ISSN:1096-6218    

DOI:10.1089/jpm.2000.3.4.381

出版商:Mary Ann Liebert, Inc.    

年代:2000

数据来源: MAL

ISSN:1096-6218    

DOI:10.1089/jpm.2000.3.4.383

出版商:Mary Ann Liebert, Inc.    

年代:2000

数据来源: MAL

ISSN:1096-6218    

DOI:10.1089/jpm.2000.3.4.391

出版商:Mary Ann Liebert, Inc.    

年代:2000

数据来源: MAL

ISSN:1096-6218    

DOI:10.1089/jpm.2000.3.4.397

出版商:Mary Ann Liebert, Inc.    

年代:2000

数据来源: MAL

ISSN:1096-6218    

DOI:10.1089/jpm.2000.3.4.399

出版商:Mary Ann Liebert, Inc.    

年代:2000

数据来源: MAL

ISSN:1096-6218    

DOI:10.1089/jpm.2000.3.4.403

出版商:Mary Ann Liebert, Inc.    

年代:2000

数据来源: MAL

ISSN:1096-6218    

DOI:10.1089/jpm.2000.3.4.407

出版商:Mary Ann Liebert, Inc.    

年代:2000

数据来源: MAL

摘要:

Many indicators suggest that care of the dying in Oregon has been improving over the past decade. However, results from a recent study suggest that one aspect of care of the dying, pain management, may be worsening. In late 1997, family reports of moderate and severe painin dying hospitalized patients increased from 33% to 57%. This occurred during a volatile time in the Oregon political climate associated with events surrounding a second vote onphysician-assisted suicide. In order to better understand the observed increase better, a statewide sample of physicians and nurses was surveyed to obtain their opinions about factorsthat may have contributed to the increased family reports of moderate and severe pain in dying hospitalized patients. Seventy-nine percent of respondents endorsed two or more factorsas partial explanations. These factors include an increase in family expectations about pain management (endorsed by 96%), decreased physician prescribing (endorsed by 66%), and reducednurse administration of pain medication (endorsed by 59%). Physicians who thought reduced physician prescribing was a partial factor rated fears of the Board of Medical Examinersand the Drug Enforcement Administration as the most likely explanations for decreased prescribing. More research is needed to better understand family expectations for end-of-lifecare, fears of investigation, and pain medication practices.

ISSN:1096-6218    

DOI:10.1089/jpm.2000.3.4.413

出版商:Mary Ann Liebert, Inc.    

年代:2000

数据来源: MAL

摘要:

Background:Citizens have conveyed to professionals that care at the end of life is less than optimal. Efforts to improve matters have tended to work in piecemeal fashion, on tangiblemore than personal aspects of care, and without the benefit of documented perspectives of those who face dying. Policy initiatives and clinical interventions need guidance from a broadframework that is validated by patients' perspectives.Purpose:Our goals were to: (1) assess the construct validity and stability over time of the portions of a conceptual framework that concern patients' subjective experiences; (2) developa foundation for measurement of these personally meaningful factors; and (3) examine these factors' associations for potential clinical or policy significance.Population:Patients were from six diverse geographical areas whose physicians judged their survival prognosis to be 6 months or less. Physicians who referred the patients were randomlyselected from state and specialty association lists.Methods:We used in-person survey methodology and multivariate analysis of patient responses. The analysis fell into two parts. Using exploratory factor analysis, we looked for evidenceof discrete dimensions of experiences. Using regression analysis, we examined associations among them.Results:Of 1,131 eligible patients, 988 were interviewed (87.4% response rate). Of 682 patients who survived to follow-up interview 4-6 months later, 650 were interviewed (95.3% responserate). Exploratory factor analysis identified 12 discrete factors (accounting for 55% of variance; maximum Spearman'sp= 0.24), 8 of which met criteria for representing measurable dimensions (accounting for 46% of variance). These 8 were: patient-clinician relationship; socialconnectedness; caregiving needs; psychological distress; spirituality/religiousness; personal acceptance; sense of purpose; and clinician communication. Eigenvalues ranged from1.45 to 6.30 and Cronbach'sfrom 0.63 to 0.85.The concordance between these dimensions and those in the proposed framework indicated that two dimensions required minor modifications and six were confirmed, providingevidence of good construct validity for this portion of the framework. The same dimensions were also evident at follow-up except that the first two above-listed loaded on one combinedfactor, clinician interaction (eigenvalues 1.83-7.92; Cronbach'sfrom 0.64 to 0.86). This provides evidence of the construct's stability over time.Clinical communication and patient-clinician relationship were associated (odds ratio [OR] 2.79, 2.31-3.36). Better clinician communication correlated with somewhat better personal acceptance(OR 1.10,1.02-1.19), and a better patient-clinician relationship correlated with less psychological distress (OR 0.84, 0.75-0.95).Conclusions:We conclude that: (1) Personally meaningful aspects of patients' experience of terminal illness can be represented in valid, multidimensional constructs that are stable overtime; (2) They are measurable; and (3) Aspects of the therapeutic relationship appear to correlate with patients' experience of the dying process.

ISSN:1096-6218    

DOI:10.1089/jpm.2000.3.4.419

出版商:Mary Ann Liebert, Inc.    

年代:2000

数据来源: MAL

摘要:

Access to hospice care continues to be an enigma. Hospice has been available for nearly three decades in the United States, but the services continue to be underutilized. In an effort to betterunderstand access barriers, a series of focus groups were held with recently bereaved caregivers (mean = 9.9 months since the death of the patient). During the process of the focusgroup discussions, participants relived their experience with hospice. Although the purpose of this research was to ascertain access recommendations, participants integrated their accesscomments into the overall richness of their hospice experience. The 12 participants were divided into two groups, and each group met twice with a 2-week interval between sessions.From the focus group discussions, six themes emerged. Two of the six themes related to access issues: (1) societal and health system issues related to delayed hospice access and (2) educationand practice needs of health professionals that affect hospice access. Participants provided recommendations to address the concerns expressed through both of these access themes.

ISSN:1096-6218    

DOI:10.1089/jpm.2000.3.4.433

出版商:Mary Ann Liebert, Inc.    

年代:2000

数据来源: MAL