Principles and Practice of Palliative Care

2013 ◽  
Author(s):  
Kristen G Schaefer ◽  
Rachelle E Bernacki
Keyword(s):  
Palliative Care ◽  
Life Support ◽  
Advanced Life Support ◽  
Family Satisfaction ◽  
Terminal Phase ◽  
Survival Times ◽  
Advanced Illness ◽  
Post Discharge ◽  
Patient Centered ◽  
Serious Illness

The trajectories of serious illness and dying have changed in the last century; in the past, patients lived shorter lives and often died quickly of infectious disease, whereas patients in the 21st century live longer and often with prolonged debility in the advanced stages of illness. As a result, patients with serious illness can suffer undertreated symptoms and often feel poorly prepared for the final stages of disease. With more options for advanced life support and other aggressive interventions at the end of life, patients and families face increasingly complex medical decisions in the terminal phase of illness, and the treatments they receive do not always align with their goals and values. Emerging evidence suggests that integrating palliative care into the treatment of advanced illness can improve outcomes, decrease costs, and improve both patient and family satisfaction. Consequently, patient access to high-quality specialty-level palliative care is becoming standard of care at most academic cancer centers and more available in the community. This chapter describes the practice and principles of specialty-level palliative care and outlines specific "generalist" palliative care competencies essential for all physicians caring for patients with serious illness, including prognostication, patient-centered communication, and the navigation of ethical dilemmas in the field of palliative care. Tables outline the philosophy of palliative care, domains of suffering, location of death of hospice patients, the palliative performance scale, median survival times for cancer syndromes, indicators associated with a poorer prognosis in congestive heart failure, the NURSE mnemonic for accepting and responding to emotion, palliative care communication competencies in the intensive care unit, and the SPIKES mnemonic for breaking bad news. Figures depict causes of death in 1900 versus 2010, palliative care through the trajectory of serious illness, theoretical trajectories of disease, life expectancies for women and men, mortality at 1 year post discharge, and a model for patient-centered communication. This review contains 6 highly rendered figures, 9 tables, and 169 references.

Principles and Practice of Palliative Care

2013 ◽  
Author(s):  
Kristen G Schaefer ◽  
Rachelle E Bernacki
Keyword(s):  
Palliative Care ◽  
Life Support ◽  
Advanced Life Support ◽  
Family Satisfaction ◽  
Terminal Phase ◽  
Survival Times ◽  
Advanced Illness ◽  
Post Discharge ◽  
Patient Centered ◽  
Serious Illness

The trajectories of serious illness and dying have changed in the last century; in the past, patients lived shorter lives and often died quickly of infectious disease, whereas patients in the 21st century live longer and often with prolonged debility in the advanced stages of illness. As a result, patients with serious illness can suffer undertreated symptoms and often feel poorly prepared for the final stages of disease. With more options for advanced life support and other aggressive interventions at the end of life, patients and families face increasingly complex medical decisions in the terminal phase of illness, and the treatments they receive do not always align with their goals and values. Emerging evidence suggests that integrating palliative care into the treatment of advanced illness can improve outcomes, decrease costs, and improve both patient and family satisfaction. Consequently, patient access to high-quality specialty-level palliative care is becoming standard of care at most academic cancer centers and more available in the community. This chapter describes the practice and principles of specialty-level palliative care and outlines specific "generalist" palliative care competencies essential for all physicians caring for patients with serious illness, including prognostication, patient-centered communication, and the navigation of ethical dilemmas in the field of palliative care. Tables outline the philosophy of palliative care, domains of suffering, location of death of hospice patients, the palliative performance scale, median survival times for cancer syndromes, indicators associated with a poorer prognosis in congestive heart failure, the NURSE mnemonic for accepting and responding to emotion, palliative care communication competencies in the intensive care unit, and the SPIKES mnemonic for breaking bad news. Figures depict causes of death in 1900 versus 2010, palliative care through the trajectory of serious illness, theoretical trajectories of disease, life expectancies for women and men, mortality at 1 year post discharge, and a model for patient-centered communication.  This chapter contains 6 highly rendered figures, 9 tables, 169 references, 1 teaching slide set, and 5 MCQs.

Principles and Practice of Palliative Care

2013 ◽  
Author(s):  
Kristen G Schaefer ◽  
Rachelle E Bernacki
Keyword(s):  
Palliative Care ◽  
Life Support ◽  
Advanced Life Support ◽  
Family Satisfaction ◽  
Terminal Phase ◽  
Survival Times ◽  
Advanced Illness ◽  
Post Discharge ◽  
Patient Centered ◽  
Serious Illness

The trajectories of serious illness and dying have changed in the last century; in the past, patients lived shorter lives and often died quickly of infectious disease, whereas patients in the 21st century live longer and often with prolonged debility in the advanced stages of illness. As a result, patients with serious illness can suffer undertreated symptoms and often feel poorly prepared for the final stages of disease. With more options for advanced life support and other aggressive interventions at the end of life, patients and families face increasingly complex medical decisions in the terminal phase of illness, and the treatments they receive do not always align with their goals and values. Emerging evidence suggests that integrating palliative care into the treatment of advanced illness can improve outcomes, decrease costs, and improve both patient and family satisfaction. Consequently, patient access to high-quality specialty-level palliative care is becoming standard of care at most academic cancer centers and more available in the community. This chapter describes the practice and principles of specialty-level palliative care and outlines specific "generalist" palliative care competencies essential for all physicians caring for patients with serious illness, including prognostication, patient-centered communication, and the navigation of ethical dilemmas in the field of palliative care. Tables outline the philosophy of palliative care, domains of suffering, location of death of hospice patients, the palliative performance scale, median survival times for cancer syndromes, indicators associated with a poorer prognosis in congestive heart failure, the NURSE mnemonic for accepting and responding to emotion, palliative care communication competencies in the intensive care unit, and the SPIKES mnemonic for breaking bad news. Figures depict causes of death in 1900 versus 2010, palliative care through the trajectory of serious illness, theoretical trajectories of disease, life expectancies for women and men, mortality at 1 year post discharge, and a model for patient-centered communication. This review contains 6 highly rendered figures, 9 tables, and 169 references.

Principles and Practice of Palliative Care

2013 ◽  
Author(s):  
Kristen G Schaefer ◽  
Rachelle E Bernacki
Keyword(s):  
Palliative Care ◽  
Life Support ◽  
Advanced Life Support ◽  
Family Satisfaction ◽  
Terminal Phase ◽  
Survival Times ◽  
Advanced Illness ◽  
Post Discharge ◽  
Patient Centered ◽  
Serious Illness

The trajectories of serious illness and dying have changed in the last century; in the past, patients lived shorter lives and often died quickly of infectious disease, whereas patients in the 21st century live longer and often with prolonged debility in the advanced stages of illness. As a result, patients with serious illness can suffer undertreated symptoms and often feel poorly prepared for the final stages of disease. With more options for advanced life support and other aggressive interventions at the end of life, patients and families face increasingly complex medical decisions in the terminal phase of illness, and the treatments they receive do not always align with their goals and values. Emerging evidence suggests that integrating palliative care into the treatment of advanced illness can improve outcomes, decrease costs, and improve both patient and family satisfaction. Consequently, patient access to high-quality specialty-level palliative care is becoming standard of care at most academic cancer centers and more available in the community. This chapter describes the practice and principles of specialty-level palliative care and outlines specific "generalist" palliative care competencies essential for all physicians caring for patients with serious illness, including prognostication, patient-centered communication, and the navigation of ethical dilemmas in the field of palliative care. Tables outline the philosophy of palliative care, domains of suffering, location of death of hospice patients, the palliative performance scale, median survival times for cancer syndromes, indicators associated with a poorer prognosis in congestive heart failure, the NURSE mnemonic for accepting and responding to emotion, palliative care communication competencies in the intensive care unit, and the SPIKES mnemonic for breaking bad news. Figures depict causes of death in 1900 versus 2010, palliative care through the trajectory of serious illness, theoretical trajectories of disease, life expectancies for women and men, mortality at 1 year post discharge, and a model for patient-centered communication.  This chapter contains 6 highly rendered figures, 9 tables, 169 references, 1 teaching slide set, and 5 MCQs.

Integrating Principles and Practice of Palliative Medicine in Emergency Care

2016 ◽  
Author(s):  
Patricia J. O’Malley
Keyword(s):  
Palliative Care ◽  
Medical Specialty ◽  
Family Satisfaction ◽  
Emergency Setting ◽  
Advanced Illness ◽  
Patient Centered ◽  
Serious Illness ◽  
Breaking Bad ◽  
Communication Competencies ◽  
Aggressive Interventions

Trajectories of serious illness and dying have changed in the last century; people now live longer, often with prolonged debility in advanced stages of illness. With more options for aggressive interventions at the end of life, patients and families face increasingly complex medical decisions. Many of these patients will present repeatedly to the emergency department (ED) before their death, and emerging evidence suggests that integrating palliative care into the treatment of advanced illness, including in the emergency setting, can improve outcomes. This review covers changing trajectories of illness and death, palliative care as a medical specialty, emerging models of integration, essential palliative care competencies for the ED clinician, and managing the actively dying patient in the ED. Figures show palliative care through the trajectory of serious illness, theoretical trajectories of disease, life expectancies for women and men, and patient-centered communication. Tables list philosophy of palliative care, domains of suffering addressed by palliative care, palliative performance scale, NURSE mnemonic for accepting and responding to emotion, palliative care communication competencies in the intensive care unit: effect on clinical outcomes and family satisfaction, and SPIKES mnemonic for breaking bad news.   This review contains 4 highly rendered figures, 6 tables, and 113 references

scholarly journals South African paramedic perspectives on prehospital palliative care

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Caleb Hanson Gage ◽  
Heike Geduld ◽  
Willem Stassen
Keyword(s):  
Higher Education ◽  
Palliative Care ◽  
South African ◽  
Medical Service ◽  
Life Support ◽  
Healthcare Providers ◽  
Advanced Life Support ◽  
Early Palliative Care ◽  
Audio Recordings ◽  
Valuable Role

Abstract Background Palliative care is typically performed in-hospital. However, Emergency Medical Service (EMS) providers are uniquely positioned to deliver early palliative care as they are often the first point of medical contact. The aim of this study was to gather the perspectives of advanced life support (ALS) providers within the South African private EMS sector regarding pre-hospital palliative care in terms of its importance, feasibility and barriers to its practice. Methods A qualitative study design employing semi-structured one-on-one interviews was used. Six interviews with experienced, higher education qualified, South African ALS providers were conducted. Content analysis, with an inductive-dominant approach, was performed to identify categories within verbatim transcripts of the interview audio-recordings. Results Four categories arose from analysis of six interviews: 1) need for pre-hospital palliative care, 2) function of pre-hospital healthcare providers concerning palliative care, 3) challenges to pre-hospital palliative care and 4) ideas for implementing pre-hospital palliative care. According to the interviewees of this study, pre-hospital palliative care in South Africa is needed and EMS providers can play a valuable role, however, many challenges such as a lack of education and EMS system and mindset barriers exist. Conclusion Challenges to pre-hospital palliative care may be overcome by development of guidelines, training, and a multi-disciplinary approach to pre-hospital palliative care.

Palliative and Serious Illness Patient Management for Physician Assistants

2021 ◽  
Keyword(s):  
Palliative Care ◽  
Healthcare Professionals ◽  
Healthcare Providers ◽  
Medical Specialty ◽  
Physician Assistants ◽  
Medical Providers ◽  
Patient Centered ◽  
Serious Illness ◽  
Comprehensive Management ◽  
Centered Care

There are still medical providers who believe palliative care medicine is limited to care of the dying. It is actually devoted to relief of suffering at every stage of life. Comprehensive management of patients with serious illness, including the relief of their symptoms, impacts their lives and those of their families, significant others, and caregivers, including healthcare providers. The knowledge and skills inherent in this medical specialty enables them all to grow and fosters resilience in their lives. Patient centered care is the best model that incorporates team practice with physicians and other healthcare professionals, and this is a cornerstone of palliative care medicine. Furthermore, PAs are compassionate listeners who provide comprehensive diagnosis and treatment of vulnerable patient populations across the life span and in all healthcare settings. Among medical providers involved in palliative care medicine, PAs are the only group whose accreditation requirements incorporate this knowledge and training. This text represents a new resource for PAs, clinicians, researchers, and educators of the profession to further facilitate its expansion into palliative and serious illness care. PAs are thereby poised to reduce the workforce shortage of healthcare professionals in palliative care medicine.

scholarly journals Advanced Life Support in Obstetrics

2019 ◽  
Vol 2 (2) ◽  
pp. 49
Author(s):  
Lisa Soldat
Keyword(s):  
Rural Areas ◽  
Maternity Care ◽  
Life Support ◽  
Quality Care ◽  
Advanced Life Support ◽  
Care Providers ◽  
Patient Centered ◽  
High Quality ◽  
Middle Income ◽  
Service Training

Multiple barriers to high quality maternity care have been identified in Indonesia. One barrier is the shortage of well-trained maternity care providers, particularly in remote and rural areas. Maternity care training programs do not consistently prepare their graduates to provide high quality care. Poor pre-service training may then be compounded by a lack of post-service supervision and inadequate multispecialty teamwork. Maternity care continuing education is an important means to reinforce and improve the skills needed to provide high quality maternity care. Programs that have been developed for low- to middle-income countries focus on providing culturally appropriate information to improve competency, communication and teamwork. Improvement in quality of care has been documented, showing a decrease in maternal morbidity and mortality. This trend is reflected in improvements in patient satisfaction and trust, and ultimately supports the tenets of patient-centered care.

scholarly journals The Role of Palliative Care in the Cardiac Intensive Care Unit

Healthcare ◽  
2019 ◽  
Vol 7 (1) ◽  
pp. 30
Author(s):  
Massimo Romano’
Keyword(s):  
Palliative Care ◽  
Intensive Care ◽  
Life Support ◽  
Symptom Burden ◽  
Critical Conditions ◽  
Advanced Illness ◽  
Coronary Syndrome ◽  
Cardiac Devices ◽  
Cardiac Intensive Care ◽  
Epidemiological Characteristics

In the last few years, important changes have occurred in the clinical and epidemiological characteristics of patients that were admitted to cardiac intensive care units (CICU). Care has shifted from acute coronary syndrome patients towards elderly patients, with a high prevalence of non-ischemic cardiovascular diseases and a high burden of non-cardiovascular comorbid conditions: both increase the susceptibility of patients to developing life-threatening critical conditions. These conditions are associated with a significant symptom burden and mortality rate and an increased length of stay. In this context, palliative care programs, including withholding/withdrawing life support treatments or the deactivation of implanted cardiac devices, are frequently needed, according to the specific guidelines of scientific societies. However, the implementation of these recommendations in clinical practice is still inconsistent. In this review, we analyze the reasons for this gap and the main cultural changes that are required to improve the care of patients with advanced illness.

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