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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 -
Clinics in Geriatric Medicine Feb 2020Palliative care (PC) is an approach to the care of persons affected by serious illness that focuses on reducing suffering by addressing medical, psychosocial, and... (Review)
Review
Palliative care (PC) is an approach to the care of persons affected by serious illness that focuses on reducing suffering by addressing medical, psychosocial, and spiritual needs. Persons living with Parkinson disease have PC needs that begin at the time of diagnosis and continue throughout the course of the illness including nonmotor symptom burden, caregiver distress, grief, and increased mortality. Primary PC refers to essential PC skills that may be practiced by nonpalliative medicine specialists to improve outcomes for their patients.
Topics: Advance Care Planning; Aged; Caregiver Burden; Humans; Palliative Care; Parkinson Disease; Patient Care Planning; Quality of Life
PubMed: 31733696
DOI: 10.1016/j.cger.2019.09.013 -
Journal of Global Oncology Sep 2018Despite increased access to palliative care in Africa, there remains substantial unmet need. We examined the impact of approaches to promoting the development of... (Review)
Review
PURPOSE
Despite increased access to palliative care in Africa, there remains substantial unmet need. We examined the impact of approaches to promoting the development of palliative care in two African countries, Uganda and Kenya, and considered how these and other strategies could be applied more broadly.
METHODS
This study reviews published data on development approaches to palliative care in Uganda and Kenya across five domains: education and training, access to opioids, public and professional attitudes, integration into national health systems, and research. These countries were chosen because they are African leaders in palliative care, in which successful approaches to palliative care development have been used.
RESULTS
Both countries have implemented strategies across all five domains to develop palliative care. In both countries, successes in these endeavors seem to be related to efforts to integrate palliative care into the national health system and educational curricula, the training of health care providers in opioid treatment, and the inclusion of community providers in palliative care planning and implementation. Research in palliative care is the least well-developed domain in both countries.
CONCLUSION
A multidimensional approach to development of palliative care across all domains, with concerted action at the policy, provider, and community level, can improve access to palliative care in African countries.
Topics: Analgesics, Opioid; Disease Management; Education, Medical; Health Knowledge, Attitudes, Practice; Health Services Accessibility; Humans; Kenya; Neoplasms; Palliative Care; Research; Terminal Care; Uganda
PubMed: 30241205
DOI: 10.1200/JGO.2017.010090 -
BMJ Open Mar 2023The aim of this study was to map existing emergency medical services (EMS) and palliative care literature by answering the question, what literature exists concerning... (Review)
Review
OBJECTIVES
The aim of this study was to map existing emergency medical services (EMS) and palliative care literature by answering the question, what literature exists concerning EMS and palliative care? The sub-questions regarding this literature were, (1) what types of literature exist?, (2) what are the key findings? and (3) what knowledge gaps are present?
DESIGN
A scoping review of literature was performed with an a priori search strategy.
DATA SOURCES
MEDLINE via Pubmed, Web of Science, CINAHL, Embase via Scopus, PsycINFO, the University of Cape Town Thesis Repository and Google Scholar were searched.
ELIGIBILITY CRITERIA FOR SELECTING STUDIES
Empirical, English studies involving human populations published between 1 January 2000 and 24 November 2022 concerning EMS and palliative care were included.
DATA EXTRACTION AND SYNTHESIS
Two independent reviewers screened titles, abstracts and full texts for inclusion. Extracted data underwent descriptive content analysis and were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews guidelines.
RESULTS
In total, 10 725 articles were identified. Following title and abstract screening, 10 634 studies were excluded. A further 35 studies were excluded on full-text screening. The remaining 56 articles were included for review. Four predominant domains arose from included studies: (1) EMS' palliative care role, (2) challenges faced by EMS in palliative situations, (3) EMS and palliative care integration benefits and (4) proposed recommendations for EMS and palliative care integration.
CONCLUSION
EMS have a role to play in out-of-hospital palliative care, however, many challenges must be overcome. EMS provider education, collaboration between EMS and palliative systems, creation of EMS palliative care guidelines/protocols, creation of specialised out-of-hospital palliative care teams and further research have been recommended as solutions. Future research should focus on the prioritisation, implementation and effectiveness of these solutions in various contexts.
Topics: Humans; Palliative Care; Emergency Medical Services; Hospice and Palliative Care Nursing
PubMed: 36927584
DOI: 10.1136/bmjopen-2022-071116 -
American Journal of Transplantation :... Dec 2017Palliative care is an interprofessional approach that focuses on quality of life of patients who are facing life-threatening illness. Palliative care is consistently... (Review)
Review
Palliative care is an interprofessional approach that focuses on quality of life of patients who are facing life-threatening illness. Palliative care is consistently associated with improvements in advance care planning, patient and caregiver satisfaction, quality of life, symptom burden, and lower healthcare utilization. Most transplant patients have advanced chronic disease, significant symptom burden, and mortality awaiting transplant. Transplantation introduces new risks including perioperative death, organ rejection, infection, renal insufficiency, and malignancy. Numerous publications over the last decade identify that palliative care is well-suited to support these patients and their caregivers, yet access to palliative care and research within this population are lacking. This review describes palliative care and summarizes existing research supporting palliative intervention in advanced organ failure and transplant populations. A proposed model to provide palliative care in parallel with disease-directed therapy in a transplant program has the potential to improve symptom burden, quality of life, and healthcare utilization. Further studies are needed to elucidate specific benefits of palliative care for this population. In addition, there is a tremendous need for education, specifically for clinicians, patients, and families, to improve understanding of palliative care and its benefits for patients with advanced disease.
Topics: Humans; Organ Transplantation; Palliative Care; Quality of Life; Social Support; Terminal Care
PubMed: 28976070
DOI: 10.1111/ajt.14522 -
BMJ Supportive & Palliative Care Sep 2018Although many well-known poems consider illness, loss and bereavement, medicine tends to view poetry more as an extracurricular than as a mainstream pursuit. Within... (Review)
Review
OBJECTIVES
Although many well-known poems consider illness, loss and bereavement, medicine tends to view poetry more as an extracurricular than as a mainstream pursuit. Within palliative care, however, there has been a long-standing interest in how poetry may help patients and health professionals find meaning, solace and enjoyment. The objective of this paper is to identify the different ways in which poetry has been used in palliative care and reflect on their further potential for education, practice and research.
METHODS
A narrative review approach was used, drawing on searches of the academic literature through Medline and on professional, policy and poetry websites to identify themes for using poetry in palliative care.
RESULTS
I identified four themes for using poetry in palliative care. These concerned (1) leadership, (2) developing organisational culture, (3) the training of health professionals and (4) the support of people with serious illness or nearing the end of life. The academic literature was mostly made up of practitioner perspectives, case examples or conceptual pieces on poetry therapy. Patients' accounts were rare but suggested poetry can help some people express powerful thoughts and emotions, create something new and feel part of a community.
CONCLUSION
Poetry is one way in which many people, including patients and palliative care professionals, may seek meaning from and make sense of serious illnesses and losses towards the end of life. It may have untapped potential for developing person-centred organisations, training health professionals, supporting patients and for promoting public engagement in palliative care.
Topics: Bereavement; Health Personnel; Humans; Palliative Care; Poetry as Topic; Terminal Care; Terminally Ill
PubMed: 29574424
DOI: 10.1136/bmjspcare-2017-001477 -
Neurology Aug 2014Palliative care is an approach to the care of patients and families facing progressive and chronic illnesses that focuses on the relief of suffering due to physical... (Review)
Review
Palliative care is an approach to the care of patients and families facing progressive and chronic illnesses that focuses on the relief of suffering due to physical symptoms, psychosocial issues, and spiritual distress. As neurologists care for patients with chronic, progressive, life-limiting, and disabling conditions, it is important that they understand and learn to apply the principles of palliative medicine. In this article, we aim to provide a practical starting point in palliative medicine for neurologists by answering the following questions: (1) What is palliative care and what is hospice care? (2) What are the palliative care needs of neurology patients? (3) Do neurology patients have unique palliative care needs? and (4) How can palliative care be integrated into neurology practice? We cover several fundamental palliative care skills relevant to neurologists, including communication of bad news, symptom assessment and management, advance care planning, caregiver assessment, and appropriate referral to hospice and other palliative care services. We conclude by suggesting areas for future educational efforts and research.
Topics: Humans; Nervous System Diseases; Neurology; Palliative Care; Physician's Role
PubMed: 24991027
DOI: 10.1212/WNL.0000000000000674 -
Journal of Social Work in End-of-life &... 2015
Topics: Advance Care Planning; Humans; Palliative Care; Terminal Care
PubMed: 25869142
DOI: 10.1080/15524256.2015.1021651 -
Annals of Palliative Medicine Jan 2018In this article, I do not intend to present the many and well-known treatments for relieving pain and distress symptoms of the physical body, damaged by terminal... (Review)
Review
In this article, I do not intend to present the many and well-known treatments for relieving pain and distress symptoms of the physical body, damaged by terminal diseases, such as cancer, AIDS, multiple sclerosis. In this article, I'd rather focus my attention on clinical hypnosis for subjects who, freed from physical pain, thanks to palliative care, are open to receiving comfort and support for their psychological and spiritual suffering. The intent of this article is to express how clinical hypnosis can harmoniously integrate psychological and spiritual aspects so that the terminal patient can make peace with his/her past, with the people who have hurt him/her, and with the people who will suffer because of his/her death. This article will present some hypnotic suggestions inspired by universal wisdom of the Stoics, by positive psychology of Mindfulness, by laws of nature regarding changes, differences and mysteries. The basic assumption of the suggestions presented is that, if disease is an enemy to fight, death is an inevitable part of life: it cannot be avoided, or postponed or exchanged with anybody. It arrives when we have finished living. When death is preceded by an incurable disease, palliative care can offer a mantle of compassion and acceptance of what cannot be avoided. The words palliative comes from the Latin pallium-mantle. This article also presents some suggestions I have utilized several times with my patients. These suggestions have demonstrated their efficacy in alleviating patients' suffering in coping with their disease and in facing death.
Topics: Emotional Adjustment; Humans; Hypnosis; Mindfulness; Palliative Care; Quality of Life; Spiritual Therapies; Spirituality; Terminally Ill
PubMed: 29156894
DOI: 10.21037/apm.2017.07.07 -
Current Opinion in Supportive and... Sep 2018Despite increased survivorship and the subsequent need for chronic management of cancer, the association of self-management and palliative care is still emerging within... (Review)
Review
PURPOSE OF REVIEW
Despite increased survivorship and the subsequent need for chronic management of cancer, the association of self-management and palliative care is still emerging within cancer care. Routine and timely use of self-management strategies in the palliative setting can help reduce self-management burden and maximize quality of life. In this review, we consider the complementary relationship of self-management and palliative care and how they support living with cancer as a chronic illness.
RECENT FINDINGS
Recent studies provide evidence of support among patients, family caregivers and healthcare professionals for integration of self-management interventions into palliative cancer care. As a guiding framework, components of the revised Self and Family Management Framework correspond to the provision of palliative care across the care trajectory, including the phases of curative care, palliative care, end-of-life care and bereavement. Additional work among self-management partners facing cancer and other life-limiting illnesses, that is patients, family caregivers and healthcare professionals, would be useful in developing interventions that incorporate self-management and palliative care to improve health outcomes.
SUMMARY
There is an increasing acceptance of the complementarity of self-management and palliative care in cancer care. Their integration can support patients with cancer and their family caregivers across the care trajectory.
Topics: Bereavement; Caregivers; Family; Health Knowledge, Attitudes, Practice; Humans; Neoplasms; Palliative Care; Patient Education as Topic; Professional-Family Relations; Quality of Life; Self-Management; Social Support; Terminal Care; Time Factors
PubMed: 30036215
DOI: 10.1097/SPC.0000000000000373