Journal of palliative medicine
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Physician training programs in undergraduate and graduate medical education strongly recommend that their trainees gain experience in helping patients and their families address end-of-life and palliative care issues with knowledge and compassion. Currently these training programs are inadequately meeting this goal. This paper describes a creative 1-day training workshop or several half-day seminars on the end of life, which are delivered as part of our family practice intern orientation. The training includes self-awareness about death, communicating bad news, guidance with paperwork and legal issues, the stages of grief, patient's perspectives on dying, hospice, and physician well-being.
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Cultural mistrust is a prominent barrier to the involvement of African Americans in hospice care. While disavowing the theory that cultural mistrust has its origin in any single factor or event, it is argued that there needs only to exist the cultural construct of community for cultural mistrust to perpetuate itself among any ethnic group. ⋯ From a perspective that accepts the existence of the phenomenon of cultural mistrust, suggestions for structuring training for cultural competence are discussed. These suggestions are relevant for workers in institutions that serve the African American community in critical health care areas in general, and administrators and staff of hospices in particular.
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Continuity of primary care is known to be associated with both improved processes and outcomes of care. Despite continuity being a desired attribute of end-of-life care and despite the desire by most patients with cancer to die at home, there has been no health services research examining this relationship. ⋯ This study demonstrates an association between family physician continuity of care and the location of death for those with advanced cancer. Such continuity should be fostered in the development of models of integrated service delivery for end-of-life care.
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Patient care needs and patient quality-of-life (QOL) deficits can be significant stressors for family caregivers. Often, greater caregiving demands and poorer patient QOL are associated with greater caregiver strain. However, caregiver coping behavior can attenuate the effect of caregiving stressors on caregiver strain. ⋯ Caregiver strain was significantly correlated with patient ADL needs (r = 0.51), patient psychological distress (r = 0.42), and patient existential QOL (r = -0.65). Regression equations indicated that reframing coping lessened caregiver strain. Caregivers who accepted their loved one's illness, redefined illness-related problems in a more manageable way, and felt capable of solving illness-related problems had less caregiver strain than caregivers who used less of a reframing coping style.