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Saturday, July 11, 2015

http://kcur.org/post/death-and-dying-expanding-palliative-care

Death And Dying: Expanding Palliative Care

 • JUL 10, 2015

Editor’s note: On Wednesday, Medicare, announced that it would reimburse doctors for end-of-life counseling. It’s part of an emerging conversation about end-of-life issues and the policy changes needed to give people more control over what happens to them in their final days. This three-part series of stories by KHI News Service, and a video produced in partnership with Kansas City public television station KCPT, is about that conversation and the role that experts at two regional institutions are playing in it. The first story in the series focuses on efforts to encourage end-of-life discussions and the thirdon the push to enact state laws allowing terminally ill patients to receive a doctor’s aid in dying.

Palliative care's dying with dignity

Published 6:51 pm, Tuesday, July 7, 2015

The recent conference in Colonie promoting assisted suicide points to the progress of the so-called "death with dignity" movement, which would reverse the ancient Hippocratic Oath to "do no harm" in favor of allowing physicians to become active agents in the deaths of patients.
The proponents of such a change in the law are no doubt motivated by a noble desire to prevent suffering. However, in so doing, they are seeking to sanitize the dying process in a dangerous way. What's more, they have latched on to the offensive argument that there is something inherently undignified about a natural death.
As a priest of 42 years, I can tell you that nothing can be further from the truth. In my priestly ministry, I have been at the deathbeds of more people than I can count. Usually, these individuals are elderly, but I have had the sad duty of consoling those burying children or young adults as well. No one wants to see a loved one die, but, without exception, the families to whom I have ministered have seen it not only as their duty but as their privilege to care for and see their loved ones through to the point where God called them home. Most of the deaths I have witnessed, including my own father's earlier this year, have been holy and peaceful.
Science has given us drugs that can be used to poison to death those who are suffering from the fear and depression that often accompanies terminal illness. But it has also given us something much more useful — palliative care, which enables medical personnel to control pain in remarkable ways, while at the same time preparing patients emotionally and spiritually for what is to come.
I appeal to our state legislators to reject legislation that promotes suicide for those considered as unuseful or a burden to society.

Thursday, July 2, 2015

 2015 Jun 26.[Epub ahead of print]

Physician Treatment Orders in Dutch Nursing Homes.

Abstract

OBJECTIVES:

Physician treatment orders (PTOs) prevent burdensome unnecessary medical treatment of frail nursing home patients. The aim was to determine the prevalence of PTOs and time duration between nursing home admittance and PTO completion.

DESIGN:

Population-based, retrospective cohort study.

SETTING:

Nursing homes across the Netherlands.

DATA COLLECTION:

Digital medical records of patients who subsequently were submitted to 14 Dutch nursing homes across The Netherlands were studied between 2010 and 2013. The prevalence's of do-resuscitate, do-not-resuscitate, life-sustaining, and palliative care PTOs and the time intervals between nursing home admittance and documentation of PTOs were measured. Information regarding demographic patient characteristics, type of nursing home ward, and mention of a discussion of PTOs with the patient or caregivers was obtained.

RESULTS:

Eighty-two percent of the nursing home patients received a PTO regarding resuscitation, life-sustaining, or palliative care treatment. Twenty-four percent of the patients received a do-resuscitation PTO, 55% received a do-not-resuscitate PTO, 44% a life-sustaining PTO, and 16% a palliative care PTO. The median duration between nursing home admittance and documentation of the first PTO was 1 day. Most nursing home patients had PTOs within 1 week after admittance.

CONCLUSION:

A minority (18%) of Dutch nursing home patients has no documented PTOs during their nursing home stay, which could have negative effects on end-of-life care of nursing home residents.
Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

Physician treatment order; advance care planning; long-term care facility; nursing home; palliative care; resuscitation
 2015 Jun 29. doi: 10.1002/pon.3887. [Epub ahead of print]

A tsunami of unmet needs: pancreatic and ampullary cancer patients' supportive care needs and use of community and allied health services.

Abstract

OBJECTIVE:

People diagnosed with pancreatic cancer have the worst survival prognosis of any cancer. No previous research has documented the supportive care needs of this population. Our objective was to describe people's needs and use of support services and to examine whether these differed according to whether or not patients had undergone surgical resection.

METHODS:

Queensland pancreatic or ampullary cancer patients (n = 136, 54% of those eligible) completed a survey, which assessed 34 needs across five domains (Supportive Care Needs Survey-Short Form) and use of health services. Differences by resection were compared with Chi-squared tests.

RESULTS:

Overall, 96% of participants reported having some needs. More than half reported moderate-to-high unmet physical (54%) or psychological (52%) needs, whereas health system/information (32%), patient care (21%) and sexuality needs (16%) were described less frequently. The three most frequently reported moderate-to-high needs included 'not being able to do things they used to do' (41%), 'concerns about the worries of those close' (37%) and 'uncertainty about the future' (30%). Patients with non-resectable disease reported greater individual information needs, but their needs were otherwise similar to patients with resectable disease. Self-reported use of support was low; only 35% accessed information, 28%, 18% and 15% consulted a dietician, complementary medicine practitioner or mental health practitioner, respectively. Palliative care access was greater (59% vs 27%) among those with non-resectable disease.

CONCLUSION:

Very high levels of needs were reported by people with pancreatic or ampullary cancer. Future work needs to elucidate why uptake of appropriate supportive care is low and which services are required. Copyright © 2015 John Wiley & Sons, Ltd.
Copyright © 2015 John Wiley & Sons, Ltd.
 2014 Nov;20(11):542-8. doi: 10.12968/ijpn.2014.20.11.542.

Perspectives of an international education initiative in children's palliative care.

Abstract

Education is viewed as central to improving future palliative care for children and families across all countries. International education initiatives will ensure practitioners are aware of global health issues and can provide culturally sensitive care. Creative and innovative means of meeting such directives are required to achieve meaningful student learning. 
This paper focuses on one innovation, a children's palliative care workshop using case studies as a teaching method, with nursing students from the USA and nursing and midwifery students from the UK. Key learning points arising from student evaluation were recorded under three main themes, these were: differences across countries, similarities across countries, and making learning fun and memorable. 

Findings indicated that this joint learning activity was viewed positively by all students and has enabled them to learn with and from each other, potentially impacting on their future practice.