Journal of palliative medicine
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Policy developments in the health care arena in general, and in end-of-life and palliative care in particular, strongly influence the practice environment for the delivery of hospice and palliative care services and the diverse roles of social work practitioners. This article analyzes policy developments in two crucial areas-ethics and law and disenfranchisement and health disparities. It focuses on the recent social work literature and other key sources and provides recommendations to promote the roles of social workers in ethics consultation, public policy, and advocacy and to integrate better the perspectives and concerns of diverse communities into palliative care practice, education, and policy.
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Palliative care programs are becoming increasingly common in U.S. hospitals. ⋯ Our data suggest that although growth in palliative care programs has occurred throughout the nation's hospitals, larger hospitals, academic medical centers, not-for-profit hospitals, and VA hospitals are significantly more likely to develop a program compared to other hospitals.
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Clinical Trial
Gabapentin is effective in the treatment of cancer-related neuropathic pain: a prospective, open-label study.
Gabapentin has been evaluated in the treatment of nonmalignant neuropathic pain, however, there is little direct evidence evaluating its efficacy in cancer-related neuropathic pain. ⋯ We conclude that gabapentin is an effective treatment for cancer-related neuropathic pain.
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Few studies have examined physician-family caregiver communication at the end of life, despite the important role families have in end-of-life care decisions. We examined family caregiver reports of physician communication about incurable illness, life expectancy, and hospice; the timing of these discussions; and subsequent family understanding of these issues. ⋯ Our findings suggest that ineffective communication about end-of-life issues likely results from both physician's lack of discussion and family caregiver's difficulty hearing the news. Future studies should examine strategies for optimal physician-family caregiver communication about incurable illness, so that families and patients can begin the physical, emotional, and spiritual work that can lead to acceptance of the irreversible condition.
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Compounded formulations comprised of multiple medications may be useful for some patients with refractory nausea and vomiting. The combination of lorazepam, diphenhydramine, haloperidol, and metoclopramide (ABHR) has been used for more than a decade in the management of nausea and vomiting, but the tolerability of this combination in hospice patients has not been examined. ⋯ The compound ABHR is generally well tolerated in the majority of hospice patients. More investigation is warranted to determine the efficacy and tolerability of similar pharmaceutical compounds used commonly in the hospice patient population.