Journal of palliative care & medicine最新文献

{"title":"How Limited are our Resources","authors":"C. Classen","doi":"10.4172/2165-7386.1000278","DOIUrl":"https://doi.org/10.4172/2165-7386.1000278","url":null,"abstract":"","PeriodicalId":91127,"journal":{"name":"Journal of palliative care & medicine","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70682835","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}

{"title":"Physicians’ Experiences of Do-Not-Resuscitate (DNR) Orders in Hematology and Oncology Care – A Qualitative Study","authors":"Mona Pettersson, Mariann Hedström, A. Höglund","doi":"10.4172/2165-7386.1000275","DOIUrl":"https://doi.org/10.4172/2165-7386.1000275","url":null,"abstract":"Objective: In oncology and hematology care, a patient can have such a poor prognosis that cardiopulmonary resuscitation (CPR) for cardiac arrest is not considered feasible. The responsible physician can then decide to apply a do-not-resuscitate (DNR) order, meaning that neither basic (heart compressions and ventilation) nor advanced (defibrillator or medicines) CPR should be performed. Previous research has found disagreement in relation to DNR decisions among physicians and nurses working in this field. The aim of the present study was to explore the experiences and perceptions of physicians with respect to DNR orders within hematology and oncology care, in order to better understand their specific roles in this decision-making process, with focus on the ethical aspects of the decisions. Methods: Individual interviews were performed with 16 physicians working in hematology and oncology departments at seven hospitals in Sweden. Data were analyzed using systematic text condensation (STC). Results: Two main parts of the data were discerned. The first described the physicians’ different roles in the team in relation to decisions on DNR, as decision maker, patient advocate and mediator for relatives and team member. In the second part the physicians shared their experiences of making ethically challenging decisions on DNR. The experiences ranged from feeling as though they were making themselves God, to regarding a DNR order as one regular medical decision among others. The physicians made decisions on CPR or DNR with the patient's best interests in mind, primarily on medical grounds. However, they also considered ethical aspects of the decision, weighing beneficence versus maleficence. Conclusion: The results indicate that DNR decisions in oncology and hematology care are not only taken on medical grounds, such as the prognosis of the disease and the expected survival after CPR, but also with reference to ethical values, such as patient autonomy and the quality of life after resuscitation.","PeriodicalId":91127,"journal":{"name":"Journal of palliative care & medicine","volume":"6 1","pages":"1-1"},"PeriodicalIF":0.0,"publicationDate":"2016-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4172/2165-7386.1000275","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70682771","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}

{"title":"Efficacy of Continuous Brachial Plexus Block for Intractable Cancer Pain in a Terminal Patient","authors":"T. Hashimoto, T. Nakatani, Ichiro Sutou, Yoji Saito","doi":"10.4172/2165-7386.1000274","DOIUrl":"https://doi.org/10.4172/2165-7386.1000274","url":null,"abstract":"We report a case of terminal cancer in which continuous peripheral nerve block provided effective relief for cancer-related pain that was difficult to control with pharmacotherapy. A 70-year-old woman with thyroid cancer, paraplegia due to multiple bone metastases, and cauliflower-like proliferation of skin metastasis on the left upper arm was receiving inpatient palliative care. Intractable pain during treatment of the tumor and when changing body position due to metastatic tumor and pathological fracture of the left humerus was difficult to control with pharmacotherapy. Continuous interscalene brachial plexus block was therefore performed, resulting in effective pain relief over the subsequent 38 days before death. Ultrasound-guided continuous peripheral nerve block can be performed at the bedside in patients in poor general condition who cannot tolerate neuraxial block, and should be considered in cases of terminal cancer patient suffering from intractable pain despite pharmacotherapy.","PeriodicalId":91127,"journal":{"name":"Journal of palliative care & medicine","volume":"2016 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70682759","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}

{"title":"Promoting Post-Traumatic Growth among Taiwanese Cancer Survivors: CulturalIssues","authors":"Yun-Hsiang Lee, Jui-Chun Chan, In-Fun Li, Y. Hsiung","doi":"10.4172/2165-7386.1000273","DOIUrl":"https://doi.org/10.4172/2165-7386.1000273","url":null,"abstract":"Posttraumatic growth (PTG) is a phenomenon notable among cancer survivors who endure aggressive, lifethreatening treatment of severe illnesses. Such growth manifests through improved physical health, strengthened psycho-spiritual resilience, intensified coping skills, and better utilization of resources. Due to the scarce literature, the link between cancer survivorship and PTG remains unclear in Taiwan and further complicated by cultural issues. Presented in this article are summated findings from cross-cultural literature of PTG among cancer survivors, particularly various observations of posttraumatic stress and coping between Eastern and Western cultures. Clinical implications are followed to encourage health care providers to cogitate culture-specific meanings in survivors’ cancer-related posttraumatic experiences. There lies a cultural need to fill in the knowledge gap in order to ultimately promote PTG and improve cancer survivors’ quality of post-cancer life in Taiwan.","PeriodicalId":91127,"journal":{"name":"Journal of palliative care & medicine","volume":"2016 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70683063","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}

{"title":"Studying Cost as a Factor in the Choice between Quality and Quantity of Life amongst Patients with Cancer and their Caregivers at a Cancer Centre in Singapore","authors":"K. Tay, L. Rachel, Sim Shin Wei Dorsett, Sumytra Menon, R. Kanesvaran, R. Puvanendran, L. Krishna","doi":"10.4172/2165-7386.1000276","DOIUrl":"https://doi.org/10.4172/2165-7386.1000276","url":null,"abstract":"Background: Treatment costs and sociocultural concerns play a significant role in decisions regarding Quantity of Life (QuoL) options that seek to prolong life, such as chemotherapy, or a Quality of Life (QoL) approach where the patient refuses available treatments such as chemotherapy in favour of maximizing comfort and quality of life at the end of life in Singapore. Deciphering the reasons behind such care decisions is often difficult because of local social taboos regarding discussions about death and dying. Objectives: To scrutinize the rationale behind QuoL and QoL within the Singapore context and delineate the impact of cost upon such decisions. Methods: To overcome local sociocultural taboos about discussing death and dying with patients, participants watched a video vignette of a family discussing treatment options for their mother (Mrs Tan) who was recently diagnosed with terminal cancer. Participants were asked what advice they would offer Mrs Tan regarding her treatment plans in the face of a poor prognosis, incurable cancer and costly treatment. Participants were then asked what their advice would be when the costs of treatment was covered by the patient’s insurance policy. Their responses were evaluated using Grounded Theory analysis. Setting/Subjects: 132 oncology patients and their caregivers were recruited from an ambulatory treatment unit at a tertiary oncology centre. Results: 63 (47.7%) of 132 participants advised Mrs Tan to opt for the QoL approach but when treatment costs were covered by insurance, only 5 (3.8%) of 132 participants chose QoL, whilst 108 (81.8%) participants chose QuoL options. Conclusion: Whilst cost is a significant factor in end of life decision making, strong sociocultural influences that perceive QoL approaches as ‘giving up’ ultimately determines the course of care.","PeriodicalId":91127,"journal":{"name":"Journal of palliative care & medicine","volume":"2016 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4172/2165-7386.1000276","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70682944","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}

{"title":"Blindsided: A Palliative Care Chaplain Reflects on Humanness","authors":"Marcia OrrPounders","doi":"10.4172/2165-7386.1000271","DOIUrl":"https://doi.org/10.4172/2165-7386.1000271","url":null,"abstract":"","PeriodicalId":91127,"journal":{"name":"Journal of palliative care & medicine","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70681934","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}

{"title":"Decreased Survival in African Patients with Triple Negative Breast Cancer","authors":"M. Honório, N. Guerra-Pereira, Júlia Silva, J. Alves, A. Filipa, S. Braga","doi":"10.4172/2165-7386.1000270","DOIUrl":"https://doi.org/10.4172/2165-7386.1000270","url":null,"abstract":"Introduction: Triple Negative Breast Carcinomas (TNBC) are more prevalent in younger women especially those with African Ancestry, in whom the disease appears to be more aggressive. Since there are no data on Africans living in continental Europe, we sought to analyse a sample of African women from a European country and determine if, like African Americans, they have more aggressive tumor biology and poorer outcomes. \u0000Methods: We performed a retrospective review of TNBC to compare clinical and pathological features and survival between African and non-African patients. All women presented with breast cancer (BC), between 2005 and 2014, to a single general hospital, in Portugal. \u0000Results: A total of 144 (9.3% of the whole sample) TNBC patients were identified and amongst these, 17 were African (12%). African patients were not significantly younger than non-African patients (median age of 60 years vs 57.2 years, respectively, p=0.59). Regarding tumor size, nodal status and histologic grade at presentation, these variables were very similar between the two cohorts. Nevertheless, the prevalence of initially metastatic BC was significantly higher among the African population (41.2% vs 11%, p<0,005) and the outcome was worse for these patients (median survival: 62 vs 15 months, p<0.005). \u0000Conclusions: Our study demonstrated that African patients more frequently presented with late stage disease and worse survival outcome than the non-African population. These findings may be explained by more aggressive tumor biology.","PeriodicalId":91127,"journal":{"name":"Journal of palliative care & medicine","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4172/2165-7386.1000270","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70681885","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}

{"title":"Sarahs Journey through the End of Life: A Literary and Pictorial Analysis","authors":"Anat Romem, Jorunn Opstad Carmel, Chaya Greenberger","doi":"10.4172/2165-7386.1000272","DOIUrl":"https://doi.org/10.4172/2165-7386.1000272","url":null,"abstract":"Coming to grips with End of Life (EOL) is a stressful and emotionally draining experience. Coping with the circumstances is extremely challenging both for patient and caregiver. The ability to express one’s thoughts and feelings is paramount to a successful and meaningful closure. Often, unfortunately, this goal eludes both the individual and his or her caregivers. Alternatives to verbal modes of communication, such as diarizing, need to therefore be explored. \u0000The purpose of this report is to present an abridged version of excerpts from a diary written by one of our patients, with an accompanying pictorial interpretation of these excerpts chosen from the paintings of Edvard Munch. Munch is an early 20th century Norwegian painter, some of whose major themes relate to disease, emotional turmoil, death, and separation. They reflect a life overwhelmed by recurrent family tragedy and the artist’s attempt to relieve his profound sadness and grief through an artistic medium. With the family’s permission, our palliative care team uses this diary and parallel expressions from selected paintings by Munch in its staff training seminars. Group reflection on the writings and paintings has proved to be a successful avenue for enabling our staff to better understand the journey through end of life and to empower the facilitation of patients’ therapeutic description of their unique journeys. It is our hope that the report will inspire additional professionals to utilize similar techniques for staff development in their care units.","PeriodicalId":91127,"journal":{"name":"Journal of palliative care & medicine","volume":"2016 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70682985","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}

{"title":"Holistic Approach to Complex Cancer Pain","authors":"Neoh Sue Wern","doi":"10.4172/2165-7386.1000269","DOIUrl":"https://doi.org/10.4172/2165-7386.1000269","url":null,"abstract":"Cancer pain is a major cause of disability and suffering at the end of life. Cancer pain affects a significant number of patients at the end of life. This case report seeks to highlight some of the complexities associated with managing cancer pain in terminally ill patients.","PeriodicalId":91127,"journal":{"name":"Journal of palliative care & medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4172/2165-7386.1000269","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70681782","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}

{"title":"Palliative Care: UAE Perspective","authors":"N. Al-Alfi","doi":"10.4172/2165-7386.1000267","DOIUrl":"https://doi.org/10.4172/2165-7386.1000267","url":null,"abstract":"This time I am going to share a story of one of the patients that I have come across while being in a clinical training rotation with my students. What provoked me to write about this case; is how holistically this patient is not being treated! Of course, not on purpose. But incomplete assessment of her case, joined with lack of simple but yet proper knowledge, placed her in that situation. And to be fair towards the staff in that hospital, there are no palliative care consultant, not to mention a multidisciplinary team. And also, it is not a designated hospital for managing oncology patients comprehensively. But yet, they do receive cancer patients due to proximity of area for some patients, or due to insurance coverage issues.","PeriodicalId":91127,"journal":{"name":"Journal of palliative care & medicine","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4172/2165-7386.1000267","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70681708","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}