The American journal of hospice & palliative care
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Am J Hosp Palliat Care · Feb 2013
Review Case ReportsManagement of severe neuropathic cancer pain: an illustrative case and review.
Neuropathic cancer pain is common, very disabling and difficult to treat. It can be related to tumor invasion of neural structures and neuronal damage by surgery, chemotherapy and radiation therapy. ⋯ This case illustrates the challenges of managing severe pain in a patient with head and neck cancer while undergoing anti-tumor treatment. A review of the adjuvant analgesics and opioids, particularly methadone, in the management of neuropathic pain is also included.
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Am J Hosp Palliat Care · Feb 2013
Comparative StudyComparison of medical expenditure according to types of hospice care in patients with terminal cancer.
Hospice care is perceived as enhancing life quality for patients with advanced, incurable illness, but cost comparisons to nonhospice patients are difficult to make. Several studies demonstrated that palliative hospice care reduced medical expenditure in terminally ill patients compared with that of nonhospice care. ⋯ Hospice ward type in palliative hospice therapy may contribute to reduce economic medical costs as well as to more specific total care for terminally ill patients with cancer.
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Am J Hosp Palliat Care · Feb 2013
Parent's perceptions of health care providers actions around child ICU death: what helped, what did not.
To describe parents' perspectives of health care provider actions that helped or did not around the time of infant/child's intensive care unit (ICU) death. Semistructured interviews with 63 parents (Black, White, and Hispanic) 7 months post infant/child death were audio-recorded, transcribed, analyzed, and themes identified. ⋯ Compassionate, sensitive staff and understandable explanations of children's conditions were most helpful; insensitive, nonsupportive staff least helpful by gender, racial group, or care setting. Conflict between providers and parents was most problematic for minority parents and mothers.
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Little is known regarding the perceptions of parents about end-of-life care for their children. This study describes parental perceptions of the care of hospitalized, terminally ill children in the areas of (1) clinical management, (2) interdisciplinary support, and (3) pain and symptom management. ⋯ Parental satisfaction with their child's care during end of life indicates need for improvement in pain management, communication, and parental involvement in decision making. While education cannot guarantee desired changes in attitudes or behaviors, it may provide the essential foundation of knowledge, skills, and ethical understanding needed by professional providers.
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Am J Hosp Palliat Care · Feb 2013
Barriers to the detection and management of depression by palliative care professional carers among their patients: perspectives from professional carers and patients' family members.
Clinical depression is highly prevalent yet underdetected and poorly managed within palliative care settings. ⋯ Specialized training in depression is recommended for professional carers in order to improve their depression-related knowledge, detection skills, and self-efficacy. The ultimate goal of such training is to increase the rate of recognition of depression that in turn will lead to appropriate treatment for depressed patients.