology, because words like ''morphine, addiction, dependency'' and ''tolerance'' mean entirely different things in popular and medical parlance. Add to this the perceptions and attitudes the patient can have with this terminology which then can have a profound effect on the success or failure of a pain control programme. In fact, most people think that medication such as morphine are only for people who are dying and as a consequence is synonymous with death itself. Is this why Italian physicians are not prescribing morphine even though great efforts have been made recently by the Health Ministry to facilitate prescribing laws and costs? It is worthy of serious

  13. [Seeds of palliative care: nurses' discourse order].

    Science.gov (United States)

    da Silva, Karen Schein; Kruse, Maria Henriqueta Luce

    2009-06-01

    Palliative care is becoming a professional knowledge and performance field by means of the proposal of another "regimen of truths". Such fact can be observed in the broadening of palliative care services and in the increase of publications on the subject. This study aims at learning the discourses on palliative care that the nurses have conveyed in the nursing publications. For such purpose we approached the Cultural Studies, especially those inspired on Michel Foucault in order to analyze articles published in two national nursing periodicals from 1999 to 2007. Among the statements, we point out those that see the hospital as a site where the patient is divested of his individuality and identity and those that mention such care as capable of providing the family and the patient with the best quality of life possible during the death process.

  14. Compassion fatigue in pediatric palliative care providers.

    Science.gov (United States)

    Rourke, Mary T

    2007-10-01

    The experience of compassion fatigue is an expected and common response to the professional task of routinely caring for children at the end of life. Symptoms of compassion fatigue often mimic trauma reactions. Implementing strategies that span personal, professional, and organizational domains can help protect health care providers from the damaging effects of compassion fatigue. Providing pediatric palliative care within a constructive and supportive team can help caregivers deal with the relational challenges of compassion fatigue. Finally, any consideration of the toll of providing pediatric palliative care must be balanced with a consideration of the parallel experience of compassion satisfaction. PMID:17933615

  15. Palliative sedation : not just normal medical practice. Ethical reflections on the Royal Dutch Medical Association's guideline on palliative sedation

    NARCIS (Netherlands)

    Janssens, Rien; van Delden, Johannes J. M.; Widdershoven, Guy A. M.

    2012-01-01

    The main premise of the Royal Dutch Medical Association's (RDMA) guideline on palliative sedation is that palliative sedation, contrary to euthanasia, is normal medical practice. Although we do not deny the ethical distinctions between euthanasia and palliative sedation, we will critically analyse t

  16. Kenya Hospices and Palliative Care Association: integrating palliative care in public hospitals in Kenya

    Science.gov (United States)

    Ali, Zipporah

    2016-01-01

    Background In Kenya, cancers as a disease group rank third as a cause of death after infectious and cardiovascular diseases. It is estimated that the annual incidence of cancer is about 37,000 new cases with an annual mortality of 28,000 cases (Kenya National Cancer Control Strategy 2010). The incidence of non-communicable diseases accounts for more than 50% of total hospital admissions and over 55% of hospital deaths (Kenya National Strategy for the Prevention and Control of Non Communicable Diseases 2015–2020). The prevalence of HIV is 6.8 (KIAS 2014). Most of these patients will benefit from palliative care services, hence the need to integrate palliative care services in the public healthcare system. Method The process of integrating palliative care in public hospitals involved advocacy both at the national level and at the institutional level, training of healthcare professionals, and setting up services within the hospitals that we worked with. Technical support was provided to each individual institution as needed. Results Eleven provincial hospitals across the country have now integrated palliative care services (Palliative Care Units) and are now centres of excellence. Over 220 healthcare providers have been trained, and approximately, over 30,000 patients have benefited from these services. Oral morphine is now available in the hospital palliative care units. Conclusion As a success of the pilot project, Kenya Hospices and Palliative Care Association (KEHPCA) is now working with the Ministry of Health Kenya to integrate palliative care services in 30 other county hospitals across the country, thus ensuring more availability and access to more patients. Other developing countries can learn from Kenya’s successful experience.

  17. Palliative and hospice care in gynecologic cancer: a review.

    Science.gov (United States)

    Lopez-Acevedo, Micael; Lowery, William J; Lowery, Ashlei W; Lee, Paula S; Havrilesky, Laura J

    2013-10-01

    Despite the increasing availability of palliative care, oncology providers often misunderstand and underutilize these resources. The goals of palliative care are relief of suffering and provision of the best possible quality of life for both the patient and her family, regardless of where she is in the natural history of her disease. Lack of understanding and awareness of the services provided by palliative care physicians underlie barriers to referral. Oncologic providers spend a significant amount of time palliating the symptoms of cancer and its treatment; involvement of specialty palliative care providers can assist in managing the complex patient. Patients with gynecologic malignancies remain an ideal population for palliative care intervention. This review of the literature explores the current state of palliative care in the treatment of gynecologic cancers and its implications for the quality and cost of this treatment.

  18. In palliative cancer care symptoms mean everything

    NARCIS (Netherlands)

    Teunissen, S.C.C.M.

    2007-01-01

    The thesis aims to provide deeper insight into symptoms of cancer patients in palliative care, in order to improve the adequacy of decision-making for optimizing symptom control. Several aspects of symptoms and symptom management were investigated as were some aspects of communication and consultati

  19. Pediatric Palliative Care: A Personal Story

    Medline Plus

    Full Text Available ... Health - Meriter 49,205 views 13:34 Phoebe's Cancer Story - Duration: 7:46. Family A-Fair 606, ... 05:13 Pediatric Palliative Care: helping children with cancer survive and thrive - Duration: 3:29. American Cancer ...

  20. Pediatric Palliative Care: A Personal Story

    Medline Plus

    Full Text Available ... Fauman 1,271 views 1:05:13 Phoebe's Cancer Story - Duration: 7:46. Family A-Fair 622, ... 3:02 Pediatric Palliative Care: helping children with cancer survive and thrive - Duration: 3:29. American Cancer ...

  1. Oesphageal Stenting for palliation of malignant mesothelioma

    Directory of Open Access Journals (Sweden)

    Rahamim Joseph

    2008-01-01

    Full Text Available Abstract Dyspahgia in patients with malignant mesothelioma is usually due to direct infiltration of the eosophagus by the tumour. It can be distressing for the patient and challenging for the physician to treat. We describe three cases in which this condition has been successfully palliated with self expanding esophageal stents.

  2. Pediatric Palliative Care: A Personal Story

    Medline Plus

    Full Text Available ... Western Reserve 6,162 views 12:07 Phoebe's Cancer Story - Duration: 7:46. Family A-Fair 621, ... CAPC Palliative 57,541 views 5:53 Teen Cancer Stories | UCLA Daltrey/Townshend Teen & Young Adult Cancer ...

  3. Pediatric Palliative Care: A Personal Story

    Medline Plus

    Full Text Available ... 327,928 views 56:49 Dr. Patti Brennan: Nursing, Big Data, & the NIH BD2K Initiative - Duration: 58:22. NINRnews 752 views 58:22 Portraits of Life, Love & Legacy Through Pediatric Palliative Care - Duration: 54:51. WesternReservePBS 2,974 views 54: ...

  4. Pediatric Palliative Care: A Personal Story

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    Full Text Available ... Before Death 9,901 views 5:27 Phoebe's Cancer Story - Duration: 7:46. Family A-Fair 617, ... 09:38 Pediatric Palliative Care: helping children with cancer survive and thrive - Duration: 3:29. American Cancer ...

  5. Pediatric Palliative Care: A Personal Story

    Medline Plus

    Full Text Available ... in to report inappropriate content. Sign in Transcript 3,398 views Like this video? Sign in to ... Through Pediatric Palliative Care - Duration: 54:51. WesternReservePBS 3,095 views 54:51 Teen Cancer Stories | UCLA ...

  6. Palliative care registers: infringement on human rights?

    Science.gov (United States)

    Anthony-Pillai, Rosemarie

    2012-04-01

    A personal view made in light of the recent news article regarding a husband wanting to sue Addenbrooke's hospital over a Do Not Attempt Resuscitation decision. This article aims to highlight how the rolling out of cross boundary palliative care registers may be more at risk of infringing human rights.

  7. Pediatric Palliative Care: A Personal Story

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    Full Text Available ... Young Adult Cancer Program - Duration: 11:08. UCLA Health 191,156 views 11:08 A Day in the Life - Lauren (Nurse Practitioner- Palliative Care) - Duration: 2:56. JNJDiscoverNursing 8,458 views 2: ...

  8. Pediatric Palliative Care: A Personal Story

    Medline Plus

    Full Text Available ... Before Death 9,793 views 5:27 Phoebe's Cancer Story - Duration: 7:46. Family A-Fair 608, ... 31:23 Pediatric Palliative Care: helping children with cancer survive and thrive - Duration: 3:29. American Cancer ...

  9. Palliative care teams: effective through moral reflection.

    NARCIS (Netherlands)

    Hermsen, M.A.; Have, H.A.M.J. ten

    2005-01-01

    Working as a multidisciplinary or interdisciplinary team is an essential condition to provide good palliative care. This widespread assumption is based on the idea that teamwork makes it possible to address the various needs of the patient and family more effectively. This article is about teamwork

  10. Parental concerns in children requiring palliative care

    Directory of Open Access Journals (Sweden)

    Manjiri Dighe

    2008-01-01

    Full Text Available Children with advanced, life-limiting illness have unique needs which are different from those of adults. Pediatric palliative care is an under developed specialty. Aims : To identify concerns of parents of children with advanced, incurable cancers, and to elicit their attitudes toward revealing the diagnosis and prognosis to the sick child. Method : This study was carried out in a large tertiary cancer center in India. Parents of 20 pediatric palliative care patients attending the outpatient department were interviewed and emerging themes identified. Results : Parents showed varying degrees of anticipatory grief. Most families were financially strained. Most parents were reluctant to discuss disease and dying with the child. Siblings were rarely told or directly involved in care. There was resistance to allowing the palliative care team to communicate with the patient. Patients did not receive any formal support. Parents identified family and neighbors as the main sources of support. Conclusions : Parental attitudes hinder open communication with dying children in India. There is a need for research to explore the concerns of families of children with fatal illness. Specialist training is required for professionals working in pediatric palliative care to address this issue.

  11. A test instrument for palliative care.

    NARCIS (Netherlands)

    Adriaansen, M.J.M.; Achterberg, T. van

    2004-01-01

    This article describes a methodological study concerning the development of a test instrument that can be used for measuring the effects of a course in palliative care on registered nurses and licensed practical nurses. This test instrument is comprised of two parts: an expertise and insight test an

  12. Pediatric Palliative Care: A Personal Story

    Medline Plus

    Full Text Available ... 4,244,244 views 1:09:38 Phoebe's Cancer Story - Duration: 7:46. Family A-Fair 621, ... 3:02 Pediatric Palliative Care: helping children with cancer survive and thrive - Duration: 3:29. American Cancer ...

  13. Emotionality and teamwork in palliative nursing

    DEFF Research Database (Denmark)

    Nickelsen, Niels Christian

    This paper discusses the performance of palliative support teams based in an empirical study in a hospice in Denmark. The analytic strategy is based in science and technology studies (STS). The study was carried out as a number of meetings among the researcher and five non-consolidated teams in s...

  14. Pediatric Palliative Care: A Personal Story

    Medline Plus

    Full Text Available ... Medway CCG 110,583 views 27:40 Phoebe's Cancer Story - Duration: 7:46. Family A-Fair 618, ... 31:23 Pediatric Palliative Care: helping children with cancer survive and thrive - Duration: 3:29. American Cancer ...

  15. Benefiting Africans

    Institute of Scientific and Technical Information of China (English)

    2011-01-01

    Along with thriving Sino-African economic and trade ties,Chinese companies have attached greater importance to their social responsibility to Africans.More than 2,000 sweaters woven by Chinese mothers were sent to orphans and disabled children in Kenya and four other African countries in September. This activity was launched by Hengyuanxiang,aleading Chinese wool manufacturer.

  16. Benefiting Africans

    Institute of Scientific and Technical Information of China (English)

    ZHANG ZHIPING

    2011-01-01

    Along with thriving Sino-African economic and trade ties,Chinese companies have attached greater importance to their social responsibility to Africans.More than 2,000 sweaters woven by Chinese mothers were sent to orphans and disabled children in Kenya and four other African countries in September.This activity was launched by Hengyuanxiang,a leading Chinese wool manufacturer.

  17. Patterns of Practice of Palliative Radiotherapy in Africa, Part 1: Bone and Brain Metastases

    International Nuclear Information System (INIS)

    Purpose: To provide data on the pattern of practice of palliative radiotherapy (RT) on the African continent. Methods and Materials: A questionnaire was distributed to participants in a regional training course of the International Atomic Energy Agency in palliative cancer care and sent by e-mail to other institutions in Africa. Requested information included both infrastructure and human resources available and the pattern of RT practice for metastatic and locally advanced cancers. Results: Of 35 centers contacted, 24 (68%) completed the questionnaire. Although RT is used by most centers for most metastatic cancers, liver and lung metastases are treated with chemotherapy. Of 23 centers, 14 (61%) had a single RT regimen as an institutional policy for treating painful bone metastases, but only 5 centers (23%) of 23 used 8 Gy in 1 fraction. Brain metastases were being treated by RT to the whole brain to 30 Gy in 10 fractions, either exclusively (n = 13, 56%) or in addition to the use of 20 Gy in 5 fractions (n = 3, 14%). Conclusion: Radiotherapy is a major component of treatment of cancer patients in African countries. There is consensus among few centers for treatment schedules for almost all sites regarding time and dose-fractionation characteristics of RT regimens used and/or indications for the use of RT in this setting

  18. Palliative nursing care for children and adolescents with cancer

    Directory of Open Access Journals (Sweden)

    Gilmer MJ

    2012-06-01

    Full Text Available Terrah L Foster,1,2 Cynthia J Bell,1 Carey F McDonald,2 Joy S Harris,3 Mary Jo Gilmer,1,21Vanderbilt University School of Nursing, Nashville, 2Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, 3Vanderbilt University, Nashville, TN, USAAbstract: Pediatric palliative care aims to enhance life and decrease suffering of children and adolescents living with life-threatening conditions and their loved ones. Oncology nurses are instrumental in providing palliative care to pediatric oncology populations. This paper describes pediatric palliative care and provides an overview of literature related to the physical, psychological, social, and spiritual domains of palliative nursing care for children and adolescents with cancer. Nurses can provide optimal palliative care by accounting for children's understanding of death, encouraging early initiation of palliative care services, and improving utilization of pediatric palliative care in cancer settings. Specific roles of registered nurses and advanced practice nurses in pediatric palliative care will be addressed. Recommendations for future research are made to further advance the science of pediatric palliative care and decrease suffering for children and teens with cancer.Keywords: pediatric palliative care, pediatric cancer, oncology, child, suffering

  19. The Role of Psychology in Pediatric Palliative Care.

    Science.gov (United States)

    Edlynn, Emily; Kaur, Harpreet

    2016-07-01

    Pediatric medicine increasingly has recognized the value of integrating behavioral health in medical care, but this trend has not yet extended to pediatric palliative care. Results from a recent survey of pediatric palliative care programs across the United States indicate that team composition almost never included a psychologist. This article presents a model of collaborative care to optimize the integration of psychosocial and medical aspects of treatment in pediatric palliative care, delineating how a psychologist adds to this model. This article argues that psychology brings specialized skills in assessment, intervention, and research that fit with the premise of palliative care as a holistic approach that relieves symptoms. Systematic inclusion of psychologists on pediatric palliative care teams may help to improve effectiveness of services as well as extend the knowledge base of mental health in pediatric palliative care. PMID:27008276

  20. Palliative care in India: Current progress and future needs

    Directory of Open Access Journals (Sweden)

    Divya Khosla

    2012-01-01

    Full Text Available Despite its limited coverage, palliative care has been present in India for about 20 years. Obstacles in the growth of palliative care in India are too many and not only include factors like population density, poverty, geographical diversity, restrictive policies regarding opioid prescription, workforce development at base level, but also limited national palliative care policy and lack of institutional interest in palliative care. Nonetheless we have reasons to be proud in that we have overcome several hurdles and last two decades have seen palpable changes in the mindset of health care providers and policy makers with respect to need of palliative care in India. Systematic and continuous education for medical staff is mandatory, and a major break-through for achieving this purpose would be to increase the number of courses and faculties in palliative medicine at most universities.

  1. Palliative Care: Increasing the quality of life for patients and families… | NIH MedlinePlus the Magazine

    Science.gov (United States)

    ... this page please turn JavaScript on. Feature: Palliative Care Palliative Care: Increasing the quality of life for patients ... gov/conversationsmatter . Palliative Care Is Different from Hospice Care Palliative care is available to you at any time ...

  2. Perception of older adults receiving palliative care

    Directory of Open Access Journals (Sweden)

    Fernanda Laporti Seredynskyj

    2014-06-01

    Full Text Available The present study aimed at understanding the perception of older adults who are receiving palliative oncological care on self care in relation to different stages of the disease and how such perception affected their lives. This is a qualitative study using oral history conducted with 15 older adults receiving palliative chemotherapy treatment in a health institution. The following categories emerged: social network, perspectives for confronting life, changes and spirituality. It is necessary for nursing staff to understand this process so that the measures implemented take into account all of the implications of the disease and aim at improving quality of life.   doi: 10.5216/ree.v16i2.22795.

  3. Custom ocular prosthesis: A palliative approach

    Directory of Open Access Journals (Sweden)

    Prachi Thakkar

    2015-04-01

    Full Text Available The goal of palliative care is the achievement of the best quality of life for patients and their families. Eyes are generally the first features of the face to be noticed. Loss of an eye is a traumatic event which has a crippling effect on the psychology of the patient. Several ocular and orbital disorders require surgical intervention that may result in ocular defects. An ocular prosthesis is fabricated to restore the structure, function, and cosmetics of the defects created by such conditions. Although an implant eye prosthesis has a superior outcome, due to economic factors it may not be a feasible option for all patients. Therefore, a custom-made ocular prosthesis is a good alternative. This case report presents a palliative treatment for a patient with an enucleated eye by fabricating a custom ocular prosthesis which improved his psychological, physical, social, functional, emotional and spiritual needs.

  4. [Palliative care needs in advanced chronic illness].

    Science.gov (United States)

    Tripodoro, Vilma A; Rynkiewicz, María C; Llanos, Victoria; Padova, Susana; De Lellis, Silvina; De Simone, Gustavo

    2016-01-01

    About 75% of population will die from one or more chronic progressive diseases. From this projection WHO urged countries to devise strategies for strengthening palliative treatment as part of comprehensive care. In Catalonia, Spain, direct measurement of the prevalence of these patients with NECPAL CCOMS-ICO© tool was 1.5% of the population. This tool is an indicative, not dichotomous, quali-quantitative multifactorial evaluation to be completed by the treating physician. In Argentina there is no information on these patients. Our goal was to explore and characterize the proportion of chronically ill patients in palliative care needs, by NECPAL CCOMS-ICO© tool, in an accessible population of the City of Buenos Aires. General hospitals of the Health Region 2 (Piñero, álvarez and Santojanni) and its program areas were surveyed. In Health Region 1, we surveyed the Udaondo gastroenterology hospital. A total of 53 physicians (704 patients) were interviewed. It was identified that 29.5% of these patients were affected by advanced chronic diseases; 72.1% of them were NECPAL positive, younger (median 64) than in others studies, and more than 98% presented high levels of comorbidity. Palliative care demand (31.4%) and needs (52.7%) were recorded. Specific indicators of fragility, progression, severity and kind of chronic disease were described. The main finding was to identify, with an instrument not based on mortality that, in Buenos Aires City, 1 in 3 patients with chronic diseases could die in the next year and had palliative care needs. PMID:27295702

  5. Pediatric Palliative Care: A Personal Story

    Medline Plus

    Full Text Available ... 1,257 views 1:05:13 Perinatal Palliative Care - The Zimmer Family Story - Duration: 13:34. UnityPoint Health - Meriter 50,610 views 13:34 Phoebe's Cancer Story - Duration: 7:46. Family A-Fair 616,342 views 7:46 Dr. Patti Brennan: ... The Cost of Dying: End-of-Life Care - Duration: 14:20. CBS 60,768 views 14: ...

  6. Relationship between three palliative care outcome scales

    Directory of Open Access Journals (Sweden)

    Donaldson Nora

    2004-11-01

    Full Text Available Abstract Background Various scales have been used to assess palliative outcomes. But measurement can still be problematic and core components of measures have not been identified. This study aimed to determine the relationships between, and factorial structure of, three widely used scales among advanced cancer patients. Methods Patients were recruited who received home or hospital palliative care services in the south of England. Hope, quality of life and palliative outcomes were assessed by patients in face to face interviews, using three previously established scales – a generic measure (EQoL, a palliative care specific measure (POS and a measure of hope (Herth Hope Index. Analysis comprised: exploratory factor analysis of each individual scale, and all scales combined, and confirmatory factor analysis for model building and validation. Results Of 171 patients identified, 140 (81% consented and completed first interviews; mean age was 71 years, 54% were women, 132 had cancer. In exploratory analysis of individual means, three out of the five factors in the EQoL explained 75% of its variability, four out of the 10 factors in POS explained 63% of its variability, and in the Hope Index, nine out of the 12 items explained 69% of its variability. When exploring the relative factorial structure of all three scales, five factors explained 56% of total combined variability. Confirmatory analysis reduced this to a model with four factors – self-sufficiency, positivity, symptoms and spiritual. Removal of the spiritual factor left a model with an improved goodness of fit and a measure with 11 items. Conclusion We identified three factors which are important outcomes and would be simple to measure in clinical practice and research.

  7. Supportive and Palliative Care of Pancreatic Cancer

    OpenAIRE

    Salman Fazal; Muhammad Wasif Saif

    2007-01-01

    Pancreatic cancer is one of the most lethal malignancies. An estimated 32,300 patients will die of pancreatic cancer in year 2006. It is the tenth most common malignancy in the United State. Despite recent advances in pathology, molecular basis and treatment, the overall survival rate remains 4% for all stages and races. Palliative care represents an important aspect of care in patient with pancreatic malignancy. Identifying and treating disease related symptomology are priorities. As a physi...

  8. Palliative Care Eases Symptoms, Enhances Lives | NIH MedlinePlus the Magazine

    Science.gov (United States)

    ... this page please turn JavaScript on. Feature: Palliative Care Palliative Care Eases Symptoms, Enhances Lives Past Issues / Spring 2014 ... pharmacists, nutritionists, and others. When do I need palliative care? Many adults and children living with serious diseases ...

  9. Palliative Percutaneous Jejunal Stent for Patients with Short Bowel Syndrome

    OpenAIRE

    Takayama, Satoru; Ochi, Yasuo; Yasuda, Akira; Sakamoto, Masaki; Takahashi, Hideki; Akamo, Yoshimi; Takeyama, Hiromitsu

    2009-01-01

    Gastrointestinal obstruction is a common preterminal event in patients with gastric and pancreatic cancer who often undergo palliative bypass surgery. Although endoscopic palliation with self-expandable metallic stents has emerged as a safe and effective alternative to surgery, experience with this technique remains limited. In particular, a proximal jejunal obstruction requires more technical expertise than a duodenal obstruction. Palliative treatment modalities include both surgical and non...

  10. Improving palliative care outcomes for Aboriginal Australians: service providers’ perspectives

    OpenAIRE

    Shahid, Shaouli; Bessarab, Dawn; van Schaik, Katherine D; Aoun, Samar M.; Thompson, Sandra C

    2013-01-01

    Background: Aboriginal Australians have a lower rate of utilisation of palliative care services than the general population. This study aimed to explore care providers’ experiences and concerns in providing palliative care for Aboriginal people, and to identify opportunities for overcoming gaps in understanding between them and their Aboriginal patients and families. Methods: In-depth, qualitative interviews with urban, rural and remote palliative care providers were undertaken in inpatient a...

  11. Metronomic palliative chemotherapy in maxillary sinus tumor

    Directory of Open Access Journals (Sweden)

    Vijay M Patil

    2016-01-01

    Full Text Available Background: Metronomic chemotherapy consisting of methotrexate and celecoxib recently has shown promising results in multiple studies in head and neck cancers. However, these studies have not included patients with maxillary sinus primaries. Hence, the role of palliative metronomic chemotherapy in patients with maxillary sinus carcinoma that is not amenable to radical therapy is unknown. Methods: This was a retrospective analysis of carcinoma maxillary sinus patients who received palliative metronomic chemotherapy between August 2011 and August 2014. The demographic details, symptomatology, previous treatment details, indication for palliative chemotherapy, response to therapy, and overall survival (OS details were extracted. SPSS version 16 was used for analysis. Descriptive statistics have been performed. Survival analysis was done by Kaplan-Meier method. Results: Five patients had received metronomic chemotherapy. The median age was 60 years (range 37-64 years. The proportion of patients surviving at 6 months, 12 months, and 18 months were 40%, 40%, and 20%, respectively. The estimated median OS was 126 days (95% confidence interval 0-299.9 days. The estimated median survival in patients with an event-free period after the last therapy of <6 months was 45 days, whereas it was 409 days in patients with an event-free period postlast therapy above 6 months (P = 0.063. Conclusion: Metronomic chemotherapy in carcinoma maxillary sinus holds promise. It has activity similar to that seen in head and neck cancers and needs to be evaluated further in a larger cohort of patients.

  12. Palliative care and neurology: time for a paradigm shift.

    Science.gov (United States)

    Boersma, Isabel; Miyasaki, Janis; Kutner, Jean; Kluger, Benzi

    2014-08-01

    Palliative care is an approach to the care of patients and families facing progressive and chronic illnesses that focuses on the relief of suffering due to physical symptoms, psychosocial issues, and spiritual distress. As neurologists care for patients with chronic, progressive, life-limiting, and disabling conditions, it is important that they understand and learn to apply the principles of palliative medicine. In this article, we aim to provide a practical starting point in palliative medicine for neurologists by answering the following questions: (1) What is palliative care and what is hospice care? (2) What are the palliative care needs of neurology patients? (3) Do neurology patients have unique palliative care needs? and (4) How can palliative care be integrated into neurology practice? We cover several fundamental palliative care skills relevant to neurologists, including communication of bad news, symptom assessment and management, advance care planning, caregiver assessment, and appropriate referral to hospice and other palliative care services. We conclude by suggesting areas for future educational efforts and research.

  13. Palliative care in India: Situation assessment and future scope.

    Science.gov (United States)

    Kar, S S; Subitha, L; Iswarya, S

    2015-01-01

    Palliative care is an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through prevention and relief of suffering by means of early identification, assessment and treatment of pain, and other problems - physical, psychosocial, and spiritual. It is estimated that in India the total number of people who need palliative care is likely to be 5.4 million people a year. Though palliative care services have been in existence for many years, India ranks at the bottom of the Quality of Death index in overall score. However there has been steady progress in the past few years through community-owned palliative care services. One of the key objectives of the National Programme for prevention and control of cancer, diabetes, cardiovascular diseases, and stroke is to establish and develop capacity for palliative and rehabilitative care. Community models for the provision of home-based palliative care is possible by involving community caregivers and volunteers supervised by nurses trained in palliative care. Training of medical officers and health care professionals, and sensitization of the public through awareness campaigns are vital to improve the scope and coverage of palliative care. Process of translating palliative care plan into action requires strong leadership, competent management, political support and integration across all levels of care.

  14. Palliative care in India: Situation assessment and future scope

    Directory of Open Access Journals (Sweden)

    S S Kar

    2015-01-01

    Full Text Available Palliative care is an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through prevention and relief of suffering by means of early identification, assessment and treatment of pain, and other problems – physical, psychosocial, and spiritual. It is estimated that in India the total number of people who need palliative care is likely to be 5.4 million people a year. Though palliative care services have been in existence for many years, India ranks at the bottom of the Quality of Death index in overall score. However there has been steady progress in the past few years through community-owned palliative care services. One of the key objectives of the National Programme for prevention and control of cancer, diabetes, cardiovascular diseases, and stroke is to establish and develop capacity for palliative and rehabilitative care. Community models for the provision of home-based palliative care is possible by involving community caregivers and volunteers supervised by nurses trained in palliative care. Training of medical officers and health care professionals, and sensitization of the public through awareness campaigns are vital to improve the scope and coverage of palliative care. Process of translating palliative care plan into action requires strong leadership, competent management, political support and integration across all levels of care.

  15. [Use of music in palliative care].

    Science.gov (United States)

    Skrbina, Dijana; Simunović, Dubravka; Santek, Vjerocka; Njegovan-Zvonarević, Tatjana

    2011-12-01

    Man is mortal, which means that as the earthly body perishes being, final. Disease and death will always be an inevitable and integral part of human experience. The way in which we try to identify and respond to the unique and individual needs of the dying is an indication of our maturity as a society. The number of people requiring palliative care is growing. Palliative care does not intend to either accelerate or postpone death she emphasizes the life and looks at dying as a normal process. It is an active form of care for patients with advanced, progressive illness, with the aim of suppressing pain and other symptoms in addition to providing psychological, social and spiritual support which ensures the best possible quality of life for patients and their families. Therefore requires a coordinated and interdisciplinary contribution team. The variety of professions in a team, and determine the needs of patients should be ready to provide physical, psychological, social and spiritual support using methods that result from an interdisciplinary, collaborative team approach. Development of a holistic approach and awareness in the medical and allied professions has led to a renewal of interest in the inclusion of music and other expressive media in contemporary concepts of palliative care, which are consistent with problem areas, clinical manifestations and the needs of patients. Music offers a direct and uncomplicated medium of intimacy, living in a man who listens to her, has a place where words lose their power. Music is like our existence, constantly polarizing and emotionally stimulating, as it touches the medium of the earliest layers of our becoming. The use of music in palliative care has proved very effective for a variety of effects that music creates in patients. These effects are achieved through the use of various musical techniques, such as musical improvisation, songwriting, receiving creative techniques, guided by imagination and music. These techniques

  16. Creation of minimum standard tool for palliative care in India and self-evaluation of palliative care programs using it

    Directory of Open Access Journals (Sweden)

    M R Rajagopal

    2014-01-01

    Full Text Available Background: It is important to ensure that minimum standards for palliative care based on available resources are clearly defined and achieved. Aims: (1 Creation of minimum National Standards for Palliative Care for India. (2 Development of a tool for self-evaluation of palliative care organizations. (3 Evaluation of the tool in India. In 2006, Pallium India assembled a working group at the national level to develop minimum standards. The standards were to be evaluated by palliative care services in the country. Materials and Methods: The working group prepared a "standards" document, which had two parts - the first composed of eight "essential" components and the second, 22 "desirable" components. The working group sent the document to 86 hospice and palliative care providers nationwide, requesting them to self-evaluate their palliative care services based on the standards document, on a modified Likert scale. Results: Forty-nine (57% palliative care organizations responded, and their self-evaluation of services based on the standards tool was analyzed. The majority of the palliative care providers met most of the standards identified as essential by the working group. A variable percentage of organizations had satisfied the desirable components of the standards. Conclusions: We demonstrated that the "standards tool" could be applied effectively in practice for self-evaluation of quality of palliative care services.

  17. Integrating palliative care with usual care of diabetic foot wounds.

    Science.gov (United States)

    Dunning, Trisha

    2016-01-01

    Palliative care is a philosophy and a system for deciding care and can be used alone or integrated with usual chronic disease care. Palliative care encompasses end-of-life care. Palliative care aims to enhance quality of life, optimize function and manage symptoms including early in the course of chronic diseases. The purposes of this article are to outline palliative care and discuss how it can be integrated with usual care of diabetic foot wounds. Many people with diabetes who have foot wounds also have other comorbidities and diabetes complications such as cardiovascular and renal disease and depression, which affect medicine and other treatment choices, functional status, surgical risk and quality of life. Two broad of diabetic foot disease exist: those likely to heal but who could still benefit from integrated palliative care such as managing pain and those where healing is unlikely where palliation can be the primary focus. People with diabetes can die suddenly, although the life course is usually long with periods of stable and unstable disease. Many health professionals are reluctant to discuss palliative care or suggest people to document their end-of-life care preferences. If such preferences are not documented, the person might not achieve their desired death or place of death and health professionals and families can be confronted with difficult decisions. Palliative care can be integrated with usual foot care and is associated with improved function, better quality of life and greater patient and family satisfaction.

  18. Access to palliative medicine training for Canadian family medicine residents.

    Science.gov (United States)

    Oneschuk, D; Bruera, E

    1998-01-01

    The authors conducted a nine-item mail questionnaire of the 16 Canadian family medicine teaching programme directors to determine the accessibility and operation of palliative care education for their respective family medicine residents. All 16 faculties of medicine responded (100%). The survey revealed that while all universities offer elective time in palliative care only five out of 16 (31%) have a mandatory rotation. The median durations of the mandatory and elective rotations are limited to two and three-and-a-half weeks, respectively. The majority of the universities offer formal lectures in palliative care (12/16, 75%) and educational reading material (13/16, 81%), with the main format in 14/16 (87%) of the sites being case-based learning. The two most common sites for teaching to occur for the residents are the community/outpatient environment and an acute palliative care unit. Fifty-six per cent (9/16) of the universities have designated faculty positions for palliative medicine with a median number of two positions per site. Only one centre offers a specific palliative medicine examination during the rotation. Feedback from the residents regarding their respective palliative medicine programmes were positive overall. Findings from our survey indicate an ongoing need for improved education in palliative medicine at the postgraduate level. PMID:9616456

  19. Sammenhængende palliative forløb

    DEFF Research Database (Denmark)

    Vedsted, Peter; Åbom, Birgit; Jespersen, Bodil Abild;

    2009-01-01

    Almen praksis har altid spillet en central rolle i palliative forløb. I de senere år er der sket en udbygning af den specialiserede palliative indsats, og det stiller krav om en integreret og sammenhængende indsats med shared care, klar ansvarsfordeling og let tilgængelige kommunikationslinjer...

  20. The Evidence Behind Integrating Palliative Care Into Oncology Practice.

    Science.gov (United States)

    Dailey, Erin

    2016-08-01

    Palliative care services provided alongside traditional oncology care have been shown to be beneficial to patients and families. This article provides a brief history of palliative care, a pathway to implementing these services into currently established oncology programs, and a brief discussion of common barriers.

  1. Intention, procedure, outcome and personhood in palliative sedation and euthanasia.

    Science.gov (United States)

    Materstvedt, Lars Johan

    2012-03-01

    Palliative sedation at the end of life has become an important last-resort treatment strategy for managing refractory symptoms as well as a topic of controversy within palliative care. Furthermore, palliative sedation is prominent in the public debate about the possible legalisation of voluntary assisted dying (physician-assisted suicide and euthanasia). This article attempts to demonstrate that palliative sedation is fundamentally different from euthanasia when it comes to intention, procedure, outcome and the status of the person. Nonetheless, palliative sedation in its most radical form of terminal deep sedation parallels euthanasia in one respect: both end the experience of suffering. However, only the latter intentionally ends life and also has this as its goal. There is the danger that deep sedation could bring death forward in time due to particular side effects of the treatment. Still that would, if it happens, not be intended, and accordingly is defensible in view of the doctrine of double effect. PMID:24653491

  2. Intention, procedure, outcome and personhood in palliative sedation and euthanasia.

    Science.gov (United States)

    Materstvedt, Lars Johan

    2012-03-01

    Palliative sedation at the end of life has become an important last-resort treatment strategy for managing refractory symptoms as well as a topic of controversy within palliative care. Furthermore, palliative sedation is prominent in the public debate about the possible legalisation of voluntary assisted dying (physician-assisted suicide and euthanasia). This article attempts to demonstrate that palliative sedation is fundamentally different from euthanasia when it comes to intention, procedure, outcome and the status of the person. Nonetheless, palliative sedation in its most radical form of terminal deep sedation parallels euthanasia in one respect: both end the experience of suffering. However, only the latter intentionally ends life and also has this as its goal. There is the danger that deep sedation could bring death forward in time due to particular side effects of the treatment. Still that would, if it happens, not be intended, and accordingly is defensible in view of the doctrine of double effect.

  3. Cooperating with a palliative home-care team

    DEFF Research Database (Denmark)

    Goldschmidt, Dorthe; Groenvold, Mogens; Johnsen, Anna Thit;

    2005-01-01

    BACKGROUND: Palliative home-care teams often cooperate with general practitioners (GPs) and district nurses. Our aim was to evaluate a palliative home-care team from the viewpoint of GPs and district nurses. METHODS: GPs and district nurses received questionnaires at the start of home-care and one...... by 91 %, mainly due to improvement in symptom management, 'security', and accessibility of specialists in palliative care. After one month, 57% of the participants reported to have learnt aspects of palliative care, primarily symptom control, and 89% of them found cooperation satisfactory....... Dissatisfaction was caused mainly by lack of information from the home-care team to primary-care professionals. CONCLUSION: GPs and district nurses welcomed the palliative home-care team and most experienced benefits to patients. Strengthened communication, initiated by the home-care team would enhance...

  4. Self-assessment in cancer patients referred to palliative care

    DEFF Research Database (Denmark)

    Strömgren, Annette S; Goldschmidt, Dorthe; Groenvold, Mogens;

    2002-01-01

    BACKGROUND: Research in palliative care is considered difficult due to the poor health of patients. However, patient-provided data are essential for a thorough description of patient symptomatology and for the evaluation of care. METHODS: The authors examined the feasibility of a questionnaire......-based study using the European Organization for Research and Treatment of Cancer quality-of-life instrument EORTC QLQ-C30, the Edmonton Symptom Assessment System (ESAS), and the Hospital Anxiety and Depression Scale (HADS) in cancer patients who were receiving palliative care. This report describes...... the symptomatology of participating patients and examines differences in symptomatology between patients in three palliative care functions: inpatient, outpatient, and palliative home care. RESULTS: Of 267 eligible patients who were referred to a department of palliative medicine, initial self...

  5. Palliative Rehabilitation: Call for an everyday and activity perspective

    DEFF Research Database (Denmark)

    la Cour, Karen

    Over the past decade there has been a growing awareness of the relationship between rehabilitation and palliative care. The Danish National Board of Health recommend further coordination and integration of Rehabilitation and Palliative care.. Some of the reasons for this recommendation is the inc......Over the past decade there has been a growing awareness of the relationship between rehabilitation and palliative care. The Danish National Board of Health recommend further coordination and integration of Rehabilitation and Palliative care.. Some of the reasons for this recommendation...... professionals can learn from each other. One of the challenges raised by hospices in the turn towards rehabilitation in palliative care is the understanding and awareness of how to address issues related to forthcoming death. This paper discusses how occupational therapist meet the challenges of integrating...

  6. Outcome measures for palliative oxygen therapy: relevance and practical utility.

    Science.gov (United States)

    Antoniu, Sabina; Mihaltan, Florin

    2014-06-01

    Dyspnea is a common symptom in many advanced malignant and non-malignant diseases and often is refractory to the usual therapies. In such circumstances palliative care approaches are necessary and among them palliative care oxygen therapy can be applied although currently its effectiveness is rather uncertain. Palliative oxygen therapy can be given on either continuous basis or on demand. Often the continuous palliative oxygen therapy is seen as long-term oxygen therapy although their aims are rather different. Palliative oxygen therapy was evaluated in populations with mixed underlying diseases, with outcome measures not only the most appropriate for the setting and therefore these limitations might have influenced the overall perceived therapeutic benefit. Therefore an evaluation of this method in subsets defined based on the etiology and pathogenic mechanisms and with appropriate outcome measures would help to better define the criteria for its indication and would increase its acceptability.

  7. Palliative wound care: principles of care.

    Science.gov (United States)

    Dale, Barbara; Emmons, Kevin R

    2014-01-01

    Home care nursing occurs in a complex care environment. Nurses working in this setting care for a wide array of individuals who often are sicker and more complex than ever before. The high prevalence of wounds among these individuals requires that home care nurses have a certain level of knowledge to provide excellent care. Many times, individuals with wounds do not have the capacity to heal or are burdened with numerous symptoms affecting quality of life. In these cases, the home care nurse must understand concepts of palliative wound care to alleviate symptoms with the goal of improving quality of life.

  8. Mapping levels of palliative care development: a global update.

    Science.gov (United States)

    Lynch, Thomas; Connor, Stephen; Clark, David

    2013-06-01

    Our purpose is to categorize palliative care development, country by country, throughout the world, showing changes over time. We adopt a multi-method approach. Development is categorized using a six-part typology: Group 1 (no known hospice-palliative care activity) and Group 2 (capacity-building activity) are the same as developed during a previous study (2006), but Groups 3 and 4 have been subdivided to produce two additional levels of categorization: 3a) Isolated palliative care provision, 3b) Generalized palliative care provision, 4a) Countries where hospice-palliative care services are at a stage of preliminary integration into mainstream service provision, and 4b) Countries where hospice-palliative care services are at a stage of advanced integration into mainstream service provision. In 2011, 136 of the world's 234 countries (58%) had at least one palliative care service--an increase of 21 (+9%) from 2006, with the most significant gains having been made in Africa. Advanced integration of palliative care has been achieved in only 20 countries (8.5%). Total countries in each category are as follows: Group 1, 75 (32%); Group 2, 23 (10%); Group 3a, 74 (31.6%); Group 3b, 17 (7.3%); Group 4a, 25 (10.7%); and Group 4b, 20 (8.5%). Ratio of services to population among Group 4a/4b countries ranges from 1:34,000 (in Austria) to 1:8.5 million (in China); among Group 3a/3b countries, from 1:1000 (in Niue) to 1:90 million (in Pakistan). Although more than half of the world's countries have a palliative care service, many countries still have no provision, and major increases are needed before palliative care is generally accessible worldwide. PMID:23017628

  9. Children's palliative care now! Highlights from the second ICPCN conference on children's palliative care, 18-21 May 2016, Buenos Aires, Argentina.

    Science.gov (United States)

    Downing, J; Kiman, R; Boucher, S; Nkosi, B; Steel, B; Marston, C; Lascar, E; Marston, J

    2016-01-01

    The International Children's Palliative Care Network held its second international conference on children's palliative care in Buenos Aires, Argentina, from the 18th-21st May 2016. The theme of the conference was 'Children's Palliative Care…. Now!' emphasising the need for palliative care for children now, as the future will be too late for many of them. Six pre-conference workshops were held, addressing issues connected to pain assessment and management, adolescent palliative care, ethics and decision-making, developing programmes, the basics of children's palliative care, and hidden aspects of children's palliative care. The conference brought together 410 participants from 40 countries. Plenary, concurrent, and poster presentations covered issues around the status of children's palliative care, genetics, perinatal and neonatal palliative care, the impact of children's palliative care and the experiences of parents and volunteers, palliative care as a human right, education in children's palliative care, managing complex pain in children, spiritual care and when to initiate palliative care. The 'Big Debate' explored issues around decision-making and end of life care in children, and gave participants the opportunity to explore a sensitive and thought provoking topic. At the end of the conference, delegates were urged to sign the Commitment of Buenos Aires which called for governments to implement the WHA resolution and ensure access to palliative care for neonates, children and their families, and also commits us as palliative care providers to share all that we can and collaborate with each other to achieve the global vision of palliative care for all children who need it. The conference highlighted the ongoing issues in children's palliative care and participants were continually challenged to ensure that children can access palliative care NOW. PMID:27610193

  10. Japanese Bereaved Family Members' Perspectives of Palliative Care Units and Palliative Care: J-HOPE Study Results.

    Science.gov (United States)

    Kinoshita, Satomi; Miyashita, Mitsunori; Morita, Tatsuya; Sato, Kazuki; Shoji, Ayaka; Chiba, Yurika; Miyazaki, Tamana; Tsuneto, Satoru; Shima, Yasuo

    2016-06-01

    The study purpose was to understand the perspectives of bereaved family members regarding palliative care unit (PCU) and palliative care and to compare perceptions of PCU before admission and after bereavement. A cross-sectional questionnaire survey was conducted, and the perceptions of 454 and 424 bereaved family members were obtained regarding PCU and palliative care, respectively. Family members were significantly more likely to have positive perceptions after bereavement (ranging from 73% to 80%) compared to before admission (ranging from 62% to 71%). Bereaved family members who were satisfied with medical care in the PCU had a positive perception of the PCU and palliative care after bereavement. Respondents younger than 65 years of age were significantly more likely to have negative perceptions of PCU and palliative care.

  11. Japanese Bereaved Family Members' Perspectives of Palliative Care Units and Palliative Care: J-HOPE Study Results.

    Science.gov (United States)

    Kinoshita, Satomi; Miyashita, Mitsunori; Morita, Tatsuya; Sato, Kazuki; Shoji, Ayaka; Chiba, Yurika; Miyazaki, Tamana; Tsuneto, Satoru; Shima, Yasuo

    2016-06-01

    The study purpose was to understand the perspectives of bereaved family members regarding palliative care unit (PCU) and palliative care and to compare perceptions of PCU before admission and after bereavement. A cross-sectional questionnaire survey was conducted, and the perceptions of 454 and 424 bereaved family members were obtained regarding PCU and palliative care, respectively. Family members were significantly more likely to have positive perceptions after bereavement (ranging from 73% to 80%) compared to before admission (ranging from 62% to 71%). Bereaved family members who were satisfied with medical care in the PCU had a positive perception of the PCU and palliative care after bereavement. Respondents younger than 65 years of age were significantly more likely to have negative perceptions of PCU and palliative care. PMID:25852202

  12. Generalist primary and palliative care is associated with few hospitalisations in the last month of life.

    NARCIS (Netherlands)

    Onwuteaka-Philipsen, B.; Korte-Verhoef, M.C. de; Schweitzer, B.; Francke, A.L.; Deliens, L.; Pasman, H.R.W.

    2015-01-01

    Background: Hospitalisations in the last phase of life may be related to poor quality of palliative care at home. In the Netherlands, that has a generalist palliative care model, palliative care at home can be given by generalist and palliative care consultants. Aim: To study the association between

  13. Palliative radiation therapy for multiple myeloma

    International Nuclear Information System (INIS)

    Radiation therapy is a useful palliative modality for refractory lesions of multiple myeloma. It has been reported that total doses of 10 to 20 Gy are usually adequate to obtain some degree of pain relief. However, there are many patients who need additional doses to obtain sufficient pain relief. In this study. we retrospectively analyzed the records of patients with multiple myeloma irradiated at our department, in an attempt to develop an effective treatment policy for this disease. Twenty-nine patients with 53 lesions were treated between 1968 and 1993. Total irradiation doses were 4 to 60 Gy (median 40 Gy) with daily fractions of 2 Gy or less, and 16 to 51 Gy (median 30 Gy) with daily fractions greater than 2 Gy. Evaluated were 59 symptoms, including pain (68%), neurological abnormalities (15%), and masses (28%). Symptomatic remission was obtained in 33 of 36 (92%) lesions with pain, 6 of 8 (75%) with neurological abnormalities, and 13 of 15 (87%) mass lesions. Pain was partially relieved at a median TDF of 34, and completely at a median TDF of 66 (equivalent to 40-42 Gy with daily fractions of 2 Gy). Radiation therapy is an effective and palliative treatment method for symptomatic multiple myeloma. However, the treatment seems to require higher radiation doses than those reported to obtain adequate relief of symptoms. (author)

  14. Palliative care and elderly health in Brazil

    Directory of Open Access Journals (Sweden)

    Angela Maria Amaral Soares Abou Ali

    2011-09-01

    Full Text Available In recent years elderly population is increasing substantially, about 650,000 per year, as well as the concept of unifamílies, ie, families consisting of a single person. In this paper, is proposed a reflection about health of elderly in Brazil, and the conditions of a chronic disease and its acute state - terminal. In the actual society, capitalist and capitalized, the individual is valued by his production, losing his value when acquires a disabling illnesses. There is a growing need for work, and each time there is less time and resources to manage the permanence of an elderly patient at home, or pay for a caregiver. This situation leads families to resort to hospitalization, which in turn makes the hospitals overcrowded with patients in this state, affecting both emergency care as the treatment of chronic patients. This fact occurs due to lack of hospital infrastructure, as well by the lack of units of the healthy system capable of providing palliative care. The questioning about the elderly who need palliative care, and reflection about the type of care dispended for this kind of patient, should be the focal point of professional's reflections, capable to lead him to a new way of thinking and, consequently, to inspire him to act in a new way.

  15. Middle East experience in palliative care.

    Science.gov (United States)

    Zeinah, Ghaith F Abu; Al-Kindi, Sadeer G; Hassan, Azza Adel

    2013-02-01

    Palliative Care (PC) is still a relatively new concept in the Middle East (ME). It was first introduced in Saudi Arabia in 1992 and only recently in countries such as Qatar, Bahrain, and the UAE. Although the majority of Middle-Eastern countries, including Palestine, Iraq, Oman and Lebanon are in the capacity building phase, others such as Saudi and Jordan already have localized provision. In the absence of any of the ME countries approaching integration with the mainstream service providers, Saudi Arabia and Jordan are currently setting examples of achievement in the field. There are still countries with little or no known Palliative Care activity (Yemen and Syria). Political issues, scarcity of resources, and lack of education and awareness seem to be the common factors restricting the progress of this field in most countries. In order to improve the suboptimal PC services in the ME, emphasis should be directed toward providing formal education to professionals and raising awareness of the public. It is also necessary to put all differences aside and develop cross-border collaborations, whether through third party organizations such as the Middle East Cancer Consortium (MECC) or otherwise. This review compiles the available literature on the history and progress of the field of PC in most ME countries, while pointing out the major obstacles encountered by the active parties of each country.

  16. Using cannabinoids in pain and palliative care.

    Science.gov (United States)

    Peat, Sue

    2010-10-01

    Interest in the use of cannabinoids in a clinical setting is gradually increasing, particularly in patients where more conventional treatments have failed. They have been reported as offering perceived benefits in a wide range of conditions, but the major interest at present is centred on their place in pain management and in the palliation of symptoms secondary to terminal cancer and neurological disease. The potential benefits include symptomatic relief for patients suffering from intractable neuropathic pain, anorexia, anxiety and muscle spasm. There is clear consensus that cannibinoids should not be used as a first-line monotherapy, but should be considered as valuable adjuvants to more commonly indicated therapeutic options in the management of palliative care patients. Scientific evidence documenting the benefits of the canibinoids nabilone and sativex is accumulating, but needs to be evaluated carefully in the light of the paucity of available data. Both drugs are usually used under the guidance of specialist units. Nabilone and Sativex are now controlled drugs, and are frequently used outside of their licensed indication (control of chemotherapy-induced nausea and vomiting) and hence particular care needs to be taken in evaluating the rational for their use. Sativex has been recently licenced for use in the management of patients with multiple sclerosis. PMID:20972379

  17. Integrating palliative care into the trajectory of cancer care.

    Science.gov (United States)

    Hui, David; Bruera, Eduardo

    2016-03-01

    Over the past five decades, palliative care has evolved from serving patients at the end of life into a highly specialized discipline focused on delivering supportive care to patients with life-limiting illnesses throughout the disease trajectory. A growing body of evidence is now available to inform the key domains in the practice of palliative care, including symptom management, psychosocial care, communication, decision-making, and end-of-life care. Findings from multiple studies indicate that integrating palliative care early in the disease trajectory can result in improvements in quality of life, symptom control, patient and caregiver satisfaction, illness understanding, quality of end-of-life care, survival, and costs of care. In this narrative Review, we discuss various strategies to integrate oncology and palliative care by optimizing clinical infrastructures, processes, education, and research. The goal of integration is to maximize patient access to palliative care and, ultimately, to improve patient outcomes. We provide a conceptual model for the integration of supportive and/or palliative care with primary and oncological care. We also discuss how health-care systems and institutions need to tailor integration based on their resources, size, and the level of primary palliative care available.

  18. Palliative care in home care: perceptions of occupational therapists

    Directory of Open Access Journals (Sweden)

    Séfora Gomez Portela

    2015-03-01

    Full Text Available This research aimed at understanding and reflecting on the perceptions of occupational therapists regarding the implementation of palliative care in home care. This is an exploratory, qualitative study, through semi-structured interviews, conducted in the second semester of 2012 with eight occupational therapists with experience in palliative care in the city of São Paulo. Content analysis identified four themes: characterization and professional trajectory in the field, understanding the concepts of palliative care, home care and palliative care, and occupational therapy and palliative care in home care. The results suggest that the role of the occupational therapist in this field has taken place at different levels of health care, being addressed to people with varying needs. The use of the concept of palliative care by the interviewees exceeds the notion of end of life, following the changes in the epidemiological transition. They understand that professional services follow the trend of national palliative care services with focus on specialized levels, but manifest the importance of its implementation in primary and home care. Among the barriers to practice, they identified the complexity of “being at home “, peculiarities of palliative care with high cost demands, lack of infrastructure and implementation of the current policy. Professional training and scientific roduction in the area were viewed as inadequate, although they identified a call for change. The interviewees recognized palliative care in home care as a strong professional field, but one still requiring study and discussions regarding its limits and conditions of implementation, especially in the Unified Health System.

  19. Cancer and African Americans

    Science.gov (United States)

    ... Population Profiles > Black/African American > Cancer Cancer and African Americans African Americans have the highest mortality rate ... 65MB] At a glance – Top Cancer Sites for African Americans (2008-2012) Cancer Incidence Rates per 100, ...

  20. Palliative Care as a Standard of Care in Pediatric Oncology.

    Science.gov (United States)

    Weaver, Meaghann S; Heinze, Katherine E; Kelly, Katherine P; Wiener, Lori; Casey, Robert L; Bell, Cynthia J; Wolfe, Joanne; Garee, Amy M; Watson, Anne; Hinds, Pamela S

    2015-12-01

    The study team conducted a systematic review of pediatric and adolescent palliative cancer care literature from 1995 to 2015 using four databases to inform development of a palliative care psychosocial standard. A total of 209 papers were reviewed with inclusion of 73 papers for final synthesis. Revealed topics of urgent consideration include the following: symptom assessment and intervention, direct patient report, effective communication, and shared decision-making. Standardization of palliative care assessments and interventions in pediatric oncology has the potential to foster improved quality of care across the cancer trajectory for children and adolescents with cancer and their family members.

  1. Pediatric Palliative Care in the Intensive Care Unit.

    Science.gov (United States)

    Madden, Kevin; Wolfe, Joanne; Collura, Christopher

    2015-09-01

    The chronicity of illness that afflicts children in Pediatric Palliative Care and the medical technology that has improved their lifespan and quality of life make prognostication extremely difficult. The uncertainty of prognostication and the available medical technologies make both the neonatal intensive care unit and the pediatric intensive care unit locations where many children will receive Pediatric Palliative Care. Health care providers in the neonatal intensive care unit and pediatric intensive care unit should integrate fundamental Pediatric Palliative Care principles into their everyday practice. PMID:26333755

  2. Edmonton, Canada: a regional model of palliative care development.

    Science.gov (United States)

    Fainsinger, Robin L; Brenneis, Carleen; Fassbender, Konrad

    2007-05-01

    Palliative care developed unevenly in Edmonton in the 1980s and early 1990s. Health care budget cuts created an opportunity for innovative redesign of palliative care service delivery. This report describes the components that were developed to build an integrated comprehensive palliative care program, the use of common clinical assessments and outcome evaluation that has been key to establishing credibility and ongoing support. Our program has continued to develop and grow with an ongoing focus on the core areas of clinical care, education, and research. PMID:17482060

  3. Associations between successful palliative cancer pathways and community nurse involvement

    DEFF Research Database (Denmark)

    Neergaard, Mette Asbjoern; Vedsted, Peter; Olesen, Frede;

    2009-01-01

    ABSTRACT: BACKGROUND: Most terminally ill cancer patients and their relatives wish that the patient dies at home. Community nurses (CNs) are often frontline workers in the patients' homes and CN involvement may be important in attaining successful palliative pathways at home.The aim of the present...... between bereaved relatives' evaluation of palliative pathways at home and place of death and CN involvement were analysed. RESULTS: 'A successful palliative pathway at home' was positively associated with home-death and death at a nursing home compared with death at an institution. No significant...

  4. [Ethical challenge in palliative support of intensive care patients].

    Science.gov (United States)

    Salomon, Fred

    2015-01-01

    Intensive care medicine and palliative care medicine were considered for a long time to be contrasting concepts in therapy. While intensive care medicine is directed towards prolonging life and tries to stabilize disordered body functions, palliative care medicine is focused upon the relief of disturbances to help patients in the face of death. Today both views have become congruent. Palliative aspects are equally important in curative therapy. In the course of illness or in respect of the patient's will, the aim of therapy may change from curative to palliative. Two examples are presented to illustrate the ethical challenges in this process. They follow from the medical indication, attention to the patient's will, different opinions in the team, truth at the bedside and from what must be done in the process of withdrawing therapy.

  5. Overcoming Recruitment Challenges in Palliative Care Clinical Trials

    OpenAIRE

    LeBlanc, Thomas W.; Lodato, Jordan E.; Currow, David C; Abernethy, Amy P.

    2013-01-01

    Challenges to clinical trial recruitment in palliative care are significant but not insurmountable. Through their experience with designing and deploying a social-marketing based protocol, the authors show that a carefully crafted recruitment and retention protocol can be effective.

  6. [Pressure ulcers in palliative home care patients: prevalence and characteristics].

    Science.gov (United States)

    Queiroz, Ana Carolina de Castro Mendonça; Mota, Dálete Delalibera Corrêa de Faria; Bachion, Maria Marcia; Ferreira, Ana Cássia Mendes

    2014-04-01

    Persons in palliative care develop pressure ulcers (PU) as death approaches, but the extent of the problem is still unknown. The objectives were to identify the prevalence of pressure ulcers in people with cancer in palliative home care, compare the socio-demographic and clinical profile of patients with and without pressure ulcers, and analyze the characteristics of the ulcers. This descriptive, cross-sectional study included 64 people with advanced cancer in palliative home care. Twelve of them (18.8%) had PU, of whom 75.0% were men. The participants had one to three PU, amounting to 19 lesions, 89.4% of those developed at home and 47.4% at stage 3. The presence of PU was higher among those who had a history of previous wound. PU consisted of a significant event occurring in the studied population, indicating that preventive measures should be included in the home palliative care health team.

  7. Early Palliative Care Improves Patients' Quality of Life

    Science.gov (United States)

    ... fullstory_160885.html Early Palliative Care Improves Patients' Quality of Life Also increases chances of having end-of-life ... incurable cancer helps patients cope and improves their quality of life, a new study shows. It also leads to ...

  8. Smarter palliative care for cancer: Use of smartphone applications

    Directory of Open Access Journals (Sweden)

    Nisha Rani Jamwal

    2016-01-01

    Full Text Available Smartphones are technologically advanced mobile phone devices which use software similar to computer-based devices as a user-friendly interface. This review article is aimed to inform the palliative care professionals, cancer patients and their caregivers about the role of smartphone applications (apps in the delivery of palliative care services, through a brief review of existing literature on the development, feasibility, analysis, and effectiveness of such apps. There is a dearth need for sincere palliative care clinicians to work together with software professionals to develop the suitable smartphone apps in accordance with the family/caregivers' necessities and patients' biopsychosocial characteristics that influence the technology driven evidence informed palliative cancer care.

  9. A randomised, multicentre clinical trial of specialised palliative care plus standard treatment versus standard treatment alone for cancer patients with palliative care needs

    DEFF Research Database (Denmark)

    Johnsen, Anna Thit; Damkier, Anette; Vejlgaard, Tove Bahn;

    2013-01-01

    Advanced cancer patients experience considerable symptoms, problems, and needs. Early referral of these patients to specialised palliative care (SPC) could improve their symptoms and problems.The Danish Palliative Care Trial (DanPaCT) investigates whether patients with metastatic cancer, who report...... palliative needs in a screening, will benefit from being referred to 'early SPC'....

  10. Pharmacological treatments for fatigue associated with palliative care

    OpenAIRE

    Mücke, M.; Mochamat; Cuhls, H; Peuckmann-Post, V.; Minton, O.; Stone, P.; Radbruch, L.

    2015-01-01

    BACKGROUND: This review updates the original review, 'Pharmacological treatments for fatigue associated with palliative care' and also incorporates the review 'Drug therapy for the management of cancer-related fatigue'.In healthy individuals, fatigue is a protective response to physical or mental stress, often relieved by rest. By contrast, in palliative care patients' fatigue can be severely debilitating and is often not counteracted with rest, thereby impacting daily activity and quality of...

  11. Retroperitoneal endodermal sinus tumor patient with palliative care needs

    Directory of Open Access Journals (Sweden)

    Surbhi Kashyap

    2016-01-01

    Full Text Available This article is a case reflection of a personal encounter on the palliative care treatment required after the removal of a complicated case of a primary extra-gonadal retro-peritoneal endodermal sinus tumor (yolk sac tumor. This reflection is from the perspective of a recently graduated MD student who spent one month with an Indian pain management and palliative care team at the Institute Rotary Cancer Hospital (IRCH, All India Institute of Medical Sciences (AIIMS, New Delhi

  12. Orientations can avert psychosocial risks to palliative staff

    OpenAIRE

    Kamau, Caroline; Medisauskaite, A.; Lopes, B.

    2014-01-01

    Key points 1. Personnel in palliative care wards and hospices are at risk of chronic stress, burnout, anxiety, depression and substance/alcohol abuse because working in end-of-life care involves frequent grief, death anxiety and feelings of professional helplessness. 2. This commentary discusses the reported labour shortage in palliative care, and why some occupations are particularly at risk of quitting (e.g., care workers). 3. Most healthcare organizations are not providing pal...

  13. Palliative care in medical outliers with heart failure

    OpenAIRE

    Jammula Prabhakar Patro; Pavani Priyadarsini

    2016-01-01

    Medical outliers are the patients who present to medical practices without health insurance or with serious co-morbidities needing prolonged hospital stay. Palliative care is part of standard guidelines for management of heart failure. But in medical outliers suffering from heart failure, palliative care should begin more early than it is recommended in standard guidelines because of financial reasons. It is suggested that guidelines be framed also for medical outliers with heart failure. It ...

  14. Endoscopic Stent Placement in the Palliation of Malignant Biliary Obstruction

    OpenAIRE

    Kim, Jin Hong

    2011-01-01

    Biliary drainage with biliary stent placement is the treatment of choice for palliation in patients with malignant biliary obstruction caused by unresectable neoplasms. In such patients, the endoscopic approach can be initially used with percutaneous radiological intervention. In patients with unresectable malignant distal bile duct obstructions, endoscopic biliary drainage with biliary stent placement has now become the main and least invasive palliative modality, which has been proven to be...

  15. Treating nausea and vomiting in palliative care: a review

    Directory of Open Access Journals (Sweden)

    Glare P

    2011-09-01

    Full Text Available Paul Glare, Jeanna Miller, Tanya Nikolova, Roma TickooPain and Palliative Care Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USAAbstract: Nausea and vomiting are portrayed in the specialist palliative care literature as common and distressing symptoms affecting the majority of patients with advanced cancer and other life-limiting illnesses. However, recent surveys indicate that these symptoms may be less common and bothersome than has previously been reported. The standard palliative care approach to the assessment and treatment of nausea and vomiting is based on determining the cause and then relating this back to the “emetic pathway” before prescribing drugs such as dopamine antagonists, antihistamines, and anticholinergic agents which block neurotransmitters at different sites along the pathway. However, the evidence base for the effectiveness of this approach is meager, and may be in part because relevance of the neuropharmacology of the emetic pathway to palliative care patients is limited. Many palliative care patients are over the age of 65 years, making these agents difficult to use. Greater awareness of drug interactions and QTc prolongation are emerging concerns for all age groups. The selective serotonin receptor antagonists are the safest antiemetics, but are not used first-line in many countries because there is very little scientific rationale or clinical evidence to support their use outside the licensed indications. Cannabinoids may have an increasing role. Advances in interventional gastroenterology are increasing the options for nonpharmacological management. Despite these emerging issues, the approach to nausea and vomiting developed within palliative medicine over the past 40 years remains relevant. It advocates careful clinical evaluation of the symptom and the person suffering it, and an understanding of the clinical pharmacology of medicines that are available for palliating

  16. Palliative care for adolescents and young adults with cancer

    Directory of Open Access Journals (Sweden)

    Rosenberg AR

    2013-03-01

    Full Text Available Abby R Rosenberg,1–3 Joanne Wolfe4–61Division of Pediatric Hematology/Oncology, Seattle Children’s Hospital, Seattle, WA; 2Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA; 3Department of Pediatrics, University of Washington, Seattle, WA; 4Department of Psychosocial Oncology and Palliative Care/Division of Pediatric Palliative Care, Dana-Farber Cancer Institute, Boston, MA; 5Department of Medicine/Division of Hematology/Oncology, Boston Children’s Hospital, Boston, MA; 6Department of Pediatrics, Harvard University School of Medicine, Boston, MA, USAAbstract: Adolescents and young adults (AYAs with cancer represent a unique and challenging group of patients with distinct developmental and psychosocial needs that may be unrecognized or unmet during their cancer experience. Palliative care refers to the total care of a patient, regardless of his or her disease status, and aims to improve quality of life by controlling symptoms and alleviating physical, social, psychological, and spiritual suffering. Integrating palliative care into standard oncology practice for AYAs is therefore valuable, if not imperative, in improving their overall cancer experience. In this review, we aimed to describe the scope, benefits, and challenges of palliative care for AYA oncology patients. We provide a broad impression of the existing literature describing or investigating palliative care in this population. Put together, the evidence suggests that palliative care is not only needed, but can also be critically beneficial to patients, families, and health care professionals alike. As we increase public and professional awareness of the needs and applications of palliative care for AYA patients with cancer, we will ultimately enable better psychosocial outcomes of the AYA patients and their larger communities.Keywords: supportive care, end of life, psychosocial outcomes, psychosocial oncology, psychosocial needs, quality of life

  17. Program Assessment Framework for a Rural Palliative Supportive Service

    OpenAIRE

    Barbara Pesut; Brenda Hooper; Richard Sawatzky; Robinson, Carole A; Bottorff, Joan L.; Miranda Dalhuisen

    2013-01-01

    Although there are a number of quality frameworks available for evaluating palliative services, it is necessary to adapt these frameworks to models of care designed for the rural context. The purpose of this paper was to describe the development of a program assessment framework for evaluating a rural palliative supportive service as part of a community-based research project designed to enhance the quality of care for patients and families living with life-limiting chronic illness. A review ...

  18. African dance

    OpenAIRE

    Mumberson, Stephen

    2012-01-01

    The RE Open will be shown at the Mall Gallery London and the international section was judged by major practitioners and educators, print dealers and collectors, President of RE and Keeper of the Ashmolean Museum Dr Bren Unwin, John Purcell, Deborah Roslund, Colin Harrison, Dave Ferry, and Mark Hampson. Piece selected "African Dance" print.

  19. "African Connection."

    Science.gov (United States)

    Adelman, Cathy; And Others

    This interdisciplinary unit provides students in grades kindergarten through seventh grade an opportunity to understand diversity through a study of Africa as a diverse continent. The project is designed to provide all elementary students with cultural enrichment by exposing them to African music, art, storytelling, and movement. This project can…

  20. Radiotherapy in Palliative Cancer Care: Development and Implementation

    International Nuclear Information System (INIS)

    It is estimated that in 2008 there were over 12 million new cancer diagnoses and 7 million cancer deaths worldwide. The World Health Organisation (WHO) predicts that cancer rates will increase from 10 million to 24 million in the next 50 years. More than half of cancer cases will be diagnosed in low income nations, where 80% or more of patients will have incurable disease at diagnosis. In situations where most patients are diagnosed with incurable disease or where curative treatment is logistically unavailable, as is the case in many low income countries, the allocation of limited health care resources should reflect a greater emphasis on palliative care. Ironically, access to palliative care is greater in health care systems with well developed infrastructures and facilities for prevention, early detection, and curative treatment of cancer. To provide comprehensive cancer care, a multidisciplinary approach is needed. This maximizes the available treatments and interventions, whilst ensuring a cost effective and ethically sound approach to the treatment of patients at each stage of the disease. Barriers to palliative care may result from its low prioritization in health care policy and education. The WHO expert committee on cancer pain and palliative care report of 1990 called for the integration of efforts directed at maintaining patient quality of life through all stages of cancer treatment. As a result supportive interventions aimed at improving quality of life are needed for patients undergoing both curative and palliative cancer treatment. The International Atomic Energy Agency is currently collaborating with the Open Society Institute to develop palliative care programmes in Eastern Europe, Africa and India, as well as supporting programmes in other regions of the world, through the International Palliative Care Initiative. OSI partners with the IAEA's Programme of Action for Cancer Therapy, the World Health Organization, the International Agency for Research

  1. Palliative Treatment of Malignant Pleural Effusion

    Directory of Open Access Journals (Sweden)

    Chenyang Liu

    2015-01-01

    Full Text Available Malignant pleural effusion (MPE is a common clinical problem caused by cancers. Pleural effusion can be the first sign of cancer in more than 25% of patients. Lung cancer and breast cancer are the most common cancers that metastasize to the pleura in men and women, respectively. Other cancers, including, but not limited to, lymphomas, ovarian cancer, stomach cancer, and several unknown primary cancers can also lead to MPE. Dyspnea and chest pain are the most common symptoms of MPE along with other symptoms such as a cough, weight loss, anorexia, fatigue, and weakness. Aggravation of these symptoms is closely related to the rate of accumulation of pleural effusion. Treatment options to MPE are determined by the type and extent of the underlying malignancy. The major goals of the treatment are to relieve symptoms, restore functions, improve the quality of life, and minimize the duration of hospital stay and costs. Although some patients can be treated with systemic therapies, most of these treatments are temporary, and MPE would recur soon. Hence, further palliative treatments to effectively control pleural effusions and relieve symptoms are necessary. This review addresses the pathophysiology of MPE and the treatment options for patients with MPE.

  2. Malignant biliary obstruction: From palliation to treatment

    Science.gov (United States)

    Boulay, Brian R; Birg, Aleksandr

    2016-01-01

    Malignant obstruction of the bile duct from cholangiocarcinoma, pancreatic adenocarcinoma, or other tumors is a common problem which may cause debilitating symptoms and increase the risk of subsequent surgery. The optimal treatment - including the decision whether to treat prior to resection - depends on the type of malignancy, as well as the stage of disease. Preoperative biliary drainage is generally discouraged due to the risk of infectious complications, though some situations may benefit. Patients who require neoadjuvant therapy will require decompression for the prolonged period until attempted surgical cure. For pancreatic cancer patients, self-expanding metallic stents are superior to plastic stents for achieving lasting decompression without stent occlusion. For cholangiocarcinoma patients, treatment with percutaneous methods or nasobiliary drainage may be superior to endoscopic stent placement, with less risk of infectious complications or failure. For patients of either malignancy who have advanced disease with palliative goals only, the choice of stent for endoscopic decompression depends on estimated survival, with plastic stents favored for survival of stent patency and patient survival for these patients by achieving local control of the obstructing tumor. Both photodynamic therapy and radiofrequency ablation may play a role in extending survival of patients with malignant biliary obstruction. PMID:27326319

  3. Opportunities for Palliative Care in Public Health.

    Science.gov (United States)

    De Lima, Liliana; Pastrana, Tania

    2016-01-01

    In May 2014, the World Health Assembly, of the World Health Organization (WHO), unanimously adopted a palliative care (PC) resolution, which outlines clear recommendations to the United Nations member states, such as including PC in national health policies and in the undergraduate curricula for health care professionals, and highlights the critical need for countries to ensure that there is an adequate supply of essential PC medicines, especially those needed to alleviate pain. This resolution also carries great challenges: Every year over 20 million patients (of which 6% are children) need PC at the end of life (EOL). However, in 2011, approximately three million patients received PC, and only one in ten people in need is currently receiving it. We describe this public health situation and systems failure, the history and evolution of PC, and the components of the WHO public health model. We propose a role for public health for PC integration in community settings to advance PC and relieve suffering in the world.

  4. Gynaecological malignancies from palliative care perspective

    Directory of Open Access Journals (Sweden)

    Kamlesh Mishra

    2011-01-01

    Full Text Available Of the approximately 80,000 new cases of all cancers detected every year in India, 10-15% are gynecological malignancies. As per population-based registries under the National Cancer Registry Program, the leading sites of cancer among women are the cervix uteri, breast, and oral cavity. About 50-60% of all cancers among women in India are mainly of the following four organs: cervix uteri, breast, corpus uteri, and ovaries. Over 70% of these women report for diagnostic and treatment services at an advanced stage of disease, resulting in poor survival and high mortality rates. Among all gynecological cancers, ovarian cancer is the deadliest one and, in 2/3 rd of the cases, is detected in an advanced stage. But, in India and in other developing countries, due to inadequate screening facilities for the preventable cancer cervix, this kills more women than any other cancer in females. Gynecology Oncologist as a sub-specialist has an immensely important role in curtailing the menace of gynecological malignancies by providing comprehensive preventive, curative, palliative and follow-up services, with the aim of assuring a good quality of life to women as a cornerstone of cancer management.

  5. Palliative care in advanced gynecological cancers: Institute of palliative medicine experience

    Directory of Open Access Journals (Sweden)

    Sushmita Pathy

    2008-01-01

    Full Text Available Aim: To study the epidemiological profile, clinical symptoms and referral patterns of patients with gynecological malignancy. To evaluate pain symptoms, response to treatment and factors affecting management in patients with advanced gynecological malignancies. Methods: A retrospective analysis was performed of the gynecological malignancy cases registered at the Pain and Palliative Care Clinic, Calicut, over a 12-month period between January 2006 and December 2006.Patient characteristics, symptoms and response to treatment were evaluated in detail. Results: A total of 1813 patients registered, of which 64 had gynecological malignancies. Most of the cases were referred from the Oncology Department of the Calicut Medical College. Fifty-five percent of the patients were unaware of their diagnosis. Psychosocial issues and anxiety were observed in 48%. Insomnia was seen in 52% of the cases. Pain was the most common and most distressing symptom. Adequate pain relief was achieved in only 32% of the patients. Conclusions: The number of gynecological malignancy cases attending the Pain and Palliative Care Clinic is small. Pain is the most common and distressing symptom, with only 32% of the patients achieving adequate pain relief. Poor drug compliance, incomplete assessment of pain and the lack of awareness of morphine therapy were identified as the most common causes for poor pain control.

  6. "PRIMARY PALLIATIVE CARE? - Treating terminally ill cancer patients in the primary care sector"

    DEFF Research Database (Denmark)

    Neergaard, Mette Asbjørn; Jensen, AB; Olesen, Frede;

    2006-01-01

    4th Research Forum of the European Association for Palliative Care "Collaborate to Catalyse Research", Venice Lido,......4th Research Forum of the European Association for Palliative Care "Collaborate to Catalyse Research", Venice Lido,...

  7. Self-Expanding Metal Stenting for Palliation of Patients with Malignant Colonic Obstruction

    DEFF Research Database (Denmark)

    Meisner, Søren; González-Huix, Ferran; Vandervoort, Jo G;

    2012-01-01

    Background. Self-expanding metal stents can alleviate malignant colonic obstruction in incurable patients and avoid palliative stoma surgery. Objective. Evaluate stent effectiveness and safety on palliation of patients with malignant colorectal strictures. Design. Two prospective, one Spanish and...

  8. Palliative Interventional and Surgical Therapy for Unresectable Pancreatic Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Assfalg, Volker; Hüser, Norbert; Michalski, Christoph; Gillen, Sonja; Kleeff, Jorg; Friess, Helmut, E-mail: friess@chir.med.tu-muenchen.de [Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, D-81675 Munich (Germany)

    2011-02-14

    Palliative treatment concepts are considered in patients with non-curatively resectable and/or metastasized pancreatic cancer. However, patients without metastases, but presented with marginally resectable or locally non-resectable tumors should not be treated by a palliative therapeutic approach. These patients should be enrolled in neoadjuvant radiochemotherapy trials because a potentially curative resection can be achieved in approximately one-third of them after finishing treatment and restaging. Within the scope of best possible palliative care, resection of the primary cancer together with excision of metastases represents a therapeutic option to be contemplated in selected cases. Comprehensive palliative therapy is based on treatment of bile duct or duodenal obstruction for certain locally unresectable or metastasized advanced pancreatic cancer. However, endoscopic or percutaneous stenting procedures and surgical bypass provide safe and highly effective therapeutic alternatives. In case of operative drainage of the biliary tract (biliodigestive anastomosis), the prophylactic creation of a gastro-intestinal bypass (double bypass) is recommended. The decision to perform a surgical versus an endoscopic procedure for palliation depends to a great extent on the tumor stage and the estimated prognosis, and should be determined by an interdisciplinary team for each patient individually.

  9. Palliative care and dementia--A time and place?

    Science.gov (United States)

    Kydd, Angela; Sharp, Barbara

    2016-02-01

    The current focus in dementia care places emphasis on the potential of people to live well with the condition. Given the historical tendency to neglect the full rights and citizenship of people with dementia, such an emphasis gives hope and optimism that there is life after diagnosis. This paper seeks to explore the potential compromise of effective preparation for the complexities of advanced illness that may be presented by this consistently up-beat message. Dementia is a life limiting condition, currently without cure. Therefore, the appropriateness of palliative care may seem obvious. Yet, until relatively recently, palliative care was seen as an adjunct to oncology in the minds of professionals and public alike. However, there is a growing recognition that specialist palliative care has much to offer people with a range of long term conditions, including people with dementia. So, whilst 'living well' is an important message-especially following diagnosis-planning for advanced dementia and dying well is equally important. The aim of this paper is to highlight policy on the living well and the palliative care approach for people with dementia. A word limited narrative literature review was conducted to explore how policies have or have not informed the literature on both messages. The findings emphasise the need for a continuum approach to dementia care, with discussion on when, where, and how can palliative care be delivered for people with dementia. PMID:26586105

  10. Palliative care and dementia--A time and place?

    Science.gov (United States)

    Kydd, Angela; Sharp, Barbara

    2016-02-01

    The current focus in dementia care places emphasis on the potential of people to live well with the condition. Given the historical tendency to neglect the full rights and citizenship of people with dementia, such an emphasis gives hope and optimism that there is life after diagnosis. This paper seeks to explore the potential compromise of effective preparation for the complexities of advanced illness that may be presented by this consistently up-beat message. Dementia is a life limiting condition, currently without cure. Therefore, the appropriateness of palliative care may seem obvious. Yet, until relatively recently, palliative care was seen as an adjunct to oncology in the minds of professionals and public alike. However, there is a growing recognition that specialist palliative care has much to offer people with a range of long term conditions, including people with dementia. So, whilst 'living well' is an important message-especially following diagnosis-planning for advanced dementia and dying well is equally important. The aim of this paper is to highlight policy on the living well and the palliative care approach for people with dementia. A word limited narrative literature review was conducted to explore how policies have or have not informed the literature on both messages. The findings emphasise the need for a continuum approach to dementia care, with discussion on when, where, and how can palliative care be delivered for people with dementia.

  11. Evidence of improved quality of life with pediatric palliative care.

    Science.gov (United States)

    O'Quinn, Lucy P; Giambra, Barbara K

    2014-01-01

    Pediatric nurses provide holistic family-centered care for children with life-limiting illnesses while being sensitive to children's growth and developmental needs. To learn how pediatric palliative care programs benefit children and their families, the following clinical question was asked: Among children with a life-limiting illness, does the use of a palliative care program compared with not using a palliative care program improve quality of life for patients and their families? Evidence from two studies found that palliative care services improve quality of life for children with life-limiting illness and their families in the areas of the child's emotional well-being and parental perception of preparation for the child's end of life, resulting in a low grade for the body of evidence. Future research should include high quality studies with larger sample sizes and control groups, and include children's perspectives--from both patients and siblings--to give a more complete picture of how best to improve their quality of life. A reliable tool is needed that includes a spiritual component and sensitive indicators specific to children with a life-limiting illness. Future research using this tool will more fully answer how palliative care services improve children's quality of life. PMID:25929123

  12. An Ecological Understanding of Caregiver Experiences in Palliative Care.

    Science.gov (United States)

    Chandran, Devyani; Corbin, J Hope; Shillam, Casey

    2016-01-01

    Palliative care is specialized health care to improve quality of life for patients with serious illness and their families through prevention and relief of suffering. A Palliative Care Institute was held in western Washington to capture community voices about diverse needs, strengths, and opportunities for improvement of palliative care. Researchers employed qualitative methods to obtain thematic data, provide real-time analysis, and engage in a multivoting technique to reflect stakeholder interest in individual themes and prioritize larger group interests. Bronfenbrenner's ecological systems framework was used to explore caregiver experiences. Within the microsystem, caregivers reported difficulties in interactions with medical providers as a key challenge. Within the mesosysytem, interactions between patients and medical providers and the impact on caregivers were explored. Within the exosystem, caregivers reported lack of control over the schedules of personal care staff. Macrosystem influences included impact of local culture on the development of palliative care services. Chronosystem influences include de-medicalization of childbirth and its impact on perceptions of palliative care. Implications include the need for social workers to be proactive in fostering trust and effective communication between care providers and caregivers, and the demand for health care provider training in communication with patients and families. PMID:27143579

  13. Obesity and African Americans

    Science.gov (United States)

    ... Data > Minority Population Profiles > Black/African American > Obesity Obesity and African Americans African American women have the ... ss6304.pdf [PDF | 3.38MB] HEALTH IMPACT OF OBESITY More than 80 percent of people with type ...

  14. Study of nurses′ knowledge about palliative care: A quantitative cross-sectional survey

    OpenAIRE

    Venkatesan Prem; Harikesavan Karvannan; Kumar, Senthil P; Surulirajan Karthikbabu; Nafeez Syed; Vaishali Sisodia; Saroja Jaykumar

    2012-01-01

    Context: Studies have documented that nurses and other health care professionals are inadequately prepared to care for patients in palliative care. Several reasons have been identified including inadequacies in nursing education, absence of curriculum content related to pain management, and knowledge related to pain and palliative care. Aims: The objective of this paper was to assess the knowledge about palliative care amongst nursing professionals using the palliative care knowledge tes...

  15. The Role and Timing of Palliative Care in Supporting Persons with Intellectual Disability and Advanced Dementia

    Science.gov (United States)

    McCarron, Mary; McCallion, Philip; Fahey-McCarthy, Elizabeth; Connaire, Kevin

    2011-01-01

    Aim: To better describe the role and timing of palliative care in supporting persons with intellectual disabilities and advanced dementia (AD). Background: Specialist palliative care providers have focused mostly on people with cancers. Working with persons with intellectual disabilities and AD offers opportunities to expand such palliative care…

  16. [Current status of palliative care in medical oncology].

    Science.gov (United States)

    Sasaki, Tsubasa; Ohta, Syuji; Seki, Nobuhiko; Eguchi, Kenji

    2010-06-01

    A team approach is efficient in palliative care for cancer patients. People suffered from cancer have a right to receive high-quality palliative care earlier in cancer treatment. In Japan the National Act for Strategy against Cancer was enacted in 2007. Systematic educational programs supported by the Ministry of Health Labor and Welfare has been conducted for medical staffs, home care staffs, local pharmacists, care managers etc. at core institutes in each district. Pain control is still major target for cancer palliative medicine. Recently various types of opioids can be used routinely in daily clinical setting for Japanese cancer patients. Complementary and alternative medicine (CAM) may also effective in some patients but further study for proving scientific evidence in CAM should be warranted. Tailor-maid pain control will be established in the near future with molecular based pharmacogenomics.

  17. Reflections on Palliative Care from the Jewish and Islamic Tradition

    Directory of Open Access Journals (Sweden)

    Michael Schultz

    2012-01-01

    Full Text Available Spiritual care is a vital part of holistic patient care. Awareness of common patient beliefs will facilitate discussions about spirituality. Such conversations are inherently good for the patient, deepen the caring staff-patient-family relationship, and enhance understanding of how beliefs influence care decisions. All healthcare providers are likely to encounter Muslim patients, yet many lack basic knowledge of the Muslim faith and of the applications of Islamic teachings to palliative care. Similarly, some of the concepts underlying positive Jewish approaches to palliative care are not well known. We outline Jewish and Islamic attitudes toward suffering, treatment, and the end of life. We discuss our religions' approaches to treatments deemed unnecessary by medical staff, and consider some of the cultural reasons that patients and family members might object to palliative care, concluding with specific suggestions for the medical team.

  18. Development and efficacy of music therapy techniques within palliative care.

    Science.gov (United States)

    Clements-Cortés, Amy

    2016-05-01

    Music therapy is increasingly becoming an intervention used in palliative care settings around the globe. While the specialty of palliative care music therapy is relatively young having emerged in the late 1980s, there is a strong and growing body of evidence demonstrating its efficacy in assisting a variety of issues common at end-of-life. There are multiple music therapy techniques that are implemented with clients in palliative care and they can be categorized in four broad areas: receptive, creative, recreative and combined. These techniques will be presented with respect to their development by clinicians as supported by the descriptive and research literature. Information is also provided on the use of music therapy in facilitating the grieving and bereavement process. PMID:25986297

  19. Palliative radiotherapy in head and neck cancers: Evidence based review

    Directory of Open Access Journals (Sweden)

    Talapatra Kaustav

    2006-01-01

    Full Text Available Squamous cell carcinoma of head and neck (SCCHN is one of the commonest cancers seen in India, constituting up to 25% of their overall cancer burden. Advanced SCCHN is a bad disease with a poor prognosis and patients usually die of uncontrolled loco-regional disease. Curative intent management of loco-regionally advanced SCCHN has become more evidence-based with active clinical research in the form of large prospective randomized controlled trials and meta-analyses. However, little has been written about palliative radiotherapy (PRT in head and neck cancers. It is widely recognized that PRT provides effective palliation and improved quality-of-life in advanced incurable malignancies. It is in this context that this study proposes to review the existing literature on palliative radiotherapy in advanced incurable SCCHN to help formulate consensus guidelines and recommendations.

  20. The importance of measuring customer satisfaction in palliative care.

    Science.gov (United States)

    Turriziani, Adriana; Attanasio, Gennaro; Scarcella, Francesco; Sangalli, Luisa; Scopa, Anna; Genualdo, Alessandra; Quici, Stefano; Nazzicone, Giulia; Ricciotti, Maria Adelaide; La Commare, Francesco

    2016-03-01

    In the last decades, palliative care has been more and more focused on the evaluation of patients' and families' satisfaction with care. However, the evaluation of customer satisfaction in palliative care presents a number of issues such as the presence of both patients and their families, the frail condition of the patients and the complexity of their needs, and the lack of standard quality indicators and appropriate measurement tools. In this manuscript, we critically review existing evidence and literature on the evaluation of satisfaction in the palliative care context. Moreover, we provide - as a practical example - the preliminary results of our experience in this setting with the development of a dedicated tool for the measurement of satisfaction.

  1. [Palliative care to adolescents with cancer: a literature review].

    Science.gov (United States)

    Remedi, Patrícia Pereira; Mello, Débora Faleiros de; Menossi, Maria José; Lima, Regina Aparecida Garcia de

    2009-01-01

    Providing care to adolescents with cancer in the process of death and dying has been a great challenge for health professionals. This challenge is marked by a high emotional burden and specificities of this stage of human development. The purpose of the present study was to review the scientific literature regarding palliative care to adolescents with cancer. This study is a literature review, which data collection was performed using Lilacs, Medline, and PsycInfo, in addition to non-systematic databases. An analysis of the manuscripts revealed three themes: adolescence and its different definitions; the particularities of adolescents with cancer; and palliative care to adolescents with cancer. The study showed there is a scarcity of evidenced-based research defining the panorama of symptoms affecting the quality of life during palliative care and an absence of specific programs in the stage of fast changes that, alone, demand for adaptive efforts.

  2. The importance of measuring customer satisfaction in palliative care.

    Science.gov (United States)

    Turriziani, Adriana; Attanasio, Gennaro; Scarcella, Francesco; Sangalli, Luisa; Scopa, Anna; Genualdo, Alessandra; Quici, Stefano; Nazzicone, Giulia; Ricciotti, Maria Adelaide; La Commare, Francesco

    2016-03-01

    In the last decades, palliative care has been more and more focused on the evaluation of patients' and families' satisfaction with care. However, the evaluation of customer satisfaction in palliative care presents a number of issues such as the presence of both patients and their families, the frail condition of the patients and the complexity of their needs, and the lack of standard quality indicators and appropriate measurement tools. In this manuscript, we critically review existing evidence and literature on the evaluation of satisfaction in the palliative care context. Moreover, we provide - as a practical example - the preliminary results of our experience in this setting with the development of a dedicated tool for the measurement of satisfaction. PMID:26837318

  3. Underutilization of palliative care services in the liver transplant population

    Science.gov (United States)

    Kathpalia, Priya; Smith, Alexander; Lai, Jennifer C

    2016-01-01

    AIM To evaluate use of palliative care services in patients with end-stage liver disease who do not have access to liver transplant. METHODS Evaluated were end-stage liver disease patients who were removed from the liver transplant wait-list or died prior to transplant at a single transplant center over a 2-year period. Those who were removed due to noncompliance or ultimately transplanted elsewhere were excluded from this study. Patient characteristics associated with palliative care consultation were assessed using logistic regression analysis. RESULTS Six hundred and eighty-three patients were listed for liver transplant in 2013-2014 with 107 (16%) dying (n = 62) or removed for clinical decompensation prior to liver transplant (n = 45): Median age was 58 years, and the majority were male (66%), Caucasian (53%), had Child C cirrhosis (61%) or hepatocellular carcinoma (52%). The palliative care team was consulted in only 18 of the 107 patients (17%) who died or were removed, 89% of which occurred as inpatients. Half of these consultations occurred within 72 h of death. In univariable analysis, patients of younger age, white race, and higher end-stage liver disease scores at time of listing and delisting were more likely to receive palliative care services. Only younger age [Odds ratio (OR) = 0.92; P = 0.02] and Caucasian race (OR = 4.90; P = 0.02) were still associated with integration of palliative care services through multivariable analysis. CONCLUSION Palliative care services are grossly underutilized in older, non-white patients with cirrhosis on the liver transplant wait-list. We encourage early integration of these services into clinical decision-making in the transplant population, with further studies aimed at understanding barriers to consultation. PMID:27683638

  4. Family meetings in palliative care: Multidisciplinary clinical practice guidelines

    Directory of Open Access Journals (Sweden)

    O'Hanlon Brendan

    2008-08-01

    Full Text Available Abstract Background Support for family carers is a core function of palliative care. Family meetings are commonly recommended as a useful way for health care professionals to convey information, discuss goals of care and plan care strategies with patients and family carers. Yet it seems there is insufficient research to demonstrate the utlility of family meetings or the best way to conduct them. This study sought to develop multidisciplinary clinical practice guidelines for conducting family meetings in the specialist palliative care setting based on available evidence and consensus based expert opinion. Methods The guidelines were developed via the following methods: (1 A literature review; (2 Conceptual framework; (3 Refinement of the guidelines based on feedback from an expert panel and focus groups with multidisciplinary specialists from three palliative care units and three major teaching hospitals in Melbourne, Australia. Results The literature review revealed that no comprehensive exploration of the conduct and utility of family meetings in the specialist palliative care setting has occurred. Preliminary clinical guidelines were developed by the research team, based on relevant literature and a conceptual framework informed by: single session therapy, principles of therapeutic communication and models of coping and family consultation. A multidisciplinary expert panel refined the content of the guidelines and the applicability of the guidelines was then assessed via two focus groups of multidisciplinary palliative care specialists. The complete version of the guidelines is presented. Conclusion Family meetings provide an opportunity to enhance the quality of care provided to palliative care patients and their family carers. The clinical guidelines developed from this study offer a framework for preparing, conducting and evaluating family meetings. Future research and clinical implications are outlined.

  5. Communication as a core skill of palliative surgical care.

    Science.gov (United States)

    Miner, Thomas J

    2012-03-01

    Excellence as a surgeon requires not only the technical and intellectual ability to effectively take care of surgical disease but also an ability to respond to the needs and questions of patients. This article provides an overview of the importance of communication skills in optimal surgical palliation and offers suggestions for a multidisciplinary team approach, using the palliative triangle as the ideal model of communication and interpersonal skills. This article also discusses guidelines for advanced surgical decision making and outlines methods to improve communication skills.

  6. Communication skills in palliative surgery: skill and effort are key.

    Science.gov (United States)

    Miner, Thomas J

    2011-04-01

    Excellence as a surgeon requires not only the technical and intellectual ability to effectively take care of surgical disease but also an ability to respond to the needs and questions of patients. This article provides an overview of the importance of communication skills in optimal surgical palliation and offers suggestions for a multidisciplinary team approach, using the palliative triangle as the ideal model of communication and interpersonal skills. This article also discusses guidelines for advanced surgical decision making and outlines methods to improve communication skills.

  7. Integrating Pediatric Palliative Care into the School and Community.

    Science.gov (United States)

    Davis, Kathleen G

    2016-10-01

    Children and adolescents with complex chronic conditions often receive pediatric palliative care (PPC) from health care professionals. However, children's needs exist both in a health care context and in the community where children interact with peers, including school, places of worship, sports, activities, and organizations. Partnerships between PPC professionals in health care settings and teachers, coaches, spiritual leaders, activity directors, and others, may lead to greater health and well-being. Children near the end of life or those with out-of-hospital do-not-resuscitate orders may also find palliation in their community. Cooperation between all caregivers benefit the child and family. PMID:27565367

  8. In the sandbox: palliative care and hematologic malignancies.

    Science.gov (United States)

    LeBlanc, Thomas W

    2014-02-01

    Palliative care specialists have had little involvement in the care of patients with hematologic malignancies. The reasons for this are not clear, because these patients certainly face a significant symptom burden, and many hematologic malignancies are either incurable or carry poor prognoses. For example, acute myeloid leukemia (AML) in patients over age 60 has a 5-year survival of less than 10%, akin to pancreatic cancer. Although most oncologists would agree with involving palliative care specialists in the case of advanced pancreatic cancer, few seem to consider this in the context of AML. Why should AML be any different?

  9. Addressing Palliative Sedation during Expert Consultation: A Descriptive Analysis of the Practice of Dutch Palliative Care Consultation Teams.

    Directory of Open Access Journals (Sweden)

    Patrick Hoek

    Full Text Available Since palliative sedation is considered a complex intervention, consultation teams are increasingly established to support general practice. This study aims to offer insight into the frequency and characteristics of expert consultations regarding palliative sedation.We performed a retrospective analysis of a longitudinal database. This database contained all patient-related consultations by Dutch Palliative Care Consultation teams, that were requested between 2004 and 2011. We described the frequency and characteristics of these consultations, in particular of the subgroup of consultations in which palliative sedation was addressed (i.e. PSa consultations. We used multivariate regression analysis to explore consultation characteristics associated with a higher likelihood of PSa consultations.Of the 44,443 initial consultations, most were requested by general practitioners (73% and most concerned patients with cancer (86%. Palliative sedation was addressed in 18.1% of all consultations. Palliative sedation was relatively more often discussed during consultations for patients with a neurologic disease (OR 1.79; 95% CI: 1.51-2.12 or COPD (OR 1.39; 95% CI: 1.15-1.69 than for patients with cancer. We observed a higher likelihood of PSa consultations if the following topics were also addressed during consultation: dyspnoea (OR 1.30; 95% CI: 1.22-1.40, agitation/delirium (OR 1.57; 95% CI: 1.47-1.68, exhaustion (OR 2.89; 95% CI: 2.61-3.20, euthanasia-related questions (OR 2.65; 95% CI: 2.37-2.96 or existential issues (OR 1.55; 95% CI: 1.31-1.83.In conclusion, PSa consultations accounted for almost one-fifth of all expert consultations and were associated with several case-related characteristics. These characteristics may help clinicians in identifying patients at risk for a more complex disease trajectory at the end of life.

  10. What Makes a Good Palliative Care Physician? A Qualitative Study about the Patient's Expectations and Needs when Being Admitted to a Palliative Care Unit.

    Directory of Open Access Journals (Sweden)

    Eva K Masel

    Full Text Available The aims of the study were to examine a patients' knowledge of palliative care, b patients' expectations and needs when being admitted to a palliative care unit, and c patient's concept of a good palliative care physician.The study was based on a qualitative methodology, comprising 32 semistructured interviews with advanced cancer patients admitted to the palliative care unit of the Medical University of Vienna. Interviews were conducted with 20 patients during the first three days after admission to the unit and after one week, recorded digitally, and transcribed verbatim. Data were analyzed using NVivo 10 software, based on thematic analysis enhanced with grounded theory techniques.The results revealed four themes: (1 information about palliative care, (2 supportive care needs, (3 being treated in a palliative care unit, and (4 qualities required of palliative care physicians. The data showed that patients lack information about palliative care, that help in social concerns plays a central role in palliative care, and attentiveness as well as symptom management are important to patients. Patients desire a personal patient-physician relationship. The qualities of a good palliative care physician were honesty, the ability to listen, taking time, being experienced in their field, speaking the patient's language, being human, and being gentle. Patients experienced relief when being treated in a palliative care unit, perceived their care as an interdisciplinary activity, and felt that their burdensome symptoms were being attended to with emotional care. Negative perceptions included the overtly intense treatment.The results of the present study offer an insight into what patients expect from palliative care teams. Being aware of patient's needs will enable medical teams to improve professional and individualized care.

  11. French physicians' attitudes toward legalisation of euthanasia and the ambiguous relationship between euthanasia and palliative care.

    Science.gov (United States)

    Peretti-Watel, Patrick; Bendiane, Marc K; Galinier, Anne; Favre, Roger; Lapiana, Jean-Marc; Pégliasco, Hervé; Moatti, Jean-Paul

    2003-01-01

    In 1999, the French Parliament established a "right to palliative care", which reactivated public debate about euthanasia. In order to investigate jointly physicians' attitude toward palliative care and euthanasia, we conducted a cross-sectional survey of a national sample of French GPs, oncologists, and neurologists. Overall, 917 physicians participated in the survey. Significant proportions of respondents, especially among GPs and neurologists, considered that palliative sedation and withdrawing life-sustaining treatments (WLST) were euthanasia. Multivariate analysis showed that the physicians who had special medical training in palliative care, and those who distinguish palliative sedation and WLST from euthanasia were more likely to oppose legalisation of euthanasia. Thus, French physicians' attitude to the legalisation of euthanasia is strongly influenced by whether or not they distinguish palliative care from euthanasia. Improved palliative care requires better training of the entire medical profession, and clearer guidelines about which end-of-life care practices are legally and ethically acceptable. PMID:14959598

  12. Team-based education in a palliative approach for rural nurses and unlicensed care providers.

    Science.gov (United States)

    Potter, Gail; Pesut, Barbara; Hooper, Brenda Pherne; Erbacker, Lynnelle

    2015-06-01

    This article describes the preparation and delivery of an educational intervention designed to improve rural nurses and unlicensed care providers' confidence in a palliative approach to care. A palliative approach takes the principles of supportive palliative care and adapts them for application earlier in nonspecialized palliative contexts for individuals living with life-limiting chronic illness. Curriculum in a palliative approach was constructed for nurses and unlicensed care providers (care aides and home health workers) and was delivered through a workshop and monthly follow-up sessions offered through distance technology. Participants valued the joint interactive education and came away with greater appreciation for one another's contributions to care. Insights were gained into common challenges when attempting to apply a palliative approach in rural areas. Important lessons were learned about educating nurses and unlicensed care providers together, about the use of technology for this group, and about teaching the concept of a palliative approach.

  13. Intercultural palliative care: do we need cultural competence?

    Science.gov (United States)

    Gunaratnam, Yasmin

    2007-10-01

    Recognition of the importance of 'cultural competence' is now central to health care policy and to nurse education and training across the international spectrum. Detailed engagement with models of cultural competence is comparatively recent in palliative care nursing. This article presents the findings from a development project on elders and carers from 'minority ethnic' groups, funded by the Department of Health, to increase awareness of palliative care and to improve understanding of the needs of these groups of service users. The article describes the experiences of nurses involved in the delivery of palliative care who were interviewed in focus groups as a part of the project. It draws attention to the complicated relationships between cultural knowledge and practice and to the non-rational and visceral dimensions of intercultural care. These aspects of nursing are marginalised in current approaches to cultural competence, which emphasise the rational acquisition and application of cultural knowledge and skills by practitioners. It is suggested that recognition of these marginalised experiences can contribute to the development of new approaches to intercultural nursing that are also more attuned to the ethos and values of palliative care. PMID:18073705

  14. Intercultural palliative care: do we need cultural competence?

    Science.gov (United States)

    Gunaratnam, Yasmin

    2007-10-01

    Recognition of the importance of 'cultural competence' is now central to health care policy and to nurse education and training across the international spectrum. Detailed engagement with models of cultural competence is comparatively recent in palliative care nursing. This article presents the findings from a development project on elders and carers from 'minority ethnic' groups, funded by the Department of Health, to increase awareness of palliative care and to improve understanding of the needs of these groups of service users. The article describes the experiences of nurses involved in the delivery of palliative care who were interviewed in focus groups as a part of the project. It draws attention to the complicated relationships between cultural knowledge and practice and to the non-rational and visceral dimensions of intercultural care. These aspects of nursing are marginalised in current approaches to cultural competence, which emphasise the rational acquisition and application of cultural knowledge and skills by practitioners. It is suggested that recognition of these marginalised experiences can contribute to the development of new approaches to intercultural nursing that are also more attuned to the ethos and values of palliative care.

  15. Moral differences in deep continuous palliative sedation and euthanasia.

    Science.gov (United States)

    Juth, Niklas; Lindblad, Anna; Lynöe, Niels; Sjöstrand, Manne; Helgesson, Gert

    2013-06-01

    In palliative care there is much debate about which end of life treatment strategies are legitimate and which are not. Some writers argue that there is an important moral dividing-line between palliative sedation and euthanasia, making the first acceptable and the latter not. We have questioned this. In a recent article, Lars Johan Materstvedt has argued that we are wrong on two accounts: first, that we fail to account properly for the moral difference between continuous deep palliative sedation at the end of life and euthanasia, and, second, that we fail to account properly for the difference between permanent loss of consciousness and death. Regarding the first objection, we argue that Materstvedt misses the point: we agree that there is a difference in terms of intentions between continuous deep palliative sedation and euthanasia, but we question whether this conceptual difference makes up for a moral difference. Materstvedt fails to show that it does. Regarding the second objection, we argue that if nothing else is at stake than the value of the patient's life, permanent unconsciousness and death are morally indifferent.

  16. Spirituality in palliative home care: a framework for the clinician

    NARCIS (Netherlands)

    Vermandere, M.; Lepeleire, J. De; Mechelen, W. van; Warmenhoven, F.C.; Thoonsen, B.A.; Aertgeerts, B.

    2013-01-01

    PURPOSE: Spiritual care at the end of life remains poorly understood despite its promotion by the World Health Organisation. The purpose of this paper was to develop a consensus-based framework of the main elements of spiritual care in palliative home care. METHODS: Expert meeting using the nominal

  17. Inoperable esophageal cancer and outcome of palliative care

    Institute of Scientific and Technical Information of China (English)

    Sima Besharat; Ali Jabbari; Shahryar Semnani; Abbasali Keshtkar; Jeran Marjani

    2008-01-01

    AIM: To determine the outcome of esophageal cancer patients referred for palliative care, in Gorgan and Gonbad gastrointestinal clinics, northeast of Iran.METHODS: This cross-sectional study was done on inoperable esophageal cancer cases referred to gastrointestinal clinics in Gorgan and Gonbad city (2005-2006). Demographic data were collected during the procedure and cases were followed up every one month. Improvement proportion was calculated with 95% confidence interval, to determine the rate of improvement. Survival analysis and Kaplan-Meier methods were used to estimate the duration of palliative care effectiveness.RESULTS: We recruited 39 cases into the study. Squamous cell carcinoma was the most prevalent (92.3%). The middle third of the esophagus was involved predominantly (51.3%). Dilation was the most preferred method (89.7%) and stenting was done in 4 cases. Decreasing dysphagia score was not related to palliation method or pathology type of carcinoma. Age of the patients was significantly related to the improvement of dysphagia score. Mean survival time was 137.6d and median was 103d.CONCLUSION: Results of this study showed a low survival rate after palliative care in esophageal cancer cases despite dysphagia scores' improvement after dilating or stenting.

  18. Reality of evidence-based practice in palliative care

    Institute of Scientific and Technical Information of China (English)

    Claire Visser; Gina Hadley; Bee Wee

    2015-01-01

    hTere has been a paradigm shitf in medicine away from tradition, anecdote and theoretical reasoning from the basic sciences towards evidence-based medicine (EBM). In palliative care however, statistically signiifcant beneifts may be marginal and may not be related to clinical meaningfulness. hTe typical treatmentvs. placebo comparison necessitated by ‘gold standard’ randomised controlled trials (RCTs) is not necessarily applicable. hTe complex multimorbidity of end of life care involves considerations of the patient’s physical, psychological, social and spiritual needs. In addition, the field of palliative care covers a heterogeneous group of chronic and incurable diseases no longer limited to cancer. Adequate sample sizes can be diffcult to achieve, reducing the power of studies and high attrition rates can result in inadequate follow up periods. hTis review uses examples of the management of cancer-related fatigue and death rattle (noisy breathing) to demonstrate the current state of EBM in palliative care. hTe future of EBM in palliative care needs to be as diverse as the patients who ultimately derive benefit. Non-RCT methodologies of equivalent quality, validity and size conducted by collaborative research networks using a ‘mixed methods approach’ are likely to pose the correct clinical questions and derive evidence-based yet clinically relevant outcomes.

  19. Palliative Care for Extremely Premature Infants and Their Families

    Science.gov (United States)

    Boss, Renee D.

    2010-01-01

    Extremely premature infants face multiple acute and chronic life-threatening conditions. In addition, the treatments to ameliorate or cure these conditions often entail pain and discomfort. Integrating palliative care from the moment that extremely premature labor is diagnosed offers families and clinicians support through the process of defining…

  20. Barriers to palliative radiotherapy referral: A Canadian perspective

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    Samant, Rajiv S.; Fitzgibbon, Edward; Meng, Joanne; Graham, Ian D. [Univ. of Ottawa. Ottawa, ON (Canada)

    2007-07-15

    Radiotherapy is an effective but underutilized treatment modality for cancer patients. We decided to investigate the factors influencing radiotherapy referral among family physicians in our region. A 30-item survey was developed to determine palliative radiotherapy knowledge and factors influencing referral. It was sent to 400 physicians in eastern Ontario (Canada) and the completed surveys were evaluated. The overall response rate was 50% with almost all physicians seeing cancer patients recently (97%) and the majority (80%) providing palliative care. Approximately 56% had referred patients for radiotherapy previously and 59% were aware of the regional community oncology program. Factors influencing radiotherapy referral included the following: waiting times for radiotherapy consultation and treatment, uncertainty about the benefits of radiotherapy, patient age, and perceived patient inconvenience. Physicians who referred patients for radiotherapy were more than likely to provide palliative care, work outside of urban centres, have hospital privileges and had sought advice from a radiation oncologist in the past. A variety of factors influence the referral of cancer patients for radiotherapy by family physicians and addressing issues such as long waiting times, lack of palliative radiotherapy knowledge and awareness of Cancer Centre services could increase the rate of appropriate radiotherapy patient referral.

  1. Acceptance of dying: a discourse analysis of palliative care literature.

    Science.gov (United States)

    Zimmermann, Camilla

    2012-07-01

    The subject of death denial in the West has been examined extensively in the sociological literature. However, there has not been a similar examination of its "opposite", the acceptance of death. In this study, I use the qualitative method of discourse analysis to examine the use of the term "acceptance" of dying in the palliative care literature from 1970 to 2001. A Medline search was performed by combining the text words "accept or acceptance" with the subject headings "terminal care or palliative care or hospice care", and restricting the search to English language articles in clinical journals discussing acceptance of death in adults. The 40 articles were coded and analysed using a critical discourse analysis method. This paper focuses on the theme of acceptance as integral to palliative care, which had subthemes of acceptance as a goal of care, personal acceptance of healthcare workers, and acceptance as a facilitator of care. For patients and families, death acceptance is a goal that they can be helped to attain; for palliative care staff, acceptance of dying is a personal quality that is a precondition for effective practice. Acceptance not only facilitates the dying process for the patient and family, but also renders care easier. The analysis investigates the intertextuality of these themes with each other and with previous texts. From a Foucauldian perspective, I suggest that the discourse on acceptance of dying represents a productive power, which disciplines patients through apparent psychological and spiritual gratification, and encourages participation in a certain way to die. PMID:22513246

  2. Specialized Pediatric Palliative Home Care: A Prospective Evaluation

    OpenAIRE

    Groh, Gesa; Borasio, Gian Domenico; Nickolay, Carla; Bender, Hans-Ulrich; von Lüttichau, Irene; Führer, Monika

    2013-01-01

    Objectives: In Germany since 2007 children with advanced life-limiting diseases are eligible for Pediatric Palliative Home Care (PPHC), which is provided by newly established specialized PPHC teams. The objective of this study was to evaluate the acceptance and effectiveness of PPHC as perceived by the parents.

  3. Attachment theory and spirituality: two threads converging in palliative care?

    Science.gov (United States)

    Loetz, Cécile; Müller, Jakob; Frick, Eckhard; Petersen, Yvonne; Hvidt, Niels Christian; Mauer, Christine

    2013-01-01

    The aim of this paper is to discuss and explore the interrelation between two concepts, attachment theory and the concept of spirituality, which are important to palliative care and to founding a multivariate understanding of the patient's needs and challenges. Both concepts have been treated by research in diverse and multiform ways, but little effort has yet been made to integrate them into one theoretical framework in reference to the palliative context. In this paper, we begin an attempt to close this scientific gap theoretically. Following the lines of thought in this paper, we assume that spirituality can be conceptualized as an adequate response of a person's attachment pattern to the peculiarity of the palliative situation. Spirituality can be seen both as a recourse to securely based relationships and as an attempt to explore the ultimate unknown, the mystery of one's own death. Thus, spirituality in the palliative context corresponds to the task of attachment behavior: to transcend symbiosis while continuing bonds and thus to explore the unknown environment independently and without fear. Spiritual activity is interpreted as a human attachment behavior option that receives special quality and importance in the terminal stage of life. Implications for clinical practice and research are discussed in the final section of the paper.

  4. Attachment Theory and Spirituality: Two Threads Converging in Palliative Care?

    Directory of Open Access Journals (Sweden)

    Cécile Loetz

    2013-01-01

    Full Text Available The aim of this paper is to discuss and explore the interrelation between two concepts, attachment theory and the concept of spirituality, which are important to palliative care and to founding a multivariate understanding of the patient’s needs and challenges. Both concepts have been treated by research in diverse and multiform ways, but little effort has yet been made to integrate them into one theoretical framework in reference to the palliative context. In this paper, we begin an attempt to close this scientific gap theoretically. Following the lines of thought in this paper, we assume that spirituality can be conceptualized as an adequate response of a person’s attachment pattern to the peculiarity of the palliative situation. Spirituality can be seen both as a recourse to securely based relationships and as an attempt to explore the ultimate unknown, the mystery of one’s own death. Thus, spirituality in the palliative context corresponds to the task of attachment behavior: to transcend symbiosis while continuing bonds and thus to explore the unknown environment independently and without fear. Spiritual activity is interpreted as a human attachment behavior option that receives special quality and importance in the terminal stage of life. Implications for clinical practice and research are discussed in the final section of the paper.

  5. Palliative care: a challenge for orthopaedic nursing care.

    Science.gov (United States)

    Watters, Carol L; Harvey, Carol V; Meehan, Anita J; Schoenly, Lorry

    2005-01-01

    Patients who face chronic, incurable, or life-ending musculoskeletal conditions often receive inadequate care either due to a lack of caregiver awareness or inattention to maintaining the highest quality at the end of life. Palliative care focuses on the comprehensive physical, psychological, social, spiritual, and existential needs of patients with life-threatening or debilitating illness. Orthopaedic nurses and all nurses in general are challenged to incorporate palliative care principles into care planned with patients and families facing end-of-life issues. This article addresses the leadership role the National Association of Orthopaedic Nurses (NAON) has taken to develop a consensus document which endorses the Last Acts Precepts of Palliative Care and affirms the need for palliative care with patients who experience life-threatening illness. A case study is used to illustrate the opportunity a multidisciplinary team has to center care on the individual, while remaining sensitive to the holistic needs of the patient for self-determination at the end of life.

  6. Initiating palliative care conversations: lessons from Jewish bioethics.

    Science.gov (United States)

    Schultz, Michael; Bar-Sela, Gil

    2013-03-01

    What are the ethical responsibilities of the medical staff (doctors, nurses, social workers, and chaplains) regarding the preservation of meaningful life for their patients who are approaching the end of life (EOL)? In particular, what is the staff's ethical responsibility to initiate a conversation with their patient regarding palliative care? By subjecting traditional Jewish teachings to an ethical analysis and then exploring the underlying universal principles, we will suggest a general ethical duty to inform patients of the different care options, especially in a manner that preserves hope. The principle that we can derive from Jewish bioethics teaches that the medical staff has a responsibility to help our patients live in a way that is consistent with how they understand their task or responsibility in life. For some patients, the best way to preserve a meaningful life in which they can fulfill their sense of purpose in the time that remains is to focus on palliation. For this reason, although palliative and supportive care are provided from the time of diagnosis, it is critical we make sure our patients realize that they have the opportunity to make a decision between either pursuing additional active treatments or choosing to focus primarily on palliative therapies to maximize quality of life. The Jewish tradition and our experience in spiritual care suggest the importance of helping patients preserve hope while, simultaneously, honestly acknowledging their situation. Staff members can play a vital role in helping patients make the most of this new period of their lives. PMID:23089233

  7. Reporting characteristics of cancer pain: A systematic review and quantitative analysis of research publications in palliative care journals

    Directory of Open Access Journals (Sweden)

    Senthil P Kumar

    2011-01-01

    Full Text Available Objective: A common disorder requiring symptom palliation in palliative and end-of-life care is cancer. Cancer pain is recognized as a global health burden. This paper sought to systematically examine the extent to which there is an adequate scientific research base on cancer pain and its reporting characteristics in the palliative care journal literature. Materials and Methods: Search conducted in MEDLINE and CINAHL sought to locate all studies published in 19 palliative/ hospice/ supportive/ end-of-life care journals from 2009 to 2010. The journals included were: American Journal of Hospice and Palliative Care, BMC Palliative Care, Current Opinion in Supportive and Palliative Care, End of Life Care Journal, European Journal of Palliative Care, Hospice Management Advisor, Indian Journal of Palliative Care, International Journal of Palliative Nursing, Internet Journal of Pain Symptom Control and Palliative Care, Journal of Pain and Palliative Care Pharmacotherapy, Journal of Palliative Care, Journal of Palliative Medicine, Journal of Social Work in End-of-life and Palliative Care, Journal of Supportive Oncology, Palliative Medicine, Palliative and Supportive Care, and Supportive Care in Cancer. Journal contents were searched to identify studies that included cancer pain in abstract. Results: During the years 2009 and 2010, of the selected 1,569 articles published in the journals reviewed, only 5.86% (92 articles were on cancer pain. Conclusion: While researchers in the field of palliative care have studied cancer pain, the total percentage for studies is still a low 5.86%. To move the field of palliative care forward so that appropriate guidelines for cancer pain management can be developed, it is critical that more research be reported upon which to base cancer pain therapy in an evidence-based palliative care model.

  8. Health care professionals' perceptions towards lifelong learning in palliative care for general practitioners: a focus group study

    OpenAIRE

    Pype, Peter; Symons, Linda; Wens, Johan; Van den Eynden, Bart; Stes, Ann; Deveugele, Myriam

    2014-01-01

    Background: There is a growing need for palliative care. The majority of palliative patients prefer their general practitioner (GP) to organize their palliative home care. General practitioners need a range of competences to perform this task. However, there has been no general description so far of how GPs keep these competences up-to-date. The present study explores current experiences, views and preferences towards training and education in palliative care among GPs, palliative home-care p...

  9. ROLE OF PALLIATION IN STAGE IV CARCINOMA CERVIX

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    Smriti

    2013-03-01

    Full Text Available ABSTRACT: BACKGROUND: Palliation reduces the severity of disease symptoms, rather than reversing its progression or providing a cure. Metast atic cancer cervix (Ca Cx is incurable by surgery, radiation or chemotherapy, but these modali ties are useful for palliation. Globally about five to six lakh new cases of carcinoma cervi x are diagnosed every year. Of these, one lakh cases are diagnosed in India of which 25.0% are fro m West Bengal only. OBJECTIVES: Our objective was to study the role of palliation in Sta ge IV Carcinoma Cervix. SETTINGS AND DESIGN: During the study period of five years from January 2 007 to December 2011, consecutive seventy five new cases of stage IV carc inoma cervix diagnosed at Netaji Subhas Chandra Bose Cancer Research Institute, Kolkata, we re included in our study. MATERIALS AND METHODS: Clinical examination with relevant investigations l ike kidney function tests (KFT, biopsy, cystoscopy, CT scan etc were done for diagno sis & staging. Treatment was decided based on woman's age, general health and the locati on & type of the tumour. Treatment options were surgery, radiotherapy (RT, chemotherapy (CT an d simple palliation. In our study, combined CT+RT was done in 18.67% patients most of w ho presented with Stage IV disease. Radiation was given as brachytherapy following telet herapy. Chemotherapy was used as adjunct to RT or for palliation or as neo-adjuvant c hemotherapy (NACT, most commonly using paclitaxel (135mg/square metre, cisplatin (50mg/ squ are metre and 5- fluorouracil (600mg/ square metre. At times, chemotherapy could provide pa in relief only. Vault smear and metastatic workup was done during follow-up visits ev ery 8-12 weeks after treatment completion. RESULTS: Majority of patients belonged to the age group 42-69 years with a median age of 53 years. Bladder involvement was see n in 15(20.0% cases, bowel involvement in 14(19.0% and distant metastasis in 46(61.0% ca ses. Most cases were of Squamous

  10. Heart Disease and African Americans

    Science.gov (United States)

    ... Minority Population Profiles > Black/African American > Heart Disease Heart Disease and African Americans Although African American adults are ... were 30 percent more likely to die from heart disease than non-Hispanic whites. African American women are ...

  11. Palliative care in heart failure : a position statement from the palliative care workshop of the Heart Failure Association of the European Society of Cardiology

    NARCIS (Netherlands)

    Jaarsma, Tiny; Beattie, James M.; Ryder, Mary; Rutten, Frans H.; McDonagh, Theresa; Mohacsi, Paul; Murray, Scott A.; Grodzicki, Thomas; Bergh, Ingrid; Metra, Marco; Ekman, Inger; Angermann, Christiane; Leventhal, Marcia; Pitsis, Antonis; Anker, Stefan D.; Gavazzi, Antonello; Ponikowski, Piotr; Dickstein, Kenneth; Delacretaz, Etienne; Blue, Lynda; Strasser, Florian; McMurray, John

    2009-01-01

    Heart failure is a serious condition and equivalent to malignant disease in terms of symptom burden and mortality. At this moment only a comparatively small number of heart failure patients receive specialist palliative care. Heart failure patients may have generic palliative care needs, such as ref

  12. Desires in Palliative Medicine. Five models of the Physician-Patient Interaction on Palliative Treatments Related to Hellenistic Therapies of Desire.

    NARCIS (Netherlands)

    Huijer, Marli; Widdershoven, Guy

    2001-01-01

    In this paper, we explore the desires that play a role at the palliative stage and relate them to various approaches to patient autonomy. What attitude can physicians and other caregivers take to the desires of patients at the palliative stage? We examine this question by introducing five physicians

  13. Palliative care provision for patients with chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Yohannes Abebaw

    2007-04-01

    Full Text Available Abstract Chronic obstructive pulmonary disease (COPD is a major cause of disability, morbidity and mortality in old age. Patients with advanced stage COPD are most likely to be admitted three to four times per year with acute exacerbations of COPD (AECOPD which are costly to manage. The adverse events of AECOPD are associated with poor quality of life, severe physical disability, loneliness, and depression and anxiety symptoms. Currently there is a lack of palliative care provision for patients with advanced stage COPD compared with cancer patients despite having poor prognosis, intolerable dyspnoea, lower levels of self efficacy, greater disability, poor quality of life and higher levels of anxiety and depression. These symptoms affect patients' quality of life and can be a source of concern for family and carers as most patients are likely to be housebound and may be in need of continuous support and care. Evidence of palliative care provision for cancer patients indicate that it improves quality of life and reduces health care costs. The reasons why COPD patients do not receive palliative care are complex. This partly may relate to prognostic accuracy of patients' survival which poses a challenge for healthcare professionals, including general practitioners for patients with advanced stage COPD, as they are less likely to engage in end-of-life care planning in contrast with terminal disease like cancer. Furthermore there is a lack of resources which constraints for the wider availability of the palliative care programmes in the health care system. Potential barriers may include unwillingness of patients to discuss advance care planning and end-of-life care with their general practitioners, lack of time, increased workload, and fear of uncertainty of the information to provide about the prognosis of the disease and also lack of appropriate tools to guide general practitioners when to refer patients for palliative care. COPD is a chronic

  14. African Americans and Glaucoma

    Science.gov (United States)

    ... Involved News About Us Donate In This Section African Americans and Glaucoma email Send this article to ... glaucoma is the leading cause of blindness in African Americans. Half of those with glaucoma don't ...

  15. The palliative care needs of ethnic minority patients: staff perspectives.

    Science.gov (United States)

    Diver, Fiona; Molassiotis, Alexander; Weeks, Les

    2003-08-01

    The aim of this study was to assess palliative care staff's perceptions of multicultural care provision and explore the barriers and facilitators to culturally sensitive care. Qualitative semi-structured interviews with five palliative care staff were conducted. Staff showed awareness of inter-cultural diversity and the importance of individualized care. It also became apparent that staff did not possess ethnocentric attitudes. Facilitators of multicultural care that emerged from the data included training, learning from experience, the use of culturally specific literature and resources, and effective communication channels in the team. However, barriers were present, including limited interpreting services, and some staff and other patients' negative behaviours towards ethnic minority patients. The findings lead to recommendations for better resourcing and expansion of interpreting services, and for more training, based on staff's desire for limited culturally specific knowledge in sensitive combination with an individualized care philosophy. PMID:12968120

  16. Operationalizing reflexivity to improve the rigor of palliative care research.

    Science.gov (United States)

    Johnston, Bridget; Pringle, Jan; Buchanan, Deans

    2016-08-01

    Reflective practice involves deliberate consideration of actions, attitudes and behaviors. Reflexivity in research is considered important for ensuring that research is ethically and rigorously conducted. This paper details the challenges of conducting research involving patients with palliative care needs within the acute hospital environment. It discusses the contribution of reflexivity to a pilot study using the Patient Dignity Question (PDQ) "What do I need to know about you as a person to take the best care of you that I can?" as a brief intervention to foster a more person-centered climate. Challenges that emerged are discussed from the perspectives of the researchers, the participants, and the setting; they relate to: timing and recruitment, the nature of palliative care illness, attitudes to research, and the research environment. Awareness of such issues can prompt researchers to devise appropriate strategies and approaches that may inform and assist the rigor and conduct of future research. PMID:26620579

  17. Palliative home care: A designer′s perspective

    Directory of Open Access Journals (Sweden)

    Tigmanshu Bhatnagar

    2015-01-01

    Full Text Available The purpose for this observational research was to understand how Can Support provides palliative care at home and analyze its strengths and weaknesses in various socioeconomic scenarios for future development. In the period of 2 weeks, patients and their caregivers were silently observed in their natural surroundings during home care visits in order to listen their problems, identify the pattern of questions for the home care team, their natural way of storytelling, organizational techniques for medicines and medical reports, care givers lives, patient journey, etc. Such observations have enabled the understanding of the phenomena of home palliative care and have led to the identification of certain influential variables of the practice.

  18. Radiologically placed tunneled peritoneal catheter in palliation of malignant ascites

    Energy Technology Data Exchange (ETDEWEB)

    Akinci, Devrim; Erol, Bekir; Ciftci, Tuerkmen T. [Hacettepe University, Faculty of Medicine, Department of Radiology, 06100 Ankara (Turkey); Akhan, Okan, E-mail: akhano@tr.net [Hacettepe University, Faculty of Medicine, Department of Radiology, 06100 Ankara (Turkey)

    2011-11-15

    The purpose of this study was to evaluate retrospectively the safety and effectiveness of radiologically placed tunneled peritoneal catheter in palliation of malignant ascites. Between July 2005 and June 2009, 41 tunneled peritoneal catheters were placed under ultrasonographic and fluoroscopic guidance in 40 patients (mean age, 55 years; 22 women) who had symptomatic malignant ascites. No procedure related mortality was observed. Major complication occurred in one patient (2.5%) in the form of serious bacterial peritonitis that necessitated catheter removal. Minor complications such as minor bacterial peritonitis, catheter dislodgement, tunnel infection, and catheter blockage occurred in 11 patients (27.5%). The mean duration of survival after catheter placement was 11.8 weeks. All patients expired of their primary malignancies in the follow-up. Radiologically placed tunneled peritoneal catheter is safe and effective in palliation of symptomatic malignant ascites.

  19. Symptom management in palliative care and end of life care.

    Science.gov (United States)

    Bookbinder, Marilyn; McHugh, Marlene E

    2010-09-01

    There is a need for generalist- and specialist-level palliative care clinicians proficient in symptom management and care coordination. Major factors contributing to this need include changed disease processes and trajectories, improved medical techniques and diagnostic testing, successful screening for chronic conditions, and drugs that often prolong life. The rapid progressive illnesses and deaths that plagued the first half of the twentieth century have been replaced in the twenty-first century by increased survival rates. Conditions that require ongoing medical care beyond a year define the current chronic illness population. Long years of survival are often accompanied by a reduced quality of life that requires more medical and nursing care and longer home care. This article reviews the management of selected symptoms in palliative and end of life care.

  20. Twin pregnancy in a Fontan-palliated patient.

    Science.gov (United States)

    Nair, Anupama; Radhakrishnan, Sitaraman; Iyer, Krishna S

    2016-08-01

    The Fontan connection, originally described in 1971, is used to provide palliation for patients with many forms of CHDs that cannot support a biventricular circulation. An increasing number of females who have undergone these connections in childhood are now surviving into adulthood and some are becoming pregnant. We report a case of a 29-year-old woman who presented with a twin pregnancy at 33 weeks of gestation. She had significant deterioration of her cardiovascular status before the twin babies were delivered by emergency caesarean section owing to associated obstetric complications. This report also highlights the various maternal and fetal complications occurring in pregnancy of Fontan-palliated patients and suggests the need for meticulous pre-conception counselling and strict perinatal care. PMID:27125813

  1. Pediatric palliative care online: the views of health care professionals.

    Science.gov (United States)

    Ens, Carla D L; Chochinov, Harvey M; Bérard, Josette L M; Harlos, Mike S; Stenekes, Simone J; Wowchuk, Suzanne M

    2008-01-01

    The purpose of the study was to evaluate the role of an online resource for dying children, their family members, and health care providers from the perspective of pediatric palliative care experts. Semistructured interviews with 12 leaders in pediatric palliative care in North America were conducted, exploring their perceptions and attitudes towards various aspects of Web-based resources for dying children and their care providers. Informants felt that an online resource may allow for a different form of expression, a connection between people undergoing a rare event, and an increase in education and support. Major challenges, such as accessibility, monitoring, and remaining current, would be ongoing. Other key themes included access, information, and anonymity. The data suggest that developing Web-based resources for dying young patients and their families may have merit. Should this take place, a feasibility study will be necessary to further determine the value of such a Web site for these vulnerable populations. PMID:18459596

  2. Hybrid Palliation for Ductal-Dependent Systemic Circulation.

    Science.gov (United States)

    Evans, William N; Galindo, Alvaro; Rothman, Abraham; Ciccolo, Michael L; Carrillo, Sergio A; Acherman, Ruben J; Mayman, Gary A; Cass, Kathleen A; Kip, Katrinka T; Luna, Carlos F; Ludwick, Joseph M; Rollins, Robert C; Castillo, William J; Alexander, John A; Restrepo, Humberto

    2016-06-01

    We reviewed our hybrid palliation experience for 91 neonates, with ductal-dependent systemic circulation, born between August 2007 and October 2015. For analysis, we stratified the 91 patients by a risk factor (RF) score and divided them into three groups: (1) high-risk two-functional ventricles (2V) median RF score of 3 (N = 20); (2) low-risk one-functional ventricle (1V) RF score 0-1 (N = 32); and (3) high-risk 1V RF score ≥2 (N = 39). Midterm survival (median 4 years) by group was: (1) 95 %, (2) 91 %, and (3) 15 %, (p = 0.001). In conclusion, hybrid palliation was associated with excellent midterm results for high-risk 2V and low-risk 1V patients with ductal-dependent systemic circulation. In contrast, high-risk 1V patients had significantly worse outcomes.

  3. Team Interactions in Specialized Palliative Care Teams: A Qualitative Study

    OpenAIRE

    Klarare, Anna; Hagelin, Carina Lundh; Fürst, Carl Johan; Fossum, Bjoorn

    2013-01-01

    Background: Teamwork is a standard of care in palliative care and that is emphasized by leading organizations. When interdisciplinary teams communicate their varied assessments, outcomes may be more than additive due to the synthesis of information. Interprofessionality does not guarantee multidimensionality in health care interventions, however, and that interprofessional teams promote collaboration may be questioned. Aim: The aim was to explore team interaction among team members in special...

  4. Gynecologic oncology patients' satisfaction and symptom severity during palliative chemotherapy

    OpenAIRE

    Gibbons Heidi E; Reidy Anne; Hutchins Jessica R; von Gruenigen Vivian E; Daly Barbara J; Eldermire Elisa M; Fusco Nancy L

    2006-01-01

    Abstract Background Research on quality and satisfaction with care during palliative chemotherapy in oncology patients has been limited. The objective was to assess the association between patient's satisfaction with care and symptom severity and to evaluate test-retest of a satisfaction survey in this study population. Methods A prospective cohort of patients with recurrent gynecologic malignancies receiving chemotherapy were enrolled after a diagnosis of recurrent cancer. Patients completed...

  5. Update in palliative management of hormone refractory cancer of prostate

    OpenAIRE

    Singh, Pratipal; Srivastava, Aneesh

    2007-01-01

    Hormone refractory prostate cancer (HRPC) is an incurable disease and as in the pressure sensitive adhesive era the median survival of patients is increasing, these men increasingly develop symptomatic problems as a result of advanced local and or metastatic disease during their progression to death. Recently, it has been shown that it is possible to improve survival in this group of patients with use of chemotherapy which reinforces the need of better options in palliative care. We discus th...

  6. Treatment of bone metastases with palliative radiotherapy: Patients' treatment preferences

    International Nuclear Information System (INIS)

    Purpose: To determine the proportion of patients undergoing palliative radiotherapy (RT) for bone pain who would like to participate in the decision-making process, and to determine their choice of palliative RT regimen (2000 cGy in five fractions vs. 800 cGy in one fraction) for painful bone metastases. Methods and Materials: Eligible patients were approached and all patients agreeing to participate provided written informed consent. Patients' decisional preferences were studied using a five-statement preference instrument. A decision board was used to help patients decide their preferred palliative RT regimen. Factors influencing patients' choices were studied using a visual analog scale. Results: A total of 101 patients were enrolled in the study (55 women and 46 men). The preferences for decision-making were as follows: 30 active, 47 collaborative, and 24 passive. Most (55 [76%] of 72) patients favored one fraction of palliative RT (95% confidence interval, 65-86%). Patients were more likely to select the 800 cGy in one fraction because of the convenience of the treatment plan (odds ratio, 1.024; 95% confidence interval, 1.004-1044) but were less likely to choose it because of the chance of bone fracture (odds ratio, 0.973; 95% confidence interval, 0.947-1.000) compared with 2000 cGy in five fractions. Conclusion: Most participating patients preferred to decide either by themselves or with the radiation oncologists which treatment option they preferred. An 800-cGy-in-one-fraction regimen was favored, independent of the treated site. The convenience of the treatment plan and the likelihood of bone fracture were the most important factors influencing patients' choice

  7. Intrathecal analgesia and palliative care: A case study

    Directory of Open Access Journals (Sweden)

    Naveen S Salins

    2010-01-01

    Full Text Available Intrathecal analgesia is an interventional form of pain relief with definite advantages and multiple complications. Administration of intrathecal analgesia needs a good resource setting and expertise. Early complications of intrathecal analgesia can be very distressing and managing these complications will need a high degree of knowledge, technical expertise and level of experience. Pain control alone cannot be the marker of quality in palliative care. A holistic approach may need to be employed that is more person and family oriented.

  8. Modelling the landscape of palliative care for people with dementia: a European mixed methods study

    OpenAIRE

    Iliffe, Steve; Davies, Nathan; Vernooij-Dassen, Myrra; van Riet Paap, Jasper; Sommerbakk, Ragni; Mariani, Elena; Jaspers, Birgit; Radbruch, Lukas; Manthorpe, Jill; Maio, Laura; Haugen, Dagny; Engels, Yvonne

    2013-01-01

    BACKGROUND: Palliative care for people with dementia is often sub-optimal. This is partly because of the challenging nature of dementia itself, and partly because of system failings that are particularly salient in primary care and community services. There is a need to systematize palliative care for people with dementia, to clarify where changes in practice could be made.To develop a model of palliative care for people with dementia that captures commonalities and differences across Europe,...

  9. Improving palliative care in selected settings in England using quality indicators: a realist evaluation

    OpenAIRE

    Iliffe, Steve; Davies, Nathan; Manthorpe, Jill; Crome, Peter; Ahmedzai, Sam H; Vernooij-Dassen, Myrra; Engels, Yvonne

    2016-01-01

    Background: There is a gap between readily available evidence of best practice and its use in everyday palliative care. The IMPACT study evaluated the potential of facilitated use of Quality Indicators as tools to improve palliative care in different settings in England.Methods: 1) Modelling palliative care services and selecting a set of Quality Indicators to form the core of an intervention, 2) Case studies of intervention using the Quality Indicator set supported by an expert in service ch...

  10. Improving palliative care in selected settings in England using quality indicators: a realist evaluation

    OpenAIRE

    Iliffe, S.; Davies, N; Manthorpe, J; Crome, P; Ahmedzai, S.; Vernooij-Dassen, M; Engels, Y.

    2016-01-01

    Background: There is a gap between readily available evidence of best practice and its use in everyday palliative care. The IMPACT study evaluated the potential of facilitated use of Quality Indicators as tools to improve palliative care in different settings in England. / Methods: 1) Modelling palliative care services and selecting a set of Quality Indicators to form the core of an intervention, 2) Case studies of intervention using the Quality Indicator set supported by an expert in service...

  11. Does the Culture of Modern Day Palliative Care Social Work Leave Room for Leadership?

    OpenAIRE

    Davidson, Jason

    2016-01-01

    This paper describes research undertaken as part of an MA study in leadership. It draws on interviews with six high profile leaders at the fore front of end of life care sector in the UK. Its findings and emerging themes offer insights about the opportunities for social work leaders in palliative care in the future and how the profession and palliative care sector address current barriers to taking advantage of such opportunity. The main focus of this paper is leadership related to palliative...

  12. Changes in symptoms and pain intensity of cancer patients after enrollment in palliative care at home

    OpenAIRE

    Dumitrescu, Luminita; van den Heuvel-Olaroiu, Marinela; van den Heuvel, Wim J. A.

    2007-01-01

    This study describes the activities and interventions carried out by an at-home palliative care team treating cancer patients who died within two years of being enrolled in a palliative care program. It analyzes which changes in symptoms and pain occurred and which sociodemographic and medical characteristics were related to these changes. The analysis is based on 102 cancer patients. Data were collected through systematic registration during the palliative care process. At enrollment, patien...

  13. Validation of a New Instrument for Self-Assessment of Nurses’ Core Competencies in Palliative Care

    OpenAIRE

    Kari Slåtten; Ove Hatlevik; Lisbeth Fagerström

    2014-01-01

    Competence can be seen as a prerequisite for high quality nursing in clinical settings. Few research studies have focused on nurses’ core competencies in clinical palliative care and few measurement tools have been developed to explore these core competencies. The purpose of this study was to test and validate the nurses’ core competence in palliative care (NCPC) instrument. A total of 122 clinical nurse specialists who had completed a postbachelor program in palliative care at two university...

  14. Palliative care curriculum for speech-language pathology students.

    Science.gov (United States)

    Mathisen, Bernice; Yates, Patsy; Crofts, Penny

    2011-01-01

    This paper reports on the experience of undergraduate speech-language pathology students at one university chosen for the implementation stage of the Palliative Care Curriculum for Undergraduates (PCC4U) Project. Funded by a government department for health and ageing through a national palliative care programme, the project was managed by a team of researchers from the discipline of nursing. The PCC4U project championed the inclusion of palliative care education as an integral part of medical, nursing, and allied healthcare undergraduate training. Of the pilot sites chosen for the PCC4U project, only one site, reported here, included both speech-language pathology and social work disciplines, providing an important opportunity for interdisciplinary collaboration on novel curriculum development in an area of mutual interest. This synergy served as an excellent foundation for ongoing opportunities for interdisciplinary teaching and learning in the university. Speech-language pathology students reported that the project was an invaluable addition to their education and preparation for clinical practice.

  15. Short-course palliative radiotherapy for uterine cervical cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Dong Hyun; Lee, Ju Hye; Ki, Yong Kan; Kim, Won Taek; Park, Dahl; Kim, Dong Won [Dept. of Radiation Oncology, Biomedical Research Institute, Pusan National University Hospital, Busan (Korea, Republic of); Nam, Ji Ho; Jeon, Sang Ho [Dept. of Radiation Oncology, Pusan National University Yangsan Hospital, Yangsan (Korea, Republic of)

    2013-12-15

    The purpose of this retrospective study was to evaluate the efficacy and feasibility of short-course hypofractionated radiotherapy (RT) for the palliation of uterine cervical cancer. Seventeen patients with cancer of the uterine cervix, who underwent palliative hypofractionated 3-dimensional conformal radiotherapy between January 2002 and June 2012, were retrospectively analyzed. RT was delivered to symptomatic lesions (both the primary mass and/or metastatic regional lymph nodes). The total dose was 20 to 25 Gy (median, 25 Gy) in 5 Gy daily fractions. The median follow-up duration was 12.2 months (range, 4 to 24 months). The median survival time was 7.8 months (range, 4 to 24 months). Vaginal bleeding was the most common presenting symptom followed by pelvic pain (9 patients). The overall response rates were 93.8% and 66.7% for vaginal bleeding control and pelvic pain, respectively. Nine patients did not have any acute side effects and 7 patients showed minor gastrointestinal toxicity. Only 1 patient had grade 3 diarrhea 1 week after completion of treatment, which was successfully treated conservatively. Late complications occurred in 4 patients; however, none of these were of grade 3 or higher severity. Short-course hypofractionated RT was effective and well tolerated as palliative treatment for uterine cervical cancer.

  16. Cancer patients, emergencies service and provision of palliative care

    Directory of Open Access Journals (Sweden)

    Bruno Miranda

    2016-06-01

    Full Text Available SUMMARY Objective: To describe the clinical and sociodemographic profile of cancer patients admitted to the Emergency Center for High Complexity Oncologic Assistance, observing the coverage of palliative and home care. Method: Cross sectional study including adult cancer patients admitted to the emergency service (September-December/2011 with a minimum length of hospital stay of two hours. Student’s t-test and Pearson chi-square test were used to compare the means. Results: 191 patients were enrolled, 47.6% elderly, 64.4% women, 75.4% from the city of Recife and greater area. The symptom prevalent at admission was pain (46.6%. 4.2% of patients were linked to palliative care and 2.1% to home care. The most prevalent cancers: cervix (18.3%, breast (13.6% and prostate (10.5%; 70.7% were in advanced stages (IV, 47.1%; 39.4% without any cancer therapy. Conclusion: Patients sought the emergency service on account of pain, probably due to the incipient coverage of palliative and home care. These actions should be included to oncologic therapy as soon as possible to minimize the suffering of the patient/family and integrate the skills of oncologists and emergency professionals.

  17. Attitudes of Nonpalliative Care Nurses towards Palliative Care

    Directory of Open Access Journals (Sweden)

    Victoria Tait

    2015-01-01

    Full Text Available The quality of palliative care given to terminally ill patients and their family members can be directly impacted by the attitudes that nurses hold towards palliative care. This study aimed to investigate the attitudes of nonpalliative care nurses towards death and dying in the context of palliative care. Nurses working within the medical aged care, cardiology and respiratory wards at two metropolitan teaching hospitals in Sydney completed the Frommelt Attitudes Towards Care of the Dying (FATCOD scale, an anonymous self-administered questionnaire, and a twelve-item demographic questionnaire. A total of 95 completed surveys were used in the final analysis. The total FATCOD score was 119.8±11.1, patient FATCOD was 79.6±8.6, and family FATCOD was 40.2±4.4. Of significance, the professional variables designation and role were associated with attitudes in the total FATCOD and country of birth, designation, highest level of education, and role were associated with attitudes towards the patient FATCOD. Scores for communication between the nurse and the terminally ill patient were poor. Health care facilities should focus on developing strategies to improve the communication skills among nonpalliative care nurses in order to optimize patient outcomes.

  18. Surgical palliation of gastric outlet obstruction in advanced malignancy

    Science.gov (United States)

    Potz, Brittany A; Miner, Thomas J

    2016-01-01

    Gastric outlet obstruction (GOO) is a common problem associated with advanced malignancies of the upper gastrointestinal tract. Palliative treatment of patients’ symptoms who present with GOO is an important aspect of their care. Surgical palliation of malignancy is defined as a procedure performed with the intention of relieving symptoms caused by an advanced malignancy or improving quality of life. Palliative treatment for GOO includes operative (open and laparoscopic gastrojejunostomy) and non-operative (endoscopic stenting) options. The performance status and medical condition of the patient, the extent of the cancer, the patients prognosis, the availability of a curative procedure, the natural history of symptoms of the disease (primary and secondary), the durability of the procedure, and the quality of life and life expectancy of the patient should always be considered when choosing treatment for any patient with advanced malignancy. Gastrojejunostomy appears to be associated with better long term symptom relief while stenting appears to be associated with lower immediate procedure related morbidity. PMID:27648158

  19. Whose Business is Dying? Death, the Home and Palliative Care

    Directory of Open Access Journals (Sweden)

    John Rosenberg

    2011-03-01

    Full Text Available The process of dying at home brings the nexus between the paternalism of conventional palliative care and a social understanding of end of life care into sharp focus. Away from institutional places of care, issues of ownership, compliance and communal responsibility are heightened. At this interface, palliative care services are confronted with the irony of relinquishing their 'ownership' of dying whilst leading communities to reclaim their principal role in the business of dying. This benign – but enduring – paternalism remains a barrier to a paradigmatic shift towards a more complete understanding of the business of dying. Whilst nascent attempts to promote community engagement in end of life issues are evident in the interface between palliative care and public health, dying remains, for the most part, the remit of health care services. In this article, I contend that the business of dying is incompletely attended. This lack of attention will be partially redressed here by considering the home as a fitting death scene.

  20. Whose business is dying? : death, the home and palliative care

    Directory of Open Access Journals (Sweden)

    Rosenberg, John

    2011-01-01

    Full Text Available The process of dying at home brings the nexus between the paternalism of conventional palliative care and a social understanding of end of life care into sharp focus. Away from institutional places of care, issues of ownership, compliance and communal responsibility are heightened. At this interface, palliative care services are confronted with the irony of relinquishing their 'ownership' of dying whilst leading communities to reclaim their principal role in the business of dying. This benign – but enduring – paternalism remains a barrier to a paradigmatic shift towards a more complete understanding of the business of dying. Whilst nascent attempts to promote community engagement in end of life issues are evident in the interface between palliative care and public health, dying remains, for the most part, the remit of health care services. In this article, I contend that the business of dying is incompletely attended. This lack of attention will be partially redressed here by considering the home as a fitting death scene.

  1. Stomach-interposed cholecystogastrojejunostomy: A palliative approach for periampullary carcinoma

    Institute of Scientific and Technical Information of China (English)

    Chun-Yi Hao; Xiang-Qian Su; Jia-Fu Ji; Xin-Fu Huang; Bao-Cai Xing

    2005-01-01

    AIM: For patients of periampullary carcinoma found to be unresectable at the time of laparotomy, surgical palliation is the primary choice of treatment. Satisfactory palliation to maximize the quality of life with low morbidity and mortality is the gold standard for a good procedure.Our aim is to explore such a procedure as an alternative to the traditional ones.METHODS: A modified double-bypass procedure is performed by, in addition to the usual gastrojejunostomy,implanting a mushroom catheter from the gall bladder into the jejunum through the interposed stomach as an internal drainage. A retrospective review was performed including 22 patients with incurable periampullary carcinomas who underwent this surgery.RESULTS: Both jaundice and impaired liver function improved significantly after surgery. No postoperative deaths, cholangitis, gastrojejunal, biliary anastomotic leaks, recurrent jaundice or late gastric outlet obstruction occurred. Delayed gastric emptying occurred in two patients. The total surgical time was 150±26 min. The estimated blood loss was 160±25 mL. The mean length of hospital stay after surgery was 22±6 d. The mean survival was 8 mo (range 1.5-18 mo).CONCLUSION: In patients of unresectable periampullary malignancies, stomach-interposed cholecystogastrojejunostomy is a safe, simple and efficient technique for palliation.

  2. African American Suicide

    Science.gov (United States)

    African American Suicide Fact Sheet Based on 2012 Data (2014) Overview • In 2012, 2,357 African Americans completed suicide in the U.S. Of these, ... 46 per 100,000. • The suicide rate for African Americans ages 10-19 was 2.98 per ...

  3. Linguistic Imperialism: African Perspectives.

    Science.gov (United States)

    Phillipson, Robert

    1996-01-01

    Responds to an article on aspects of African language policy and discusses the following issues: multilingualism and monolingualism, proposed changes in language policy from the Organization for African Unity and South African initiatives, the language of literature, bilingual education, and whose interests English-language teaching is serving.…

  4. Palliative care in amyotrophic lateral sclerosis: a review of current international guidelines and initiatives.

    LENUS (Irish Health Repository)

    Bede, Peter

    2011-04-01

    Amyotrophic lateral sclerosis (ALS) is a relentlessly progressive neurodegenerative condition. Optimal management requires a palliative approach from diagnosis with emphasis on patient autonomy, dignity and quality of life.

  5. Victoria BGY palliative care model--a new model for the 1990s.

    Science.gov (United States)

    Downing, G M; Braithwaite, D L; Wilde, J M

    1993-01-01

    If, as palliative care practitioners, we ensure that distressing symptoms such as pain, vomiting, dyspnea, confusion, and pre-death restlessness are fully controlled (note "fully"), then most people are deeply appreciative and continue to live until they die, confident that whatever happens, their worth, desires, and comfort are secure. Credibility (Latin, fides dignus) is remaining true and reliable to what was agreed. Patients registering with palliative care generally desire comfort, which can only occur when palliative care physicians and programs are capable and willing to apply all three types of palliation discussed here--the BGY model. PMID:7510798

  6. Development of a palliative education assessment tool for medical student education.

    Science.gov (United States)

    Meekin, S A; Klein, J E; Fleischman, A R; Fins, J J

    2000-10-01

    Studies assessing palliative care education in U.S. medical schools reveal that little attention is paid to this topic. Although core competencies have been defined, few schools have implemented effective means to incorporate formal palliative care education into undergraduate curricula. To promote reform, each school needs to conduct a thorough assessment to identify palliative care content throughout the four-year curriculum. The authors developed an innovative assessment instrument to facilitate curricular mapping of palliative care education. The Palliative Education Assessment Tool (PEAT) comprises seven palliative care domains: palliative medicine, pain, neuropsychologic symptoms, other symptoms, ethics and the law, patient/family/nonclinical caregiver perspectives on end-of-life care, and clinical communication skills. Each domain details specific curricular objectives of knowledge, skills, and attitudes. Designed as a flexible self-assessment tool, PEAT helps determine the existence of palliative care education, which usually is found in various formats throughout a medical school's curriculum and thus sometimes "hidden." PEAT enables educators to describe a specific, multidimensional aspect of the curriculum and use the information for strategic planning, educational reform, and evaluation. The curricular reform implications of such an instrument are broader than palliative care assessment. A modified version of PEAT can be used to assess systematically other topics that are taught in various formats in the curriculum and to develop collaborative approaches to fulfilling the educational objectives of those topics. PMID:11031142

  7. Exploring the leadership role of the clinical nurse specialist on an inpatient palliative care consulting team.

    Science.gov (United States)

    Stilos, Kalli; Daines, Pat

    2013-03-01

    Demand for palliative care services in Canada will increase owing to an aging population and the evolving role of palliative care in non-malignant illness. Increasing healthcare demands continue to shape the clinical nurse specialist (CNS) role, especially in the area of palliative care. Clinical nurse specialists bring specialized knowledge, skills and leadership to the clinical setting to enhance patient and family care. This paper highlights the clinical leadership role of the CNS as triage leader for a hospital-based palliative care consulting team. Changes to the team's referral and triage processes are emphasized as key improvements to team efficiency and timely access to care for patients and families.

  8. Organization position statements and the stance of "studied neutrality" on euthanasia in palliative care.

    Science.gov (United States)

    Johnstone, Megan-Jane

    2012-12-01

    In recent years, palliative care and related organizations have increasingly adopted a stance of "studied neutrality" on the question of whether euthanasia should be legalized as a bona fide medical regimen in palliative care contexts. This stance, however, has attracted criticism from both opponents and proponents of euthanasia. Pro-euthanasia activists see the stance as an official position of indecision that is fundamentally disrespectful of a patient's right to "choose death" when life has become unbearable. Some palliative care constituents, in turn, are opposed to the stance, contending that it reflects an attitude of "going soft" on euthanasia and as weakening the political resistance that has hitherto been successful in preventing euthanasia from becoming more widely legalized. In this article, attention is given to examining critically the notion and possible unintended consequences of adopting a stance of studied neutrality on euthanasia in palliative care. It is argued that although palliative care and related organizations have an obvious stake in the outcome of the euthanasia debate, it is neither unreasonable nor inconsistent for such organizations to be unwilling to take a definitive stance on the issue. It is further contended that, given the long-standing tenets of palliative care, palliative care organizations have both a right and a responsibility to defend the integrity of the principles and practice of palliative care and to resist demands for euthanasia to be positioned either as an integral part or logical extension of palliative care.

  9. Negotiating the equivocality of palliative care: a grounded theory of team communicative processes in inpatient medicine.

    Science.gov (United States)

    Ledford, Christy J W; Canzona, Mollie Rose; Cafferty, Lauren A; Kalish, Virginia B

    2016-01-01

    In the majority of U.S. hospitals, inpatient medicine teams make palliative care decisions in the absence of a formalized palliative system. Using a grounded theory approach, interviews with inpatient team members were systematically analyzed to uncover how participants conceptualize palliative care and how they regard the communicative structures that underlie its delivery. During analysis, Weick's model of organizing emerged as a framework that fit the data. The 39 participant inpatient team members discussed palliative care as primarily a communicative process. Themes describing the meaning of palliative care emerged around the concepts of receiver of care, timeline of care, and location of care. The emerging model included four stages in the communicative processes of inpatient palliative care: (a) interpret the need, (b) initiate the conversation, (c) integrate the processes, and (d) identify what works. In contrast to stable, focused palliative care teams or hospice care teams, which have prescribed patient populations and processes, the inpatient medicine team faces the equivocality of providing palliative care within a broader practice. This research offers a four-phase model to show how these inpatient teams communicate within this context. Implications for the provision of palliative care are discussed.

  10. Care or custody? An evaluation of palliative care in prisons in North West England.

    Science.gov (United States)

    Turner, Mary; Payne, Sheila; Barbarachild, Zephyrine

    2011-06-01

    This study aimed to evaluate health professionals' views about palliative care provision in prisons in the counties of Cumbria and Lancashire in the North West of England. Seventeen prison healthcare staff and nine specialist palliative care staff participated in semi-structured interviews and 16 prison healthcare staff completed a questionnaire designed to measure knowledge, skills and confidence in relation to palliative care. The findings highlighted tensions between the philosophies of care and custody, and the many challenges in providing palliative care in a custodial setting. This paper presents two illustrative case study examples, and suggests ways in which some of these challenges can be overcome in practice.

  11. Exploring the leadership role of the clinical nurse specialist on an inpatient palliative care consulting team.

    Science.gov (United States)

    Stilos, Kalli; Daines, Pat

    2013-03-01

    Demand for palliative care services in Canada will increase owing to an aging population and the evolving role of palliative care in non-malignant illness. Increasing healthcare demands continue to shape the clinical nurse specialist (CNS) role, especially in the area of palliative care. Clinical nurse specialists bring specialized knowledge, skills and leadership to the clinical setting to enhance patient and family care. This paper highlights the clinical leadership role of the CNS as triage leader for a hospital-based palliative care consulting team. Changes to the team's referral and triage processes are emphasized as key improvements to team efficiency and timely access to care for patients and families. PMID:24863582

  12. Palliative care physicians′ religious / world view and attitude towards euthanasia: A quantitative study among flemish palliative care physicians

    Directory of Open Access Journals (Sweden)

    B Broeckaert

    2009-01-01

    Full Text Available Aims: To Study the religious and ideological views and practice of Palliative Care physician towards Euthanasia. Materials and Methods: An anonymous self administered questionnaire approved by Flemish Palliative Care Federation and its ethics steering group was sent to all physicians(n-147 working in Flemish Palliative Care. Questionnaire consisted of three parts. In first part responded were requested to provide demographic information. In second part the respondents were asked to provide information concerning their religion or world view through several questions enquiring after religious or ideological affiliation,religious or ideological self-definition, view on life after death, image of God, spirituality, importance of rituals in their life, religious practice, and importance of religion in life. The third part consisted of a list of attitudinal statements regarding different treatment decisions in advanced disease on which the respondents had to give their opinion using a five-point Likert scale.99 physician responded. Results: We were able to distinguish four clusters: Church-going physicians, infrequently church-going physicians, atheists and doubters. We found that like the Belgian general public, many Flemish palliative care physicians concoct their own religious or ideological identity and feel free to drift away from traditional religious and ideological authorities. Conclusions: In our research we noted that physicians who have a strong belief in God and express their faith through participation in prayer and rituals, tend to be more critical toward euthanasia. Physicians who deny the existence of a transcendent power and hardly attend religious services are more likely to approve of euthanasia even in the case of minors or demented patients. In this way this study confirms the influence of religion and world view on attitudes toward euthanasia.

  13. Patients who die during palliative radiotherapy. Status survey

    Energy Technology Data Exchange (ETDEWEB)

    Berger, B.; Ankele, H.; Bamberg, M.; Zips, D. [University of Tuebingen, Department of Radiation Oncology, Tuebingen (Germany)

    2014-02-15

    Palliative radiotherapy (RT) is routinely used in end of life care of patients with advanced malignancies; however, unnecessarily burdensome treatment shortly before death should be avoided. There is little knowledge on incidence and causes of intercurrent deaths during palliative RT. In this study death events among inpatients receiving palliative RT between January 2009 and December 2011 at this department were retrospectively analyzed. Among epidemiological factors, treatment schedule and chronology, latency and duration of treatment in relation to the actual survival were identified. In this study 52 patients died during or shortly after palliative RT. Symptomatic bone metastases and brain metastases represented the most common RT indications. The general health status was poor with a median Karnofsky performance score of 50 %, RT was realized with a median single dose of 2.5 Gy to a median total dose of 30.5 Gy and was stopped prematurely in 73 % of patients. On average 53 % of the remaining lifetime was occupied by latency to starting RT. Once RT was begun the treatment duration required a median 64 % of the still remaining lifetime. The majority of patients who died had explicitly adverse pre-existing factors and rarely completed RT as scheduled. Latency to RT and RT duration occupied more than half of the remaining lifetime. (orig.) [German] Die palliative Radiotherapie (RT) hat einen hohen Stellenwert in der Symptomenkontrolle terminal erkrankter Tumorpatienten. Unnoetig belastende Therapien kurz vor Lebensende sollten jedoch vermieden werden. Bislang gibt es kaum strukturierte Daten ueber Sterbefaelle unter palliativer RT. Im Rahmen der vorgestellten Studie wurden die Sterbefaelle unter stationaer palliativ bestrahlten Patienten der eigenen Abteilung zwischen Januar 2009 und Dezember 2011 analysiert. Ausgewertet wurden epidemiologische Faktoren, Behandlungskonzept und -verlauf. Zeit bis zum RT-Beginn und RT-Dauer wurden ins Verhaeltnis zur tatsaechlichen

  14. Reporting characteristics of cancer pain: A systematic review and quantitative analysis of research publications in palliative care journals

    OpenAIRE

    Kumar, Senthil P

    2011-01-01

    Objective: A common disorder requiring symptom palliation in palliative and end-of-life care is cancer. Cancer pain is recognized as a global health burden. This paper sought to systematically examine the extent to which there is an adequate scientific research base on cancer pain and its reporting characteristics in the palliative care journal literature. Materials and Methods: Search conducted in MEDLINE and CINAHL sought to locate all studies published in 19 palliative/ hospice/ suppo...

  15. Organizing palliative care for rural populations: a systematic review of the evidence.

    NARCIS (Netherlands)

    Evans, R.W.; Stone, D.; Elwyn, G.

    2003-01-01

    BACKGROUND: Palliative care services have developed mostly in urban areas. Rural areas typically are characterized by the lack of well-organized services, with primary care professionals, specifically GPs and community nurses, having to undertake most of the palliative care. Little is known, however

  16. Clinical oncology and palliative medicine as a combined specialty--a unique model in Hong Kong.

    Science.gov (United States)

    Yeung, Rebecca; Wong, Kam-Hung; Yuen, Kwok-Keung; Wong, Ka-Yan; Yau, Yvonne; Lo, Sing-Hung; Liu, Rico

    2015-07-01

    The importance of early integration of palliative care (PC) into oncology treatment is increasingly being recognized. However, there is no consensus on what is the optimal way of integration. This article describes a unique model in Hong Kong where clinical oncology and palliative medicine (PM) is integrated through the development of PM as a subspecialty under clinical oncology.

  17. Integration of early specialist palliative care in cancer care: Survey of oncologists, oncology nurses, and patients

    Directory of Open Access Journals (Sweden)

    Naveen Salins

    2016-01-01

    Conclusion: Oncologists, oncology nurses, and patients felt that integration of early specialist palliative care in cancer improves symptom control, end-of-life care, health-related communication, and continuity of care. The perceptions of benefit of the palliative care intervention in the components surveyed, differed among the three groups.

  18. Interventions geared towards strengthening the health system of Namibia through the integration of palliative care.

    Science.gov (United States)

    Freeman, Rachel; Luyirika, Emmanuel Bk; Namisango, Eve; Kiyange, Fatia

    2016-01-01

    The high burden of non-communicable diseases and communicable diseases in Africa characterised by late presentation and diagnosis makes the need for palliative care a priority from the point of diagnosis to death and through bereavement. Palliative care is an intervention that requires a multidisciplinary team to address the multifaceted needs of the patient and family. Thus, its development takes a broad approach that involves engaging all key stakeholders ranging from policy makers, care providers, educators, the public, patients, and families. The main focus of stakeholder engagement should address some core interventions geared towards improving knowledge and awareness, strengthening skills and attitudes about palliative care. These interventions include educating health and allied healthcare professionals on the palliative care-related problems of patients and best practices for care, explaining palliative care as a clinical and holistic discipline and demonstrating its effectiveness, the need to include palliative care into national policies, strategic plans, training curriculums of healthcare professionals and the engagement of patients, families, and communities. Interventions from a five-year programme that was aimed at strengthening the health system of Namibia through the integration of palliative care for people living with HIV and AIDS and cancer in Namibia are shared. This article illustrates how a country can implement the World Health Organisation's public health strategy for developing palliative care services, which recommends four pillars: government policy, education, drug availability, and implementation. PMID:27563348

  19. Interventions geared towards strengthening the health system of Namibia through the integration of palliative care

    Science.gov (United States)

    Freeman, Rachel; Luyirika, Emmanuel BK; Namisango, Eve; Kiyange, Fatia

    2016-01-01

    The high burden of non-communicable diseases and communicable diseases in Africa characterised by late presentation and diagnosis makes the need for palliative care a priority from the point of diagnosis to death and through bereavement. Palliative care is an intervention that requires a multidisciplinary team to address the multifaceted needs of the patient and family. Thus, its development takes a broad approach that involves engaging all key stakeholders ranging from policy makers, care providers, educators, the public, patients, and families. The main focus of stakeholder engagement should address some core interventions geared towards improving knowledge and awareness, strengthening skills and attitudes about palliative care. These interventions include educating health and allied healthcare professionals on the palliative care-related problems of patients and best practices for care, explaining palliative care as a clinical and holistic discipline and demonstrating its effectiveness, the need to include palliative care into national policies, strategic plans, training curriculums of healthcare professionals and the engagement of patients, families, and communities. Interventions from a five-year programme that was aimed at strengthening the health system of Namibia through the integration of palliative care for people living with HIV and AIDS and cancer in Namibia are shared. This article illustrates how a country can implement the World Health Organisation’s public health strategy for developing palliative care services, which recommends four pillars: government policy, education, drug availability, and implementation.

  20. Inappropriateness of using opioids for end-stage palliative sedation: a Dutch study.

    NARCIS (Netherlands)

    Reuzel, R.P.B.; Hasselaar, J.G.J.; Vissers, K.C.P.; Wilt, G.J. van der; Groenewoud, J.M.M.; Crul, B.J.P.

    2008-01-01

    To be able to distinguish end-stage palliative sedation from euthanasia without having to refer to intentions that are difficult to verify, physicians must be able to manage palliative sedation appropriately (i.e., see that death is not hastened as a result of disproportionate medication). In the pr

  1. Changes in Emotion Work at Interdisciplinary Conferences Following Clinical Supervision in a Palliative Outpatient Ward

    DEFF Research Database (Denmark)

    Nordentoft, Helle Merete

    2008-01-01

    In this article, I describe changes in emotion work at weekly interdisciplinary conferences in a palliative1 outpatient ward following clinical supervision (CS). I conceive emotions as constantly negotiated in interaction, and I researched the similarity between how this is done during CS and at ...... conclude that CS enhances professional development and may prevent burnout in palliative care....

  2. Review of palliative sedation and its distinction from euthanasia and lethal injection.

    Science.gov (United States)

    Hahn, Michael P

    2012-01-01

    Palliative sedation evolved from within the practice of palliative medicine and has become adopted by other areas of medicine, such as within intensive care practice. Clinician's usually come across this practice for dying patients who are foregoing or having life support terminated. A number of intolerable and intractable symptom burdens can occur during the end of life period that may require the use of palliative sedation. Furthermore, when patients receive palliative sedation, the continued use of hydration and nutrition becomes an issue of consideration and there are contentious bioethical issues involved in using or withholding these life-sustaining provisions. A general understanding of biomedical ethics helps prevent abuse in the practice of palliative sedation. Various sedative drugs can be employed in the provision of palliative sedation that can produce any desired effect, from light sedation to complete unconsciousness. Although there are some similarities in the pharmacotherapy of palliative sedation, euthanasia, physician-assisted suicide, and lethal injection, there is a difference in how the drugs are administered with each practice. There are some published guidelines about how palliative sedation should be practiced, but currently there is not any universally accepted standard of practice.

  3. [Resistance from caregivers and doctors to a transfer to palliative care].

    Science.gov (United States)

    Azémard, Alain

    2014-04-01

    Doctors' and caregivers' knowledge, acquired experience and representation of death might favour or delay a patient's transfer to a palliative care unit. The mobile palliative care team, witnessing resistance to a transfer, is in a position to respond thanks to the multidisciplinary nature of the team and the trust established between the different players in the patient's care. PMID:24881246

  4. General practitioners (GPs) and palliative care: perceived tasks and barriers in daily practice.

    NARCIS (Netherlands)

    Groot, C.M.; Vernooy-Dassen, M.J.F.J.; Crul, B.J.P.; Grol, R.P.T.M.

    2005-01-01

    BACKGROUND: General practitioners (GPs) play a crucial part in palliative care. The quality of care can be improved by investigating and addressing barriers perceived by GPs in daily practice. The aim of this study was to investigate GPs' task perception and barriers involved in palliative care. MET

  5. Sexuality and Life-Threatening Illness: Implications for Social Work and Palliative Care

    Science.gov (United States)

    Cagle, John G.; Bolte, Sage

    2009-01-01

    Social workers in hospice and palliative care settings have been charged with the responsibility of addressing sexuality with their patients and families. However, little direction has been offered as to how to approach this difficult subject within the context of palliative care. This article provides a critical analysis of the previous…

  6. Shared Care in Basic Level Palliative Home Care: Organizational and Interpersonal Challenges

    DEFF Research Database (Denmark)

    Neergaard, Mette Asbjørn; Olesen, Frede; Jensen, Anders Bonde;

    2010-01-01

    Little is known about the existing barriers to cooperation among health professionals in basic level palliative care for terminally ill patients with cancer in primary health care.......Little is known about the existing barriers to cooperation among health professionals in basic level palliative care for terminally ill patients with cancer in primary health care....

  7. Changes in symptoms and pain intensity of cancer patients after enrollment in palliative care at home

    NARCIS (Netherlands)

    Dumitrescu, Luminita; van den Heuvel-Olaroiu, Marinela; van den Heuvel, Wim J. A.

    2007-01-01

    This study describes the activities and interventions carried out by an at-home palliative care team treating cancer patients who died within two years of being enrolled in a palliative care program. It analyzes which changes in symptoms and pain occurred and which sociodemographic and medical chara

  8. Palliative treatment of Erdheim-Chester disease with radiotherapy: A Rare Cancer Network study

    International Nuclear Information System (INIS)

    A retrospective study of the use of palliative external beam radiotherapy (EBRT) in nine patients with Erdheim-Chester disease was conducted through the Rare Cancer Network. Patients received EBRT for bone pain, brain infiltration, or retro-orbital involvement. EBRT typically provided short-term palliation, with later recurrence of symptoms in most cases

  9. Palliative or curative treatment intent affects communication in radiation therapy consultations.

    NARCIS (Netherlands)

    Timmermans, L.; Maazen, R.W.M. van der; Leer, J.W.H.; Kraaimaat, F.W.

    2006-01-01

    OBJECTIVE: To assess whether communication in radiotherapy consultations is affected by palliative or curative treatment intent. SUBJECTS AND METHODS: The study involved 160 patients and 8 radiation oncologists. Eighty patients visited the radiation oncologist (RO) for palliative treatment and 80 fo

  10. Access to palliative care: insights into ground realities post-2014 amendment to NDPS Act.

    Science.gov (United States)

    Rajagopal, M R

    2016-01-01

    Medical practice today is disease-focused, ignoring the universally accepted definition of health as not just the absence of disease, but the promotion of complete physical, social and mental well-being. Generations of doctors in India have not studied modern pain management, and palliative care is practically unknown in most parts of the country, causing patients to be rejected by hospitals and doctors when they need help the most. The draconian Narcotic Drugs and Psychotropic Substances (NDPS) Act of 1985, outdated medical and nursing education, lack of public awareness and lack of clear governmental policy are responsible for this sorry state of affairs. The development of a community-oriented palliative care network eventually led to the formulation of a state palliative care policy in Kerala. The acceptance of palliative care as a medical specialty by the Medical Council of India and introduction of a postgraduate degree course in palliative medicine in 2010, the development of a National Programme for Palliative Care in 2012 by the Ministry of Health of the Government of India, and the amendment of the NDPS Act in 2014 have been major positive developments which have the potential to change the current state of affairs. However, these recent achievements represent but one step in the right direction. An improvement in palliative care education, a realistic palliative care policy and implementation of the NDPS Amendment Act are necessary for doing away with the gross, needless violation of the human right to life with dignity. PMID:26826658

  11. Transmural palliative care by means of teleconsultation: a window of opportunities and new restrictions

    NARCIS (Netherlands)

    J. van Gurp; M. van Selm; E. van Leeuwen; J. Hasselaar

    2013-01-01

    Background: Audio-visual teleconsultation is expected to help home-based palliative patients, hospital-based palliative care professionals, and family physicians to jointly design better, pro-active care. Consensual knowledge of the possibilities and limitations of teleconsultation in transmural pal

  12. Transmural palliative care by means of teleconsultation: a window of opportunities and new restrictions

    NARCIS (Netherlands)

    Gurp, J.L. van; Selm, M. van; Leeuwen, E. van; Hasselaar, J.G.

    2013-01-01

    BACKGROUND: Audio-visual teleconsultation is expected to help home-based palliative patients, hospital-based palliative care professionals, and family physicians to jointly design better, pro-active care. Consensual knowledge of the possibilities and limitations of teleconsultation in transmural pal

  13. Quality palliative care for cancer and dementia in five European countries: some common challenges

    NARCIS (Netherlands)

    Davies, N.; Maio, L.; Riet Paap, J.C. van; Mariani, E.; Jaspers, B.; Sommerbakk, R.; Grammatico, D.; Manthorpe, J.; Ahmedzai, S.; Vernooij-Dassen, M.J.F.J.; Iliffe, S.

    2014-01-01

    Objectives: There is a growing consensus worldwide that palliative care needs to be both more inclusive of conditions other than cancer and to improve. This paper explores some common challenges currently faced by professionals providing palliative care for patients with either cancer or dementia ac

  14. How do GPs recognize needs for palliative care in their patients?

    NARCIS (Netherlands)

    Claessen, S.J.; Francke, A.L.; Deliens, L.

    2012-01-01

    Aim: The aim of this study was to explore how GPs in the Netherlands recognize patients’ needs for palliative care. Methods: We conducted qualitative semi-structured interviews with about 25 GPs. These GPs were interviewed about recognition of the needs for palliative care in their patients and how

  15. 77 FR 76053 - Proposed Collection; Comment Request; Pediatric Palliative Care Campaign Pilot Survey

    Science.gov (United States)

    2012-12-26

    ... Care Campaign Pilot Survey Summary: In compliance with the requirement of Section 3506(c)(2)(A) of the.... Proposed Collection: Pediatric Palliative Care Campaign Pilot Survey-0925-New-National Institute of Nursing... conditions. The Pediatric Palliative Care Campaign Pilot Survey will assess the information and...

  16. Patient autonomy problems in palliative care: systematic development and evaluation of a questionnaire.

    NARCIS (Netherlands)

    Vernooy-Dassen, M.J.F.J.; Osse, B.H.P.; Schade, E.; Grol, R.P.T.M.

    2005-01-01

    No instrument to assess autonomy problems in palliative care is currently available. The purpose of this study was to develop a comprehensive and concise questionnaire to measure autonomy problems in palliative cancer patients and to study its validity and reliability. We systematically developed a

  17. Radiation therapy for the palliation of multiple myeloma

    International Nuclear Information System (INIS)

    This study reviews the experience at the University of Arizona in an effort to define the minimum effective radiation dose for durable pain relief in the majority of patients with symptomatic multiple myeloma. The records of 101 patients with multiple myeloma irradiated for palliation at the University of Arizona between 1975 and 1990 were reviewed. Three hundred sixteen sites were treated. Ten sites were asymptomatic, including six hemibody fields with advanced disease unresponsive to chemotherapy and four local fields with impending pathological fractures. Three hundred six evaluable symptomatic sites remained. The most common symptom was bone pain. Other symptoms included neurological impairment with a palpable mass. Total tumor dose ranged from 3.0 to 60 Gy, with a mean of 25 Gy. Symptom relief was obtained in 297 of 306 evaluable symptomatic sites (97%). Complete relief of symptoms was obtained in 26% and partial relief in 71%. Symptom relief was obtained in 92% of sites receiving a total dose less than 10 Gy (n = 13) and 98% of sites receiving 10 Gy or more (n = 293). No dose-response could be demonstrated. The likelihood of symptom relief was not influenced by the location of the lesion or the use of concurrent chemotherapy. Of the 297 responding sites, 6% (n = 19) relapsed after a median symptom-free interval of 16 months. Neither the probability of relapse nor the time to relapse was related to the radiation dose. Retreatment of relapsing sites provided effective palliation in all cases. Radiation therapy is effective in palliating local symptoms in multiple myeloma. A total dose of 10 Gy should provide durable symptom relief in the majority of patients. 16 refs., 3 figs., 4 tabs

  18. [Importance of Anesthesiologists in the Work of a Palliative Care Team].

    Science.gov (United States)

    Hozumi, Jun; Sumitani, Masahiko

    2016-03-01

    World Health Organization has proposed that palliative medicine should be applied early in the course of the malignant diseases. Regrettably, however, palliative care has been usually provided to patients with the advanced stage of cancer, as terminal care. Recently, palliative medicine begins at the time when patients are diagnosed with cancer. In response to changes in clinical settings of palliative medicine, anesthesiologists, with substantial experience in interdisciplinary pain management, can utilize their advantages in providing palliative medicine to cancer patients: 1) use of opioid analgesics; 2) considering the biopsychosocial model of pain; 3) helping patients live as actively as possible until death; and 4) helping the family cope with the patient's illness and their own bereavement.

  19. Palliative cancer care ethics: Principles and challenges in the Indian setting

    Directory of Open Access Journals (Sweden)

    Tejaswi Mudigonda

    2010-01-01

    Full Text Available Palliative cancer treatment is a system of care that seeks to relieve suffering in patients with progressive cancer. Given the intractable symptoms with which certain malignancies manifest, palliative care offers a practical approach towards improving the patient′s quality of life. However, there are an array of ethical issues associated with this treatment strategy such as particular methods of pain relief, a reliable assessment of suffering, autonomy, and multi-specialist care. While these principles are important to increase and improve the network of palliative care, the resource-poor Indian environments present numerous barriers for these principles to be practically applied. As the infrastructure of comprehensive cancer centers develop, paralleled with an increase in training of palliative care professionals, significant improvements need to be made in order to elevate the status of palliative cancer care in India.

  20. Palliative Mitral Valve Repair During Infancy for Neonatal Marfan Syndrome.

    Science.gov (United States)

    Kitahara, Hiroto; Aeba, Ryo; Takaki, Hidenobu; Shimizu, Hideyuki

    2016-05-01

    An infant with neonatal Marfan syndrome (nMFS), a condition that is nearly always lethal during infancy, was referred to our hospital with symptoms of congestive heart failure resulting from severe mitral valve insufficiency. During mitral valve repair, the use of an annuloplasty ring was waived until annular dilatation was achieved after 2 palliative mitral valvuloplasty procedures. After the definitive operation, the patient's mitral valve function remained within normal limits until the last follow-up when the patient was 11 years old. To the best of our knowledge, this patient has the longest recorded survival after mitral valve repair. PMID:27106438

  1. Emotion management in children′s palliative care nursing

    Directory of Open Access Journals (Sweden)

    Eryl Zac Maunder

    2008-01-01

    Full Text Available This article explores the emotional labor involved for nurses providing palliative care for children/young people living with life-limiting illnesses/conditions, and their families. It highlights the challenges nurses face in managing their emotion when caring for children/young people and their families, and explores strategies to enable nurses to cope with this aspect of their role without compromising their personal wellbeing. It suggests that emotional labor within nursing goes largely unrecorded, and remains undervalued by managers and health care services.

  2. The Culture of General Palliative Nursing Care in Medical Departments

    DEFF Research Database (Denmark)

    Bergenholtz, Heidi; Jarlbæk, Lene; Hølge-Hazelton, Bibi

    2015-01-01

    in medical departments. Methods: An ethnographic study, using Spradley's 12-step method, with observational field studies and interviews with nurses from three medical departments in a Danish regional hospital. Findings: Three cultural themes emerged from the analysis, focusing on the setting, the practice...... and the nurses' reflections on GPNC: (1) GPNC provided in a treatment setting, (2) transition to loving care and the licence to perform palliative care (PC) and (3) potential for team improvement. Conclusions: GPNC as a culture in medical departments seemed to be embedded in a setting not suited for dying...

  3. Primary peritoneal serous carcinoma: A rare case and palliative approach

    Directory of Open Access Journals (Sweden)

    Viral M Bhanvadia

    2014-01-01

    Full Text Available Primary peritoneal serous carcinoma (PPSC is a rare primary malignancy that diffusely involves the peritoneum, indistinguishable clinically and histopathologically from primary serous ovarian carcinoma. The origin of PPSC has not been well characterized. Here we present a case of PPSC diagnosed in ultrasonography-guided fine needle aspiration cytology (FNAC in a 76- old female presenting with ascites, abdominal pain, distension and constipation. PPSC is an unusual tumour but cytomorphology is distinctive enough to diagnose preoperatively. In the case report hereby described PPSC is an inoperable malignancy, hence chemotherapy and palliative care are the only offered treatment.

  4. [Hypnosis as an alternative treatment for pain in palliative medicine].

    Science.gov (United States)

    Peintinger, Christa; Hartmann, Wolfgang

    2008-01-01

    Pain--which can have a variety of causes--constitutes a severe problem for patients in need of palliative care, because this pain usually dramatically impairs their quality of life. Thus, the more advanced a terminal illness has become, the more hospital staff should focus on holistic treatment, encompassing body, mind and soul of the patient. Apart from conventional medication-based pain therapy, there is also a variety of non-medicinal treatments for pain. One of these methods is hypnosis, an imaginative treatment that activates available resources; it is not only an effective way of alleviating pain, but it also can ease psychological problems at the same time. PMID:19165446

  5. Narrative palliative care: a method for building empathy.

    Science.gov (United States)

    Stanley, Patricia; Hurst, Marsha

    2011-01-01

    We make meaning of illness, suffering, and death through narrative, by telling a story. In this article, the authors explore narrative and palliative care: how, at the end of life, narratives of patients, caregivers, and clinicians serve to connect to those still living, and how through each telling and listening, we honor and validate the experience of suffering. A discussion of narrative competence and the skills of attention, representation, and affiliation is followed by an outline of the format for a narrative medicine workshop and a detailed analysis of an experiential exercise in close reading and reflective writing. PMID:21391077

  6. Pain and Symptom Management in Pediatric Palliative Care.

    Science.gov (United States)

    Komatz, Kelly; Carter, Brian

    2015-12-01

    Pain and symptom management is considered one of the cornerstones of palliative and hospice medicine. However, general clinicians and specialists are not usually comfortable addressing the most common forms of pain seen in the pediatric population. In addition, non-pain symptom management, especially when related to underlying chronic medical conditions, can be managed by the general clinician and specialists. The goal of this article is to educate clinicians about pain categories, taking a detailed pain history, and developing a plan for treatment, including nonpharmacologic methods. Finally, we discuss common symptoms in patients with chronic medical conditions, including first-line treatment options.

  7. Lutetium-177-EDTMP for pain palliation in bone metastases

    International Nuclear Information System (INIS)

    Experiences with the new palliative agent Lu-177 EDTMP are summarized. The production of primary 177Lu by the 176Lu(n,γ) 177Lu reaction and the synthesis of the radioactive complex are described as well as the procedures used for the control of the radionuclidic and the radiochemical purity. The stability of the compound has been also studied. The in vivo essays with rats and the use of the radiopharmaceutical, after a careful dose evaluation, in a patient with bone metastases from a breast cancer, show that the behaviour of Lu-177 EDTMP is similar to that of the analogue Sm-153 EDTMP. (author)

  8. Psychosocial issues in palliative care: A review of five cases

    OpenAIRE

    Onyeka, Tonia C

    2010-01-01

    Palliative care is not just vital in controlling symptoms of the patient’s disease condition, but also aims to extend the patient’s life, giving it a better quality. However, several times in the course of management, the psychosocial impact of cancer, HIV/AIDS, and other life-limiting disease conditions may not be noticed and dealt with during the admission period, thereby giving rise to a more complex situation than the disease condition itself. This article aims to review some psychosocial...

  9. Validity, reliability and responsiveness to change of the Italian palliative care outcome scale:A multicenter study of advanced cancer patients Cancer palliative care

    OpenAIRE

    COSTANTINI, MASSIMO; Rabitti, Elisa; Beccaro, Monica; Fusco, Flavio; Peruselli, Carlo; La Ciura, Pietro; Valle, Alessandro; Suriani, Cinzia; Berardi, Maria Alejandra; Valenti, Danila; Mosso, Felicita; Morino, Piero; Zaninetta, Giovanni; Tubere, Giorgio; Piazza, Massimo

    2016-01-01

    Background There is an increasing requirement to assess outcomes, but few measures have been tested for advanced medical illness. We aimed to test the validity, reliability and responsiveness of the Palliative care Outcome Scale (POS), and to analyse predictors of change after the transition to palliative care. Methods Phase 1: multicentre, mixed method study comprising cognitive and qualitative interviews with patients and staff, cultural refinement and adaption. Phase 2: consecutive cancer ...

  10. Age Disparity in Palliative Radiation Therapy Among Patients With Advanced Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Wong, Jonathan [University of Hawaii, John A. Burns School of Medicine, Honolulu, Hawaii (United States); Xu, Beibei [Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California (United States); Moores Cancer Center, University of California San Diego, La Jolla, California (United States); Yeung, Heidi N.; Roeland, Eric J. [Moores Cancer Center, University of California San Diego, La Jolla, California (United States); Division of Palliative Medicine, Department of Internal Medicine, University of California San Diego, La Jolla, California (United States); Martinez, Maria Elena [Moores Cancer Center, University of California San Diego, La Jolla, California (United States); Department of Family and Preventive Medicine, University of California San Diego, La Jolla, California (United States); Le, Quynh-Thu [Department of Radiation Oncology, Stanford University, Stanford, California (United States); Mell, Loren K. [Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California (United States); Moores Cancer Center, University of California San Diego, La Jolla, California (United States); Murphy, James D., E-mail: j2murphy@ucsd.edu [Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California (United States); Moores Cancer Center, University of California San Diego, La Jolla, California (United States)

    2014-09-01

    Purpose/Objective: Palliative radiation therapy represents an important treatment option among patients with advanced cancer, although research shows decreased use among older patients. This study evaluated age-related patterns of palliative radiation use among an elderly Medicare population. Methods and Materials: We identified 63,221 patients with metastatic lung, breast, prostate, or colorectal cancer diagnosed between 2000 and 2007 from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database. Receipt of palliative radiation therapy was extracted from Medicare claims. Multivariate Poisson regression analysis determined residual age-related disparity in the receipt of palliative radiation therapy after controlling for confounding covariates including age-related differences in patient and demographic covariates, length of life, and patient preferences for aggressive cancer therapy. Results: The use of radiation decreased steadily with increasing patient age. Forty-two percent of patients aged 66 to 69 received palliative radiation therapy. Rates of palliative radiation decreased to 38%, 32%, 24%, and 14% among patients aged 70 to 74, 75 to 79, 80 to 84, and over 85, respectively. Multivariate analysis found that confounding covariates attenuated these findings, although the decreased relative rate of palliative radiation therapy among the elderly remained clinically and statistically significant. On multivariate analysis, compared to patients 66 to 69 years old, those aged 70 to 74, 75 to 79, 80 to 84, and over 85 had a 7%, 15%, 25%, and 44% decreased rate of receiving palliative radiation, respectively (all P<.0001). Conclusions: Age disparity with palliative radiation therapy exists among older cancer patients. Further research should strive to identify barriers to palliative radiation among the elderly, and extra effort should be made to give older patients the opportunity to receive this quality of life-enhancing treatment at the end

  11. Age Disparity in Palliative Radiation Therapy Among Patients With Advanced Cancer

    International Nuclear Information System (INIS)

    Purpose/Objective: Palliative radiation therapy represents an important treatment option among patients with advanced cancer, although research shows decreased use among older patients. This study evaluated age-related patterns of palliative radiation use among an elderly Medicare population. Methods and Materials: We identified 63,221 patients with metastatic lung, breast, prostate, or colorectal cancer diagnosed between 2000 and 2007 from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database. Receipt of palliative radiation therapy was extracted from Medicare claims. Multivariate Poisson regression analysis determined residual age-related disparity in the receipt of palliative radiation therapy after controlling for confounding covariates including age-related differences in patient and demographic covariates, length of life, and patient preferences for aggressive cancer therapy. Results: The use of radiation decreased steadily with increasing patient age. Forty-two percent of patients aged 66 to 69 received palliative radiation therapy. Rates of palliative radiation decreased to 38%, 32%, 24%, and 14% among patients aged 70 to 74, 75 to 79, 80 to 84, and over 85, respectively. Multivariate analysis found that confounding covariates attenuated these findings, although the decreased relative rate of palliative radiation therapy among the elderly remained clinically and statistically significant. On multivariate analysis, compared to patients 66 to 69 years old, those aged 70 to 74, 75 to 79, 80 to 84, and over 85 had a 7%, 15%, 25%, and 44% decreased rate of receiving palliative radiation, respectively (all P<.0001). Conclusions: Age disparity with palliative radiation therapy exists among older cancer patients. Further research should strive to identify barriers to palliative radiation among the elderly, and extra effort should be made to give older patients the opportunity to receive this quality of life-enhancing treatment at the end

  12. Integration of palliative care in the context of rapid response: a report from the Improving Palliative Care in the ICU advisory board.

    Science.gov (United States)

    Nelson, Judith E; Mathews, Kusum S; Weissman, David E; Brasel, Karen J; Campbell, Margaret; Curtis, J Randall; Frontera, Jennifer A; Gabriel, Michelle; Hays, Ross M; Mosenthal, Anne C; Mulkerin, Colleen; Puntillo, Kathleen A; Ray, Daniel E; Weiss, Stefanie P; Bassett, Rick; Boss, Renee D; Lustbader, Dana R

    2015-02-01

    Rapid response teams (RRTs) can effectively foster discussions about appropriate goals of care and address other emergent palliative care needs of patients and families facing life-threatening illness on hospital wards. In this article, The Improving Palliative Care in the ICU (IPAL-ICU) Project brings together interdisciplinary expertise and existing data to address the following: special challenges for providing palliative care in the rapid response setting, knowledge and skills needed by RRTs for delivery of high-quality palliative care, and strategies for improving the integration of palliative care with rapid response critical care. We discuss key components of communication with patients, families, and primary clinicians to develop a goal-directed treatment approach during a rapid response event. We also highlight the need for RRT expertise to initiate symptom relief. Strategies including specific clinician training and system initiatives are then recommended for RRT care improvement. We conclude by suggesting that as evaluation of their impact on other outcomes continues, performance by RRTs in meeting palliative care needs of patients and families should also be measured and improved.

  13. Pediatric palliative care and pediatric medical ethics: opportunities and challenges.

    Science.gov (United States)

    Feudtner, Chris; Nathanson, Pamela G

    2014-02-01

    The fields of pediatric palliative care (PPC) and pediatric medical ethics (PME) overlap substantially, owing to a variety of historical, cultural, and social factors. This entwined relationship provides opportunities for leveraging the strong communication skills of both sets of providers, as well as the potential for resource sharing and research collaboration. At the same time, the personal and professional relationships between PPC and PME present challenges, including potential conflict with colleagues, perceived or actual bias toward a palliative care perspective in resolving ethical problems, potential delay or underuse of PME services, and a potential undervaluing of the medical expertise required for PPC consultation. We recommend that these challenges be managed by: (1) clearly defining and communicating clinical roles of PPC and PME staff, (2) developing questions that may prompt PPC and PME teams to request consultation from the other service, (3) developing explicit recusal criteria for PPC providers who also provide PME consultation, (4) ensuring that PPC and PME services remain organizationally distinct, and (5) developing well-defined and broad scopes of practice. Overall, the rich relationship between PPC and PME offers substantial opportunities to better serve patients and families facing difficult decisions.

  14. Parents' Voices Supporting Music Therapy within Pediatric Palliative Care

    Directory of Open Access Journals (Sweden)

    Kathryn Lindenfelser

    2005-11-01

    Full Text Available It has been my experience that parents are willing and open to express their voices to promote and advocate for music therapy services for their terminally ill children. By listening to parents' voices when providing care for terminally ill children, much can be done to ease the suffering of children and families at the end of life (Widger & Wilkins, 2004. My music therapy masters research at the University of Melbourne with Dr. Katrina McFerran will investigate bereaved parents' experiences of music therapy with their terminally ill child. This inquiry unfolded through my music therapy work with several children and families within hospice and palliative care. Parents have reflected that music therapy was a vital component in their child's care at the end of life. As one mom commented, "I don't care what anyone says, it has made a world of a difference." In order to further explore parents' experiences of music therapy, in-depth interviews will be conducted and transcripts will be analyzed using phenomenological strategies. It has been reported that parents find the interview process helpful in working through grief. They have also reported feeling an overall eagerness to share their child's story in order to provide input that might assist other families in the future (Widger & Wilkins, 2004. This article will describe pediatric palliative and hospice care, discuss parents as advocates for their terminally ill children, portray the use of music therapy within pediatrics, and share an example of music therapy with Jack.

  15. Current Surgical Aspects of Palliative Treatment for Unresectable Pancreatic Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Karapanos, Konstantinos, E-mail: dr.kostaskarapanos@gmail.com; Nomikos, Iakovos N. [Department of Surgery (B' Unit), METAXA Cancer Memorial Hospital, Piraeus (Greece)

    2011-02-11

    Despite all improvements in both surgical and other conservative therapies, pancreatic cancer is steadily associated with a poor overall prognosis and remains a major cause of cancer mortality. Radical surgical resection has been established as the best chance these patients have for long-term survival. However, in most cases the disease has reached an incurable state at the time of diagnosis, mainly due to the silent clinical course at its early stages. The role of palliative surgery in locally advanced pancreatic cancer mainly involves patients who are found unresectable during open surgical exploration and consists of combined biliary and duodenal bypass procedures. Chemical splanchnicectomy is another modality that should also be applied intraoperatively with good results. There are no randomized controlled trials evaluating the outcomes of palliative pancreatic resection. Nevertheless, data from retrospective reports suggest that this practice, compared with bypass procedures, may lead to improved survival without increasing perioperative morbidity and mortality. All efforts at developing a more effective treatment for unresectable pancreatic cancer have been directed towards neoadjuvant and targeted therapies. The scenario of downstaging tumors in anticipation of a future oncological surgical resection has been advocated by trials combining gemcitabine with radiation therapy or with the tyrosine kinase inhibitor erlotinib, with promising early results.

  16. Current Surgical Aspects of Palliative Treatment for Unresectable Pancreatic Cancer

    International Nuclear Information System (INIS)

    Despite all improvements in both surgical and other conservative therapies, pancreatic cancer is steadily associated with a poor overall prognosis and remains a major cause of cancer mortality. Radical surgical resection has been established as the best chance these patients have for long-term survival. However, in most cases the disease has reached an incurable state at the time of diagnosis, mainly due to the silent clinical course at its early stages. The role of palliative surgery in locally advanced pancreatic cancer mainly involves patients who are found unresectable during open surgical exploration and consists of combined biliary and duodenal bypass procedures. Chemical splanchnicectomy is another modality that should also be applied intraoperatively with good results. There are no randomized controlled trials evaluating the outcomes of palliative pancreatic resection. Nevertheless, data from retrospective reports suggest that this practice, compared with bypass procedures, may lead to improved survival without increasing perioperative morbidity and mortality. All efforts at developing a more effective treatment for unresectable pancreatic cancer have been directed towards neoadjuvant and targeted therapies. The scenario of downstaging tumors in anticipation of a future oncological surgical resection has been advocated by trials combining gemcitabine with radiation therapy or with the tyrosine kinase inhibitor erlotinib, with promising early results

  17. Palliative embolization of hemorrhages in extensive head and neck tumors

    International Nuclear Information System (INIS)

    A lot has changed in terms of intervention technique, indications and embolic agents since Duggan introduced embolization to management of postraumatic epistaxis in 1970. Embolization is used in treatment of spontaneous and traumatic epistaxis, palliative tumors and vascular defects, as well as vascularized tumors and juvenile nasopharyngeal angiofibromas. The possibility of simultaneous visualization of pathology and implementation of therapy is one of its greatest advantages. Authors analyzed the efficacy of selective embolization treatment of haemorrhage in advanced head and neck tumors. Seventy-six patients with such tumors treated at the Department of Otolaryngology in Bialystok between1999 and 2011 were examined. Embolization of bleeding vessel within the tumor was effective (hemorrhage was stopped) in 65 patients (86%). Although the method is highly efficient, it is still associated with complications. Fourteen patients suffered from headaches that lasted for several days and six from face edema. Rebleeding was rare. Unfortunately, there was one case of hemiparesis. We conclude that superselective endovascular treatment deserves to be considered alongside standard options for the palliative or preoperative management of acute hemorrhage from advanced head and neck cancers

  18. Changing the focus of care: from curative to palliative care

    Directory of Open Access Journals (Sweden)

    Silvia Soffritti

    2014-06-01

    Full Text Available The improvements in the obstetrical and neonatal diagnosis and therapies have resulted into an increase in the survival rate of infants previously considered as non-viable. Debate is focusing on professionals’ behaviour about withdrawal or withholding of life sustaining treatment (LST and administration of palliative care for newborns whose conditions are incompatible with a prolonged life. Decisions about treatment should be made jointly by the professionals’ team and the family, placing the interest of the baby at the very heart of the decision process. It is very important that the environment in which the family has to make the decision is characterized by openness, dialogue and frankness. A proper and effective communication with parents is always necessary and can resolve any conflict caused by disagreement. Furthermore, parents need time in the decision making process. Other supports, which could help the family in the final decision are the possibility to ask for a specialist’s second opinion and the involvement of religious leaders and of an indipendent clinical ethics committee. Withholding or withdrawal of LST does not mean cessation of care for the baby, it means to change the focus of care from curative to palliative care. Proceedings of the 10th International Workshop on Neonatology · Cagliari (Italy · October 22nd-25th, 2014 · The last ten years, the next ten years in Neonatology Guest Editors: Vassilios Fanos, Michele Mussap, Gavino Faa, Apostolos Papageorgiou 

  19. Implementing a Palliative Care Nurse Leadership Fellowship Program in Uganda.

    Science.gov (United States)

    Downing, Julia; Leng, Mhoira; Grant, Liz

    2016-05-01

    Global oncology and palliative care needs are increasing faster than the available capacity to meet these needs. This is particularly marked in sub-Saharan Africa, where healthcare capacity and systems are limited and resources are stretched. Uganda, a country of 35.6 million people in eastern Africa, faces the challenges of a high burden of communicable disease and a rising number of cases of non-communicable disease, including cancer. The vast majority of patients in Uganda are diagnosed with cancer too late for curative treatment to be an option because of factors like poor access to healthcare facilities, a lack of health education, poverty, and delays resulting from seeking local herbal or other traditional remedies. This article describes an innovative model of nurse leadership training in Uganda to improve the delivery of palliative care. The authors believe this model can be applicable to other low- and middle-income countries, where health resources are constrained and care needs are great.
. PMID:27105201

  20. Quality of life of cancer patients motivation for palliative radiotherapy

    International Nuclear Information System (INIS)

    Full text: Most patients with advanced diseases suffer from symptoms that are distressing in nature and can interfere with their activities of daily living and different aspects of functioning. In these circumstances, improving quality of life is very important. Patients with bone metastases feel pain with different intensity and the palliative irradiation helps to relieve this pain. The primary goal of palliative irradiation with different radiation schedules in advanced cancer is to control the incurable disease and to maintain or improve the patients' quality of life. Two features characterize most forms of QOL evaluation: 1. QOL is a multidimensional construct and is best measured using instruments that assess multiple domains of functioning and well-being. They measure physical, social and emotional aspects of functioning as well as common symptoms of cancer and its treatment (pain, nausea and fatigue). 2. QOL is subjective phenomenon and the patient is the best judge of his own QOL. Assessment of QOL in radiooncology is performed using patient self-report questionnaires. Two of the most widely used multidimensional QOL instruments are the General Version of the Functional Assessment of Cancer Therapy (FACT-G) and the EORTC-QOL-C30. In patients with advanced disease with metastases another endpoint besides survival may be of interest and it is QOL

  1. The power of integration: radiotherapy and global palliative care.

    Science.gov (United States)

    Rodin, Danielle; Grover, Surbhi; Elmore, Shekinah N; Knaul, Felicia M; Atun, Rifat; Caulley, Lisa; Herrera, Cristian A; Jones, Joshua A; Price, Aryeh J; Munshi, Anusheel; Gandhi, Ajeet K; Shah, Chiman; Gospodarowicz, Mary

    2016-07-01

    Radiotherapy (RT) is a powerful tool for the palliation of the symptoms of advanced cancer, although access to it is limited or absent in many low- and middle-income countries (LMICs). There are multiple factors contributing to this, including assumptions about the economic feasibility of RT in LMICs, the logical challenges of building capacity to deliver it in those regions, and the lack of political support to drive change of this kind. It is encouraging that the problem of RT access has begun to be included in the global discourse on cancer control and that palliative care and RT have been incorporated into national cancer control plans in some LMICs. Further, RT twinning programs involving high- and low-resource settings have been established to improve knowledge transfer and exchange. However, without large-scale action, the consequences of limited access to RT in LMICs will become dire. The number of new cancer cases around the world is expected to double by 2030, with twice as many deaths occurring in LMICs as in high-income countries (HICs). A sustained and coordinated effort involving research, education, and advocacy is required to engage global institutions, universities, health care providers, policymakers, and private industry in the urgent need to build RT capacity and delivery in LMICs. PMID:27481320

  2. "It Was Definitely Very Different": An evaluation of palliative care teaching to medical students using a mixed methods approach.

    Science.gov (United States)

    Brand, Alison H; Harrison, Amanda; Kumar, Koshila

    2015-01-01

    Given our ageing population and the increase in chronic disease, palliative care will become an increasingly important part of doctors' workloads, with implications for palliative care education. This study used a mixed methods strategy to evaluate second-year medical students' learning outcomes and experiences within a palliative care education program. Analysis of pre- and post-test scores showed a significant improvement in students' attitudinal scores, but no change in knowledge as measured by multiple-choice questions. Analysis of qualitative data revealed that students' learning experience was marked by a lack of clear learning objectives and experiential learning opportunities. Students also reported divergent reactions to death and dying and noted that palliative care was different from other areas of clinical medicine. This study revealed that palliative care teaching results in improved attitudes toward palliative care, reflecting the holistic and patient-focused nature of the palliative care curriculum. PMID:26399087

  3. Palliative Care, Hospice, and Advance Care Planning: Views of People Living with HIV and Other Chronic Conditions.

    Science.gov (United States)

    Slomka, Jacquelyn; Prince-Paul, Maryjo; Webel, Allison; Daly, Barbara J

    2016-01-01

    People living with HIV (PLWH) who survive to older adulthood risk developing multiple chronic medical conditions. Health policymakers recognize the role of early palliative care and advance care planning in improving health quality for at-risk populations, but misperceptions about palliative care, hospice, and advance care planning are common. Before testing a program of early palliative care for PLWH and other chronic conditions, we conducted focus groups to elicit perceptions of palliative care, hospice, and advance care planning in our target population. Overall, participants were unfamiliar with the term palliative care, confused concepts of palliative care and hospice, and/or associated hospice care with dying. Participants misunderstood advance care planning, but valued communication about health care preferences. Accepting palliative care was contingent on distinguishing it from hospice and historical memories of HIV and dying. Provision of high-quality, comprehensive care will require changing public perceptions and individuals' views in this high-risk population.

  4. Keeping African Masks Real

    Science.gov (United States)

    Waddington, Susan

    2012-01-01

    Art is a good place to learn about our multicultural planet, and African masks are prized throughout the world as powerfully expressive artistic images. Unfortunately, multicultural education, especially for young children, can perpetuate stereotypes. Masks taken out of context lose their meaning and the term "African masks" suggests that there is…

  5. African agricultural trade

    DEFF Research Database (Denmark)

    Jensen, Hans Grinsted; Sandrey, Ron

    2015-01-01

    This article starts with a profile of African agricultural trade. Using the pre-release version 9.2 of the GTAP database, we then show that the results for tariff elimination on intra-African trade are promising, but these tariff barriers are not as significant as the various trade-related barriers...

  6. African Literature as Celebration.

    Science.gov (United States)

    Achebe, Chinua

    1989-01-01

    Describes the Igbo tradition of "Mbari," a communal creative enterprise that celebrates the world and the life lived in it through art. Contrasts the cooperative, social dimension of pre-colonial African culture with the exclusion and denial of European colonialism, and sees new African literature again celebrating human presence and dignity. (AF)

  7. Empowering African States

    Institute of Scientific and Technical Information of China (English)

    2011-01-01

    China helps bring lasting peace and stability to Africa African think tanks expressed a high opinion of China’s role in helping build African peace and security at the first meeting of the China-Africa Think Tanks Forum. The

  8. Role of radiation therapy in palliative care of the patient with cancer.

    Science.gov (United States)

    Lutz, Stephen T; Jones, Joshua; Chow, Edward

    2014-09-10

    Radiotherapy is a successful, time-efficient, well-tolerated, and cost-effective intervention that is crucial for the appropriate delivery of palliative oncology care. The distinction between curative and palliative goals is blurred in many patients with cancer, requiring that treatments be chosen on the basis of factors related to the patient (ie, poor performance status, advanced age, significant weight loss, severe comorbid disease), the cancer (ie, metastatic disease, aggressive histology), or the treatment (ie, poor response to systemic therapy, previous radiotherapy). Goals may include symptom relief at the site of primary tumor or from metastatic lesions. Attention to a patient's discomfort and transportation limitations requires hypofractionated courses, when feasible. Innovative approaches include rapid response palliative care clinics as well as the formation of palliative radiotherapy specialty services in academic centers. Guidelines are providing better definitions of appropriate palliative radiotherapy interventions, and bone metastases fractionation has become the first radiotherapy quality measure accepted by the National Quality Forum. Further advances in the palliative radiation oncology subspecialty will require integration of education and training between the radiotherapy and palliative care specialties.

  9. Role of radiation therapy in palliative care of the patient with cancer.

    Science.gov (United States)

    Lutz, Stephen T; Jones, Joshua; Chow, Edward

    2014-09-10

    Radiotherapy is a successful, time-efficient, well-tolerated, and cost-effective intervention that is crucial for the appropriate delivery of palliative oncology care. The distinction between curative and palliative goals is blurred in many patients with cancer, requiring that treatments be chosen on the basis of factors related to the patient (ie, poor performance status, advanced age, significant weight loss, severe comorbid disease), the cancer (ie, metastatic disease, aggressive histology), or the treatment (ie, poor response to systemic therapy, previous radiotherapy). Goals may include symptom relief at the site of primary tumor or from metastatic lesions. Attention to a patient's discomfort and transportation limitations requires hypofractionated courses, when feasible. Innovative approaches include rapid response palliative care clinics as well as the formation of palliative radiotherapy specialty services in academic centers. Guidelines are providing better definitions of appropriate palliative radiotherapy interventions, and bone metastases fractionation has become the first radiotherapy quality measure accepted by the National Quality Forum. Further advances in the palliative radiation oncology subspecialty will require integration of education and training between the radiotherapy and palliative care specialties. PMID:25113773

  10. Endoscopic palliation of malignant dysphagia: a challenging task in inoperable oesophageal cancer

    Directory of Open Access Journals (Sweden)

    Mylvaganam S

    2006-07-01

    Full Text Available Abstract Background The main goal when managing patients with inoperable oesophageal cancer is to restore and maintain their oral nutrition. The aim of the present study was to assess the value of endoscopic palliation of dysphagia in patients with oesophageal cancer, who either due to advanced stage of the disease or co-morbidity are not suitable for surgery. Patients and methods All the endoscopic palliative procedures performed over a 5-year period in our unit were retrospectively reviewed. Dilatation and insertion of self-expandable metal stents (SEMS were mainly used for tight circumferential strictures whilst ablation with Nd-YAG laser was used for exophytic lesions. All procedures were performed under sedation. Results Overall 249 palliative procedures were performed in 59 men and 40 women, with a median age of 73 years (range 35 – 93. The median number of sessions per patient was 2 (range 1 – 13 sessions. Palliation involved laser ablation alone in 24%, stent insertion alone in 22% and dilatation alone in 13% of the patients. In 41% of the patients, a combination of the above palliative techniques was applied. A total of 45 SEMS were inserted. One third of the patients did not receive any other palliative treatment, whilst the rest received chemotherapy, radiotherapy or chemoradiotherapy. Swallowing was maintained in all patients up to death. Four oesophageal perforations were encountered; two were fatal whilst the other two were successfully treated with covered stent insertion and conservative treatment. The median survival from diagnosis was 10.5 months (range 0.5–83 months and the median survival from 1st palliation was 5 months (range 0.5–68.5 months. Conclusion Endoscopic interventions are effective and relatively safe palliative modalities for patients with oesophageal cancer. It is possible to adequately palliate almost all cases of malignant dysphagia. This is achieved by expertise in combination treatment.

  11. Palliative care for the elderly - developing a curriculum for nursing and medical students

    Directory of Open Access Journals (Sweden)

    Bongartz Maren

    2010-09-01

    Full Text Available Abstract Background Delivering palliative care to elderly, dying patients is a present and future challenge. In Germany, this has been underlined by a 2009 legislation implementing palliative care as compulsory in the medical curriculum. While the number of elderly patients is increasing in many western countries multimorbidity, dementia and frailty complicate care. Teaching palliative care of the elderly to an interprofessional group of medical and nursing students can help to provide better care as acknowledged by the ministry of health and its expert panels. In this study we researched and created an interdisciplinary curriculum focussing on the palliative care needs of the elderly which will be presented in this paper. Methods In order to identify relevant learning goals and objectives for the curriculum, we proceeded in four subsequent stages. We searched international literature for existing undergraduate palliative care curricula focussing on the palliative care situation of elderly patients; we searched international literature for palliative care needs of the elderly. The searches were sensitive and limited in nature. Mesh terms were used where applicable. We then presented the results to a group of geriatrics and palliative care experts for critical appraisal. Finally, the findings were transformed into a curriculum, focussing on learning goals, using the literature found. Results The literature searches and expert feedback produced a primary body of results. The following deduction domains emerged: Geriatrics, Palliative Care, Communication & Patient Autonomy and Organisation & Social Networks. Based on these domains we developed our curriculum. Conclusions The curriculum was successfully implemented following the Kern approach for medical curricula. The process is documented in this paper. The information given may support curriculum developers in their search for learning goals and objectives.

  12. The global state of palliative care-progress and challenges in cancer care.

    Science.gov (United States)

    Reville, Barbara; Foxwell, Anessa M

    2014-07-01

    All persons have a right to palliative care during cancer treatment and at the end-of-life. The World Health Organization (WHO) defines palliative care as a medical specialty that addresses physical, psychological, social, legal, and spiritual domains of care by an interdisciplinary team of professional and lay health care providers. Widespread adoption of this universal definition will aid policy development and educational initiatives on a national level. The need for palliative care is expanding due to the aging of the world's population and the increase in the rate of cancer in both developed and developing countries. However, in one third of the world there is no access to palliative care for persons with serious or terminal illness. Palliative care improves symptoms, most frequently pain, and improves quality of life for patients and their families, especially in the terminal disease phase. Accessibility to palliative care services, adequately trained health care professionals, availability of essential medicines, and gaps in education vary greatly throughout the world. Pain management is an integral concept in the practice of palliative care; however, opioiphobia, insufficient supply of opioids, and regulatory restrictions contribute to undue suffering for millions. Ongoing advocacy efforts call for increased awareness, palliative care integration with cancer care, and public and professional education. Enacting necessary change will require the engagement of health ministries and the recognition of the unique needs and resources of each country. The aim of this review is to examine progress in palliative care development and explore some of the barriers influencing cancer care across the globe. PMID:25841689

  13. Attitudes Regarding Palliative Sedation and Death Hastening Among Swiss Physicians: A Contextually Sensitive Approach.

    Science.gov (United States)

    Foley, Rose-Anna; Johnston, Wendy S; Bernard, Mathieu; Canevascini, Michela; Currat, Thierry; Borasio, Gian D; Beauverd, Michel

    2015-01-01

    In Switzerland, where assisted suicide but not euthanasia is permitted, the authors sought to understand how physicians integrate palliative sedation in their practice and how they reflect on existential suffering and death hastening. They interviewed 31 physicians from different care settings. Five major attitudes emerged. Among specialized palliative care physicians, convinced, cautious and doubtful attitudes were evident. Within unspecialized settings, palliative sedation was more likely to be considered as death hastening: clinicians either avoid it with an inexperienced attitude or practice it with an ambiguous attitude, raising the issue of unskilled and abusive uses of sedatives at the end of life. PMID:26107119

  14. Can general practitioners create a successful palliative pathway for cancer patients?

    DEFF Research Database (Denmark)

    Neergaard, Mette Asbjørn; Olesen, Frede; Vedsted, Peter;

      Background: Most terminal cancer patients and their relatives wish that the patient should be allowed to die at home. Palliative home care often involves general practitioners (GPs) and community nurses who become frontline workers in the patients' homes. GP home visits have been shown...... to be positively associated with home death, but this does not necessarily mean that the palliative pathway was successful since many factors and professionals are involved. GP-related factors may be important for a successful palliative course, but there is a lack of knowledge of the importance of these factors...

  15. Symptom severity of patients with advanced cancer in palliative care unit: longitudinal assessments of symptoms improvement

    OpenAIRE

    Tai, Shu-Yu; Lee, Chung-Yin; Wu, Chien-Yi; Hsieh, Hui-ya; Huang, Joh-Jong; Huang, Chia-Tsuan; Chien, Chen-Yu

    2016-01-01

    Background This study assessed the symptom severity of patients with advanced cancer in a palliative care unit and explored the factors associated with symptom improvement. Methods This study was conducted in a palliative care unit in Taiwan between October 2004 and December 2009. Symptom intensity was measured by the “Symptom Reporting Form”, and graded on a scale of 0 to 4 (0 = none, and 4 = extreme). These measures were assessed on the 1st, 3rd, 5th, and 7th Day in the palliative care unit...

  16. African American Diaspora

    Directory of Open Access Journals (Sweden)

    Angela Brown

    2013-07-01

    Full Text Available The migration of blacks in North America through slavery became united.  The population of blacks past downs a tradition of artist through art to native born citizens. The art tradition involved telling stories to each generation in black families. The black culture elevated by tradition created hope to determine their personal freedom to escape from poverty of enslavement and to establish a way of life through tradition. A way of personal freedoms was through getting a good education that lead to a better foundation and a better way of life. With regard to all historic migrations (forced and voluntary, the African Union defined the African diaspora as "[consisting] of people of African origin living outside the continent, irrespective of their citizenship and nationality and who are willing to contribute to the development of the continent and the building of the African Union." Its constitutive act declares that it shall "invite and encourage the full participation of the African diaspora as an important part of our continent, in the building of the African Union." Keywords: literature concepts, African American abstracts

  17. Improving Palliative Care Team Meetings: Structure, Inclusion, and "Team Care".

    Science.gov (United States)

    Brennan, Caitlin W; Kelly, Brittany; Skarf, Lara Michal; Tellem, Rotem; Dunn, Kathleen M; Poswolsky, Sheila

    2016-07-01

    Increasing demands on palliative care teams point to the need for continuous improvement to ensure teams are working collaboratively and efficiently. This quality improvement initiative focused on improving interprofessional team meeting efficiency and subsequently patient care. Meeting start and end times improved from a mean of approximately 9 and 6 minutes late in the baseline period, respectively, to a mean of 4.4 minutes late (start time) and ending early in our sustainability phase. Mean team satisfaction improved from 2.4 to 4.5 on a 5-point Likert-type scale. The improvement initiative clarified communication about patients' plans of care, thus positively impacting team members' ability to articulate goals to other professionals, patients, and families. We propose several recommendations in the form of a team meeting "toolkit." PMID:25794871

  18. Nobel Prize winners for literature as palliative for scientific English.

    Science.gov (United States)

    Sri Kantha, Sachi

    2003-02-01

    Plagiarism causes a serious concern in scientific literature. I distinguish two types of plagiarism. What is routinely highlighted and discussed is the reprehensible type of stealing another author's ideas and words. This type I categorize as "heterotrophic" plagiarism. A more prevalent and less-discussed type of plagiarism is the verbatim use of same sentences repetitively by authors in their publications. This I categorize as "autotrophic" plagiarism. Though harmless per se, autotrophic plagiarism is equally taxing on the readers. The occurrence of autotrophic plagiarism is mainly caused by the lack of proficiency in the current lingua franca of science, ie, English. The writings of 22 Nobel literature laureates who wrote in English, especially their travelogues, essays, and letters to the press can be used for benefit of improving one's own vocabulary and writing skills and style. I suggest the writings of three literati--Bernard Shaw, Bertrand Russell, and Ernest Hemingway--as palliatives for autotrophic plagiarism in scientific publishing. PMID:12590423

  19. Collaborative care in NSCLC; the role of early palliative care

    Directory of Open Access Journals (Sweden)

    Marnie eHowe

    2014-07-01

    Full Text Available The management of non-small-cell-lung-cancer (NSCLC has evolved into a multidisciplinary team approach that traditionally has involved medical oncology, radiation oncology and thoracic surgery. However, in the era of personalized medicine the importance of molecular diagnostics requires adequate tissue for histologic subtyping and molecular testing and thus requires the engagement of other subspecialties such as pathology, respirology and interventional radiology. Unfortunately in 2014 the majority of patients presenting with NSCLC will succumb to their disease and the early integration of palliative care into the treatment strategy will improve the quality of life (QoL and end of life (EOL care of our patients and may in fact improve their overall survival.

  20. Adverse effects and treatment on palliative radiotherapy for bone metastases

    International Nuclear Information System (INIS)

    Adverse effects on palliative radiotherapy for bone metastases are generally mild. Acute and late adverse effects are similar between 8 Gy single fraction and multi-fraction radiotherapy (e.g. 30 Gy in 10 fractions). Both external beam radiotherapy and radiopharmaceutical therapy with strontium-89 may cause pain flare. A randomized controlled trial is currently performed to confirm the effectiveness of dexamethasone for the prevention of pain flare. Reirradiation for the same site is widely used. However, its safeness has not been confirmed enough. Radiation myelitis is an unrecoverable severe adverse effect. However, the tolerated accumulated dose for the spinal cord is not fully understood. Stereotactic body radiotherapy may be considered to deliver reirradiation for spinal metastases without exposing too much dose for the spinal cord. Another solution to prevent radiation myelitis after reirradiation may use dose fractionations of 8 Gy single or 20 Gy in 5 fractions instead of 30 Gy in 10 fractions. (author)

  1. Palliative care providers' perspectives on service and education needs.

    Science.gov (United States)

    Sellick, S M; Charles, K; Dagsvik, J; Kelley, M L

    1996-01-01

    To obtain the information necessary for coordinated regional program development, we examined (a) the multidisciplinary viewpoint of palliative care service provision and (b) the continuing education needs reported by non-physician service providers. Of 146 surveys distributed to care providers from multiple settings, 135 were returned. Respondents cited these problems: fragmented services, poor pain and symptom control, lack of education for providers, lack of public awareness, problems with the continuity and coordination of care, lack of respite, and lack of hospice beds. Stress management for caregivers, pain management, communication skills, and symptom assessment were rated as priorities in continuing education. Lectures, small group discussions, practicum, and regular medical centre rounds were the preferred learning formats, while costs and staff shortages were cited as educational barriers.

  2. Chronic pain management as a barrier to pediatric palliative care.

    Science.gov (United States)

    Thompson, Lindsay A; Meinert, Elizabeth; Baker, Kimberly; Knapp, Caprice

    2013-12-01

    Pain is common as a presenting complaint to outpatient and emergency departments for children, yet pain management represents one of the children's largest unmet needs. A child may present with acute pain for an intermittent issue or may have acute or chronic pain in the setting of chronic illness. The mainstay of treatment for pain uses a stepwise approach for pain management, such as set up by the World Health Organization. For children with life-limiting illnesses, the Institute of Medicine guidelines recommends referral upon diagnosis for palliative care, meaning that the child receives comprehensive services that include pain control in coordination with curative therapies; yet barriers remain. From the provider perspective, pain can be better addressed through a careful assessment of one's own knowledge, skills, and attitudes. The key components of pain management in children are multimodal, regardless of the cause of the pain. PMID:23329083

  3. Management of stage Ⅳ rectal cancer:Palliative options

    Institute of Scientific and Technical Information of China (English)

    Sean M Ronnekleiv-Kelly; Gregory D Kennedy

    2011-01-01

    Approximately 30% of patients with rectal cancer present with metastatic disease.Many of these patients have symptoms of bleeding or obstruction.Several treatment options are available to deal with the various complications that may afflict these patients.Endorectal stenting,laser ablation,and operative resection are a few of the options available to the patient with a malignant large bowel obstruction.A thorough understanding of treatment options will ensure the patient is offered the most effective therapy with the least amount of associated morbidity.In this review,we describe various options for palliation of symptoms in patients with metastatic rectal cancer.Additionally,we briefly discuss treatment for asymptomatic patients with metastatic disease.

  4. Psychosocial issues in palliative care: A review of five cases

    Directory of Open Access Journals (Sweden)

    Tonia C Onyeka

    2010-01-01

    Full Text Available Palliative care is not just vital in controlling symptoms of the patient′s disease condition, but also aims to extend the patient′s life, giving it a better quality. However, several times in the course of management, the psychosocial impact of cancer, HIV/AIDS, and other life-limiting disease conditions may not be noticed and dealt with during the admission period, thereby giving rise to a more complex situation than the disease condition itself. This article aims to review some psychosocial issues and measures that can be taken to address them. It highlights the various roles and the importance of the clinician, nurse, social worker, and other members of the multidisciplinary team in tackling these issues and will help healthcare professionals in this field achieve better practice in the future.

  5. Oropharyngeal Candidiasis in Palliative Care Patients in Denmark

    DEFF Research Database (Denmark)

    Astvad, Karen; Johansen, Helle Krogh; Høiby, Niels;

    2015-01-01

    BACKGROUND: Oropharyngeal candidiasis (OPC) is a significant cause of morbidity, especially among patients with advanced cancer. The incidence and significance of yeast carriage and OPC in the palliative care setting in Denmark is unknown. The best diagnostic strategy and treatment regimen has...... to be defined. OBJECTIVE: This study evaluated the clinical and microbiological incidence of yeast carriage/OPC and assessed available diagnostic procedures-culture and microscopy. The distribution of Candida species and fluconazole susceptibility was determined. METHODS: Terminal care patients admitted...... recently treated with azoles. CONCLUSIONS: In total, 52% of culture-positive patients harbored at least one isolate with innately or acquired decreased fluconazole susceptibility. Therefore, susceptibility testing appears recommendable for patients with clinical signs of OPC....

  6. The Illness Experience: Palliative Care Given the impossibility of Healing.

    Science.gov (United States)

    Dantas, Margarida Maria Florêncio; Amazonas, Maria Cristina Lopes de Almeida

    2016-06-01

    This paper presents a reflection about being terminally ill and the various ways that the subject has at its disposal to deal with this event. The objective is to understand the experience of palliation for patients undergoing no therapeutic possibilities of cure. The methodology of this study has the instruments to semi-structured interview, the participant observation and the field diary, and the Descriptive Analysis of Foucault's inspiration how the narratives of the subjects were perceived. The Results of paper there was the possibility of looking at the experience of illness through the eyes of a subject position assumed by the very sick. As conclusion we have than when choosing palliative care, the terminally ill opts for a way to feel more comfortable and resists the impositions of the medical model of prolonging life. O presente trabalho traz uma reflexão a respeito do ser um doente terminal e das várias maneiras que o sujeito tem a seu dispor para lidar com esse acontecimento. Nosso objetivo foi compreender a experiência da paliação por sujeitos doentes sem possibilidades terapêuticas de cura. A metodologia deste estudo teve como instrumentos a Entrevista Narrativa, a Observação Participante e o Diário de Campo, sendo a Análise Descritiva de inspiração foucaultiana o modo como as narrativas dos sujeitos foram percebidas. O resultado do estudo mostrou a possibilidade de olhar a experiência do adoecer através da ótica de uma posição de sujeito assumida pelo próprio enfermo. E concluímos que ao escolher os cuidados paliativos, o doente terminal opta por um modo de se sentir mais confortável e resiste às imposições do modelo médico de prolongamento da vida.

  7. The Illness Experience: Palliative Care Given the impossibility of Healing.

    Science.gov (United States)

    Dantas, Margarida Maria Florêncio; Amazonas, Maria Cristina Lopes de Almeida

    2016-06-01

    This paper presents a reflection about being terminally ill and the various ways that the subject has at its disposal to deal with this event. The objective is to understand the experience of palliation for patients undergoing no therapeutic possibilities of cure. The methodology of this study has the instruments to semi-structured interview, the participant observation and the field diary, and the Descriptive Analysis of Foucault's inspiration how the narratives of the subjects were perceived. The Results of paper there was the possibility of looking at the experience of illness through the eyes of a subject position assumed by the very sick. As conclusion we have than when choosing palliative care, the terminally ill opts for a way to feel more comfortable and resists the impositions of the medical model of prolonging life. O presente trabalho traz uma reflexão a respeito do ser um doente terminal e das várias maneiras que o sujeito tem a seu dispor para lidar com esse acontecimento. Nosso objetivo foi compreender a experiência da paliação por sujeitos doentes sem possibilidades terapêuticas de cura. A metodologia deste estudo teve como instrumentos a Entrevista Narrativa, a Observação Participante e o Diário de Campo, sendo a Análise Descritiva de inspiração foucaultiana o modo como as narrativas dos sujeitos foram percebidas. O resultado do estudo mostrou a possibilidade de olhar a experiência do adoecer através da ótica de uma posição de sujeito assumida pelo próprio enfermo. E concluímos que ao escolher os cuidados paliativos, o doente terminal opta por um modo de se sentir mais confortável e resiste às imposições do modelo médico de prolongamento da vida. PMID:27384275

  8. Malignant duodenal obstructions: palliative treatment with covered expandable nitinol stent

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hyun Chul; Jung, Gyoo Sik; Lee, Sang Hee; Kim, Sung Min; Oh, Kyung Seung; Huh, Jin Do; Cho, Young Duk [College of Medicine, Kosin Univ, Pusan (Korea, Republic of); Song, Ho Young [College of Medicine, Ulsan Univ., Seoul (Korea, Republic of)

    2002-04-01

    To evaluate the feasibility and clinical effectiveness of using a polyurethane-covered expandable nitinol stent in the palliative treatment of malignant duodenal obstruction. Under fluoroscopic guidance, a polyurethane-covered expandable nitinol stent was placed in 12 consecutive patients with malignant duodenal obstructions. All presented with severe nausea and recurrent vomiting. The underlying causes of obstruction were duodenal carcinoma (n=4), pancreatic carcinoma (n=4), gall bladder carcinoma (n=2), distal CBD carcinoma (n=1), and uterine cervical carcinoma (n=1). The sites of obstruction were part I (n=1), part II (n=8), and III (n=3). Due to pre-existing jaundice, eight patients with part II obstructions underwent biliary decompression prior to stent placement. An introducer sheath with a 6-mm outer diameter and stents 16 mm in diameter were employed, and to place the stent, and after-loading technique was used. Stent placement was technically successful in ten patients, and no procedural complications occuured. In one of two patients in whom there was technical failure, and in whom the obstructions were located in part III, the stent was placed transgastrically. Stent migration occurred in one patient four days after the procedure, and treatment involved the palcement of a second, uncovered, nitinol stent. After stent placement, symptoms improved in all patients. During follow-up, obstructive symptoms due to stent stenosis (n=1), colonic obstruction (n=1), and multiple small bowel obstruction (n=1) recurred in three patients. Two of these were treated by placing additional stents in the duodenum and colon, respectively. One of the eight patients in whom a stent was placed in the second portion of the duodenum developed jaundice. The patients died a mean 14 (median, 9) weeks after stent placement. The placement of a polyurethane-covered expandable nitinol stent seems to be technically feasible, safe and effective for the palliative treatment of malignant

  9. African Peacekeepers in Africa

    DEFF Research Database (Denmark)

    Emmanuel, Nikolas G.

    2015-01-01

    peacekeeping operations in the region. It is important to add that the international community has frequently tried to facilitate the deployment of African armed forces with aid and training. From this reality, the following study goes beyond the current literature by focusing on the international factors...... behind African participation in United Nations (UN) peacekeeping operations in Africa. In doing so, this research focuses on US military aid and foreign troop training from 2002 to 2012, and its impact on African deployments into UN peacekeeping missions in Africa. As can be expected, such third...

  10. Reading the African context

    OpenAIRE

    Musonda Bwalya

    2012-01-01

    There is so much alienation, pain and suffering in our today�s world. In this vein, African Christianity, a voice amongst many voices, should seek to be a transformational religion for the whole of life, affecting all facets of human life towards a fuller life of all in Africa. This article sought to highlight and point to some of the major societal challenges in the African context which African Christianity, as a life-affirming religion, should continue to embrace, re-embrace and engag...

  11. Palliative care among heart failure patients in primary care: a comparison to cancer patients using English family practice data.

    Directory of Open Access Journals (Sweden)

    Amy Gadoud

    Full Text Available INTRODUCTION: Patients with heart failure have a significant symptom burden and other palliative care needs often over a longer period than patients with cancer. It is acknowledged that this need may be unmet but by how much has not been quantified in primary care data at the population level. METHODS: This was the first use of Clinical Practice Research Datalink, the world's largest primary care database to explore recognition of the need for palliative care. Heart failure and cancer patients who had died in 2009 aged 18 or over and had at least one year of primary care records were identified. A palliative approach to care among patients with heart failure was compared to that among patients with cancer using entry onto a palliative care register as a marker for a palliative approach to care. RESULTS: Among patients with heart failure, 7% (234/3 122 were entered on the palliative care register compared to 48% (3 669/7 608 of cancer patients. Of heart failure patients on the palliative care register, 29% (69/234 were entered onto the register within a week of their death. CONCLUSIONS: This confirms that the stark inequity in recognition of palliative care needs for people with heart failure in a large primary care dataset. We recommend a move away from prognosis based criteria for palliative care towards a patient centred approach, with assessment of and attention to palliative needs including advance care planning throughout the disease trajectory.

  12. Early identification of and proactive palliative care for patients in general practice, incentive and methods of a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Thoonsen Bregje

    2011-11-01

    Full Text Available Abstract Background According to the Word Health Organization, patients who can benefit from palliative care should be identified earlier to enable proactive palliative care. Up to now, this is not common practice and has hardly been addressed in scientific literature. Still, palliative care is limited to the terminal phase and restricted to patients with cancer. Therefore, we trained general practitioners (GPs in identifying palliative patients in an earlier phase of their disease trajectory and in delivering structured proactive palliative care. The aim of our study is to determine if this training, in combination with consulting an expert in palliative care regarding each palliative patient's tailored care plan, can improve different aspects of the quality of the remaining life of patients with severe chronic diseases such as chronic obstructive pulmonary disease, congestive heart failure and cancer. Methods/Design A two-armed randomized controlled trial was performed. As outcome variables we studied: place of death, number of hospital admissions and number of GP out of hours contacts. Discussion We expect that this study will increase the number of identified palliative care patients and improve different aspects of quality of palliative care. This is of importance to improve palliative care for patients with COPD, CHF and cancer and their informal caregivers, and to empower the GP. The study protocol is described and possible strengths and weaknesses and possible consequences have been outlined. Trial Registration The Netherlands National Trial Register: NTR2815

  13. Capitalism and African business cultures

    OpenAIRE

    Taylor, Scott D.

    2014-01-01

    Scholars and practitioners once commonly linked 'African culture' to a distinctive 'African capitalism', at odds with genuine capitalism and the demands of modern business. Yet contemporary African business cultures reveal that a capitalist ethos has taken hold within both state and society. The success and visibility of an emergent, and celebrated, class of African big business reveals that business and profit are culturally acceptable. Existing theories of African capitalism are ill-equippe...

  14. Rehabilitering og palliation af patienter med svær KOL bør integreres

    DEFF Research Database (Denmark)

    Ringbæk, Thomas; Wilcke, Jon Torgny Rostrup

    2013-01-01

    Treatment elements of rehabilitation and palliative care are described in relation to the main clinical manifestations of severe and very severe chronic obstructive pulmonary disease (COPD). With increasing loss of function the need for multidisciplinary effort increases. Physiotherapy, occupatio...

  15. Palliative Care: The Relief You Need When You're Experiencing Symptoms of Serious Illness

    Science.gov (United States)

    ... Need When You’re Experiencing the Symptoms of Serious Illness Palliative Care: Improving quality of life when ... Dealing with the symptoms of any painful or serious illness is difficult. However, special care is available ...

  16. Palliative care communication curriculum: what can students learn from an unfolding case?

    Science.gov (United States)

    Goldsmith, Joy; Wittenberg-Lyles, Elaine; Shaunfield, Sara; Sanchez-Reilly, Sandra

    2011-06-01

    Limited attention to palliative care communication training is offered to medical students. In this work, we pursued unfolding case responses and what they indicated about student tendencies to use palliative care communication as well as what medical students can learn from their own reflective practice about palliative care. Findings showed an overwhelming trend for students to avoid palliative care communication or inclusion of topics including advance directives, place of care, family support, and dying. Instead, students relied heavily on the SPIKES protocol, communication that was strategically vague and ambiguous, and discussions that centered on specialty care and referral. In reflecting on their own case study responses, students noted an absence of direct communication about prognosis, no coordination of care, late hospice entry, and patient pain resulting from communication inefficacies. Future research should focus on the development of formal and adaptive curriculum structures to address these communication needs. PMID:21071434

  17.  Cancer palliation in primary care - what is good and bad?

    DEFF Research Database (Denmark)

    Neergaard, Mette Asbjørn

    sectors. Methods. A series of focus group interviews is presently being conducted with participation of relatives of recently deceased cancer patients, GPs, community nurses and hospital physicians working with palliative patients. The interviews are transcribed and analysed  according...... involved in care for terminally ill cancer patients, only little is known about how the palliation efforts are perceived, a knowledge that is vital to make improvements. We aimed to analyse the quality of palliative home care based on evaluations by the relatives and the primary and secondary health care...... to the phenomenological approach.The interviews will form the basis of a survey of 500 episodes of palliative home care as evaluated by relatives, GPs and district nurses.Results. These results are the preliminary results from the first interviews with GPs. Three themes emerged from the interviews: 1) The key persons...

  18. An interdisciplinary approach to palliative care - context and challenges in basic education programmes

    DEFF Research Database (Denmark)

    Sangild Stølen, Karen Marie; Breum, Wanda Elisabeth; Andersen, Tanja Thinggaard

    2015-01-01

    , psychological, social and existential perspectives is necessary in order to be able to meet the needs of these people. The health education programmes should therefore offer instruction in palliative care. On this background, University College Capital has developed an interdisciplinary elective course...... on palliative care. Methods: The physiotherapy, psychomotor-therapy and nursing programmes offer an interdisciplinary elective course in palliative care twice annually. The course consists of two weeks of theory followed by two weeks of clinical practice, and wraps up with two more weeks of theory. Throughout...... the course, the students work in interdisciplinary groups. The programme for the course has been developed on the basis of WHO’s definition of palliative care, with special emphasis on the interdisciplinary perspectives and activities in relation to the physical, psychological, social and spiritual areas...

  19. [The cultural history of palliative care in primitive societies: an integrative review].

    Science.gov (United States)

    Siles González, José; Solano Ruiz, Maria Del Carmen

    2012-08-01

    The objective of this study is to describe the evolution of palliative care in order to reflect on the possibility of its origin in primitive cultures and their relationship with the beginnings of the cult of the dead. It describes the change in the symbolic structures and social interactions involved in palliative care during prehistory: functional unit, functional framework and functional element. The theoretical framework is based on cultural history, the dialectical structural model and symbolic interactionism. Categorization techniques, cultural history and dialectic structuralism analyses were performed. Palliative care existed in primitive societies, mostly associated with the rites of passage with a high symbolic content. The social structures - functional unit, functional framework and functional element - are the pillars that supported palliative care in prehistory societies.

  20. Identifying Patients in the Acute Psychiatric Hospital Who May Benefit From a Palliative Care Approach.

    Science.gov (United States)

    Burton, M Caroline; Warren, Mark; Cha, Stephen S; Stevens, Maria; Blommer, Megan; Kung, Simon; Lapid, Maria I

    2016-04-01

    Identifying patients who will benefit from a palliative care approach is the first critical step in integrating palliative with curative therapy. Criteria are established that identify hospitalized medical patients who are near end of life, yet there are no criteria with respect to hospitalized patients with psychiatric disorders. The records of 276 consecutive patients admitted to a dedicated inpatient psychiatric unit were reviewed to identify prognostic criteria predictive of mortality. Mortality predictors were 2 or more admissions in the past year (P = .0114) and older age (P = .0006). Twenty-two percent of patients met National Hospice and Palliative Care Organization noncancer criteria for dementia. Palliative care intervention should be considered when treating inpatients with psychiatric disorders, especially older patients who have a previous hospitalization or history of dementia.

  1. Palliative medicine physician education in the United States: a historical review.

    Science.gov (United States)

    Case, Amy A; Orrange, Susan M; Weissman, David E

    2013-03-01

    In this review we discuss the history of Hospice and Palliative Medicine (HPM) physician education in the United States over the last 20 years, as there has been dramatic growth in our specialty during this time. A Medline literature search was completed and we surveyed leaders in the field of HPM education regarding their experiences in promoting palliative medicine education. Educators were selected based on their peer reviewed publications on key educational initiatives since 1990. A survey tool was designed and emailed to 18 educators across the country and follow-up phone interviews were done to further explore specific questions. The survey and interviews sought information about major palliative care education milestones, instrumental projects, and barriers to further development of palliative medicine education.

  2. Predictors of home death among palliative cancer patients in a primary care setting

    DEFF Research Database (Denmark)

    Neergaard, Mette Asbjørn; Olesen, Frede; Vedsted, Peter;

      Background: In most western countries, the majority of palliative cancer patients wish to die at home, where GPs are often deeply involved. However, most research focuses on specialised palliative care, which results in a lack of reliable predictors of home death in primary care. Aim: To analyse...... predictors of home death among deceased palliative cancer patients in a primary care setting. Methods: Using Danish registers, we identified 787 deceased cancer patients and sent a questionnaire to their GPs. The questions concerned the GPs' involvement and the duration of the palliative period at home. We......-of-hours, and whether the GP had had contact with the relatives. Results: 350 questionnaires were filled out. In the preliminary analysis we found that even though many patients died in hospital, this group spent nearly as much of their last time at home as the patients who actually died at home. The analysis...

  3. Impact of teaching session on concepts of palliative care in medical undergraduates.

    Directory of Open Access Journals (Sweden)

    Sirisha Annavarapu

    2016-02-01

    Conclusions: Concept of palliative care was poor among medical undergraduates. Health care providers can overcome by knowledge construction, interrelation between practice and evidence based medicine. [Int J Basic Clin Pharmacol 2016; 5(1.000: 188-191

  4. What Proportion of Terminally Ill and Dying People Require Specialist Palliative Care Services?

    Directory of Open Access Journals (Sweden)

    Donna M. Wilson

    2014-01-01

    Full Text Available Currently, around 55 million people die each year worldwide. That number is expected to increase rapidly with accelerating population aging. Despite growth in the number of palliative care specialists and specialist services in most countries, the prospect of an increasing number of terminally ill and dying persons is daunting. This paper attempts to answer the question: what proportion of terminally ill and dying persons require specialist palliative care services? To address this question and highlight which persons require specialist palliative care, the current state of access to specialist palliative care services and specialists in Canada and other countries is highlighted, along with available evidence-based information on specialist services utilization and the care needs of terminally ill and dying persons. Current evidence and information gaps reveal that this question cannot be answered now, but it should be answered in advance of a crisis of unmet end-of-life care needs with the rising death toll.

  5. A Parent's Journey: Incorporating Principles of Palliative Care into Practice for Children with Chronic Neurologic Diseases.

    Science.gov (United States)

    Brown, Allyson; Clark, Jonna D

    2015-09-01

    Rather than in conflict or in competition with the curative model of care, pediatric palliative care is a complementary and transdisciplinary approach used to optimize medical care for children with complex medical conditions. It provides care to the whole child, including physical, mental, and spiritual dimensions, in addition to support for the family. Through the voice of a parent, the following case-based discussion demonstrates how the fundamentals of palliative care medicine, when instituted early in the course of disease, can assist parents and families with shared medical decision making, ultimately improving the quality of life for children with life-limiting illnesses. Pediatric neurologists, as subspecialists who provide medical care for children with chronic and complex conditions, should consider invoking the principles of palliative care early in the course of a disease process, either through applying general facets or, if available, through consultation with a specialty palliative care service. PMID:26358425

  6. The Use of Emergency Medication Kits in Community Palliative Care: An Exploratory Survey of Views of Current Practice in Australian Home-Based Palliative Care Services.

    Science.gov (United States)

    Bullen, Tracey; Rosenberg, John P; Smith, Bradley; Maher, Kate

    2015-09-01

    Improving symptom management for palliative care patients has obvious benefits for patients and advantages for the clinicians, as workload demands and work-related stress can be reduced when the emergent symptoms of patients are managed in a timely manner. The use of emergency medication kits (EMKs) can provide such timely symptom relief. The purpose of this study was to conduct a survey of a local service to examine views on medication management before and after the implementation of an EMK and to conduct a nationwide prevalence survey examining the use of EMKs in Australia. Most respondents from community palliative care services indicated that EMKs were not being supplied to palliative care patients but believed such an intervention could improve patient care. PMID:24871345

  7. A comparison of two methods of palliation of large bowel obstruction due to irremovable colon cancer.

    OpenAIRE

    Johnson, Richard; Marsh, Ralph; Corson, John; Seymour, Keith

    2004-01-01

    INTRODUCTION: Untreated malignant large bowel obstruction is rapidly fatal. Short-term palliation of symptoms can be achieved by formation of a stoma in those patients for whom resection surgery is inappropriate. In the final months of life, a stoma represents a significant burden for both patients and carers. Palliative endoluminal stenting may therefore be an attractive alternative option for this poor prognostic group. PATIENTS: Thirty-six patients were studied of whom 18 had obstructing l...

  8. Relieving suffering at the end of life: practitioners' perspectives on palliative sedation from three European countries.

    Science.gov (United States)

    Seymour, Jane E; Janssens, Rien; Broeckaert, Bert

    2007-04-01

    This paper reports findings from visits to palliative care settings and research units in the UK, Belgium and the Netherlands. The aim was to learn about clinicians' (both nurses and doctors) and academic researchers' understandings and experiences of palliative sedation for managing suffering at the end of life, and their views regarding its clinical, ethical and social implications. The project was linked to two larger studies of technologies used in palliative care. Eleven doctors, 14 nurses and 10 researchers took part in informal interviews. Relevant reports and papers from the academic, clinical and popular press were also collected from the three countries. The study took place in a context in which attention has been drawn towards palliative sedation by the legalisation of euthanasia in the Netherlands and Belgium, and by the re-examination of the legal position on assisted dying in the UK. In this context, palliative sedation has been posited by some as an alternative path of action. We report respondents' views under four headings: understanding and responding to suffering; the relationship between palliative sedation and euthanasia; palliative sedation and artificial hydration; and risks and uncertainties in the clinician-patient/family relationship. We conclude that the three countries can learn from one another about the difficult issues involved in giving compassionate care to those who are suffering immediately before death. Future research should be directed at enabling dialogue between countries: this has already been shown to open the door to the development of improved palliative care and to enhance respect for the different values and histories in each. PMID:17250941

  9. Edmonton Regional Palliative Care Program: impact on patterns of terminal cancer care

    OpenAIRE

    Bruera, E; Neumann, C M; Gagnon, B.; Brenneis, C; Kneisler, P; Selmser, P; J Hanson

    1999-01-01

    The Edmonton Regional Palliative Care Program was established in July 1995 to measure the access of patients with terminal cancer to palliative care services, decrease the number of cancer-related deaths in acute care facilities and increase the participation of family physicians in the care of terminally ill patients. In this retrospective study the authors compared the pattern of care and site of deaths before establishment of the program (1992/93) and during its second year of operation (1...

  10. Study protocol: optimization of complex palliative care at home via telemedicine. A cluster randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Hasselaar Jeroen

    2011-08-01

    Full Text Available Abstract Background Due to the growing number of elderly with advanced chronic conditions, healthcare services will come under increasing pressure. Teleconsultation is an innovative approach to deliver quality of care for palliative patients at home. Quantitative studies assessing the effect of teleconsultation on clinical outcomes are scarce. The aim of this present study is to investigate the effectiveness of teleconsultation in complex palliative homecare. Methods/Design During a 2-year recruitment period, GPs are invited to participate in this cluster randomized controlled trial. When a GP refers an eligible patient for the study, the GP is randomized to the intervention group or the control group. Patients in the intervention group have a weekly teleconsultation with a nurse practitioner and/or a physician of the palliative consultation team. The nurse practitioner, in cooperation with the palliative care specialist of the palliative consultation team, advises the GP on treatment policy of the patient. The primary outcome of patient symptom burden is assessed at baseline and weekly using the Edmonton Symptom Assessment Scale (ESAS and at baseline and every four weeks using the Hospital Anxiety and Depression Scale (HADS. Secondary outcomes are self-perceived burden from informal care (EDIZ, patient experienced continuity of medical care (NCQ, patient and caregiver satisfaction with the teleconsultation (PSQ, the experienced problems and needs in palliative care (PNPC-sv and the number of hospital admissions. Discussion This is one of the first randomized controlled trials in palliative telecare. Our data will verify whether telemedicine positively affects palliative homecare. Trial registration The Netherlands National Trial Register NTR2817

  11. Identification and characteristics of patients with palliative care needs in Brazilian primary care

    OpenAIRE

    Marcucci, Fernando C. I.; Cabrera, Marcos A. S.; Perilla, Anamaria Baquero; Brun, Marilia Maroneze; de Barros, Eder Marcos L.; Martins, Vanessa M.; Rosenberg, John P.; Yates, Patsy

    2016-01-01

    Background The Brazilian healthcare system offers universal coverage but lacks information about how patients with PC needs are serviced by its primary care program, Estratégia Saúde da Família (ESF). Methods Cross-sectional study in community settings. Patients in ESF program were screened using a Palliative Care Screening Tool (PCST). Included patients were assessed with Karnofsky Performance Scale (KPS), Edmonton Symptom Assessment System (ESAS) and Palliative Care Outcome Scale (POS). Res...

  12. Palm Kernel Shells as a Dust Control Palliative on an Unpaved Road

    Directory of Open Access Journals (Sweden)

    Peter Ndoke NDOKE

    2006-07-01

    Full Text Available An assessment of the effectiveness of the use palm kernel shells as a dust control palliative on an unpaved road has been carried out. The palm kernel shells were able to reduce the quantity of dust generated from the road to about 75% a few days after the application. It was then suggested that with the absence of funds for road maintenance works organic materials like palm kernel shells could be used as palliatives.

  13. Measuring the diffusion of palliative care in long-term care facilities – a death census

    OpenAIRE

    Santos-Eggimann Brigitte; Paroz Sophie

    2009-01-01

    Abstract Background The dissemination of palliative care for patients presenting complex chronic diseases at various stages has become an important matter of public health. A death census in Swiss long-term care facilities (LTC) was set up with the aim of monitoring the frequency of selected indicators of palliative care. Methods The survey covered 150 LTC facilities (105 nursing homes and 45 home health services), each of which was asked to complete a questionnaire for every non-accidental d...

  14. Living in the face of death: Studies on palliative care in upper GI cancer patients

    OpenAIRE

    Uitdehaag, Madeleen

    2012-01-01

    textabstractThis thesis explores palliative care provided to patients with advanced upper gastrointestinal (GI) cancer. The 5-year survival rates for these cancer sites range between 4 and 17%, which implies that many of these patients require palliative care. Considering the fact that there is no uniform management policy aiming at improvement of quality of life (QoL) of these patients and their families, we decided to study different interventions with effect on this primary aim. The introd...

  15. Infomarkers for Transition to Goals Consistent with Palliative Care in Dying Patients

    Science.gov (United States)

    Yao, Yingwei; Stifter, Janet; Ezenwa, Miriam O.; Lodhi, Muhammad; Khokhar, Ashfaq; Ansari, Rashid; Keenan, Gail M.; Wilkie, Diana J.

    2015-01-01

    Objective Electronic health records (EHRs) may contain infomarkers that identify patients near the end of life for whom it would be appropriate to shift care goals to palliative care. Discovery and use of such infomarkers could be used to conduct effectiveness research that ultimately could help to reduce the monumental costs for dying care. Our aim was to identify changes in the plans of care that represented infomarkers, which signaled the transition of care goals from non-palliative care goals to those consistent with palliative care. Methods Using an existing electronic health record database generated during a two-year, longitudinal study of 9 diverse medical-surgical units from 4 Midwest hospitals and a known group approach, we evaluated the patient care episodes for 901 patients who died (mean age=74.5±14.6 years). We used ANOVA and Tukey’s post-hoc tests to compare patient groups. Results We identified 11 diagnoses, including Death Anxiety and Anticipatory Grieving, whose addition to the care plan, some of which also occurred with removal of non-palliative care diagnoses, represent infomarkers of transition to palliative care goals. There were four categories of patients, those who had: no infomarkers on plans (n=507); infomarkers added on the admission plan (n=194); infomarkers added on a post admission plan (minor transitions, n=109), and infomarkers added and non-palliative care diagnoses removed on a post admission plan (major transition, n=91). Age, length of stay, and pain outcomes differed significantly for these four categories of patients. Significance of Results EHRs contain pertinent infomarkers that if confirmed in future studies could be used for timely referral to palliative care for improved focus on comfort outcomes and to identify palliative care subjects from data repositories for to conduct big data research, comparative effectiveness studies, and health services research. PMID:25711431

  16. The role of religious, social and political groups in palliative care in Northern Kerala

    Directory of Open Access Journals (Sweden)

    Sallnow Libby

    2005-01-01

    Full Text Available The local community has played an important and central role in the development and determination of palliative care services in Northern Kerala. This article looks at the history of the collaboration and how palliative care services have evolved over the past 4 years from 2001 to 2005. The contribution of groups such as nongovernmental organizations, charities and religious groups is outlined and benefits gained by each side discussed.

  17. Team meetings in specialist palliative care: Asking questions as a strategy within interprofessional interaction

    OpenAIRE

    Arber, A

    2008-01-01

    In this article, I explore what happens when specialist palliative care staff meet together to discuss patients under their care. Many studies (e.g., Atkinson) have discussed how health care practitioners in various settings use rhetorical strategies when presenting cases in situations such as ward rounds and team meetings. Strategies for arguing and persuading are central to medical practice in the interprofessional context. The context of specialist palliative care is an interesting place...

  18. The role and significance of nurses in managing transitions to palliative care: a qualitative study

    OpenAIRE

    Kirby, Emma; Broom, Alex; Good, Phillip

    2014-01-01

    Objectives Nurses are generally present, and often influential, in supporting patient and family acceptance of medical futility and in assisting doctors in negotiating referral to palliative care. Yet the specificities of the nursing role and how nurses may contribute to timely and effective referrals is not well understood. This study aimed to systematically explore hospital-based nurses’ accounts of the transition to palliative care, and the potential role of nurses in facilitating more eff...

  19. Palliative Care Improves Survival, Quality of Life in Advanced Lung Cancer | Division of Cancer Prevention

    Science.gov (United States)

    Results from the first randomized clinical trial of its kind have revealed a surprising and welcome benefit of early palliative care for patients with advanced lung cancer—longer median survival. Although several researchers said that the finding needs to be confirmed in other trials of patients with other cancer types, they were cautiously optimistic that the trial results could influence oncologists’ perceptions and use of palliative care. |

  20. Palliative care in advanced cancer patients in a tertiary care hospital in Uttarakhand

    OpenAIRE

    Manisha Bisht; Bist, S. S.; Dhasmana, D. C.; Sunil Saini

    2008-01-01

    Aim: Advanced cancer, irrespective of the site of the cancer, is characterized by a number of associated symptoms that impair the quality of life of patients. The management of these symptoms guides palliative care. The present study aims to describe the symptoms and appropriate palliation provided in patients with advanced cancer in a tertiary care hospital in Uttarakhand. Methods: This was an observational study. A total of 100 patients with advanced cancer were included in the study. T...

  1. Acupuncture and Related Therapies for Symptom Management in Palliative Cancer Care

    OpenAIRE

    Lau, Charlotte H. Y.; Wu, Xinyin; Vincent C. H. Chung; Liu, Xin; Hui, Edwin P.; Cramer, Holger; Lauche, Romy; Wong, Samuel Y. S.; Lau, Alexander Y.L.; Sit, Regina S. T.; Eric T. C. Ziea; Ng, Bacon F. L.; Wu, Justin C. Y.

    2016-01-01

    Abstract Available systematic reviews showed uncertainty on the effectiveness of using acupuncture and related therapies for palliative cancer care. The aim of this systematic review and meta-analysis was to summarize current best evidence on acupuncture and related therapies for palliative cancer care. Five international and 3 Chinese databases were searched. Randomized controlled trials (RCTs) comparing acupuncture and related therapies with conventional or sham treatments were considered. ...

  2. The case for home based telehealth in pediatric palliative care: a systematic review

    OpenAIRE

    Bradford Natalie; Armfield Nigel R; Young Jeanine; Smith Anthony C

    2013-01-01

    Abstract Background Over the last decade technology has rapidly changed the ability to provide home telehealth services. At the same time, pediatric palliative care has developed as a small, but distinct speciality. Understanding the experiences of providing home telehealth services in pediatric palliative care is therefore important. Methods A literature review was undertaken to identify and critically appraise published work relevant to the area. Studies were identified by searching the ele...

  3. Progress in palliative care in Israel: comparative mapping and next steps

    Directory of Open Access Journals (Sweden)

    Bentur Netta

    2012-02-01

    Full Text Available Abstract Palliative care was established rapidly in some countries, while in other countries its establishment has taken a different trajectory. This paper identifies core steps in developing a medical specialty and examines those taken by Israel as compared with the US and England for palliative care. It considers the next steps Israel may take. Palliative care aims to provide quality of life for those with serious illnesses by attending to the illness-prompted physical, mental, social, and spiritual needs of patients and their families. It has ancient roots in medicine; its modern iteration began against the backdrop of new cures and life-sustaining technology which challenged conceptions of how to respect the sanctity of life. The first modern hospice was created by Saunders; it provided proof that palliative care works, and this has occurred in Israel as well (the first step. Another key step is usually skills development among clinicians; in Israel, few education and training opportunities exist so far. Specialty recognition also has not yet occurred in Israel. Service development remains limited and a major shortage of services exists, compared to the US. Research capacity in Israel is also limited. Policy to develop and sustain palliative care in Israel is underway; in 2009, the Ministry of Health established policy for implementing palliative care. However, it still lacks a financially viable infrastructure. We conclude that palliative care in Israel is emerging but has far to go. Adequate resource allocation, educational guidelines, credentialed manpower and specialty leadership are the key factors that palliative care development in Israel needs.

  4. [Successful intervention of a Palliative Liaison Service in case of ethical conflicts].

    Science.gov (United States)

    Hannesschläger, Heinz; Kopp, Martin; Holzner, Bernhard

    2006-05-01

    In multiprofessional teams, the processes underlying ethical decisions in Palliative Care often become complicated and could cause many conflicts. Different interests and ethical positions often slow down the necessary decision-making. The lack of resources, lack of managerial structures and deficits in competence and education make the situation more difficult. We demonstrated in our case report that an established Palliative Liaison Service could support the creation of consensual decisions by forming multiprofessional ethic round-ups.

  5. Palliative and end of life care communication as emerging priorities in postgraduate medical education

    OpenAIRE

    des Ordons, Amanda Roze; Ajjawi, Rola; MacDonald, John; Sarti, Aimee; Lockyer, Jocelyn; Hartwick, Michael

    2016-01-01

    Background Reliance on surveys and qualitative studies of trainees to guide postgraduate education about palliative and end of life (EOL) communication may lead to gaps in the curriculum. We aimed to develop a deeper understanding of internal medicine trainees’ educational needs for a palliative and EOL communication curriculum and how these needs could be met. Methods Mixed methods, including a survey and focus groups with trainees, and interviews with clinical faculty and medical educators,...

  6. Use of dependency and prioritization tools by clinical nurse specialists in palliative care: an exploratory study.

    LENUS (Irish Health Repository)

    Bracken, Mairéad

    2011-12-01

    The principal aim was to assess the utility of three needs assessment\\/dependency tools for use in community-based palliative care services. Specific objectives were to assess a sample of patients receiving specialist palliative care community nursing using these tools, to assess the predictive ability of each tool, and to explore the utility of prioritizing and measuring patient dependency from a clinical nurse specialist (CNS) perspective.

  7. The basis, ethics and provision of palliative care for dementia: A review.

    Science.gov (United States)

    Mahin-Babaei, Fariba; Hilal, Jamal; Hughes, Julian C

    2016-01-01

    Interest in palliative care for people with dementia has been around for over two decades. There are clinical and ethical challenges and practical problems around the implementation of good quality palliative care in dementia. This narrative review of the literature focuses on the rationale or basis for services, some of the ethical issues that arise (particularly to do with artificial nutrition and hydration) and on the provision and implementation of services. We focus on the most recent literature. The rationale for palliative care for people with dementia is based on research and on an identified need for better clinical care. But the research largely demonstrates a paucity of good quality evidence, albeit particular interventions (and non-interventions) can be justified in certain circumstances. Numerous specific clinical challenges in end-of-life care for people with dementia are ethical in nature. We focus on literature around artificial nutrition and hydration and conclude that good communication, attention to the evidence and keeping the well-being of the person with dementia firmly in mind will guide ethical decision-making. Numerous challenges surround the provision of palliative care for people with dementia. Palliative care in dementia has been given definition, but can still be contested. Different professionals provide services in different locations. More research and education are required. No single service can provide palliative care for people with dementia.

  8. The comparative palliative care needs of those with heart failure and cancer patients.

    LENUS (Irish Health Repository)

    O'Leary, Norma

    2012-02-01

    PURPOSE OF REVIEW: Patients with heart failure seem particularly suited to palliative care having needs that fall within the prototypical palliative care domains. Despite this there is still much debate as to who should respond to these needs and when. RECENT FINDINGS: Since the early 1990s many studies have been published outlining the unmet needs of patients with heart failure. However, there have been limitations to these studies and they have not guided professionals as to how to respond. More recently comparative studies using cancer as the reference have explored similarities and highlighted differences in need between heart failure and cancer patients. These studies are useful for informing future service development. SUMMARY: Patients with heart failure have variable needs and variable disease trajectories. A targeted response to these needs is required. Palliative triggers or transitions should be recognized by professionals caring for patients with heart failure. It is unlikely that either specialist palliative care or medical specialists working in isolation will be sufficiently experienced to respond to these needs. Research is required to determine the effectiveness of different collaborative approaches; heart failure specialist care aligned with palliative care consultancy or heart failure-oriented palliative care services.

  9. [Palliative Medicine as a New Career Path for Anesthesiologists: Preface and Comments].

    Science.gov (United States)

    Kawamata, Mikito

    2016-03-01

    The aim of Japanese Society of Anesthesiologists is to provide safe and comfortable medical care through biological management in emergency and intensive care using pain management and palliative medical care to deal with disease and surgery. Thus, in addition to the fields of intensive care medicine and emergency medicine, anesthesiologists have been expected to play an important role in the field of palliative medicine. Recently, anesthesiologists have been becoming professors and heads in the field of palliative medicine at many university hospitals in Japan. This is because anesthesiologists can provide care for the patient to prevent pain and various distress symptoms they would experience. Palliative care is provided by a team of physicians, nurses, and other health professionals who work together with the primary care physician and referred specialists to provide an extra layer of support. It is appropriate at any age and at any stage of a serious illness and can be provided along with curative treatment. Palliative care is also appropriate for patients from the point of diagnosing a serious illness--not just for the end of life. Anesthesiologists should show more leadership in the field of such palliative medicine in Japan. PMID:27097500

  10. Oncologists’ Perspectives on Concurrent Palliative Care in an NCI-designated Comprehensive Cancer Center

    Science.gov (United States)

    Bakitas, Marie; Lyons, Kathleen Doyle; Hegel, Mark T.; Ahles, Tim

    2013-01-01

    Purpose To understand oncology clinicians’ perspectives about the care of advanced cancer patients following the completion of the ENABLE II (Educate, Nurture, Advise, Before Life Ends) randomized clinical trial (RCT) of a concurrent oncology palliative care model. Methods Qualitative interview study of 35 oncology clinicians about their approach to patients with advanced cancer and the effect of the ENABLE II RCT. Results Oncologists believed that integrating palliative care at the time of an advanced cancer diagnosis enhanced patient care and complemented their practice. Self-assessment of their practice with advanced cancer patients comprised four themes: 1) treating the whole patient, 2) focusing on quality versus quantity of life, 3) “some patients just want to fight”, and 4) helping with transitions; timing is everything. Five themes comprised oncologists’ views on the complementary role of palliative care: 1) “refer early and often”, 2) referral challenges: “Palliative” equals hospice; “Heme patients are different”, 3) palliative care as consultants or co-managers, 4) palliative care “shares the load”, and 5) ENABLE II facilitated palliative care integration. Conclusions Oncologists described the RCT as holistic and complementary, and as a significant factor in adopting concurrent care as a standard of care. PMID:23040412

  11. Using routine data to improve palliative and end of life care.

    Science.gov (United States)

    Davies, Joanna M; Gao, Wei; Sleeman, Katherine E; Lindsey, Katie; Murtagh, Fliss E; Teno, Joan M; Deliens, Luc; Wee, Bee; Higginson, Irene J; Verne, Julia

    2016-09-01

    Palliative and end of life care is essential to healthcare systems worldwide, yet a minute proportion of research funding is spent on palliative and end of life care research. Routinely collected health and social care data provide an efficient and useful opportunity for evaluating and improving care for patients and families. There are excellent examples of routine data research in palliative and end of life care, but routine data resources are widely underutilised. We held four workshops on using routinely collected health and social care data in palliative and end of life care. Researchers presented studies from the UK, USA and Europe. The aim was to highlight valuable examples of work with routine data including work with death registries, hospital activity records, primary care data and specialist palliative care registers. This article disseminates that work, describes the benefits of routine data research and identifies major challenges for the future use of routine data, including; access to data, improving data linkage, and the need for more palliative and end of life care specific data.

  12. The basis, ethics and provision of palliative care for dementia: A review.

    Science.gov (United States)

    Mahin-Babaei, Fariba; Hilal, Jamal; Hughes, Julian C

    2016-01-01

    Interest in palliative care for people with dementia has been around for over two decades. There are clinical and ethical challenges and practical problems around the implementation of good quality palliative care in dementia. This narrative review of the literature focuses on the rationale or basis for services, some of the ethical issues that arise (particularly to do with artificial nutrition and hydration) and on the provision and implementation of services. We focus on the most recent literature. The rationale for palliative care for people with dementia is based on research and on an identified need for better clinical care. But the research largely demonstrates a paucity of good quality evidence, albeit particular interventions (and non-interventions) can be justified in certain circumstances. Numerous specific clinical challenges in end-of-life care for people with dementia are ethical in nature. We focus on literature around artificial nutrition and hydration and conclude that good communication, attention to the evidence and keeping the well-being of the person with dementia firmly in mind will guide ethical decision-making. Numerous challenges surround the provision of palliative care for people with dementia. Palliative care in dementia has been given definition, but can still be contested. Different professionals provide services in different locations. More research and education are required. No single service can provide palliative care for people with dementia. PMID:26421475

  13. [Personal and dignified death. The role of pastoral care in palliative medicine].

    Science.gov (United States)

    Breit-Keßler, Susanne

    2016-03-01

    Palliative pastoral care is not about "adding days to life, but about "adding life to days". It does not matter whether the dying process is short or long. What matters is to ensure the best possible quality of life until the very end through mindful companionship. Palliative pastoral care is a path towards a personal dying, dying where the person is taken seriously as an individual until the last moment. Palliative care includes medical assistance, careful care, psychosocial support, and counselling that addresses the spiritual needs of the dying. This palliative care includes inpatient and outpatient hospice work and accompanies not only the patients but also their relatives. It must become the standard procedure in end of life care. The palliative pastoral care also take the needs of medical staff into account: Time-consuming care for the dying exceeds the staff's time budget. A sudden death can be perceived as traumatic. In this case palliative pastoral care must perform the tasks of crisis management, crisis intervention and de-escalation. The debriefing of involved staff can prevent the development of burn-out syndrome. In the view of holistic healthcare, health insurance funds should co-finance pastoral care. Society and humanity benefit from addressing the needs of the dying. In an economically dominated environment it is a social responsibility to make dying humane. PMID:26983110

  14. [The present and future of community/home-based palliative care in Taiwan].

    Science.gov (United States)

    Ueng, Ruey-Shiuan; Hsu, Su-Hsuan; Shih, Chih-Yuan; Huang, Sheng-Jean

    2015-04-01

    In Taiwan, the Department of Health (DOH) has implemented regulations and policies related to hospice and palliative care since 1995. Taiwan is the first country in Asia to have a Natural Death Act, promulgated in 2000. Although recognition of the need for palliative care in non-cancer terminally ill patients is increasing, at present, the needs of these patients are often not met. Moreover, while a majority of the population prefers to die at home, the percentage of patients who die in the home setting remains small. The palliative care system should be adjusted to improve the accessibility and continuity of care based on the needs of patients. Therefore, the Jin-Shan Branch of the National Taiwan University Hospital has run a pilot community palliative care service model since 2012. National Health Insurance reimbursement was introduced in 2014 for community-based palliative care services. Establishing a formal system of community-based palliative care should be encouraged in order to improve the quality of care at the end of life and to allow more patients to receive end-of-life care and die in their own communities. This system will require that skilled nurses provide discharge planning, symptoms control, end-of-life communications, social-resources integration, and social-support networks in order to achieve a high quality of end-of-life care. PMID:25854944

  15. Extending emotion and decision-making beyond the laboratory: The promise of palliative care contexts.

    Science.gov (United States)

    Ferrer, Rebecca A; Padgett, Lynne; Ellis, Erin M

    2016-08-01

    Although laboratory-based research on emotion and decision-making holds the distinct advantage of rigorous experimental control conditions that allow causal inferences, the question of how findings in a laboratory generalize to real-world settings remains. Identifying ecologically valid, real-world opportunities to extend laboratory findings is a valuable means of advancing this field. Palliative care-or care intended to provide relief from serious illness and aging-related complications during treatment or at the end of life-provides a particularly rich opportunity for such work. Here, we present an overview of palliative care, summarize existing research on emotion and palliative care decision-making, highlight challenges associated with conducting such research, outline examples of collaborative projects leveraging palliative care as a context for generating fundamental knowledge about emotion and decision-making, and describe the resources and collaborations necessary to conduct this type of research. In sum, palliative care holds unique promise as an emotionally laden context in which to answer fundamental questions about emotion and decision-making that extends our theoretical understanding of the role of emotion in high-stakes decision-making while simultaneously generating knowledge that can improve palliative care implementation. (PsycINFO Database Record PMID:27018611

  16. A day in the life: a case series of acute care palliative medicine--the Cleveland model.

    Science.gov (United States)

    Lagman, Ruth; Walsh, Declan; Heintz, Jessica; Legrand, Susan B; Davis, Mellar P

    2008-01-01

    Palliative care in advanced disease is complex. Knowledge and experience of symptom control and management of multiple complications are essential. An interdisciplinary team is also required to meet the medical and psychosocial needs in life-limiting illness. Acute care palliative medicine is a new concept in the spectrum of palliative care services. Acute care palliative medicine, integrated into a tertiary academic medical center, provides expert medical management and specialized care as part of the spectrum of acute medical care services to this challenging patient population. The authors describe a case series to provide a snapshot of a typical day in an acute care inpatient palliative medicine unit. The cases illustrate the sophisticated medical care involved for each individual and the important skill sets of the palliative medicine specialist required to provide high-quality acute medical care for the very ill.

  17. Integration of Early Specialist Palliative Care in Cancer Care and Patient Related Outcomes: A Critical Review of Evidence

    Science.gov (United States)

    Salins, Naveen; Ramanjulu, Raghavendra; Patra, Lipika; Deodhar, Jayita; Muckaden, Mary Ann

    2016-01-01

    Introduction: World Health Organization and American Society of Clinical Oncology recommend early integration of specialist palliative care in patients with cancer. This paper focuses on critical review of evidence on integration of early specialist palliative care in cancer care and patient-related outcomes. Methods: The question for the literature search was – Does integration of early specialist palliative care in cancer care influences patient-related outcomes? 31 articles related to literature search review question were included in this paper. Results: Ten patient-related outcomes of early specialist palliative care in adult cancer care was studied. Studies by Temel et al. (2012), Bakitas et al. (2009), Zimmermann et al. (2014), Rugno et al. (2014), Lowery et al. (2013) and Walker et al. (2014) showed early specialist palliative care improves health-related quality of life (HRQOL). Studies by Pirl et al. (2012), Lowery et al. (2013), and Walker et al. (2014) showed early specialist palliative care improved mood depression and anxiety. Studies by Zimmermann et al. and Rugno et al. (2014) showed symptom control benefit of early specialist palliative care. Studies by Temel (2010), Bakitas (2015) and Rugno et al. (2014) showed survival improvement with early specialist palliative care. All these studies were carried in ambulatory palliative care setting. No survival benefit of palliative care intervention was seen in inpatient palliative care setting. The studies by Geer et al. (2012), Rugno et al. (2014), and Lowery et al. (2013) showed that early palliative care intervention positively influences treatment decision making. All the studies showed that palliative care intervention group received less intravenous chemotherapy in last few weeks of life. Studies by Yoong et al. and Temel et al. (2011) shows early specialist palliative care improves advanced care planning. Studies by Temel et al. (2010), Greer et al. (2012), McNamara et al. (2013), Hui et al. (2014

  18. [Key ethic discussions in hospice/palliative care].

    Science.gov (United States)

    Jusić, Anica

    2008-12-01

    The goal of palliative care is to provide the best possible quality of life for patients and their families in the process of dying as well as before, during the course of illness. Emphasis is on the role of team approach in every aspect of patient care. The moral principles of sacredness of life and the right of personal autonomy may occasionally come in conflict. The basic principle of the respect of life prohibits killing, which has been accepted in one way or another by all societies - for the reasons of survival. Similar to this, modern morality supports the principle of respecting autonomy and self-management based on informed, conscious personality of an individual. Still, if the needs of another person appear to be more important or desirable than reaching certain individual goals, then the right of an individual regarding autonomy may be legitimately limited. Decisions on not applying or terminating certain procedures must be based on thorough discussion and consideration of the nature and expected result of treatment. If the patient is not competent, then the discussion should involve a team providing care for the patient and a representative of the patient. When the physician and the team can clearly see that unfavorable effects of treatment will outweigh therapeutic benefits, then, according to medical ethics of the respecting beneficiary, the team is not obliged to provide that form of treatment. Except for palliative care, there is no medical treatment that is always obligatory. A physician that does not accept the patient's request to be killed does not limit the patient's autonomy. Autonomy is self-management and capability of the patient to kill him/herself is not limited by the physician's refusal to do so. Even in those cases when patients for various reasons say that death will be a relief, it does not mean that the physician is obliged to terminate life. The superior obligation of physicians is to alleviate pain. If euthanasia would be legal

  19. Overcoming the Obstacles in Promoting Hospice Palliative Care--Sharing Experiences of the Taiwan Changhua Christian Hospital.

    Science.gov (United States)

    Tsai, Pei-Yu

    2015-01-01

    Hospice palliative care for terminal patients is necessary, yet challenges are on the way worldwide. This study demonstrated that hospice palliative care has been quickly developed in Taiwan due to the support of the National Health Insurance system, the promotion by civil societies and religious groups, patient's legal right for DNR, easier access to pain killers through medical prescription, and well-planned hospice staff training programs. This paper introduces how hospice consultation is provided by a comprehensive hospice palliative team at Changhua Christian Hospital to establish trust and cooperation with the medical team, and to improve hospice-palliative care referral and utilization rates.

  20. Barriers and facilitators to palliative care of patients with chronic heart failure in Germany: a study protocol

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    Stefan Köberich

    2015-07-01

    Full Text Available Background. Despite its high prevalence, similar symptoms and symptom burden, people suffering from chronic heart failure receive less palliative care than patients with malignant diseases. Internationally, numerous barriers to palliative care of patients with chronic heart failure are known, however, there are no credible data regarding barriers and facilitators to palliative care of people suffering from chronic heart failure available for Germany. Design and Methods. Tripartite study. First part of this study evaluates health care providers’ (physicians and nurses perceived barriers and facilitators to palliative care of patients with chronic heart failure using a qualitative approach. At least 18 persons will be interviewed. In the second part, based on the results of part one, a questionnaire about barriers and facilitators to palliative care of patients with chronic heart failure will be designed and applied to at least 150 physicians and nurses. In the last part a classic Delphi method will be used to develop specific measures to improve the palliative care for chronic heart failure patients. Expected Impact for Public Health. The results of this study will help to understand why patients with heart failure are seldom referred to palliative care and will provide solutions to overcome these barriers. Developed solutions will be the first step to improve palliative care in patients with heart failure in Germany. In addition, the results will help health care providers in other countries to take action to improve palliative care situations for heart failure patients.

  1. Integration of early specialist palliative care in cancer care and patient related outcomes: A critical review of evidence

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    Naveen Salins

    2016-01-01

    Conclusions: In adult oncology, there is evidence to suggest early specialist palliative care improves HRQOL, mood, treatment decision-making, health care utilization, advanced care planning, patient satisfaction, and end-of-life care. There is moderate evidence to support the role of early specialist palliative care intervention in improvement of symptoms, survival, and health-related communication. There is limited evidence at present to support role of early specialist palliative care interventions in pediatric and geriatric oncology. Qualitative studies on barriers and negative patient outcomes may provide useful insights toward restructuring early specialist palliative care interventions.

  2. Impact of comorbidity on survival after palliative radiotherapy

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    Nieder, Carsten [Nordland Hospital, Department of Oncology and Palliative Medicine, Bodoe (Norway); University of Tromsoe, Institute of Clinical Medicine, Faculty of Health Sciences, Tromsoe (Norway); Engljaehringer, Kirsten [Nordland Hospital, Department of Oncology and Palliative Medicine, Bodoe (Norway); Angelo, Kent [University of Tromsoe, Institute of Clinical Medicine, Faculty of Health Sciences, Tromsoe (Norway)

    2014-12-15

    To evaluate prognostic factors for survival after palliative radiotherapy (PRT) with consideration of different comorbidities and the Charlson comorbidity index (CCI). Between 2007 and 2012, 525 consecutive patients were treated with PRT and included in this retrospective study. Most patients received PRT for bone metastases, for brain metastases, or in order to improve thoracic symptoms from lung cancer. Median age was 69 years. Uni- and multivariate analyses were performed. We recommend assessment of comorbidity when prescribing PRT and selecting the optimal fractionation regimen, because most patients with severe comorbidities had limited survival. One of the possible explanations could be that only a minority of these patients are fit for systemic therapy, which plays an important role in the overall treatment concept. (orig.) [German] Auswertung der prognostischen Faktoren nach palliativer Strahlentherapie (PST) unter besonderer Beruecksichtigung von Begleiterkrankungen und des Charlson Komorbiditaetsindex (CCI). Zwischen 2007 und 2012 wurden 525 konsekutive Patienten mit PST behandelt und in diese retrospektive Studie eingeschlossen. Die haeufigsten PST Indikationen waren Skelett- und Hirnmetastasen bzw. symptomatische Lungentumoren. Das mediane Alter betrug 69 Jahre. Die Ueberlebensdaten wurden in uni- und multivariaten Modellen analysiert. Nur 7 % der Patienten hatten keinerlei Begleiterkrankungen. Bei 49 % lag ein CCI von 1-2 vor, bei 36 % von 3-4 und bei 9 % von mehr als 4. Juengere Patienten, Frauen und Nichtraucher hatten signifikant weniger Begleiterkrankungen. Patienten ohne Begleiterkrankungen waren in signifikant besserem Allgemeinzustand (AZ) und erhielten oefter eine zusaetzliche palliative systemische Therapie. Sowohl Patienten mit niedrigem CCI als auch solche mit nur einer Krebserkrankung in der Anamnese ueberlebten signifikant laenger. In der multivariaten Analyse waren auch noch der AZ und die Anzahl der mit Metastasen befallenen Organe mit

  3. Measuring the diffusion of palliative care in long-term care facilities – a death census

    Directory of Open Access Journals (Sweden)

    Santos-Eggimann Brigitte

    2009-01-01

    Full Text Available Abstract Background The dissemination of palliative care for patients presenting complex chronic diseases at various stages has become an important matter of public health. A death census in Swiss long-term care facilities (LTC was set up with the aim of monitoring the frequency of selected indicators of palliative care. Methods The survey covered 150 LTC facilities (105 nursing homes and 45 home health services, each of which was asked to complete a questionnaire for every non-accidental death over a period of six months. The frequency of 4 selected indicators of palliative care (resort to a specialized palliative care service, the administration of opiates, use of any pain measurement scale or other symptom measurement scale was monitored in respect of the stages of care and analysed based on gender, age, medical condition and place of residence. Results Overall, 1200 deaths were reported, 29.1% of which were related to cancer. The frequencies of each indicator varied according to the type of LTC, mostly regarding the administration of opiate. It appeared that the access to palliative care remained associated with cancer, terminal care and partly with age, whereas gender and the presence of mental disorders had no effect on the indicators. In addition, the use of drugs was much more frequent than the other indicators. Conclusion The profile of patients with access to palliative care must become more diversified. Among other recommendations, equal access to opiates in nursing homes and in home health services, palliative care at an earlier stage and the systematic use of symptom management scales when resorting to opiates have to become of prime concern.

  4. Quality of life in patients with esophageal stenting for the palliation of malignant dysphagia

    Institute of Scientific and Technical Information of China (English)

    Giorgio Diamantis; Marco Scarpa; Paolo Bocus; Stefano Realdon; Carlo Castoro; Ermanno Ancona; Giorgio Battaglia

    2011-01-01

    Incidence of esophageal cancer (EC) is rising more rapidly in the Western world than that of any other cancer.Despite advances in therapy, more than 50% of patients have incurable disease at the time of presentation. This precludes curative treatment and makes palliative treatment a more realistic option for most of these patients.Dysphagia is the predominant symptom in more than 70% of patients with EC and although several management options have been developed in recent years to palliate this symptom, the optimum management is not established. Self-expanding metal stents (SEMS) are a well-established palliation modality for dysphagia in such patients. Health-related quality of life (HRQoL) is becoming a major issue in the evaluation of any therapeutic or palliative intervention. To date, only a few published studies can be found on Medline examining HRQoL in patients with advanced EC treated with SEMS implantation.The aim of this study was to review the impact on HRQoL of SEMS implantation as palliative treatment in patients with EC. All Medline articles regarding HRQoL in patients with advanced EC, particularly those related to SEMS, were reviewed. In most studies, relief of dysphagia was the only aspect of HRQoL being measured and SEMS implantation was compared with other palliative treatments such as brachytherapy and laser therapy.SEMS insertion provides a swift palliation of dysphagia compared to brachytherapy and no evidence was found to suggest that stent implantation is different to laser treatment in terms of improving dysphagia, recurrent dysphagia and better HRQoL, although SEMS insertion has a better technical success rate and also reduces the number of repeat interventions.

  5. Palliative radiotherapy in patients with a symptomatic pelvic mass of metastatic colorectal cancer

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    Chun Ho Kyung

    2011-05-01

    Full Text Available Abstract Background To evaluate the palliative role of radiotherapy (RT and define the effectiveness of chemotherapy combined with palliative RT (CCRT in patients with a symptomatic pelvic mass of metastatic colorectal cancer. Methods From August 1995 to December 2007, 80 patients with a symptomatic pelvic mass of metastatic colorectal cancer were treated with palliative RT at Samsung Medical Center. Initial presenting symptoms were pain (68 cases, bleeding (18 cases, and obstruction (nine cases. The pelvic mass originated from rectal cancer in 58 patients (73% and from colon cancer in 22 patients (27%. Initially 72 patients (90% were treated with surgery, including 64 complete local excisions; 77% in colon cancer and 81% in rectal cancer. The total RT dose ranged 8-60 Gy (median: 36 Gy with 1.8-8 Gy per fraction. When the α/β for the tumor was assumed to be 10 Gy for the biologically equivalent dose (BED, the median RT dose was 46.8 Gy10 (14.4-78. Twenty one patients (26% were treated with CCRT. Symptom palliation was assessed one month after the completion of RT. Results Symptom palliation was achieved in 80% of the cases. During the median follow-up period of five months (1-44 months, 45% of the cases experienced reappearance of symptoms; the median symptom control duration was five months. Median survival after RT was six months. On univariate analysis, the only significant prognostic factor for symptom control duration was BED ≥40 Gy10 (p Conclusions RT was an effective palliation method in patients with a symptomatic pelvic mass of metastatic colorectal cancer. For improvement of symptom control rate and duration, a BED ≥ 40 Gy10 is recommended when possible. Considering the low morbidity and improved symptom palliation, CCRT might be considered in patients with good performance status.

  6. Developing leadership in rural interprofessional palliative care teams.

    Science.gov (United States)

    Hall, Pippa; Weaver, Lynda; Handfield-Jones, Richard; Bouvette, Maryse

    2008-01-01

    This project brought together community-based practitioners and academics to develop and deliver interventions designed to enhance the leadership abilities of the designated leaders of seven rural/small town-based palliative care teams. Members of these community-based teams have already gained recognition for their teams' leadership and service delivery in their communities. All of the teams had worked closely with most members of the academic team prior to this project. The team members participated in a needs assessment exercise developed by the Sisters of Charity of Ottawa Health Service and University of Ottawa academic team. Results of the needs assessment identified leadership qualities that had contributed to their success, as well as their needs to further enhance their individual leadership qualities. The team effort, however, was the most important factor contributing to the success of their work. The interventions developed to address the identified needs had to be adapted creatively through the collaborative efforts of both the community and academic teams. The educational interventions facilitated the integration of learning at the individual and community level into the busy work schedules of primary health care providers.

  7. Developing leadership in rural interprofessional palliative care teams.

    Science.gov (United States)

    Hall, Pippa; Weaver, Lynda; Handfield-Jones, Richard; Bouvette, Maryse

    2008-01-01

    This project brought together community-based practitioners and academics to develop and deliver interventions designed to enhance the leadership abilities of the designated leaders of seven rural/small town-based palliative care teams. Members of these community-based teams have already gained recognition for their teams' leadership and service delivery in their communities. All of the teams had worked closely with most members of the academic team prior to this project. The team members participated in a needs assessment exercise developed by the Sisters of Charity of Ottawa Health Service and University of Ottawa academic team. Results of the needs assessment identified leadership qualities that had contributed to their success, as well as their needs to further enhance their individual leadership qualities. The team effort, however, was the most important factor contributing to the success of their work. The interventions developed to address the identified needs had to be adapted creatively through the collaborative efforts of both the community and academic teams. The educational interventions facilitated the integration of learning at the individual and community level into the busy work schedules of primary health care providers. PMID:19005956

  8. Uncertainty quantification in virtual surgery predictions for single ventricle palliation

    Science.gov (United States)

    Schiavazzi, Daniele; Marsden, Alison

    2014-11-01

    Hemodynamic results from numerical simulations of physiology in patients are invariably presented as deterministic quantities without assessment of associated confidence. Recent advances in cardiovascular simulation and Uncertainty Analysis can be leveraged to challenge this paradigm and to quantify the variability of output quantities of interest, of paramount importance to complement clinical decision making. Physiological variability and errors are responsible for the uncertainty typically associated with measurements in the clinic; starting from a characterization of these quantities in probability, we present applications in the context of estimating the distributions of lumped parameters in 0D models of single-ventricle circulation. We also present results in virtual Fontan palliation surgery, where the variability of both local and systemic hemodynamic indicators is inferred from the uncertainty in pre-operative clinical measurements. Efficient numerical algorithms are required to mitigate the computational cost of propagating the uncertainty through multiscale coupled 0D-3D models of pulsatile flow at the cavopulmonary connection. This work constitutes a first step towards systematic application of robust numerical simulations to virtual surgery predictions.

  9. End-of-life palliative chemotherapy: Where do we stand?

    International Nuclear Information System (INIS)

    Background: This study evaluates the use of palliative chemotherapy (PCT) and possible associated factors at the end of life. Method: The study includes all advanced non hematological cancer patients who died in the King Abdullah Medical City during the period from January 2011 to April 2014. Demographic and disease features were registered. Results: 420 patients were included in the study, median age 62 years (range 17-108); 52% female and 48% male. 87.4% of patients were Saudis and 12.6% non Saudis. 124 (29.5%) patients received PCT at the last month before death (LM-PCT): 21.8%, 22.6% and 55.6% within one, two and four weeks of death, respectively. Place of death (critical care vs. regular ward) and mode of admission (ER vs. OPD vs. Transferred) had a strong association with LM-PCT (p< 0.0001, / = 0.35) and (p< 0.0001, V = 0.43), respectively. There was a gradual increase in the number of patients receiving LM-PCT from January 2011 to April 2014; 15.3%, 28.2%, 37.1% and 19.4%, respectively. Conclusion: In our center; at the end of life, there is a gradual increase in the number of patients receiving chemotherapy which significantly increased cancer patients’ odds without clear predictive factors associated with its use, which calls into question the benefits of PCT in terminally ill cancer patients.

  10. An evaluation of aromatherapy massage in palliative care.

    Science.gov (United States)

    Wilkinson, S; Aldridge, J; Salmon, I; Cain, E; Wilson, B

    1999-09-01

    The use of complementary therapies, such as massage and aromatherapy massage, is rising in popularity among patients and healthcare professionals. They are increasingly being used to improve the quality of life of patients, but there is little evidence of their efficacy. This study assessed the effects of massage and aromatherapy massage on cancer patients in a palliative care setting. We studied 103 patients, who were randomly allocated to receive massage using a carrier oil (massage) or massage using a carrier oil plus the Roman chamomile essential oil (aromatherapy massage). Outcome measurements included the Rotterdam Symptom Checklist (RSCL), the State-Trait Anxiety Inventory (STAI) and a semi-structured questionnaire, administered 2 weeks postmassage, to explore patients' perceptions of massage. There was a statistically significant reduction in anxiety after each massage on the STAI (P essential oils appears to reduce levels of anxiety. The addition of an essential oil seems to enhance the effect of massage and to improve physical and psychological symptoms, as well as overall quality of life. PMID:10659113

  11. Structuring a palliative care service in Brazil: experience report

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    João Batista Santos Garcia

    2014-07-01

    Full Text Available BACKGROUND AND OBJECTIVES: in Brazil, palliative care (PC is not properly structured and that reality transforms this theme in a public health problem; therefore, initiatives become relevant in this context. This paper aims to share the experience that occurred in an oncology referral hospital in the State of Maranhão and present initiatives that helped in the development of PC Service. EXPERIENCE REPORT: the hospital had an outpatient Pain and PC Service, but without specialized beds. The terminally ill patients stayed in common wards, which caused much unrest. A sensitization process was initiated in the hospital through initiatives, such as a photo contest called Flashes of Life and a ward called Room of Dreams, designed in partnership with the architecture course at the Universidade Estadual do Maranhão. The process culminated in the granting of wards to the PC and in the commitment of the Foundation, sponsor of the hospital, to run the project. CONCLUSION: this experience was a reproducible local initiative for the establishment of PC in a cancer hospital. Local initiatives are valuable in Brazil because they favor a significant number of patients and show its effectiveness in practice to governments and society. To structure a PC service, it is essential to establish priorities that include the assignment of drugs for management of symptoms, humanization, multidisciplinarity, sensitization and education of professionals.

  12. The Role of Play in Children’s Palliative Care

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    Sue Boucher

    2014-10-01

    Full Text Available Play is the universal language of childhood and the time and opportunity to play is every child’s right. The role of play as a vehicle for communication, a tool for distraction and its value in the holistic development of a normal child is without dispute. The role and value of play increase proportionately when a child is made more vulnerable through illness or disability. Despite this, providing time and opportunities to play can be overlooked or considered to be of little importance or relevance when the focus of the adult carers is the amelioration of clinical symptoms of the illness and on lessening the psychological impact the illness may have on the child. This paper outlines the role and the value of play as an integral component in the provision of palliative care for children with chronic, life-threatening and life-limiting conditions. It will show how providing appropriate equipment, sufficient time and relevant play opportunities not only improves the very sick child’s psychological wellbeing, but also allows the child to cast aside the confines and restrictions imposed upon them by their illness and for a few golden moments to be nothing more than a child at play.

  13. The Role of Play in Children's Palliative Care.

    Science.gov (United States)

    Boucher, Sue; Downing, Julia; Shemilt, Rise

    2014-10-01

    Play is the universal language of childhood and the time and opportunity to play is every child's right. The role of play as a vehicle for communication, a tool for distraction and its value in the holistic development of a normal child is without dispute. The role and value of play increase proportionately when a child is made more vulnerable through illness or disability. Despite this, providing time and opportunities to play can be overlooked or considered to be of little importance or relevance when the focus of the adult carers is the amelioration of clinical symptoms of the illness and on lessening the psychological impact the illness may have on the child. This paper outlines the role and the value of play as an integral component in the provision of palliative care for children with chronic, life-threatening and life-limiting conditions. It will show how providing appropriate equipment, sufficient time and relevant play opportunities not only improves the very sick child's psychological wellbeing, but also allows the child to cast aside the confines and restrictions imposed upon them by their illness and for a few golden moments to be nothing more than a child at play.

  14. Applying sociodramatic methods in teaching transition to palliative care.

    Science.gov (United States)

    Baile, Walter F; Walters, Rebecca

    2013-03-01

    We introduce the technique of sociodrama, describe its key components, and illustrate how this simulation method was applied in a workshop format to address the challenge of discussing transition to palliative care. We describe how warm-up exercises prepared 15 learners who provide direct clinical care to patients with cancer for a dramatic portrayal of this dilemma. We then show how small-group brainstorming led to the creation of a challenging scenario wherein highly optimistic family members of a 20-year-old young man with terminal acute lymphocytic leukemia responded to information about the lack of further anticancer treatment with anger and blame toward the staff. We illustrate how the facilitators, using sociodramatic techniques of doubling and role reversal, helped learners to understand and articulate the hidden feelings of fear and loss behind the family's emotional reactions. By modeling effective communication skills, the facilitators demonstrated how key communication skills, such as empathic responses to anger and blame and using "wish" statements, could transform the conversation from one of conflict to one of problem solving with the family. We also describe how we set up practice dyads to give the learners an opportunity to try out new skills with each other. An evaluation of the workshop and similar workshops we conducted is presented. PMID:22889858

  15. The Role of Play in Children’s Palliative Care

    Science.gov (United States)

    Boucher, Sue; Downing, Julia; Shemilt, Rise

    2014-01-01

    Play is the universal language of childhood and the time and opportunity to play is every child’s right. The role of play as a vehicle for communication, a tool for distraction and its value in the holistic development of a normal child is without dispute. The role and value of play increases proportionately when a child is made more vulnerable through illness or disability. Despite this, providing time and opportunities to play can be overlooked or considered to be of little importance or relevance when the focus of the adult carers is the amelioration of clinical symptoms of the illness and on lessening the psychological impact the illness may have on the child. This paper outlines the role and the value of play as an integral component in the provision of palliative care for children with chronic, life-threatening and life-limiting conditions. It will show how providing appropriate equipment, sufficient time and relevant play opportunities not only improves the very sick child’s psychological wellbeing, but also allows the child to cast aside the confines and restrictions imposed upon them by their illness and for a few golden moments to be nothing more than a child at play.

  16. [Palliative Care for Rectal Cancer Complicated with Gastric Cancer].

    Science.gov (United States)

    Furukawa, Takeshi; Takahashi, Hitoshi; Tanaka, Kei; Muto, Takaaki

    2015-11-01

    Medical advancements have led to an increase in the number of elderly people. However, standard treatments may sometimes be difficult to use in elderly people. Here, we report the case of an elderly patient with rectal and gastric cancer who refused radical surgery. The patient was an 83-year-old man who had type-2 diabetes, hypertension, hyperuricemia, mitral valve regurgitation, and mild dementia. Furthermore, he was blind in both eyes owing to glaucoma. He first visited our hospital in 2005. In 2010, he was diagnosed with anemia, but he refused a thorough examination; however, he did consent to take iron supplements. In July 2011, he consulted our hospital for symptoms of frequent diarrhea, and agreed to an examination. After colonoscopy, he was diagnosed with rectal cancer that was becoming obstructive. There were no metastases to other organs, but he was also diagnosed with gastric cancer. As he and his family refused radical surgery, a stoma was constructed. After the operation, he received palliative care but died in September 2013. PMID:26805335

  17. African-Americans and Alzheimer's

    Science.gov (United States)

    ... Share Plus on Google Plus African-Americans and Alzheimer's alz.org | IHaveAlz Introduction 10 Warning Signs Brain ... African-Americans are at a higher risk for Alzheimer's disease. Many Americans dismiss the warning signs of ...

  18. African Cultural Astronomy

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    Holbrook, Jarita C; Medupe, R. Thebe; Current Archaeoastronomy and Ethnoastronomy research in Africa

    2008-01-01

    Astronomy is the science of studying the sky using telescopes and light collectors such as photographic plates or CCD detectors. However, people have always studied the sky and continue to study the sky without the aid of instruments this is the realm of cultural astronomy. This is the first scholarly collection of articles focused on the cultural astronomy of Africans. It weaves together astronomy, anthropology, and Africa. The volume includes African myths and legends about the sky, alignments to celestial bodies found at archaeological sites and at places of worship, rock art with celestial imagery, and scientific thinking revealed in local astronomy traditions including ethnomathematics and the creation of calendars. Authors include astronomers Kim Malville, Johnson Urama, and Thebe Medupe; archaeologist Felix Chami, and geographer Michael Bonine, and many new authors. As an emerging subfield of cultural astronomy, African cultural astronomy researchers are focused on training students specifically for do...

  19. African names for American plants

    NARCIS (Netherlands)

    Andel, van T.R.

    2015-01-01

    African slaves brought plant knowledge to the New World, sometimes applying it to related plants they found there and sometimes bringing Old World plants with them. By tracing the linguistic parallels between names for plants in African languages and in communities descended from African slaves, pie

  20. The Struggles over African Languages

    Science.gov (United States)

    Maseko, Pam; Vale, Peter

    2016-01-01

    In this interview, African Language expert Pam Maseko speaks of her own background and her first encounter with culture outside of her mother tongue, isiXhosa. A statistical breakdown of South African languages is provided as background. She discusses Western (originally missionary) codification of African languages and suggests that this approach…

  1. Palliative sedation in advanced cancer patients: Does it shorten survival time? - A systematic review

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    B Barathi

    2013-01-01

    Full Text Available Background: Patients with advanced cancer often suffer from multiple refractory symptoms in the terminal phase of their life. Palliative sedation is one of the few ways to relieve this refractory suffering. Objectives: This systematic review investigated the effect of palliative sedation on survival time in terminally ill cancer patients. Materials and Methods: Six electronic databases were searched for both prospective and retrospective studies which evaluated the effect of palliative sedation on survival time. Only those studies which had a comparison group that did not receive palliative sedation were selected for the review. Abstracts of all retrieved studies were screened to include the most relevant studies and only studies which met inclusion criteria were selected. References of all retrieved studies were also screened for relevant studies. Selected studies were assessed for quality and data extraction was done using the structured data extraction form. Results: Eleven studies including four prospective and seven retrospective studies were identified. Mean survival time (MST was measured as the time from last admission until death. A careful analysis of the results of all the 11 studies indicated that MST of sedated and non-sedated group was not statistically different in any of the studies. Conclusion: This systematic review supports the fact that palliative sedation does not shorten survival in terminally ill cancer patients. However, this conclusion needs to be taken with consideration of the methodology, study design, and the population studied of the included studies in this review.

  2. Development of a set of process and structure indicators for palliative care: the Europall project

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    Woitha Kathrin

    2012-11-01

    Full Text Available Abstract Background By measuring the quality of the organisation of palliative care with process and structure quality indicators (QIs, patients, caregivers and policy makers are able to monitor to what extent recommendations are met, like those of the council of the WHO on palliative care and guidelines. This will support the implementation of public programmes, and will enable comparisons between organisations or countries. Methods As no European set of indicators for the organisation of palliative care existed, such a set of QIs was developed. An update of a previous systematic review was made and extended with more databases and grey literature. In two project meetings with practitioners and experts in palliative care the development process of a QI set was finalised and the QIs were categorized in a framework, covering the recommendations of the Council of Europe. Results The searches resulted in 151 structure and process indicators, which were discussed in steering group meetings. Of those QIs, 110 were eligible for the final framework. Conclusions We developed the first set of QIs for the organisation of palliative care. This article is the first step in a multi step project to identify, validate and pilot QIs.

  3. Improving medical graduates' training in palliative care: advancing education and practice

    Directory of Open Access Journals (Sweden)

    Head BA

    2016-02-01

    Full Text Available Barbara A Head,1 Tara J Schapmire,1 Lori Earnshaw,1 John Chenault,2 Mark Pfeifer,1 Susan Sawning,3 Monica A Shaw,3 1Division of General Internal Medicine, Palliative Care and Medical Education, University of Louisville School of Medicine, 2Kornhouser Health Sciences Library, University of Louisville, 3Undergraduate Medical Education Office, University of Louisville School of Medicine, Louisville, KY, USA Abstract: The needs of an aging population and advancements in the treatment of both chronic and life-threatening diseases have resulted in increased demand for quality palliative care. The doctors of the future will need to be well prepared to provide expert symptom management and address the holistic needs (physical, psychosocial, and spiritual of patients dealing with serious illness and the end of life. Such preparation begins with general medical education. It has been recommended that teaching and clinical experiences in palliative care be integrated throughout the medical school curriculum, yet such education has not become the norm in medical schools across the world. This article explores the current status of undergraduate medical education in palliative care as published in the English literature and makes recommendations for educational improvements which will prepare doctors to address the needs of seriously ill and dying patients. Keywords: medical education, palliative care, end-of-life care

  4. Palliative care for all? A review of the evidence in community hospitals.

    Science.gov (United States)

    Steers, Julie; Brereton, Louise; Ingleton, Christine

    2007-08-01

    The provision of palliative care in the UK has traditionally focused on people with cancer. People who are elderly, live in rural areas or have diagnoses other than cancer often have difficulty accessing palliative care services. Community hospitals could be important for those groups currently under-served. A literature review was conducted to determine the role played by community hospitals in the provision of palliative care in the U.K. Papers were identified using a keyword search of six electronic databases and hand search of five journals. Fifteen papers were identified according to inclusion and exclusion criteria. Findings indicate that many community hospitals in the UK already have the resources to counter inequalities in access to general palliative care. Much of the evidence uses quantitative methods based on small or non-representative samples and retrospective data collection approaches. Insufficient information about the populations involved meant that findings could not be fully interpreted. More prospective research using qualitative methods involving patients, carers and nurses is required to fully understand the complexities of providing palliative care in this setting. PMID:18018819

  5. Family Caregivers’ Social Representations of Death in a Palliative Care Context

    Directory of Open Access Journals (Sweden)

    Sabrina Lessard

    2016-03-01

    Full Text Available The objective of this study was to consider the social representations of death of family caregivers in a palliative care context. The authors focused on the analysis of 23 interviews with family caregivers who cared for a terminally ill person at home and/or in a specialized palliative care unit, in Québec, Canada. The finding showed that family caregivers had different images that specifically represented death: (a losses as different kinds of “deaths,” (b palliative care as a place to negotiate with death, and (c last times as confirmation of the end. These images highlight the meaning attributed to the body and the position of the dying person in our Western society. Representations of palliative care reveal a kind of paradox, a place of respect and of “gentle death,” and a place where death is almost too omnipresent. They also show the strong beliefs surrounding the use of painkillers at the end of life. Finally, these images refer to end-of-life personal rituals viewed as support for the passage into a new state of being. This study provides a better understanding of the common sense of death for family caregivers in a palliative care context and of the meanings of this emotional subject.

  6. Palliative and end of life care for people living with dementia in care homes: part 1.

    Science.gov (United States)

    Mitchell, Gary; Agnelli, Joanne; McGreevy, Jessie; Diamond, Monica; Roble, Herlindina; McShane, Elaine; Strain, Joanne

    2016-06-22

    The terms palliative and end of life care are often used interchangeably and healthcare practitioners may perceive that palliative care is only appropriate during the terminal stages of an illness. This article, the first of two parts, provides healthcare practitioners with an overview of the concept of palliative care. It explains how this can be differentiated from end of life care and how it should be commenced in a timely manner, so that people who are living with dementia can contribute to the planning of their future care and death. The policies and tools used in the provision of palliative and end of life care are discussed, including advance care planning and The Gold Standards Framework. The article is framed in a care home context; there is little research about how to optimise palliative care for people living with dementia in care homes. The second part of this article will discuss end of life care and the best practices for providing end of life care, including nutrition and hydration, oral hygiene, pain management and spiritual care. PMID:27332611

  7. Providing Palliative Care in a Swedish Support Home for People Who Are Homeless.

    Science.gov (United States)

    Håkanson, Cecilia; Sandberg, Jonas; Ekstedt, Mirjam; Kenne Sarenmalm, Elisabeth; Christiansen, Mats; Öhlén, Joakim

    2016-07-01

    Despite high frequencies of multiple, life-limiting conditions relating to palliative care needs, people who are homeless are one of the most underserved and rarely encountered groups in palliative care settings. Instead, they often die in care places where palliative competence is not available. In this qualitative single-case study, we explored the conditions and practices of palliative care from the perspective of staff at a Swedish support home for homeless people. Interpretive description guided the research process, and data were generated from repeated reflective conversations with staff in groups, individually, and in pairs. The findings disclose a person-centered approach to palliative care, grounded in the understanding of the person's health/illness and health literacy, and how this is related to and determinant on life as a homeless individual. Four patterns shape this approach: building trustful and family-like relationships, re-dignifying the person, re-considering communication about illness and dying, and re-defining flexible and pragmatic care solutions. PMID:25994318

  8. Strategic planning by the palliative care steering committee of the Middle East Cancer Consortium.

    Science.gov (United States)

    Moore, Shannon Y; Pirrello, Rosene D; Christianson, Sonya K; Ferris, Frank D

    2011-04-01

    High quality comprehensive palliative care is a critical need for millions of patients and families, but remains only a dream in many parts of the world. The failure to do a strategic planning process is one obstacle to advancing education and pain prevention and relief. The Middle Eastern Cancer Consortium Steering Committee attendees completed an initial strategic planning process and identified "developmental steps" to advance palliative care. Underscoring the multi-disciplinary nature of comprehensive palliative care, discipline-specific planning was done (adult and pediatric cancer and medicine, pharmacy, nursing) in a separate process from country-specific planning. Delineating the layers of intersection and differences between disciplines and countries was very powerful. Finding the common strengths and weaknesses in the status quo creates the potential for a more powerful regional response to the palliative care needs. Implementing and refining these preliminary strategic plans will augment and align the efforts to advance palliative care education and pain management in the Middle East. The dream to prevent and relieve suffering for millions of patients with advanced disease will become reality with a powerful strategic planning process well implemented.

  9. The use of bedside ultrasound and community-based paracentesis in a palliative care service

    Directory of Open Access Journals (Sweden)

    Landers A

    2014-06-01

    Full Text Available INTRODUCTION: There is little information, particularly in New Zealand, on the use of ultrasound to enhance clinical decision-making in a specialist palliative care service. Technological advances have resulted in increasingly portable, user-friendly ultrasound machines that can be used in the home setting to offer convenient access to this treatment option. AIM: To evaluate the clinical use of portable ultrasonography in the management of abdominal ascites in a community palliative care service. METHODS: Patients referred to the Nurse Maude Hospice and Palliative Care Service requiring assessment for abdominal ascites over 12 months were scanned using a newly purchased handheld ultrasound machine. The patients had a variety of diagnoses; the most common diagnosis was ovarian cancer. RESULTS: Forty-one ultrasound scans performed for 32 patients to assess for ascites drainage were recorded. Fluid was identified in 19 assessments and drainage undertaken in 17. Over half the scans were completed at home, allowing nine procedures to be performed safely and conveniently, which reduced time spent at the local hospital. There were no major complications. DISCUSSION: Ultrasonography is a tool that has not previously been utilised in palliative care locally, but has significant potential patient benefits. This novel use of technology also highlighted potential cost savings to the patient and health system, which may be beneficial to other palliative care services in New Zealand.

  10. Quality palliative care for cancer and dementia in five European countries: some common challenges

    Science.gov (United States)

    Davies, Nathan; Maio, Laura; van Riet Paap, Jasper; Mariani, Elena; Jaspers, Birgit; Sommerbakk, Ragni; Grammatico, Daniela; Manthorpe, Jill; Ahmedzai, Sam; Vernooij-Dassen, Myrra; Iliffe, Steve

    2013-01-01

    Objectives There is a growing consensus worldwide that palliative care needs to be both more inclusive of conditions other than cancer and to improve. This paper explores some common challenges currently faced by professionals providing palliative care for patients with either cancer or dementia across five countries. Method One focus group (n = 7) and 67 interviews were conducted in 2012 across five countries: England, Germany, Italy, the Netherlands and Norway, with professionals from dementia, cancer and palliative care settings. Results The interviews revealed five common challenges faced across the five countries: communication difficulties (between services; and between professionals, and patients and their families); the variable extent of structural/functional integration of services; the difficulties in funding of palliative care services; problematic processes of care (boundaries, definitions, knowledge, skills and inclusiveness) and, finally, time constraints. Conclusion These are not problems distinct to palliative care, but they may have different origins and explanations compared to other areas of health care. This paper explored deeper themes hidden behind a discourse about barriers and facilitators to improving care. PMID:24131061

  11. Validation of a new instrument for self-assessment of nurses' core competencies in palliative care.

    Science.gov (United States)

    Slåtten, Kari; Hatlevik, Ove; Fagerström, Lisbeth

    2014-01-01

    Competence can be seen as a prerequisite for high quality nursing in clinical settings. Few research studies have focused on nurses' core competencies in clinical palliative care and few measurement tools have been developed to explore these core competencies. The purpose of this study was to test and validate the nurses' core competence in palliative care (NCPC) instrument. A total of 122 clinical nurse specialists who had completed a postbachelor program in palliative care at two university colleges in Norway answered the questionnaire. The initial analysis, with structural equation modelling, was run in Mplus 7. A modified confirmatory factor analysis revealed the following five domains: knowledge in symptom management, systematic use of the Edmonton symptom assessment system, teamwork skills, interpersonal skills, and life closure skills. The actual instrument needs to be tested in a practice setting with a larger sample to confirm its usefulness. The instrument has the potential to be used to refine clinical competence in palliative care and be used for the training and evaluation of palliative care nurses.

  12. Appraisal of cooperation with a palliative care case manager by general practitioners and community nurses: a cross-sectional questionnaire study.

    OpenAIRE

    Plas, A.G.M. van der; Onwuteaka-Philipsen, B.D.; Vissers, K.C.; Deliens, L.; Jansen, W.J.J.; Francke, A.L.

    2016-01-01

    Aims: To investigate how general practitioners and community nurses value the support that they receive from a nurse case manager with expertise in palliative care, whether they think the case manager is helpful in realizing appropriate care and what characteristics of the patient and case management are associated with this view. Background: For sustainable palliative care in an ageing society, basic palliative care is provided by generalists and specialist palliative care is reserved for co...

  13. Dying in Palliative Care Units and in Hospital: A Comparison of the Quality of Life of Terminal Cancer Patients.

    Science.gov (United States)

    Viney, Linda L.; And Others

    1994-01-01

    Compared quality of life of terminal cancer patients (n=182) in two palliative care units with that of those in general hospital. Patients in specialized palliative care units were found to differ from those dying in hospital, showing less indirectly expressed anger but more positive feelings. They also reported more anxiety about death but less…

  14. Efficacy and safety of palliative chemotherapy for patients with advanced breast cancer pretreated with anthracyclines and taxanes: a systematic review

    NARCIS (Netherlands)

    Oostendorp, L.J.M.; Stalmeier, P.F.M.; Donders, A.R.T.; Graaf, W.T.A. van der; Ottevanger, P.B.

    2011-01-01

    No standard monotherapy or combination palliative chemotherapy currently exists for patients with advanced breast cancer pretreated with anthracyclines and taxanes. In this systematic review we assess the current knowledge on the efficacy and safety of palliative single-agent chemotherapy drugs--cap

  15. 76 FR 59145 - Submission for OMB Review; Comment Request; NINR End-of-Life and Palliative Care Science Needs...

    Science.gov (United States)

    2011-09-23

    ...-Life and Palliative Care Science Needs Assessment: Funding Source (Survey of Authors) Summary: Under... Request: NEW. Need and Use of Information Collection: The NINR End-of-Life Science Palliative Care (EOL PC... in the 30-day Federal Register Notice. Proposed Collection: Title: NINR End-of-Life and...

  16. 76 FR 35221 - Proposed Collection; Comment Request; NINR End-of-Life and Palliative Care Science Needs...

    Science.gov (United States)

    2011-06-16

    ...-of-Life and Palliative Care Science Needs Assessment: Funding Source Questionnaire (Survey of Authors...-Life Science Palliative Care (EOL PC) Needs Assessment: Funding Source Questionnaire will obtain... HUMAN SERVICES National Institutes of Health Proposed Collection; Comment Request; NINR End-of-Life...

  17. Integrating palliative care within acute stroke services: developing a programme theory of patient and family needs, preferences and staff perspectives

    Directory of Open Access Journals (Sweden)

    Burton Christopher R

    2012-11-01

    Full Text Available Abstract Background Palliative care should be integrated early into the care trajectories of people with life threatening illness such as stroke. However published guidance focuses primarily on the end of life, and there is a gap in the evidence about how the palliative care needs of acute stroke patients and families should be addressed. Synthesising data across a programme of related studies, this paper presents an explanatory framework for the integration of palliative and acute stroke care. Methods Data from a survey (n=191 of patient-reported palliative care needs and interviews (n=53 exploring experiences with patients and family members were explored in group interviews with 29 staff from 3 United Kingdom stroke services. A realist approach to theory building was used, constructed around the mechanisms that characterise integration, their impacts, and mediating, contextual influences. Results The framework includes two cognitive mechanisms (the legitimacy of palliative care and individual capacity, and behavioural mechanisms (engaging with family; the timing of intervention; working with complexity; and the recognition of dying through which staff integrate palliative and stroke care. A range of clinical (whether patients are being ‘actively treated’, and prognostic uncertainty and service (leadership, specialty status and neurological focus factors appear to influence how palliative care needs are attended to. Conclusions Our framework is the first, empirical explanation of the integration of palliative and acute stroke care. The specification in the framework of factors that mediate integration can inform service development to improve the outcomes and experiences of patients and families.

  18. Effective palliative treatment of epidemic Kaposi's sarcoma of the foot

    International Nuclear Information System (INIS)

    PURPOSE: Limited information is available in the medical literature on Epidemic Kaposi's Sarcoma (EKS) of the foot. A considerable amount of distress is experienced from EKS of the foot because minimal disease can cause severe discomfort, making it difficult to ambulate and even wear shoes. Various fractionation schemes and doses have been proposed to palliate these patients. The limiting factor for higher dose regimens appears to be the acute toxicity of foot discomfort which is experienced towards the end of treatment. Even doses as low as 20.0 Gy at 2.0 Gy/fx have been associated with transient episodes of generalized foot pain followed by desquamation of the skin of the sole in (5(7)) patients treated to the foot at Los Angeles County Hospital (JCO 6:863-867, 1988). In fact, Piedbois et al. (IJROBP 30:1207-1211, 1994) discontinued treatment to the foot if a partial remission was appreciated with split course radiation therapy to 20.0 Gy to lessen the risk of morbidity. These observations prompted us to review the treatment results of radiation therapy for EKS of the foot at our institutions. METHODS: Between 1985 and 1996, 36 patients with EKS of the foot were treated with palliative intent. All of the patients were homosexual or bisexual males with a median age of 35 years (range 24 - 68 years). Most patients were referred for radiation therapy due to foot discomfort and difficulty with ambulation. The majority of patients had prior or concurrent treatment with chemotherapy or immunotherapy. Opportunistic infections were noted in 43% of patients at the time of treatment. From the pool of 36 patients, 40 sites were evaluable at least one month after completion of radiation therapy with a median follow-up time of 7 months. These sites were treated with either electrons (n = 10), orthovoltage photons (n = 3), or megavoltage photons (n 27). The most common regimen entailed a novel fractionation schedule of 3 fractions a week at 3.5 Gy/fx to a total dose of 21.0 Gy

  19. Radiotherapy of the neuroaxis for palliative treatment of leptomeningeal carcinomatosis

    Energy Technology Data Exchange (ETDEWEB)

    Hermann, B.; Hueltenschmidt, B.; Sautter-Bihl, M.L. [Staedtisches Klinikum Karlsruhe (Germany). Klinik fuer Strahlentherapie und Nuklearmedizin

    2001-04-01

    Background: Leptomeningeal carcinomatosis occurs in about 5% of solid tumors and may seriously compromise quality of life. Aim of the present study was to evaluate the feasibility of craniospinal irradiation with and without intrathecal chemotherapy and its efficacy with regard to symptom palliation and survival. Patients and Methods: 16 patients (mean age 46 years; nine breast cancers, five lung cancers, one renal cell cancer, one tumor of unknown primary site) with leptomeningeal carcinomatosis occurring after a median interval from primary tumor diagnosis of 5 months (0-300 months) received craniospinal irradiation between October 1995 and May 2000. The median total dose was 36 Gy (a 1.6-2.0 Gy). Ten patients were additionally treated with intrathecal methotrexate (15 mg per cycle, 2-8 cycles). Results: Median survival was 12 weeks, 8 weeks after radiotherapy alone, 16 weeks after combined modality treatment. 14 patients died from disease. Eleven patients (68%) experienced regression of their neurological symptoms during or soon after completion of radiotherapy. Seven patients regained their ability to walk, six had pain reduction, three regression of bladder and bowel incontinence. In three patients symptom progression and in two patients no change occurred. Side effects were: Myelosuppression (CTC) Grade I: n=2, Grade II: n=4, Grade III: n=4 patients and Grade IV: n=1. Nine patients had dysphagia, seven mucositis, three suffered from nausea. No late toxicity was observed. Conclusion: Craniospinal radiotherapy is feasible and effective for palliative treatment of leptomeningeal carcinomatosis. As far as the small patient number permits any definite conclusions, combined modality treatment seems superior to irradiation alone. (orig.) [German] Hintergrund: Eine Leptomeningeosis carcinomatosa, die bei ca. 5% aller soliden Tumoren auftritt, kann die Lebensqualitaet erheblich beeintraechtigen. Ziel der Studie war es, Machbarkeit und Effektivitaet einer

  20. African Women Writing Resistance

    Institute of Scientific and Technical Information of China (English)

    Jennifer Browdy de Hernandez; Pauline Dongala; Omotayo; Jolaosho; Anne Serafin

    2011-01-01

    AFRICAN Women Writing Resistance is the first transnational anthology to focus on women's strategies of resistance to the challenges they face in Africa today.The anthology brings together personal narratives,testimony,interviews,short stories,poetry,performance scripts,folktales and lyrics.

  1. African Women Writing Resistance

    Institute of Scientific and Technical Information of China (English)

    Jennifer; Browdy; de; Hernandez; Pauline; Dongala; Omotayo; Jolaosho; Anne; Serafin

    2011-01-01

    An Anthology of Contemporary Voices AFRICAN Women Writing Resistance is the first transnational anthology to focus on women’s strategies of resistance to the challenges they face in Africa today.The anthology brings together personal narratives,testimony,interviews, short stories,po-

  2. Deepening African Ties

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Chinese President Hu Jintao has just embarked on his state visits to eight African countries that will take him to both the northern and southern tips of the continent. This is his first trip abroad this year, and also his third visit to Africa

  3. East African institutions

    DEFF Research Database (Denmark)

    Nordby, Johannes Riber; Jacobsen, Katja

    For the past decade security in East Africa has gained focus internationally. However there is a growing ambition among African states to handle such issues by themselves, sometimes through regional institutions. This has been supported by many Western states but potential risks are often forgotten....

  4. African tick bite fever

    DEFF Research Database (Denmark)

    Johansen, Jakob Aaquist; Thybo, Søren

    2011-01-01

    The incident of spotted fever imported to Denmark is unknown. We present a classic case of African Tick Bite Fever (ATBF) to highlight a disease, which frequently infects wildlife enthusiasts and hunters on vacation in South Africa. ATBF has a good prognosis and is easily treated with doxycyclin...

  5. West African Antislavery Movements

    DEFF Research Database (Denmark)

    Hahonou, Eric Komlavi; Pelckmans, Lotte

    2011-01-01

    In the context of liberalization of West African political regimes, the upsurge of audacious political entrepreneurs who want to end chattel slavery in their nation-state, resulted in the legal criminalisation of slavery in both Mauritania (2007) and Niger (2003) and in a proposal to revise the...... cultures (or ‘mentalities’) go hand in hand....

  6. Immunizations and African Americans

    Science.gov (United States)

    ... Program Grants Other Grants Planning and Evaluation Grantee Best Practices Black/African American Asthma Cancer Chronic Liver Disease ... 13 to 17 years who ever received the human papillomavirus (HPV) vaccination, 2014 - Males # doses ... 240-453-2882 Office of Minority Health Resource Center Toll Free: 1-800-444-6472 / Fax: ...

  7. Protocol on the constipation in an oncology palliative care unit

    Directory of Open Access Journals (Sweden)

    Montserrat Cordero Ponce

    2008-07-01

    Full Text Available Constipation is a problem relatively common even in healthy people, mainly in the western world, influenced mainly by the nutritional diets and the diminution of the physical activity. It is a symptom of difficult valuation by its subjective nature and the difficulty to establish a normality pattern.The incidence is high. It is observed in a 70 - 80% of the patients in terminal situation, the 40 - 50% of the patients with disease outpost and in 90% of the patients dealing with opiate.As nurses in of a palliative care unit we detected the high number of patients which they present/display the symptom and the time that takes in its diagnose and treatment, increasing the incidence-appearance of fecal impactación and intestinal obstruction. It is one of the symptoms that worry to our patients more.We take too frequently the “rectal measures,” being more painful and a little shameful for these patients, instead of using preventive measures, precocious oral treatment and continuous evaluation of the symptom. The knowledge that these patients have of the constipation is in many deficient cases. In order to be able to educate and to take care of to the oncology terminal patient in terminal state with constipation it is essential that we know its physiopathology, causes and complications. Also we will deepen in the most suitable treatment according to the consistency, the effort that the patient must make when defecating and the symptoms that presents/displays, trying that the treatment is customized and individual, although starting off of a previous protocol of performance decided by the health professionals who are going to treat the patient.

  8. Complementary medicine in palliative care and cancer symptom management.

    Science.gov (United States)

    Mansky, Patrick J; Wallerstedt, Dawn B

    2006-01-01

    Complementary and alternative medicine (CAM) use among cancer patients varies according to geographical area, gender, and disease diagnosis. The prevalence of CAM use among cancer patients in the United States has been estimated to be between 7% and 54%. Most cancer patients use CAM with the hope of boosting the immune system, relieving pain, and controlling side effects related to disease or treatment. Only a minority of patients include CAM in the treatment plan with curative intent. This review article focuses on practices belonging to the CAM domains of mind-body medicine, CAM botanicals, manipulative practices, and energy medicine, because they are widely used as complementary approaches to palliative cancer care and cancer symptom management. In the area of cancer symptom management, auricular acupuncture, therapeutic touch, and hypnosis may help to manage cancer pain. Music therapy, massage, and hypnosis may have an effect on anxiety, and both acupuncture and massage may have a therapeutic role in cancer fatigue. Acupuncture and selected botanicals may reduce chemotherapy-induced nausea and emesis, and hypnosis and guided imagery may be beneficial in anticipatory nausea and vomiting. Transcendental meditation and the mindfulness-based stress reduction can play a role in the management of depressed mood and anxiety. Black cohosh and phytoestrogen-rich foods may reduce vasomotor symptoms in postmenopausal women. Most CAM approaches to the treatment of cancer are safe when used by a CAM practitioner experienced in the treatment of cancer patients. The potential for many commonly used botanical to interact with prescription drugs continues to be a concern. Botanicals should be used with caution by cancer patients and only under the guidance of an oncologist knowledgeable in their use.

  9. Gynecologic oncology patients' satisfaction and symptom severity during palliative chemotherapy

    Directory of Open Access Journals (Sweden)

    Gibbons Heidi E

    2006-10-01

    Full Text Available Abstract Background Research on quality and satisfaction with care during palliative chemotherapy in oncology patients has been limited. The objective was to assess the association between patient's satisfaction with care and symptom severity and to evaluate test-retest of a satisfaction survey in this study population. Methods A prospective cohort of patients with recurrent gynecologic malignancies receiving chemotherapy were enrolled after a diagnosis of recurrent cancer. Patients completed the Quality of End-of-Life care and satisfaction with treatment scale (QUEST once upon enrollment in an outpatient setting and again a week later. Patients also completed the Mini-Mental Status Exam, the Hospital Anxiety/Depression Scale, a symptom severity scale and a demographic survey. Student's t-test, correlation statistics and percent agreement were used for analysis. Results Data from 39 patients were analyzed. Mean (SD quality of care summary score was 41.95 (2.75 for physicians and 42.23 (5.42 for nurses (maximum score was 45; p = 0.76 for difference in score between providers. Mean (SD satisfaction of care summary score was 29.03 (1.92 for physicians and 29.28 (1.70 for nurses (maximum score was 30; p = 0.49 for difference between providers. Test-retest for 33 patients who completed both QUEST surveys had high percent agreement (74–100%, with the exception of the question regarding the provider arriving late (45 and 53%. There was no correlation between quality and satisfaction of care and symptom severity. Weakness was the most common symptom reported. Symptom severity correlated with depression (r = 0.577 p Conclusion The QUEST Survey has test-retest reliability when used as a written instrument in an outpatient setting. However, there was no correlation between this measure and symptom severity. Patient evaluation of care may be more closely related to the interpersonal aspects of the health care provider relationship than it is to physical

  10. ENDOSCOPIC STENT FOR PALLIATING MALIGNANT AND BENIGN BILIARY OBSTRUCTION

    Institute of Scientific and Technical Information of China (English)

    缪林; 范志宁; 季国忠; 文卫; 蒋国斌; 吴萍; 刘政; 黄光明

    2004-01-01

    Objective: To study the techniques of placement of memory alloy plating gold biliary stent and plastic stent for palliation of malignant and benign biliary obstruction, and to assess its clinical effectiveness. Methods: The patients in plastic stent group included paplilla of duodenum inflamational strictures (n=24), common bile duct inflammational inferior segment strictures (n=4), choledocholithiasis (n=5), bile leak (n=11), bile duct surgery injurey (n=7) and pancreatic carcinoma (n=1). The patients in plating gold stent group included common bile duct carcinoma (n=5) and pancreatic carcinoma (n=6). Under fluoroscopic guidance the stent was inserted into biliary obstruction sites from oral cavity in all cases. Complications, liver function and blood serum amylase were investigated during the study period. Results: Successful stent placement was achieved in all cases. After operation of 7 days, in gold biliary stent groups, the rates of decrease of blood serum total bilirubin, glutamic-pyruvic transaminase, r-glutamyl transpeptidase and alkaline phosphatase were 67.16%, 58.37%, 40.63% and 41.54% respectively. In plastic stent group, the rates of decrease of STB, ALT, r-GT and AKP were 53.24%, 55.03%, 37.15%, 34.12% respectively. Early complication included post-ERCP pancreatitis and cholangititis. Occlusion of stent was the major late complication. Conclusion: Memory alloy plating gold biliary stent and plastic stent were safe and efficacious methods for malignant and benign biliary obstruction, and could improve patient's living quality. Plastic stent was an efficient complement for therapy of bile leak and bile duct injury.

  11. Awareness, understanding and attitudes of Italians regarding palliative care

    Directory of Open Access Journals (Sweden)

    Franca Benini

    2011-01-01

    Full Text Available There are numerous difficulties encountered in the diffusion of palliative care (PC in developed countries. A correct and widespread awareness of PC among the general public represents an important factor for its enhanced diffusion and use. The aim of this study is to verify the level of awareness of PC among Italians and their perception of the needs of patients with incurable illness. A random sample of 1897 adult subjects, aged 18 to 74 years, representative of the Italian population, was interviewed after stratification by gender, age (6 strata, education (3 levels, geographic area of residency (4 areas and town of residency (4 dimensions. 59.4% of those interviewed had heard of PC, but only 23.5% of them believed that they had an adequate or precise idea of what PC is; 27% of them did not know or had a mistaken idea about the nature of PC. The most accepted perception was that PC alleviates pain and improves quality-of-life. The principal concerns attributed to incurable patients were: fear of suffering and of death, and the principal needs were perceived as: relief from pain and physical suffering. The primary needs of the family were identified in: medical and nursing care at home, followed by: care provided by volunteers and psychological support. The most appropriate care-setting for these patients was indicated as their home, possibly with the support of professional carers. In the case of children, the main concern indicated was that of being "separated" from family, friends, home and toys. Only 45.2% of interviewees thought that they knew a person who had experienced PC. In conclusion, the awareness of the Italian population of PC is scarce and often incorrect. In order to achieve a greater diffusion and better use of PC in our country, this awareness needs to be improved by appropriate intervention.

  12. Palliative radiation treatment of cutaneous mycosis fungoides - a dose response

    Energy Technology Data Exchange (ETDEWEB)

    Cotter, G.W.; Baglan, R.J.; Wasserman, T.H.; Mill, W.

    1983-10-01

    Between 1966 and 1981, 20 patients (191 lesions) underwent palliative radiation therapy for control of biopsy-proven cutaneous mycosis fungoides. Six patients (47 lesions) and an additional 34 lesions from the remaining 14 patients with complete response to treatment were excluded from the study because of follow-up of less than one year. Included in the remaining 110 lesions were all recurrences and all partial responses. The modalities for treatment included superficial X rays, Cobalt-60 or electron beam irradiation. The total tumor doses employed ranged from 600-4000 cGy. The 110 lesions (14 patients) were retrospectively analyzed to determine the dose required for local control of the lesions. Fifty-three percent of the lesions were classified as plaques, 20% as tumors less than or equal to 3 cm in diameter, and 27% as tumors > 3 cm in diameter. Complete response to treatment was observed in 95% of the plaque lesions, 95% of the tumors less than or equal to 3 cm in diameter and 93% of tumor > 3 cm in diameter. A complete response to treatment was noted in all lesions receiving greater than 2000 cGy. In the total population of lesions having a complete response, a local infield recurrence rate of 42% was noted in the group receiving less than or equal to 1000 cGy, 32% in those receiving 1001-2000 cGy, 21% in those receiving 2001-3000 cGy, and 0% in the group receiving > 3000 cGy. The data from this study indicate that tumor doses equivalent to at least 3000 cGy at 200 cGy per fraction, five fractions per week (TDF greater than or equal to) are needed for adquate local control of cutaneous mycosis fungoides lesions.

  13. The denial of death thesis: sociological critique and implications for palliative care.

    Science.gov (United States)

    Zimmermann, Camilla; Rodin, Gary

    2004-03-01

    It has become commonplace to say that contemporary western society is 'death-denying'. This characterization, which sociologists have termed the 'denial of death thesis', first arose in the social science, psychological and clinical medical literature in the period between 1955 and 1985. During the same time period, the hospice and palliative care movements were developing and in part directed themselves against the perceived cultural denial of death in western society. While the denial of death has been taken for granted by the lay public as well as by clinicians, in the sociological literature it has been increasingly questioned. In this paper we use sociological critiques of the denial of death thesis to raise critical questions about the theory and practice of contemporary palliative care. In particular, we argue that the emphasis of palliative care should not be on extinguishing the denial of death but on the relief of suffering.

  14. Preparing the Pediatric Dentist for Palliative and End-of-life Care.

    Science.gov (United States)

    Sarvas, Elise W; Schwantes, Scott A; Karp, Jeffrey M

    2016-01-01

    Pediatric dentists are the primary providers of dental homes for children with life-threatening and complex chronic conditions. These children are increasingly living at home and seeking health care in community-based settings, including dental offices. Pediatric dentists may feel ill prepared to assume the roles and responsibilities of a pediatric palliative care provider due to limited education and training during dental school and residency; however, they should be sensitive to the palliative care needs of children and families. The purpose of this clinical article was to highlight palliative care scenarios in pediatric dentistry and provide actionable resources to empower pediatric dentists to gather health care information, make informed ethical decisions, promote patient- and family-centered care, and prepare dentists and their dental teams for episodes of death and bereavement when providing a dental home to patients with life-threatening and complex chronic conditions.

  15. Preparing the Pediatric Dentist for Palliative and End-of-life Care.

    Science.gov (United States)

    Sarvas, Elise W; Schwantes, Scott A; Karp, Jeffrey M

    2016-01-01

    Pediatric dentists are the primary providers of dental homes for children with life-threatening and complex chronic conditions. These children are increasingly living at home and seeking health care in community-based settings, including dental offices. Pediatric dentists may feel ill prepared to assume the roles and responsibilities of a pediatric palliative care provider due to limited education and training during dental school and residency; however, they should be sensitive to the palliative care needs of children and families. The purpose of this clinical article was to highlight palliative care scenarios in pediatric dentistry and provide actionable resources to empower pediatric dentists to gather health care information, make informed ethical decisions, promote patient- and family-centered care, and prepare dentists and their dental teams for episodes of death and bereavement when providing a dental home to patients with life-threatening and complex chronic conditions. PMID:27557917

  16. Cooperating with a palliative home-care team: expectations and evaluations of GPs and district nurses

    DEFF Research Database (Denmark)

    Goldschmidt, Dorthe; Groenvold, Mogens; Johnsen, Anna Thit;

    2005-01-01

    BACKGROUND: Palliative home-care teams often cooperate with general practitioners (GPs) and district nurses. Our aim was to evaluate a palliative home-care team from the viewpoint of GPs and district nurses. METHODS: GPs and district nurses received questionnaires at the start of home-care and one...... month later. Questions focussed on benefits to patients, training issues for professionals and cooperation between the home-care team and the GP/ district nurse. A combination of closed- and open-ended questions was used. RESULTS: Response rate was 84% (467/553). Benefits to patients were experienced....... Dissatisfaction was caused mainly by lack of information from the home-care team to primary-care professionals. CONCLUSION: GPs and district nurses welcomed the palliative home-care team and most experienced benefits to patients. Strengthened communication, initiated by the home-care team would enhance...

  17. [Bioethics and nutrition in adult patients with cancer in palliative care].

    Science.gov (United States)

    Benarroz, Monica de Oliveira; Faillace, Giovanna Borges Damião; Barbosa, Leandro Augusto

    2009-09-01

    Cancer constitutes a major group of chronic diseases and is the second leading cause of death in the developed countries. Palliative care proposes to offer comprehensive support to control symptoms and improve quality of life for patients and their families. Nutrition is an important tool in palliative care, helping patients with their physical, psychological, and social issues and promoting comfort and quality of life. However, in the context of palliative care, nutritional support rarely achieves its role of fully recovering and assuring nutritional status. At this point, the nutritionist must consider the individual patient's needs, preferences, and eating habits, which are essential both for controlling symptoms and assuring satisfaction and comfort. The impossibility of conventionally applying established management and the development of a new perception of the patient often raise dilemmas for professional nutritionists. PMID:19750375

  18. Informal Caregivers of Palliative Oncohematologic Patients: The Invisible Guests: An Exhaustive Review of the Literature Available.

    Science.gov (United States)

    Uceda-Torres, María Elena; Rodríguez-Rodríguez, Juan Nicolás; Alvarado-Gómez, Francisco; Sánchez-Ramos, José Luis; McGrath, Pam

    2016-08-01

    Informal caregivers are crucial members of the teams that care for palliative patients with cancer, including those with oncohematological malignancies. Publications concerning specific aspects of this latter group of carers are limited. This literature review indicates that palliative oncohematologic patients' caregivers do not differ from those of patients with solid tumors in ethical and related problems. However, there are specific problems for the former group with regard to negotiating the curative system, which are experienced as distressing, often without support from the health system and without offers of the possibility of being referred to palliative teams that they would have valued as very positive. Although this tendency seems to be changing, there is still considerable work to be done to improve the role of these carers. PMID:25907184

  19. Palliative and end-of-life decision-making in dementia care.

    Science.gov (United States)

    Mitchell, Gary

    2015-11-01

    This paper will highlight some of the pertinent issues associated with palliative and end-of-life decision-making in relation to dementia. To achieve this, the author will consider why there is disparity in relation to shared decision-making practices across non-malignant disease through exploration of models of disease trajectories. The author will then go on to highlight how people living with dementia, a non-malignant disease, have a human right to receive palliative care and be an active agent in the shared decision-making process about their future and care preferences. The challenges of shared decision-making in dementia care will be discussed along with some implications for nursing practice. The aim of this paper is to provide nurses, practising across all settings, with an overview of the fundamental importance of timely palliative and end-of-life shared decision-making in dementia care.

  20. Establishing research in a palliative care clinical setting: perceived barriers and implemented strategies.

    Science.gov (United States)

    Bullen, Tracey; Maher, Kate; Rosenberg, John P; Smith, Bradley

    2014-02-01

    There are many challenges in developing research projects in research-naïve clinical settings, especially palliative care where resistance to participate in research has been identified. These challenges to the implementation of research are common in nursing practice and are associated with attitudes towards research participation, and some lack of understanding of research as a process to improve clinical practice. This is despite the professional nursing requirement to conduct research into issues that influence palliative care practice. The purpose of this paper is to describe the process of implementing a clinical research project in collaboration with the clinicians of a palliative care community team and to reflect on the strategies implemented to overcome the challenges involved. The challenges presented here demonstrate the importance of proactively implementing engagement strategies from the inception of a research project in a clinical setting.

  1. Integrated oncology and palliative care: five years experience at the National Cancer Institute of Mexico.

    Science.gov (United States)

    Allende-Pérez, Silvia; Verástegui-Avilés, Emma; Mohar-Betancourt, Alejandro; Meneses-García, Abelardo; Herrera-Gómez, Angel

    2016-04-01

    Under the national plan for addressing cancer, prevention and detection play important roles. However, the cost of treatments and late diagnosis represent a significant burden on health services. At the National Cancer Institute, more than half of patients present with tumors in advanced stages, and approximately 10% of patients seen for the first time exhibit terminal-stage malignancies, where there are no feasible cancer treatment options, and the patients are instead admitted to the hospital exclusively for palliative symptomatic management. In 2010, the National Cancer Plan began implementing a model of integrative management of palliative care in oncology that has gradually come to include symptomatic palliative care, involving ambulatory, distant and hospitalized management of patients with cancer, in its final stages and, more recently, in earlier stages. PMID:27557392

  2. Usefulness of Palliative Care to Complement the Management of Patients on Left Ventricular Assist Devices.

    Science.gov (United States)

    Luo, Nancy; Rogers, Joseph G; Dodson, Gwen C; Patel, Chetan B; Galanos, Anthony N; Milano, Carmelo A; O'Connor, Christopher M; Mentz, Robert J

    2016-09-01

    Within the last decade, advancements in left ventricular assist device therapy have allowed patients with end-stage heart failure (HF) to live longer and with better quality of life. Like other life-saving interventions, however, there remains the risk of complications including infections, bleeding episodes, and stroke. The candidate for left ventricular assist device therapy faces complex challenges going forward, both physical and psychological, many of which may benefit from the application of palliative care principles by trained specialists. Despite these advantages, palliative care remains underused in many advanced HF programs. Here, we describe the benefits of palliative care, barriers to use within HF, and specific applications to the integrated care of patients on mechanical circulatory support. PMID:27474339

  3. The denial of death thesis: sociological critique and implications for palliative care.

    Science.gov (United States)

    Zimmermann, Camilla; Rodin, Gary

    2004-03-01

    It has become commonplace to say that contemporary western society is 'death-denying'. This characterization, which sociologists have termed the 'denial of death thesis', first arose in the social science, psychological and clinical medical literature in the period between 1955 and 1985. During the same time period, the hospice and palliative care movements were developing and in part directed themselves against the perceived cultural denial of death in western society. While the denial of death has been taken for granted by the lay public as well as by clinicians, in the sociological literature it has been increasingly questioned. In this paper we use sociological critiques of the denial of death thesis to raise critical questions about the theory and practice of contemporary palliative care. In particular, we argue that the emphasis of palliative care should not be on extinguishing the denial of death but on the relief of suffering. PMID:15046408

  4. Combined endoscopic and laparoscopic approach for palliative resection of metastatic melanoma of the stomach

    Directory of Open Access Journals (Sweden)

    Pritchard SA

    2006-03-01

    Full Text Available Abstract Background Metastatic tumours of the stomach present a clinical dilemma for the surgeon. Palliative surgical resection can alleviate symptoms and prolong survival in selected patients. However, previous studies have used open methods of surgical resection with potentially high morbidity and mortality. We describe the use of laparoscopic wedge resection of the stomach for palliative resection of metastatic melanoma to highlight the benefits of this technique. Case presentation A 58 year old male was investigated for iron deficiency anaemia while under treatment for pulmonary metastatic malignant melanoma. An upper gastrointestinal endoscopy revealed a 5 cm diameter ulcer on the anterior wall of the stomach, biopsies from the ulcer confirmed metastatic melanoma. Laparoscopic wedge resection of the stomach lesion was performed without complication. Conclusion Laparoscopic approach has many benefits and is useful for the palliative resection of rare tumours of the stomach in order to preserve the quality of life. Its use should be considered in selected patients.

  5. Does the Culture of Modern Day Palliative Care Social Work Leave Room for Leadership?

    Science.gov (United States)

    Davidson, Jason

    2016-01-01

    This paper describes research undertaken as part of an MA study in leadership. It draws on interviews with six high profile leaders at the fore front of end of life care sector in the UK. Its findings and emerging themes offer insights about the opportunities for social work leaders in palliative care in the future and how the profession and palliative care sector address current barriers to taking advantage of such opportunity. The main focus of this paper is leadership related to palliative care social work. However, it relates to much broader themes including the history, politics and culture of this profession and the requirements for leadership on the part of social work in the broader contexts of health and social care.

  6. PRIMARY PALLIATIVE CARE? - Treating terminally ill cancer patients in the primary care sector

    DEFF Research Database (Denmark)

    Neergaard, Mette Asbjørn; Jensen, Anders Bonde; Olesen, Frede;

    sectors.METHOD. A number of focus group interviews were conducted with three types of subgroups: 1) Bereaved relatives, 2) GPs and 3) Various health-care-professionals, namely community nurses, hospital physicians and GPs. The interviews were transcribed and analysed according to a phenomenological......BACKGROUND. Palliative care for cancer patients is an important part of a GP's work. Although every GP is frequently involved in care for terminally ill cancer patients, only little is known about how these palliative efforts are perceived by the patients and their families, a knowledge...... approach.RESULTS. The analyses revealed several key areas, e.g.: 1) How to take, give and maintain professional responsibility for palliative home care. 2) A need for transparent communication both among primary care professionals and among professionals across the primary/secondary interface. 3...

  7. [Palliative Care Network - 20 years of experiences from Ticino / Southern Switzerland].

    Science.gov (United States)

    Neuenschwander, Hans; Gamondi, Claudia

    2012-02-01

    The PC program of the Italian speaking part of Switzerland (Ticino) has been developed bottom up since 1990. It was started with a palliative homecare service, called Hospice Ticino. Six years later PC consultant teams were introduced in the public hospitals. Finally in 2003 an acute palliative care unit was opened. Few resources are still lacking to ensure a comprehensive network, especially in the private clinics and in the elderly homes. Through the newly implemented National Strategy in PC 2010 - 12, the government of Canton Ticino has been charged with promoting a comprehensive, strategic and operative program in PC in order to guarantee access to high quality PC to every patient wherever he choses to be cared for. The article describes the history of Ticino's palliative care program, highlighting some of its controversial issues.

  8. Challenges to participation in paediatric palliative care research: a review of the literature.

    Science.gov (United States)

    Tomlinson, Deborah; Bartels, Ute; Hendershot, Eleanor; Constantin, Julie; Wrathall, Glynis; Sung, Lillian

    2007-07-01

    It has been identified that there is a need for increased palliative care research within the paediatric setting. The assessment of parental views is necessary for this population. However, the conduct of research and recruitment of participants is often challenging. While conducting a study that involved parents of children receiving palliative or end-of-life care, the authors found that there were particular challenges to recruiting these parents. This comprehensive review of the literature aims to address the ethical and recruitment issues of involving parents of children that are receiving palliative or end-of-life care. Key elements, that may maximize completion of research and a more representative sample, are also discussed. These elements include obtaining the opinions on study design and interview script from experienced families and maximizing the partnership between health care professionals and the research team. PMID:17901103

  9. [Nursing in palliative care to children and adolescents with cancer: integrative literature review].

    Science.gov (United States)

    da Costa, Thailly Faria; Ceolim, Maria Filomena

    2010-12-01

    Pediatric palliative care is a challenge for nursing because it requires emotional balance and knowledge about its specific features. This study is an integrative literature review that aims to identify nursing actions in palliative care for children and adolescents with cancer, considering peculiarities of the disease and dying process. The review was performed by searching for articles indexed in Biblioteca Virtual da Adolescência (Adolec), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) and PubMed databases from January 2004 till May 2009. From 29 references found, six met inclusion criteria. Results show teamwork, home care, pain management, dialogue, family support and particularities of childhood cancer fundamental tools for nursing in palliative care. The complexity of care in this situation requires solidarity, compassion, support and relieving suffering.

  10. Content analysis of legal acts and the determination of the directions of optimization of palliative care in modern Russia

    Directory of Open Access Journals (Sweden)

    Yerugina M.V.

    2015-12-01

    Full Text Available The article presents the author's analysis of the normative documents of the Russian Federation necessary for providing palliative care. According to the authors regulatory — legal support of palliative medical care to the population allows to plan and to develop this kind of assistance in Russia. To ensure the availability of palliative care it is necessary to have scientific and methodological basis and to develop a general classification of the states under which the palliative care is needed and should be organized. The procedure for medical care must be brought into conformity with the mentioned above classification. The authors consider the trends of medicalisation of palliative care in Russia in the context of dysfunctional practices of the social institute of Public Health.

  11. Communication About Sexuality in Advanced Illness Aligns With a Palliative Care Approach to Patient-Centered Care.

    Science.gov (United States)

    Leung, Margaret W; Goldfarb, Shari; Dizon, Don S

    2016-02-01

    Treatment-related sexual complications are common in cancer patients although rarely discussed in the palliative care setting. Sexuality is an important survivorship issue and remains relevant even in the terminal setting. There are multiple barriers in dialoguing about intimacy and sexual functioning from the patient and provider perspectives. Palliative care providers, while not expected to be sexual health experts, can provide comprehensive patient-centered care by including sexual health as part of their evaluation. They can explore how sexual dysfunction can impair functioning and utilize an interdisciplinary approach to manage symptoms. Palliative care providers can help patients identify their goals of care and explore what anticipated sexual changes and treat-related side effects are tolerable and intolerable to the patient's quality of life. Principles on addressing sexuality in the palliative setting and practical ways of incorporating sexual history into the palliative care assessment are provided.

  12. Specialist pediatric palliative care prescribing practices: A large 5-year retrospective audit

    Directory of Open Access Journals (Sweden)

    Anuja Damani

    2016-01-01

    Full Text Available Introduction: There is a gradual increasing trend in childhood cancers in India and pediatric palliative care in India is an emerging specialty. Prescribing pain and symptom control drugs in children with cancer requires knowledge of palliative care formulary, dosing schedules, and prescription guidelines. This study is a retrospective audit of prescribing practices of a specialist palliative care service situated in a tertiary cancer center. Methods: A total of 1135 medication records of children receiving specialist pediatric palliative care services were audited for 5 years (2010-2014 to evaluate prescribing practices in children with advanced cancer. Results: A total of 51 types of drugs were prescribed with an average of 4.2 drugs per prescription. 66.9% of the prescriptions had paracetamol, and 33.9% of the prescriptions had morphine. Most common nonsteroidal anti-inflammatory drugs prescribed was ibuprofen (23.9%, and more than 50% of the prescriptions had aperients. The most commonly prescribed aperient was a combination of liquid paraffin and sodium-picosulfate. Dexamethasone was prescribed in 51.9% of patients and in most cases this was part of oral chemotherapy regimen. Generic names in prescription were used only in 33% of cases, and adverse effects of the drugs were documented in only 9% of cases. In 25% of cases, noncompliance to the WHO prescription guidelines was seen, and patient compliance to prescription was seen in 40% of cases. Conclusions: Audit of the prescribing practices in specialist pediatric palliative care service shows that knowledge of pediatric palliative care formulary, rational drug use, dosing, and prescribing guidelines is essential for symptom control in children with advanced life-limiting illness. Noncompliance to WHO prescribing guidelines in one fourth of cases and using nongeneric names in two-thirds of prescription indicates poor prescribing practices and warrants prescriber education. Prescription

  13. Palliative care services for Indian migrants in Australia: Experiences of the family of terminally Ill patients

    Directory of Open Access Journals (Sweden)

    Sujatha Shanmugasundaram

    2009-01-01

    Full Text Available Background: The way that health care systems in developing countries like India care for dying patients, has an impact on the expectations of such care for those who migrate to other countries faces. At the end of life, cultural issues may impact on the quality of life remaining and for that reason, it is important that particular cultural practices are understood. This paper describes a study that investigated the cultural issues of access to palliative care services for Indian migrants in Australia. Purpose of the Study: To investigate the experiences of the family members of terminally ill Indian migrants in Victoria, Australia. Objective of the Study: To explore the issues related to accessing palliative care services for Indian migrants; to identify the effectiveness of palliative care in supporting the patient and family and to recommend strategies for improving this care. Materials and Methods: A qualitative descriptive design was utilized. Up to 6 family members were selected for in-depth interviews in understanding cultural issues related to the palliative care services for a family member. Results: Analysis of the interviews revealed that families of Indian patients experience difficulties whilst receiving palliative care services, which fell into three main categories: Indian support systems, cultural issues, and caring experiences. Although each of these issues had a direct influence on the experience of terminal care that their family member received, cultural issues and support systems also influenced the caring experiences. Conclusion: Despite the successful implementation of palliative care services across Australia, there are still problems in accessing and receiving the services among minority and disadvantaged groups like various cultural groups.

  14. Developing a web-based information resource for palliative care: an action-research inspired approach

    Directory of Open Access Journals (Sweden)

    Gliddon Terry

    2007-09-01

    Full Text Available Abstract Background General Practitioners and community nurses rely on easily accessible, evidence-based online information to guide practice. To date, the methods that underpin the scoping of user-identified online information needs in palliative care have remained under-explored. This paper describes the benefits and challenges of a collaborative approach involving users and experts that informed the first stage of the development of a palliative care website 1. Method The action research-inspired methodology included a panel assessment of an existing palliative care website based in Victoria, Australia; a pre-development survey (n = 197 scoping potential audiences and palliative care information needs; working parties conducting a needs analysis about necessary information content for a redeveloped website targeting health professionals and caregivers/patients; an iterative evaluation process involving users and experts; as well as a final evaluation survey (n = 166. Results Involving users in the identification of content and links for a palliative care website is time-consuming and requires initial resources, strong networking skills and commitment. However, user participation provided crucial information that led to the widened the scope of the website audience and guided the development and testing of the website. The needs analysis underpinning the project suggests that palliative care peak bodies need to address three distinct audiences (clinicians, allied health professionals as well as patients and their caregivers. Conclusion Web developers should pay close attention to the content, language, and accessibility needs of these groups. Given the substantial cost associated with the maintenance of authoritative health information sites, the paper proposes a more collaborative development in which users can be engaged in the definition of content to ensure relevance and responsiveness, and to eliminate unnecessary detail. Access to

  15. Receiving palliative treatment moderates the effect of age and gender on demoralization in patients with cancer.

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    Sigrun Vehling

    Full Text Available BACKGROUND: Existential distress is an important factor affecting psychological well-being in cancer patients. We studied occurrence and predictors of demoralization, a syndrome of existential distress, in particular the interaction of age, gender, and curative vs. palliative treatment phase. METHODS: A cross-sectional sample of N = 750 patients with different tumor sites was recruited from in- and outpatient treatment facilities. Patients completed the following self-report questionnaires: Demoralization Scale, Patient Health Questionnaire-9, Illness-Specific Social Support Scale Short Version-8, and physical problems list of the NCCN Distress Thermometer. Moderated multiple regression analyses were conducted. RESULTS: We found high demoralization in 15% and moderate demoralization in 8% of the sample. Curative vs. palliative treatment phase moderated the impact of age and gender on demoralization (three-way interaction: b = 1.30, P = .02: the effect of age on demoralization was negative for women receiving palliative treatment (b = -.26, P = .02 and positive for men receiving palliative treatment (b = .25, P = .03. Effects of age and gender were not significant among patients receiving curative treatment. Female gender was associated with higher demoralization among younger patients receiving palliative treatment only. Analyses were controlled for significant effects of the number of physical problems (b = 6.10, P<.001 and social support (b = -3.17, P<.001. CONCLUSIONS: Existential distress in terms of demoralization is a relevant problem within the spectrum of cancer-related distress. It is associated with a complex interaction of demographic and medical patient characteristics; existential challenges related to palliative treatment may exacerbate the impact of age- and gender-related vulnerability factors on demoralization. Psychosocial interventions should acknowledge this interaction in order to address the individual nature of existential

  16. Female genital mutilation in African and African American women's literature

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    Darja Marinšek

    2007-12-01

    Full Text Available The article builds on the existing dispute between African and African American women writers on the competence of writing about female genital mutilation (FGM, and tries to determine the existence and nature of the differences between the writings of these two groups. The author uses comparative analysis of two popular African and African American novels, comparing their ways of describing FGM, its causes and consequences, the level ob objectivity and the style of the narrations.This is followed by a discussion on the reasons for such differences, incorporating a larger circle of both African and African American women authors, at the same time analysing the deviance within the two groups. While the differences between African American writers are not that great, as they mostly fail to present the issue from different points of view, which is often the result of their lack of direct knowledge of the topic, African authors' writing is in itself discovered to be ambivalent and not at all invariable. The reasons for such ambivalence are then discussed in greater context, focusing on the effect of the authors' personal contact with circumcision as well as their knowledge and acceptance of Western values. The author concludes by establishing the African ambivalent attitude towards FGM, which includes different aspects of the issue, as the most significant difference between their and African American writers' description of this practice.

  17. Palliative Care Education: Focusing on Care and Not Just Disease | Division of Cancer Prevention

    Science.gov (United States)

    At the Institute for Palliative Medicine (IPM) in San Diego, medical residents are re-tooling for one of the most essential aspects of medicine: caring for seriously ill patients. “The goal is to teach them the core competencies in palliative care,” explained Dr. Charles von Gunten, the institute’s provost. These competencies include pain management, good communication skills, and the ability to provide patients with psychosocial and spiritual assessments and to work in interdisciplinary teams in hospitals, as well as through hospice and in nursing homes, he said. |

  18. General practitioners' use and experiences of palliative care services: a survey in south east England

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    Higginson Irene J

    2008-11-01

    Full Text Available Abstract Background The role of the General Practitioner (GP is central to community palliative care. Good liaison between the different professionals involved in a patient's care is extremely important in palliative care patients. In cases where GPs have previously been dissatisfied with palliative services, this may be seen as a barrier to referral when caring for other patients. The aim of this survey is to investigate the use and previous experiences of GPs of two palliative care services, with particular emphasis on barriers to referral and to explore issues surrounding the GP's role in caring for palliative patients. Methods Design: Descriptive postal survey of use and experience of palliative care services with particular emphasis on barriers to referral. Setting: One Primary Care Trust (PCT, south London, England, population 298,500. Subjects: 180 GPs in the PCT, which is served by two hospice services (A&B. Results An overall questionnaire response rate of 77% (138 was obtained, with 69% (124 used in analysis. Over 90% of GPs were satisfied with the palliative care services over the preceding two years. Two areas of possible improvement emerged; communication and prescribing practices. GPs identified some patients that they had not referred, most commonly when patients or carers were reluctant to accept help, or when other support was deemed sufficient. Over half of the GPs felt there were areas where improvement could be made; with clarification of the rules and responsibilities of the multi disciplinary team being the most common. The majority of GPs were working, and want to work with, the specialist services as part of an extended team. However, a greater number of GPs want to hand over care to the specialist services than are currently doing so. Conclusion A large number of GPs were happy with the service provision of the palliative care services in this area. They suggested that 3 out of 4 terminally ill patients needed specialist

  19. [Palliative care birth plan: a field of perinatal medicine to build].

    Science.gov (United States)

    Tosello, B; Le Coz, P; Payot, A; Gire, C; Einaudi, M-A

    2013-04-01

    Some couples may choose to continue the pregnancy unable to decide for termination of pregnancy. Such situations recently occurred in neonatology units and may lead to neonatal palliative care. Faced with all uncertainties inherent to medicine and the future of the baby, medical teams must inform parents of different possible outcome step by step. Consistency in the reflection and intentionality of the care is essential among all different stakeholders within the same health team to facilitate support of parents up to a possible fatal outcome. This issue in perinatal medicine seems to be to explore how caregivers can contribute in the construction of parenthood in a context of a palliative care birth plan.

  20. Extending the team component of the Latimer ethical decision-making model for palliative care

    Directory of Open Access Journals (Sweden)

    Purkis ME

    2011-04-01

    Full Text Available Mary Ellen Purkis1, Elizabeth Borycki1,2, Craig Kuziemsky3, Fraser Black4, Denise Cloutier-Fisher5, Lee Ann Fox6, Patricia MacKenzie7, Ann Syme1,8, Coby Tschanz1,41School of Nursing, 2School of Health Information Science, University of Victoria, Victoria, British Columbia; 3Telfer School of Management, University of Ottawa, Ottawa, Ontario; 4Victoria Hospice Society, Victoria, British Columbia; 5Department of Geography, University of Victoria, Victoria, British Columbia; 6Kingston General Hospital, Kingston, Ontario; 7School of Social Work, University of Victoria, Victoria, British Columbia; 8British Columbia Cancer Agency, Vancouver Island Centre, Victoria, British Columbia, CanadaBackground: Each year more than 240,000 Canadians die from terminal and chronic illnesses. It is estimated that 62% of those deaths require palliative care. Palliative care is a specialized domain of health professional team practice that requires discipline-specific knowledge, skills, judgment, and expertise in order to address patient hopes, wishes, symptoms, and suffering. With the emergence of palliative care as a specialized area of interdisciplinary practice, new practice models have also emerged, eg, the Latimer ethical decision-making model for palliative care. The purpose of this research was to undertake a descriptive ethnographic field study of palliative care team practices to understand better the interdisciplinary team communication and the issues that arise when members of different health professions work together as a team.Methods: Study data were collected by observing and videotaping palliative care team meetings. Data were then analyzed using direct content analysis.Results: The study findings substantiated many of the team practice concepts outlined in Latimer's model. Palliative care teams engage in a number of processes that address patient symptoms, suffering, hopes, and plans. However, several new findings also emerged from the data that were

  1. Piloting the role of a pharmacist in a community palliative care multidisciplinary team: an Australian experience

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    Box Margaret

    2011-10-01

    Full Text Available Abstract Background While the home is the most common setting for the provision of palliative care in Australia, a common problem encountered here is the inability of patient/carers to manage medications, which can lead to misadventure and hospitalisation. This can be averted through detection and resolution of drug related problems (DRPs by a pharmacist; however, they are rarely included as members of the palliative care team. The aim of this study was to pilot a model of care that supports the role of a pharmacist in a community palliative care team. A component of the study was to develop a cost-effective model for continuing the inclusion of a pharmacist within a community palliative care service. Methods The study was undertaken (February March 2009-June 2010 in three phases. Development (Phase 1 involved a literature review; scoping the pharmacist's role; creating tools for recording DRPs and interventions, a communication and education strategy, a care pathway and evidence based patient information. These were then implemented in Phase 2. Evaluation (Phase 3 of the impact of the pharmacist's role from the perspectives of team members was undertaken using an online survey and focus group. Impact on clinical outcomes was determined by the number of patients screened to assess their risk of medication misadventure, as well as the number of medication reviews and interventions performed to resolve DRPs. Results The pharmacist screened most patients (88.4%, 373/422 referred to the palliative care service to assess their risk of medication misadventure, and undertook 52 home visits. Medication reviews were commonly conducted at the majority of home visits (88%, 46/52, and a variety of DRPs (113 were detected at this point, the most common being "patient requests drug information" (25%, 28/113 and "condition not adequately treated" (22%, 25/113. The pharmacist made 120 recommendations in relation to her interventions. Fifty percent of online

  2. The palliative care needs of patients with stage 3 and 4 HIV infection

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    C Jameson

    2008-01-01

    Conclusions : Medical problems with poor symptom control were the commonest problems, followed by socioeconomic issues related to no income, poor living conditions and fears for the future of their children. Spiritual and psychological issues were surprisingly less of a problem possibly because the immediacy and severity of the demands of day-to-day survival. As a result of the needs identified among these patients, it became apparent that a palliative care ward catering to these needs was needed. The guiding principles in the development of this ward were the need for privacy, for a teamwork approach and for meticulous medical care, all of which underpin good palliative care.

  3. Palliative treatment of primary lung tumors with Transpulmonary Chemoembolization (TPCE); Transpulmonale Chemoembolisation (TPCE) als palliatives Behandlungskonzept bei primaeren Lungentumoren

    Energy Technology Data Exchange (ETDEWEB)

    Vogl, T.J.; Herzog, C.; Zangos, S.; Lindemayr, S. [Frankfurt Univ. (Germany). Inst. fuer Diagnostische und Interventionelle Radiologie

    2007-03-15

    Purpose: To evaluate transpulmonary chemoembolization (TPCE) as a symptomatic palliative method for treating inoperable primary lung tumors. Materials and Method: From 2002 to 2005, 17 patients (17 males, 3 females; average age: 64.5 years) suffering from primary lung tumors were treated in 3.6 sessions (range: 2 to 8) using TPCE. The patients had the following primary tumors: adenocarcinoma (n = 6), pleural mesothelioma (n = 2), squamous cell carcinoma (n = 1), small cell carcinoma (n = 1), and non-small cell carcinoma (n = 7). After femoral vein puncture, tumor-supplying pulmonary arteries were selectively explored, and 5 - 10 mg mitomycin C and 5 - 10 mL lipiodol and microsphere particles (Spherex) (20 - 70 {mu}m in diameter) were applied with balloon protection. Diagnosis and follow-up were performed in 4-week intervals with unenhanced and contrast-enhanced computed tomography (CT). The mean follow-up was 11.3 months. Results: Treatment was well tolerated by all patients with no major side effects or complications. The laboratory parameters were not significantly influenced. 11.8 % of the patients (n = 2) showed high or moderate lipiodol uptake, and 76.5 % (n = 13) showed low lipiodol uptake. After evaluation of morphologic criteria, a mean volume regression of 12.1 ml (40.4 %) of the embolized areas was achieved in four patients (23.5 %), while a constant value was identified during follow-up for seven patients (41.2 %). In six patients (35.3 %), progression of the treated lung tumors was recorded. The tumor increased by a mean of 38.37 ml (165.38 %). (orig.)

  4. Leadership in the African context

    Directory of Open Access Journals (Sweden)

    M. Masango

    2002-08-01

    Full Text Available The Western world has always viewed the African continent as plagued by corruption; dictatorship; military coups; rebellious leaders; greediness; misuse of power; and incompetent, politically unstable leaders - in effect, suspicious leaders who undermine their own democracies. This paper analyzes African leadership and its impact by concentrating on three historical eras, namely; the African Religious era; the Christian era, and the era of Globalization. These affected African leadership. In addition, many brilliant minds left the continent in search of greener pastures. A review of these three eras will help us understand how leadership shifted from African values into Western concepts. The role of missionaries lead African people to live with both an African and a Western concept of life. In spite of the above problems, our past leaders did their best in addressing the difficulties they faced during the three eras. African concepts of leadership were often regarded as barbaric and uncultured. Structures were evaluated by Western standards. Due to globalisation, African leaders, through programmes like NEPAD, are going back to basics, drawing on African concepts of unity among its leadership. Effectiveness or life-giving leadership is emerging and empowering villagers/communities in the continent. This type of leadership is innovative and has brought new hope for the continent.

  5. [Assessment of the spiritual needs of patients in palliative care].

    Science.gov (United States)

    Hajnová Fukasová, E; Bužgová, R; Feltl, D

    2015-01-01

    The appraisal and the right diagnostics of all needs and problems of patients, including the spiritual needs, are unavoidable for increase of the quality of the all-embracing nursing care. In the case of satisfying of the needs of the patients, it is important to have view the person as a unity of thebody and the soul. Identification and satisfying of the spiritual needs are not uncomplicated; moreover, spirituality does not have a target--ed and clear definition. In the palliative care, the solution and saturation of spiritual needs have a great priority, and it can be the key aspect of psychological activity. Also, medical experts are becoming aware of the meaning of spirituality as the part of psychological contentment more and more. Smaller importance is attached to measurement of spiritual needs, and in many medical institutions ends at the case history with the questions: "Are you a believer?", "Do you have any spiritual needs?". Spirituality and religion are very personal matters of every human. Many patients turn to religion to find answers to difficult questions while others find support through the spiritual beliefs outside the scope of organized religion. Mistaking of meanings of the spirituality and religionism can lead to many misunderstandings. The basic condition for the right diagnostics and satisfaction of spiritual needs are the definition of the used terms and using of standardized measurement devices in the clinical praxis. The target of summarizing study was to define the term of spirituality, to describe a lot of measurement devices these are suitable for the evaluation of human spiritual needs. For methodology for acquiring of the results of research works that are concerned with the questions of spiritual needs in case of the incurable patients, the following databases were used (2005-2013): EBSCO, Bibliographia Medica Čechoslovaca, Google Scholar, Solen - www.solen.cz, Profese on-line as the source of the data. The choice of studies were

  6. [Assessment of the spiritual needs of patients in palliative care].

    Science.gov (United States)

    Hajnová Fukasová, E; Bužgová, R; Feltl, D

    2015-01-01

    The appraisal and the right diagnostics of all needs and problems of patients, including the spiritual needs, are unavoidable for increase of the quality of the all-embracing nursing care. In the case of satisfying of the needs of the patients, it is important to have view the person as a unity of thebody and the soul. Identification and satisfying of the spiritual needs are not uncomplicated; moreover, spirituality does not have a target--ed and clear definition. In the palliative care, the solution and saturation of spiritual needs have a great priority, and it can be the key aspect of psychological activity. Also, medical experts are becoming aware of the meaning of spirituality as the part of psychological contentment more and more. Smaller importance is attached to measurement of spiritual needs, and in many medical institutions ends at the case history with the questions: "Are you a believer?", "Do you have any spiritual needs?". Spirituality and religion are very personal matters of every human. Many patients turn to religion to find answers to difficult questions while others find support through the spiritual beliefs outside the scope of organized religion. Mistaking of meanings of the spirituality and religionism can lead to many misunderstandings. The basic condition for the right diagnostics and satisfaction of spiritual needs are the definition of the used terms and using of standardized measurement devices in the clinical praxis. The target of summarizing study was to define the term of spirituality, to describe a lot of measurement devices these are suitable for the evaluation of human spiritual needs. For methodology for acquiring of the results of research works that are concerned with the questions of spiritual needs in case of the incurable patients, the following databases were used (2005-2013): EBSCO, Bibliographia Medica Čechoslovaca, Google Scholar, Solen - www.solen.cz, Profese on-line as the source of the data. The choice of studies were

  7. Palliative surgical bypass for unresectable periampullar y carcinoma

    Institute of Scientific and Technical Information of China (English)

    Shivendra Singh; Ajay Kumar Sachdev; Adarsh Chaudhary; Anil Kumar Agarwal

    2008-01-01

    BACKGROUND:Around 60% to 80% of patients with periampullary carcinoma are unresectable either due to distant metastasis or local vascular invasion. With the advancement of endoscopic interventional procedures, the role of surgical bypass has diminished. However, surgical bypass is still appropriate in patients with unresectable disease discovered at the time of surgery. This study was conducted to assess the results of palliative surgical bypass for patients with unresectable periampullary carcinoma at our hospital, a tertiary referral center of Northern India. METHOD:The study group comprised 204 patients who had undergone surgical bypass for advanced periampullary carcinoma over the last 15 years. RESULTS:Between January 1990 and December 2004, 204 patients (128 males, 76 females) consisting of 179 patients with carcinoma of head of the pancreas, 14 patients with ampullary carcinoma, 8 patients with lower end cholangiocarcinoma and 3 patients with duodenal carcinoma underwent surgical bypass. Their average age was 51 years (range 20-78 years). Both biliary and gastric bypasses were done in 158 (77.45%), biliary bypass alone in 37 (18.13%), and gastric bypass alone in 9 (4.32%). Biliary bypass was done by Roux-en-Y hepaticojejunostomy, and gastric bypass by retrocolic gastrojejunostomy. The overall postoperative mortality and morbidity were 0.98%and 26.9%, respectively. The patients who died had undergone previously endoscopic intervention. Complications included wound infection in 12.25% of the patients, bile leak in 5.12%, delayed gastric emptying in 5.38%, ascitic leak from drains in 8.8%, and upper gastrointestinal bleeding in 1.96%. The incidences of wound infection and bile leak both were signiifcantly higher in patients who had had preoperative biliary stenting. None of the patients who had undergone Roux-en-Y hepati-cojejunostomy+retrocolic gastrojejunostomy required any intervention later in their life. CONCLUSIONS:Surgical bypass is a safe procedure with

  8. Steps to African Development

    Institute of Scientific and Technical Information of China (English)

    2011-01-01

    The development of Africa is vital to the world’s sustainable development.However,African countries still face key challenges in achieving the meaningful expansion of their economies.At the High-Level Symposium on China-Africa Investment Cooperation in Xiamen,southeast China’s Fujian Province,held from September 8 to 10,Chen Deming,Minister of Commerce of China,elaborates on these challenges and sees

  9. Diversity among African pygmies.

    Science.gov (United States)

    Ramírez Rozzi, Fernando V; Sardi, Marina L

    2010-01-01

    Although dissimilarities in cranial and post-cranial morphology among African pygmies groups have been recognized, comparative studies on skull morphology usually pull all pygmies together assuming that morphological characters are similar among them and different with respect to other populations. The main aim of this study is to compare cranial morphology between African pygmies and non-pygmies populations from Equatorial Africa derived from both the Eastern and the Western regions in order to test if the greatest morphological difference is obtained in the comparison between pygmies and non-pygmies. Thirty three-dimensional (3D) landmarks registered with Microscribe in four cranial samples (Western and Eastern pygmies and non-pygmies) were obtained. Multivariate analysis (generalized Procrustes analysis, Mahalanobis distances, multivariate regression) and complementary dimensions of size were evaluated with ANOVA and post hoc LSD. Results suggest that important cranial shape differentiation does occur between pygmies and non-pygmies but also between Eastern and Western populations and that size changes and allometries do not affect similarly Eastern and Western pygmies. Therefore, our findings raise serious doubt about the fact to consider African pygmies as a homogenous group in studies on skull morphology. Differences in cranial morphology among pygmies would suggest differentiation after divergence. Although not directly related to skull differentiation, the diversity among pygmies would probably suggest that the process responsible for reduced stature occurred after the split of the ancestors of modern Eastern and Western pygmies.

  10. Diversity among African pygmies.

    Directory of Open Access Journals (Sweden)

    Fernando V Ramírez Rozzi

    Full Text Available Although dissimilarities in cranial and post-cranial morphology among African pygmies groups have been recognized, comparative studies on skull morphology usually pull all pygmies together assuming that morphological characters are similar among them and different with respect to other populations. The main aim of this study is to compare cranial morphology between African pygmies and non-pygmies populations from Equatorial Africa derived from both the Eastern and the Western regions in order to test if the greatest morphological difference is obtained in the comparison between pygmies and non-pygmies. Thirty three-dimensional (3D landmarks registered with Microscribe in four cranial samples (Western and Eastern pygmies and non-pygmies were obtained. Multivariate analysis (generalized Procrustes analysis, Mahalanobis distances, multivariate regression and complementary dimensions of size were evaluated with ANOVA and post hoc LSD. Results suggest that important cranial shape differentiation does occur between pygmies and non-pygmies but also between Eastern and Western populations and that size changes and allometries do not affect similarly Eastern and Western pygmies. Therefore, our findings raise serious doubt about the fact to consider African pygmies as a homogenous group in studies on skull morphology. Differences in cranial morphology among pygmies would suggest differentiation after divergence. Although not directly related to skull differentiation, the diversity among pygmies would probably suggest that the process responsible for reduced stature occurred after the split of the ancestors of modern Eastern and Western pygmies.

  11. Biofuels: The African experience

    Energy Technology Data Exchange (ETDEWEB)

    Carrillo, L.A.; Nkolo, M. [German Agency for Technical Cooperation GTZ, Delegation Regionale des Eaux et Forets, Bertoua (Cameroon)

    2009-07-01

    In July 2006, the African Non-Petroleum Producers Association was formed in Senegal, Africa to develop alternative energy sources. It involved 13 of Africa's poorest nations, who joined forces to become global suppliers of biofuels, and some have set mandatory mixing of ethanol into gasoline. Although several biofuel production projects have been launched in western Africa, many of the new projects and plantations have not yet reached maturity due to the time lag between plantation and full-scale production, which is about 6 years. Major projects that could be producing significant quantities of biofuels in the next few years are not yet reflected in production statistics. Although ethanol is not yet being produced in large quantities in Africa, short-term opportunities exist. Countries in the South African Development Community are using molasses from the sugar can industry to produce ethanol. Biodiesel is also not currently produced on a significant scale in western Africa, but several other countries are gaining experience with cotton and palm oil resources, and Jatropha. Biomass residue also represents a large potential for all African countries involved in timber production. Unlike biodiesel production, land use conflicts are not an issue with biomass residue production.

  12. A region-based palliative care intervention trial using the mixed-method approach: Japan OPTIM study

    Directory of Open Access Journals (Sweden)

    Morita Tatsuya

    2012-01-01

    Full Text Available Abstract Background Disseminating palliative care is a critical task throughout the world. Several outcome studies explored the effects of regional palliative care programs on a variety of end-points, and some qualitative studies investigated the process of developing community palliative care networks. These studies provide important insights into the potential benefits of regional palliative care programs, but the clinical implications are still limited, because: 1 many interventions included fundamental changes in the structure of the health care system, and, thus, the results would not be applicable for many regions where structural changes are difficult or unfeasible; 2 patient-oriented outcomes were not measured or explored only in a small number of populations, and interpretation of the results from a patient's view is difficult; and 3 no studies adopted a mixed-method approach using both quantitative and qualitative methodologies to interpret the complex phenomenon from multidimensional perspectives. Methods/designs This is a mixed-method regional intervention trial, consisting of a pre-post outcome study and qualitative process studies. The primary aim of the pre-post outcome study is to evaluate the change in the number of home deaths, use of specialized palliative care services, patient-reported quality of palliative care, and family-reported quality of palliative care after regional palliative care intervention. The secondary aim is to explore the changes in a variety of outcomes, including patients' quality of life, pain intensity, family care burden, and physicians' and nurses' knowledge, difficulties, and self-perceived practice. Outcome measurements used in this study include the Care Evaluation Scale, Good Death Inventory, Brief pain Inventory, Caregiving Consequence Inventory, Sense of Security Scale, Palliative Care Knowledge test, Palliative Care Difficulties Scale, and Palliative Care Self-reported Practice Scale. Study

  13. Perinatal Palliative Care: Barriers and Attitudes of Neonatologists and Nurses in Poland

    Directory of Open Access Journals (Sweden)

    Aleksandra Korzeniewska-Eksterowicz

    2013-01-01

    Full Text Available Objective. To identify barriers and personnel attitudes towards realization of palliative care principles in neonatological units. Study Design. An anonymous questionnaire was posted to all heads of departments and head nurses of all the 27 neonatological units in the Lodz area. Results. We received 46 (85% questionnaires. Final analysis comprised 42 properly filled-in questionnaires (by 22 doctors and 20 nurses. In case of prenatal diagnosis of a lethal defect, 77.27% of doctors and 65% of nurses opted for informing the mother also about the possibility of pregnancy continuation and organization of palliative care after delivery. Most of respondents accepted conditions for abortion pointed by the Polish law. The most common barriers pointed out by both groups were insufficient knowledge of the personnel on palliative medicine and family preference for life sustaining treatment. Conclusions. Understanding attitudes of personnel towards palliative care and identification of barriers are a starting point for future efforts to improve the system of neonatological care.

  14. Paediatric palliative care : recommendations for treatment of symptoms in the Netherlands

    NARCIS (Netherlands)

    Knops, Rutger R. G.; Kremer, Leontien C. M.; Verhagen, A. A. Eduard

    2015-01-01

    Background: Children dying of a life threatening disease suffer a great deal at the end of life. Symptom control is often unsatisfactory, partly because many caregivers are simply not familiar with paediatric palliative care. To ensure that a child with a life-threatening condition receives high qua

  15. Physical therapy in palliative care: From symptom control to quality of life: A critical review

    Directory of Open Access Journals (Sweden)

    Senthil P Kumar

    2010-01-01

    Full Text Available Physiotherapy is concerned with identifying and maximizing movement potential, within the spheres of promotion, prevention, treatment and rehabilitation. Physical therapists practice in a broad range of inpatient, outpatient, and community-based settings such as hospice and palliative care centers where as part of a multidisciplinary team of care, they address the physical and functional dimensions of the patients′ suffering. Physiotherapy treatment methods like therapeutic exercise, electrical modalities, thermal modalities, actinotherapy, mechanical modalities, manual physical therapy and assistive devices are useful for a range of life-threatening and life-limiting conditions like cancer and cancer-associated conditions; HIV; neurodegenerative disorders like amyotrophic lateral sclerosis, multiple sclerosis; respiratory disorders like idiopathic pulmonary fibrosis; and altered mental states. The professional armamentarium is still expanding with inclusion of other miscellaneous techniques which were also proven to be effective in improving quality of life in these patients. Considering the scope of physiotherapy in India, and in palliative care, professionals in a multidisciplinary palliative care team need to understand and mutually involve toward policy changes to successfully implement physical therapeutic palliative care delivery.

  16. Medication use during end-of-life care in a palliative care centre

    NARCIS (Netherlands)

    A.D. Masman (Anniek); M. van Dijk (Monique); D. Tibboel (Dick); F.P.M. Baar (Frans); R.A. Mathot (Ron)

    2015-01-01

    textabstractBackground In end-of-life care, symptoms of discomfort are mainly managed by drug therapy, the guidelines for which are mainly based on expert opinions. A few papers have inventoried drug prescriptions in palliative care settings, but none has reported the frequency of use in combination

  17. A comparative study of the palliative care needs of heart failure and cancer patients.

    LENUS (Irish Health Repository)

    O'Leary, Norma

    2012-02-01

    AIMS: Studies suggest that patients with advanced heart failure (HF) have unmet palliative care (PC) needs. However, many of these studies have been retrospective or based on patients receiving poorly coordinated ad hoc care. We aimed to demonstrate whether the PC needs of patients with advanced HF receiving specialist multidisciplinary coordinated care are similar to cancer patients deemed to have specialist PC needs; thereby justifying the extension of specialist PC services to HF patients. METHODS AND RESULTS: This was a cross-sectional comparative cohort study of 50 HF patients and 50 cancer patients, using quantitative and qualitative methods. Both patient cohorts were statistically indistinguishable in terms of symptom burden, emotional wellbeing, and quality-of-life scores. HF patients had good access to community and social support. HF patients particularly valued the close supervision, medication monitoring, ease of access to service, telephone support, and key worker provided at the HF unit. A small subset of patients had unmet PC needs. A palliative transition point is described. CONCLUSION: HF patients should not be excluded from specialist PC services. However, the majority of their needs can be met at a HF unit. Recognition of the palliative transition point may be key to ensuring that end-of-life issues are addressed. The palliative transition point needs further evaluation.

  18. End-of-Life Decisions and Palliative Care in Advanced Heart Failure.

    Science.gov (United States)

    Meyers, Deborah E; Goodlin, Sarah J

    2016-09-01

    Advanced heart failure (HF) therapies are focused on extending life and improving function. In contrast, palliative care is a holistic approach that focuses on symptom alleviation and patients' physical, psychosocial, and spiritual needs. HF clinicians can integrate palliative care strategies by incorporating several important components of planning and decision-making for HF patients. Future care planning (FCP) for HF patients should incorporate the basic tenets of shared decision-making (SDM). These include understanding the patient's perspective and care preferences, articulating what is medically feasible, and integrating these considerations into the overall care plan. Use of defined triggers for FCP can stimulate important patient-caregiver conversations. Guidelines advocate an annual review of HF status and future care preferences. Advance directives are important for any individual with a chronic, life-limiting illness and should be integrated into FCP. Nevertheless, use of advance directives by HF patients is extremely low. Consideration of illness trajectories and risk-scoring tools might facilitate prognostication and delivery of appropriate HF care. Decisions about heart transplantation or left ventricular assist device implantation should include planning for potential complications associated with these therapies. Such decisions also should include a discussion of palliative management, as an alternative to intervention and also as an option for managing symptoms or adverse events after intervention. Palliative care, including FCP and SDM, should be integrated into the course of all patients with advanced HF. Clinicians who provide HF care should acquire the skills necessary for conducting FCP and SDM discussions.

  19. Towards a standardised approach for evaluating guidelines and guidance documents on palliative sedation: Study protocol

    NARCIS (Netherlands)

    E. Abarshi (Ebun); J.A.C. Rietjens (Judith); A. Caraceni; S. Payne (Sheila); L. Deliens (Luc); L. van den Block (Lieve)

    2014-01-01

    textabstractBackground: Sedation in palliative care has received growing attention in recent years; and so have guidelines, position statements, and related literature that provide recommendations for its practice. Yet little is known collectively about the content, scope and methodological quality

  20. Complex aortopulmonary window in a single ventricle setting: Technical considerations for staged palliation

    Directory of Open Access Journals (Sweden)

    Gananjay G Salve

    2016-01-01

    Full Text Available We report a successful surgical management of a case presented with a combination of aortopulmonary window (APW with large ventricular septal defect (VSD amounting to a single ventricle, with a view to highlight technical considerations during staged single-ventricle palliation.