Pub Date : 1999-01-01DOI: 10.1080/0742-969x.1999.11882917
K C Archer, D P Boyle
An evaluation of caregiver satisfaction with social services in a large hospice in a major southeastern city was conducted utilizing an instrument developed for this study. The usual processes for developing an instrument were followed, resulting in a survey questionnaire which was useful in testing the degree of satisfaction of caregivers with the hospice's social services. Results indicated that most caregivers were very satisfied with hospice social services. The development of such an instrument could aid others in the field in evaluating caregiver satisfaction with hospice services.
{"title":"Toward a measure of caregiver satisfaction with hospice social services.","authors":"K C Archer, D P Boyle","doi":"10.1080/0742-969x.1999.11882917","DOIUrl":"https://doi.org/10.1080/0742-969x.1999.11882917","url":null,"abstract":"<p><p>An evaluation of caregiver satisfaction with social services in a large hospice in a major southeastern city was conducted utilizing an instrument developed for this study. The usual processes for developing an instrument were followed, resulting in a survey questionnaire which was useful in testing the degree of satisfaction of caregivers with the hospice's social services. Results indicated that most caregivers were very satisfied with hospice social services. The development of such an instrument could aid others in the field in evaluating caregiver satisfaction with hospice services.</p>","PeriodicalId":77421,"journal":{"name":"The Hospice journal","volume":"14 2","pages":"1-15"},"PeriodicalIF":0.0,"publicationDate":"1999-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/0742-969x.1999.11882917","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21480699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The failings of the American Health Care System in meeting the comprehensive needs of the seriously and terminally ill have led to both professional and public efforts to improve end-of-life care. Following a discussion of the shortcomings of end-of-life in America, this article describes the goals and philosophy of palliative care, while highlighting current innovative programs in end-of-life needs and insure quality of life for patients and families experiencing incurable, progressive illness. Health care professionals are called to respond to the challenges and opportunities of end-of-life care as individual health care providers, as members of professions, and as members of interdisciplinary teams committed to improving the care of the dying in America.
{"title":"End-of-life care: challenges and opportunities for health care professionals.","authors":"D W Sherman","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The failings of the American Health Care System in meeting the comprehensive needs of the seriously and terminally ill have led to both professional and public efforts to improve end-of-life care. Following a discussion of the shortcomings of end-of-life in America, this article describes the goals and philosophy of palliative care, while highlighting current innovative programs in end-of-life needs and insure quality of life for patients and families experiencing incurable, progressive illness. Health care professionals are called to respond to the challenges and opportunities of end-of-life care as individual health care providers, as members of professions, and as members of interdisciplinary teams committed to improving the care of the dying in America.</p>","PeriodicalId":77421,"journal":{"name":"The Hospice journal","volume":"14 3-4","pages":"109-21"},"PeriodicalIF":0.0,"publicationDate":"1999-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21683307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1999-01-01DOI: 10.1080/0742-969X.1999.11882935
Paul R. Brenner
The establishment of the first Department of Pain Medicine and Palliative Care in a Medical Center in the United States is noteworthy. Since the design of the Department integrates a full-functioning hospice program within it, that has both a dedicated inpatient unit and extensive home care program, this Department represents a milestone in the development of the hospice movement, with full interrelationship between palliative care and hospice care. This paper will explore this interrelationship, its implications, and some of the background.
{"title":"Hospice care and palliative care: a perspective from experience.","authors":"Paul R. Brenner","doi":"10.1080/0742-969X.1999.11882935","DOIUrl":"https://doi.org/10.1080/0742-969X.1999.11882935","url":null,"abstract":"The establishment of the first Department of Pain Medicine and Palliative Care in a Medical Center in the United States is noteworthy. Since the design of the Department integrates a full-functioning hospice program within it, that has both a dedicated inpatient unit and extensive home care program, this Department represents a milestone in the development of the hospice movement, with full interrelationship between palliative care and hospice care. This paper will explore this interrelationship, its implications, and some of the background.","PeriodicalId":77421,"journal":{"name":"The Hospice journal","volume":"14 3-4 1","pages":"155-66"},"PeriodicalIF":0.0,"publicationDate":"1999-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/0742-969X.1999.11882935","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"59936380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1999-01-01DOI: 10.1080/0742-969X.1999.11882934
B. Stuart
For much of its history, hospice focused on problems related to malignant disease. Recently, however, non-cancer diagnoses such as congestive heart failure, emphysema and Alzheimer's disease have comprised an increasing proportion of hospice referrals. This paper details criteria published by NHO and adopted by the US Health Care Financing Administration for hospice eligibility for common non-cancer diagnoses. A provisional list of domains for documenting "evidence of rapid decline," by which patients with advanced disease who do not meet criteria can still be certified for the Medicare Hospice Benefit, is also outlined.
{"title":"The NHO Medical Guidelines for Non-Cancer Disease and local medical review policy: hospice access for patients with diseases other than cancer.","authors":"B. Stuart","doi":"10.1080/0742-969X.1999.11882934","DOIUrl":"https://doi.org/10.1080/0742-969X.1999.11882934","url":null,"abstract":"For much of its history, hospice focused on problems related to malignant disease. Recently, however, non-cancer diagnoses such as congestive heart failure, emphysema and Alzheimer's disease have comprised an increasing proportion of hospice referrals. This paper details criteria published by NHO and adopted by the US Health Care Financing Administration for hospice eligibility for common non-cancer diagnoses. A provisional list of domains for documenting \"evidence of rapid decline,\" by which patients with advanced disease who do not meet criteria can still be certified for the Medicare Hospice Benefit, is also outlined.","PeriodicalId":77421,"journal":{"name":"The Hospice journal","volume":"14 3-4 1","pages":"139-54"},"PeriodicalIF":0.0,"publicationDate":"1999-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/0742-969X.1999.11882934","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"59936687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The project on Death in America was established to promote a better understanding of the experience of dying and bereavement and by doing so help transform the culture surrounding death. The Faculty Scholars Program provides three year fellowships for projects that explore critical aspects of the care of the dying, for those who will become academic leaders on the issue, as well as, role models and mentors to future generations of health professionals. A Grants Program broad enough to cover every aspect of the culture of dying allocates funding for innovative projects. A new grants program is underway to support projects aimed at enhancing the role of the humanities in transforming the culture of death and dying in America.
{"title":"Reflections on death in America.","authors":"G Soros","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The project on Death in America was established to promote a better understanding of the experience of dying and bereavement and by doing so help transform the culture surrounding death. The Faculty Scholars Program provides three year fellowships for projects that explore critical aspects of the care of the dying, for those who will become academic leaders on the issue, as well as, role models and mentors to future generations of health professionals. A Grants Program broad enough to cover every aspect of the culture of dying allocates funding for innovative projects. A new grants program is underway to support projects aimed at enhancing the role of the humanities in transforming the culture of death and dying in America.</p>","PeriodicalId":77421,"journal":{"name":"The Hospice journal","volume":"14 3-4","pages":"205-15"},"PeriodicalIF":0.0,"publicationDate":"1999-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21683190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Quality of care and quality of life change substantially for those with a serious chronic illness and nearing the end of their lives. As one dies, life takes on new shape-values change and things once ignored become more important. Existing quality of care measures do not attend to the changes in priorities or to dimensions that acquire new significance (e.g., Spirituality and transcendence). An important impediment to addressing the inadequacies in the evidence base for palliative care, improving shortcomings of care, and holding institutions or health care systems accountable for the quality of care is the lack of valid and reliable measurement tools. In this article, an overview is presented of an ongoing research effort to develop measurement tools which will utilize the patient and family perspective to measure the quality of care.
{"title":"Putting patient and family voice back into measuring quality of care for the dying.","authors":"J M Teno","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Quality of care and quality of life change substantially for those with a serious chronic illness and nearing the end of their lives. As one dies, life takes on new shape-values change and things once ignored become more important. Existing quality of care measures do not attend to the changes in priorities or to dimensions that acquire new significance (e.g., Spirituality and transcendence). An important impediment to addressing the inadequacies in the evidence base for palliative care, improving shortcomings of care, and holding institutions or health care systems accountable for the quality of care is the lack of valid and reliable measurement tools. In this article, an overview is presented of an ongoing research effort to develop measurement tools which will utilize the patient and family perspective to measure the quality of care.</p>","PeriodicalId":77421,"journal":{"name":"The Hospice journal","volume":"14 3-4","pages":"167-76"},"PeriodicalIF":0.0,"publicationDate":"1999-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21683311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1999-01-01DOI: 10.1080/0742-969x.1999.11882925
D C Saunders
It was because a number of people took time to listen to patients and families facing mortal illness that the Hospice Movement has grown world-wide since it began in the 1960s. The addition of new skills in pain and symptom control, the understanding of the problems faced by families and the need for research and teaching has brought the old traditions in care and caring into the present day. It has shown that it can be relevant in many settings and cultures and in countries with widely different resources.
{"title":"Origins: international perspectives, then and now.","authors":"D C Saunders","doi":"10.1080/0742-969x.1999.11882925","DOIUrl":"https://doi.org/10.1080/0742-969x.1999.11882925","url":null,"abstract":"<p><p>It was because a number of people took time to listen to patients and families facing mortal illness that the Hospice Movement has grown world-wide since it began in the 1960s. The addition of new skills in pain and symptom control, the understanding of the problems faced by families and the need for research and teaching has brought the old traditions in care and caring into the present day. It has shown that it can be relevant in many settings and cultures and in countries with widely different resources.</p>","PeriodicalId":77421,"journal":{"name":"The Hospice journal","volume":"14 3-4","pages":"1-7"},"PeriodicalIF":0.0,"publicationDate":"1999-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/0742-969x.1999.11882925","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21684058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The concept of hospice and palliative care emerged a quarter of a century ago out of recognition of the unmet needs of dying persons and the social issues of the 1960s and 1970s. The issues of the day included the sexual revolution; a questioning of social values; an increased awareness of death resulting from the murder of the Kennedy brothers and Martin Luther King and daily television exposure to deaths in the Vietnam War, feminism, consumerism, reclaiming a more humanized role in the birth process, and hence in the process of death. The history of the hospice movement and the stress experienced by staff is traced from the early developmental days through to the present. Initially there was sometimes a struggle to integrate the concepts of relief of physical symptoms with meeting the psychosocial and emotional needs of patients and families, caregivers were expected to sacrifice much of their personal life for work, emotional intensity was high and supports were developed to ease some of the stress experienced by caregivers. From the early days team stress and burnout have been issues of concern. In the 1980s issues involved establishing funding sources, dealing with the new crisis of AIDS, and dealing with the gap between the ideal and the real. In the 1990s the economic climate has escalated some of the tensions that have always existed as hospice attempts to position itself within mainstream care with diminishing fiscal resources. These are issues that confront us as we move into the next century.
{"title":"Reflections on the history of occupational stress in hospice/palliative care.","authors":"M L Vachon","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The concept of hospice and palliative care emerged a quarter of a century ago out of recognition of the unmet needs of dying persons and the social issues of the 1960s and 1970s. The issues of the day included the sexual revolution; a questioning of social values; an increased awareness of death resulting from the murder of the Kennedy brothers and Martin Luther King and daily television exposure to deaths in the Vietnam War, feminism, consumerism, reclaiming a more humanized role in the birth process, and hence in the process of death. The history of the hospice movement and the stress experienced by staff is traced from the early developmental days through to the present. Initially there was sometimes a struggle to integrate the concepts of relief of physical symptoms with meeting the psychosocial and emotional needs of patients and families, caregivers were expected to sacrifice much of their personal life for work, emotional intensity was high and supports were developed to ease some of the stress experienced by caregivers. From the early days team stress and burnout have been issues of concern. In the 1980s issues involved establishing funding sources, dealing with the new crisis of AIDS, and dealing with the gap between the ideal and the real. In the 1990s the economic climate has escalated some of the tensions that have always existed as hospice attempts to position itself within mainstream care with diminishing fiscal resources. These are issues that confront us as we move into the next century.</p>","PeriodicalId":77421,"journal":{"name":"The Hospice journal","volume":"14 3-4","pages":"229-46"},"PeriodicalIF":0.0,"publicationDate":"1999-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21683192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A greater interest in end of life care has been emerging in the United States. A description of the evolution of hospice and palliative care is reviewed with issues such as studies and reports on the care of the dying, physician assisted suicide, medical education, the author's two hospital audit surveys and discussion of the challenges that face both hospice and palliative care.
{"title":"Hospice vs. palliative care.","authors":"P O'Connor","doi":"10.1300/j011v14n03_09","DOIUrl":"https://doi.org/10.1300/j011v14n03_09","url":null,"abstract":"<p><p>A greater interest in end of life care has been emerging in the United States. A description of the evolution of hospice and palliative care is reviewed with issues such as studies and reports on the care of the dying, physician assisted suicide, medical education, the author's two hospital audit surveys and discussion of the challenges that face both hospice and palliative care.</p>","PeriodicalId":77421,"journal":{"name":"The Hospice journal","volume":"14 3-4","pages":"123-37"},"PeriodicalIF":0.0,"publicationDate":"1999-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21683308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1999-01-01DOI: 10.1080/0742-969x.1999.11882919
P Sloan, R Melzack
Cancer pain remains a worldwide problem and some patients continue to be undermedicated because of concerns about tolerance and drug dependence. The aim of this study was to document the morphine intake of patients with chronic cancer pain in an inpatient palliative care unit and to describe the long-term pattern of morphine use and pain intensity in this patient population. With IRB approval and written informed consent, patients admitted over a 64-week period to the palliative care unit at the Royal Victoria Hospital, Montreal, were candidates for this study. Cancer patients receiving morphine for 30 days or longer who were able to complete the pain scale were included. Excluded were patients with a confused or clouded sensorium. Daily pain intensity was recorded by the PPI (0-5 scale) of the McGill pain questionnaire. The daily morphine consumption was recorded and the occurrence and intensity of breakthrough pain were also recorded. Of the 35 potential candidates for study, 17 patients with a mean age of 59 (14) years completed the study. Patients were followed up for a mean of 82 (52) days. The mean (S.D.) daily morphine dosage at study entry was 135 (127) mg, and the daily morphine dose at study completion was 244 (240) mg. There was no evidence that any patient rapidly developed tolerance to morphine. Pain was well controlled for most patients. For 10 of 17 patients, 93% reported PPI scores of either 0 or 1. Occasional breakthrough pain was experienced by 4 of these 10 patients. Four other patients reported 79% of their PPI scores as either 0 or 1, and 18% of the PPI scores as either 2 (discomforting) or 3 (disturbing), Thus 82% of patients had good to excellent pain control. Three of 17 patients spent more than four months in the unit and had less than good pain control. All of these patients had neuropathic cancer pain. These results support the conclusion that pain was well controlled for most cancer patients, and that increases in daily morphine dose, when it occurred, generally developed over a period of weeks to months, and a pattern of rapid escalation in morphine dose did not occur.
{"title":"Long-term patterns of morphine dosage and pain intensity among cancer patients.","authors":"P Sloan, R Melzack","doi":"10.1080/0742-969x.1999.11882919","DOIUrl":"https://doi.org/10.1080/0742-969x.1999.11882919","url":null,"abstract":"<p><p>Cancer pain remains a worldwide problem and some patients continue to be undermedicated because of concerns about tolerance and drug dependence. The aim of this study was to document the morphine intake of patients with chronic cancer pain in an inpatient palliative care unit and to describe the long-term pattern of morphine use and pain intensity in this patient population. With IRB approval and written informed consent, patients admitted over a 64-week period to the palliative care unit at the Royal Victoria Hospital, Montreal, were candidates for this study. Cancer patients receiving morphine for 30 days or longer who were able to complete the pain scale were included. Excluded were patients with a confused or clouded sensorium. Daily pain intensity was recorded by the PPI (0-5 scale) of the McGill pain questionnaire. The daily morphine consumption was recorded and the occurrence and intensity of breakthrough pain were also recorded. Of the 35 potential candidates for study, 17 patients with a mean age of 59 (14) years completed the study. Patients were followed up for a mean of 82 (52) days. The mean (S.D.) daily morphine dosage at study entry was 135 (127) mg, and the daily morphine dose at study completion was 244 (240) mg. There was no evidence that any patient rapidly developed tolerance to morphine. Pain was well controlled for most patients. For 10 of 17 patients, 93% reported PPI scores of either 0 or 1. Occasional breakthrough pain was experienced by 4 of these 10 patients. Four other patients reported 79% of their PPI scores as either 0 or 1, and 18% of the PPI scores as either 2 (discomforting) or 3 (disturbing), Thus 82% of patients had good to excellent pain control. Three of 17 patients spent more than four months in the unit and had less than good pain control. All of these patients had neuropathic cancer pain. These results support the conclusion that pain was well controlled for most cancer patients, and that increases in daily morphine dose, when it occurred, generally developed over a period of weeks to months, and a pattern of rapid escalation in morphine dose did not occur.</p>","PeriodicalId":77421,"journal":{"name":"The Hospice journal","volume":"14 2","pages":"35-47"},"PeriodicalIF":0.0,"publicationDate":"1999-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/0742-969x.1999.11882919","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21480322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}