Journal of pain and symptom management
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J Pain Symptom Manage · Oct 2020
Terminally ill cancer patients' emotional preparedness for death is distinct from their accurate prognostic awareness.
Emotional preparedness for death (hereafter called death preparedness) and prognostic awareness (PA), a distinct but related concept, each contributes to patients' practical, psychological, and interpersonal preparations for death. However, the distinction between these two concepts has never been investigated. ⋯ The distinction between death preparedness and accurate PA was supported by their poor agreement, lack of reciprocal associations, and two different sets of predictors. Health care professionals should not only cultivate cancer patients' accurate PA but also facilitate emotional preparation for death to achieve a good death and improve end-of-life care quality.
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The International Association for Hospice and Palliative Care developed a consensus-based definition of palliative care (PC) that focuses on the relief of serious health-related suffering, a concept put forward by the Lancet Commission Global Access to Palliative Care and Pain Relief. ⋯ Participants had significantly different perceptions and interpretations of PC. The greatest challenge faced by the core group was trying to find a middle ground between those who think that PC is the relief of all suffering and those who believe that PC describes the care of those with a very limited remaining life span.
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The coronavirus disease 2019 (COVID-19) pandemic has highlighted the need for health care providers skilled in rapid and flexible decision making, effective and anticipatory leadership, and in dealing with trauma and moral distress. Palliative care (PC) workers have been an essential part of the COVID-19 response in advising on goals of care, symptom management and difficult decision making, and in supporting distressed health care workers, patients, and families. We describe Global Palliative Education Collaborative (GPEC), a training partnership between Harvard, University of California San Francisco, and Tulane medical schools in the U. ⋯ S.-based PC fellows participation in an international elective to learn about resource-limited PC provision, gain perspective on global challenges to caring for patients at the end of life, and cultivate resiliency. International PC colleagues have much to teach about practicing compassionate PC amidst resource constraints and humanitarian crisis. We also describe a novel educational project that our GPEC faculty and fellows are participating in-the Resilience Inspiration Storytelling Empathy Project-and discuss positive outcomes of the project.
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J Pain Symptom Manage · Oct 2020
"To speak of death is to invite it": Provider perceptions of palliative care for cardiovascular patients in Western Kenya.
Cardiovascular disease (CVD) is the leading cause of death globally and a significant health burden in Kenya. Despite improved outcomes in CVD, palliative care has limited implementation for CVD in low-income and middle-income countries. This may be partly because of providers' perceptions of palliative care and end-of-life decision making for patients with CVD. ⋯ These results suggest that attainable interventions supported by local providers can help improve CVD care and quality of life for patients living with advanced heart disease in low-resource settings worldwide.
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J Pain Symptom Manage · Oct 2020
Narrative Approach to Goals of Care Discussions: Assessing Use of the 3-Act Model in the Clinical Setting.
The 3-Act Model is an innovative narrative approach to goals of care (GOC) discussions centered on patients' unique stories. Previous studies have demonstrated the effectiveness of the 3-Act Model training in enhancing trainees' skills objectively in role-plays with standardized patients. This study moves beyond the classroom to the clinical setting to assess whether learners preferred this approach, believed it to be clinically effective, and demonstrated proficiency objectively. ⋯ The vast majority of interns reported preferential use and effectiveness of the 3-Act Model several months after training, and trainers found a subset to be proficient in GOC discussions with hospitalized patients. This study contributes evidence that training in the 3-Act Model positively impacted intern behavior in the clinical setting.