Journal of palliative medicine
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Anticipatory medications (AM) have been widely used in various settings across many countries in people approaching end of life. Access to palliative care in rural and remote areas of Australia is lacking as are other medical services when compared with the metropolitan setting. Our aim is to identify challenges with the administration and access to AM in rural and remote communities with outcomes to guide improved delivery of care. ⋯ Provision of timely AM has the potential to improve the quality of life of patients and their caregivers. Key barriers to access AM can be overcome with community-level planning and nurses' education. Advanced nurses' roles have the opportunity to provide specialized care where access to specialist physicians is challenging.
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Community-based palliative care (CBPC) plays an integral role in addressing the complex care needs of older adults with serious chronic illnesses, but is premised on effective communication and collaboration between primary care providers (PCPs) and the providers of specialty palliative care (SPC). Optimal strategies to achieve the goal of coordinated care are ill-defined. ⋯ Our findings suggest that processes are needed that promote communication, including structured communication strategies between PCPs and SPC providers, clarification of role boundaries, enrichment of nonspecialty providers' competence in GPC, and enhanced access to CBPC.
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Despite increasing attention in the medical and nursing literature about the importance of self-care for clinicians and the prevention of burnout, coping with the deaths of patients is an often-neglected component of clinical training. In this article, we describe the development of "Remembrance," an interdisciplinary approach to acknowledge and process the deaths of patients on our inpatient palliative care service, paying particular attention to how patients and their families affect us as clinicians. We believe that such a practice is an important component of both quality end-of-life care and clinician self-care, which should be routinely taught and incorporated into clinical services. We provide a template that summarizes our approach, which can be easily adapted by other hospitals to use.