Articles: palliative-care.
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Critical care medicine · Sep 1999
ReviewIncorporating palliative care into critical care education: principles, challenges, and opportunities.
To identify the goals and methods for medical education about end-of-life care in the intensive care unit (ICU). ⋯ Teaching care of the dying in the ICU should emphasize the following: a) the goals of care should guide the use of technology; b) understanding of prognostication and treatment withholding and withdrawal is essential; c) effective communication and trusting relationships are crucial to good care; d) cultural differences should be acknowledged and respected; and e) the delivery of excellent palliative care is appropriate and necessary when patients die in the ICU.
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Case Reports Comparative Study
Physicians' decision-making in incompetent elderly patients: a comparative study between Austria, Germany (East, West), and Sweden.
In order to investigate to what extent various determinants in the decision-making process for the treatment of severely ill incompetent patients are influenced by cultural and sociopolitical factors, 540 physicians in Austria, Germany (East and West), and Sweden, countries representing different healthcare systems, were surveyed using a self-administered questionnaire. It provided three case vignettes with different levels of information about the patient's treatment wishes in case of incompetence in a life-threatening situation. We found a general trend to a lower level of treatment in line with the patient's wishes when the information provided was more detailed. ⋯ Ethical concerns and patient's wishes appeared as the most important factors whereas religious beliefs of the physician and hospital costs scored lowest. Because of the variability of treatment decisions and the importance of various factors determining the decision-making, an advance directive may be a feasible way of reducing the number of conflicts in critical situations. We recommend that ethical issues of clinical practice should be emphasized in the medical curriculum and in the training of physicians.
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Palliative medicine · Sep 1999
ReviewDevelopment of a breathlessness assessment guide for use in palliative care.
The complex nature of breathlessness in advanced cancer makes it a difficult symptom to understand and control. Measurement instruments applied to breathlessness have thus far failed to consider the multivariant components of this symptom. ⋯ The guide aims to encourage breathlessness to be addressed as a multidimensional problem, in which the emotional experience of breathlessness is inseparable from the sensory experience and the causative biological mechanisms. This guide provides the foundation for understanding the symptom of breathlessness in advanced cancer, and in turn promotes the development of management strategies to deal with this complex symptom.
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Randomized Controlled Trial Clinical Trial
Intrathecal coadministration of bupivacaine diminishes morphine dose progression during long-term intrathecal infusion in cancer patients.
To determine the difference in intrathecal morphine dose progression between a continuous intrathecal infusion of a morphine/bupivacaine mixture and morphine for pain relief in patients with cancer. ⋯ The diminished intrathecal morphine dose increase in the combination group is considered to be due to a synergistic effect of bupivacaine on the intrathecal morphine-induced antinociception. A dose increment during long-term intrathecal infusion in cancer patients appears to be related to both disease progression and tolerance phenomena.
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Palliative medicine · Sep 1999
Acute care palliative medicine: psychosocial assessment of patients and primary caregivers.
This paper describes the application of an empirically-derived psychosocial assessment for use in advanced cancer. The patient population selected for this study was those patients no longer pursuing aggressive antitumour treatment, and the focus of care was on management of major symptoms and complications, and psychosocial support of the patient and family. ⋯ Through this assessment of all patients admitted to our inpatient palliative medicine unit, care needs were identified and psychosocial interventions planned. The results of 150 assessments are reported, as well as observations of the process, implications for psychosocial care and modifications of the assessment based on this experience.