Deepening Prognostic Awareness

2021 ◽  
pp. 91-126
Author(s):  
Juliet Jacobsen ◽  
Vicki Jackson ◽  
Joseph Greer ◽  
Jennifer Temel
Keyword(s):  
Palliative Care ◽  
Distress Tolerance ◽  
Current Situation ◽  
Illness Trajectory ◽  
Serious Illness ◽  
Difficult Conversations ◽  
The Future ◽  
Clinical Dilemma

This chapter describes the fourth challenge of serious illness, deepening prognostic awareness. It discusses how to hold conversations about the meaning of the prognosis. These conversations range beyond, and need not include, explicit prognostic disclosures. To engage in them, patients need distress tolerance: the capacity to experience oneself and the current situation without trying to change the situation. Then, through these conversations, patients develop and refine their inchoate worries and reprioritize their values. The chapter discusses, first, how to approach patients who can talk about the future (who more easily pair hopes and worries). It then explores the clinical dilemma of patients who hesitate to talk about the future. It discusses how to invite these patients into difficult conversations based on the clinician’s attunement to how the patient is coping and the illness trajectory. The chapter ends by discussing of how the collaboration between palliative care and oncology clinicians is affected by the patient’s deepening prognostic awareness.

What's in the Syringe?

2021 ◽  
Author(s):  
Juliet Jacobsen ◽  
Vicki Jackson ◽  
Joseph Greer ◽  
Jennifer Temel
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Clinical Experience ◽  
Clinical Skills ◽  
Psychological Skills ◽  
Illness Trajectory ◽  
Serious Illness ◽  
Case Based

What’s in the Syringe? Principles of Early Integrated Palliative Care, a guide for clinicians, teaches the psychological skills of outpatient palliative care. It does so based on a framework that articulates five challenges faced by patients through the illness trajectory. Each challenge forms the focus of a chapter. By helping patients meet each challenge, clinicians help them cope with serious illness. Patients thereby experience better quality of life and develop prognostic awareness. From this awareness, they can make informed medical and personal decisions. Each chapter focuses on clinical skills to support patients as they take up that challenge. Each chapter then ends with a discussion of how to collaborate with oncology colleagues around that challenge. Rich in illustrative examples and built around case-based chapters, the book draws on two decades of research and clinical experience.

Pairing Hopes and Worries

2021 ◽  
pp. 27-50
Author(s):  
Juliet Jacobsen ◽  
Vicki Jackson ◽  
Joseph Greer ◽  
Jennifer Temel
Keyword(s):  
Palliative Care ◽  
Communication Skills ◽  
Illness Trajectory ◽  
Serious Illness

This chapter describes the second challenge of serious illness, pairing hopes and worries. It discusses how clinicians help patients acknowledge worries and explains how, by pairing hopes and worries, patients can step outside of their moment-to-moment feelings enough to gain a broader perspective. This slight distance helps patients to see themselves with clarity and empathy. The chapter describes communication skills for helping patients pair hopes and worries and introduces clinical attunement, a specialist concept that includes aspects of attunement specific to palliative care: being aware of how the patient is coping and of the mostly likely illness trajectory. The chapter ends with skills for talking with oncology colleagues about how patients are learning to pair hopes and worries and to develop prognostic awareness.

scholarly journals Consensus-based approach to managing opioids, including opioid misuse and opioid use disorder, in patients with serious illness: protocol for a modified Delphi process

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e045402
Author(s):  
Caroline King ◽  
Robert Arnold ◽  
Emily Dao ◽  
Jennifer Kapo ◽  
Jane Liebschutz ◽  
...  
Keyword(s):  
Palliative Care ◽  
Opioid Therapy ◽  
Opioid Use Disorder ◽  
Opioid Misuse ◽  
Opioid Use ◽  
Serious Illness ◽  
Modified Delphi ◽  
Delphi Approach ◽  
Institutional Review ◽  
Management Guidance

IntroductionManagement of opioid misuse and opioid use disorder (OUD) among individuals with serious illness is an important yet understudied issue. Palliative care clinicians caring for individuals with serious illness, many of whom may live for months or years, describe a complex tension between weighing the benefits of opioids, which are considered a cornerstone of pain management in serious illness, and serious opioid-related harms like opioid misuse and OUD. And yet, little literature exists to inform the management of opioid misuse and OUDs among individuals with serious illness. Our objective is to provide evidence-based management guidance to clinicians caring for individuals with serious illness who develop opioid misuse or OUD.Methods and analysisWe chose a modified Delphi approach, which is appropriate when empirical evidence is lacking and expert input must be used to shape clinical guidance. We sought to recruit 60 clinicians with expertise in palliative care, addiction or both to participate in this study. We created seven patient cases that capture important management challenges in individuals with serious illness prescribed opioid therapy. We used ExpertLens, an online platform for conducting modified Delphi panels. Participants completed three rounds of data collection. In round 1, they rated and commented on the appropriateness of management choices for cases. In round 2, participants reviewed and discussed their own and other participants’ round 1 numerical responses and comments. In round 3 (currently ongoing), participants again reviewed rounds 1 and 2, and are allowed to change their final numerical responses. We used ExpertLens to automatically identify whether there is consensus, or disagreement, among responses in panels. Only round 3 responses will be used to assess final consensus and disagreement.Ethics and disseminationThis project received ethical approval from the University of Pittsburgh’s Institutional Review Board (study 19110301) and the RAND Institutional Research Board (study 2020-0142). Guidance from this work will be disseminated through national stakeholder networks to gain buy-in and endorsement. This study will also form the basis of an implementation toolkit for clinicians caring for individuals with serious illness who are at risk of opioid misuse or OUD.

Engaging Social Justice Methods to Create Palliative Care Programs That Reflect the Cultural Values of African American Patients with Serious Illness and Their Families: A Path Towards Health Equity

2021 ◽  
Vol 49 (2) ◽  
pp. 222-230
Author(s):  
Ronit Elk ◽  
Shena Gazaway
Keyword(s):  
Palliative Care ◽  
Social Justice ◽  
African American ◽  
Middle Class ◽  
Cultural Values ◽  
End Of Life Care ◽  
Life Care ◽  
Serious Illness ◽  
White Middle Class ◽  
Healing Power

AbstractCultural values influence how people understand illness and dying, and impact their responses to diagnosis and treatment, yet end-of-life care is rooted in white, middle class values. Faith, hope, and belief in God’s healing power are central to most African Americans, yet life-preserving care is considered “aggressive” by the healthcare system, and families are pressured to cease it.

The Research on the Current Situation and Advances of Petrochemical Wastewater Treatment

2012 ◽  
Vol 550-553 ◽  
pp. 2416-2419 ◽  
Author(s):  
Wen Jun Xiang
Keyword(s):  
Organic Matter ◽  
Wastewater Treatment ◽  
Petrochemical Industry ◽  
Present Situation ◽  
Current Situation ◽  
High Salt ◽  
Petrochemical Wastewater ◽  
Existing Problems ◽  
The Future ◽  
At Home

At present, it is so prominent in the development of the petrochemical industry in China，and it is accompanied by petrochemical wastewater, which has become a big problem need to solve urgently.Because petrochemical wastewater mainly contains benzene-compound, organic matter, high salt wastewater and oil sewage, etc. They are very damaging and highly contaminated. The composition and properties of the petrochemical wastewater were introduced firstly, the current situation of petrochemical wastewater treatment at home and abroad were reviewed in the study. Especially the development of petrochemical industry in sichuan was introduced. Based on the present situation and the existing problems, put forward some countermeasures and expect technique develop direction in the future.

scholarly journals Hope to reality: The future of hospitalists and palliative care

2015 ◽  
Vol 10 (10) ◽  
pp. 701-702
Author(s):  
Steven Z. Pantilat
Keyword(s):  
Palliative Care ◽  
The Future

Sexuality and Intimacy Needs Within a Hospitalized Palliative Care Population: Results From a Qualitative Study

2021 ◽  
pp. 104990912110369
Author(s):  
Anne Kelemen ◽  
Clara Van Gerven ◽  
Katherine Mullins ◽  
Hunter Groninger
Keyword(s):  
Palliative Care ◽  
Family Relationships ◽  
Comparative Method ◽  
Future Research ◽  
Spiritual Needs ◽  
Structured Interviews ◽  
Course Of Illness ◽  
Serious Illness ◽  
Medical Teams ◽  
The Impact

Background: Palliative care (PC) clinicians are well trained to address physical, psychosocial and spiritual needs of patients who have a serious illness. However, one area that is often overlooked is intimacy and sexuality. Objective: To explore patient concerns regarding intimacy as it relates to illness, family reactions, physician conversations, and coping strategies and challenges. Methods: Eligible subjects (at least 18 years old, capacitated, receiving PC consultation at the lead author’s institution) participated in semi-structured interviews between November and December 2017. Transcripts were open-coded and analyzed using Dedoose 3.5.35 software. A constant comparative method was used to identify patterns in the data. Results: 21 interviews were analyzed and several themes emerged. Participants described the effect of physical and mental/emotional changes on their relationships. Family relationships, romantic relationships, and sexuality were prominent in patients’ experiences of intimacy and how it changed as the illness progressed. Relationships were often noted to strengthen during the course of illness, while sexual activity was frequently reported to be negatively impacted. Patients consistently reported little provider communication on the impact of illness on intimacy beyond instructions about what sexual activities they could or could not engage in. Conclusion: This study underlines the significant impact of serious, progressive illness on relationships, sexuality, and physical and emotional intimacy. It highlights that these topics continue to be priorities for patients with serious illness, and that medical teams frequently fail to address them at all. Future research should further explore these issues across diverse patient populations.

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