Articles: palliative-care.
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General practitioners (GPs) have become more responsible for budget allocation over the years. The 1997 White Paper has signalled major changes in GPs' roles in commissioning. In general, palliative care is ranked as a high priority, and such services are therefore likely to be early candidates for commissioning. ⋯ The 1997 White Paper, The New NHS, has indicated that the various forms of GP purchasing are to be replaced by primary care groups (PCGs), in which both GPs and DNs are to be involved in commissioning decisions. For many palliative care services, DNs' views of service adequacy and priorities for future development differ significantly from their GP colleagues; resolution of these differences will need to be attained within PCGs. Both professional groups give high priority to the further development of quick-response clinical services, especially urgent hospice admission and Marie Curie nurses.
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Physicians who treat patients approaching the end of life often face moral, ethical, and legal issues involving shared decision making, futility, the right to refuse medical treatment, euthanasia, and physician-assisted suicide. ⋯ Legal and ethical issues continue to confront patients, courts, and physicians. A better understanding of these issues and an awareness of the availability of effective palliative care will help physicians, patients, and families adequately address the end-of-life issues that are an intrinsic part of medical care.
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J Pain Symptom Manage · Feb 1999
ReviewResearch agenda for developing measures to examine quality of care and quality of life of patients diagnosed with life-limiting illness.
Despite the universality of dying, research has not focused on developing conceptual models and measurement tools for examining the quality of care and quality of life of dying patients and their loved ones. We present here a vision and research agenda for the development of a Tool Kit of Instruments to Measure End of Life Care (TIME). ⋯ For this vulnerable population, research is needed regarding the timing and sources of data collection. In order to achieve maximal benefit, ultimately measurement tools must be incorporated into existing measurement systems and consideration be given to generating informative reports which leads to institutional action to improve the quality of care.
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The modern hospice movement had its formal beginnings in the United Kingdom with the 1967 opening of the St. Christopher's Hospice in London by Dame Cicely Saunders. Global uptake of the hospice principles and, more recently, palliative care, is widespread. ⋯ The downside of this is increased regulation, competition, and a potential loss of specificity for those who are dying. This article explores the changing face of palliative care, with particular emphasis on palliative care delivery in the developing world. These issues for developing countries include access to services, access to morphine, and professional access to information and education.