The American journal of hospice & palliative care
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Am J Hosp Palliat Care · Mar 2012
Free-text comments: understanding the value in family member descriptions of hospice caregiver relationships.
Invitations for free-text comments on surveys provide family members of hospice patients an opportunity to "tell" their story of the hospice experience and caregiver relationships during the last months of life. These comments are a rich source of data for understanding the complex interpersonal relationships that influence patient/family perceptions of both quality of care and quality of life. Analysis of 438 free-text comments provided by 243 hospice family members revealed 5 emergent caregiver relationship themes: knowledge, skills, and abilities; empathy and compassion; trust and acceptance; communication experience and time spent with caregiver. Findings support the value of free-text comments to explain or add depth to quality assessments, modify therapeutic interventions, and identify strategies for process improvement that advance hospice quality of care.
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Am J Hosp Palliat Care · Mar 2012
Anticipatory grief among close relatives of patients in hospice and palliative wards.
A Swedish widowhood study revealed that four out of ten widows regarded the pre-loss period more stressful than the post-loss. The present investigation of close relatives to patients dying from cancer (using interviews and the Anticipatory Grief Scale) found that preparatory grief involves much emotional stress, as intense preoccupation with the dying, longing for his/her former personality, loneliness, tearfulness, cognitive dysfunction, irritability, anger and social withdrawal, and a need to talk. ⋯ However, the relatives mostly stated adjustment and ability to mobilize strength to cope with the situation. The results suggest development of support and guiding programs also for the anticipatory period.
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Physician home visits (HVs) are an important model of care for the terminally ill. Hospice and palliative medicine (HPM) fellows make a minimum of 25 HVs. ⋯ HVs are an important part for patient care and fellow education, which provided an opportunity for medication revision and symptom education.
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Am J Hosp Palliat Care · Mar 2012
Treating constipation in palliative care: the impact of other factors aside from opioids.
Opioids are major contributing factors to the problem of constipation in palliative care. Whilst this is without doubt, it remains unclear how much other factors also contribute to the problem. The aim of this audit is to review what other contributing factors are present when methylnaltrexone, the peripheral opioid antagonist is prescribed for constipation. ⋯ In conclusion, methylnaltrexone is targeted treatment for the management of opioid-induced constipation. However, there is a percentage of people who fail to respond. The impact of other factors on the problem of constipation requires greater clarification.
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Over the past 30 years, and increasingly over the past decade, palliative care services characteristically address the complexity of communication, decision making, and management of end-of-life issues for patients and families of all ages. Clinical ethics services have a parallel 30-plus year history in the United States-so much so that some have offered that clinical ethics has "cut its teeth" on issues attendant to the beginning and end of life. The authors propose considerations necessary in determining the appropriateness of consultation with palliative care, clinical ethics, or both, and when either may be necessary but perhaps not sufficient for patient and family management. A resolution for any encountered tension and identification of common or overlapping domains for both consultants is presented.