Journal of palliative medicine
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Gay men and lesbians have special interests in documenting their preferences regarding advance care planning and end-of-life care. A 64-item survey instrument was developed to ascertain the preferences of this community regarding approaches to end-of-life care, viewpoints on physician-assisted suicide (PAS) and euthanasia, and practices regarding advance care planning. The survey was completed by 575 participants recruited through community-based health care and social service organizations serving the lesbian and gay community, primarily in the New York metropolitan area. ⋯ Although respondents completed advance directives at a higher rate than adults generally, the legal importance for gay men and lesbians to execute directives should encourage health care providers and community organizations to assume a larger educational role on advance care planning. Results confirm other reports on the need to address provider communication skills. It is speculated that the HIV epidemic was a major influence behind these results because of the overwhelming personal impact of the epidemic on most gay men and lesbians during the past two decades.
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The Pan American Health Organization (PAHO) is engaged in field demonstration projects in Latin America and the Caribbean to expand the availability and effectiveness of palliative care services. Workshops and calls for proposals address the multiple causes of inadequate palliative care services that are typical for countries in the developing world. These include regulatory barriers and drug interdiction policies that interfere with the medical use of opioids, lack of education among health professionals, and insufficient palliative care infrastructure.
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Biography Historical Article
Religion, medicine, and community in the early origins of St. Christopher's Hospice.
Commentators on the history and development of hospice and palliative care can appear inclined toward a revisionist viewpoint that sees something "lost" in recent years from the original concept. The thesis concerning the "secularization of hospice" is one such example. It is suggested that the quality of these debates can be improved by serious scholarly attention to earlier events and circumstances, drawing on contemporary source materials, rather than retrospective viewpoints. ⋯ It shows how Cicely Saunders and her associates created an Aim and Basis for the hospice that sought to reconcile questions about its religious orientation; its relationship to medicine; and its status as a community. We see how tensions between these were resolved, resulting in a model that would be applicable in other contexts. Without this pragmatic turn, it is unlikely that the hospice movement would have spread so quickly and so far in the 1970s and 1980s.
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To define symptoms and therapeutic requirements for patients with metastatic or locally recurrent lung cancer. ⋯ Patients with advanced lung cancer suffer frequent and severe symptoms that worsen in the final months of life. The appropriate timing and combination of radiotherapy and chemotherapy are yet to be resolved. Future studies will require use of validated quality of life instruments to better catalogue palliation and treatment toxicity.