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At least 19 recordsLinked to original sources
PubMed2001

[Intensive care - palliative care. Contradiction or supplement? Considerations on ethical issues and principles in the treatment of dying patients].

Over the last five decades the progress in intensive care has extended the limitations of controlling the process of dying and given doctors more influence in determining the time of death. More recently, palliative care has emerged as a new approach in response to the ethical dilemmas of modern medicine, which accepts that dying is a natural process that should not be hastened or delayed through medical interventions. While in Germany in 1999 more than 50 000 people have died in intensive care units, only a small number of 8000 patients have died in palliative care. In comparison to the highly-developed intensive care sector, palliative care is a much neglected area. The public debate following the legalisation of euthanasia in the Netherlands has highlighted concerns in Germany that intensive care has the potential of inappropriately prolonging life and raised expectations about the alternative therapies offered by palliative care. Doctors in intensive care and in palliative care face similar ethical dilemmas, though with a different weighting: the dilemma between professional judgement and patient autonomy, between traditional medical roles and patient self-determination and the dilemma of extending the span of life at the expense of quality of life. The approach of palliative care with its strong focus on alleviating the suffering of the terminally ill, has influenced the ethical debate of dying in intensive care. Although intensive care and palliative care have different aims and priorities, there are common problems of decision-making which could benefit from a shared orientation and interdisciplinary debate. Both the interpretation of a dying parent's will as well as withdrawing or withholding treatment in patients who are unable to decide for themselves should not merely be guided by the debate on active and passive euthanasia, but rather take into account the appropriateness or inappropriateness of medical actions in the specific situation.

Critical Care↗
PubMedDate not supplied

Community implementation of home care palliative care education.

PURPOSE: The purpose of this National Cancer Institute-funded training project was to improve end-of-life care agencies through implementation of a palliative care curriculum. The Home Care Outreach for Palliative Care Education (HOPE) program was designed to improve the knowledge and skills of home healthcare professionals who provide care to the terminally ill and their families at home. DESCRIPTION OF PROGRAM: A five-module palliative care education curriculum was designed and implemented in five home care agencies in the Los Angeles area. One hundred twenty-five nurses and 28 home health aides participated. The methods of data collection included two written surveys conducted before and after intervention, chart audit tool and a case study analysis form. RESULTS: The precourse data revealed deficiencies in home-care agency staff knowledge in and clinical aspects of end-of-life care. Regarding agency nurses' knowledge on end-of-life issues, the overall percentage scores from preeducation to posteducation rose from 84.6% to 89.0% (P =.0001). Participants rated the education program as extremely valuable for the home care agency staff. CLINICAL IMPLICATIONS: As home care will likely continue to be a primary setting for end-of-life healthcare, improvement of palliative care education in home health agencies is needed. The HOPE project provided insight and experience in the education of nonhospice home care staff in end-of-life care. Participant responses and evaluations indicated that end-of-life care education can improve the quality of care provided by home health agencies. Finally, this education program may result in a heightened awareness of hospice care and, although not objectively quantified, perhaps an increase in referrals to hospice.

Health Services Research↗
PubMed2000

American Academy of Pediatrics. Committee on Bioethics and Committee on Hospital Care. Palliative care for children.

This statement presents an integrated model for providing palliative care for children living with a life-threatening or terminal condition. Advice on the development of a palliative care plan and on working with parents and children is also provided. Barriers to the provision of effective pediatric palliative care and potential solutions are identified. The American Academy of Pediatrics recommends the development and broad availability of pediatric palliative care services based on child-specific guidelines and standards. Such services will require widely distributed and effective palliative care education of pediatric health care professionals. The Academy offers guidance on responding to requests for hastening death, but does not support the practice of physician-assisted suicide or euthanasia for children.

Child↗
PubMed2004

Cancer care. Palliative care. The last days of care.

The government has promised a further 12m pounds over three years for end-of-life care, on top of the 50m pounds a year for palliative care. A framework developed by Macmillan Cancer Relief has identified seven gold standards of care including communication, coordination, control of symptoms, carer support and care in the dying phase. The government has committed to doubling the number of palliative care consultants by 2015.

Health Priorities↗
PubMed2003

The role of the psychiatric nurse in a home care palliative care program.

The psychiatric nurse can play a vital role on a palliative care team. Psychiatric nurses can work with patients to sort out the intense and conflicting feelings that affect patients and their families facing terminal illness and death. Patients can be guided through "life reviews," or nurses can craft interventions to reduce patient anxiety, assist with pain management, or promote physical and psychological comfort.

Attitude to Death↗
PubMed2001

Family physicians and cancer care. Palliative care patients' perspectives.

OBJECTIVE: To explore factors that affect the integrity of palliative cancer patients' relationships with family physicians and to ascertain their perceptions of their FPs' roles in their care. DESIGN: Qualitative study using grounded-theory methods, taped semistructured interviews, and chart reviews. SETTING: Two palliative care hospital wards in Winnipeg, Man. PARTICIPANTS: A purposeful sample of 11 men and 14 women. METHOD: Qualitative content analysis of interview transcripts. MAIN FINDINGS: Cancer care is organized in a sequential, parallel, or shared manner between FPs and cancer specialists, with sequential care a common outcome if patients' relationships with their FPs wane. Cancer patients can lose contact with FPs because of patient or physician relocation, distrust over delays in diagnosis, failure to perceive a need for FPs, poor communication between FPs and specialists, and a lack of FP involvement in the hospital. People with cancer value FPs for being accessible through prompt appointments and telephone contact; for providing emotional and family support; and for referral, triage, and general medical care. CONCLUSION: Family physicians can enhance care of cancer patients. Contact with FPs can be maintained by ensuring good communication between specialists and FPs, defining a clear role for FPs, addressing concerns about delays in diagnosis, and referring patients back to FPs, particularly after hospitalization.

Adult↗
PubMed1999

Development and validation of a core outcome measure for palliative care: the palliative care outcome scale. Palliative Care Core Audit Project Advisory Group.

OBJECTIVES: To develop an outcome measure for patients with advanced cancer and their families which would cover more than either physical symptoms or quality of life related questions. To validate the measure in various specialist and non-specialist palliative care settings throughout the UK. DESIGN: A systematic literature review of measures appropriate for use in palliative care settings was conducted. In conjunction with a multidisciplinary project advisory group, questions were chosen for inclusion into the scale based on whether they measured aspects of physical, psychological, or spiritual domains pertinent to palliative care, and whether similar items had shown to be valid as part of another measure. A staff completed version was developed to facilitate data collection on all patients throughout their care, and a patient completed version was designed to enable the patient to contribute to the assessment of their outcomes when possible. A full validation study was conducted to evaluate construct validity, internal consistency, responsiveness to change over time, and test-retest reliability. Assessments were timed. SETTING: Eight centres in England and Scotland providing palliative care, including inpatient care, outpatient care, day care, home care, and primary care. PATIENTS: A total of 450 patients entered care during the study period. Staff collected data routinely on patients in care long enough to be assessed (n = 337). Of these, 262 were eligible for patient participation; 148 (33%) went on to complete a questionnaire. MAIN MEASURES: The Palliative Care Outcome Scale (POS), the European Organisation for Research on Cancer Treatment, and the Support Team Assessment Schedule. RESULTS: The POS consists of two almost identical measures, one of which is completed by staff, the other by patients. Agreement between staff and patient ratings was found to be acceptable for eight out of 10 items at the first assessment. The measure demonstrated construct validity (Spearman rho = 0.43 to 0.80). Test/re-test reliability was acceptable for seven items. Internal consistency was good (Cronbach's alpha = 0.65 (patients), 0.70 (staff)). Change over time was shown, but did not reach statistical significance. The questionnaire did not take more than 10 minutes to complete by staff or patients. CONCLUSION: The POS has acceptable validity and reliability. It can be used to assess prospectively palliative care for patients with advanced cancer.

England↗
PubMed2001

Palliative care: what is it?

Palliative care developed during the hospice movement. Hospice was associated as a rest place for weary travelers in ancient times, many of whom were ill. Hospice first became associated with the dying in France in 1842; the first modern hospice, St. Christopher's Hospice, was established in London by Dame Cicely Saunders in 1967. It was the first facility founded as a "place" to care for the dying. In 1974, the first U.S. hospice was established in Connecticut based on a home care model. In 1975, Balfour Mount, MD, founded the Palliative Care Service in The Royal Victoria Hospital in Montreal; the concept of "palliative care" in North America was established (Sheehan & Forman, 1996). The traditional view of palliative care indicates that symptomatic and supportive care are generally withheld until all attempts to treat the underlying disease and other medical problems are exhausted. Many times, palliative care is offered with little time left for living. Palliative care should be considered in conjunction with active treatment, and, as death nears, palliative care becomes more important as active treatment while cure become less important.

Evidence-Based Medicine↗
PubMed2006

Doctors' understanding of palliative care.

Palliative care has been challenged to share its message with a wider audience, and for many years it has been articulating an approach that is suitable for all patients. However, it is not clear how widely this message has been accepted. As part of a study into end-of-life care for heart failure, we conducted seven focus groups with doctors in general practice, palliative medicine, cardiology, geriatrics and general medicine. In these, we explored doctors' understanding of palliative care. Participants displayed a reasonable grasp of the wider concept of palliative care, but the specialists' role was ill-defined, reflected in scepticism about their place outside of cancer. Perceptions of palliative care fell into three broad areas: it was more than a service, about managing dying, and the concern of nurses, rather than doctors. Palliative care was welcomed as providing permission to fail, whilst representing a dilemma between quantity and quality of life for the interviewees. Our work suggests that specialist palliative care has been partially successful in getting their message across, and poor understanding or receptivity are not major barriers to implementing palliative care. Educational or other interventions to implement change in palliative care need to acknowledge the complex interaction of factors influencing physicians' behaviour.

Attitude of Health Personnel↗
PubMedDate not supplied

Ireland, the UK and Europe: a review of undergraduate medical education in palliative care.

Palliative Care is an important and emerging medical speciality, formally recognised by the Irish Medical Council in June 1995. Three years previously, in 1992, the Association of Palliative Medicine for Great Britain and Ireland published an official curriculum for undergraduate medical education in palliative care. The European Association of Palliative Care held a workshop the following year and reported that, with the exception of the UK, education for medical students is incomplete. This review examines the evidence that European undergraduate medical education in palliative care is underdeveloped. Key elements of effective undergraduate teaching programmes in this discipline are identified. Finally, it is noted that little has been written about undergraduate palliative care education in Irish medical schools; the situation in this country is thus unknown. A study to determine current education in palliative care in Irish medical schools is required.

Curriculum↗
PubMedDate not supplied

Looking backward toward our future: creating the nexus between community health nursing and palliative care.

Palliative care literature and practice have historically been dominated by end-of-life discussion, with palliative care often seen as the prequel to hospice care. As the population ages and previously fatal illnesses convert to chronic illnesses, the medically modeled, institutionally based care model is changing. Community health nurses (CHNs) are well equipped to play a role in this arena of care. They have a population-focused practice, experience with care in the community, an orientation to health, and skills related to advocacy and social justice. The authors outline salient issues in palliative care, exemplars of community-based palliative care programs, and the contributions CHNs can make toward development of an integrated model of care. A course of action is outlined for CHNs to pursue in this rapidly developing field and they are urged to participate in the next iteration of palliative care.

Clinical Competence↗
PubMed2002

The challenge of palliative care.

Palliative care is patient-centered, rather than disease-focused; accepts the inevitability of death while simultaneously is life-affirming; addresses psychological, social, and spiritual concerns as well as physical ones; and is best delivered by a multiprofessional team working in partnership with patients and their families. Palliative care stresses the importance of "appropriate treatment" and the need for doctors not to prescribe a lingering death. Even though there is no chance of cure, there is much scope for psychosocial and spiritual healing, and often some scope for physical rehabilitation. Palliative care is emotionally demanding for professional carers, and strategies for personal support are necessary. The World Health Organization has played a major part in the ongoing campaign to improve cancer pain management and to make medicinal morphine more widely available. A systematic approach to pain and symptom management is essential, and there is need for specific training for all health professionals. In most countries, for palliative care to take root, there is need for a charismatic "champion". However, for palliative care to flourish, there is need for a governmental commitment to its development. Charisma continues to be necessary to prevent palliative care being strangled by an over-rigid bureaucracy, but incorporation into existing health delivery systems is necessary to prevent it being stillborn through lack of resources.

Attitude of Health Personnel↗