Articles: palliative-care.
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Palliative medicine · May 1999
ReviewPatient and carer preference for, and satisfaction with, specialist models of palliative care: a systematic literature review.
This systematic literature review examined the impact of specialist models of palliative care on consumer satisfaction, opinion and preference over the past 20 years. From the literature search, 83 relevant papers were identified. Research findings from North America did not reveal any reliable or consistent trends, and this was due primarily to methodological flaws in the research. ⋯ Even though research findings consistently indicate that consumers appreciate the psychosocial climate in hospices, this research was based on small-scale local studies which were mainly focused on a single hospice. The dearth of high quality, comprehensive research was notable on the impact on consumer preference, opinion or satisfaction of hospice home care services, and other forms of palliative care in the community. It was concluded that further research is needed into consumer priorities for patients dying of noncancer diseases, and into the possible impact of patient characteristics on consumer satisfaction, opinion and preference for specialist models of palliative care.
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In order to develop standards of care that alleviate pain and other distressing symptoms among dying patients, the Providence Hospice of Yakima team has developed and utilized pain and nonpain symptom management algorithms. In use since late 1993, the system is a success, as demonstrated by positive satisfaction surveys among physicians, staff, and family members. This article offers an introduction to the algorithmic process, key components of its success, and guidelines for further improvement in the care provided to dying patients.
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Gallbladder cancer is the fifth most common gastrointestinal malignancy. Although overall 5-year survival is less than five percent, improved survival has been reported in recent years for extended resection of localized lesions. Nonetheless, one-third of operations for gallbladder cancer are palliative procedures. ⋯ Gastrointestinal bypass may be required for patients with gastric outlet obstruction. Although biliary bypass can be attempted to the extrahepatic biliary system or can be achieved by surgical intubation, there is increasing evidence that segment III cholangiojejunostomy provides effective long-term decompression of the obstructed biliary tree. A sound multidisciplinary approach is required in the management of these patients, the majority of whom are unlikely to survive beyond six months.
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Despite evidence that doctor-patient communication affects important patient outcomes, patient expectations are often not met. Communication is especially important in terminal illness, when the appropriate course of action may depend more on patient values than on medical dogma. We sought to describe the issues important to terminally ill patients receiving palliative care and to determine whether patient characteristics influence the needs of these patients. ⋯ Few easily identifiable patient characteristics were associated with expressed concerns or needs, suggesting that physicians need to individually assess patient needs. Terminally ill patients receiving palliative care had needs that were broad in scope. Given that few patient characteristics predicted responses, and that the majority opinion may not accurately reflect that of an individual patient, health care providers must be aware of the diverse concerns among this population and individualize assessment of each patient's needs and expectations.
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Support Care Cancer · May 1999
The Palliative Prognostic Index: a scoring system for survival prediction of terminally ill cancer patients.
Although accurate prediction of survival is essential for palliative care, few clinical methods of determining how long a patient is likely to live have been established. To develop a validated scoring system for survival prediction, a retrospective cohort study was performed with a training-testing procedure on two independent series of terminally ill cancer patients. Performance status (PS) and clinical symptoms were assessed prospectively. ⋯ Also, when a PPI of more than 6 was adopted as a cut-off point, 3 weeks' survival was predicted with a sensitivity of 80% and a specificity of 85%. When a PPI of more than 4 was used as a cutoff point, 6 weeks' survival was predicted with a sensitivity of 80% and a specificity of 77%. In conclusion, whether patients live longer than 3 or 6 weeks can be acceptably predicted by PPI.