The American journal of hospice & palliative care
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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.
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Am J Hosp Palliat Care · Aug 2007
Comparative StudyThe cost of home hospice care for terminal patients in Israel.
This study examined and compared the cost of care provided to terminal metastatic cancer patients by home hospices and by conventional health services. The study population included 146 patients with metastatic cancer. Half received home hospice services, and the other half received conventional services. ⋯ A multiple regression analysis revealed that treatment units per patient, care framework, and patient age significantly contributed to explaining the cost variance. The findings suggest a financial advantage for home hospice care for terminal patients. This should be investigated further, as should the cost of informal caregivers and patient and caregiver satisfaction with the quality of care in both frameworks.
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Am J Hosp Palliat Care · Aug 2007
Comparative StudyLack of ethnic differences in end-of-life care in the Veterans Health Administration.
Although existing literature shows pervasive ethnic disparities in end-of-life care, this study sought to determine if there were ethnic differences in the processes of care related to the end of life in a cohort of hospitalized, seriously ill veterans. The medical records of 217 patients (13% African American, 68% white, 9% Hispanic White) were reviewed for documentation of end-of-life care (advance directive discussions, pain, symptom-directed plan, and do-not-resuscitate orders). ⋯ African American patients were more likely to have a do-not-resuscitate order and advance directive discussion documented compared with white patients. In this equal access system, minority patients were at least as likely or more likely to have important aspects of end-of-life care addressed compared with white patients.