The American journal of hospice & palliative care
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Dialysis patients are often denied hospice benefits unless they forego dialysis treatments. However, many of those patients might benefit from as-needed dialysis treatments to palliate symptoms of uremia, fluid overload, etc. The current Medicare payment system precludes this "palliative dialysis" except in those few cases where the terminal diagnosis is unrelated to renal failure. As approximately three quarters of all US patients on dialysis have Medicare as their primary insurance, a of review of Medicare policy is suggested, with a goal of creating a new "palliative dialysis" category that would allow patients to receive treatments on a less regular schedule without affecting the quality statistics of the dialysis center.( 1 ).
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Little doubt (if any) remains as to the assured importance of physicians possessing praxis regarding psychosocial issues, including grief dynamics, in order to tend to dying and sorrowing people. It stands to reason then that palliative care physicians become knowledgeable enough about the phenomenon of grief. But imperative nuances must also be considered: what sort of knowledge on grief, as well as how much of such knowledge, is enough? This article poses topical queries on the importance of the palliative care physician exercising a deliberate agenda to persistently refine one's personal framework or beliefs regarding grief. In doing so, it is proposed physicians will engender improved self-knowledge, which will serve to better poise themselves toward being with and purposefully encountering aggrieved others.
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Am J Hosp Palliat Care · Nov 2011
ReviewExploring uncertainty in advance care planning in African Americans: does low health literacy influence decision making preference at end of life.
African Americans over 65 represent 3.5 of the 35.6 million Americans. Morbidity and mortality rates are highest among this group; associated with lack of resources and awareness of health problems. ⋯ Low health literacy may contribute to this disparity. This scholarly review examines the health literacy in advance care planning and refines concepts of uncertainty in illness theory deriving a model for advance care planning in African Americans.
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Am J Hosp Palliat Care · Nov 2011
Development and validation of a modified version of the Edmonton Symptom Assessment Scale in a Flemish palliative care population.
Palliative cancer patients are faced with multiple symptoms that threaten their quality of life. To manage these symptoms, a reliable and valid way of registration is crucial. In this study, the Edmonton Symptom Assessment Scale (ESAS) has been translated, modified, and tested on content, face, criterion, construct validity, and internal consistency for patients admitted to Flemish palliative care units. ⋯ The second sample checked the face validity and consisted of 4 patients, 5 family members, and 5 nurses. The last sample involved 23 patients admitted to 3 Flemish palliative care units. Heedful of the "new-wave" vision on validity, the translated and altered ESAS seemed a suitable instrument for the symptom assessment of patients with cancer admitted to a palliative care unit.
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Patients receiving palliative care often possess multiple risk factors and predisposing conditions for delirium. The impact of delirium on patient care in this population may also be far-reaching: affecting not only quality of remaining life but the dying process experienced by patients, caregivers, and the medical team as well. ⋯ This article summarizes the multifactorial nature, numerous predisposing medical risk factors, neuropsychiatric adverse effects of palliative medications, pharmacokinetic changes, and challenges complicating delirium assessment and provides a systematic framework for assessment. The benefits, risks, and patient-specific considerations for treatment selection are also discussed.