Palliative medicine
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There are many difficulties of communication with patients with amyotrophic lateral sclerosis (motor neurone disease). In France, most physicians have a policy of keeping the fact of this diagnosis from both patients and relatives. This paper describes an alternative approach based on open communication, and applies that principle to handling issues of communication associated with various aspects of four different topics: the diagnosis itself, the development of handicap, swallowing difficulties, and respiratory difficulties.
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Taboos, whether held by professional carers, patients or families have the capacity to influence a whole range of choices that must be made during the course of any illness. In the case of motor neurone disease, decisions regarding if, when and how to break bad news, the place of care (home, hospital or hospice), the introduction of aids and devices, and, ultimately, choices regarding the place of death, will all be influenced by a range of taboos. ⋯ In discussing taboos, essentially what is of concern is attitudes. A basic change in attitudes is required if we are to stop viewing patients with incurable illness as some kind of medical failure.
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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.
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Palliative medicine · Jan 1993
Comparative StudyCharacteristics of clients referred to home, hospice and hospital palliative care services in Western Australia.
Perth, in Western Australia, has three major palliative care services: a home care service, a freestanding hospice and a purpose-built palliative care unit in a teaching hospital. A retrospective study of patients referred to these services over a six-month period was carried out to find how they were used. The records of 176 clients were compared, which showed that there were some differences between the client groups referred to each of the services. ⋯ Lung cancer accounted for more male admissions (29%) to all services, while breast and lung cancer were more common among women, with a mixed pattern of referral. Lack of private insurance did not seem to influence the choice of service. Overall the clients of the inpatient services were older, had more nursing needs and were less likely to have someone to care for them, characteristics which health services facing an ageing population need to consider.