Articles: palliative-care.
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J Pain Symptom Manage · Feb 1995
ReviewPsychosocial issues in palliative care: the patient, the family, and the process and outcome of care.
This article presents a synopsis of the psychosocial needs of patients and families in the terminal phase of malignant disease, as well as approaches to auditing the care of these clients. Recommendations for future research from the National Cancer Institute of Canada Workshop on Symptom Control and Supportive Care in Patients with Advanced Cancer are presented. These include recommendations on the need for more effective tools to measure the symptoms and burden of illness; an improved taxonomy to describe terminal illness; and studies to (1) measure the impact of interventions for improved symptom relief on the psychosocial distress of patients and families, (2) determine the impact of psychosocial interventions on the symptomatology associated with terminal illness, (3) operationalize "good palliative care" and the optimal delivery of palliative care, (4) assess the auditing of palliative care, (5) develop family typologies of adaptation to terminal illness, (6) describe high risk families, and (7) measure the impact of staff support programs on improving patient/family care.
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To identify factors associated with the location of death (home or hospital) of patients referred to a palliative care home support team. ⋯ Patients' preference as to place of death, level of caregiver support and entitlement to private shift nursing were significantly associated with patients' dying at home. The determination of these factors should be part of every palliative care assessment. Patients and their families should be informed about available home support services.
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Pain relief for the cancer patient in the hospice setting is almost always achievable. Cancer pain is caused by tumor growth and by psychosocial and spiritual factors. Opioid drugs are the mainstay of effective treatment. ⋯ Nonsteroidal anti-inflammatory drugs and adjuvant analgesics are synergistic with opioids in providing analgesia and allow lower opioid doses and fewer side effects. Ten to 15 percent of hospice patients will require regional anesthesia for pain relief. The hospice team of physicians, nurses, social workers, chaplains, aides, and volunteers is more effective than any single health care provider in achieving optimal pain relief and comfort.
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The "modern" hospice movement was established at the beginning of the 1960s in Great Britain. Philosophical issues and a holistic treatment model have been emphasized in order to meet the physical, emotional, social and psychological needs of dying patients. Less time has been devoted to research. ⋯ It is also important to increase the teaching about palliative medicine at medical school. The first unit of palliative has been established at the University Hospital, Trondheim. Similar clinics should be established at the other university hospitals in Norway.