Journal of palliative medicine
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Palliative care is increasingly seen as an integral component of care for patients with advanced malignant and nonmalignant illness. Clinical audit data can provide important insights into patient care, but limited published data are available investigating statewide palliative care provision issues. ⋯ The pooled epidemiological data reviewed identify a number of areas of interest including the lack of Aboriginal Australians identified and accessing inpatient palliative care, and variations in inpatient care across geographical areas. This highlights issues of access and equity of access to inpatient palliative care.
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Randomized Controlled Trial
Efficacy of dignity therapy on depression and anxiety in Portuguese terminally ill patients: a phase II randomized controlled trial.
Dignity therapy is a brief psychotherapy developed for patients living with a life-limiting illness. ⋯ Dignity therapy resulted in a beneficial effect on depression and anxiety symptoms in end-of-life care. The therapeutic benefit of dignity therapy was sustained over a 30-day period. Having established its efficacy, future trials of dignity therapy may now begin, comparing it with other psychotherapeutic approaches within the context of terminal illness.
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Prognosis discussion is an essential component of informed decision-making. However, many terminally ill patients have a limited awareness of their prognosis and the causes are unclear. ⋯ Few patients with advanced cancer could articulate an accurate prognosis estimate, despite most having received chemotherapy and many physicians reported they would discuss prognosis early. Physicians' propensity to discuss prognosis earlier was associated with more accurate patient reports of prognosis. Enhancing the communication skills of providers with important roles in cancer care may help to improve cancer patients' understanding of their prognosis.
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Comparative Study
Sadness, anxiety, and experiences with emotional support among veteran and nonveteran patients and their families at the end of life.
Although many veterans are progressing into older adulthood and a substantive subset of people who die each year in the United States served in the military, there is limited evidence on the role of military service at the end of life. ⋯ Results provide preliminary evidence for veteran status being a risk factor for emotional distress at the end of life, highlighting the possible need for augmented support services for veterans and their families in hospice and palliative care.
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The development of brain metastases is a common cause of morbidity and mortality in cancer patients. Limited life expectancy is well established once a patient requires whole-brain radiotherapy (WBRT). There is emerging evidence demonstrating the value of involving palliative care services alongside traditional treatments. However, data regarding the utilization of these services in patients requiring WBRT remain unexplored. ⋯ Patients with brain metastasis requiring WBRT have a predictable dying trajectory. These patients are likely to have a high symptom burden and would benefit from palliative care. Timely palliative care referrals in this population remain inadequate and classically follow a hospital admission. Referrals continued to be late in the dying process and the recommendation for WBRT can be used as an independent marker for initiating end-of-life discussions and involving palliative care.