The American journal of hospice & palliative care
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Am J Hosp Palliat Care · Jun 2012
Case ReportsImproving cultural competency among hospice and palliative care volunteers: recommendations for social policy.
This case study of 14 hospice and palliative care volunteers looked for recommendations and suggestions on how to increase cultural competency among hospice volunteers. In-depth interviews were conducted with a hospice in Toronto, Canada, and findings reveal that volunteers have very specific and diverse recommendations on how they prefer to be briefed and educated on cultural competency issues surrounding their patients. Findings also reveal hospice volunteers want more cultural competency training and acknowledge the importance of being culturally competent. This article concludes with a précis on recommendations for increasing cultural competency in hospice and palliative care for both volunteers and agencies and discusses the top 4 future trends in cultural competency for hospice care.
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Am J Hosp Palliat Care · Jun 2012
Assessing challenges in end-of-life conversations with elderly patients with multiple morbidities.
This study reports on physicians' experiences in conducting end-of-life conversations with elderly patients who suffered from multiple co-morbidities (MCM). Our hypothesis was that both the lack of prognostic certainty and the lack of good communication tools contributed to physicians' discomfort with conducting EOL conversations with patients and families of patients with these conditions especially when compared with patients and families of patients who had a single, clear terminal diagnosis (e.g. pancreatic cancer). ⋯ Prognostic indicies and communication scripts may better prepare physicians to facilitate end-of-life conversations with MCM patients/families.
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Am J Hosp Palliat Care · Jun 2012
Case ReportsPain management in hypertrophic pulmonary osteoarthropathy: an illustrative case and review.
Hypertrophic pulmonary osteoarthropathy (HOA) is a condition associated with lung cancer and many other diseases. Pain associated with HOA can be disabling, unremitting, and refractory to conventional analgesic medications. We present a challenging case of HOA in a patient with nonsmall cell lung cancer and review specific therapies for management of HOA-related pain.
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Am J Hosp Palliat Care · Jun 2012
Palliative care and support for persons with HIV/AIDS in 7 African countries: implementation experience and future priorities.
To combat morbidity and mortality from the worldwide epidemic of the human immunodeficiency virus (HIV), the United States Congress implemented a President's Emergency Plan for AIDS Relief (PEPFAR) in 30 resource-limited countries to integrate combination antiretroviral therapy (ART) for both prevention and cure. Over 35% of eligible persons have been successfully treated. Initial legislation cited palliative care as an essential aspect of this plan but overall health strengthening became critical to sustainability of programming and funding priorities shifted to assure staffing for care delivery sites; laboratory and pharmaceutical infrastructure; data collection and reporting; and financial management as individual countries are being encouraged to assume control of in-country funding. ⋯ Technical assistance staff of one implementing partner representing seven African countries met to clarify domains of palliative care compared with the substituted term "care and support" to understand potential gaps in on-going HIV care. They prioritized care needs as: 1) mental health (depression and other mood disorders); 2) communication skills (age-appropriate disclosure of HIV status); 3) support of care-providers (stress management for sustainability of a skilled HIV workforce); 4) Tied Priorities: symptom management in opportunistic infections; end-of-life care; spiritual history-taking; and 5) Tied Priorities: attention to grief-related needs of patients, their families and staff; and management of HIV co-morbidities. This process can inform health policy as funding transitions to new priorities.