Palliative medicine
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Palliative medicine · Mar 2007
ReviewFeeling like a burden to others: a systematic review focusing on the end of life.
Research into the burden of illness has focused predominantly on family caregivers, with little consideration of the other side of the caregiving relationship-care recipients' perspectives on having become a 'burden to others'. However, there is now a small but growing body of evidence to suggest that worry about creating burden to others is a common and troubling concern for people who are nearing the end of their lives. This concern is referred to as 'self-perceived burden'. ⋯ It is correlated with loss of dignity, suffering, and a 'bad death'. Self-perceived burden has also been identified as a relevant factor in death-hastening acts among patients with life-threatening illness, as well as in clinical decisions, such as the choice of place of care at the end of life, advance directives, and acceptance of treatment. Given the unique challenges faced by patients with advanced disease and their families, there is a need for further investigation into this under-researched area.
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Palliative medicine · Jan 2007
Multicenter Study Comparative StudyTerminally-ill people living alone without a caregiver: an Australian national scoping study of palliative care needs.
Home-based palliative care services are facing increasing challenges in servicing the needs of clients who live alone and without a primary caregiver. The findings from the analysis of 721 services' records from three Australian states, and feedback from health professionals in interviews and postal surveys, demonstrated that there were aspects of being on one's own with a terminal illness and living at home that require a specialised approach and support. This study explored the issues of palliative care patients living alone, from a service provider perspective, and provided evidence-based information to assist with service planning. The study made recommendations to the Australian Department of Health and Ageing about services considered important in developing support structures for this growing population.
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Palliative medicine · Jan 2007
Comparative StudyA retrospective review of place of death of palliative care patients in regional north Queensland.
Palliative care strives to offer patients and their families choice in the location of their management and final terminal care. The place of death has been shown to be related to various patient, carer and health service factors. ⋯ The results of this study are in keeping with available, largely urban-based literature, with respect to predictive factors of home death. Further prospective study, with an emphasis on choice regarding place of care and GP involvement with palliative care patients, is warranted.
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Palliative medicine · Jan 2007
Acceptability of an advance care planning interview schedule: a focus group study.
There is growing recognition that patients should have greater opportunity to plan their future care, a process known as advance care planning. The aims of this phase I qualitative focus group study were (1) to explore the acceptability of an interview schedule, designed to encourage conversations regarding future care; and (2) to explore the suitability of such discussions and inquire about their possible timing, nature and impact. Purposive sampling was used to achieve a balanced sample of 22 palliative care and oncology patients, relatives and user group members. ⋯ Advance care planning should take place over a number of meetings, and be conducted by an appropriately trained professional with sufficient time to talk through the issues raised, and with the knowledge and skills to answer questions, tailor the discussion to the individual, and avoid destroying hope. Advance decisions to refuse treatment should not be the focus of the discussion, but one component of a broader conversation about end-of-life issues. If patients make an advance decision to refuse certain treatments, they should be given the opportunity to change their minds in the future.