The Hospice journal
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As the concept of hospice has evolved in the United States, it has become apparent that there is a significant need for increased physician participation in all aspects of the care of terminally ill patients provided by hospice programs. Four distinct physician roles have emerged: the attending physician, the consulting physician, the hospice medical director, and the hospice team physician. As the roles of the hospice medical director and team physician have become better defined, many physicians are finding that palliative medicine and full time hospice employment is a rewarding career option. The increased involvement of physicians in all aspects of hospice and palliative care will result in measurable improvement in the quality of patient care that hospice programs provide to terminally ill patients and families.
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Oncology and hospice literature have addressed the problem of psychiatric complications, secondary to the stressors of diagnosis and treatment. This literature focuses particularly on depression and anxiety, which not only compound patients' suffering but also may interfere with optimal care. ⋯ In order to contribute to collegial dialogue that addresses this minority population in hospice services, a case study is presented in this article of the process of care for a hospice patient with a preexisting psychiatric condition. Interventions are suggested, using a theoretical matrix of hospice philosophy and principles of care for manipulative patients.