Journal of palliative medicine
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Palliative care services are lacking in rural hospitals. Implementing palliative care services in rural and remote areas requires knowledge of available resources, specific barriers, and a commitment from the hospital and community. ⋯ It is imperative for quality of care that rural hospitals have practitioners who are up to date on current evidence and practice within a palliative care framework. Unique challenges exist to implementing palliative care services in rural hospitals. Opportunities for informing rural areas focus around utilizing existing hospice resources and relationships, and favoring Web-based classes and online courses. The development of a multifaceted intervention to facilitate education about palliative care and cultivate palliative care services in rural settings is indicated.
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Prognosis conversations are complex phenomena of substantial importance to palliative care (PC), yet these remain poorly understood. This study empirically identifies and describes major types of prognosis conversations that occur in the natural setting of PC consultation. ⋯ We observed three discrete types of prognosis conversations, each placing different communication demands upon all participants for achieving goal-concordant care: Navigating Options & Goals (56% of consultations), Facilitating New Goals (23%) and Preparing for End-of-Life (21%). This study provides the first step for developing educational and clinical prognosis communication interventions that are tailored to common decision-making contexts facing seriously ill patients, their families, and PC clinicians.
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The sexual health needs of people with advanced incurable diseases are underexplored and under assessed by health care practitioners and under studied by researchers. The loss of sexual health can impact a person's overall quality of life and well-being. This integrative review of the literature presents the current state of the science and was conducted to identify and summarize publications in the professional literature related to the sexual health needs of people with advanced illness. ⋯ Of the 30 possibly relevant abstracts and titles identified, there was only one prospective or case control trial focusing on sexual health in this population thereby offering the practitioner little research evidence to inform clinical practice. Increasing our understanding of the sexual health needs of people facing the end of their lives is crucial if we are to conduct appropriate assessments and initiate relevant treatments. Further prospective research is required to assess and establish the sexual health concerns of people along the disease trajectory of incurable illness as well as those imminently facing the end of their lives.
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Opioids are the preferred medications to treat cancer pain; however, several barriers to cancer pain management exist, including those related to the patient, health care provider, and family caregiver. We describe one such situation in which a family member prevents the patient from receiving adequate pain management at the end of life despite interdepartmental and interdisciplinary efforts. This case highlights the importance of understanding and addressing fears regarding opioid use and implementing an integrated approach including oncologists and palliative care physicians, along with early referrals to palliative care.