scholarly journals Los Cuidados Paliativos, una revisión documental

2017 ◽  
Vol 1 (2) ◽  
pp. 75
Author(s):  
Amarelys Rodríguez León ◽  
Roberto Garcés González ◽  
Luis Ernesto Paz Enrique
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Hospice Care ◽  
Care Quality ◽  
Evolutionary Development ◽  
Critically Ill Patient ◽  
Calidad De Vida ◽  
Palabras Clave ◽  
Key Words Palliative Care

Los cuidados paliativos u hospice son un modelo de cuidados de salud que mejora la calidad de vida del paciente con enfermedades crónicas, debilitantes. Existe escasa literatura publicada que sistematice las características y evolución de los cuidados hospice. Se planteó como objetivo del estudio, examinar el surgimiento y desarrollo de los cuidados paliativos a partir de una revisión documental de la literatura científica publicada. Se realizó un estudio documental con el propósito de describir el desarrollo evolutivo de los Cuidados Paliativos desde su surgimiento y las tendencias que han caracterizado su desarrollo. Se recopiló gran cantidad de información acerca los orígenes de los cuidados hospice en distintos contextos tanto de salud como en el la comunidad y hogar. Se realizó un estudio de varias fuentes de información histórica. Como resultado se obtuvieron datos de gran relevancia sobre cómo se introdujeron y evolucionaron los cuidados paliativos en la atención al paciente críticamente enfermo. Igualmente, se describieron los principios sobre los que se sustentan los cuidados paliativos y las funciones del equipo de salud interdisciplinario. Palabras clave: Cuidados paliativos, enfermedades crónicas, equipo interdisciplinario, cuidados hospice, calidad de vida. Abstract Palliative care or hospice is a model of health care that improves the quality of life of the patient with chronic, debilitating diseases. There is scarce published literature that systematizes the characteristics and evolution of hospice care. The objective of the study was to examine the emergence and development of palliative care based on a documentary review of published scientific literature. A documentary study was carried out with the aim of describing the evolutionary development of palliative care since its emergence and the trends that have characterized its development. A great deal of information was gathered about the origins of hospice care in different health contexts, as well as in the community and at home. A study of several sources of historical information was carried out. As a result, very relevant data were obtained on how palliative care was introduced and developed in the care of the critically ill patient. The principles on which palliative care and the functions of the interdisciplinary health team are supported were also described. Key words: Palliative care, chronic diseases, interdisciplinary team, hospice care, quality of life.

scholarly journals Los Cuidados Paliativos, una revisión documental

2017 ◽  
Vol 1 (2) ◽  
pp. 75
Author(s):  
Amarelys Rodríguez León ◽  
Roberto Garcés González ◽  
Luis Ernesto Paz Enrique
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Hospice Care ◽  
Care Quality ◽  
Evolutionary Development ◽  
Critically Ill Patient ◽  
Calidad De Vida ◽  
Palabras Clave ◽  
Key Words Palliative Care

Los cuidados paliativos u hospice son un modelo de cuidados de salud que mejora la calidad de vida del paciente con enfermedades crónicas, debilitantes. Existe escasa literatura publicada que sistematice las características y evolución de los cuidados hospice. Se planteó como objetivo del estudio, examinar el surgimiento y desarrollo de los cuidados paliativos a partir de una revisión documental de la literatura científica publicada. Se realizó un estudio documental con el propósito de describir el desarrollo evolutivo de los Cuidados Paliativos desde su surgimiento y las tendencias que han caracterizado su desarrollo. Se recopiló gran cantidad de información acerca los orígenes de los cuidados hospice en distintos contextos tanto de salud como en el la comunidad y hogar. Se realizó un estudio de varias fuentes de información histórica. Como resultado se obtuvieron datos de gran relevancia sobre cómo se introdujeron y evolucionaron los cuidados paliativos en la atención al paciente críticamente enfermo. Igualmente, se describieron los principios sobre los que se sustentan los cuidados paliativos y las funciones del equipo de salud interdisciplinario. Palabras clave: Cuidados paliativos, enfermedades crónicas, equipo interdisciplinario, cuidados hospice, calidad de vida. Abstract Palliative care or hospice is a model of health care that improves the quality of life of the patient with chronic, debilitating diseases. There is scarce published literature that systematizes the characteristics and evolution of hospice care. The objective of the study was to examine the emergence and development of palliative care based on a documentary review of published scientific literature. A documentary study was carried out with the aim of describing the evolutionary development of palliative care since its emergence and the trends that have characterized its development. A great deal of information was gathered about the origins of hospice care in different health contexts, as well as in the community and at home. A study of several sources of historical information was carried out. As a result, very relevant data were obtained on how palliative care was introduced and developed in the care of the critically ill patient. The principles on which palliative care and the functions of the interdisciplinary health team are supported were also described. Key words: Palliative care, chronic diseases, interdisciplinary team, hospice care, quality of life.

Does a Patient-Held Quality-of-Life Diary Benefit Patients With Inoperable Lung Cancer?

2009 ◽  
Vol 27 (1) ◽  
pp. 70-77 ◽  
Author(s):  
Moyra E. Mills ◽  
Liam J. Murray ◽  
Brian T. Johnston ◽  
Chris Cardwell ◽  
Michael Donnelly
Keyword(s):  
Quality Of Life ◽  
Lung Cancer ◽  
Palliative Care ◽  
Health Care Professionals ◽  
Standard Care ◽  
Care Quality ◽  
Care Group ◽  
Consistent Difference ◽  
Life Questionnaire

Purpose To examine the effect of weekly completion of a patient-held quality-of-life (QOL) diary in routine oncology practice for palliative care patients. Patients and Methods In a pragmatic randomized controlled trial, 115 patients with inoperable lung cancer were randomly assigned to receive either standard care or a structured QOL diary (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 and the related lung cancer module LC13) that they completed at home each week for 16 weeks. Patients were encouraged to share the QOL information with health professionals involved in their care. Changes in QOL over time (measured by the Functional Assessment of Cancer Therapy–Lung questionnaire and the Palliative Care Quality of Life Index), discussion of patient problems, and satisfaction with communication and general care were assessed at baseline and at 2 and 4 months after baseline. Results Analysis of QOL indicated a small but consistent difference between patients in the diary group and the standard care group. The diary group had a poorer QOL in many domains. Two different QOL summary scores (total and overall QOL) indicated a statistically significant between-group difference. No effects were found in relation to satisfaction with care, communication, or the discussion of patient problems. Conclusion The regular completion of a QOL questionnaire without appropriate feedback to health care professionals and without the provision of appropriate support may have a negative impact on inoperable lung cancer patients. Further research should focus on identifying features such as feedback loops that are required for the successful and meaningful use of QOL questionnaires in routine patient care.

Cost effectiveness in palliative care setting

2018 ◽  
Vol 21 (2) ◽  
pp. 62-71
Author(s):  
Henry O’Lawrence ◽  
Rohan Chowlkar
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
End Of Life ◽  
Hospice Care ◽  
Home Health ◽  
Data Set ◽  
Content Type ◽  
Care Services ◽  
The Cost

Purpose The purpose of this paper is to determine the cost effectiveness of palliative care on patients in a home health and hospice setting. Secondary data set was utilized to test the hypotheses of this study. Home health care and hospice care services have the potential to avert hospital admissions in patients requiring palliative care, which significantly affects medicare spending. With the aging population, it has become evident that demand of palliative care will increase four-fold. It was determined that current spending on end-of-life care is radically emptying medicare funds and fiscally weakening numerous families who have patients under palliative care during life-threatening illnesses. The study found that a majority of people registering for palliative and hospice care settings are above the age group of 55 years old. Design/methodology/approach Different variables like length of stay, mode of payment and disease diagnosis were used to filter the available data set. Secondary data were utilized to test the hypothesis of this study. There are very few studies on hospice and palliative care services and no study focuses on the cost associated with this care. Since a very large number of the USA, population is turning 65 and over, it is very important to analyze the cost of care for palliative and hospice care. For the purpose of this analysis, data were utilized from the National Home and Hospice Care Survey (NHHCS), which has been conducted periodically by the Centers for Disease Control and Prevention’s National Center for Health Statistics. Descriptive statistics, χ2 tests and t-tests were used to test for statistical significance at the p<0.05 level. Findings The Statistical Package for Social Sciences (SPSS) was utilized for this result. H1 predicted that patients in the age group of 65 years and up have the highest utilization of home and hospice care. This study examined various demographic variables in hospice and home health care which may help to evaluate the cost of care and the modes of payments. This section of the result presents the descriptive analysis of dependent, independent and covariate variables that provide the overall national estimates on differences in use of home and hospice care in various age groups and sex. Research limitations/implications The data set used was from the 2007 NHHCS survey, no data have been collected thereafter, and therefore, gap in data analysis may give inaccurate findings. To compensate for this gap in the data set, recent studies were reviewed which analyzed cost in palliative care in the USA. There has been a lack of evidence to prove the cost savings and improved quality of life in palliative/hospice care. There is a need for new research on the various cost factors affecting palliative care services as well as considering the quality of life. Although, it is evident that palliative care treatment is less expensive as compared to the regular care, since it eliminates the direct hospitalization cost, but there is inadequate research to prove that it improves the quality of life. A detailed research is required considering the additional cost incurred in palliative/hospice care services and a cost-benefit analysis of the same. Practical implications While various studies reporting information applicable to the expenses and effect of family caregiving toward the end-of-life were distinguished, none of the previous research discussed this issue as their central focus. Most studies addressed more extensive financial effect of palliative and end-of-life care, including expenses borne by the patients themselves, the medicinal services framework and safety net providers or beneficent/willful suppliers. This shows a significant hole in the current writing. Social implications With the aging population, it has become evident that demand of palliative/hospice care will increase four-fold. The NHHCS have stopped keeping track of the palliative care requirements after 2007, which has a negative impact on the growing needs. Cost analysis can only be performed by analyzing existing data. This review has recognized a huge niche in the evidence base with respect to the cost cares of giving care and supporting a relative inside a palliative/hospice care setting. Originality/value The study exhibited that cost diminishments in aggressive medications can take care of the expenses of palliative/hospice care services. The issue of evaluating result in such a physically measurable way is complicated by the impalpable nature of large portions of the individual components of outcome. Although physical and mental well-being can be evaluated to a certain degree, it is significantly more difficult to gauge in a quantifiable way, the social and profound measurements of care that help fundamentally to general quality of care.

scholarly journals INDICADORES GEORREFERENCIADOS DE QUALIDADE DE VIDA URBANA: possibilidades para o planejamento urbano

2020 ◽  
Vol 14 (01) ◽  
pp. 191-214
Author(s):  
Isabela Veloso Lopes Versiani
Keyword(s):  
Quality Of Life ◽  
Urban Planning ◽  
Urban Quality Of Life ◽  
Calidad De Vida ◽  
Palabras Clave ◽  
Quality Of Life Indicators ◽  
The Social ◽  
Urban Quality ◽  
Development Paradigm

O presente artigo tem como objetivo aprofundar o debate acerca da emergência do tema da qualidade de vida vinculado ao meio urbano e de suas possibilidades para o planejamento urbano. De caráter exploratório, através de pesquisa bibliográfica e documental, o artigo procura delimitar marcos conceituais sobre a qualidade de vida e sua relação com um novo modelo de planejamento urbano a partir do paradigma do desenvolvimento social e de diretrizes do Estatuto da Cidade (2001), além de discutir formas de operacionalização desse conceito tendo como base algumas experiências de construção de sistemas de indicadores de qualidade de vida urbana no Brasil. Como resultados, evidencia-se que a preocupação com a qualidade de vida tem sido expressão recorrente nos debates sobre o presente e futuro das cidades, ganhando espaço e legitimidade a partir de um esforço de delimitação conceitual e de instrumentos para sua mensuração, destacando a contribuição de indicadores georreferenciados para melhor compreensão de desigualdades intraurbanas em diversas áreas. Acredita-se que a incorporação dessa discussão ao planejamento urbano pode contribuir de maneira significativa para pensar e operacionalizar instrumentos que auxiliem no direcionamento de ações e efetivação de políticas públicas para melhoria das condições de vida da população. Palavras-chave: Planejamento Urbano; Indicadores; Qualidade de vida.   GEOREFERENCED INDICATORS OF URBAN QUALITY OF LIFE: possibilities for urban planning  Abstract  This article aims to deepen the debate on the growth of the quality of life theme linked to the urban environment and its possibilities for the urban planning. With exploratory character, through bibliographical and documentary research, the article seeks to define conceptual frameworks on the quality of life and its relationship with a new urban planning model from the social development paradigm and the “City Statute” guidelines (2001), besides discussing ways of operationalizing this concept, basing on experiences of previously existing systems of urban quality of life indicators in Brazil. As a result, it is clear that the concern for quality of life has been a recurring point in discussions regarding the present and future of cities, gaining ground and legitimacy from efforts of conceptual delimitation and tools for its measurement, highlighting the contribution of georeferenced indicators for a better understanding of intra-urban inequalities in many areas. It is believed that the incorporation of this discussion into urban planning can contribute significantly to think and operationalize instruments that can help to direct actions and execution of public policies to improve the living conditions of the population. Keywords: Urban Planning; Indicators; Quality of life.   INDICADORES GEOREFERENCIADOS DE CALIDAD DE VIDA URBANA: posibilidades de planificación urbana Resumen En este artículo se pretende profundizar el debate sobre el surgimiento del tema de la calidad de vida relacionado con el ambiente urbano y sus posibilidades para la planificación urbana. De carácter exploratorio, a través de la investigación bibliográfica y documental, el artículo busca definir los marcos conceptuales de la calidad de vida y su relación con un nuevo modelo de planificación urbana desde el paradigma del desarrollo social y las directrices del Estatuto de la Ciudad (2001), además de discutir maneras de hacer operativo este concepto basado en algunas experiencias en la construcción de sistemas de indicadores de calidad de vida urbana en Brasil. Como resultado de ello, es evidente que la preocupación por la calidad de vida ha sido una expresión recurrente en los debates sobre el presente y futuro de las ciudades, ganando terreno y legitimidad a través de esfuerzos de delimitación conceptual y herramientas para su medición, destacando la contribución de indicadores georeferenciados para una mejor comprensión de las desigualdades intra-urbanas en muchas áreas. Se cree que la incorporación de esta discusión a la planificación urbana puede contribuir significativamente a pensar y operar instrumentos que ayudan a dirigir las acciones y ejecución de políticas públicas para mejorar las condiciones de vida de la población. Palabras-clave: Planificación urbana, indicadores, calidad de vida.

scholarly journals MODERN METHODS OF TREATMENT IN PALLIATIVE CARE

2019 ◽  
Vol 72 (7) ◽  
pp. 1229-1235
Author(s):  
Ewa Kucharska ◽  
Aleksandra Kucharska ◽  
Aleksander Sieroń ◽  
Mariusz Nowakowski ◽  
Karolina Sieroń
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Hospice Care ◽  
Clinical Symptoms ◽  
Care Patient ◽  
Unique Type ◽  
Modern Methods ◽  
High Dynamics ◽  
Methods Of Treatment

The palliative care patient is definitely a unique type of patient. Due to the complexity of the symptoms requires a holistic therapeutic approach. Modern methods of treatment in palliative and hospice care underline an important role of physio, kinesiotherapy and pharmacological treatment coexistence. The rehabilitation reduces clinical symptoms, accompanying the basic disease and increases the quality of life of palliative patients and their families. It becomes an inseparable element of treatment, both in outpatient care as well as in stationary care and home care. Due to the high dynamics onset of cancer in the group of geriatric patients there is a need for a broader analysis of the topic. The goal of palliative care is to achieve the best possible quality of life for patients and their families.

scholarly journals Intervenção em cuidados paliativos: conhecimento e percepção dos enfermeiros

2018 ◽  
Vol 12 (5) ◽  
pp. 1325
Author(s):  
Hashilley Alberto da Silva ◽  
Gleice Kelle Beserra Viana ◽  
Ana Karine Girão Lima ◽  
Carla Monique Lopes Mourão ◽  
Ana Luiza Almeida de Lima
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Care Hospital ◽  
Chi Square ◽  
Calidad De Vida ◽  
Before And After ◽  
Data Collection Instrument ◽  
Post Test ◽  
Nursing Quality

RESUMOObjetivo: avaliar a percepção dos enfermeiros sobre cuidado paliativo antes e depois de uma intervenção. Método: estudo quantitativo, quase experimental, desenvolvido nas unidades de um hospital de atenção secundária. O instrumento de coleta de dados foi adaptado de um estudo realizado com anestesiologistas, esses foram analisados no programa Excel e organizados em tabelas, sendo aplicado o teste estatístico de qui-quadrado de Pearson, com tabelas que apresentam os valores obtidos dentro de categorias distintas, mas que eram relacionáveis. Foi calculada, também, a proporção das diferenças entre as respostas do pré-teste e pós-teste, sendo considerados significantes os resultados com p<0,05. Resultados: houve predominância dos profissionais antes da intervenção que escolheram a expressão Morte Digna para designar cuidado paliativo (72,9%). Após a intervenção, os profissionais escolheram a expressão Qualidade de Vida (55,9%). Conclusão: a percepção dos enfermeiros acerca dos cuidados paliativos foi deficiente. Esse fato esteve associado à deficiência na formação técnico-científica ainda na graduação. A intervenção realizada promoveu melhoria da compreensão de conceitos relacionados ao cuidado paliativo colaborando para a assistência diferenciada e promotora da qualidade de vida dos profissionais. Descritores: Cuidados Paliativos; Enfermagem; Qualidade de Vida; Assistência Hospitalar.ABSTRACTObjective: to evaluate nurses' perception of palliative care before and after an intervention. Method: quantitative, almost experimental study, developed in the units of a secondary care hospital. The data collection instrument was adapted from a study carried out with anesthesiologists, these were analyzed in the Excel program and organized into tables, being applied the statistical test of chi-square of Pearson, with tables that present the values obtained within distinct categories, but that they were relatable. The proportion of differences between pre-test and post-test responses was also calculated, and the results with p <0.05 were considered significant. Results: there was a predominance of professionals before the intervention who chose the term Digned Death to designate palliative care (72.9%). After the intervention, professionals chose the term Quality of Life (55.9%). Conclusion: nurses' perception about palliative care was deficient. This fact was associated to the deficiency in the technical-scientific formation still in the graduation. The intervention promoted an improvement of the understanding of concepts related to palliative care collaborating for differentiated assistance and promoting the quality of life of professionals  Descriptors: Palliative Care, Nursing, Quality of Life, Hospital Care.RESUMENObjetivo: evaluar la percepción de los enfermeros sobre el cuidado paliativo antes y después de una intervención. Método: estudio cuantitativo, casi experimental, desarrollado en las unidades de un hospital de atención secundaria. El instrumento de recolección de datos fue adaptado de un estudio realizado con anestesiólogos, se analizaron en el programa Excel y organizados en tablas, siendo aplicado el test estadístico de chi-cuadrado de Pearson con tablas que presentan los valores obtenidos dentro de categorías distintas, pero que eran relacionables. Se calculó, también, la proporción de las diferencias entre las respuestas del pre-test y post-test, siendo considerados significantes los resultados con p <0,05. Resultados: hubo predominancia de los profesionales antes de la intervención que eligieron la expresión Muerte Digna para designar cuidado paliativo (72,9%). Después de la intervención, los profesionales escogieron la expresión Calidad de Vida (55,9%). Conclusión: la percepción de los enfermeros acerca de los cuidados paliativos fue deficiente. Este hecho estuvo asociado a la deficiencia en la formación técnica-científica aún en la graduación. La intervención realizada promovió la mejora de la comprensión de conceptos relacionados al cuidado paliativo, colaborando para la asistencia diferenciada y promotora de la calidad de vida de los profesionales. Descriptores: Cuidados Paliativos, Enfermeira, Calidad de Vida, Atención Hospitalaria.

Tablero estratégico para el cambio, plan para el desarrollo

2021 ◽  
Vol 2 (2) ◽  
pp. 22-35
Author(s):  
Eduardo Nicolás Bonne Falcón ◽  
Niurka Tellez Rodríguez
Keyword(s):  
Quality Of Life ◽  
Natural Resources ◽  
Decision Makers ◽  
Clear Cut ◽  
Calidad De Vida ◽  
Palabras Clave ◽  
Institutional Organization

Las crecientes demandas que se producen de forma natural y otras por política de los órganos decisores en función de alcanzar la satisfacción de las crecientes necesidades de la población, imponen más y más exigencias a todas las organizaciones de la estructura de la sociedad. Las contextualizaciones obligan a los gestores a proyectar las alternativas más efectivas para asumir las exigencias de los cambios, sean esos de índole organizacional, estructural, funcional, u otro. El Tablero Estratégico para el Cambio (TEC), es una herramienta para la transformación y el desarrollo, para la actuación colectiva, simple por áreas y de acciones personales bien orientadas, las que necesitan de escribirse y de constituirse en un documento orientador de las transformaciones. En las organizaciones, donde son diversas, convergentes, simples y complejas las acciones a cumplir, sí es muy importante tenerla bien escritas, bien definidas y bien orientadas hacia los objetivos colectivos. Palabras clave: Visión integral para el cambio desde el Tablero Estratégico, movilidad de la organización institucional promovido desde el tablero estratégico, la conquista de la efectividad una misión para mejorar la calidad de vida. ABSTRACT The increasing requests that are  produced spontaneously and another one for policy of the organs decision makers in terms of attaining the satisfaction of the increasing needs of the population, they force more and more on requirements all of the organizations of the structure of the society. All country, with his natural resources and his social and productive infrastructures, with his roads of interior commerces and exteriors, affected his administrative and entrepreneurial institution is forced in the position of constant way to contextualizar for the various universal crises that today they coexist. The Strategic Chessboard for the Change, a tool for transformation and development, for the collective, simple acting for areas and actions in personam well guided, they are in need of writing to each other and of getting constituted in a guiding document of transformations. In the organizations, where actions are various, convergent, simple and complex to do one's job, definitely you are very important to have it good written, clear-cut and very guided toward the collective objectives. Keywords: Integral vision for the change from the Strategic Board, mobility of the institutional organization promoted from the strategic board, the conquest of the effectiveness a mission to improve the quality of life.

The Promise of Palliative Care

Pained ◽  
2020 ◽  
pp. 203-206
Author(s):  
Michael D. Stein ◽  
Sandro Galea
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
End Of Life ◽  
Social Workers ◽  
Hospice Care ◽  
Care Plan ◽  
Life Care ◽  
High Quality ◽  
Life Threatening

This chapter assesses palliative care. Palliative care focuses on improving the quality of life for people with life-threatening illnesses by involving a team of nurses, doctors, social workers, and clergy in a care plan. Hospice care—administered in dedicated units and in services delivered at home—has been slowly expanding over the past two decades, but the increasing percentage of patients who use hospice for less than 7 days suggests that the full benefits of end-of-life palliative care are not being realized. Meanwhile, the use of unwanted, aggressive end-of-life care, often inconsistent with patient preferences, remains pervasive. For palliative care to be effective, it must be supported by government policies and insurer incentives; it must also be owned by communities, which must continue to ask for help in designing and paying for high-quality palliative care for patients and their caregiving families.

High–Tech, Aggressive Palliative Care: In the Service of Quality of Life

1993 ◽  
Vol 9 (1) ◽  
pp. 37-41 ◽  
Author(s):  
David M. Dush
Keyword(s):  
Quality Of Life ◽  
United States ◽  
Health Care ◽  
Palliative Care ◽  
Hospice Care ◽  
High Technology ◽  
The United States ◽  
High Tech ◽  
Hospice Movement

The hospice movement grew in part as a reaction to the perception that modern medical care had become too technological at the expense of being impersonal and insensitive to human psychological and spiritual concerns. In the United States, the institutionalization of hospice care under Medicare and other reimbursement systems has further established hospice as an alternative to high-technology, high-cost care. The present paper examines the question: What if hospice care becomes itself high-technology, aggressive, costly health care in order to remain true to its goal of maximizing quality of life? Implications for the goals and philosophical underpinnings of palliative care are discussed.

scholarly journals Longitudinal Pediatric Palliative Care: Quality of Life & Spiritual Struggle (FACE): Design and methods

2012 ◽  
Vol 33 (5) ◽  
pp. 1033-1043 ◽  
Author(s):  
Ronald H. Dallas ◽  
Megan L. Wilkins ◽  
Jichuan Wang ◽  
Ana Garcia ◽  
Maureen E. Lyon
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Care Quality ◽  
Pediatric Palliative Care ◽  
Spiritual Struggle ◽  
Design And Methods
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