Journal of palliative medicine
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Review of published research indicates the need to better incorporate patient and caregiver perceptions when providing end-of-life (EOL) care. Although considerable research regarding patient and caregiver experience of EOL has been done, little research has studied patients, caregivers, and clinicians as a connected system. ⋯ Awareness of these crucial patient and caregiver EOL issues and expectations and how they differ from clinician perspectives can assist clinicians to appropriately explore and address patient/caregiver concerns and thereby provide better quality EOL care.
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Contemporary medicine has begun to reemphasize the importance of palliative and end-of-life-care. This shift requires a commensurate change in physician education to provide adequate palliative care training. The present research assessed medical residents' perceptions of their clinical and educational experiences in palliative care training as provided by a large urban teaching hospital. ⋯ In order to provide adequate palliative care education to future physicians, residency programs must strategically target hospital training units, enhance the quality of palliative care supervision and training that residents receive, and increase the number of dying patients they care for in ambulatory care and nonhospital settings. Recommendations for change are discussed.
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Multicenter Study
Initial assessment of a new instrument to measure quality of life at the end of life.
We conducted this study to pilot a new multidimensional instrument to assess the quality of life at the end of life. ⋯ We have developed a new instrument to measure the quality of life at the end of life that assesses empirically derived domains that are of demonstrated importance to dying patients, is acceptable to a seriously ill population, and exhibits excellent psychometric properties. Some items related to completion and preparation represent particularly new contributions to quality-of-life measurement.
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Tube feeding should always be considered relative to patient goals. Physicians should be prepared to discuss tube feeding as an option bearing in mind what evidence (or lack thereof) exists that tube feeding will help reach such goals.
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To describe the palliative care needs of dying nursing home residents during the last 3 months of life. ⋯ Dying nursing home residents need improved emotional and spiritual care, help with personal cleanliness, and treatment for pain. Efforts to improve end-of-life care in nursing homes should combine traditional palliative care services with increased attention to emotional symptoms and personal care services.