Annals of palliative medicine
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Palliative care aims to improve cancer patients' quality of life through expert symptom management, psychosocial and spiritual care, patient-clinician communication, facilitation of complex decision making, and end-of-life care planning. Over the past few years, there has been increasing interest and evidence to support integration of oncology and palliative care. However, it remains unclear how best to promote integration. The goal of this review is to examine contemporary conceptual models and clinical approaches to integrate oncology and palliative care. ⋯ There are multiple conceptual models and clinical models to promote integration. Further research is needed to inform best practices for integration at different healthcare settings.
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The importance of early integration of palliative care (PC) into oncology treatment is increasingly being recognized. However, there is no consensus on what is the optimal way of integration. This article describes a unique model in Hong Kong where clinical oncology and palliative medicine (PM) is integrated through the development of PM as a subspecialty under clinical oncology.
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Case Reports
A values-based conceptual framework for surgical appropriateness: an illustrative case report.
Appropriateness in surgical decision-making necessitates that surgical treatments are aligned with patients' goals and values for care. To arrive at informed decisions for surgery, patients must have an understanding of post-operative recovery, the impact on quality of life, and expected functional outcomes. ⋯ Palliative care needs that arose during the course of the patient's treatment are identified and described, revealing opportunities for better integration between palliative and postoperative care. A conceptual framework for measuring appropriateness in surgery, which incorporates patients' goals, values and preferences for medical treatments, is proposed.
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In 2000, the City of Hope Medical Center and the American Association of Colleges of Nursing (AACN) developed the End-of-Life Nursing Education Consortium (ELNEC)-Core curriculum to educate nurses and other healthcare professionals on end of life care, so that attention to the dying could be improved and their unique needs addressed. Since its inception, over 19,500 nurses and other professionals have attended the ELNEC train-the-trainer courses. Upon course completion, the participants, often nurse educators, returned to their schools, healthcare systems, and communities and introduced the ELNEC content into nursing curricula, annual competencies, and new employee orientation. ⋯ The first ELNEC International course was launched in 2006 in Salzburg, Austria. Since that time, trainers have come from 85 countries world-wide, and the curriculum has been translated into eight languages. In 2015, three international courses will be presented: in Beijing, China, Kipkaren, Kenya, and Salzburg, Austria.
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This article reviews the lessons learned from the development and implementation of New York's community approach to advance care planning (ACP) as a wellness initiative and the key components of the complementary programs: Community Conversations on Compassionate Care (CCCC) and Medical Orders for Life-Sustaining Treatment (MOLST). Shared, informed medical decision-making is a patient-centered process that is critical to ensuring patient preferences for care are honored at the end of life. ⋯ Development, implementation, outcomes, lessons learned and sustainability of the CCCC and MOLST programs highlight the success of a healthcare and community collaborative initiative focused on improving care at the end of life. Community data support the value of implementing the CCCC and New York's MOLST throughout the country.