Journal of palliative medicine
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Abstract Background: Access to integrated, palliative care regardless of location of residence is a palliative care standard yet we know such access is limited for those living in rural and remote settings. As a beginning step in the development of research aimed at informing policy and program development, a comprehensive review of the state of knowledge regarding palliative care in rural contexts is required. Purpose: To identify, evaluate and synthesize the published literature on rural palliative care. ⋯ Studies were grouped by subject matter into one of three categories: patient and caregiver perspectives; professional attitudes, knowledge and practice issues; and health care services. Conclusion: The body of research literature is small and eclectic, which means there is little strong evidence to inform palliative policy and service development in rural settings. Coordinated programs of research are clearly required to develop a body of knowledge that is adequate to support effective service and policy development.
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The Physician Orders for Life-Sustaining Treatment (POLST) Paradigm Program was designed to ensure the full range of patient treatment preferences are honored throughout the health care system. Data are lacking about the use of POLST in the hospice setting. ⋯ The POLST is viewed by hospice personnel as useful, helpful, and reliable. It is effective at ensuring preferences for limitations are honored. When given a choice, most hospice patients want the option for more aggressive treatments in selected situations.
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Bereavement services are an important part of comprehensive end-of-life care with potential to ameliorate physical, psychological, and spiritual distress. We studied bereaved spouses of hospice patients to examine bereavement service utilization, barriers, and preferences regarding content, structure, and delivery of potential bereavement services. We also examined the impact of depressive symptoms and social network. ⋯ Clinicians and service providers may facilitate coping by routinely screening for depressive symptoms and social network and tailoring interventions to those identified as experiencing elevated distress or lacking social resources. Attitudinal barriers and preferences suggest that even in the service-rich environment of hospice some modification of bereavement services might reach more bereaved spouses. Future studies might address whether preferences lead individuals to services of the greatest benefit.
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Electrolyte abnormalities are common among patients with advanced cancer. Our aim was to estimate the prognostic significance of such abnormalities in a palliative care setting. ⋯ Some electrolyte abnormalities may be useful as prognostic indicators in the palliative care setting. However, their prognostic value needs to be investigated in prospective studies and adjusted against proven prognostic indicators.
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Internal medicine programs are now required to integrate palliative care into teaching conferences, and palliative care content is already tested on the American Board of Internal Medicine examination. Previous research has focused on integration of palliative care into existing rotations and seminars, but none has studied a required inpatient palliative care rotation. ⋯ Palliative care knowledge, as tested by objective examination, improves during internal medicine residency at our institution and specifically over the course of a required, 2-week palliative care rotation. Further study is warranted to determine the relative contributions to this improvement from the palliative care rotation itself, the institutional culture and/or Rochester residents' preexisting interest in the bio-psychosocial model.