Pub Date : 1989-05-01DOI: 10.1177/104990918900600316
H I Meyers
{"title":"Spiritual care in pediatric hospice.","authors":"H I Meyers","doi":"10.1177/104990918900600316","DOIUrl":"https://doi.org/10.1177/104990918900600316","url":null,"abstract":"","PeriodicalId":77805,"journal":{"name":"The American journal of hospice care","volume":"6 3","pages":"12"},"PeriodicalIF":0.0,"publicationDate":"1989-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/104990918900600316","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13748051","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 : 1989-05-01DOI: 10.1177/104990918900600317
R J Miller
Thereis considerabledisagreement abouttheuseofwordslike palliativeor curative. In curativetherapythegoaloftreatmentis to eradicatediseasein orderto returnthepatienttohisnormalstateof health.Curativetherapymaywarrant toleratingsignificanttreatmentrelated morbidity to accomplishthisgoal. Palliativetherapywould be everythingelse.Theproblemisthatthereare atleasttwo distincttypesof palliative therapy.In somesituationstheintentof therapyis toarrestor controldiseasein an effort to prolong survival. In this situationsometreatmentrelatedmorbidity is acceptable. Thesepatientsare generallynot consideredhospice candidates. In the other type of palliative therapythe intent haschangedfrom diseasecontrol to symptomcontrol. Thediseaseis treatedonly in sofar as thiswifi reducesymptoms. In thissituationsignificanttreatment relatedmorbidity would be unacceptable.These patientsmaybecandidatesforhospice. Finally, supportive care would be treatment designedto control symptomswith no disease-directed therapy.In this situation,no treatment relatedmorbiditywouldbeacceptable, and thesepatientsareclearlyhospice candidates. The useof the term palliative has moreto do with the intentof the interventionthanthe outcome. Bulldnstatedthatinorderto qualify for the Medicarehospicebenefit the patientmust be: “unable to benefit from further aggressive(curative) therapy.”1TheMedicarecriteriaarea life expectancyof six monthsor less and an: “understandingof the palliative rather thancurativenature of hospicecare.”2 If a physician usesthe operative definition that palliative therapy precludesthe useof any therapythat might arrestdiseaseor prolong survival, hewould not considera patient an appropriatereferraltohospiceuntil chemotherapywasclearlyofno further valueandhadbeenabandoned. If heusesthedefinition thatpalliativecarefocuseson symptommanagementbutdoesnotrestrictthetreatment of diseaseif qualityoflife is improved; then, under Medicareguidelines,as long as survival is six monthsor less, the patientmay be an appropriate hospicepatientandmaystill beacandidatefor chemotherapy. Isthisevenaproblemworthdiscussing? I think it is. Therehas beena strong desire to get patientsinto the hospiceprogramsearlierin the course oftheirdisease(themediansurvivalof patientsin manyhospiceprogramsis 25 to 30 days). However, raisingthis issue is likely to exacerbateexisting controversies.
{"title":"The role of chemotherapy in the hospice patient. A problem of definition.","authors":"R J Miller","doi":"10.1177/104990918900600317","DOIUrl":"https://doi.org/10.1177/104990918900600317","url":null,"abstract":"Thereis considerabledisagreement abouttheuseofwordslike palliativeor curative. In curativetherapythegoaloftreatmentis to eradicatediseasein orderto returnthepatienttohisnormalstateof health.Curativetherapymaywarrant toleratingsignificanttreatmentrelated morbidity to accomplishthisgoal. Palliativetherapywould be everythingelse.Theproblemisthatthereare atleasttwo distincttypesof palliative therapy.In somesituationstheintentof therapyis toarrestor controldiseasein an effort to prolong survival. In this situationsometreatmentrelatedmorbidity is acceptable. Thesepatientsare generallynot consideredhospice candidates. In the other type of palliative therapythe intent haschangedfrom diseasecontrol to symptomcontrol. Thediseaseis treatedonly in sofar as thiswifi reducesymptoms. In thissituationsignificanttreatment relatedmorbidity would be unacceptable.These patientsmaybecandidatesforhospice. Finally, supportive care would be treatment designedto control symptomswith no disease-directed therapy.In this situation,no treatment relatedmorbiditywouldbeacceptable, and thesepatientsareclearlyhospice candidates. The useof the term palliative has moreto do with the intentof the interventionthanthe outcome. Bulldnstatedthatinorderto qualify for the Medicarehospicebenefit the patientmust be: “unable to benefit from further aggressive(curative) therapy.”1TheMedicarecriteriaarea life expectancyof six monthsor less and an: “understandingof the palliative rather thancurativenature of hospicecare.”2 If a physician usesthe operative definition that palliative therapy precludesthe useof any therapythat might arrestdiseaseor prolong survival, hewould not considera patient an appropriatereferraltohospiceuntil chemotherapywasclearlyofno further valueandhadbeenabandoned. If heusesthedefinition thatpalliativecarefocuseson symptommanagementbutdoesnotrestrictthetreatment of diseaseif qualityoflife is improved; then, under Medicareguidelines,as long as survival is six monthsor less, the patientmay be an appropriate hospicepatientandmaystill beacandidatefor chemotherapy. Isthisevenaproblemworthdiscussing? I think it is. Therehas beena strong desire to get patientsinto the hospiceprogramsearlierin the course oftheirdisease(themediansurvivalof patientsin manyhospiceprogramsis 25 to 30 days). However, raisingthis issue is likely to exacerbateexisting controversies.","PeriodicalId":77805,"journal":{"name":"The American journal of hospice care","volume":"6 3","pages":"19-26"},"PeriodicalIF":0.0,"publicationDate":"1989-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/104990918900600317","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13627823","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 : 1989-05-01DOI: 10.1177/104990918900600309
P Hunsberger
The author summarizes the experiences of four long-term hospice staff support groups in which he served as facilitator. From these experiences he identifies what seem to be the key elements in the success or failure of a hospice staff support group, including its membership, the group contract, and the facilitator's leadership style. He outlines three developmental stages of the long-term staff support group: trust-building, individual support and team-focus. He suggests that the team-focused group is ideally suited to deal with crucial staff and agency sources of worker stress.
{"title":"Creation and evolution of the hospice staff support group: lessons from four long-term groups.","authors":"P Hunsberger","doi":"10.1177/104990918900600309","DOIUrl":"https://doi.org/10.1177/104990918900600309","url":null,"abstract":"<p><p>The author summarizes the experiences of four long-term hospice staff support groups in which he served as facilitator. From these experiences he identifies what seem to be the key elements in the success or failure of a hospice staff support group, including its membership, the group contract, and the facilitator's leadership style. He outlines three developmental stages of the long-term staff support group: trust-building, individual support and team-focus. He suggests that the team-focused group is ideally suited to deal with crucial staff and agency sources of worker stress.</p>","PeriodicalId":77805,"journal":{"name":"The American journal of hospice care","volume":"6 3","pages":"37-41"},"PeriodicalIF":0.0,"publicationDate":"1989-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/104990918900600309","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13748015","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 : 1989-05-01DOI: 10.1177/104990918900600320
R J Miller
Lessthantwo minutesshowedon theclockandthehometeamwasdown 60-0 in the fourth quarter.The fans were unanimousin their supportand respectfor a team and coachwho playedon andrefusedto admitdefeat until thefinalwhistleblew. Theold manfinally diedduringhis fifth hospitalizationfor experimental chemotherapy, thenursestalkedglowinglyoftheoncologistwhonevergave up on his patient. Only the family seemedbitter. Using sports analogiesto treat peoplewith terminaldiseaseis simplistic atbest,andyet theproperroleofthe physicianin this setting is not well defmedandin needofnewdefinition. In the United States,ourcultural and moralidealsemphasizetheimportance of evenone humanlife and champion thosewhotry to denytheirmortality. It is not surprisingthat the hospice movementcameto this country from abroadand only recently is moving from a grassroots level into mainstreammedicine.Therearethreeconceptualobstaclesthathaveto beovercomebefore terminal carewill be properlyintegratedinto medicalcare. 1. Thegoalofmedicineis to saveor at leastprolonglife at all cost.This is basedon a narrowview of the roleof the physician.The wordsof the Hippocratic Oath actually call for physiciansto “help the sick” and not “battle diseasewhere ever you encounterit.” Studiesshowthatfor cancer patients survival is not the only relevantgoal.1Manypatientshavethe
{"title":"The football approach to treating cancer patients.","authors":"R J Miller","doi":"10.1177/104990918900600320","DOIUrl":"https://doi.org/10.1177/104990918900600320","url":null,"abstract":"Lessthantwo minutesshowedon theclockandthehometeamwasdown 60-0 in the fourth quarter.The fans were unanimousin their supportand respectfor a team and coachwho playedon andrefusedto admitdefeat until thefinalwhistleblew. Theold manfinally diedduringhis fifth hospitalizationfor experimental chemotherapy, thenursestalkedglowinglyoftheoncologistwhonevergave up on his patient. Only the family seemedbitter. Using sports analogiesto treat peoplewith terminaldiseaseis simplistic atbest,andyet theproperroleofthe physicianin this setting is not well defmedandin needofnewdefinition. In the United States,ourcultural and moralidealsemphasizetheimportance of evenone humanlife and champion thosewhotry to denytheirmortality. It is not surprisingthat the hospice movementcameto this country from abroadand only recently is moving from a grassroots level into mainstreammedicine.Therearethreeconceptualobstaclesthathaveto beovercomebefore terminal carewill be properlyintegratedinto medicalcare. 1. Thegoalofmedicineis to saveor at leastprolonglife at all cost.This is basedon a narrowview of the roleof the physician.The wordsof the Hippocratic Oath actually call for physiciansto “help the sick” and not “battle diseasewhere ever you encounterit.” Studiesshowthatfor cancer patients survival is not the only relevantgoal.1Manypatientshavethe","PeriodicalId":77805,"journal":{"name":"The American journal of hospice care","volume":"6 3","pages":"13-4"},"PeriodicalIF":0.0,"publicationDate":"1989-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/104990918900600320","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13627822","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 : 1989-05-01DOI: 10.1177/104990918900600313
R B Patt
{"title":"Interventional analgesia: epidural and subarachnoid therapy.","authors":"R B Patt","doi":"10.1177/104990918900600313","DOIUrl":"https://doi.org/10.1177/104990918900600313","url":null,"abstract":"","PeriodicalId":77805,"journal":{"name":"The American journal of hospice care","volume":"6 3","pages":"18"},"PeriodicalIF":0.0,"publicationDate":"1989-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/104990918900600313","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13748012","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 : 1989-05-01DOI: 10.1177/104990918900600308
B S Giacquinta
The epidemic of acquired immunodeficiencysyndrome(AIDS) has beenspreadingin theUnitedStatesfor sevenyearsnow. As a result, a great dealhasbeenwritten abouttheillness, andits effectson personswith AIDS (PWAs). But,thefactis that“AIDS affectsand is affectedby the responses of importantothersin thePWA’s context.” Yet, we know next to nothing abouttheactualresponsesof theseimportantothers,especiallythe families of PWAs. How do families interact with their loved ones,onceAIDS is detected?What are their resources when AIDS hits home?Does AIDS changerelationshipsin families? Are thelivesof PWAsextendedin families conveyingstrongsupporto thePWA? Thesequestionsareat the heartof my longitudinal,qualitative study of PWAfamiliesinthetn-state,NewYork area, which began in Novemberof 1987andisnowinprogress.Otherkey questionsI am examiningare: How openis family conununicationabout the PWA’s lifestyle?Which stagecontainsthe greatestemotionalupheaval andanguishfor families:thediagnosis of AIDS, the period of living with AIDS, the dying stage,or deathand bereavement?What, if any, familial falloutoccursin thesestages?If atall, how do familiesdisclosethe diseaseto extendedfamilyandfriends?Whatare patternsof social support,social distanceandstigmashownby families andfriends?And, after the deathsof PWAs, how do familiesgrieve,utilize mourningrituals,andendure?This investigationissupportedinpartby aresearchgrantand a scholarlyresearch awardfrom PaceUniversity.
{"title":"Researching the effects of AIDS on families.","authors":"B S Giacquinta","doi":"10.1177/104990918900600308","DOIUrl":"https://doi.org/10.1177/104990918900600308","url":null,"abstract":"The epidemic of acquired immunodeficiencysyndrome(AIDS) has beenspreadingin theUnitedStatesfor sevenyearsnow. As a result, a great dealhasbeenwritten abouttheillness, andits effectson personswith AIDS (PWAs). But,thefactis that“AIDS affectsand is affectedby the responses of importantothersin thePWA’s context.” Yet, we know next to nothing abouttheactualresponsesof theseimportantothers,especiallythe families of PWAs. How do families interact with their loved ones,onceAIDS is detected?What are their resources when AIDS hits home?Does AIDS changerelationshipsin families? Are thelivesof PWAsextendedin families conveyingstrongsupporto thePWA? Thesequestionsareat the heartof my longitudinal,qualitative study of PWAfamiliesinthetn-state,NewYork area, which began in Novemberof 1987andisnowinprogress.Otherkey questionsI am examiningare: How openis family conununicationabout the PWA’s lifestyle?Which stagecontainsthe greatestemotionalupheaval andanguishfor families:thediagnosis of AIDS, the period of living with AIDS, the dying stage,or deathand bereavement?What, if any, familial falloutoccursin thesestages?If atall, how do familiesdisclosethe diseaseto extendedfamilyandfriends?Whatare patternsof social support,social distanceandstigmashownby families andfriends?And, after the deathsof PWAs, how do familiesgrieve,utilize mourningrituals,andendure?This investigationissupportedinpartby aresearchgrantand a scholarlyresearch awardfrom PaceUniversity.","PeriodicalId":77805,"journal":{"name":"The American journal of hospice care","volume":"6 3","pages":"31-6"},"PeriodicalIF":0.0,"publicationDate":"1989-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/104990918900600308","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13748014","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 : 1989-05-01DOI: 10.1177/104990918900600315
R S Taylor
{"title":"Hospice and Medicare benefits.","authors":"R S Taylor","doi":"10.1177/104990918900600315","DOIUrl":"https://doi.org/10.1177/104990918900600315","url":null,"abstract":"","PeriodicalId":77805,"journal":{"name":"The American journal of hospice care","volume":"6 3","pages":"18"},"PeriodicalIF":0.0,"publicationDate":"1989-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/104990918900600315","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13831636","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 : 1989-05-01DOI: 10.1177/104990918900600304
R E Enck
Patientswith advancedcancerfrequently complain of fatigue and generalizedweakness, oftenmuscular in nature. There are several wellknown syndromesdemonstratingthe remoteeffectsof canceronneuromuscular function.’ Patientswith either dermatomyositisor polymyositishave five to seventimes the incidenceof malignancy comparedto the general population.Clinically, thissyndromeis characterizedby agradual progressive muscularweaknessoccurring over a periodof weeksto months.Theweaknesseventuallystabilizes, is usually notdisabling,andusuallyinvolvesthe proximal muscles.In the majority of cases, themyopathyandcancer present within one year of eachother. The myasthenic syndrome(Eaton-Lambert) is anotherclassicexampleof a cancer,mostoftensmallcellcarcinoma of the lung, producing a remoteor paraneoplastic effectontheneuromuscular system. This myasthenic syndromeis characterizedby muscle weaknessandfatigue,which aremost pronouncedin the pelvic girdle and thigh. Othercommonfeaturesinclude drynessof the mouth, dysphagia, dysarthriaandperipheralparesthesias. Successful treatmentof theunderlying smallcelllungcancercanproduceimprovementin themuscularsymptoms. Finally, the associationof myasthenia gravis and thymoma is well established.Patientswithmyastheniagravis presentwith muscularweaknessespecially in theocularandcranialmuscles. Thereis atendencyfor fluctuationand partial reversibility by cholinergic drugs.A numberof tumorsincluding lymphomas,pancreas, breast,prostate, ovary, thyroid, cervix, kidney, rectum andpalatehavebeendescribedin associationwith myastheniagravis,but most authors concludethat the incidenceis thesameasthatexpectedin thenonnalpopulation. Given this background,two recent publicationsshed further light on the relationshipbetweencancerand neuromuscular dysfunction.2’3 Brueraetal,2fromtheCrossCancer Institute,Edmonton,Canada, prospectively studied61 consecutivepatients with advancedbreastcancerto assess muscleelectrophysiology.This group ofpatientswascomparedto 20 nonnal ageandsex-matchedfemalecontrols. Nutritional status,lean body mass, voluntary and involuntary muscle electrophysiologytestsof theadductor pollicis, and ultrasonographicmeasurement of thetricepsbrachialis,sternomastoidand adductorpollicis muscleswere determinedin patients andcontrols.Patientswith breastcancerwerechosenbecause in thispopulation the incidenceof malnutrition is significantly lower thanpatientswith other cancerssuch as lung or gastrointestinal. Malnutritionalonehas beenreportedas a causeof abnormal muscle electrophysiology.The funcCommentary on contemporary care of patientswith advanced cancer
{"title":"Neuromuscular dysfunction.","authors":"R E Enck","doi":"10.1177/104990918900600304","DOIUrl":"https://doi.org/10.1177/104990918900600304","url":null,"abstract":"Patientswith advancedcancerfrequently complain of fatigue and generalizedweakness, oftenmuscular in nature. There are several wellknown syndromesdemonstratingthe remoteeffectsof canceronneuromuscular function.’ Patientswith either dermatomyositisor polymyositishave five to seventimes the incidenceof malignancy comparedto the general population.Clinically, thissyndromeis characterizedby agradual progressive muscularweaknessoccurring over a periodof weeksto months.Theweaknesseventuallystabilizes, is usually notdisabling,andusuallyinvolvesthe proximal muscles.In the majority of cases, themyopathyandcancer present within one year of eachother. The myasthenic syndrome(Eaton-Lambert) is anotherclassicexampleof a cancer,mostoftensmallcellcarcinoma of the lung, producing a remoteor paraneoplastic effectontheneuromuscular system. This myasthenic syndromeis characterizedby muscle weaknessandfatigue,which aremost pronouncedin the pelvic girdle and thigh. Othercommonfeaturesinclude drynessof the mouth, dysphagia, dysarthriaandperipheralparesthesias. Successful treatmentof theunderlying smallcelllungcancercanproduceimprovementin themuscularsymptoms. Finally, the associationof myasthenia gravis and thymoma is well established.Patientswithmyastheniagravis presentwith muscularweaknessespecially in theocularandcranialmuscles. Thereis atendencyfor fluctuationand partial reversibility by cholinergic drugs.A numberof tumorsincluding lymphomas,pancreas, breast,prostate, ovary, thyroid, cervix, kidney, rectum andpalatehavebeendescribedin associationwith myastheniagravis,but most authors concludethat the incidenceis thesameasthatexpectedin thenonnalpopulation. Given this background,two recent publicationsshed further light on the relationshipbetweencancerand neuromuscular dysfunction.2’3 Brueraetal,2fromtheCrossCancer Institute,Edmonton,Canada, prospectively studied61 consecutivepatients with advancedbreastcancerto assess muscleelectrophysiology.This group ofpatientswascomparedto 20 nonnal ageandsex-matchedfemalecontrols. Nutritional status,lean body mass, voluntary and involuntary muscle electrophysiologytestsof theadductor pollicis, and ultrasonographicmeasurement of thetricepsbrachialis,sternomastoidand adductorpollicis muscleswere determinedin patients andcontrols.Patientswith breastcancerwerechosenbecause in thispopulation the incidenceof malnutrition is significantly lower thanpatientswith other cancerssuch as lung or gastrointestinal. Malnutritionalonehas beenreportedas a causeof abnormal muscle electrophysiology.The funcCommentary on contemporary care of patientswith advanced cancer","PeriodicalId":77805,"journal":{"name":"The American journal of hospice care","volume":"6 3","pages":"9-10"},"PeriodicalIF":0.0,"publicationDate":"1989-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/104990918900600304","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13748530","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}
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