The Hospice journal
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The withholding of nutritional support from patients is one of the most controversial issues in modern medical ethics and law. Withholding support from a consenting, terminally ill patient is the simplest case situation to defend, but patients in a persistent vegetative state or irreversible, chronic illness, require more careful deliberation. Regarding this issue, five primary principles have been utilized in legal decision making. ⋯ Optimally, those wishes should be codified into an advance directive and a proxy decision maker named. If a patient is not competent, and without previously expressed wishes, immediate family members are usually consulted for what they believe are the patient's best interests. Last, although limitations of care for terminally ill children fall under the same general guidelines as for adults, the "Baby Doe Rules" are a complicating factor.
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The Hospice journal · Jan 1992
Assessment of the terminally ill patient with pain: the example of cancer.
Efforts to understand pain associated with terminal illness have been guided traditionally by the biomedical model in which psychological and environmental factors are considered incidental and not causally significant influences of pain. More recent conceptualizations of pain, however, recognize that pain can be affected by a variety of factors including mood, beliefs about pain, past learning, as well as physical perturbations. This development has led to assessment strategies that are more comprehensive, multidimensional, and less singularly aligned with a biomedical model. ⋯ Thus, in this paper we will describe a comprehensive, multi-dimensional assessment of cancer pain. Information regarding cancer and cancer pain is first presented and then a strategy for comprehensively assessing cancer pain is outlined. Recent developments in the assessment of cancer pain are briefly reviewed.
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Recent passage of the Patient Self-Determination Act will require health care providers to develop policies concerning patients' wishes for life prolonging therapy. Since American hospice programs have generally had do-not-resuscitate (DNR) policies since their inception we thought it timely to review the experience of hospice programs with the DNR order. ⋯ This lack of uniformity exposes the unresolved issue within the hospice community as to what is considered appropriate hospice or palliative care. Problems with paramedics responding to 911 calls and not respecting DNR orders or living wills are also discussed.
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The Hospice journal · Jan 1990
Cancer pain intensity measurement: concurrent validity of three tools--finger dynamometer, pain intensity number scale, visual analogue scale.
Although the visual analogue scale (VAS) and number scales are known to be valid and sensitive measures of pain intensity, some older individuals are unable to use them. For individuals who lack the ability to use these scales, valid alternative measures of pain intensity would be useful for research and clinical practice. The purpose of this study was to examine the concurrent validity of a new measure of pain intensity, the Finger Dynamometer (FD), in a sample of 15 adults with advanced stage cancer pain. ⋯ Strong correlation was found between the VAS and the PINS (gamma = .77 to .89; p less than .001). Findings support the concurrent validity of the VAS and the PINS but indicate that further research is necessary to establish the psychometric properties of the FD as a measure of pain intensity in chronic pain models, such as cancer pain. Recommendations are made regarding important variables to be considered in further research with the FD.
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Two complementary studies examined social structural dimensions of discussions and decisions to enter hospice care. In Study 1, intensive interviews were conducted with caregivers, patients, "other" decision makers, and physicians for 150 hospice cases. In Study 2, survivors of cancer deaths were surveyed by mail. ⋯ Data from Study 2 showed the importance of the timing of communications about hospice. Both studies revealed high levels of awareness of hospice care, as well as how social networks, particularly friends and relatives, serve to communicate information about hospice. Implications for the timing of communications related to hospice care, as well as for future research and models of decision-making are discussed.