Thursday, 24 April 2008

The American journal of hospice & palliative care, Feb-Mar 2008, vol. 25, no. 1

Letter to the editor on: the impact of volunteering in hospice palliative care.
p. 74-5
Marchese-Kyrra-A.
Comment on: Am J Hosp Palliat Care. 2007 Aug-Sep; 24(4):259-63

The ethical concept of best interest.
p. 56-62
Baumrucker-Steven-J, Sheldon-Joanne-E et al

Gabapentin for intractable hiccups in palliative care.
p. 52-4
Tegeler-Monica-L, Baumrucker-Steven-J.
Abstract
Intractable hiccups are not common in the general population or in the palliative care population but can adversely impact quality of life and cause other complications such as weight loss and sleep disturbance. Many treatments have been proposed for intractable hiccups, but there is little consensus regarding treatment in the medical literature. This is partly because hiccups are relatively uncommon and many of the proposed treatments are unproven or have long-term side effects. Pharmacologic treatments rather than home remedies or surgical treatments are more appropriate for the palliative care patient. Gabapentin is a promising medication for the treatment of intractable hiccups for its safety, lack of serious side effects, and rapid onset of action. Further research is indicated to determine whether gabapentin is consistently effective.

A day in the life: a case series of acute care palliative medicine-- the Cleveland model.
p. 24-32
Lagman-Ruth, Walsh-Declan, Heintz-Jessica, Legrand-Susan-B, Davis- Mellar-P.
Abstract
Palliative care in advanced disease is complex. Knowledge and experience of symptom control and management of multiple complications are essential. An interdisciplinary team is also required to meet the medical and psychosocial needs in life-limiting illness. Acute care palliative medicine is a new concept in the spectrum of palliative care services. Acute care palliative medicine, integrated into a tertiary academic medical center, provides expert medical management and specialized care as part of the spectrum of acute medical care services to this challenging patient population. The authors describe a case series to provide a snapshot of a typical day in an acute care inpatient palliative medicine unit. The cases illustrate the sophisticated medical care involved for each individual and the important skill sets of the palliative medicine specialist required to provide high-quality acute medical care for the very ill.

Narrative accounts of volunteers in palliative care settings.
p. 16-23
Guirguis-Younger-Manal, Grafanaki-Soti.
Abstract
The long and evolving tradition of palliative care has always had a strong volunteer dimension. The difficult nature of palliative care invites questions around why volunteers choose this particular line of contribution. To expand our knowledge of the elements that create meaning and capture the essence of volunteer experience, we asked volunteers to share the rewards and the challenges of their work and its personal meaning. Significant themes emerged around what volunteers considered the most valuable aspects of their experience. Volunteers identified freedom of choice and the ability to use their natural gifts as an important condition for satisfaction. In addition, they perceived emotional resilience and personal hardiness as important dimensions of their suitability for working in palliative care. Finally, volunteers felt that their approach must be one of a balanced perspective, with an understanding of life and death as part of the human condition.

Identification of quality indicators of end-of-life cancer care from medical chart review using a modified Delphi method in Japan.
p. 33-8
Miyashita-Mitsunori, Nakamura-Asumi, Morita-Tatsuya, Bito-Seiji.
Abstract
End-of life care is one of the principle components of cancer care. Measurement of the quality of care provided for end-of-life cancer patients is an important issue. The aim of this study was to identify the quality indicators (QIs) for end-of-life cancer care for Japanese patients using a medical chart review. A modified Delphi method for the development of QIs was adopted. Seventeen multi-professional specialists participated by rating the appropriateness and feasibility of potential QIs. Thirty QIs for end-of-life cancer care were ultimately identified within 4 domains: (1) symptom control, (2) decision-making and preference of care, (3) family care, and (4) psychosocial and spiritual concerns. These QIs will be useful for monitoring and evaluating end-of-life care for Japanese cancer patients. The QIs are feasible for use in any clinical setting and cover a comprehensive area in accordance with the World Health Organization's (WHO) definition of palliative care including physical, psychosocial, and spiritual concerns.

Documentation in palliative care: nursing documentation in a palliative care unit-a pilot study.
p. 45-51
Gunhardsson-Inger, Svensson-Anna, Berteroe-Carina
Abstract
Palliative care seeks to enhance quality of life in the face of death by addressing the physical, psychological, social, and spiritual needs of patients with advanced disease. The purpose of this paper is to explore whether palliative patients' needs, nursing actions, and evaluation can be identified in the nursing documentation. Data consisted of reviews of patients' case records in a palliative care unit. Data were analyzed using content analysis and counting frequency of keywords used from the Well-being Integrity Prevention and Safety (VIPS) model, followed by an inductive analysis of the case record documentation aiming to identify palliative care components. The result shows that the documentation revealed physical care, especially pain, more frequently than other needs. Nursing documentation focuses on identification more than on nursing actions and evaluation.

A UK perspective on worldwide inadequacies in palliative care training: a short postgraduate course is proposed.
p. 63-71
Charlton-Rodger, Currie-Andy.
Abstract
A chronological literature review illustrates how undergraduate and postgraduate education and training in the care of the dying and bereaved is inadequate worldwide. This is despite the foundation of the modern hospice movement in the United Kingdom in 1967 and its wider dissemination as a specialty in 1985. This situation has implications for those doctors working in both primary and secondary care, and this paper describes a 3-day course which has been successfully run in the West Midlands, UK, since 1997 for family physicians in training. A pre-course survey of 250, with a response rate of 54%, in 2003 revealed that 100% of respondents felt that they needed further training, and 51.5% said that they had had no previous training in palliative care.

Confronting death: perceptions of a good death in adults with lung cancer.
p. 39-44
Hughes-Travonia, Schumacher-Mitzi, Jacobs-Lawson-Joy-M, Arnold- Susanne.
Abstract
Investigations regarding patients' concerns about death have focused on the importance of autonomy, resolution of concerns, family relationships, and religiosity, and relied on data from physicians, nurses, family members, and healthy older adults. Few studies have focused on patients with diseases that have short-term survival rates. This study examined lung cancer patients' perceptions of a good death. One hundred lung cancer patients answered open-ended questions about what a good death was and completed measures assessing coping, spirituality, religious coping, and life satisfaction. Content analysis revealed 4 themes describing a good death: (a) during sleep, (b) pain-free, (c) peaceful, and (d) quick. These findings have implications for those caring for terminally ill patients as the 4 themes differ from those derived from studies of more heterogeneous patients, their families, and health care providers.

A poor prognosis: guide or misleading?
p. 5-8
Wijnia-Jan-W, Corstiaensen-Inno-J-P-M.
Abstract
Patients admitted to a palliative care unit have a limited life expectancy. Sometimes, however, the accuracy of the prognosis is compromised by atypical progress of a disease or incorrect assumptions. If a predicted short life expectancy proves to be longer, the increased need of care may result in chronic admission and in a significantly reduced quality of life. A given poor prognosis may be mistakenly adhered to and might lead to insufficient diagnostic procedures or treatment. However, palliative care requires a patient-oriented and active approach. To be aware of possible incomplete diagnostics is an important step in preventing adverse consequences of a wrong prognosis.

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