Palliative medicine
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Palliative medicine · Jul 2000
Multicenter Study Comparative StudyAttitudes and beliefs of palliative care physicians regarding communication with terminally ill cancer patients.
The subject of communication between palliative care physicians and their patients regarding their diagnosis and prognosis has not been extensively researched. The purpose of this survey was to compare the attitudes and beliefs of palliative care specialists regarding communication with the terminally ill in Europe, South America, and Canada. A sample of palliative care physicians from South America (Argentina and Brazil), French-speaking Europe, and Canada were identified, and posted a questionnaire. ⋯ Canadian physicians were more likely to support autonomy as compared with beneficence. In summary, our findings suggest that there are major regional differences in the attitudes and beliefs of physicians regarding communication at the end of life. More research is badly needed on the attitudes and beliefs of patients, families, and health care professionals in different regions of the world.
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Palliative medicine · Jul 2000
Multicenter StudyA multicentre international study of sedation for uncontrolled symptoms in terminally ill patients.
The issue of symptom management at the end of life and the need to use sedation has become a controversial topic. This debate has been intensified by the suggestion that sedation may correlate with 'slow euthanasia'. The need to have more facts and less anecdote was a motivating factor in this multicentre study. ⋯ Midazolam was the most common medication prescribed to achieve sedation. The diversity in symptom distress, intent to sedate and use of sedatives, provides further knowledge in characterizing and describing the use of deliberate pharmacological sedation for problematic symptoms at the end of life. The international nature of the patient population studied enhances our understanding of potential differences in definition of symptom issues, variation of clinical practice, and cultural and psychosocial influences.
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Palliative medicine · Jul 2000
ReviewCardiopulmonary resuscitation for palliative care patients: a discussion of ethical issues.
Medical advances have significantly improved the prognosis and life-expectancy for many patients with life-threatening illness. However, the ability to extend and prolong life increases the complexity of clinical decision-making, and this is particularly true in the context of palliative care. ⋯ It is in this setting that ethical dilemmas are likely to arise regarding the use of life-prolonging measures such as cardiopulmonary resuscitation (CPR). This paper considers some of the ethical issues surrounding the use of CPR for palliative care patients in the hospital setting.
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Palliative medicine · Jul 2000
Cognitive impairment and its influence on pain and symptom assessment in a palliative care unit: development of a Minimal Documentation System.
Symptom assessment in the palliative care unit must consider the reduced physical and mental status of the patients. Standardized instruments are often not completed by patients with cognitive impairment. We tried to combine minimal burden for patients and staff with sufficient information content in a Minimal Documentation System (MIDOS) for pain and symptom assessment in palliative care patients. ⋯ Pain and symptom assessments were performed by the physician for 17% of the patients at admission, and for 16% of the follow-up controls because self-assessment was not possible. In this study, cognitive impairment prevented symptom assessment with longer and more complicated instruments such as the SF-12 in a large number of the patients admitted to the palliative care unit. Assessment instruments for patients with advanced disease must provide simple categorical scales and the possibility of being administered by interview.
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Palliative medicine · Jul 2000
Palliative day care: what do services do? Palliative Day Care Project Group.
Palliative day care has expanded rapidly in the recent years, but the types of care available vary. To understand more about the different models of day care we conducted a questionnaire survey of the 43-day care centres in North and South Thames Regions in England (total population 13.75 million). The questionnaire covered: management, staffing and organizational policies; the numbers, types and reasons for referral; and the services and care provided. ⋯ Centres describing themselves as more or mostly social were less likely to undertake daily assessment of new symptoms and wound care (chi-squared 13.0, 10.1, respectively, df 4, P < 0.05). However, we found no significant differences between centres describing themselves as more medical or more social in reported levels of staffing, who was in charge, funding or most activities. The findings suggest that there are core activities offered in palliative day care, but also variations in medical assessments, nurse-led clinics, trips, art and music therapy, and artistic activities.