Current opinion in supportive and palliative care
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Curr Opin Support Palliat Care · Mar 2008
ReviewDignity-based approaches in the care of terminally ill patients.
Promoting dignified dying is an altruistic goal in palliative care. Until recently, what was meant by this construct was poorly understood. This review seeks to clarify what is meant by dignity at the end of life, what threatens dignity, and evidence of the domains that define dignity. A model of dignity is proposed from which interventions can be derived. ⋯ Despite the fact that little research exists exploring the notion of dignity at the end of life, a robust model of dignity exists and is helpful in directing interventions aimed at improving care at the end of life.
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This review provides an overview of the immunological effects of commonly used analgesic opioid drugs with particular emphasis on human studies, with the final aim to highlight their potential clinical relevance. ⋯ The impact of opioid drug treatment on immunity may be a new safety concern for the physician. Although many advances have been made in understanding the effects of opioid drugs on immune responses, their relevance is not completely clear. The scientific community must be aware that it is about time to perform well designed clinical studies in order to assess the importance of opioid-induced immune suppression.
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Curr Opin Support Palliat Care · Mar 2008
ReviewManagement of constipation in palliative care patients.
Constipation is a common symptom in palliative care patients that can generate considerable suffering due to both unpleasant physical symptoms and psychological preoccupations that may arise. There is uncertainty about the choice from varying recommendations for management of constipation and a varying clinical practice in palliative care settings. The purpose of the review is to evaluate the current recommendations of therapy guidelines and to determine the effectiveness of laxative administration for the management of constipation in palliative care patients. ⋯ The treatment of constipation in palliative care is based on inadequate experimental evidence, such that there are insufficient randomized controlled trial data. Recommendations for laxative use can be related to efficacy. Particularly in patients with advanced-stage tumor disease this must be undertaken with careful consideration of their physical activity and dietary needs.
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Curr Opin Support Palliat Care · Dec 2007
ReviewPsychological, social and spiritual distress at the end of life in heart failure patients.
Chronic heart failure patients have palliative care needs that include psychosocial and spiritual support, particularly towards the end of life, when breathlessness and resultant immobility become increasingly severe. This review informs clinicians of the importance of understanding, assessing and managing patients' psychosocial and spiritual needs. ⋯ We hope this review will inform cardiac and palliative care staff about the prevalence of psychosocial and spiritual distress in advanced chronic heart failure, and highlight the importance of their assessment and management. There is an urgent need for research in this field, including the rigorous development and evaluation of service models and nonpharmacological interventions.
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Curr Opin Support Palliat Care · Dec 2007
ReviewDifficult conversations and chronic heart failure: do you talk the talk or walk the walk?
Effective communication is critical for palliative and supportive care in heart failure. This article contains a review of available information to assist clinicians in undertaking discussions regarding prognosis, treatment decisions and advance care planning. ⋯ When having these difficult conversations, clinicians need to assess the individual's need and wishes for information as well as their social and cultural background. They also need to consider the setting, timing and content of the discussion, as well as strategies to promote coping and adjustment. Most importantly, patients need a treatment plan to address palliative and supportive care needs to be implemented at the time of breaking this bad news, so that they and their families do not feel abandoned. Learning effective communication skills, implementing strategies for debriefing and the fostering of a team approach, may minimize burden on health providers and improve palliative and supportive care for people with heart failure.