Articles: palliative-care.
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Chronic pain is a common condition for which patients seek care from various health-care providers. This type of pain causes much suffering and disability and is frequently mistreated or undertreated. Patients who present for evaluation for chronic pain should undergo a careful assessment before therapy. ⋯ These patients suffer from a chronic condition and often require long-term care, with frequent reassessment and adjustment of therapy. Although cure is possible, it is also infrequent. Therefore, therapy is provided with the aim of decreasing pain and suffering while improving physical and mental functioning.
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Making palliative care decisions for a patient who lacks decision-making capacity presents several challenges. Other people, such as family and caregivers, must choose for the patient. The goals and values of these decision makers may conflict with those of each other and with those of the patient, who now lacks the capacity to participate in the decision. ⋯ The case study describes a consensus-based decision-making strategy that keeps what is known about the patient's wishes and values in the foreground but also expects guidance from the physician and elicits input from family members and other people who care for and have knowledge about the patient. The steps of this process, including key clinical prompts and potential transition statements, are outlined and described. The overall goal of the case commentary is to demonstrate that physicians can guide a highly emotional and personal process in a structured manner that has meaning for the patient, family, physician, and other caregivers.
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Palliative care of terminal cancer patients is one of the tasks of our Home Care Unit. Increasing hospitalization costs have brought forward the decision to treat them at home, assuming that they would prefer to return and die in their natural surroundings, among family. Most of our patients are aged, recent immigrants from the Soviet Union, of low socioeconomic status; most live with their close families. ⋯ Families in which treatment was 24 weeks or more were generally less satisfied than those with shorter treatment at home. We learned that an early entry into treatment is necessary; hospital referral criteria should consider to a greater extent the coping ability of families; nursing aid hours should be increased and professional emotional support added; additional pain control methods should be used. All these would strengthen families, improve quality of care, and contribute to additional savings by decreasing hospital stay.
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La Revue du praticien · May 1999
Comparative Study[Pain at the end of life: assessment and management].
Pain assessment and management of pain at the end of life require a good knowledge of pain pathophysiology and of the connections between pain and facing death related suffering. Pain is a multidimensional experience. Only an interdisciplinary team is able to provide a compassionate care with a comprehensive approach.
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Palliative care in children at the end of life should associate the family, the general practitioner, and the hospital team. The care of pain is especially important, with some specific aspects in children. ⋯ Non drug treatments have an increasing role for treating pain in children. Recommendations for palliative care in children with cancer have been established.