Articles: caregivers.
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In addition to medical care, dying patients often need many types of assistance, including help with transportation, nursing care, homemaking services, and personal care. We interviewed terminally ill adults and their care givers in six randomly selected areas of the United States (five metropolitan areas and one rural county) to determine how their needs for assistance were met and the frequency with which they received such assistance from family members and paid and volunteer care givers. ⋯ In our survey of terminally ill patients, family members, usually women, provided the majority of assistance with nonmedical care. Although many people received assistance from paid care givers, very few had assistance from volunteers.
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In the absence of specific therapies, interventions for delirium are largely educational. This paper reviews educational interventions targeted at physicians, nurses, patients and their families. Most studies to date have had methodological deficiencies, and few have been developed in keeping with current principles for adult learning. ⋯ Future studies should incorporate principles of adult learning and have improved methodological rigour. The strength of educational interventions needs to be assessed carefully. Interventions which are time-sensitive, less complex, directed to observable, patient-focused endpoints are more likely to be successful.
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The moral distinctions between prolonging life, allowing for a dignified death, and assisting patients to die (hastening death) are troublesome to health practitioners. On 26 June 1997 the United States Supreme Court ruled that individuals do not have a constitutional right to physician-assisted suicide, but that individual states can legislate their preferences. ⋯ How health professionals integrated their perspectives of science/data with their perspectives on persons and personal goals affected the vigour with which they would institute treatment for the terminal patient. Further, ethical uncertainty dominated the decision making of all participants in this study when they were confronted with the question of assisting/hastening patients' dying.
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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.