Biomedical subjects
Laurie Lyckholm
Publications and source records attributed to Laurie Lyckholm.
Improving palliative and supportive care in cancer patients.
Twenty years of research in controlling symptoms such as pain and nausea have shown persistent suboptimal performance by the US oncology system. The data suggest that some of the tools of palliative care programs can improve physical symptoms of seriously ill patients at a cost society can afford. To fix these problems will require recognition of the symptoms or concerns, a system such as an algorithm or care plan for addressing each, measurement of the change, and accountability for the change. Symptom assessment scales such as the Edmonton Symptom Assessment Scale or Rotterdam Symptom Check List work to make symptoms manifest. Listing symptoms on a problem list is a necessary step in addressing them. Physical symptoms such as pain can be improved by use of computer prompts, algorithms, dedicated staff time, team management, or combinations of these strategies. Less concrete problems such as medically appropriate goal-setting, integrating palliative care into anticancer care sooner, and informing patients about the benefits and risks of chemotherapy near the end of life require more complex solutions. We review what is known about symptom control in oncology, how and why some programs do better, and make suggestions for practice. Finally, we suggest a practical plan for using symptom assessment scales, listing the problems, and managing them according to algorithms or other predetermined plans.
Child welfare versus parental autonomy: medical ethics, the law, and faith-based healing.
Over the past three decades more than 200 children have died in the U.S. of treatable illnesses as a result of their parents relying on spiritual healing rather than conventional medical treatment. Thirty-nine states have laws that protect parents from criminal prosecution when their children die as a result of not receiving medical care. As physicians and citizens, we must choose between protecting the welfare of children and maintaining respect for the rights of parents to practice the religion of their choice and to make important decisions for their children. In order to make and defend such choices, it is essential that we as health care professionals understand the history and background of such practices and the legal aspects of previous cases, as well as formulate an ethical construct by which to begin a dialogue with the religious communities and others who share similar beliefs about spiritual healing. In this paper, we provide a framework for these requirements.
Truth or consequences: what to do when the patient doesn't want to know.
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Truth or consequences: what to do when the patient doesn't want to know.
Explore the source record for details and available documents.