ISSN:1096-6218    

DOI:10.1089/jpm.1999.2.1

出版商:Mary Ann Liebert, Inc.    

年代:1999

数据来源: MAL

ISSN:1096-6218    

DOI:10.1089/jpm.1999.2.3

出版商:Mary Ann Liebert, Inc.    

年代:1999

数据来源: MAL

摘要:

Given the commitment of the Veterans Health Administration (VA) to excellent, compassionate end-of-life and palliative care and the VA's extensive system of academic affiliationswith the nation's medical schools, there may exist an opportunity to accelerate acceptance of state-of-the-art training for improved care for dying patients. Accordingly, the VA has initiateda project to develop strategies for implementation of benchmark curricula for end-of-life and palliative care. With the support of the Robert Wood Johnson Foundation, this initiativehas been implemented in 30 internal medicine residency training programs affiliated with the VA nationally.

ISSN:1096-6218    

DOI:10.1089/jpm.1999.2.5

出版商:Mary Ann Liebert, Inc.    

年代:1999

数据来源: MAL

摘要:

Hospice is recognized as the model for excellence in end-of-life care but its accessibility remains limited. A committee of the National Hospice Organization recently examined the barriersto hospice care and articulated a vision for quality end-of-life care for the 21st century. Its recommendations include public policy changes and other initiatives involving research,the education and practice of health professionals, the engagement of the public, and the operation of hospice programs.

ISSN:1096-6218    

DOI:10.1089/jpm.1999.2.9

出版商:Mary Ann Liebert, Inc.    

年代:1999

数据来源: MAL

摘要:

The Bazelon Center For Mental Health Law in Washington, D.C., has undertaken a palliative care project to examine how litigation might be used to secure the rights of terminally ill patientsto receive adequate palliative care, including the medications necessary to relieve the pain that often accompanies a final illness. One area of inquiry is the Medicare Hospice Benefitand the requirement that, to qualify for the benefit, a patient must have a prognosis of 6 months or less to live. A second major area of inquiry is regulatory restrictions on the prescriptionof opioids for pain relief of terminally ill patients and whether those restrictions improperly impede the physicians in their ability to engage in effective and appropriate painmanagement.

ISSN:1096-6218    

DOI:10.1089/jpm.1999.2.15

出版商:Mary Ann Liebert, Inc.    

年代:1999

数据来源: MAL

摘要:

Objective:To examine whether use of the Medicare Hospice Benefit between health maintenance organization (HMO) and Fee-For-Service (FFS)-enrolled beneficiaries varies by income or race.Data source:Medicare enrollment and claims data for South Florida.Results:In the FFS system, rate of death in hospice varied by income. In the HMO system, it did not. Time spent in hospice varied by income in the HMO system and not in the FFS system. There waslittle evidence that racial differences in hospice use differed between FFS and HMO options.Conclusions:These differences raise questions about whether some hospice use may be in response to system-level incentives.

ISSN:1096-6218    

DOI:10.1089/jpm.1999.2.23

出版商:Mary Ann Liebert, Inc.    

年代:1999

数据来源: MAL

摘要:

We conducted telephone interviews to assess family satisfaction with end-of-life care in the hospital and to gauge the extent of bereavement follow-up. We interviewed 53 relatives orclose companions of adults who had died in our hospital within 5 to 12 months, representing 51 of the 153 families of English-speaking patients who had experienced a nontraumatic,nonsudden hospital death over a 4-month period. Overall satisfaction with care and with communication was rated high on the Likert scale (mean 4.3, median 5 for both topics). However,we suggest that this commonly used quantitative evaluation method is inadequate for assessing family satisfaction with terminal care because simple, open-ended questions yieldedan array of disturbing problems. We report on the major complaints of the bereaved, which primarily focused on respect for privacy, dignity, and comfort; communication with the family;emergency ward care; attention to advance directives; and bereavement support. We documented that commonly recommended bereavement services were lacking. Over a third ofrelatives reported no contact with hospital health professionals after the death, and over a quarter of contacts were patient-initiated. Most bereavement follow-up on the part of hospitalstaff seemed cursory or haphazard, rather than representing a serious and sustained attempt to assess or facilitate bereavement or identify a need for referral. Although 19% of respondentshad sought professional help, none had been referred by their physician or the deceased's physician. Hospital-based social workers and chaplains played, at best, a minorrole in bereavement follow-up.

ISSN:1096-6218    

DOI:10.1089/jpm.1999.2.33

出版商:Mary Ann Liebert, Inc.    

年代:1999

数据来源: MAL

摘要:

This study was conducted to estimate the level of interest in assisted suicide among persons with multiple sclerosis (MS), the hypothetical conditions under which they would considerassisted suicide, and the factors associated with such interest. The sample of 511 members drawn from the Oregon and Michigan chapters of the National Multiple Sclerosis Society(NMSS) completed a mail questionnaire indicating whether they had ever considered assisted suicide, under what conditions they would consider it, and the correlates of considering assistedsuicide. Close to one third of persons with MS in this study had thought about assisted suicide as an option for themselves. One quarter to one half would consider assisted suicidein five hypothetical circumstances, including experiencing unbearable pain, being unable to do things that made them happy, causing financial burden to caregivers or family members,or experiencing extreme emotional distress. Religiosity, social support, depressive symptomatology, MS symptoms, NMSS chapter, years since diagnosis, and gender were associatedwith some or all of the responses to the hypothetical conditions. The clinical and policy implications of these findings are discussed.

ISSN:1096-6218    

DOI:10.1089/jpm.1999.2.51

出版商:Mary Ann Liebert, Inc.    

年代:1999

数据来源: MAL

摘要:

Education of health care providers has historically been based on the traditional model of curative care. In this model, the curative care focus suddenly ends, substituted by a palliativeapproach to care, too often only in the last hours of life. Patient goals and wishes may never be clearly established, leaving family and care providers to guess at what the patient's wisheswere. If we are to provide quality palliative care, we must equate it with health care providers establishing, acknowledging, and honoring patient and family goals. A major facilitator inaccomplishing palliative care goals can arise from the nursing assessment. This article reviews the elements of a comprehensive nursing palliative care assessment (PCA). Although this articlefocuses on nurses, it has application for all health care professionals. Completion of the PCA provides an opportunity for reflection and evaluation of personal practices that supportintegrating palliative care into the care of all patients diagnosed with a life-threatening illness, beginning at the time of diagnosis and accelerating in intensity as the disease progresses.

ISSN:1096-6218    

DOI:10.1089/jpm.1999.2.65

出版商:Mary Ann Liebert, Inc.    

年代:1999

数据来源: MAL

摘要:

Those who provide care for the dying seek to address issues of pain and suffering in the context of the psychological, spiritual, mental, and physical complexities of the individual experiencinga terminal illness. People who are dying are still living. They have the right to be in control of their lives. The staff (caregivers) also have an integrity which must be preserved.They too must be connected to the decision-making process. The reality of palliative care brings up unresolved psychological issues, often turbulent personal issues, for all involvedin the process. This can cause extra unnecessary pain and suffering for all concerned. It is essential that a real (unflinching) and an ethical relationship between the patient and the staffbe maintained and valued as these issues are confronted and resolved. This relationship will be subject to group process influences, which must be recognized and embraced. Avoidanceof these issues can lead to unfairness, misunderstanding, shame, and lasting resentment among the caregivers, as well as to tragic consequences for the patient and the family. Thepurpose of this article is to describe a decision-making process in palliative care that includes the use of ethical principles as well as features of group process. The ethical grid was adaptedand developed from the work of Jonsen, Siegler, and Winslade. The features of group process are based on theories of group work as defined by Trotzer; Johnson and Johnson; Gladding;Bion; Yalom; and Amundson, Borgen, Westwood and Pallard.

ISSN:1096-6218    

DOI:10.1089/jpm.1999.2.75

出版商:Mary Ann Liebert, Inc.    

年代:1999

数据来源: MAL