Journal of palliative medicine
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Comparative Study
Comparing unmet needs between community-based palliative care patients with heart failure and patients with cancer.
As the role of palliative care (PC) has yet to be clearly defined in patients with heart failure (HF), such patients may face barriers regarding PC referral. In order to maximally meet the needs of HF patients, it is necessary to understand how they compare to the classic PC population: patients with cancer. ⋯ Patients with HF possess care needs that are squarely within the purview of PC. Future work is needed to delineate how PC referral policies should be refined to optimize PC access for patients with HF.
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Case Reports
When open-ended questions don't work: the role of palliative paternalism in difficult medical decisions.
Abstract The balance between patient autonomy and medical paternalism must be reexamined. The tension between autonomy and paternalism is both an ethical and practical issue. ⋯ Paternalism, characterized as the antithesis of autonomy, is widely dismissed as having any role in medicine. We disagree and believe that paternalism still has an important role in medical decision making.
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Loved ones of a patient with an incurable disease will accompany the patient to the end of life. Health care professionals must discuss difficult matters with loved ones and be sure that they really understand the seriousness of the patient's disease. The study explore how the professionals do when they explore the grounds on which they make their assessment of loved ones' insight into a patient's fatal disease. ⋯ Ways to communicate with loved ones are crucial when making an assessment. The different ways loved ones use hope and other strategies made it problematic for the professionals to use these as indicators of state of mind in this matter. Training in conversation skills could be one way to support professionals when discussing and managing these difficult situations.
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Humor frequently occurs in palliative care environments; however, the acceptability of humor, particularly between patients and health care providers has not been previously examined. ⋯ The vast majority of participants found humorous interactions with their health care providers acceptable and appropriate, and this may indicate a opportunity for enhanced and more effective end-of-life care in the future.