The American journal of hospice & palliative care
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Am J Hosp Palliat Care · Nov 2005
ReviewSedation and analgesia-prescribing patterns in terminally ill patients at the end of life.
The extensive use of sedative and analgesic medication at the end of life is often controversial due to the perception that death may be hastened as a result of progressive drug escalation. Physician attitudes toward prescribing medication in this setting vary, resulting in widely differing prescribing patterns for patients with advanced cancer. This investigation attempted to identify overall prescribing patterns and variation in the use of sedation and analgesia in an inpatient hospice setting at the end of life. ⋯ Further there was no significant impact on survival related to an individual physician's prescribing pattern at the end of life. These results suggest that, in the institution where the review was conducted, neither sedation nor individual variation in physician prescribing habits in terminally ill patients was associated with hastening of death. Overall, the amount of sedative drugs required for adequate symptom control during terminal care was moderate.
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Am J Hosp Palliat Care · Nov 2005
ReviewRole of the doctor in relieving spiritual distress at the end of life.
Relief of spiritual distress is a part of good palliative care. This literature review examines journal articles and texts dealing with patient spiritual issues at the end of life to see what constitutes spiritual care, why such issues are felt to be part of healthcare, and how, when, and by whom they should be explored. It also looks at the anticipated outcomes of addressing spiritual distress. This review also notes recommendations in the literature regarding prerequisite skills and attributes of those providing spiritual care and some tools for spiritual assessment and guidance.
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Am J Hosp Palliat Care · Nov 2005
Controlled Clinical TrialSystemic radionuclide therapy in pain palliation.
Several radiopharmaceuticals were investigated to determine their efficacy and toxicity in the palliation of painful bone metastases. Data on the influence of rhenium-188 hydroxyethylidene diphosphonate (188Re-HEDP), rhenium-186 hydroxyethylidene diphosphonate (186Re-HEDP), and strontium-89 (89Sr) on pain symptoms, quality of life, and bone-marrow function were obtained in 64 patients with breast and prostate cancer. Thirty-one patients were treated with 188Re-HEDP (3194 +/- 387 MBq), 15 patients with 186Re-HEDP (1358 +/- 158 MBq), and 18 patients with 89Sr (152 +/- 19 MBq). ⋯ There were no significant differences in bone marrow toxicity (p = 0.123-0.421). Results of this study indicate that all evaluated radiopharmaceuticals were effective in pain palliation without induction of severe side effects. The increase in KPS after 188Re-HEDP was the only statistically significant finding (p = 0.001).