Primary care
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The end of life is a period of intensive care. It is imperative that physicians have training and skills in the care of dying patients. Understanding the process of dying and recognizing physical changes aids in prognostication. Skills in facilitating family coping, treating pain, respiratory distress and delirium are critical.
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Hospice and palliative care programs have grown rapidly in the United States over the last 25 years. Relief of suffering and maximization of quality of life including symptom control, psychosocial health, and spiritual care are the primary goals of hospice and palliative care. This article reviews the development, philosophy, and practice of hospice and palliative care, and describes barriers to and suggestions for integrating this approach into mainstream medicine.
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Excellent symptom management is paramount in palliative care. Without it, the individual patient will be unable to focus appropriately on other issues of concern, including those of a psychosocial, emotional, or spiritual nature. This article reviews current pharmacologic and nonpharmacologic interventions for symptoms commonly encountered in palliative care. These symptoms are organized into gastrointestinal, respiratory and neuropsychiatric categories.