Palliative medicine
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Palliative medicine · Mar 2008
Case ReportsOpioid withdrawal syndrome on switching from hydromorphone to alfentanil.
Opioid switching is increasingly practiced. This patient did not tolerate morphine, oxycodone or hydromorphone due to opioid toxicity. ⋯ Administration of small aliqouts of this drug reversed the symptoms. The existance of incomplete cross tolerance between hydromorphone and alfentanil is demonstrated.
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Palliative medicine · Jan 2008
Multicenter StudyPreferences for location of death of seriously ill hospitalized patients: perspectives from Canadian patients and their family caregivers.
Previous studies involving palliative patients suggest a preference for dying at home. The purpose of this paper is to examine, prospectively, patient and family caregiver preferences for, and congruence with, location of death for hospitalized patients with cancer and end-stage medical conditions. Questionnaires were administered to 440 eligible in-patients and 160 family caregivers in five hospitals across Canada. ⋯ The results suggest that only half of all patients and family caregivers report a preference for a home death. Furthermore, half of the patient/family caregiver dyads disagree on preferred location of death. If one of the primary goals of end of life care is to enhance the quality of life of dying patients and their family caregivers, policies directed towards ensuring that patients die in their location of choice ought to be a priority and resources should be allocated to promote the development of excellent care, not only in the home, but also within our institutional settings.
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Palliative medicine · Jan 2008
Cancer specialists' palliative care referral practices and perceptions: results of a national survey.
Cancer specialists can facilitate timely and appropriate access to specialized palliative care (SPC) services. To better match patients' needs with access to SPC services, we must understand factors associated with referral. This study aimed to investigate cancer specialists' referral practices, perceptions of, barriers to and triggers for referral of people with advanced cancer to SPC services. ⋯ Specialists mainly refer people with advanced cancer for symptom-related reasons. Measures are needed to encourage ongoing needs-based assessments, especially of emotional, cultural and spiritual issues.
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Palliative medicine · Jan 2008
Populations who die without specialist palliative care: does lower uptake equate with unmet need?
In palliative care, the target population (all people with life-limiting illnesses and their family/caregivers) and the complexity of their needs from diagnosis to bereavement should define the subpopulation who access specialist palliative care services (SPCS). Have caregivers of patients who have not accessed SPCS had their needs met? ⋯ SPCS under utilization has previously been described in the population subgroups explored in this study and assumed to equal unmet needs and poorer outcomes. Caregiver responses suggest that, except for people with a non-cancer diagnosis, lack of service uptake may not represent unmet needs. These results are limited to people with caregivers.