A palliative medicine program in a community setting: 12 points from the first 12 months

Abstract

This paper reports the first year's experience of a consultative, interdisciplinary, integrated palliative medicine program in a community hospital system. Prospective data collection was performed on 308 consecutive consultations. A computer database was developed and used to analyze demographics, reason for consultation, complexity of medical problems, current medications and allergies, physical suffering, spiritual concerns, personal and family concerns, consult recommendations, and mortality. In addition, data were collected on patient rating of the severity of physical symptoms, pain, spiritual suffering, and personal and family suffering; this data also was analyzed using the database. Cancer was the most frequent diagnosis (34 percent) and pain the most common reason for consultation (43 percent). Population medians were identified as follows: five (range, 1 to 10) acute medical problems; three (range, 1 to 10) chronic medical problems; and one (range, 0 to 10) medication allergy/intolerance. Patients were taking a median of 10 (range, 0 to 29) medications, including a median of two analgesics. Eighty percent could communicate concerning physical symptoms and had a median of two (range, 0 to 7) bothersome symptoms, with pain the most frequent. Fifty percent or fewer could rate physical suffering, pain, hope, spiritual suffering, or personal/family suffering using a 0 to 10 scale at consultation. Individual patient ratings provided over time for physical suffering, pain, hope, spiritual suffering, and personal/family suffering were available for less than 25 percent. A median of eight recommendations was made for each consultation, with medication changes suggested for 84 percent. For those known to have died, the median survival from time of consultation to death was 11 days.

Hope in palliative care: An integrative review

“…Hope can also be defined as a future-oriented (Flemming, 1997) and goal-oriented phenomenon: Having a sense of one's future and experiencing and achieving important events or goals (Benzein et al, 2001; Hong & Ow, 2007) are important in hope (e.g., Clayton et al, 2005). Hoping for something may include hope in the person's worth as an individual (e.g., Cowan et al, 2003), finding meaning (spiritual and existential) in one's own life (e.g., Tan et al, 2005), or hope of being a model for others (Cowan et al, 2003). Hoping for something may also focus on the healing of relationships and having special time with significant others (Clayton et al, 2005).…”

“…Hoping for something may refer to healing (Cowan et al, 2003), being cured (e.g., Tan et al, 2005), a miracle cure or spontaneous remission (Clayton et al, 2005), or hope for God's help (Cowan et al, 2003). In addition, hoping for something may imply the hope of living a normal life as long as possible (e.g., Benzein et al, 2001), living to the fullest in the time left (Duggleby & Wright, 2004), living longer than expected (Clayton et al, 2005), hope for everyday living (Clayton et al, 2005), or hope for a positive change that could make it possible to stay at home for a time (Appelin & Berterö, 2004).…”

“…Hoping for something may also mean hope of good pain and symptom management (e.g., Clayton et al, 2005), hope of being well cared for and supported (Clayton et al, 2005), hope for an end to suffering (Duggleby & Wright, 2004), or hope that the final phase of life will be short if the pain is out of control (Appelin & Berterö, 2004). Hoping can also focus on hope for a peaceful death (e.g., Clayton et al, 2005) or a quick death (Cowan et al, 2003) and hope for heaven (Cowan et al, 2003) or life after death (Duggleby & Wright, 2004). Sometimes, hope is focused on others, as in Duggleby and Wright's (2004) study, where hope was focused on a better life in the future for the family.…”

A importância da integração da espiritualidade e da religiosidade no manejo da dor e dos cuidados paliativos

“…Revelou-se que 95% das pessoas acreditam em Deus, 77% acreditam que os médicos devem considerar as suas crenças espirituais, 73% acreditam que devem compartilhar as suas crenças religiosas com o profissional médico e 66% demonstram interesse de que o médico pergunte sobre sua espiritualidade. No entanto, apenas 10% a 20% relataram que os médicos discutiram a espiritualidade com elas (Larson e Koenig, 2000;Anaya, 2002;Cowan et al, 2003).…”

Auricular Point Acupressure as an Adjunct Analgesic Treatment for Cancer Patients: A Feasibility Study

“…Ó 2014 by the American Society for Pain Management Nursing Cancer-related pain is considered one of the most challenging symptoms that cancer patients experience (van den Beuken-van Everdingen et al, 2007). The prevalence of pain is estimated to range from 29% to 85% for patients undergoing active cancer treatment (Pignon et al, 2004;Portenoy et al, 1992;Wang et al, 1999) and 66% to 85% for those with advanced cancer (Bradley, Davis, & Chow, 2005;Cowan, Burns, Palmer, Scott, & Feeback, 2003;Mercadante, Casuccio, & Fulfaro, 2000;Swanwick, Haworth, & Lennard, 2001;Tranmer et al, 2003). Opioid use is the most common strategy to manage pain.…”