Articles: palliative-care.
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Multicenter Study
Policies on medical decisions concerning the end of life in Dutch health care institutions.
To describe the prevalence and some features of policies on medical decisions concerning the end of life (MDELs) in Dutch hospitals, nursing homes, and institutions for the mentally disabled. ⋯ This study indicates that an important step toward policy development on EAS has been made by Dutch hospitals and nursing homes. Particularly with respect to policies on such decisions as withholding or withdrawing treatment, symptom and pain control, and DNR orders, an unexplored field is open to management for policy development in the Netherlands.
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Tidsskr. Nor. Laegeforen. · Feb 1996
Comparative Study[Patients with cancer-related pain and other chronic pain. Priorities and assessment].
In a survey completed at our hospital, 519 doctors and nurses were asked how pain treatment was estimated whether it received priority, and to what degree patients' pain syndromes were assessed. A total of 473 responded to the questionnaire. In the study cancer-related pain and pain from causes other than cancer were assessed in separate population groups. ⋯ Only 46% assumed that a planned pain assessment was done as a routine. Physicians and nurses alike experienced great inadequacy in their work with patients in pain. This was expressed more clearly in connection with pain not caused by cancer.
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Non-small cell lung cancer is the most common cause of cancer death in both males and females. Despite this high incidence and mortality, comparatively little research has addressed the palliative treatment of thoracic symptoms. Until recently, information regarding the indications and effectiveness of radiation in this setting was obtained from retrospective reviews of single institutional experiences. ⋯ The panel agreed that favourable patients with stage IIIB NSCLC should be offered combined modality therapy with the intent of prolonging survival, and that patient preferences regarding the risks and benefits of this therapy should be considered. Further study was recommended, namely, a randomized trial evaluating five fractions of radiation vs a single fraction, using patient-based evaluation of palliation. The panel also recommended phase II development of a combined chemotherapy and low-dose radiation protocol appropriate for future study.
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In fact that radiation therapy is often the most effective means of palliating symptoms caused by cancer is well recognized in the United States. Estimates of the proportion of patients treated in the US with radiation therapy who are treated for palliative rather than curative intent range from 15% to 50% and depend on the geographic location, cancer incidence, referral patterns, etc. ⋯ Estimates from patterns of care studies indicate that over 250,000 patients were treated with palliative radiation therapy at a cost of between $1.0 and $1.8 billion in 1994. The scope of this presentation will cover four aspects of palliative radiation therapy in the United States: 1. existing practice patterns; 2. factors affecting treatment patterns; 3. the cost of palliative radiation therapy; and 4. present research and guidelines developments efforts.