Journal of palliative medicine
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Physician cultural sensitivity is particularly important for end-of-life care. This study correlates physicians' own racial background, clinical experience, and cultural sensitivity training with their attitudes, perceptions, and knowledge of advance care planning issues for African American patients. ⋯ The majority of the physicians surveyed routinely provide end-of-life care and believe they are aware of racial differences in advance care planning. Yet, most were unfamiliar with specific end-of-life preferences of African American patients. We advocate for further research and cultural sensitivity training to improve end-of-life care for African American patients.
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Conventional analgesic treatment involves the use of oral and transdermal formulations of drugs that require repetitive administration for sustained pain relief to be achieved. Along with the potential of analgesia, the risk of ongoing side effects consequent on the use of these analgesics also exists and this may have a detrimental effect on the patient's quality of life. In contrast, an intriguing body of evidence suggests that short-term administration of intravenous lidocaine may produce pain relief that far exceeds both the duration of infusion and the half-life of the drug. When pain relief is produced, concomitant analgesic medication can be reduced, side effects from pain relieving medication minimized with a potential for very real improvement in the quality of life of the patient. ⋯ While this form of therapy is not commonplace in the terminally ill patient, it could be argued that its use has much merit in that field and should be considered.
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Although differences in physician practices of artificial hydration therapy for terminally ill patients with cancer can cause unnecessary suffering from overhyrdration or underhydration of patients, no clinical guideline is available in Japan. This paper illustrates a summary of a nationwide project to construct a clinical guideline for artificial hydration therapy. ⋯ The Japanese Society of Palliative Medicine constructed a clinical guideline for artificial hydration therapy for terminally ill patients with cancer, using evidence-based and formal consensus-building methods. The clinical efficacy of this guideline should be tested in the future.
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By the year 2020, chronic obstructive pulmonary disease (COPD) will be the third leading cause of death globally. While there have been consistent calls for increased palliative care involvement in the care of patients with advanced COPD, these calls should be based on empirical evidence that such an approach improves the symptom burden and poor quality of life associated with advanced COPD. Rather than reviewing the traditional treatments of airflow obstruction and palliative measures familiar to the palliative care community, we will focus on some novel approaches to the management of patients with advanced COPD from the perspective of clinicians involved in end of life care provision and research. By combining the clinical and research skills of pulmonologists and palliative medicine specialists we can advance the care of patients with this progressive and incurable disease.