Referring a Patient and Family to High-Quality Palliative Care at the Close of Life

Teno, Joan M.; Connor, Stephen R.

doi:10.1001/jama.2009.109

Cited by 40 publications

(39 citation statements)

References 25 publications

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“…Many physicians are unclear about when to refer patients for hospice or palliative care and how these options differ 1. Their knowledge about fundamental approaches to pain and symptom relief is also limited.…”

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confidence: 99%

Undertreating pain violates ethical principles

Macpherson

2009

J Med Ethics

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Disabling pain or symptoms can occur at any age from many different causes. Pain and palliative specialists are able to relieve most pain and symptoms, although repeated adjustments to modalities, medications and doses may be needed. Because pain and palliative specialists comprise only a small percentage of physicians, many patients find it difficult to access them or obtain pain relief. Globally, there are too few such specialists to meet existing needs. Most are affiliated with hospice and palliative units, so their accessibility to patients without terminal conditions is negligible. Doctors outside pain and palliative specialties are often unfamiliar with pain guidelines and sceptical about patient reports of unrelieved pain. They are therefore likely to undertreat it. Undertreating pain, however, violates respect for persons and beneficence. This paper reviews literature supporting these claims and offers a narrative description of the author's attempts to find relief from shingles and postherpetic neuralgia. It argues that physicians in most specialties are not, but should be, familiar with palliative evidence and guidelines so that they are equipped to relieve pain and symptoms quickly and effectively. Such information should be routinely introduced in medical curricula to encourage the mastery of knowledge, attitudes and skills necessary to upholding ethical principles and to ensure that more doctors in any discipline are willing to believe and be compassionate to patients whose pain is unresponsive to initial treatments. Routinely exposing students to such information would better prepare them to fulfil their professional duties to patients and society.

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confidence: 99%

Undertreating pain violates ethical principles

Macpherson

2009

J Med Ethics

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“…Teno and Connor (2009) compared hospice and hospital-based palliative care services in the United States, noting the variation not only in level of service but also in quality of care. The primary care physician is usually the one making the decision to refer to palliative care.…”

Section: Discussionmentioning

confidence: 99%

The Use of Nurses in Community Palliative Care

McKechnie

MacLeod²,

Jaye³

2011

Home Healthcare Nurse

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This qualitative study uses a phenomenological life world perspective to examine the utilization of nurses in community palliative care for people with noncancer conditions with a life expectancy of 2 years. Sited in Otago, New Zealand, while there was a number of health professionals involved in providing palliative care in the community for people with malignant conditions, none of the participants with nonmalignant disease were receiving specialist palliative care at the time of interview. Support services used a rehabilitative model of care that was not always appropriate in meeting the needs of the people who were dying and their families.

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“…2 In addition, premeeting consultations with support service such as palliative care, pastoral care, and/or social work can be valuable in informing the medical team about institutional, community, and spiritual supports/ resources that are available and might be helpful to the family. 23 These services may also be helpful in facilitating the discussion during the family conference, particularly when the clinicians may be uncomfortable or inexperienced with these types of conversations. Obviously, whatever plan is developed should be consistent with the policies of the institution and any relevant legal statues.…”

Section: Formulate Recommendation/optionsmentioning

confidence: 99%

How I conduct the family meeting to discuss the limitation of life-sustaining interventions: a recipe for success

DeLisser

2010

Blood

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The meeting with the family of a hospitalized patient dying with advanced cancer or hematologic disease in which the limitation of life-sustaining interventions is discussed can be a challenge, particularly for junior physicians. A successful conclusion to this discussion involves an outcome in which the family, without coercion or manipulation, comes to accept that the appropriate care has been provided to their loved one, while the caregivers are enabled to provide care that is goal-directed and patient-centered.

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Referring a Patient and Family to High-Quality Palliative Care at the Close of Life

Cited by 40 publications

References 25 publications

Undertreating pain violates ethical principles

Undertreating pain violates ethical principles

The Use of Nurses in Community Palliative Care

How I conduct the family meeting to discuss the limitation of life-sustaining interventions: a recipe for success

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