Journal of palliative medicine
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Selective participation in retrospective studies of families recruited after the patient's death may threaten generalizability of reports on end-of-life experiences. ⋯ Families may be more likely to participate in research with more harmonious teamwork in end-of-life caregiving. Where family participation is an enrollment criterion, comparing demographics alone may not capture possible selection bias, especially in more subjective measures. Selection bias toward more positive experiences, which may include the physician's and probably also the family's experiences, should be considered if representativeness is aimed for. Future work should address selection bias in other palliative settings and countries, and with prospective recruitment.
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Despite Islam being the world's second largest religion and despite the fact that there are 22 Arabic-speaking nations representing North Africa and the Middle East, little is known about the relationship between spiritual well-being and health-related quality of life (HrQoL) for Arabic-speaking Muslims in treatment for cancer. ⋯ The FACIT-Sp distinguishes between domains of HrQoL and patient characteristics. Further study on the unique contribution of the FACIT-Sp's Peace and Meaning subscales to HrQoL is needed.
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The experiences of people with pain under palliative care is not well documented longitudinally. This work aims to describe the prevalence, intensity, progression, and associations of self-reported pain scores of people under a community palliative care service, by retrospectively examining how routinely collected pain scores changed over time. ⋯ Even in the context of expert delivery of palliative care where pain is most likely to be optimally managed, pain continues to be a problem. Work such as this suggests that the different mechanisms that contribute to pain may influence patients' experiences even when analgesia is optimized in a specialist setting. Particular attention is needed in the future to explore the relationship between severe pain and mobility.
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Case Reports
How do we talk to the children? Child life consultation to support the children of seriously ill adult inpatients.
Families with young children often struggle to talk about and cope with a parent's life-threatening illness and potential death. Adult interdisciplinary palliative medicine teams often feel unprepared to facilitate the open communication with these children that has been shown to reduce anxiety, depression, and other behavioral problems. In pediatric settings, child life specialists routinely provide this support to hospitalized children as well as their siblings and parents. Although these services are the standard of care in pediatrics, no research reports their use in the care of children of adults with serious illness. ⋯ All hospitals should consider providing broad-based in-service training enabling their staff to improve the support they offer to the children of seriously ill parents. Medical centers with access to child life services should consider developing a child life consultation service to further enhance this support. More research is needed to evaluate both the short- and long-term clinical impact of these interventions.
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The project intended to describe the format of the Wrap-up, a unique multidisciplinary guided debriefing following a child's death. Specific feedback from pediatric residents was sought to assess the model. ⋯ The Wrap-up, a unique forum for debriefing after a pediatric death, was well-received by residents and assisted them with processing, understanding, and resolving their experience regarding the pediatric death. The Wrap-up was a valuable addition to residents' experience and education in pediatric critical care medicine and can be replicated in other institutions.