Journal of pain and symptom management
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J Pain Symptom Manage · Oct 2023
Service level characteristics of rural palliative care for people with chronic disease.
Despite clear benefit from palliative care in end-stage chronic, non-malignant disease, access for rural patients is often limited due to workforce gaps and geographical barriers. ⋯ Palliative care service structure and capacity varies across rural areas, and relies on a complex, at times ad hoc, network of onsite and external supports. Services for people with chronic, non-malignant disease are sparse and largely unknown, with a call for the development of specific referral pathways to improve patient care.
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J Pain Symptom Manage · Oct 2023
Professional Roles, Services, and Quality of Life for End-of-Life Doulas in the United States.
End-of-life doulas provide support to the chronically ill, dying, and their families. However, little is known about the roles and services of doulas practicing in the United States. ⋯ In the complex healthcare system of the United States, end-of-life doulas offer valuable interpersonal services like legacy and grief work as well as practical services like financial and logistical end-of-life planning.
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J Pain Symptom Manage · Oct 2023
Should (prophylactic) medications be used for the management of death rattle?
Death rattle is a common symptom in the dying phase and has impact on relatives and health care providers. One controversial topic regarding the management of death rattle in the dying phase is whether the symptom should be treated. In this "Controversies in Palliative Care" article, three expert clinicians independently answer this question. ⋯ But considering the known burden on some of the relatives, there might be good reasons to use medication to relieve this symptom. Whether this treatment should be performed preventively or only when death rattle develops remains an matter of debate. Further scientific, clinical, and societal debate on the concept of a "good death" for relatives, the meaning of the symptom death rattle, and the impact of medication is needed.
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J Pain Symptom Manage · Sep 2023
Real world experience of change in psycho-existential symptoms in palliative care.
Psycho-existential symptoms in palliative care are addressed insufficiently. Routine screening, ongoing monitoring and meaningful treatment of psycho-existential symptoms may contribute to the relief of suffering in palliative care. ⋯ As we better recognize through screening patients carrying psycho-existential distress in palliative care programs, there is considerable room for improvement in ameliorating this suffering. Inadequate clinical skills, poor psychosocial staffing or a biomedical program culture may all contribute to inadequate symptom control. Person-centered care necessitates greater attention to authentic multidisciplinary care that ameliorates psycho-spiritual and existential distress.