Journal of palliative medicine
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To describe the postresuscitative hospital course of emergency department patients who initially survive nontraumatic out-of-hospital cardiac arrests (OOHCA) but die in the hospital. ⋯ In this urban setting, approximately three of four OOHCA patients who are initially resuscitated do not survive to hospital discharge. This short in-hospital course post-CPR is often marked by pain and ends with the withdrawal of life support. This information may be an important component of advance planning discussions and may assist patients as they weigh the pros and cons associated with resuscitation preferences.
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Few studies have examined ease of integrating palliative care programs into hospital culture. The purpose of this article is to report findings from focus groups conducted among physicians and nurses to elicit their perceptions of an inpatient palliative care team consultation service after 1 year of operation. ⋯ The vast majority of comments expressed were related to positive aspects of the program. However, barriers exist that prevent some terminally ill patients from receiving these services. Findings from this study have implications for the need for education and training among providers on palliative and hospice services and, in particular, on the benefits of an inpatient palliative care team for patients, regardless of their attitudes toward end-of-life care programs.
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Medical oncologists often must deliver bad news. The authors were interested in the extent of formal training in delivering bad news in hematology/oncology fellowships in the United States. ⋯ Of the program directors who responded to our survey, a large majority did not have formal training in delivering bad news. Despite this lack of training, most program directors felt that training was useful for skill development in delivering bad news. The majority of today's fellows do receive training in delivering bad news. However, there was still a significant percentage of program directors who reported little or no formal training for fellows. Most program directors would like to see improvements in how fellows are trained. Specific institutional support for training fellows in delivering bad news remains lacking.
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Abstract The subject of patient-physician boundaries has been most extensively explored in the psychiatric literature, but to date, little has been published about this concept within the realm of palliative care. Some palliative care physicians may be particularly susceptible to boundary crossings due to the intensity and intimacy of the bonds that form with patients at the end-of-life. ⋯ We discuss the nature of the patient-physician relationship using role theory and discuss how the formation of dual roles can be detrimental to the patient-physician relationship. Finally, we explore why palliative care practitioners and trainees are particularly vulnerable to crossing boundaries and how to recognize and manage these crossings when they occur.