The American journal of hospice & palliative care
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Am J Hosp Palliat Care · Jan 2007
ReviewThe ethics of palliative sedation as a therapy of last resort.
Many patients nearing the end of life reach a point at which the goals of care change from an emphasis on prolonging life and optimizing function to maximizing the quality of remaining life, and palliative care becomes a priority. For some patients, however, even high-quality aggressive palliative care fails to provide relief. For patients suffering from severe pain, dyspnea, vomiting, or other symptoms that prove refractory to treatment, there is a consensus that palliative sedation is an appropriate intervention of last resort. In this report, the National Ethics Committee, Veterans Health Administration examines what is meant by palliative sedation, explores ethical concerns about the practice, reviews the emerging professional consensus regarding the use of palliative sedation for managing severe, refractory symptoms at the end of life, and offers specific recommendations for institutional policy.
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Am J Hosp Palliat Care · Jan 2007
ReviewManagement of patients with metastatic malignancy in the intensive care unit.
Intensive care units serve to provide temporary physiologic support to patients with reversible organ failure. However, with increasing frequency, patients with end-stage and terminal illnesses are being admitted to the intensive care unit. ⋯ In patients with a terminal illness, the focus should be on measures that ensure comfort, and admission to an intensive care unit should generally be avoided. Intensivists, who are charged with making the best use of limited resources, should ultimately be the individuals who determine the appropriateness of admitting such patients to the intensive care unit.
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Am J Hosp Palliat Care · Jan 2007
Assessing spirituality and religiousness in advanced cancer patients.
The aim of this study was to translate the Spiritual Involvement and Beliefs Scale into the Greek language and validate its psychometric properties in a sample of advanced cancer patients treated in a palliative care unit. The scale was translated into Greek with the "forward-backward" procedure. It was administered twice, with a 3-day interval, to 82 patients with advanced cancer. ⋯ Satisfactory construct validity was supported between the Spiritual Involvement and Beliefs Scale subscales and Hospital Anxiety and Depression subscales. Interscale and interitem correlations were found satisfactory at P<.0005. These results support that the Spiritual Involvement and Beliefs Scale is an instrument with satisfactory psychometric properties and is a valid research tool for spirituality in advanced cancer patients.
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Am J Hosp Palliat Care · Jan 2007
Case ReportsVideo-assisted thoracoscopic neurectomy of intercostal nerves in a patient with intractable cancer pain.
Cancer-related pain is complicated and unbearable. Pain management techniques must be constantly modified and improved, with the goal of decreasing pain and enabling patients to withstand it. ⋯ Radiofrequency ablation was then performed under fluoroscopic monitoring; however, the procedure resulted in little pain relief. Finally, a neurectomy to cauterize the intercostal nerves was completed with video-assisted thoracoscopy under general anesthesia.