J Palliat Care
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The population in Canada and other developing countries is aging, increasing the need for palliative care services. In rural communities, care of dying people is normally provided by health care professionals as part of a generalist practice, not by palliative care specialists. Despite a lack of specialists and resources, some rural communities have developed local palliative care programs. ⋯ The outcome is a theoretical model that conceptualizes the process of developing palliative care programs in four sequential phases: antecedent community conditions, a catalyst, creating the team, and growing the program. The activities of each phase are outlined. This research offers practical and theoretical knowledge to guide practitioners and planners seeking to develop palliative care programs in other rural communities.
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Collaboration between nurses and physicians is essential for successful pain management, especially in home care settings. This study describes how physicians collaborate with nurses for the pain management of terminally ill cancer patients treated at home in Japan, and evaluates the use of standing orders in pain management. ⋯ In general, institutions caring for fewer patients per year were less likely to make specific efforts to collaborate with nurses and less likely to use standing orders in pain management. Given that many institutions provide home palliative care services on a small scale, a standard protocol for care should be developed and applied across all institutions to ensure the availability of quality home palliative care throughout the country.
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To provide further evidence about the prevalence and correlates of the sense of "self-perceived burden" (SPB) to others, and to examine its association with caregiver reports of burden. ⋯ SPB is a common and distressing concern for many patients receiving palliative care and is associated with a number of other distressing concerns.
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Most care received by cancer patients is provided in the community by informal or unpaid caregivers. The unrelenting care demands can lead to physical, emotional, social, and financial reactions; furthermore, studies indicate that the effects of caregiving may endure after the patient's death. A need therefore exists for instruments measuring both caregiving and post-caregiving reactions. ⋯ As hypothesized, results provide support for a 5-factor structure of responses to this modified version of the CRA. The concurrent validity of responses to the scale was also supported. Replication of the findings with randomly derived and larger sample sizes is needed.