Journal of palliative medicine
-
The processes surrounding psychological adjustment to losses due to advancing and end-stage illness have not been well delineated. While adjustment to losses due to death are often thought of as the bereaved's lot, dying persons experience multiple, accumulating, and profound losses of functions, abilities, roles, and relationships and therefore have to adjust as well. Many people who are facing death in the near future negotiate these losses, still achieving quality of life in all dimensions. ⋯ We term this the reintegration model. It has comprehension, creative adaptation and reintegration components, each involving the physical, psychological, social, and existential domains in ways that are characteristic of the needs, tasks and options available to a seriously ill and dying person. In this paper, we discuss the model, focusing on normal adjustment processes, and describe the implications of the framework for the dying person, caregivers, and the palliative care team.
-
There is limited information available about the role and effect of a palliative care consultation service (mobile team, MT) in patient care. The purpose of this retrospective chart review was to determine the characteristics, findings, and outcomes of patients referred to MT in a comprehensive cancer center and to thereby gain information about its role in this setting. ⋯ The MT had a positive impact on these patients' care in terms of clinical findings and outcomes. Further investigations are warranted.
-
To report on implementation of a Veterans Affairs (VA) network-wide, standardized, high-quality palliative care (PC) program using a Web-based PC Report Card for performance monitoring and improvement. ⋯ All the sites established PC teams and the number of consultations showed a sustained increase over baseline in 2002. All sites improved on the key process measures captured by the Report Card.
-
Good communication is a fundamental skill for all palliative care clinicians. Patients present with varied desires, beliefs, and cultural practices, and navigating these issues presents clinicians with unique challenges. ⋯ In addition, it reviews the literature regarding cultural aspects of care for terminally ill patients and their families and offers strategies for engaging them. Through good communication practices, clinicians can help to avoid conflict and understand patients' desires for end of life care.