Diagnosis, assessment, and treatment of depression in advanced disease

Author(s):  
Matthew Hotopf

Depression in palliative care is common, under-recognised and has significant impacts for sufferers. There are effective treatments but often a shortage of staff to provide them. This chapter sets out a number of key issues to consider when assessing and treating individual patients and considers the way in which palliative care services can innovate to provide a population level response to depression. Palliative care staff can be trained to deliver basic depression care and follow simple protocols to initiate, monitor and adjust antidepressant treatment. These approaches have been tested in trials in cancer care but the challenge is to take these approaches from research trials conducted in centres of excellence with good resources, to other settings.

2012 ◽  
Vol 23 (2) ◽  
pp. 147-155 ◽  
Author(s):  
Allison Kabel

The popularity of British hospice day care signals the expanding boundaries of palliative care beyond end-stage illness. In this article, I examine the ways hospice philosophy was interpreted and implemented in an outpatient day therapy setting run by a multidisciplinary team of health professionals. Findings suggest that hospice day care staff members used several strategies to help patients cope and retain a sense of personhood while facing numerous emotional and physical challenges associated with life-threatening illness. Health professionals in the United States will need to prepare for patients accessing hospice and palliative care services earlier in the illness trajectory to take advantage of these opportunities for patient support and advocacy.


Author(s):  
Sheila Payne ◽  
Tom Lynch

This chapter provides an overview of the development of palliative medicine as a specialized discipline, and seeks to trace the development of international initiatives that have promoted and facilitated the growth of palliative care services. The focus is on palliative care services for adults with life-limiting conditions and advanced disease. A chronological narrative is traced from the first hospices developed in Dublin, Ireland, to the emergence of the modern hospices in the United Kingdom in the 1960s. The global spread of the principles of palliative care is traced in the formation of national and regional organizations. The chapter offers evidence on the progress of educational initiatives, both within medicine and for other members of the multidisciplinary team, at undergraduate and post-qualification level. The proposal for ten core common interdisciplinary competencies defines the essential foundations of palliative care. Finally, the chapter considers what areas of palliative medicine require further development.


Author(s):  
Ros Scott

This chapter explores the history of volunteers in the founding and development of United Kingdom (UK) hospice services. It considers the changing role and influences of volunteering on services at different stages of development. Evidence suggests that voluntary sector hospice and palliative care services are dependent on volunteers for the range and quality of services delivered. Within such services, volunteer trustees carry significant responsibility for the strategic direction of the organiszation. Others are engaged in diverse roles ranging from the direct support of patient and families to public education and fundraising. The scope of these different roles is explored before considering the range of management models and approaches to training. This chapter also considers the direct and indirect impact on volunteering of changing palliative care, societal, political, and legislative contexts. It concludes by exploring how and why the sector is changing in the UK and considering the growing autonomy of volunteers within the sector.


Author(s):  
Valeria Cardenas ◽  
Anna Rahman ◽  
Yujun Zhu ◽  
Susan Enguidanos

Background: Despite some insurance plans now paying for home-based palliative care, recent reports have suggested that insurance coverage for palliative care may be insufficient in expanding patient access to home-based palliative care. Aim: To identify patients’ and caregivers’ perceived barriers to home-based palliative care and their recommendations for overcoming these barriers. Design: We conducted a qualitative study using semi-structured individual interviews. Our interview protocol elicited participants’ perspectives on home-based palliative care services; positive and negative aspects of the palliative program explanation; and suggestions for improving messaging around home-based palliative care. Setting/Participants: Twenty-five participants (patients, proxies, and their caregivers) who were eligible for a randomized controlled trial of home-based palliative care were interviewed by telephone. Results: Themes related to home-based palliative care referral barriers included reluctance to have home visits, enrollment timing, lack of palliative care knowledge, misconceptions about palliative care, and patients’ self-perceived health condition. Themes related to recommendations for overcoming these obstacles included ensuring that palliative care referrals come from healthcare providers or insurance companies and presenting palliative care services more clearly. Conclusion: Findings reinforce the need for additional palliative care education among patients with serious illness (and their caregivers) and the importance of delivering palliative care information and referrals from trusted sources.


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