Journal of palliative medicine
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Case Reports
Clinical supervision in the palliative care team setting: a concrete approach to team wellness.
Clinical supervision is a structured, case-based approach to learning that is used most often in the mental health field. An established palliative care consultation service at a large, academic medical center implemented a modified clinical supervision model in an effort to improve team members' awareness of their own emotions and the way those emotions impact behavior during, primarily, clinical encounters. This report discusses clinical supervision in detail and, by way of a case, illustrates the power of this intervention as a source of self-care and a concrete approach to managing palliative care team well-being.
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Comparative Study
Association between early palliative care referrals, inpatient hospice utilization, and aggressiveness of care at the end of life.
Palliative care has a positive effect on many clinical outcomes, yet most referrals to palliative care have occurred late. End-of-life (EOL) cancer care has become increasingly aggressive. There have been no studies investigating the association between early palliative care referrals and aggressive EOL care in Japan. ⋯ Early palliative referrals were associated with more inpatient hospice utilization and less aggressive EOL care.
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Pain is one of the most common and distressing symptoms in patients with cancer, with a high prevalence of 90%. Appropriate pain assessment is very important in managing cancer pain. ⋯ The use of a self-reporting pain assessment tool as a communication instrument provides an effective foundation for evaluating pain intensity in cancer pain management. A more individualized approach to patient education about pain management may improve patient outcome.
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Most providers do not receive training in expressing condolences to bereaved families, and most health care institutions do not have policies in place encouraging expression of condolences. Physicians may fail to meet the expectations of bereaved families. ⋯ A small majority of providers at an academic medical center usually expressed condolences to the families of patients who died. Hospitalists and less experienced providers may be less likely to express condolences and interventions should target these physicians.