Articles: palliative-care.
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Palliative care is received by a small number of patients with terminal illness, most of them with cancer. ⋯ Recognizing and overcoming the barriers to the provision of palliative care can bring about changes in education, health care practices, and administration to achieve the desired goals.
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Palliative medicine · Apr 1996
Randomized Controlled Trial Clinical TrialA randomized controlled trial of the cost-effectiveness of a district co-ordinating service for terminally ill cancer patients.
The objective of this paper is to compare the cost effectiveness of a co-ordination service with standard services for terminally ill cancer patients with a prognosis of less than one year. We designed a randomized controlled trial, with patients randomized by the general practice with which they were registered. Co-ordination group patients received the assistance of two nurse coordinators whose role was to ensure that patients had access to appropriate services. ⋯ In conclusion, the co-ordination service for cancer patients who were terminally ill with a prognosis of less than one year was more cost effective than standard services, due to achieving the same outcomes at lower service use, particularly inpatient days in acute hospital. Assuming that the observed effects are real, improved co-ordination of palliative care offers the potential for considerable savings. Further research is needed to explore this issue.
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Requirements for healthcare professionals in the United Kingdom to undertake continuing education are discussed. For nurses, midwives and many career-grade doctors, formal arrangements are in place; for other professionals, continuing education is recommended but not yet a formal requirement. In order to explore what is available, courses, conferences and seminars advertised in the Hospice Information Service's publication Choices for the academic year September 1994 to July 1995 are reviewed in terms of number, intended audience, participants and duration. ⋯ Issues of approval, quality assurance and evaluation are addressed. Suggestions are offered with regard to future financing of courses, and co-ordination of planning and provision. It is suggested that the National Council for Hospice and Specialist Palliative Care might encourage increasing co-operation between units in the provision of education.
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Seminars in oncology · Apr 1996
ReviewPalliative and supportive care of patients with pancreatic cancer.
Pancreatic cancer tends to be diagnosed at a relatively late stage of disease and often secondary to significant complaints of pain. In addition there is evidence of higher rates of depressive symptoms at diagnosis in pancreatic cancer than in other forms of cancer. These factors, along with the specific tumor anatomy and pathophysiology of pancreatic cancer make palliative considerations central to the care of patients with the disease. ⋯ Depression should be treated with pharmacotherapy and supportive psychotherapy as indicated. Hospice should be considered early on in the treatment relationship and can provide pain and symptom management services as well as play an important role in providing emotional support to the patient and family. Attention to pain, mood, psychological distress, and other quality of life issues can often allow for successful treatment of symptoms and improvement in functioning even in the setting of late stage pancreatic cancer.
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J Pain Symptom Manage · Apr 1996
Comprehensive pretreatment and outcome assessment for chronic opioid therapy in nonmalignant pain.
Guidelines currently exist on the use of opioid therapy for chronic nonmalignant pain. Unfortunately, no randomized, prospective, controlled studies have been conducted to verify these guidelines or determine the optimal inclusion or exclusion criteria for this treatment. The decision to administer opioid therapy is often based on treatment orientation and subjective clinical impressions. ⋯ Second, current guidelines for opioid therapy are discussed, and areas considered critical in assessing treatment efficacy are reviewed, including (1) pain intensity, (2) functional capacity, (3) personality and mood, (4) pain beliefs, (5) medication usage, (6) adverse effects, (7) health-care utilization, and (8) medical and psychosocial history. Finally, questions are posed for future investigations of the efficacy of opioid therapy in selected patients with chronic nonmalignant pain. This article identifies important areas to consider when initiating controlled trials designed to identify those patients most suitable for chronic use of opioids.