Palliative & supportive care
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Palliat Support Care · Mar 2010
Beyond communication: the development of a training program for hospital and hospice staff in the detection and management of psychological distress--preliminary results.
In the United Kingdom, a Four-Tier Model of Psychological Support has been recommended for all patients with cancer and their families. This model suggests that staff at Tier 2, such as nurses, doctors, and allied health professionals, should be proficient in screening for psychological distress and intervening with techniques such as psycho-education and problem solving. Research has suggested that although communication skills training is essential for staff working in cancer services, it does not necessarily improve the detection of specific psychological disorder or staff confidence in intervening with highly distressed patients. The objective was therefore to design a training program that addressed this deficit and was easily accessible to hospital staff. ⋯ Although the results have limitations and the data are subjective, we can conclude that this course significantly improves staff confidence in dealing with psychological distress and that this increased confidence is maintained over a 6-month follow-up period.
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Palliat Support Care · Dec 2009
Randomized Controlled TrialSeriously ill patients' discussions of preparation and life completion: an intervention to assist with transition at the end of life.
Patients approaching the end of life not only face challenges to physical well-being but also threats to emotional and spiritual integrity. Yet, identifying appropriate, effective, and brief interventions to address those concerns has proven elusive. We developed an intervention based on life review and emotional disclosure literatures and conducted a pilot study to determine feasibility and acceptability. This article presents qualitative intervention responses. ⋯ Discussions of life completion may improve important health outcomes for patients at the end of life. This intervention may provide a brief, standardized, and transportable means for improving the quality of life of patients with advanced serious illness.
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Palliat Support Care · Dec 2009
ReviewApplying feminist, multicultural, and social justice theory to diverse women who function as caregivers in end-of-life and palliative home care.
Women are largely responsible for providing care to terminally ill family members at home. The goal of this review is to conceptualize diverse women's experiences in palliative home care from feminist, multicultural, and social justice perspectives. ⋯ The principle finding of the review was the highlighting of potential risks that culturally diverse female caregivers are likely to face at the end of life. The application of social justice theory provides a number of implications for practice and policy. Specifically, the identifying significant concerns regarding female caregivers in palliative home care, as well as suggesting ways to appropriately attend to these concerns, and oppression of women is less likely to be perpetuated, specific areas for future research in this domain are identified.
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Palliat Support Care · Dec 2009
Delirium superimposed on dementia versus delirium in the absence of dementia: phenomenological differences.
To examine differences in the phenomenological characteristics of delirium superimposed on dementia compared to those observed in delirious patients without dementia, based on the rating items of the Memorial Delirium Assessment Scale (MDAS). ⋯ Delirium superimposed on dementia has phenomenological differences compared to delirium in the absence of dementia. There are no significant differences in the severity of hallucinations, delusions, psychomotor behavior, or sleep-wake cycle disturbances. However, level of disturbance in consciousness (arousal and awareness) and impairments in multiple cognitive domains are significantly more severe in patients with delirium superimposed on dementia.
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A lightening, or clearing, of the mental state in the hours or days before death, particularly in those delirious, is occasionally noted by those caring for the dying. Similar phenomena have been described in the natural world and in classical literature. ⋯ The increasing use of palliative sedation may diminish the possibility of lightening up before death occurring. The theoretical concepts of Hughlings Jackson may provide an explanation for this phenomenon.