ISSN:1096-6218    

DOI:10.1089/jpm.1998.1.1

出版商:Mary Ann Liebert, Inc.    

年代:1998

数据来源: MAL

摘要:

Patients' families are important in hospice not only because they themselves might benefit from it, but also because they influence whether and how hospice is used to begin with. Wehypothesized that, among the married, people with less capable spouses (in this case, those who are less healthy) should be less able to use home hospice care and should enroll in hospicelater in the course of their illness, closer to death. We tested this hypothesis by evaluating the impact of spousal health on the timing of patients' use of hospice in a select groupof 517 couples, a total of 1034 patients, for whom we have health data for both partners from Medicare claims records. We evaluated cohort survival using the Kaplan-Meier method andCox regression, and we measured illness burden using the Charlson comorbidity score. Among the probands, 45.6% had a primary cancer diagnosis, 44.5% were female, 7.5% werenonwhite, their mean age was 80.0 years (7.6 SD), and their mean Charlson score was 3.13.0. The probands' median survival after hospice enrollment was 55 days. Spouses were similarly composed demographically, but were less likely to have a cancer primary diagnosis(35.4% had cancer) and were slightly younger than the probands; their mean Charlson score was 2.92.9. Each additional point in the Charlson score of the spouse, controlling for measured characteristics of the proband, is associated with a 5.1% increase in the risk of death afterenrollment. That is, after controlling for the characteristics of hospice patients themselves, those with sicker spouses are enrolled later. Compared with patients with the healthiestspouses, those with moderately sick and very sick spouses had considerably later enrollment into hospice, with the median survival decreasing from 111 to 49 to 22 days across the groups.Our data suggest that there may be a separate role of spousal health in affecting the time of hospice enrollment, and that patients' social support may affect not just their health status tobegin with, but also their use of health care in general.

ISSN:1096-6218    

DOI:10.1089/jpm.1998.1.3

出版商:Mary Ann Liebert, Inc.    

年代:1998

数据来源: MAL

摘要:

A training program for home care professionals, HOPE (Home care Outreach for Palliative care Education), was designed to improve the knowledge and skills of those providing care to patients and family caregivers at home. This article presents an overview of the pilot HOPEtraining program and a case study to illustrate the complex end-of-life (EOL) care needs in nonhospice home care settings. HOPE was designed as five training modules based on a needsassessment survey completed by 134 home care agencies. The training modules were composed of (a) General Overview of End of Life Care; (b) Pain Management; (c) Symptom Management;(d) Communication with Patients and Families; and (e) the Death Event. The program was implemented for clinical staff (N = 52), predominantly nurses, in two home careagencies and evaluated with pre- and postcourse surveys. Pre- and postcourse evaluations demonstrated an increase in the overall rating of EOL care from a mean rating of 5.97 to 7.42for self-assessment and from 6.59 to 7.94 for agency assessment (on a scale of 0 = not at all effective to 10 = very effective). Future palliative care education should also include evaluationof the impact of such programs on patient care. We concluded that increasing palliative care knowledge of home care professionals is necessary to improve patient care at the EOL.

ISSN:1096-6218    

DOI:10.1089/jpm.1998.1.11

出版商:Mary Ann Liebert, Inc.    

年代:1998

数据来源: MAL

摘要:

Death occurs among older adults in institutions more often than at home with family and friends. The older people are, the more likely they are to die in a nursing home. The purposeof this study was to describe staff and administrator's perspectives on death and dying in long-term care and to explore problems in providing humane care to dying residents that fostersgentle closure to life. Using focus group interviews as the primary data collection method, 22 focus group sessions were conducted in 11 nursing homes. Separate group sessions wereheld for staff and administrators in the nursing homes. The core variable identified in this study was the attachment of staff to residents in long term care. Attachment enhanced thequality of terminal care and fostered a gentle closure to life. Mediating forces influencing the process of attachment were identified as individual forces, as well as forces internal and externalto the nursing home.

ISSN:1096-6218    

DOI:10.1089/jpm.1998.1.21

出版商:Mary Ann Liebert, Inc.    

年代:1998

数据来源: MAL

摘要:

A faculty development course was offered at the Medical College of Wisconsin to bolster existing medical student and housestaff training opportunities in palliative medicine. An 8-week, 12 contact-hour course was designed to provide up to 15 faculty members training in the practice and teaching of end-of-life care. Fifteen faculty registered, but only 10 attendedat least three of eight educational sessions. Educational formats included didactic presentations, case studies, study guides and completion of action plansexplicit plans for utilization of newly learned material in clinical and educational practice. In a retrospective, pre/postself-evaluation, participants indicated poor or fair precourse knowledge and self-confidence in most areas of end-of-life care. Significant improvement in end-of-life knowledge and selfconfidencewas noted for eight of 11 content areas and in self-assessed education skills in six of seven content areas. Although attendance was disappointing, the course was strongly endorsedby participating faculty. Faculty who attended at least three sessions reported significant improvement in many aspects of end-of-life clinical care, as well as in self-confidenceand education skills, and were able to use the educational material to train a range of learners. Sample educational material is included with this report.

ISSN:1096-6218    

DOI:10.1089/jpm.1998.1.35

出版商:Mary Ann Liebert, Inc.    

年代:1998

数据来源: MAL

摘要:

A hospice/palliative medicine consultation team was formed in July 1993 in a U.S. teaching hospital to provide patient care and education. The team consists of an attending physician,nurse, fellow, and any residents or medical students rotating on the service. More than 500 consultations are received each year. Beginning in January 1995,108 consecutive referrals tothe service were assessed using a standard form completed by the nurse. The average age was 62 years. The gender of patients was 58% male and 42% female. At the time of consultation87% were hospitalized on general medical services (including hematology/oncology), 4% were on surgical services, 3% on the neurology service, and 6% were in an intensive care unit. Cancerwas the primary diagnosis in 52%, AIDS in 24%, with the rest being distributed among cardiac, renal, pulmonary, neurologic, and other diseases. The most prominent physical symptomswere 48% weakness/malaise, 44% pain, 28% dyspnea, and 23% agitation/confusion. The average length of time patients were followed was 2 days (range 1-10). We conclude that ahospice/palliative medicine consultation service sees a broad range of patients and problems and is a rich resource for teaching hospice and palliative medicine.

ISSN:1096-6218    

DOI:10.1089/jpm.1998.1.45

出版商:Mary Ann Liebert, Inc.    

年代:1998

数据来源: MAL

摘要:

The physiochemical characteristics of the potent synthetic opioid agonist fentanyl make it ideal for noninvasive transmucosal delivery. Studies of oral transmucosal fentanyl citrate(OTFC), a candied matrix formulation administered orally as a palatable lozenge on a stick, have investigated and determined this analgesic's pharmacokinetics and pharmacodynamicsin a number of clinical settings, including premedication before surgery, acute analgesia for painful medical procedures, and, most recently, for the control of breakthrough cancer pain.The onset to meaningful pain relief in patients with acute pain from surgery or breakthrough pain from cancer is between 5 and 10 minutes after initiating OTFC use, equivalent to intravenousmorphine. Analgesic dose equivalency studies suggest that OTFC is, on average, about 10 times more potent than morphine, although, in randomized, controlled, and blinded studies,many patients who were using relatively high doses of opioid anlagesics on an aroundthe- clock schedule for control of cancer pain reported that even a low dose of OTFC (i.e., 200g) provided adequate relief from breakthrough pain. Side effects from OTFC are similar in character and frequency to other opioids, including sedation, nausea, and pruritus. These effectsappear to wane rapidly with repeated use of this medication. To date there have been no reported serious adverse events in any of the population groups studied or treated withOTFC.

ISSN:1096-6218    

DOI:10.1089/jpm.1998.1.55

出版商:Mary Ann Liebert, Inc.    

年代:1998

数据来源: MAL

摘要:

Malignant bowel obstruction is an odious complication of numerous malignancies, most notably ovarian and colorectal cancers. It reduces quality of life and promotes considerable physicaland emotional suffering, precluding a peaceful and comfortable death and deterring appropriate familial bereavement. Palliative management of bowel obstruction includesoperative and nonoperative strategies, with therapeutic selection based on patient preference and anticipated life expectancy. Available therapies include laparotomy, enteral intubation,intravenous and subcutaneous hydration, parenteral nutrition, and pharmacologic agents.

ISSN:1096-6218    

DOI:10.1089/jpm.1998.1.65

出版商:Mary Ann Liebert, Inc.    

年代:1998

数据来源: MAL

ISSN:1096-6218    

DOI:10.1089/jpm.1998.1.73

出版商:Mary Ann Liebert, Inc.    

年代:1998

数据来源: MAL

ISSN:1096-6218    

DOI:10.1089/jpm.1998.1.83

出版商:Mary Ann Liebert, Inc.    

年代:1998

数据来源: MAL