Palliative medicine
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The question of whether a coherent tradition in research and research methods (or paradigm) exists in palliative care is explored in this paper through an examination of the discussion and debate surrounding palliative care; attempts at achieving consensus for research through priority setting exercises; and a critical review of published research in palliative care accessed through a systematic review of studies. The findings of this systematic review of 384 published studies are reported. ⋯ More creativity in palliative care research is needed, and the future of palliative care research needs to be determined strategically. A model on which such a strategy might be based is presented.
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The question of whether a coherent tradition in research and research methods (or paradigm) exists in palliative care is explored in this paper through an examination of the discussion and debate surrounding palliative care; attempts at achieving consensus for research through priority setting exercises; and a critical review of published research in palliative care accessed through a systematic review of studies. The findings of this systematic review of 384 published studies are reported. ⋯ More creativity in palliative care research is needed, and the future of palliative care research needs to be determined strategically. A model on which such a strategy might be based is presented.
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A review of the research in the area of staff stress in hospice/palliative care since the start of the modern hospice movement shows that, while high stress was identified as a problem in the early days of the movement, later studies have shown that stress and burnout in palliative care are by no means universal. Staff stress and burnout in hospice/palliative care has been demonstrated to be less than in professionals in many other settings. However, other studies have noted suicidal ideation, increased alcohol and drug usage, anxiety, depression, and difficulty in dealing with issues of death and dying. ⋯ Staff in hospice/palliative care have been found to have increased stress when mechanisms such as social support, involvement in work and decision-making, and a realistic work-load are not available. The stress that exists in palliative care is due in large measure to organizational and societal issues, although personal variables were also found to have an influence. Suggestions are given for the direction of future research in the field.
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Prognosis in severe chronic obstructive pulmonary disease is poor, and it is increasingly accepted that such patients need good palliative care. This paper reviews the medical management of chronic obstructive pulmonary disease, and also discusses the place of long-term oxygen therapy. ⋯ The drug treatment of dyspnoea has been disappointing, but close attention to psychosocial aspects can improve mobility and control. The place of palliation in a number of other chronic lung conditions is also mentioned.
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There are many ethical decisions to be made during palliative care of a patient with motor neurone disease. These may concern the physical and psychosocial care of the patient and will become highlighted when death approaches. By close involvement of the patient and his/her family with the interdisciplinary team the most appropriate decisions on the patient's care can be made.