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The Medical Clinics of North America Sep 2020Goals of care conversations are important but complex for clinicians caring for older adults. Although clinicians tend to focus on specific medical interventions, these... (Review)
Review
Goals of care conversations are important but complex for clinicians caring for older adults. Although clinicians tend to focus on specific medical interventions, these conversations are more successful if they begin with gaining a shared understanding of the medical conditions and possible outcomes, followed by discussion of values and goals. Although training in the medical setting is incomplete, there are many published and online resources that can help clinicians gain these valuable skills.
Topics: Aged; Clinical Competence; Decision Making, Shared; Humans; Palliative Care; Patient Care Planning; Physician-Patient Relations
PubMed: 32773044
DOI: 10.1016/j.mcna.2020.06.002 -
Mayo Clinic Proceedings Oct 2017Palliative medicine is a specialty that focuses on improving the quality of life for patients with serious or advanced medical conditions, and it is appropriate at any... (Review)
Review
Palliative medicine is a specialty that focuses on improving the quality of life for patients with serious or advanced medical conditions, and it is appropriate at any stage of disease, including at the time of diagnosis. Neurologic conditions tend to have high symptom burdens, variable disease courses, and poor prognoses that affect not only patients but also their families and caregivers. Patients with a variety of neurologic conditions such as Parkinson disease, dementia, amyotrophic lateral sclerosis, brain tumors, stroke, and acute neurologic illnesses have substantial unmet needs that can be addressed through a combination of primary and specialty palliative care. The complex needs of these patients are ideally managed with a comprehensive approach to care that addresses the physical, psychological, social, and spiritual aspects of care in an effort to reduce suffering. Early discussions about prognosis, goals of care, and advance care planning are critical as they can provide guidance for treatment decisions and allow patients to retain a sense of autonomy despite progressive cognitive or functional decline. With the rapid growth in palliative care across the United States, there are opportunities to improve the palliative care knowledge of neurology trainees, the delivery of palliative care to patients with neurologic disease by both neurologists and nonneurologists, and the research agenda for neuropalliative care.
Topics: Central Nervous System Diseases; Humans; Palliative Care; Patient Care Planning; Prognosis; Quality of Life
PubMed: 28982489
DOI: 10.1016/j.mayocp.2017.08.003 -
Seminars in Oncology Nursing Aug 2018To provide a brief review of common palliative care practices in the assessment and management of cancer pain for practicing oncology nurses. (Review)
Review
OBJECTIVE
To provide a brief review of common palliative care practices in the assessment and management of cancer pain for practicing oncology nurses.
DATA SOURCES
Published literature as indexed in Medline, relevant guideline documents, textbooks, and clinical experience.
CONCLUSION
All persons with cancer should undergo a comprehensive pain assessment, using validated instruments when possible, and receive expert-guided cancer pain therapy. Specialist palliative care consultation should be engaged as needed to provide an extra layer of support.
IMPLICATIONS FOR NURSING PRACTICE
By better understanding cancer pain assessment and management strategies, nurses will be best equipped to meet the needs of patients and families.
Topics: Comprehensive Health Care; Hospice and Palliative Care Nursing; Humans; Neoplasms; Nurse-Patient Relations; Oncology Nursing; Palliative Care; Quality of Health Care
PubMed: 30100369
DOI: 10.1016/j.soncn.2018.06.003 -
Advances in Neonatal Care : Official... Jun 2020First defined in 2002 by Catlin and Carter, neonatal palliative care (NPC) is a relatively new model of care in neonatal pediatrics, first appearing in the medical... (Review)
Review
BACKGROUND
First defined in 2002 by Catlin and Carter, neonatal palliative care (NPC) is a relatively new model of care in neonatal pediatrics, first appearing in the medical literature in the early 1980s.
PURPOSE
The purpose of this article is to suggest a conceptual definition of NPC that encompasses all the essential concepts as a way of moving NPC forward by having a consistent approach.
METHODS
Following a review of the NPC literature, a thematic analysis as a method for identifying, analyzing, and interpreting patterns of meaning in the definitions ("themes") within the literature was undertaken.
FINDINGS
The major themes identified included philosophies of care, support, culture and spirituality, the team, and clinical management.
IMPLICATIONS FOR RESEARCH
At the heart of NPC is the primacy of maintaining quality of life, while providing ethical and humane care that supports a "good death." The extensive elements presented in this article are considered essential to a comprehensive and conceptual definition of NPC proposed here.
Topics: Attitude to Death; Humans; Infant Care; Infant, Newborn; Medical Futility; Neonatology; Palliative Care; Patient Care Team; Patient Comfort; Quality of Life
PubMed: 32384328
DOI: 10.1097/ANC.0000000000000731 -
Clinics in Geriatric Medicine May 2015The journey to excellence in palliative care practice is to recognize the three identities of patients, refine skills in assessment to understand these interrelated... (Review)
Review
The journey to excellence in palliative care practice is to recognize the three identities of patients, refine skills in assessment to understand these interrelated dimensions of personhood, and hone the practices of caring to deliver truly comprehensive and personalized care. These practices require clinicians to first connect to persons with illness on a human-human level. Being fully present and engaged with patients is critical to practicing high-quality palliative care. Clinicians must encourage and elicit the story of the illness and the life of the person experiencing the illness.
Topics: Aged; Cultural Competency; Culturally Competent Care; Emotional Intelligence; Humans; Individuality; Life Change Events; Palliative Care; Physician-Patient Relations
PubMed: 25920062
DOI: 10.1016/j.cger.2015.01.010 -
Journal of Hospice and Palliative... Aug 2018Stroke survivors often experience life-altering functional and cognitive changes and burdensome symptoms. Palliative care could provide additional support to improve... (Review)
Review
Stroke survivors often experience life-altering functional and cognitive changes and burdensome symptoms. Palliative care could provide additional support to improve outcomes of stroke patients and their families. The purpose of this review was to describe how palliative care is conceptualized and implemented within stroke care.An integrative review of the literature published between 1990 and 2016 using the terms "palliative care," "stroke," or "acute stroke" was conducted. Of the 363 articles identified, 44 were screened, 21 met inclusion criteria, and 2 additional articles were identified through reference list review, resulting in a final sample of 23 articles.Palliative care was predominantly understood as end-of-life care and was most commonly offered in acute stages when patients were expected to die. Patients, families, and providers reported challenges surrounding decision making, uncertainty regarding transitions to palliative care, and needs related to communication and physical and psychosocial support. The quality of the research was moderate to good but was limited by retrospective designs, reliability of data collection procedures and tools, recall bias, and generalizability.This review highlights gaps in access to palliative care throughout the illness trajectory and underscores the need for study of models that integrate palliative care into stroke care.
Topics: Decision Making; Humans; Palliative Care; Quality of Life; Stroke
PubMed: 30063629
DOI: 10.1097/NJH.0000000000000450 -
Cancer Treatment and Research 2016Lung cancer is the most common cancer worldwide and is the leading cause of cancer death for both men and women in the USA. Symptom burden in patients with advanced lung... (Review)
Review
Lung cancer is the most common cancer worldwide and is the leading cause of cancer death for both men and women in the USA. Symptom burden in patients with advanced lung cancer is very high and has a negative impact on their quality of life (QOL). Palliative care with its focus on the management of symptoms and addressing physical, psychosocial, spiritual, and existential suffering, as well as medically appropriate goal setting and open communication with patients and families, significantly adds to the quality of care received by advanced lung cancer patients. The Provisional Clinical Opinion (PCO) of American Society of Clinical Oncology (ASCO) as well as the National Cancer Care Network's (NCCN) clinical practice guidelines recommends early integration of palliative care into routine cancer care. In this chapter, we will provide an overview of palliative care in lung cancer and will examine the evidence and recommendations with regard to a comprehensive and interdisciplinary approach to symptom management, as well as discussions of goals of care, advance care planning, and care preferences.
Topics: Humans; Lung Neoplasms; Palliative Care; Patient Comfort
PubMed: 27535397
DOI: 10.1007/978-3-319-40389-2_11 -
The American Journal of Medicine Feb 2019
Topics: Health Knowledge, Attitudes, Practice; Humans; Palliative Care; Patient Comfort; Patient Education as Topic; Public Opinion
PubMed: 30076826
DOI: 10.1016/j.amjmed.2018.07.032 -
Western Journal of Nursing Research Oct 2019The term was developed to describe and differentiate palliative care that is delivered prior to the end of life. The purpose of this article is to better define and... (Review)
Review
The term was developed to describe and differentiate palliative care that is delivered prior to the end of life. The purpose of this article is to better define and clarify this concept using Rodgers's evolutionary concept analysis method. Attributes of nonhospice palliative care include (a) patient- and family-centered care, (b) holistic care, (c) interdisciplinary team, (d) early intervention, (e) quality of life-enhancing, (f) advanced care planning, (g) any age of the patient, (h) at any stage in illness, (i) care coordination, (j) concurrent curative treatment options, and (k) provided by primary and specialist providers. Nonhospice palliative care antecedents are serious illness, education, and access to services; consequences include benefits for the patient, family, provider, and health care system. Offering a clearly defined concept may allow for changes in health care to improve access to these services.
Topics: Concept Formation; Humans; Palliative Care
PubMed: 31170893
DOI: 10.1177/0193945919853162 -
Journal of Palliative Medicine Oct 2015
Topics: Humans; Palliative Care; Patient Care Team; Terminal Care; United States; United States Department of Veterans Affairs; Veterans Health
PubMed: 26439727
DOI: 10.1089/jpm.2015.0348