Articles: palliative-care.
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Am J Hosp Palliat Care · Jan 2000
Comparative StudyThanatophobia and opiophobia of hospice nurses compared with that of other caregivers.
In meeting national needs for our terminally ill, health care educators need to become more aware of their students' aptitudes for hospice work. For these reasons we measured hospice nurses' attitudes toward caring for the terminally ill and their views on using opioids, and compared them to those of other health care personnel and their students. Thirty-eight hospice nurses, 64 other nurses, 93 physicians, and 676 senior medical students participated in this study. ⋯ In caring for the terminally ill, hospice nurses' other personal traits were also less maladaptive than those of the other health professionals. Psychiatrists exhibited the most opiophobia, not only scoring higher than physicians practicing oncology, but also higher than senior medical students. To assure cancer patients that they can expect to live their lives free of pain, medical educators can use these thanatophobia and opiophobia scales to develop better teaching, counseling, and monitoring strategies.
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Clinical Trial
[Research from the Palliative Care Department in Poznań on treatment of neoplasm pain with Durogesic (transdermal fentanyl)].
Transdermal Fentanyl (TF, Durogesic) is a strong opioid analgesic which is used in the treatment of cancer pain. In this article we described basic properties and dosing guidelines for TF and our own experience with use of Durogesic in the treatment of cancer pain. In this open study TF was administered in 16 pts aged of 30-88 (mean 62 +/- 17) years with advanced cancer who suffered from strong cancer pain and who had previously been treated with morphine (11 pts), buprenorphine (1 pt), tramadol (2 pts) and non-opioid analgesics (2 pts). ⋯ The treatment was well tolerated and the most frequent adverse reactions were constipation in 10 pts (63%) and drowsiness in 4 pts (25%). During the therapy with TF we didn't encounter serious side-effects which would cause cessation of the treatment. Results of our study confirmed that TF was an effective analgesic most commonly used in pts with stable nociceptive pain especially when opioid analgesics could not be administered orally.
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Comparative Study
Home versus hospice inpatient care: discharge characteristics of palliative care patients in an acute care hospital.
This prospective survey was initiated to identify factors that helped and hindered home discharge for 100 consecutive patients who did not require further specialist palliative or acute care. Information was collected on demographics, functional ability (using the Palliative Performance Scale [PPS] and Karnofsky Performance Scale [KPS]), cognitive function at discharge as measured by the Mini-Mental State Examination (MMSE), home support circumstances, and patient and family preference for discharge. 59 patients were discharged home and 41 were transferred to a hospice. Younger patients with younger caregivers were discharged home more often. ⋯ More physical support at home could have facilitated a home discharge for 13 patients. Functionally dependent and cognitively impaired patients were generally unable to return home. To support patients and their families in an environment of their choice, access to increased physical support in the home must be addressed.
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The dynamics surrounding the patient and family facing a death as the 'unit of care' is discussed. Aspects of communication, openness within the family, especially concerning children and teenagers, and factors that enable a family to function under the stress of a loved one's terminal illness are explored. The use of a genogram in palliative care to help to piece together the family dynamics and available support is fundamental to the care for the whole family.
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With recent changes in health care there is greater emphasis on providing care at home, including the support of families to enable more home deaths. Since a home death may not be practical or desirable in every family situation, there is a need for an objective way to assess the viability of a home death in each individual family situation. The purpose of this study was to describe the relative role of predictors of home death in a cohort of palliative care patients with advanced cancer. ⋯ Logistic regression identified a desire for home death by both the patient and the caregiver as the main predictive factor for a home death. The presence of more than one caregiver was also predictive of home death. The questionnaire is simple and, if our results are confirmed, it can be used for predicting those who will not have a home death.