Palliative care issues encountered by radiation oncologists caring for advanced cancer patients.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 14-14
Author(s):  
Gregory Parker ◽  
Virginia LeBaron ◽  
Monica Shalini Krishnan ◽  
Ron Y. Shiloh ◽  
Margarita Racsa ◽  
...  
Keyword(s):  
Palliative Care ◽  
Care Coordination ◽  
Radiation Oncology ◽  
Treatment Plan ◽  
Physical Symptoms ◽  
Legal Issues ◽  
Spiritual Needs ◽  
Goals Of Care ◽  
Cultural Considerations ◽  
Ethical And Legal Issues

14 Background: Palliative radiation therapy (PRT) is often administered to patients with advanced cancers. These patients may present to radiation oncology clinicians with other palliative care needs. To date, the types and frequencies of palliative care issues encountered in this setting have not been well characterized. Methods: This study assesses palliative care issues encountered by radiation oncology clinicians during PRT consults at 3 Boston-area, community and academic, hospital-based centers. For consecutive consults from 5/19/14 to 9/15/14, participating physicians and nurse practitioners complete a survey to identify and rank the relevance (5-point scale, 'not at all' to 'extremely') of palliative care issues. Eight domains adapted from national palliative care guidelines – physical symptoms, psychosocial issues, cultural considerations, spiritual needs, care coordination, advance care planning, goals of care, and ethical and legal issues – are evaluated. Preliminary descriptive statistics based on 51 completed surveys are reported (response rate = 94%; anticipated sample size = 198). Results: Most (82%) consults had 2 or more palliative care domains ranked as very or extremely relevant to patient care. The domains of physical symptoms (92%), care coordination (75%), and goals of care (57%) were very or extremely relevant in >50% of consults. Within these domains, the issues most often reported as relevant were interdisciplinary care coordination (92%), consideration of prognosis in treatment plan development (86%), pain management (71%), and discussion of patient values and priorities in treatment plan development (67%). Advanced care planning (24%), cultural considerations (10%), spiritual needs (10%), and ethical and legal issues (10%) were least commonly ranked as very or extremely relevant. Conclusions: Radiation oncology clinicians encounter multiple palliative care issues when consulting on patients for PRT. Clinicians identified physical symptoms, care coordination, and goals of care as the most relevant palliative care domains. These findings can help guide palliative care development within radiation oncology, including education and structures of care delivery.

Implementation of a multidisciplinary palliative and supportive care education lecture series.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 144-144
Author(s):  
Shawna Chan ◽  
Solomon Liao ◽  
Leslie M. Randall ◽  
Aaron Kheriaty ◽  
Rakhi Dayal ◽  
...  
Keyword(s):  
Palliative Care ◽  
Medical Students ◽  
Supportive Care ◽  
Physical Symptoms ◽  
Spiritual Needs ◽  
Cultural Considerations ◽  
Lecture Series ◽  
Communication Goals ◽  
Advance Care ◽  
Clinical Departments

144 Background: Nationwide surveys of residents including those in oncologic specialties reveal that trainees perceive their palliative and supportive care (PSC) educational curriculum as inadequate. For residents, PSC education varies from none at all to an organized department lecture series given by Palliative Medicine physicians. There have been no published experiences of institutional wide PSC lecture series open to all residents, fellows, and medical students. Methods: We piloted a monthly palliative care lecture series from August 2016 to June 2017 at UC Irvine. 12 physicians from 9 clinical departments provided monthly lectures on management of physical symptoms, psychosocial issues, cultural considerations, spiritual needs, care coordination, ethical/legal issues, communication/goals of care, and advance care planning. Lectures were advertised in advance to program directors and emails were sent the week prior to all trainees. At the end of each lecture, attendees were given a voluntary survey that consisted of 10 questions on self-perceived competency in PSC skills and 4 questions on attitudes toward PSC. Results: 143 (45 medical students, 98 residents) responses were received. Most residents (90.8%) and medical students (84.4%) viewed palliative care as an important competency. Only 16 responses from heme/onc, radiation, and gynecology oncology residents and fellows were received, comprising 11.2% of total responses. Residents characterized themselves as “not at all/minimally/somewhat confident” in their ability to care for patients with PSC issues in the following areas: management of opioids (44.2%), fatigue (82.7%), anorexia (79.6%), depression (65.3%), and prognostication (75.5%) Medical students characterized themselves as “not at all/minimally/somewhat confident” in the following areas: management of opioids (79.3%), fatigue (86.7%), anorexia (91.1%), depression (71.1%), and prognostication (91.1%). Conclusions: These findings suggest a need to further improve domains of palliative care training in residency programs and identify innovative ways to increase participation of residents and fellows from all oncologic specialties.

Provisional Educational Needs of Health Care Providers in Palliative Care in Three Nursing Homes in Ontario

1997 ◽  
Vol 13 (3) ◽  
pp. 13-17 ◽  
Author(s):  
Chris Patterson ◽  
William Molloy ◽  
Rosalie Jubelius ◽  
G.H. Guyatt ◽  
M. Bédard
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
Nursing Homes ◽  
Health Care Providers ◽  
Educational Needs ◽  
Physical Symptoms ◽  
Spiritual Needs ◽  
Care Providers ◽  
Pharmacological Management ◽  
Traditional Lectures

Health care providers in three nursing homes in Ontario were surveyed to determine educational needs, barriers to meeting these needs, and the preferred format for education. Of the 415 health care providers asked to participate, 225 completed the questionnaire. Need was expressed for the majority of the 35 educational topics identified, including the role of the palliative care team, management of physical symptoms, pharmacological and non-pharmacological management of pain, stress management, spiritual needs, culture and death, and counseling. Group discussions and seminars were favored over traditional lectures. The primary factors influencing attendance at a palliative care workshop were loss of pay and time and location of the workshop.

Baby O and the Withdrawal of Life-Sustaining Medical Treatment in the Devastated Neonate: A Review of Clinical, Ethical, and Legal Issues

2016 ◽  
Vol 34 (10) ◽  
pp. 925-930 ◽  
Author(s):  
Joseph Sacco ◽  
Rebecca Virata
Keyword(s):  
Palliative Care ◽  
Clinical Practice ◽  
Clinical Research ◽  
Medical Treatment ◽  
Clinical Guidelines ◽  
Legal Issues ◽  
Artificial Nutrition ◽  
Artificial Nutrition And Hydration ◽  
Nutrition And Hydration ◽  
Ethical And Legal Issues

The discontinuation of life sustaining medical treatment (LSMT) in severely and permanently impaired neonates, especially artificial nutrition and hydration (ANH) is subject to uncertainty and controversy. Definitive clinical guidelines are lacking, clinical research is limited, ethical disagreement is commonplace, and while case and statutory law provide legal underpinning for the practice in defined circumstances, uncertainty in this realm likely influences clinical practice. We use the case of a neurologically devastated neonate to highlight and review these arenas, and show how, using available legal, ethical, and clinical standards and practice, the case of Baby O was resolved, and to underline the need for further research in neonatal palliative care.

Palliative care undergraduate education: Do medical and nursing students need more skills in ethical and legal issues?

2020 ◽  
Vol 142 ◽  
pp. 110138
Author(s):  
Leticia Rubio ◽  
Mónica López-García ◽  
María J. Gaitán-Arroyo ◽  
Jaime Martin-Martin ◽  
Ignacio Santos-Amaya
Keyword(s):  
Palliative Care ◽  
Nursing Students ◽  
Undergraduate Education ◽  
Legal Issues ◽  
Ethical And Legal Issues

scholarly journals Legalizing physician-assisted suicide and/or euthanasia: Pragmatic implications

2015 ◽  
Vol 13 (5) ◽  
pp. 1399-1409 ◽  
Author(s):  
Peter Hudson ◽  
Rosalie Hudson ◽  
Jennifer Philip ◽  
Mark Boughey ◽  
Brian Kelly ◽  
...  
Keyword(s):  
Palliative Care ◽  
Assisted Suicide ◽  
Healthcare Professionals ◽  
Research Community ◽  
Legal Issues ◽  
Care Provision ◽  
Physician Assisted Suicide ◽  
Training Research ◽  
Ethical And Legal Issues ◽  
Practical Implications

AbstractObjective:Despite the availability of palliative care in many countries, legalization of euthanasia and physician-assisted suicide (EAS) continues to be debated—particularly around ethical and legal issues—and the surrounding controversy shows no signs of abating. Responding to EAS requests is considered one of the most difficult healthcare responsibilities. In the present paper, we highlight some of the less frequently discussed practical implications for palliative care provision if EAS were to be legalized. Our aim was not to take an explicit anti-EAS stance or expand on findings from systematic reviews or philosophical and ethico-legal treatises, but rather to offer clinical perspectives and the potential pragmatic implications of legalized EAS for palliative care provision, patients and families, healthcare professionals, and the broader community.Method:We provide insights from our multidisciplinary clinical experience, coupled with those from various jurisdictions where EAS is, or has been, legalized.Results:We believe that these issues, many of which are encountered at the bedside, must be considered in detail so that the pragmatic implications of EAS can be comprehensively considered.Significance of Results:Increased resources and effort must be directed toward training, research, community engagement, and ensuring adequate resourcing for palliative care before further consideration is given to allocating resources for legalizing euthanasia and physician-assisted suicide.

I Won’t Let You!

2020 ◽  
pp. 53-58
Author(s):  
Elissa G. Miller
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Treatment Plan ◽  
Ethics Committee ◽  
Palliative Care Team ◽  
Care Team ◽  
Medical Providers ◽  
Goals Of Care ◽  
Patient Families ◽  
Hospital Ethics

Conflicts between patient families and medical providers arise frequently. Providers and families may disagree about a patient’s prognosis, the use of life-sustaining medical treatment, the treatment plan, and other issues. Such conflicts may be exacerbated at end of life, especially at end of life for a pediatric patient. Working through such conflicts is a common role for the palliative care team. As with much of the team’s work, it relies on establishing goals of care and partnering with families to resolve conflict as well as engaging the hospital ethics committee when conflict persists. This chapter discusses the multiple ways conflicts may arise in caring for a dying child and makes recommendations for how to resolve them.

Communication of genetic information in the palliative care context: Ethical and legal issues

2018 ◽  
Vol 18 (4) ◽  
pp. 219-240 ◽  
Author(s):  
Katie M. Saulnier ◽  
Margherita Cinà ◽  
Benny Chan ◽  
Sylvie Pelletier ◽  
Michel Dorval ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Genetic Information ◽  
Social Issues ◽  
Life Stage ◽  
Legal Issues ◽  
Care Providers ◽  
Cultural Dynamics ◽  
Normative Documents ◽  
Ethical And Legal Issues

As scientific understanding of the heritable aspects of cancer deepens, the need to effectively communicate genetic information within the families of cancer patients becomes more acute. In the palliative care context, the question of when and how to disclose a patient’s genetic information raises a host of ethical, legal, and social issues, including the challenges of communicating during the end-of-life stage and complex familial and cultural dynamics. In this paper, the authors outline the legal components of these issues in three civil law jurisdictions with similarly comprehensive approaches to healthcare and palliative care - Quebec, Belgium, and France - and provide insights from bioethics literature and normative documents on the disclosure of genetic information at the end of life. From this research, the authors propose a strategy for palliative care providers who are considering available options to communicate hereditary health information.

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