Journal of palliative medicine
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Review Historical Article
Palliative medicine physician education in the United States: a historical review.
In this review we discuss the history of Hospice and Palliative Medicine (HPM) physician education in the United States over the last 20 years, as there has been dramatic growth in our specialty during this time. A Medline literature search was completed and we surveyed leaders in the field of HPM education regarding their experiences in promoting palliative medicine education. ⋯ A survey tool was designed and emailed to 18 educators across the country and follow-up phone interviews were done to further explore specific questions. The survey and interviews sought information about major palliative care education milestones, instrumental projects, and barriers to further development of palliative medicine education.
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It is unclear if physiologic measures are useful for assessing dyspnea. We examined the association among the subjective rating of dyspnea according to patients with advanced cancer, caregivers and nurses, and various physiologic measures. ⋯ Patients' level of dyspnea was weakly associated with physiologic measures. Caregivers' perception may be a useful surrogate for dyspnea assessment.
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Studies using administrative data report that racial/ethnic minority patients enroll in clinical trials less frequently than white patients. We studied a cohort of terminally ill cancer patients to determine a) if racial/ethnic minority patients have lower rates of drug trial enrollment than white patients once socioeconomic characteristics are accounted for and b) what factors most influence drug trial enrollment among patients with advanced canceroverall. ⋯ Patient race/ethnicity was not associated with clinical trial enrollment after adjustment for socioeconomic covariates. Patients with advanced cancer endorsing less engagement in end-of-life planning were more likely to be enrolled in a clinical trial.
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Community physicians are often ill-prepared for the management of complex symptoms. With a shortage of board certified physicians in palliative medicine to assist, the result is a lack of access to critical pain and symptom management expertise to care for seriously ill Californians. We report on a palliative medicine telephone hotline available to health care professionals. ⋯ The hotline proved to be a valuable resource for health care providers caring for patients requiring palliative care as evidenced by the steady increase in the number of calls over the initial 2.5 years of operation. Future research on how the information directly impacted patient care might generate data to support the continuation of this service via partnerships with other organizations.
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Surrogates of critically ill patients in the intensive care unit (ICU) want honest prognostic information, but they also want to hear good news. There has been little examination of how surrogates navigate these dual needs or how clinicians should respond. ⋯ Surrogates in the ICU experience conflicting emotional and informational needs. They describe behaviors that give the appearance of avoiding bad news while simultaneously asking physicians to help them cope with prognostic information.