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Palliative and Serious Illness Patient Management for Physician Assistants最新文献

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LGBTQ Community 同性恋群体的社区
Palliative and Serious Illness Patient Management for Physician Assistants Pub Date : 2021-08-01 DOI: 10.1093/med/9780190059996.003.0018
Diane Bruessow
{"title":"LGBTQ Community","authors":"Diane Bruessow","doi":"10.1093/med/9780190059996.003.0018","DOIUrl":"https://doi.org/10.1093/med/9780190059996.003.0018","url":null,"abstract":"Sexual and gender minority (SGM) patients are often assumed to be cisgender and heterosexual by healthcare professionals, resulting in missed opportunities for a patient-centered experience. Although lesbian, gay, bisexual, and transgender (LGBT) is the common parlance, SGM is the preferred terminology in science-based settings (e.g., the National Institutes of Health and the Centers for Disease Control and Prevention) because it includes individuals with minority sexual attraction, sexual behavior or gender identity whose sexual or gender identity is something other than LGBT. Despite bioethics placing anti-LGBT bias below professional standards, disclosure places SGM patients at risk of bias and discrimination, such as refusal to treat, stereotyping, and explicit and implicit bias. SGM patient disclosure is frequently inhibited by the anticipation of bias and discrimination from healthcare workers. By establishing a patient-centered practice, informed by the needs of SGM patients and their support network, physician assistants in palliative care medicine can enhance the end-of-life experience of their SGM patient population while optimizing community and individual resilience.","PeriodicalId":423010,"journal":{"name":"Palliative and Serious Illness Patient Management for Physician Assistants","volume":"93 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123730717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 2
Enhanced Communication Skills 提高沟通技巧
Palliative and Serious Illness Patient Management for Physician Assistants Pub Date : 2021-08-01 DOI: 10.1093/med/9780190059996.003.0005
M. Glajchen, Christina Wilkins
{"title":"Enhanced Communication Skills","authors":"M. Glajchen, Christina Wilkins","doi":"10.1093/med/9780190059996.003.0005","DOIUrl":"https://doi.org/10.1093/med/9780190059996.003.0005","url":null,"abstract":"Good communication is considered fundamental to high-quality palliative care. Communication includes serious illness conversations with patients and family caregivers, collaborative communication across teams and disciplines, and communication with community providers. This chapter explores definitions, evidence-based research, training, and best clinical practices in three areas of enhanced communication. Narrative medicine promotes empathy, patient-centered listening, and life review through reflective journaling, writing, and self-reflection. Goals-of-care discussions, which may include advance care planning, ensure that providers align care with what matters most to the patient. The family meeting is used to facilitate communication, discuss the illness experience, present treatment choices, and facilitate end-of-life decision-making. Quality healthcare mandates training for healthcare clinicians in communication using a systematic approach.","PeriodicalId":423010,"journal":{"name":"Palliative and Serious Illness Patient Management for Physician Assistants","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115990079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Decision-Making Toolkit 决策工具
Palliative and Serious Illness Patient Management for Physician Assistants Pub Date : 2021-08-01 DOI: 10.1093/med/9780190059996.003.0006
J. D. Myers
{"title":"Decision-Making Toolkit","authors":"J. D. Myers","doi":"10.1093/med/9780190059996.003.0006","DOIUrl":"https://doi.org/10.1093/med/9780190059996.003.0006","url":null,"abstract":"Physician assistant (PA) training is rooted in treating the whole patient and developing a trusting and collaborative partnership with patients and their families. This foundation is critical in the advance care planning (ACP) process for patients who are seriously or terminally ill. Understanding the ACP process, the components and reasons behind them, and the tools for successful discussions and decision-making is a key skill set for all healthcare providers, including PAs. This chapter examines the components of ACP, including advance directives, the POLST paradigm, decision-makers, prognostication, documentation, and legacy planning. ACP is key in capturing what is most important to our patients in terms of their health, their life, and their goals related to both.","PeriodicalId":423010,"journal":{"name":"Palliative and Serious Illness Patient Management for Physician Assistants","volume":"51 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132450034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Transitions in Palliative and End-of-Life Care 缓和和临终关怀的转变
Palliative and Serious Illness Patient Management for Physician Assistants Pub Date : 2021-08-01 DOI: 10.1093/med/9780190059996.003.0024
K. Steinberg, M. Fratkin
{"title":"Transitions in Palliative and End-of-Life Care","authors":"K. Steinberg, M. Fratkin","doi":"10.1093/med/9780190059996.003.0024","DOIUrl":"https://doi.org/10.1093/med/9780190059996.003.0024","url":null,"abstract":"In palliative and end-of-life care, people with serious illness and their families experience a number of transitions—in functional status, physical location, cognitive abilities, and goals of care. This chapter focuses on care transitions in location and treatment preferences and discusses some pitfalls of transitions, along with telemedicine as a palliative care tool to reduce the burden of transitions. Medication reconciliation between sites of care and interprofessional coordination of care among various clinicians and teams are important elements of safe, effective care transitions. Respecting a patient’s autonomy while optimizing safety can be a challenge, and care decisions in times of transition should be person centered, holistic, and compassionate.","PeriodicalId":423010,"journal":{"name":"Palliative and Serious Illness Patient Management for Physician Assistants","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128843687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Older Adult Population 老年人口
Palliative and Serious Illness Patient Management for Physician Assistants Pub Date : 2021-08-01 DOI: 10.1093/med/9780190059996.003.0017
H. Strothers, Dipenkumar Patel
{"title":"Older Adult Population","authors":"H. Strothers, Dipenkumar Patel","doi":"10.1093/med/9780190059996.003.0017","DOIUrl":"https://doi.org/10.1093/med/9780190059996.003.0017","url":null,"abstract":"Geriatric medicine is a specialty of medicine concerned with physical, mental, functional, and social conditions in acute, chronic, rehabilitative, preventive, and end-of-life care in older patients. Geriatric palliative care integrates the complementary specialties of geriatrics and palliative care to provide comprehensive care for older patients entering the later stage of their lives and their families. This chapter provides physician assistants with an overview of palliative care in older adults, the differences between palliative care and hospice, the understanding and managing of geriatrics syndrome, symptom management in older patients and the complexities of end of life, discussion of goals of care, and communicating with geriatric patients and families.","PeriodicalId":423010,"journal":{"name":"Palliative and Serious Illness Patient Management for Physician Assistants","volume":"244 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127538300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Patients With Substance Use Disorder 物质使用障碍患者
Palliative and Serious Illness Patient Management for Physician Assistants Pub Date : 2021-08-01 DOI: 10.1093/med/9780190059996.003.0019
H. Woodall
{"title":"Patients With Substance Use Disorder","authors":"H. Woodall","doi":"10.1093/med/9780190059996.003.0019","DOIUrl":"https://doi.org/10.1093/med/9780190059996.003.0019","url":null,"abstract":"Palliative care providers, including physician assistants, frequently encounter substance use disorder (SUD) in patients or their families. Many of these patients with SUD remain undiagnosed at the time of palliative care referral, with most patients with these issues having preexisting conditions. Management of these patients requires proper screening and diagnosis, and teams must establish clear expectations. This chapter teaches palliative care teams to detect SUD and differentiate addiction behaviors from incompletely managed symptoms; diagnose and manage associated psychosocial issues; communicate clear expectations regarding treatment; safely prescribe controlled medications; manage intoxication or withdrawal; and develop plans to deal with drug diversion. Ongoing timely multidisciplinary communication is paramount in managing these challenging illnesses.","PeriodicalId":423010,"journal":{"name":"Palliative and Serious Illness Patient Management for Physician Assistants","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133437832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Last Days and Hours of Life 生命的最后几天和几个小时
Palliative and Serious Illness Patient Management for Physician Assistants Pub Date : 2021-08-01 DOI: 10.1093/med/9780190059996.003.0023
R. Ackermann
{"title":"Last Days and Hours of Life","authors":"R. Ackermann","doi":"10.1093/med/9780190059996.003.0023","DOIUrl":"https://doi.org/10.1093/med/9780190059996.003.0023","url":null,"abstract":"Most dying patients take a peaceful road to death, progressing from sleepiness to lethargy to coma to death, without substantial agitation. Although many dying patients experience fever, hypotension, and tachycardia, no combination of physical signs accurately predicts death. Noisy respiratory secretions should be prevented and treated by discontinuing artificial hydration and nutrition and by prescribing anticholinergic drugs such as glycopyrrolate or a scopolamine patch. Delirium at the end of life is not generally evaluated with blood tests or imaging but is treated with nonpharmacological measures or with haloperidol. Teach the family what to expect as death approaches. Be prepared with a systematic approach to declaring death and comforting families in the early stages of grief and bereavement.","PeriodicalId":423010,"journal":{"name":"Palliative and Serious Illness Patient Management for Physician Assistants","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115086459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 2
Evolution of the Palliative Team 姑息治疗团队的演变
Palliative and Serious Illness Patient Management for Physician Assistants Pub Date : 2021-08-01 DOI: 10.1093/med/9780190059996.003.0003
Britni Lookabaugh, C. Gunten
{"title":"Evolution of the Palliative Team","authors":"Britni Lookabaugh, C. Gunten","doi":"10.1093/med/9780190059996.003.0003","DOIUrl":"https://doi.org/10.1093/med/9780190059996.003.0003","url":null,"abstract":"Hospice and palliative care teams are inherently interdisciplinary to be able to assess and address all the domains of palliative care for patients with chronic, complex, and life-limiting illness. These domains include the physical, psychosocial, spiritual, and practical needs of patients and families, among others. The disciplines include, but are not limited to, physician, advanced practice provider, pharmacist, nurse, social worker, and chaplain, among others. Advanced practice providers are defined in the National Consensus Project Guidelines for Quality Palliative Care as physician assistants and advanced practice nurses utilized to expand the capacity of palliative care interdisciplinary teams to deliver complex care and provide direct care. The term advanced practice provider means either physician assistants or advanced practice nurses. The development of an interdisciplinary team in the midst of team and consult growth is essential to be able to provide high-quality palliative care. Team resilience should be supported and maintained as it is necessary to meet the high demand for specialty palliative care services throughout the care continuum.","PeriodicalId":423010,"journal":{"name":"Palliative and Serious Illness Patient Management for Physician Assistants","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125183399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Constitutional Symptoms 宪法的症状
Palliative and Serious Illness Patient Management for Physician Assistants Pub Date : 2021-08-01 DOI: 10.1093/med/9780190059996.003.0010
Lara Desanti-Siska, S. Fellows, N. Polito
{"title":"Constitutional Symptoms","authors":"Lara Desanti-Siska, S. Fellows, N. Polito","doi":"10.1093/med/9780190059996.003.0010","DOIUrl":"https://doi.org/10.1093/med/9780190059996.003.0010","url":null,"abstract":"Some of these are well known to produce distress but others are not as commonly thought of as symptoms which require palliation. Fatigue is nearly ubiquitous at the end of life and in all serious illness patients. While it may not be as obvious as pain or vomiting, it can be just as debilitating. Anorexia is not usually difficult for the patient but can be very hard for family/caregivers to understand. Hiccoughs are obvious but when intractable or chronic are also very uncomfortable and may predispose to poor oral intake. Ascites causes a host of other symptoms uncluding dyspnea and often requires surgical intervention. Fever and sweating cause discomfort but may also contribute to volume depletion and electrolyte disturbances.","PeriodicalId":423010,"journal":{"name":"Palliative and Serious Illness Patient Management for Physician Assistants","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127327051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Clinical Interprofessional Model of Spiritual Care 精神护理的临床跨专业模式
Palliative and Serious Illness Patient Management for Physician Assistants Pub Date : 2021-08-01 DOI: 10.1093/med/9780190059996.003.0007
C. Puchalski
{"title":"Clinical Interprofessional Model of Spiritual Care","authors":"C. Puchalski","doi":"10.1093/med/9780190059996.003.0007","DOIUrl":"https://doi.org/10.1093/med/9780190059996.003.0007","url":null,"abstract":"To standardize and institutionalize spirituality as a component of whole-patient care, the biopsychosocial-spiritual model must be integrated across the continuum of care for all patients. This chapter explores the clinical interprofessional model of spiritual care. The biopsychosocial-spiritual model recognizes the distinct dimensions—biological, psychological, social, and spiritual—of a person and the fact that no dimension can be left out when caring for the whole person. This chapter describes a consensus- and evidence-based model that enables clinicians to fully attend to the spiritual needs and the spiritual distress that patients and their families may experience. The chapter is rounded out by two case examples.","PeriodicalId":423010,"journal":{"name":"Palliative and Serious Illness Patient Management for Physician Assistants","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128850651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
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