Hematology/oncology clinics of North America
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Hematol. Oncol. Clin. North Am. · Jun 2002
ReviewInsights from cancer patient communication research.
Good communication skills are essential for all aspects of patient care in a palliative setting. A considerable body of evidence has accrued in the general oncology literature concerning doctor-patient and doctor-doctor communication. Many of the models and methods explored in the oncology setting may be applied usefully to palliative care; however palliative care is unique in some aspects and has its own particular challenges. Further evidence is needed to guide palliative care and other health care professionals in communicating effectively and sensitively with palliative care patients while holding a balance between telling the truth and maintaining hope.
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Although most patients with cancer pain can attain a favorable balance between analgesia and side effects with a conventional approach to opioid therapy, a substantial minority cannot. For these patients, an important subgroup of whom have neuropathic pain, alternative therapeutic strategies are needed. With a detailed assessment, clinicians should be able to choose among the large and diverse group of options available and implement an approach, or combination of approaches, that have a high probability of improving analgesic outcomes.
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Dyspnea, like pain, is a subjective experience that incorporates physical elements and affective components. Management of breathlessness in patients with cancer requires expertise that includes an understanding and assessment of the multidimensional components of the symptom, knowledge of the pathophysiologic mechanisms and clinical syndromes that are common in cancer, and familiarity with the indications and limitations of the available therapeutic approaches. Relief of breathlessness should be the goal of treatment at all stages of cancer. Good control of dyspnea will improve the patient's quality of life.
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Hematol. Oncol. Clin. North Am. · Jun 2002
ReviewClinical support for families in the palliative care phase of hematologic or oncologic illness.
This article focuses on families' needs for support and care when the patient is receiving palliative care. Health care professionals providing care to patients with hematologic or oncologic illnesses are coming to understand that care for the family must begin at the time of patient's diagnosis and treatment. Families who do not receive adequate information and support in the early phases of the patient's treatment have greater needs, less trust and confidence in the health care system, and cope more poorly in the later stages than families who have been informed and supported throughout the course of the illness. This article documents the needs of families in the palliative phase of a patient's hematologic or oncologic illness and provides empirically based recommendations for assessment and care of the family unit.
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Managing delirium is of major importance in end-of-life care and frequently gives rise to controversies and to clinical and ethical dilemmas. These problems arise from a number of causes, including the sometimes-poor recognition or misdiagnosis of delirium despite its frequent occurrence. Delirium generates major symptomatic of distress for the patient, consequent stress for the patient's family, the potential to misinterpret delirium symptomatology, and behavioral management challenges for health care professionals. ⋯ Future research might focus on phenomenology, the development of low-burden instruments for assessment, communication strategies, and the family education regarding the manifestations of delirium. Further research is needed among patients with advanced cancer to establish a predictive model for reversibility that recognizes both baseline vulnerability factors and superimposed precipitating factors. Evidence-based guidelines should be developed to assist physicians in more appropriate use of sedation in the symptomatic management of delirium.