Journal of pain and symptom management
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J Pain Symptom Manage · Mar 2018
Toward a Fully Fledged Integration of Spiritual Care and Medical Care.
In this article, we aimed to set out current problems that hinder a fully fledged integration of spiritual and medical care, which address these obstacles. We discuss the following five statements: 1) spiritual care requires a clear and inclusive definition of spirituality; 2) empirical evidence for spiritual care interventions should be improved; 3) understanding patients' experiences of contingency is paramount to deliver effective spiritual care; 4) attention to spiritual needs of patients is a task for every health care practitioner; 5) courses on spirituality and spiritual care should be mandatory in the medical curriculum. ⋯ Using a clear and inclusive definition of spirituality and substantiating spiritual care using medical standards of evidence-based practice is a way to speak each other's language and to increase mutual understanding. Furthermore, including spirituality in the medical curriculum would raise awareness of medical practitioners for their task of attending to patients' spiritual needs and, subsequently, to better and more appropriate referral for spiritual care.
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J Pain Symptom Manage · Mar 2018
Oncologists' and patients' perceptions of initial, intermediate, and final goals of care conversations.
Although recommendations are for goals of care (GoC) conversations to happen early and often, their timing and content over the disease course remain unclear. ⋯ Although GoC conversations should follow individual patient preferences, our findings offer structure for their timing and content.
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J Pain Symptom Manage · Mar 2018
A nationwide survey about palliative sedation involving Japanese palliative care specialists: Intentions and key factors used to determine sedation as proportionally appropriate.
Although there has long been debate about physicians' intentions and what physicians consider to be proportionally appropriate when performing palliative sedation, few large studies have been performed. ⋯ Japanese palliative care specialists explicitly intend to control symptoms and reduce the level of consciousness when performing continuous deep sedation, but there are differences in their intentions with regard to maintaining unconsciousness until death. Predicted survival, patients' wishes, and confidence in refractoriness are associated with physicians' judgment that sedation is proportionally appropriate.
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J Pain Symptom Manage · Mar 2018
Physicians' Opinions on Engaging Patients' Religious and Spiritual Concerns: A National Survey.
There has been a sustained debate in the medical literature over whether physicians should engage with patients' religious and spiritual concerns. ⋯ The majority of U.S. physicians endorse a limited role in the provision of spiritual care, although opinions varied based on physicians' religious characteristics.
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J Pain Symptom Manage · Mar 2018
Bringing the Medical Home back Home in the Context of Population Health - Home-Based Primary Care and Home-Based Palliative Care.
With the growth of value-based care, payers and health systems have begun to appreciate the need to provide enhanced services to homebound adults. Recent studies have shown that home-based medical services for this high-cost, high-need population reduce costs and improve outcomes. ⋯ Given workforce constraints and growing demand, both HBPC and HBPalC will benefit from working together within a population health framework-where HBPC provides care to all patients who have trouble accessing traditional office practices and where HBPalC offers adjunctive care to patients with high symptom burden and those who need assistance with goals clarification. Policy changes that support provision of medical care in the home, population health strategies that tailor home-based medical care to the specific needs of the patients and their caregivers, and educational initiatives to assure basic palliative care competence for all home-based medical providers will improve access and reduce illness burden to this important and underrecognized population.