Journal of palliative medicine
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Being "fired'' by a patient is an uncomfortable, distressing, and awkward experience for most clinicians. Palliative care clinicians may be at increased risk of termination of the patient-physician relationship for a variety of reasons. Little has been written about the experience of patient-initiated termination of the patient-physician relationship, and to our knowledge, nothing has been written that is specific to palliative care. ⋯ The experience of patient-initiated termination of the patient-physician relationship can raise issues of rejection and self-doubt in the palliative care clinician, but can also provide important opportunities for growth, reflection, and learning. In some cases, re-connecting with the patients' families may be appropriate and beneficial for both the clinician and family.
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Many reports suggest clinicians are often inadequately prepared to "diagnose dying'' or discuss the likelihood of imminent death with patients and families. ⋯ Because more than two thirds of patients were unconscious or in and out of lucidity in the last few days of life, waiting for certainty about prognosis may leave little opportunity to help patients and their families prepare for death. Our results identify opportunities for improvement in communication in the face of uncertainty about the imminence of death. In addition to potential benefits to patients and families, these findings suggest that enhancing communication practices may also benefit physicians through increased satisfaction with care and closer connection with those for whom they provide care.
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Despite 56% of child deaths occurring in inpatient hospital settings, who these children are and how they die has not been fully described. The purpose of this study was to identify the characteristics of those infants and children who die in acute care settings, and describe the extent to which palliative care was used prior to their deaths. ⋯ The results of this study suggest that large numbers of children die in both general and children's hospitals with a wide variety of illnesses and at all ages, indicating that all acute care pediatric providers need a working knowledge of and access to end-of-life and palliative care services.
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Blood transfusions can be used to palliate the symptoms of fatigue or dyspnea in the presence of anemia. We studied the transfusion practices of 8 hospices in our cancer network over a 1-year period. ⋯ Blood transfusions occurred in 140 (5.7%) of 2460 hospice admissions. Median survival following first transfusion was 42 days and significantly longer for outpatients compared to inpatients (median of 104 days and 36 days, respectively, p = 0.006).
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We report here our retrospective observations on the use of recombinant human hyaluronidase (rHuPH20) for the facilitation of subcutaneous hydration and drug infusion. Thirty-two patients were treated with rHuPH20 in a hospice setting over a 6-month period. Of these, 26 received this agent to enhance hypodermoclysis with standard hydration fluids for symptom control of delirium, myoclonus and mild to moderate dehydration. ⋯ There were no significant adverse events. Induration at the infusion site occurred in 1 patient receiving hydration and higher than expected serum lidocaine concentration was observed in another patient. Based on our positive initial experience with recombinant human hyaluronidase, there is interest in expanding its use in our facility in both the inpatient and outpatient settings.