Journal of palliative medicine
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Leptomeningeal disease (LMD), spread of cancer to the lining of the brain and its protective coverings, is a feared complication of many different types of cancer. LMD negatively affects prognosis across tumor types. ⋯ An understanding of pathophysiology, symptomatology, prognosis, and treatment options is essential in providing optimal care. This article, written by clinicians who work across the cancer spectrum, uses an accessible "ten tips" format to help increase PC providers' confidence and competence around caring for people with LMD.
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Hospice care is designed to support the medical and psychosocial needs of individuals with serious illness and their caregivers through the dying process. Some individuals, though, leave hospice prior to death, generally referred to as disenrollment or a "live discharge." Live discharge from hospice is a common and often distressing issue for hospice patients, their caregivers, and also for hospice professionals and agencies. ⋯ Where applicable, we provide practical steps for hospice and palliative care clinicians to better support patients and families through this critical care transition. Further, we offer strategic directions interprofessional clinicians can take to affect systemic change to improve live discharge experiences.
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Palliative care clinicians often help facilitate coordination of care, complex serious illness, and end-of-life medical decision-making. However, the clinical and legal issues related to guardianship can complicate the decision-making process, care delivery, outcomes, and the role of the palliative care clinician. ⋯ It is crucial to be familiar with the patients' rights and the guardians' responsibilities to clarify medical decision-making processes and identify necessary authorities. This article uses an interprofessional approach to leverage the expertise of physicians, nurses, lawyers, and guardians and to guide palliative care clinicians to optimally support patients under guardianship.
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Psychological symptoms are notably prevalent in palliative care (PC) settings, significantly impacting quality of life for patients and their families. Given the inherent multidimensionality of suffering in PC, addressing these psychological aspects is essential. ⋯ They are a small sample from the vast and deep pool of wisdom contained in psychotherapeutic theory, and they were selected due to their direct applicability to PC practice. Adopting psychotherapeutic principles, along with leveraging the interdisciplinary wisdom inherent in PC practice, enhances our therapeutic relationships in PC and empowers patients to navigate their illness with greater resilience and adaptive coping.
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Introduction: Psilocybin-assisted therapy (PAT) has gained traction in palliative care as a treatment for existential distress in the last decade. Patients with brain cancer have been excluded from studies, yet they stand to benefit as much as other patients with cancer-related psychological distress. Case description: In this report, we discuss the case of a patient with end-of-life distress secondary to stage 4 astrocytoma that received PAT through Health Canada's Special Access Program. ⋯ We highlight the importance of making PAT more available as many patients with unresolved existential distress resort to medical assistance in dying without ever knowing of the existence of PAT. Conclusion: PAT was effective in partially alleviating the patient's existential distress. Access to PAT needs to be expanded urgently.