Articles: palliative-care.
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Ann Acad Med Singap · Mar 1994
Recent progress in cancer pain management and palliative care in Japan.
One out of every four deaths in Japan is due to cancer, so that health-care workers and the lay public have gradually become aware of the importance of cancer pain relief and palliative care in recent years. In 1984, the feasibility and effectiveness of the WHO method for relief of cancer pain was demonstrated in Japanese cancer patients. ⋯ These activities resulted in a 35-fold increase in the annual consumption of morphine preparations for medical purposes between 1979 and 1992. However, the annual consumption per capita is still much smaller than that in other developed countries, indicating the need for further information dissemination and professional education in the implementation of palliative care programmes.
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A retrospective study was carried out in 100 adult patients with advanced malignant disease. They were given subcutaneous continuous infusions of medication for symptom relief. The drugs were administered through a butterfly needle inserted subcutaneously in the anterior chest wall using a battery-operated infusion pump. ⋯ The treatment was well tolerated by the patients and controlled their symptoms satisfactorily in the great majority. The use of continuous subcutaneous infusion via a syringe driver gives good symptom control. In the last days of life when the patients have difficulty tolerating oral medication, continuous subcutaneous infusion is a superior alternative to frequent intermittent parenteral injections.
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Family physicians were asked about their recent experience with caring for dying patients at home and for their evaluation of a recently established Palliative Care Home Support Team. Ninety-four percent of the respondents had cared for at least one dying patient at home during the previous 2 years. ⋯ One quarter felt personally drained by the experience, but almost as many found it personally renewing. Of those who had referred patients to the team, two thirds gave the team high ratings for being supportive, helpful, quick to respond, and effective in communication.
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Social science & medicine · Feb 1994
Are bereaved family members a valid proxy for a patient's assessment of dying?
To compare assessments made retrospectively by bereaved family members (or the nearest carer to the patient) with assessments made before death by palliative staff and, where available, by patients themselves or the family member. ⋯ Retrospective assessments by bereaved family members may be valid for some items related to service provision, but not as the sole assessment of a patient's pain, symptoms or anxiety. We suggest that studies which rely on these retrospective ratings should assess the validity of their responses and record more information about the mood and grief of the family member.