The American journal of hospice & palliative care
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Breathlessness secondary to cancer and nonmalignant disease is very distressing and exhausting to patients and families. Patient quality of life and functionality can be greatly improved with effective management. The pathophysiology and treatment of dyspnea are where the science of pain management was 20 years ago. ⋯ Clearly, large scale randomized trials on opioid nebulized treatments for patients with severe dyspnea need to be published to reach a clear consensus outlining efficacy and administration parameters. Until that time, we must rely on anecdotal reports for treatment options. Such reports of the effectiveness of nebulized morphine as an alternative to hospital or hospice admission are encouraging for patients and family members managing severe dyspnea in the home.
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Am J Hosp Palliat Care · Jan 1999
Criteria for enrolling dementia patients in hospice: a replication.
Because survival time varies greatly in dementia, it is difficult for dementia patients to meet a key criterion for the Medicare Hospice Benefit, a six-month survival time. In a previous study, the authors examined guidelines for admitting dementia patients to hospice; the National Hospice Organization (NHO) guidelines were found to work well in identifying appropriate candidates for hospice among dementia patients. This was especially true for those patients whose deficits had progressed in an ordinal fashion consistent with Functional Assessment Staging (FAST) and who had reached stage 7C. ⋯ Foley catheters decreased survival time; and the use of antibiotics did not make a difference. This study echoed our previous findings regarding the usefulness of NHO guidelines in identifying dementia patients with a survival time of six months or less, specifically those at stage 7C or greater. The findings also suggest that the nature of the palliative care plan influences survival time.
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In recent decades, the hospice movement in America has experienced substantial growth, but there are still impediments preventing the majority of Americans from utilizing this type of care. Moreover, minority Americans experience greater barriers to the utilization of hospice care. Although there are positive trends to suggest utilization of hospice care by minorities may increase in the future, these factors need to be supported through strategies implemented by hospice administrators, providers, and volunteers.
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Am J Hosp Palliat Care · Jan 1999
Editorial CommentThe role of nebulized morphine in managing dyspnea.