Clinics in geriatric medicine
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Clin. Geriatr. Med. · Feb 2005
ReviewThe price of palliative care: toward a complete accounting of costs and benefits.
In this article, currently accepted standards for cost-benefit analysis of health care interventions are outlined, and a framework to evaluate palliative care within these standards is provided. Recent publications on the economic implications of palliative care are reviewed, which are only the "tip of the iceberg" of the potential costs and benefits. ⋯ Methods for gathering relevant cost-benefit information are detailed, along with potential obstacles to implementation. This approach is applicable to palliative care in general, including palliative care for elders.
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This article highlights new developments in assessment and management of pain and delirium.
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Clin. Geriatr. Med. · Feb 2005
ReviewLimitation of treatment at the end-of-life: withholding and withdrawal.
Most deaths in the United States occur under the care of a physician. In most of these cases, decisions must be made about whether to initiate and continue or withdraw life-sustaining medical technology, such as cardiopulmonary resuscitation, ventilation, nutrition and hydration, dialysis, transfusions, and antibiotics. ⋯ When a cure is not possible or appropriate, these medical technologies should be withdrawn or withheld. The circumstances in which end of life treatment may be ethically and legally limited through withholding or withdrawal are discussed.
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Must health care professionals provide treatments or interventions that they consider futile? Although much of the past and current debate about futility has centered on how to best define futility, it is the application of the concept in clinical decision making that is of central concern. Most physicians feel confident that they know futile treatment when they see it, but despite years of debate in scholarly journals, professional meetings, and popular media, consensus on a precise definition eludes us still. ⋯ It also provides a flexible definition of futility that is patient centered and reliant on goals of care as the morally preferable definition. In short, the concept of futility as a means to resolve disputes over treatment decisions may, itself, be futile.
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Hospital-based palliative care teams have evolved as a natural outgrowth of the modern hospice movement. This article examines why these hospital-based palliative care programs have proliferated, how they typically function, and what data exist as to their effectiveness. Crucial steps necessary for the design and implementation of a successful hospital-based palliative care service also are reviewed.