J Palliat Care
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The basic tenets of palliative care are frequently subsumed under the goal of helping patients to die with dignity. Our research group has studied the issue of dignity, with dying patients serving as the primary informants. ⋯ Finally, we provide the rationale based on the Dignity Model for a psychotherapeutic intervention we have coined Dignity Therapy. This brief, individualized therapeutic approach has been informed by our dignity work, and specifically designed for application in patients nearing death.
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A survey was conducted in fall 2001/spring 2002 to provide an update on the status of undergraduate palliative medicine education in Canada. The survey identified that the majority of palliative care teaching occurs in the pre-clinical years of medical school, with supervised patient encounters occurring primarily during electives. The coverage of palliative care topics is inconsistent across curricula. ⋯ A number of barriers to palliative medicine education were identified, including competition for time within the undergraduate curriculum, and lack of resources for curriculum development and teaching. Respondents recommended increased clinical exposure, curriculum development, student assessment and evaluation, faculty development, and improved infrastructure. Following these recommendations, the Undergraduate Palliative Medicine Committee has dedicated itself to developing and fostering a strategic implementation plan to improve palliative medicine education in Canadian medical schools.
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The purpose of this descriptive cross-sectional study was to describe family caregiver involvement in and perceptions of cancer pain management. A consecutively recruited cohort of 75 patient-caregiver dyads attending an outpatient oncology clinic completed self-report questionnaires comprising standardized and investigator-developed measures of pain behaviours and experiences. ⋯ At the same time, many caregivers experienced a great deal of distress and some difficulties in performing these activities. The significance and scope of these caregiving experiences suggest that developing the caregiver's ability to effectively contribute to pain management is an important priority in efforts to improve cancer pain management.
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In this exploratory study, family members of 63 decedents were interviewed by telephone, two to five months post-death, about their perceptions of their loved one's worries, symptoms, and suffering at the end of life. The most common worries reported focused on loss of bodily function (44%), being dependent (40%), and being a burden (39%). ⋯ A majority (94%) of family members reported that their loved one suffered at the end of life, but only worries about loss of quality of life (e.g., being unable to participate in enjoyable activities) were predictive of reports of suffering. Findings suggest that worries, irrespective of the level of current symptoms, play an important role in the suffering of dying patients, and that treatment plans for the terminally ill should routinely explore both symptoms and worries.
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The goal of this project was to provide guidance on what constitutes quality end-of-life care in long-term care (LTC) facilities. Seventy-nine direct care providers from six LTC facilities participated in 12 focus groups. ⋯ Analyses of the focus group data revealed six themes that contribute to quality end-of-life care in LTC facilities: responding to resident needs, creating a homelike environment, supports for families, providing quality care processes, recognizing death as a significant event, and having sufficient institutional resources. These findings challenge policy makers and providers to consider how to normalize life and death in LTC facilities.