The American journal of hospice & palliative care
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Am J Hosp Palliat Care · Oct 2007
Comparative StudyAre there racial differences in attitudes toward hospice care? A study of hospice-eligible patients at the Visiting Nurse Service of New York.
Research on African American and white attitudes, perceptions, and knowledge of hospice care has focused predominantly on patients and providers in institutions and community-based care settings. Little is known about patients receiving home health services, despite growing trends toward noninstitutional care in the United States. ⋯ An alarming proportion of African American and white home health clients held erroneous ideas about hospice care and had not discussed this option with their providers. These findings suggest that increased referrals to home-based hospice care among home health clients depend on the availability and professional dissemination of accurate, spiritually sensitive information.
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Am J Hosp Palliat Care · Oct 2007
Comparative StudyPhysician and nurse attitudes toward artificial hydration for terminally ill cancer patients in Japan: results of 2 nationwide surveys.
This study investigated physician and nurse attitudes toward artificial hydration in terminally ill cancer patients and compared differences in attitudes between these 2 professions and among clinical settings in Japan. The response rate was 53% (584/1,123) for physicians and 79% for nurses (3,328/4,210). More physicians answered that artificial hydration alleviates the sensation of thirst. ⋯ Discussion among patient-centered teams and individualized decision making are important. Because the differences identified here are attributable to differences in knowledge of artificial hydration for terminal cancer patients, oncologists should place greater emphasis on the opinion of palliative care specialists. Medical practitioners caring for terminal cancer patients should consider a broader range of views on hydration therapy, with a focus on effective hydration techniques and alternative interventions.
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Am J Hosp Palliat Care · Oct 2007
ReviewNoninvasive positive-pressure ventilation in patients with malignancy.
Noninvasive positive-pressure ventilation (NIPPV) is now accepted as the treatment of choice for subgroups of patients with acute respiratory failure. Noninvasive positive-pressure ventilation has traditionally not been considered in the management strategy of patients with malignancy; however, this mode of ventilatory support may be appropriate in some specific situations. ⋯ Noninvasive positive-pressure ventilation should be considered in select patients with cancer who develop respiratory failure and have a do-not-intubate code status. In rare instances, NIPPV may have a role in treating patients with advanced cancer who have intractable dyspnea; however, NIPPV should not be used for the sole purpose of prolonging life in patients with terminal respiratory failure.
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Am J Hosp Palliat Care · Oct 2007
ReviewThe rationale for a multimodal approach in the management of breakthrough cancer pain: a review.
Breakthrough pain has been described differently in various countries, and not surprisingly, recommendations for its management vary according to the institution. Usually when breakthrough pain occurs, the patient's pain has already been managed according to the World Health Organization 3-step ladder for cancer pain. ⋯ However, the combination of radio-oncology, adjuvant drugs, and interventional pain procedures can improve pain relief. This review addresses those questions and proposes a multimodal approach to manage breakthrough cancer pain.
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Am J Hosp Palliat Care · Oct 2007
The importance of perspective: evaluation of hospice care from multiple stakeholders.
The literature on hospice care and palliative medicine lacks a focus on the combined and concurrent assessment of services. This deficiency is problematic because research findings are then limited in their scope and applicability to particular stakeholder groups. ⋯ Results include a description of the quality of service delivery and participant satisfaction, areas of current weakness, and ideas for potential growth and development for the program. Findings from this study are compared with previous research on hospice care and the implications of the results to the provision and continued development of hospice care are discussed.