Articles: palliative-care.
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To describe the use of palliative radiotherapy (PRT) and to identify factors associated with the use of PRT. ⋯ The use of PRT varied across the dispersed population in Ontario and was influenced by factors unrelated to the patient's needs. An effort should be made to reduce barriers to access for disadvantaged groups.
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Biography Historical Article
Learning from Sir William Osler about the teaching of palliative care.
The publication by Michael Bliss of his authoritative and illuminating text William Osler: a Life in Medicine (1) provides a wonderful opportunity to reflect on the life of a great man who had a major influence on medical undergraduate teaching and medical practice. His approach to the care of both patients and colleagues was warm and encouraging. ⋯ He had the ability to blend wide knowledge with high ideals and common sense to influence the ways in which the doctor-patient relationship developed. Drawing on passages from the biography of William Osler, and linking his practice with the work of Donald Schön and the development of reflective practice, this paper identifies elements of our roles as clinicians and teachers that could be enhanced by further examination of the life of a man who has been described as the "greatest doctor in the world" (1, p. 480); a physician "whose work lies on the confines of the shadowland" (1, p. 291).
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The meaning of dignity is commonly assumed but rarely examined in palliative care. Dying with dignity often forms the basis of clinical decision making at the end of life, but is constructed differently depending upon setting and context. A discourse analysis of patient and family case studies found that relationships and embodiment were important aspects of dignity that have been neglected in the literature, although these constructions of dignity matter to dying people and their families. An understanding of these constructions can assist clinicians in providing sensitive palliative care across a range of community and medical settings.
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Cancer is the second leading cause of death among Americans. The World Health Organization has mandated an integrated approach to palliative care in the treatment of patients with cancer. However, medical decision making in the setting of life-threatening disease remains complicated. ⋯ If fully implemented, the integrated palliative care approach will result in quaternary prevention, ie, the prevention of suffering.
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This study examined activities related to the provision of psychosocial care by counsellors in the hospice/palliative care setting. A qualitative design using written reports was used in an urban Canadian hospice/palliative care program. A convenient sample of 13 counsellors indicated the activities they typically performed in their work with patients and families. ⋯ These thematic findings confirmed those of previous studies and also highlighted two additional findings. Team support was seen as an activity that directly affected client care, and there was a strong emphasis on the activity of companioning the dying and their families. Also discussed are implications of these results, as well as suggestions for further research.