Journal of palliative medicine
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Although there is poor communication about pain management between informal caregivers and hospice providers, little research has examined these interactions. ⋯ The propensity to use medical words during clinical communication with family caregivers is cautioned. In order to recognize the caregiver as a contributing team member, clinicians should limit the use of medical words, provide lay explanation alongside medical terminology, and use questions to check for understanding. More research is needed to determine assessment tools to capture the caregiver's level of understanding of medication and pain management protocol.
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Randomized Controlled Trial
An evaluation of interactive web-based curricula for teaching code status discussions.
Teaching resuscitation discussions to medical students and residents is time intensive and should be taught by teachers with competence in this area of clinical practice. There are plenty of data that these discussions are often inadequate, and that communication skills training, while time and faculty intensive, improves these conversations. The role of online instruction in teaching communication skills, such as resuscitation discussions, is not established. ⋯ This block randomized study of web-based curricula versus a written curriculum did not show differences in student performance in code status discussions. The optimal use of online communication training remains unclear and requires further investigation.
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Although dignity is increasingly considered a goal of palliative care, little research has evaluated the understanding of dignity at the end of life from a caregiver's perspective. ⋯ It seems that SCEN physicians consider the physical aspects of suffering to be most influential and problematic in practice in preserving dignity, while volunteers think psychosocial aspects are most important in preserving dignity at the end of life. These findings suggest that the role and responsibilities of caregivers involved in care for terminally ill patients affect the factors that they think influence dignity.
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Increasing numbers of patients are living with multiple, chronic medical conditions and functional impairments that leave them homebound. Home-based primary and palliative care (HBPC) programs provide access to health care services for this vulnerable population. Homebound patients have high symptom burden upon program enrollment. Yet little is known as to how individual symptoms are managed at home, especially over longer time periods. ⋯ In a chronically ill population of urban homebound, patient symptoms can be successfully managed in the home. Future work should continue to explore symptom assessment and management over time for the chronically ill homebound.
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Advance care planning (ACP) is a process of communication among patients, health care providers, and relatives regarding end-of-life care. The aim of our study was to determine if a representative sample of the Dutch general public is currently involved or is inclined to be engaged in ACP, and to delineate the factors associated with greater engagement. ⋯ Although the majority of the Dutch population seems open to discussions about end-of-life care, our study revealed that discussions with physicians are exceedingly rare. To improve ACP as a joint process among patients, relatives, and physicians, the general public's awareness of the importance of end-of-life discussions with their physicians needs to be increased and physicians need to play a more active role by initiating conversations and dialogue regarding end-of-life care.