Articles: palliative-care.
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The field of Hospice and Palliative Medicine (HPM) has its roots in the principles, promulgated by Dame Cicely Saunders, that patient and family are the unit of care and that comprehensive integration of physical, psychological, social, and spiritual care is necessary to address suffering in all its dimensions. Although we aspire to provide comprehensive care for our patients, most hospice and palliative care (HPM) physicians lack basic competencies for identifying and managing patients with psychological distress and mental health distress and disorders, a growing segment of our clinical population. ⋯ The history of our field, the nature of our clinical workforce, the culture of PC, and our educational programs all contribute to our current practice model, which is not adequate to meet the mental health needs of our patients. I propose strategies to address these challenges focused on enhancing integration between psychiatry/psychology and HPM, changes in fellowship education and faculty development, addressing the stigma against people with mental health diagnoses, and addressing system and cultural challenges that limit our ability to provide the kind of comprehensive, integrative care that our field aspires to.
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Introduction: It is a common practice in Ontario to prescribe patients with advanced life-limiting illness a Symptom Response Kit (SRK), an emergency medication and medical supply kit, to manage distressing symptoms in the community toward the end of life (EOL). These are hugely beneficial to patients; however, the medications included have high risk profiles, and there is no uniform procedure in place for the return or disposal of SRKs. This narrative review aims to identify what happens to unused SRKs when no longer needed. ⋯ There is no consensus on SRK terminology and no studies evaluating the return or safe disposal of SRKs in the community when no longer needed. Future work should establish safety regulations, disposal monitoring, supervision of use, and terminology standardization. OHAH organizations provincially are conducting innovative work in this area.
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Objectives: The aim of this study was to investigate from the perspective of palliative care (PC) patients with cancer, the frequency of sexual dysfunction (SD) and their views regarding the communication with their physicians. Design, Setting, and Participants: Adult PC patients with cancer seen at a Supportive Care Clinic in the United States were invited to participate in a survey about SD. Results: A total of 100 patients completed the survey. ⋯ Only 20% reported that their clinician ever asked them about SD. Most (79%) considered appropriate to be inquired about SD, but only 32% thought it should always be asked. Conclusions: Our findings do not support the notion that PC specialists should always initiate a discussion about SD with their PC patients with cancer.