Journal of palliative medicine
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A working group on teaching palliative care in the home was convened at The National Consensus Conference on Medical Education for Care Near the End of Life. Our consensus statement includes: (1) a justification for education in the home; (2) general guidelines about teaching palliative care at this site; (3) identification of major barriers to training in the home, and some suggestions for overcoming these barriers; and (4) specific suggestions about how and what to teach. We find that the home is an excellent site for training in comprehensive palliative medicine. ⋯ Trainees should learn the potential benefits and difficulties of managing terminal illness in the community, appreciate the role of health care teams in assuring safe, secure, high-quality care, and acquire the special knowledge, skills, and attitudes required for providing state-of-the-art palliative care for patients and families facing a terminal illness in the home, including for those dying at home. Instituting education in the home setting will require faculty development, support for more home visiting by physicians, and supervision of trainees in the home by other members of the health care team. Academic medical centers and hospice/home health agencies should collaborate to develop effective training programs.
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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.
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Comparative Study
Improving advance care planning by accommodating family preferences.
Family members often lack the knowledge of patients' values and preferences needed to function well as surrogate decision-makers. ⋯ Differences in preferences for the advance care planning process between patients and their surrogates and failure to discuss specific end-of-life values and preferences may explain why surrogates often lack information needed to serve as surrogate decision-makers.
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Sociodrama is a powerful teaching strategy that combines a case study approach with traditional role-play methodology to illustrate critical issues in end-of-life care. Building on principles of adult learning and communication skills, the sociodrama method enables the skilled facilitator to draw on the learner's past experiences as resources for teaching and reflective practice. This article describes the use of sociodrama in end-of-life education with illustrations from actual sessions including key discussion points, a typical instructional plan and staging tips.
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Inadequate pain control is a dismaying reality in cancer patients. ⋯ Educational interventions can successfully improve cancer pain knowledge and attitudes of health care professionals, but without having much impact on patients' pain levels. The most promising avenue for improving cancer pain control in ambulatory settings may be brief, nursing interventions targeting patients in combination with a daily pain diary. This review suggests that further progress may occur through incorporating a systematic and valid method of documenting daily fluctuation in pain levels, and ensuring that documented uncontrolled pain is followed rapidly by clinical reassessment and dose adjustment.