Palliative medicine
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Palliative medicine · Apr 2012
Is patient autonomy a critical determinant of quality of life in Korea? End-of-life decision making from the perspective of the patient.
We aimed to investigate the current practice of the involvement in decision making from the perspectives of terminal cancer patients, and to explore its possible associations with quality of life and quality of death in Korea. ⋯ in Korea, patient autonomy is not a universally accepted value from the perspectives of terminal cancer patients, nor is patient involvement in decision making always conducive to high quality of life or quality of death. The level of information and the pace at which it is provided should be tailored to each individual's ability, preference, need, and culture.
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Palliative medicine · Apr 2012
'That's part of everybody's job': the perspectives of health care staff in England and New Zealand on the meaning and remit of palliative care.
the right for patients of all diagnoses to be in receipt of palliative care from an early point in the diagnosis of a life-limiting condition is now enshrined in policy in a number of countries and increased emphasis is placed upon the role of generalist palliative care. However, little is known as to how this policy is enacted on the ground. ⋯ these data indicate that, within England and New Zealand, the policy rhetoric of universal palliative care provision is not being straightforwardly translated into service delivery and individual clinical practice. Further research is required to explore and evaluate different models of organization and service provision that empower 'generalists' to provide palliative care, without resulting in deskilling. Finally, definitional clarity at an academic/policy level is also needed.
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Palliative medicine · Apr 2012
Factors associated with perceived barriers to pediatric palliative care: a survey of pediatricians in Florida and California.
The provision and uptake of pediatric palliative care continues to be plagued by barriers. Several studies have documented these barriers, but none have done so with a diverse sample (most are at a single institution) or specifically about pediatric palliative care. Moreover, none have investigated the factors associated with perceived barriers. Our study has two aims: (1) to describe the barriers to pediatric palliative care as reported by a group of pediatricians practicing in two large States in the US; and (2) to identify factors associated with these perceived barriers. ⋯ Our findings can be used to develop targeted educational interventions towards providers and families. Understanding the factors that are driving the low uptake in palliative care is the first step in advancing pediatric palliative care overall.
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Clinical experience suggests that screening for delirium on admission to a hospice is often omitted but early recognition and detection can improve outcome for these patients. In a series of audits we have evidenced low use of the recommended screening tool provided within the admission proforma of two hospices. In some circumstances this omission is appropriate to the clinical situation, however the results show this is not always the case. These results have highlighted implications for future work exploring the barriers to routine cognitive screening on admission to an inpatient unit.
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Palliative medicine · Mar 2012
ReviewMethodological challenges in researching psychological distress and psychiatric morbidity among patients with advanced cancer: what does the literature (not) tell us?
Patients with advanced cancer experience multiple demands and losses that place them at risk for experiencing psychological distress. Researchers can face challenges in conducting research among this population because of their poor levels of physical and cognitive functioning. This paper aims to develop our understanding of these challenges. ⋯ Significant portions of the advanced cancer population are excluded from distress studies or are refusing to take part. In conclusion, researchers can enhance the methodological knowledge base by presenting more detailed accounts of the participant recruitment and data collection processes. Future researchers should strive to develop more flexible methods of assessing distress among patients with advanced disease.