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Toward a measure of caregiver satisfaction with hospice social services. 探讨照顾者对安宁疗护社会服务的满意度。
Pub Date : 1999-01-01 DOI: 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.

本研究以东南一主要城市之大型安宁疗护所之照护者对社会服务之满意度评估为研究之工具。我们遵循通常的开发工具的程序,制作一份调查问卷,用以测试照顾者对安宁疗护社会服务的满意程度。结果显示,大部分照护者对安宁疗护社会服务非常满意。这种工具的发展可以帮助其他领域的人评估照顾者对临终关怀服务的满意度。
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引用次数: 17
End-of-life care: challenges and opportunities for health care professionals. 临终关怀:卫生保健专业人员的挑战和机遇。
Pub Date : 1999-01-01
D W Sherman

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.

美国医疗保健系统在满足重病和绝症患者的全面需求方面的失败,导致专业人士和公众都在努力改善临终关怀。在讨论了美国临终关怀的缺点之后,本文描述了临终关怀的目标和理念,同时强调了当前临终关怀需求的创新项目,并确保患有无法治愈的渐进性疾病的患者和家庭的生活质量。卫生保健专业人员被要求作为个人卫生保健提供者,作为专业人员,作为致力于改善美国临终者护理的跨学科团队的成员,来应对生命末期护理的挑战和机遇。
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引用次数: 0
Hospice care and palliative care: a perspective from experience. 临终关怀与缓和疗护:从经验的角度。
Pub Date : 1999-01-01 DOI: 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.
值得注意的是,在美国的医疗中心建立了第一个疼痛医学和姑息治疗部门。由于该部门的设计整合了一个功能齐全的临终关怀计划,其中既有专门的住院病房,也有广泛的家庭护理计划,该部门代表了临终关怀运动发展的一个里程碑,在姑息治疗和临终关怀之间建立了充分的相互关系。本文将探讨这种相互关系,其含义,以及一些背景。
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引用次数: 4
The NHO Medical Guidelines for Non-Cancer Disease and local medical review policy: hospice access for patients with diseases other than cancer. 国家卫生组织非癌症疾病医疗指南和地方医疗审查政策:癌症以外疾病患者的临终关怀服务。
Pub Date : 1999-01-01 DOI: 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.
在其历史的大部分时间里,临终关怀关注的是与恶性疾病有关的问题。然而,最近,非癌症诊断,如充血性心力衰竭、肺气肿和阿尔茨海默病,在临终关怀转诊中所占的比例越来越大。本文详细介绍了NHO发布的标准,并由美国卫生保健融资管理局采用,用于安宁疗护资格的常见非癌症诊断。一份用于记录“快速衰退证据”的临时域名列表也被概述,通过该列表,不符合标准的晚期疾病患者仍然可以获得医疗保险临终关怀福利的认证。
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引用次数: 57
Reflections on death in America. 美国人对死亡的思考
Pub Date : 1999-01-01
G Soros

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.

美国死亡项目的建立是为了促进对死亡和丧亲之痛的体验的更好理解,并通过这样做帮助改变围绕死亡的文化。学院学者计划为那些探索临终关怀关键方面的项目提供三年的奖学金,这些项目将成为该问题的学术领袖,以及未来几代卫生专业人员的榜样和导师。一个足以涵盖死亡文化各个方面的资助计划为创新项目分配资金。一项新的拨款计划正在进行中,以支持旨在加强人文学科在改变美国死亡文化和临终文化中的作用的项目。
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引用次数: 0
Putting patient and family voice back into measuring quality of care for the dying. 将病人和家属的声音重新纳入对临终者护理质量的衡量。
Pub Date : 1999-01-01
J M Teno

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.

患有严重慢性疾病并接近生命尽头的人的护理质量和生活质量发生了重大变化。人死后,生命会有新的形态——价值观会改变,曾经被忽视的事情会变得更加重要。现有的护理质量措施没有注意到优先事项的变化或获得新意义的维度(例如,灵性和超越)。解决姑息治疗证据基础不足、改善护理缺陷以及让机构或卫生保健系统对护理质量负责的一个重要障碍是缺乏有效和可靠的衡量工具。在这篇文章中,概述了正在进行的研究工作,以开发测量工具,将利用病人和家庭的角度来衡量护理质量。
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引用次数: 0
Origins: international perspectives, then and now. 起源:国际视野,过去和现在。
Pub Date : 1999-01-01 DOI: 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.

正是因为许多人花时间倾听面临致命疾病的病人和家属的心声,临终关怀运动才从20世纪60年代开始在全球范围内发展起来。在疼痛和症状控制方面的新技能的增加,对家庭面临的问题的理解以及研究和教学的需要,使护理和护理的旧传统进入了今天。它表明,它可以适用于许多环境和文化以及资源差异很大的国家。
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引用次数: 16
Reflections on the history of occupational stress in hospice/palliative care. 安宁疗护/缓和疗护中职业压力的历史反思。
Pub Date : 1999-01-01
M L Vachon

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.

临终关怀和姑息治疗的概念是在25年前出现的,因为人们认识到临终者的需求未得到满足,以及20世纪60年代和70年代的社会问题。当时的话题包括性革命;对社会价值的质疑;由于肯尼迪兄弟和马丁·路德·金被谋杀,人们对死亡的意识越来越高,电视上每天都在报道越南战争中的死亡,女权主义,消费主义,在出生过程中重新获得更人性化的角色,因此在死亡过程中也是如此。安宁疗护运动的历史,以及工作人员所承受的压力,可追溯自安宁疗护发展初期至今。最初,有时很难将减轻身体症状的概念与满足患者和家属的社会心理和情感需求结合起来,护理人员被期望为工作牺牲大部分个人生活,情绪强度很高,并开发了支持以减轻护理人员所经历的一些压力。从早期开始,团队压力和倦怠就一直是人们关注的问题。80年代的问题包括建立资金来源,应对新的艾滋病危机,以及解决理想与现实之间的差距。在20世纪90年代,随着财政资源的减少,临终关怀试图将自己定位于主流护理,经济气候使一些一直存在的紧张局势升级。这些都是我们进入下一个世纪时所面临的问题。
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引用次数: 0
Hospice vs. palliative care. 临终关怀与姑息治疗。
Pub Date : 1999-01-01 DOI: 10.1300/j011v14n03_09
P O'Connor

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.

在美国,人们对临终关怀越来越感兴趣。对临终关怀和姑息治疗的演变的描述,回顾了诸如临终关怀的研究和报告,医生协助自杀,医学教育,作者的两次医院审计调查以及讨论临终关怀和姑息治疗面临的挑战等问题。
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引用次数: 3
Long-term patterns of morphine dosage and pain intensity among cancer patients. 癌症患者吗啡剂量和疼痛强度的长期模式。
Pub Date : 1999-01-01 DOI: 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.

癌症疼痛仍然是一个世界性的问题,一些患者由于对耐受性和药物依赖的担忧而继续用药不足。本研究的目的是记录住院姑息治疗病房慢性癌症疼痛患者的吗啡摄入量,并描述该患者群体中吗啡使用和疼痛强度的长期模式。经IRB批准和书面知情同意,在蒙特利尔皇家维多利亚医院姑息治疗部门住院64周以上的患者是本研究的候选人。接受吗啡治疗30天或更长时间且能够完成疼痛量表的癌症患者也包括在内。排除了感觉混乱或浑浊的患者。采用McGill疼痛问卷的PPI(0-5分)记录每日疼痛强度。记录每日吗啡用量,并记录突破痛的发生和强度。在35名潜在的研究候选人中,17名平均年龄为59(14)岁的患者完成了研究。患者平均随访82(52)天。研究开始时吗啡的平均日剂量为135 (127)mg,研究结束时吗啡的平均日剂量为244 (240)mg。没有证据表明任何病人对吗啡迅速产生耐受性。大多数患者的疼痛得到了很好的控制。17例患者中有10例,93%报告PPI评分为0或1。10例患者中有4例偶尔出现突破性疼痛。另外4名患者报告称,79%的PPI评分为0或1分,18%的PPI评分为2分(不舒服)或3分(令人不安),因此82%的患者疼痛控制良好至极好。17名患者中有3人在病房里待了4个多月,疼痛控制不佳。所有这些患者都有神经性癌症疼痛。这些结果支持这样的结论,即大多数癌症患者的疼痛得到了很好的控制,并且每天吗啡剂量的增加,当它发生时,通常是在几周到几个月的时间内发生的,并且吗啡剂量的快速上升模式不会发生。
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引用次数: 43
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