scholarly journals Paramedics’ perceptions and educational needs with respect to palliative care

2015 ◽  
Vol 12 (5) ◽  
Author(s):  
Ian R Rogers ◽  
Freya R Shearer ◽  
Jeremy R Rogers ◽  
Gail Ross-Adjie ◽  
Leanne Monterosso ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Causes Of Death ◽  
Ethical Issues ◽  
Symptom Control ◽  
Educational Needs ◽  
Palliative Approach ◽  
Common Causes ◽  
The Common ◽  
End Of Life Communication

IntroductionTo identify and measure paramedics’ perspectives and educational needs regarding palliative care provision, as well as their understanding of the common causes of death.MethodsAll St John Ambulance Western Australia paramedics were invited to complete a mixed methods qualitative and quantitative survey using a tool previously validated in studies involving other emergency care providers. Quantitative results are reported using descriptive statistics, while Likert-type scales were converted to ordinal variables and expressed as means +/- SD. Qualitative data was analysed using content analysis techniques and reported as themes. ResultsCompleted surveys were returned by 29 paramedics. They considered palliative care to be strongly focussed on end-of-life care, symptom control and holistic care. The dominant educational needs identified were ethical issues, end-of-life communication and the use of structured patient care pathways. Cancer diagnoses were overrepresented as conditions considered most suitable for palliative care, compared with their frequency as a cause of death. Conditions often experienced in ambulance practice, such as heart failure, trauma and cardiac arrhythmias were overestimated in their frequency as causes of death. ConclusionsParamedics have a sound grasp of some important aspects of palliative care including symptom control and the holistic nature of the palliative approach. They did however tend to equate palliative care with that occurring in the terminal phase and saw it as being particularly applied to cancer diagnoses. Paramedic palliative care educational efforts should focus on ethical issues and end-of-life communication, as well as increasing understanding of the common causes of death and those where a palliative approach might be beneficial.

Palliative Care at the End of Life

2006 ◽  
Author(s):  
David J. Bearison
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Assisted Suicide ◽  
Psychosocial Support ◽  
Symptom Control ◽  
Life Care ◽  
Curative Intent ◽  
The Board Of Directors ◽  
Life Decisions

Consider the following advice given to parents whose children are dying in hospitals: “If your child has to die, he can die peacefully. You can make sure he is free of pain. You can make sure that everyone has a chance to say good-bye” (Hilden & Tobin, 2003, p. 3). To offer parents this kind of unconditional assurance (i.e., “You can make sure . . . ”) dismisses the confusing and disturbing realities of actually having to care for a child when it becomes increasingly apparent that curative intent is failing and staff begin to question how best to proceed. The complexity of symptom control in various clinical conditions sometimes precludes children from having peaceful deaths. However, when you read findings from the few palliative care studies that exist (and there are few that consider children as participants), issues of pain management and psychosocial support at the end of life do not seem to be so difficult to resolve. These findings promote ideas that, when satisfactory end-of-life care is not achieved, it is because mistakes were made, staff were inadequately trained, and children thereby were made to suffer unnecessarily. Such ways of thinking in turn lead bereft parents to feel guilty at not having empowered themselves to have taken greater control in the care of their child and to have done the right thing for their child. Although mistakes occur, staff can be better trained, and children might unnecessarily suffer, there are very few guarantees of a comfortable way of dying from medical causes. Most textbooks and studies about end-of-life care simply ignore the messy realities and uncertainties, particularly as they pertain to children and their families. The Report to the Board of Directors of the American Psychological Association from its Working Group on Assisted Suicide and End-of-Life Decisions (2003) raised a clarion call to document publicly what it is like, in practical day-by-day terms, for people who die in hospitals and how it affects endof- life decisions for the staff, patients, and families. We all prefer to die quickly, without protracted suffering and pain and without humiliation. Deaths during sleep are particularly preferred.

Easing of Suffering in Children With Cancer at the End of Life: Is Care Changing?

2008 ◽  
Vol 26 (10) ◽  
pp. 1717-1723 ◽  
Author(s):  
Joanne Wolfe ◽  
Jim F. Hammel ◽  
Kelly E. Edwards ◽  
Janet Duncan ◽  
Michael Comeau ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Care Service ◽  
Geometric Mean ◽  
Symptom Control ◽  
Palliative Care Service ◽  
Do Not Resuscitate ◽  
Children With Cancer ◽  
Adjusted Risk

Purpose In the past decade studies have documented substantial suffering among children dying of cancer, prompting national attention on the quality of end-of-life care and the development of a palliative care service in our institutions. We sought to determine whether national and local efforts have led to changes in patterns of care, advanced care planning, and symptom control among children with cancer at the end of life. Methods Retrospective cohort study from a US tertiary level pediatric institution. Parent survey and chart review data from 119 children who died between 1997 and 2004 (follow-up cohort) were compared with 102 children who died between 1990 and 1997 (baseline cohort). Results In the follow-up cohort, hospice discussions occurred more often (76% v 54%; adjusted risk difference [RD], 22%; P < .001) and earlier (adjusted geometric mean 52 days v 28 days before death; P = .002) compared with the baseline cohort. Do-not-resuscitate orders were also documented earlier (18 v 12 days; P = .031). Deaths in the intensive care unit or other hospitals decreased significantly (RD, 16%; P = .024). Parents reported less child suffering from pain (RD, 19%; P = .018) and dyspnea (RD, 21%; P = .020). A larger proportion of parents felt more prepared during the child's last month of life (RD, 29%; P < .001) and at the time of death (RD, 24%; P = .002). Conclusion Children dying of cancer are currently receiving care that is more consistent with optimal palliative care and according to parents, are experiencing less suffering. With ongoing growth of the field of hospice and palliative medicine, further advancements are likely.

scholarly journals Integration of palliative care into the neuro-oncology practice: patterns in the United States

2014 ◽  
Vol 1 (1) ◽  
pp. 3-7 ◽  
Author(s):  
Tobias Walbert
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Brain Tumor ◽  
End Of Life ◽  
Symptom Control ◽  
Tumor Patients ◽  
Life Phase ◽  
Improve Symptom ◽  
Oncology Practice

Abstract Background Between 80%–85 percent of all adult brain tumors are high-grade gliomas (HGGs). Despite aggressive treatment with surgical resection, radiotherapy and chemotherapy, the survival of patients with HGG is limited. Brain tumor patients develop unique symptoms and needs throughout their disease trajectory, and the majority lose the ability to communicate during the end-of-life phase. Palliative care (PC) is a proactive and systematic approach to manage issues that are important to patients and families affected by serious illness. The goal is to improve quality of life and symptom control and thereby reduce suffering. Most PC interventions take place during the end-of-life phase; however, newer data suggest that early PC interventions might improve symptom control and quality of life. Methods A literature review focusing on PC, hospice care, and end-of-life care was performed with the aim to describe the integration of PC into neuro-oncology practice. Results Recently there has been increased interest in the effects of PC and brain tumor patients. The origins, methodology, and conceptual models of delivering PC and how it might be applied to the field of neuro-oncology were reviewed. Patterns of referral and utilization in neuro-oncology are described based on the findings of a recent survey. Conclusions Despite a very high symptom burden, many HGG patients do not receive the same level of PC and have fewer interactions with PC services than other cancer populations. Early PC interventions and structured advance-care planning might improve symptom control and quality of life for brain tumor patients.

Palliative care in the intensive cardiac care unit

2015 ◽  
Author(s):  
Jayne Wood ◽  
Maureen Carruthers
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Symptom Control ◽  
World Health ◽  
Terminal Phase ◽  
Cardiac Care ◽  
Life Care ◽  
Specialist Palliative Care ◽  
Cardiac Care Unit

Specialist palliative care services originally focused on improving the quality of life for patients with a diagnosis of cancer in the terminal phase of their illness. However, organizations, such as the World Health Organization, supported by recent national strategies, such as the End of Life Care Strategy (United Kingdom, 2008), promote the early integration of specialist palliative care into the management of patients with incurable disease, irrespective of the diagnosis. The primary goal of the intensive cardiac care unit is to help patients survive acute threats to their lives. However, the suddenness and severity of illness, particularly when associated with an underlying cardiological diagnosis, often means that the provision of optimal specialist palliative care is challenging. This chapter addresses key issues relating to the provision of specialist palliative care in the challenging and complex environment of the intensive cardiac care unit, including symptom control, end of life care, decision making, and communication. The benefits of multidisciplinary working for effective quality improvement in patient care and best support for patients, families/carers, and staff are also addressed. The importance of interdisciplinary working is highlighted, and, by embedding the principles of holistic care into daily practice, the intensive cardiac care unit can ensure that patients and their families/carers receive the support they need in a timely manner from individuals who are well supported in what is often considered to be one of the most challenging medical environments.

scholarly journals P135: Canadian emergency medicine residents’ training and competency in end-of-life care: a needs assessment

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S123-S123 ◽  
Author(s):  
C.J. Turner
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Small Groups ◽  
End Of Life Care ◽  
Symptom Control ◽  
Comfort Level ◽  
Formal Training ◽  
Life Care ◽  
Bedside Teaching ◽  
Further Training

Introduction: Emergency Physicians (EPs) face growing numbers of palliative care patients presenting to the emergency department (ED). Formal training for EM residents across Canada in this area is not well described. We sought to describe the training Canadian emergency medicine (EM) residents receive in end of life care issues, their attitudes toward it, self-reported knowledge and skills, and the importance they place on further training in this domain. Methods: We conducted an electronic survey across Canada. We collected demographic data, previous education in palliative care, attitudes toward end of life care, and a self-assessment of competency and desires for further training in the main components of palliative care pertinent to EM. We used simple descriptive statistics, a Mann-Whitney test to assess whether previous formal training in palliative care affected current comfort level, and a combination of self-reported knowledge and importance levels placed on key areas. Results: We received 112 responses from 17 different Universities in Canada, with 42% from the CCFP training stream, and 58% from the FRCP stream. Fifty-four percent of respondents had not completed a palliative care rotation during residency or fellowship, which was overwhelming accounted for by FRCP residents (13%, vs. 82% among CCFPs). Having completed formal training in palliative care was significantly associated with general comfort in managing terminally ill patients (p<0.0001). Sixty percent of subjects felt a lack of knowledge and skills was their main limiting factor in providing ideal care for terminally ill patients in the ED. The skills deemed highest priority with lowest comfort level among residents included discussing withdrawing and withholding care, prognosticating, pharmacology and other symptom control. Preferred methods of receiving palliative care teaching included simulation, bedside teaching and small groups. Conclusion: The care of acute illness among palliative care patients is substantially underrepresented in the Canadian EM curriculum, particularly for FRCP trainees. Formal training is associated with increased comfort in caring for patients at the end of their life. High yield teaching interventions could be directed toward knowledge of withdrawing, prognosticating and symptom control. Simulation, bedside teaching and small groups are the preferred method for receiving such teaching.

scholarly journals Visitor Restrictions, Palliative Care, and Epistemic Agency: A Qualitative Study of Nurses’ Relational Practice During the Coronavirus Pandemic

2021 ◽  
Vol 8 ◽  
pp. 233339362110517
Author(s):  
Kim McMillan ◽  
David K. Wright ◽  
Christine J. McPherson ◽  
Kristina Ma ◽  
Vasiliki Bitzas
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Moral Agency ◽  
Ethical Issues ◽  
Ethical Reasoning ◽  
Epistemic Agency ◽  
Relational Practice ◽  
Philosophy Of Palliative Care ◽  
Pandemic Response

Efforts to curb spread of COVID-19 has led to restrictive visitor policies in healthcare, which disrupt social connection between patients and their families at end of life. We interviewed 17 Canadian nurses providing palliative care, to solicit their descriptions of, and responses to, ethical issues experienced as a result of COVID-19 related circumstances. Our analysis was inductive and scaffolded on notions of nurses’ moral agency, palliative care values, and our clinical practice in end-of-life care. Our findings reveal that while participants appreciated the need for pandemic measures, they found blanket policies separating patients and families to be antithetical to their philosophy of palliative care. In navigating this tension, nurses drew on the foundational values of their practice, engaging in ethical reasoning and action to integrate safety and humanity into their work. These findings underscore the epistemic agency of nurses and highlight the limits of a purely biomedical logic for guiding the nursing ethics of the pandemic response.

Ethics in Palliative Care

2018 ◽  
Author(s):  
Robert C. Macauley
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Moral Distress ◽  
Clinical Medicine ◽  
Ethical Issues ◽  
Ethical Dilemmas ◽  
Age Groups ◽  
Life Threatening Illness ◽  
Unique Nature ◽  
The Right

No specialty faces more diverse and challenging ethical dilemmas than palliative medicine. What is the best way to plan ahead for the end of life? How should physicians respond when patients refuse treatments likely to be beneficial or demand treatments not likely to be? Who makes medical decisions for patients who are too ill to decide for themselves? Do patients have the “right to die” (and, if so, what exactly does that mean)? Other ethics texts have explored these issues but often from an academic perspective that overlooks the practical realities of clinical medicine. Conversely, medical textbooks frequently lack sufficient philosophical depth to fully explore the complexities of these issues. This complete guide to the ethics of palliative care combines clinical experience with philosophical rigor to provide a comprehensive analysis of this fascinating field. Using relevant case studies, core subjects such as intensive symptom management at the end of life, physician-assisted dying, and palliative sedation are examined from historical, legal, clinical, and ethical perspectives. Whereas pediatric issues are often an afterthought in palliative care textbooks, this guide explores the unique nature of ethical dilemmas in the prenatal, neonatal, and adolescent age groups. Other important topics such as neuro-palliative care, organ donation, research, and moral distress are also covered in detail. Written with clinical nuance for medical professionals—and clear language as well as a glossary for lay readers—this guide offers all readers an opportunity to explore and understand the fascinating ethical issues facing patients suffering from life-threatening illness.

scholarly journals Refractory suffering at the end of life and the assisted dying debate: An interview study with palliative care nurses and doctors

2020 ◽  
pp. 147775092094661
Author(s):  
Kristine Espegren Gustad ◽  
Åsta Askjer ◽  
Per Nortvedt ◽  
Olav Magnus S Fredheim ◽  
Morten Magelssen
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Symptom Control ◽  
Prima Facie ◽  
Assisted Dying ◽  
Analysis Framework ◽  
Structured Interviews ◽  
Care Services ◽  
Palliative Care Services ◽  
Shed Light

Background How often does refractory suffering, which is suffering due to symptoms that cannot be adequately controlled, occur at the end of life in modern palliative care? What are the causes of such refractory suffering? Should euthanasia be offered for refractory suffering at the end of life? We sought to shed light on these questions through interviews with palliative care specialists. Methods Semi-structured interviews with six nurses and six doctors working in palliative care in five Norwegian hospitals. Transcripts were analysed with systematic text condensation, a qualitative analysis framework. Results Informants find that refractory suffering is rare, and that with palliative sedation satisfactory symptom control can nearly always be achieved at the end of life. However, the process of reaching adequate symptom control can be protracted, and there can be significant suffering in the meantime. Both somatic, psychological, social and existential factors can contribute to refractory suffering and potentiate each other. However, informants also place significant weight on factors pertaining to the organization of palliative care services as contributing to insufficient symptom control. Conclusions If refractory suffering is indeed rare, then this arguably weakens a common prima facie argument for the legalization of assisted dying. However, the process of reaching adequate symptom control can be protracted and involve significant suffering. The experiences of palliative care clinicians constitute important empirical premises for the assisted dying debate. The study points to several areas in which palliative care can be improved.

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