Articles: palliative-care.
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J Pain Symptom Manage · Sep 2022
Close Encounters of the First Kind: An interdisciplinary ethics of care approach mitigates moral injury and family division in the midst of COVID-19.
In this compelling personal narrative describing a case from the front lines of the COVID-19 pandemic, a palliative care physician harnesses the creative powers and strengths of the interdisciplinary team to provide compassionate care to a critically ill patient and his family. The author describes the process of identifying a surrogate decision maker from among the patient's many adult children-several of whom were estranged from him and each other-and facilitating weighty decisions about his end-of-life care. Over the course of this journey, the author grapples with her inner biases and struggles with the emotional trauma associated with bearing witness to extraordinary suffering and social isolation imposed by COVID-19. Not only does the ethics of care approach embodied here lead to the creation of enduring vibrant works of art for this patient and others, but it also affirms a guiding principle of palliative care in which interdisciplinary collaboration is marshalled in the service of cultivating relationships, upholding responsibilities, and intensifying empathy among persons tied together by a common narrative.
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J Pain Symptom Manage · Sep 2022
Provider Perceptions for Withdrawing Life Sustaining Therapies at a Large Pediatric Hospital.
More than 74% of pediatric deaths occur in an intensive care unit (ICU), with 40% occurring after withdrawal of life-sustaining therapies (WOLST). No needs assessment has described provider needs or suggestions for improving the WOLST process in pediatrics. ⋯ While participants' self-rated confidence was high, it varied between disciplines. Participants identified opportunities for improved communication and planning before a WOLST. Future work includes development and implementation of a best practice guideline to address gaps and standardize care delivery.
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Serious illness often causes financial hardship for patients and families. Home-based palliative care (HBPC) may partly address this. ⋯ These findings highlight the importance and need for routine assessments of financial distress and for provision of social supports required to help families receiving palliative care services.
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J Pain Symptom Manage · Sep 2022
Multicenter StudyA Multi-Centre COVID-19 Study Examining Symptoms and Medication Use in the Final Week of Life.
Guidelines exist to direct end-of-life symptom management in COVID-19 patients. However, the real-world symptom patterns, and degree of concordance with guidelines on medication use, and palliative care involvement has received limited attention. ⋯ Symptoms peaked in final three days of life. Earlier use of in fusional and breakthrough medications should be considered in anticipation of symptoms given high likelihood of dying in discomfort. Earlier palliative care referral for high-risk patients should be considered at hospital admission.