scholarly journals What do displays of empathy do in palliative care consultations?

2019 ◽  
Vol 21 (1) ◽  
pp. 22-37 ◽  
Author(s):  
Joseph Ford ◽  
Alexa Hepburn ◽  
Ruth Parry
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Subjective Experience ◽  
Life Care ◽  
Subjective Experiences ◽  
Medical Perspective ◽  
Or Task

Empathy is an important way for doctors to demonstrate their understanding of patients’ subjective experiences. This research considers the role of empathy in 37 doctor–patient palliative or end-of-life care consultations recorded in a hospice. Specifically, it focuses on four contexts in which there is a disparity between patients’ displayed experience of their illness and the doctor’s biomedical, expertise-driven perspective on their illness. These include cases in which the patient is sceptical of the medical perspective, cases in which the patient’s expectations exceed what can realistically be provided and cases in which patients have an overly pessimistic view of their condition. The analysis shows how doctors can use empathic statements to display that they are attentive to the patient’s subjective experience even when the task at hand is, ostensibly, an expertise-driven, biomedical one. It thus demonstrates that empathy is of importance throughout palliative care consultations, even in those phases which might seem biomedical or task-driven.

Managing symptoms when “the first step or two isn’t working”: Provider and patient perceptions of the role of specialty palliative care in symptom management in gynecologic oncology.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 47-47
Author(s):  
Carolyn Lefkowits ◽  
Dio Kavalieratos ◽  
Janet Arida ◽  
Winifred Teuteberg ◽  
Heidi Donovan ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Care Provider ◽  
Symptom Management ◽  
End Of Life Care ◽  
Gynecologic Oncology ◽  
Gynecologic Cancer ◽  
Life Care ◽  
Multiple Symptoms

47 Background: Our objective was to describe gynecologic oncology (GO) providers’ and patients’ knowledge, attitudes and preferences related to utilization of specialist palliative care (SPC) for symptom management. Methods: Semi-structured qualitative interviews with 19 GO providers (7 physicians, 7 advanced practice providers, 5 nurses) and 30 patients with advanced or recurrent gynecologic cancer from an academic medical center. Key interview domains include: patient symptoms, perceived role of oncology team regarding symptom management, familiarity with SPC, and barriers and facilitators to utilization of SPC for symptom management. Qualitative analysis is underway. Results: 19 provider interviews and 29 patient interviews were completed. Preliminary findings indicate shared beliefs between providers and patients, including an overall willingness to involve SPC in symptom management. Although providers felt comfortable initially managing common symptoms, they expressed interest in involving SPC for complex or multiple symptoms. Patients do not expect their GO providers to manage severe symptoms, noting concerns of complex symptom management as burdensome to the GO team. Barriers to involving SPC in symptom management included: patients’ perceptions of SPC as synonymous with end-of-life care, and logistical issues (e.g., scheduling and transportation). When a distinction was drawn between SPC for symptom management and end-of-life care, patients were uniformly open to seeing SPC for symptom management. Conclusions: GO patients’ and providers’ perception of the role of oncology providers in symptom management is consistent with the concept of a primary palliative care provider, delivering initial management of common symptoms. Specialty palliative care services are seen as complementary to the GO providers’ skillset and particularly useful for severe or multiple symptoms. Implications include the importance of ensuring that oncology provider training includes dedicated attention to symptom management to enable them to fulfill the role of primary palliative care provider.

scholarly journals At the Grave We Make Our Song: A Palliative Care Study in Rural Guatemala

2016 ◽  
Vol 29 (1) ◽  
pp. 38-45 ◽  
Author(s):  
Erin Traister ◽  
Kim L. Larson ◽  
Dell Hagwood
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Family Involvement ◽  
End Of Life Care ◽  
The United States ◽  
Life Care ◽  
The Family ◽  
Qualitative Descriptive ◽  
Training Opportunities

Purpose: We sought to understand decision making, family involvement, and cultural factors that influence palliative care for Guatemalans. Design: A qualitative descriptive study was conducted in Guatemala to explore palliative care experiences among seven participants. Findings: The overarching theme was Relief from Suffering, reinforced by three support systems: the family, community rezadora, and priest. The family made decisions and provided physical care. The rezadora sang prayers and prepared the home altar. The priest provided traditional sacraments. Discussion: The role of the rezadora should be considered in providing palliative care to Guatemalans. Some Guatemalans are unfamiliar with or have difficulty understanding the role of the nurse in palliative and end-of-life care. Implications: We suggest training opportunities using international resources to enhance the role for Guatemalan nurses in end-of-life care. Palliative care nurses in the United States may benefit from incorporating the rezadora into strategies that extend these services to Guatemalans.

Bearing Witness: Exploring the End-of-Life Needs of Homeless Persons and Barriers to Appropriate Care

2018 ◽  
Vol 82 (1) ◽  
pp. 63-91 ◽  
Author(s):  
Keri J. West ◽  
Brittany Wrobel ◽  
Stefania Pallotta ◽  
Alex Coatsworth
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Homeless Persons ◽  
Life Care ◽  
Policy And Practice ◽  
Bearing Witness ◽  
Medical Databases ◽  
Structural Levels

Traditional models of palliative care are largely inaccessible to homeless persons, and their preferences regarding end-of-life care are poorly understood. The purpose of the present scoping review is to summarize the burgeoning gray and academic literature on end-of-life care for homeless persons. Five medical databases, seven social science databases, and four gray literature databases were searched, resulting in 57 relevant titles. Six themes emerged: (a) Characteristics of homeless persons who require end-of-life care; (b) preferences and concerns of homeless persons approaching the end of life; (c) the role of spirituality for homeless persons at the end of life; (d) barriers to care at the patient, provider, and institutional or structural levels; (e) inclusive models of palliative care; and (f) implications for policy and practice. Practitioners and homeless persons must negotiate many obstacles in the provision and receipt of palliative care. However, there is tremendous potential and opportunity to improve the quality of life at the end of life for this vulnerable population.

Safe and effective prescribing for symptom management in palliative care

2019 ◽  
Vol 80 (12) ◽  
pp. C184-C189
Author(s):  
Dylan Harris
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Symptomatic Relief ◽  
Symptom Control ◽  
Upper Airway ◽  
Life Care ◽  
Proactive Approach ◽  
Key Points

Palliative and end of life care forms an important part of the role of any doctor in training, and an awareness of a structured approach to managing common symptoms and end of life care is essential. Common symptoms include pain, nausea and vomiting, constipation, and breathlessness. Anticipatory prescribing of the 4 A's (analgesic, anti-emetic, anxiolytic, and anti-secretory) is a proactive approach to ensure medication is available, if required, for common symptoms in the last hours to days of life, such as pain, upper airway secretions, anxiety, and agitation. Prescribing or medication errors in relation to symptom control in palliative care can relate to individual errors, poor communication, poor care coordination, equipment and care planning. There are some important key points relating to prescribing to consider, for example, using recognized conversions when changing between opioids and from the oral to syringe drivers route; that diamorphine and morphine are not equipotent; prescribing liquid opioids in milligrams not millilitres where there are multiple concentrations available; making the indication for steroids clear when used, as they are multiple possible indications (and also their intended duration, to avoid unintended longer term sequelae of steroid use); and avoiding the use of oxygen for symptomatic relief of breathlessness in the absence of hypoxia.

End-of-life care in non-malignant conditions

2018 ◽  
Vol 11 (1) ◽  
pp. 41-47
Author(s):  
Rachel Lewis
Keyword(s):  
Palliative Care ◽  
Chronic Disease ◽  
End Of Life ◽  
Advance Care Planning ◽  
End Of Life Care ◽  
Care Planning ◽  
Life Care ◽  
High Quality ◽  
Advance Care

End-of-life care refers to the care of patients with progressive, incurable conditions and considered to be in the last year of life. Approximately 75% of end-of-life patients will die from non-malignant conditions. There are significant challenges, both in the identification of patients with chronic disease who are nearing the end of life and in the provision of high-quality palliative care in this group. This article explores the role of GPs in the management of end-of-life care in the most common non-malignant conditions, including management of symptoms and advance care planning.

The role of the dietitian in palliative care

2021 ◽  
pp. 219-224
Author(s):  
Samantha Cushen ◽  
Aoife Ryan
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Nutritional Support ◽  
Symptom Relief ◽  
Nutritional Therapy ◽  
Life Care

In palliative care, the aims of nutritional support change with an emphasis on quality of life and symptom relief as opposed to active nutritional therapy. The concept of palliative nutrition has evolved to include all aspects of the palliative trajectory, not just end of life care, with each stage of the trajectory having different nutritional goals. The role of the dietitian in palliative care is a topic that until recently remained relatively unexplored. This chapter introduces the concept of diet as a potential survivorship intervention as opposed to nourishment only and contextualizes the dietitian’s role in palliative care.

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