Palliative Care Pearls: Management of Delirium in Terminal Illness.

2002 ◽  
Author(s):  
Judith Kitzes
Keyword(s):  
Palliative Care ◽  
Terminal Illness

Happiness at the end of life: A qualitative study

2021 ◽  
pp. 1-7
Author(s):  
Tan Seng Beng ◽  
Wong Ka Ghee ◽  
Ng Yun Hui ◽  
Ooi Chieh Yin ◽  
Khoo Wei Shen Kelvin ◽  
...  
Keyword(s):  
Palliative Care ◽  
Qualitative Study ◽  
End Of Life ◽  
Terminal Illness ◽  
Terminally Ill ◽  
Social Connections ◽  
Targeted Interventions ◽  
Pain And Suffering ◽  
The University ◽  
Eudaimonic Happiness

Abstract Objective Dying is mostly seen as a dreadful event, never a happy experience. Yet, as palliative care physicians, we have seen so many patients who remained happy despite facing death. Hence, we conducted this qualitative study to explore happiness in palliative care patients at the University of Malaya Medical Centre. Method Twenty terminally ill patients were interviewed with semi-structured questions. The results were thematically analyzed. Results Eight themes were generated: the meaning of happiness, connections, mindset, pleasure, health, faith, wealth, and work. Our results showed that happiness is possible at the end of life. Happiness can coexist with pain and suffering. Social connections were the most important element of happiness at the end of life. Wealth and work were given the least emphasis. From the descriptions of our patients, we recognized a tendency for the degree of importance to shift from the hedonic happiness to eudaimonic happiness as patients experienced a terminal illness. Significance of results To increase the happiness of palliative care patients, it is crucial to assess the meaning of happiness for each patient and the degree of importance for each happiness domain to allow targeted interventions.

Palliative care referral practices and perceptions: The divide between metropolitan and non-metropolitan general practitioners

2011 ◽  
Vol 9 (2) ◽  
pp. 181-189 ◽  
Author(s):  
Claire E. Johnson ◽  
Afaf Girgis ◽  
Christine L. Paul ◽  
David C. Currow
Keyword(s):  
Palliative Care ◽  
General Practitioners ◽  
Advanced Cancer ◽  
Terminal Illness ◽  
Symptom Control ◽  
Physical Symptoms ◽  
Care Physician ◽  
Self Report ◽  
Psychosocial Needs ◽  
Consultative Service

AbstractObjective:Late or non-referral of patients to specialist palliative care (SPC) services may affect patients' and their carers' quality of care. General practitioners (GPs) are key professionals in linking people with SPC. The aim of this article is to assess GPs' perceptions and SPC referrals for their patients with advanced cancer and differences between metropolitan (M GPs) and non-metropolitan GPs (NM GPs).Method:Self-report survey mailed to a stratified random sample of 1,680 Australian GPs was used.Results:Thirty-one percent (469) of eligible GPs returned surveys. More M GPs than NM GPs reported referring >60% of their patients for SPC (p = 0.014); and that a more comprehensive range of SPC services was available. The most frequently reported referral prompts were: presence of terminal illness (M GPs, 71%, NM GPs, 66%, ns (not significant)); future need for symptom control (69% vs. 59%, ns) and uncontrolled physical symptoms (63% vs. 54%, ns). Reasons for not referring were: doctor's ability to manage symptoms (62% vs. 68%, ns) and the absence of symptoms (29% vs. 18%, p = 0.025). Higher referral was associated with: having a palliative care physician or consultative service available; agreeing that all patients with advanced cancer should be referred, and agreeing that with SPC, the needs of the family are better met.Significance of results:Referrals for SPC were primarily disease-related rather than for psychological and emotional concerns. Measures are needed to encourage referrals based upon psychosocial needs as well as for physical concerns, and to support GPs caring for people with advanced cancer in areas with fewer comprehensive SPC services.

Understanding the needs of family caregivers of older adults dying with dementia

2013 ◽  
Vol 12 (3) ◽  
pp. 223-231 ◽  
Author(s):  
Genevieve N. Thompson ◽  
Kerstin Roger
Keyword(s):  
Palliative Care ◽  
Family Caregivers ◽  
Terminal Illness ◽  
English Language ◽  
Psychological Needs ◽  
Support Needs ◽  
Care Services ◽  
Unique Nature ◽  
Palliative Care Services ◽  
Services And Supports

AbstractObjectives:A challenge in understanding the needs of dementia family caregivers (DFC) within the purview of dementia as a terminal illness rests on the fact that literature in this area is dispersed across disciplines and not specifically grounded within the realm of palliative care. The objective of this paper is to describe the domains of DFC needs and their impact on the delivery of palliative care services.Methods:A literature search pertaining to dementia family caregivers and palliative/end-of-life care was conducted using the databases Medline, CINHAL, Ageline, PsychInfo, and Scopus for articles published in the English language between 1997 and 2011.Results:Supporting family caregivers of individuals with dementia throughout the disease trajectory requires consideration of caregivers : (1) physical, emotional, and psychological needs; (2) information and decisional support needs; and (3) instrumental support needs. The unique nature and prolonged duration of these needs directly influences the palliative care services and supports required by these family caregivers.Significance of results:Understanding the scope of DFC needs help further our understanding of how these needs may impact the delivery of palliative care services, and assists in developing a model of care for those dying from dementia and for their family caregivers.

scholarly journals There's no Place like Home: Oklahoman's Preferences for Site of Death

2008 ◽  
Vol 1 ◽  
pp. PCRT.S1058 ◽  
Author(s):  
Marianne Matzo ◽  
Kamal Hijjazi
Keyword(s):  
Palliative Care ◽  
Terminal Illness ◽  
Income Level ◽  
Stated Preferences ◽  
Care Needs ◽  
Attitudes And Behaviors ◽  
Dying At Home ◽  
Palliative Care Needs ◽  
Insight Into ◽  
At Home

Objective This study sought to document Oklahomans knowledge, attitudes, and behaviors regarding palliative care; this paper focuses on subjects stated preferences for where they would choose to die. Design Quantitative study used a random state-wide telephone sample of Oklahoma residents. Subjects Data from 804 residents in the State of Oklahoma between November and December (2005). Results An overwhelming majority of the respondents (80%) reported preference to die at home in the event that they suffer a terminal illness. The proportion of respondents under the age of 65 who preferred to die at home (80.9%) was slightly higher than those aged 65 and over (74.8%). Also, while 81.4% of the female respondents reported preference for dying at home, 75.8% of the male respondents shared such preference (P < 0.05). More married respondents (82.7%) than non-married respondents (74.7%) reported preference for dying at home (P < 0.01). A significant association (P < 0.05) between income level and preference for dying at home was noted. While 84.3% of those with income level at $21,000 or more reported reference for dying at home, 76.4% of those with income below $21,000 reported the same preference. Conclusions This paper offers insight into factors that influence Oklahoman's stated preferences for site of death that can assist the statewide agenda in the planning and provision of palliative care. This information can be adapted in other states or countries to determine palliative care needs.

Spiritual and Existential Issues in the Care of the Dying

2014 ◽  
pp. 115-126
Author(s):  
William S. Breitbart
Keyword(s):  
Palliative Care ◽  
Terminal Illness ◽  
Spiritual Community ◽  
Psychotherapeutic Interventions ◽  
Existential Distress ◽  
Spiritual Issues ◽  
Cognitive Therapies ◽  
Loss Of Dignity ◽  
Existential Issues ◽  
Existential Concerns

Spirituality is important in the lives of patients with serious illnesses. Terminally patients may experience a number of spiritual issues, including lack of meaning, guilt, shame, hopelessness, loss of dignity, loneliness, anger toward God, abandonment by God, feeling out of control, grief, and spiritual suffering. Assessment of a patient’s spiritual beliefs, assessing the importance of spirituality in his or her life, exploring whether he or she belongs to a spiritual community, and offering chaplaincy referral or connection with the patient’s religious or spiritual leaders comprise essential components of a spiritual assessment. Psycho-oncologists should seek both specialized training, as well as referrals to appropriate sources, in order to help patients deal more effectively with the often complicated and painful spiritual issues that arise as a consequence of serious illness. Existential concerns are intrinsic to the human experience of facing mortality in palliative care settings. Patients diagnosed with terminal cancer often confront universal existential issues such as death anxiety, isolation, and meaninglessness. Psycho-oncologists must therefore be familiar with these existential concerns, their manifestations, and approaches to deal with existential issues. Psycho-oncologists have the unique ability to use a variety of psychotherapeutic interventions to alleviate existential distress in palliative care settings including cognitive therapies to help patients and families modify their appraisal of their lives with terminal illness, known as cognitive restructuring, life review techniques to facilitate a constructive reappraisal of life events, dignity-conserving therapies, and meaning-centered therapies have been shown to effectively reduce existential distress in this patient population.

The Role of PT, OT, and Other Therapies in Palliative Care for Seriously Ill Patients

2019 ◽  
pp. 682-689
Author(s):  
Dennis Lin ◽  
Megan Borjan ◽  
Seanell D. San Andres ◽  
Christina Kelly
Keyword(s):  
Palliative Care ◽  
Terminal Illness ◽  
Symptom Burden ◽  
Speech Language Pathology ◽  
Functional Impairments ◽  
Recreation Therapy ◽  
Rehabilitation Team ◽  
Language Pathology ◽  
Seriously Ill Patients

This chapter describes the roles of physical therapy, occupational therapy, speech language pathology, and recreation therapy in providing rehabilitation for patients receiving palliative care. Palliative rehabilitation should be included as part of a comprehensive interdisciplinary effort to support patients who experience functional impairments or symptoms that impact daily life and that result from terminal illness. Palliative rehabilitation focuses on creating collaborative goals that address disability and easing symptom burden to maximize or maintain function throughout every stage of disease. Patients receiving the appropriate rehabilitative interventions can adapt to the changes and foster an optimal quality of life. Nurses collaborate with the rehabilitation team so that patients and their caregivers can achieve a greater benefit from their palliative care.

Research in palliative care

2019 ◽  
pp. 53-62
Keyword(s):  
Palliative Care ◽  
Quantitative Research ◽  
Terminal Illness ◽  
Evidence Base ◽  
Attrition Rates ◽  
Quality Research ◽  
Qualitative And Quantitative ◽  
Good Quality Research

Research in palliative care is gaining momentum and good quality research is helping form an evidence base which clinicians will be able to work within. There are ongoing challenges with carrying out research in palliative care, including high attrition rates, culture and ethical views around research in patients with terminal illness, funding, and gatekeeping. However, it is essential that to provide the best care that robust research is carried out. This can take the form of qualitative and quantitative research, and both are useful and valid in developing a research base of evidence if they are used in the correct contexts.

Persistent socioeconomic inequalities in location of death and receipt of palliative care: A population-based cohort study

2020 ◽  
Vol 34 (10) ◽  
pp. 1393-1401
Author(s):  
Luke Mondor ◽  
Walter P Wodchis ◽  
Peter Tanuseputro
Keyword(s):  
Palliative Care ◽  
Cohort Study ◽  
End Of Life ◽  
Terminal Illness ◽  
Home Visits ◽  
Population Based ◽  
Relative Index ◽  
Deprived Neighbourhoods ◽  
Location Of Death ◽  
Index Of Inequality

Background: Providing equitable care to patients in need across the life course is a priority for many healthcare systems. Aim: To estimate socioeconomic inequality trends in the proportions of decedents that died in the community and that received palliative care within 30 days of death (including home visits and specialist/generalist physician encounters). Design: Cohort study based on health administrative data. Socioeconomic position was measured by area-level material deprivation. Inequality gaps were quantified annually and longitudinally using the slope index of inequality (absolute gap) and relative index of inequality (relative gap). Setting/Participants: A total of 729,290 decedents aged ⩾18 years in Ontario, Canada from 2009 to 2016. Results: In 2016, the modelled absolute gap (corresponding 95% confidence interval) between the most- and least-deprived neighbourhoods in community deaths was 4.0% (2.9–5.1%), which was 8.6% (6.2–10.9%) of the overall mean (46.6%). Relative to 2009, these inequalities declined modestly. Inequalities in 2016 were evident for palliative home visits (6.8% (5.8–7.8%) absolute gap, 26.3% (22.5–30.0%) relative gap) and for physician encounters (6.8% (5.7–7.9%) absolute gap, 13.2% (11.0–15.3%) relative gap), and widened from 2009 for physician encounters only on the absolute scale. Inequalities varied considerably across disease trajectories (organ failure, terminal illness, frailty, and sudden death). Conclusion: Key measures of end-of-life care are not achieved equally across socioeconomic groups. These data can be used to inform policy strategies to improve delivery of palliative and end-of-life services.

24 Understanding and management of terminal illness within tanzanian traditional medicine

2018 ◽  
Vol 8 (3) ◽  
pp. 368.3-369
Author(s):  
Naomi Higton ◽  
Emma Grace Lewis ◽  
Richard Walker ◽  
Richard Lee
Keyword(s):  
Palliative Care ◽  
Traditional Medicine ◽  
Terminal Illness ◽  
Healthcare Professionals ◽  
World Health Organisation ◽  
Traditional Healers ◽  
Explanatory Models ◽  
Sub Saharan Africa ◽  
World Health ◽  
List Type

BackgroundPalliative care (PC) need in Africa is projected to rise by 300% over the next 20 years.1 Late presentation and poor community awareness of services are recognised challenges to effective healthcare delivery.2 3Traditional and faith healers (TFH) hold cultural importance and provide a significant proportion of primary healthcare in Africa.4 5 This project sought to explore their understanding and management of terminal illness with the aim of improving PC delivery through collaborations between TFH and allopathic services.MethodologyData were collected through semi-structured qualitative interviews with traditional healers (n=11) and faith healers (n=8) working within the Kilimanjaro region of Tanzania. Participants were recruited through convenience and purposive sampling. Interviews were audio-recorded and translated transcripts analysed by thematic analysis.FindingsAll TFH had experience of terminally ill and dying patients. Participants had a holistic approach to healthcare with themes of biological psychological social and spiritual factors identified throughout conceptualisation and management of both terminal illness and death. This also informed opinions towards collaboration seeing healthcare professionals and TFH holding different roles within these areas.ConclusionsThe overlap with allopathic explanatory models of health (i.e. the BioPsychoSocial model) provides positive grounds for future collaborations. TFH could complement allopathic PC services through culturally acceptable spiritual care perceived to be lacking in hospitals. Joint dialogue and education between practitioners is necessary to begin collaboration. A significant challenge to this is mistrust between traditional healers and faith healers. The findings merit further research into patient’s preferences and experiences of TFHs in terminal illness.References. Grant L, Downing J, Namukwaya E. Palliative care in Africa since 2005: Good progress but much further to go. BMJ Supportive & Palliative Care2011;1(2).. Harding R, et al. Current HIV/AIDS end-of-life care in sub-Saharan Africa: A survey of models services challenges and priorities. BMC Public Health2003;3(33).. Lewis EG, Oates LL, Rogathi J, Duinmaijer A, Shayo A, Megiroo S, Bakari B, Dewhurst F, Walker RW, Dewhurst M, Urasa S. ‘We never speak about death.’ Healthcare professionals’ views on palliative care for inpatients in Tanzania: A qualitative study. Palliat Support CareAugust 2017;22:1–14.. World Health Organisation. WHO: Traditional medicine strategy: 2014–2023 2013. Geneva: World Health Organisation Geneva.. Stanifer JW, et al. The determinants of traditional medicine use in Northern Tanzania: A mixed-methods study. PLoS One2015;10(4):e0122638.

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