Journal of pain and symptom management
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J Pain Symptom Manage · Dec 2010
Hospital mortality rates: how is palliative care taken into account?
Using mortality rates to measure hospital quality presumes that hospital deaths are medical failures. To be a fair measure of hospital quality, hospital mortality measures must take patient-level factors, such as goals of care, into account. ⋯ Proliferation of, and variability among, hospital mortality measures creates a challenge for hospital administrators. PC and hospice leaders need to educate themselves and their hospital administrators about the extent to which these mortality rates take end-of-life care into account. At the national level, PC and hospice leaders should take advantage of opportunities to engage these mortality raters in conversation about possible changes in their methods and to conduct further research on this topic.
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J Pain Symptom Manage · Dec 2010
Existential and supportive care needs among patients with chronic kidney disease.
Living with chronic kidney disease (CKD) is associated with spiritual distress and frequently precipitates a search for meaning and hope; yet, very little is known about these patients' spiritual needs. ⋯ These patients had substantial spiritual and supportive care needs. There were no clear predictors of high spiritual or supportive care needs, highlighting the importance of evaluating all CKD patients for unmet needs. Health professionals will need to better understand and attend to CKD patients' spiritual needs to optimize quality care.
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J Pain Symptom Manage · Dec 2010
"At the foot of a very long ladder": discussing the end of life with older people and informal caregivers.
International policy advocates the development of approaches to raise public awareness about end-of-life-care issues, so that when people face a final illness, they may better articulate their needs for care. This article reports findings from one approach of engaging older members of the general public and informal caregivers in discussions about end-of-life care. ⋯ Further community-based solutions to questions of quality of death need to be found, encouraged by programs of public education.