Journal of pain and symptom management
-
J Pain Symptom Manage · Aug 2014
Typology of perceived family functioning in an American sample of patients with advanced cancer.
Poor family functioning affects psychosocial adjustment and the occurrence of morbidity following bereavement in the context of a family's coping with advanced cancer. Family functioning typologies assist with targeted family-centered assessment and intervention to offset these complications in the palliative care setting. ⋯ Cohesiveness, expressiveness, and conflict resolution appear to be useful dimensions by which to classify patient perceptions of family functioning. "At risk" American families may include those we have called hostile, low-communicating, and less-involved. Such families may benefit from adjuvant family-centered psychosocial services, such as family therapy.
-
J Pain Symptom Manage · Aug 2014
An analytical framework for delirium research in palliative care settings: integrated epidemiologic, clinician-researcher, and knowledge user perspectives.
Delirium often presents difficult management challenges in the context of goals of care in palliative care settings. ⋯ Using an analytical framework to represent the full clinical care pathway of delirium in palliative care settings, we identified multiple knowledge gaps in relation to the occurrence rates, assessment, management, and outcome prediction of delirium in this population. The knowledge synthesis generated from adequately powered, multicenter studies to answer the framework's research questions will inform decision making and policy development regarding delirium detection and management and thus help to achieve better outcomes for patients in palliative care settings.
-
J Pain Symptom Manage · Aug 2014
Beyond compassion fatigue: the transactional model of physician compassion.
Physician compassion is expected by both patients and the medical profession and is central to effective clinical practice. Yet, despite the centrality of compassion to medical practice, most compassion-related research has focused on compassion fatigue, a specific type of burnout among health providers. ⋯ After briefly critiquing the utility of the compassion fatigue concept, we offer a view in which physician compassion stems from the dynamic but interrelated influences of physician, patient and family, clinical situation, and environmental factors. Illuminating the specific aspects of physicians' intrapersonal, interpersonal, clinical, and professional functioning that may interfere with or enhance compassion allows for targeted interventions to promote compassion in both education and practice as well as to reduce the barriers that impede it.