J Palliat Care
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Hopelessness, loss of meaning, and existential distress are proposed as the core features of the diagnostic category of demoralization syndrome. This syndrome can be differentiated from depression and is recognizable in palliative care settings. ⋯ A treatment approach is described which has the potential to alleviate the distress caused by this syndrome. Overall, demoralization syndrome has satisfactory face, descriptive, predictive, construct, and divergent validity, suggesting its utility as a diagnostic category in palliative care.
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This paper explores how music therapy can assist patients and relatives in the processes of making friendship and love audible in a child cancer ward. Four short patient histories are presented to illustrate a health-oriented, ecological music therapy practice. Two histories describe how texts, made by patients, become songs, and how the songs are performed and used. ⋯ The paper indicates that these interventions may involve more than palliation (making a disease less severe and unpleasant without removing its cause). Not least, such activities can make it possible for the sick child to expand from being "just a patient" into playing, if only for a moment, a more active social role. The processes of artistic interplay, in- and outside the sickroom, influence various relationships in the child's social environment.
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The meaning of dignity is commonly assumed but rarely examined in palliative care. Dying with dignity often forms the basis of clinical decision making at the end of life, but is constructed differently depending upon setting and context. A discourse analysis of patient and family case studies found that relationships and embodiment were important aspects of dignity that have been neglected in the literature, although these constructions of dignity matter to dying people and their families. An understanding of these constructions can assist clinicians in providing sensitive palliative care across a range of community and medical settings.
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1) To comment on the medical literature on decision making regarding end-of-life therapy, 2) to analyze the data on disagreement about such therapy, including palliative care, and withholding and withdrawal practices for critically ill children in the pediatric intensive care unit (PICU), and 3) to make some general recommendations. ⋯ Making decisions about end-of-life care is a frequent event in the PICU. Children may need both intensive care and palliative care concurrently at different stages of their illness. Disagreements are more likely to be resolved if the root cause of the conflict is better understood.