Journal of palliative medicine
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Case Reports
Missed opportunities in providing palliative care for the urban poor: a case discussion.
We report the case of a woman with chronic, unexplained symptoms admitted to a large urban hospital, whose clinical status declined rapidly without a definite underlying diagnosis, and who died 2 days after palliative extubation. ⋯ This case illustrates some of the challenges that patients, families, caregivers, and medical teams face in cases of serious life-limiting illness in the disenfranchised poor. Proposed solutions to these challenges include introduction to palliative care earlier in the course of illness and improved access to palliative care in medical safety-net settings.
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Comparative Study
Comparison of international medical graduates with US medical students and residents after a four-week course in palliative medicine: a pilot study.
The need for doctors who have skills in pain management and palliative medicine is greatest in low and moderate resource countries where patients most frequently present to their health care system with advanced illness and greater than 80% of the global deaths occur. While medical students trained in the United States are required to have training in palliative medicine, international medical graduates (IMGs), who have completed medical school outside North America, may not have the same exposure to palliative medicine training as U.S. physicians. The goal of this study was to evaluate whether a four-week course in palliative medicine could bring IMG attitudes, concerns, competence, and knowledge to the level of U.S. trainees. ⋯ A four-week course in palliative medicine can improve the levels of concern, knowledge and self-assessed competence in IMGs to the level of US trainees.
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Effective communication is essential for shared decision making with families of critically ill patients in the intensive care unit (ICU), yet there is limited evidence on effective strategies to teach these skills. ⋯ The findings suggest that a brief intervention designed to teach residents communication skills in conducting goals of care and treatment discussions in the ICU is feasible and can improve their comfort level with these conversations.
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Review
End-of-life care discussions with nonmalignant respiratory disease patients: a systematic review.
Patients with nonmalignant respiratory diseases have limited access to palliative care services and health professionals do not adequately address discussions about end-of-life care preferences. ⋯ End-of-life discussions should be initiated by health professionals, who must be aware of patient expectations regarding palliative care and end-of-life care planning. Efforts must be made to develop relationships with patients with terminal illness and allow sufficient time to discuss the end of life during clinical encounters. Future research should address palliative care uptake in nonmalignant disease and implications for health education should be addressed.
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Extracorporeal life support (ECLS) is an advanced form of life-sustaining therapy that creates stressful dilemmas for families. In May 2009, Seattle Children's Hospital (SCH) implemented a policy to involve the Pediatric Advanced Care Team (PACT) in all ECLS cases through automatic referral. ⋯ We describe a framework for understanding the potential involvement of palliative care among patients receiving ECLS that explains how PACT organizes its efforts toward patients and families with the highest degree of need. Future studies should examine whether this approach is associated with improved patient and family outcomes.