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At least 19 recordsLinked to original sources
PubMed1985

A clinician's view on palliative care, terminal care and quality of life.

No more than 20-25% of cancer patients are cured and 55% need palliative treatment from the time of diagnosis. Medical and nurse training in palliative care, and pain control in particular, is poor and there is a great shortage of doctors trained in terminal care. Palliative care is detailed, complex care and includes many services both in the hospital and in the community. It should be available to all patients wherever they live. We need a network of Home Care and Hospital Support Teams throughout the country, and a limited number of specialist hospice inpatient units to deal with the difficult problems, research and training in terminal care. These services need to be co-ordinated and monitored and will require funding by governmental bodies.

Humans↗
PubMed2001

[Questionnaire survey comparing first-year medical students and non-medical students with regard to their level of interest and knowledge of care and terminal care for the elderly].

To study the level of interest and knowledge about care and terminal care for the elderly of medical students in Nagoya University, we made a questionnaire for first-year medical students (about 90 students per year) each April from 1998 to 2000. To assess the differences, we also gave the same questionnaire to 75 first-year non-medical students in 1999. Only about 10% of students had experienced providing care for member(s) of their family, but about one third stated that other family member(s) such as their mother, cared for older family member(s). The introduction of long-term care insurance was known by 22%, 43.5% and 96.6% of medical students in 1998, 1999 and 2000, respectively. Moreover, 19.8%, 13.0% and 52.3% of medical students knew about the care managers, respectively. About 80% of students hoped to be informed about their disease if they had terminal-stage cancer. However, about half of students could not decide whether to tell a family member who had terminal-stage cancer. Medical students had significantly more interest in the care system (68.5% in 1999) and terminal care (72.8% in 1999) for the elderly than non-medical students (41.3% and 40.0% in 1999, respectively). There were no significant differences between medical and non-medical students with regard to experiences of care, knowledge of long-term care insurance system and the attitudes to informing about terminal-stage cancer. However, more medical students had an interest in the elderly care system and terminal care than non-medical students.

Adult↗
PubMed1994

Patient requests to hasten death. Evaluation and management in terminal care.

Terminally ill patients often hope that death will come quickly. They may broach this wish with their physicians, and even request assistance in hastening death. Thoughts about accelerating death usually do not reflect a sustained desire for suicide or euthanasia, but have other important meanings that require exploration. When patients ask for death to be hastened, the following areas should be explored: the adequacy of symptom control; difficulties in the patient's relationships with family, friends, and health workers; psychological disturbances, especially grief, depression, anxiety, organic mental disorders, and personality disorders; and the patient's personal orientation to the meaning of life and suffering. Appreciation of the clinical determinants and meanings of requests to hasten death can broaden therapeutic options. In all cases, patient requests for accelerated death require ongoing discussion and active efforts to palliate physical and psychological distress. In those infrequent instances when a patient with persistent, irremediable suffering seeks a prompt and comfortable death, the physician must confront the moral, legal, and professional ramifications of his or her response. Rarely, acceding to the patient's request for hastening death may be the least terrible therapeutic alternative.

Attitude to Death↗
PubMed1990

Oral cancer and precancer: after-care and terminal care.

This paper looks at the social and psychological effects of cancer on patients and their families, and discusses the support and after-care required by a patient who has been treated for an oral cancer. The role of the dental practitioner in the maintenance of oral health and comfort is discussed, and the management of the side-effects of the different treatment modalities is described. The particular problems and needs of patients, and the relatives of patients, in the terminal stages of oral cancer are also discussed.

Aftercare↗
PubMed1994

[Home terminal care for terminal gastric cancer patients--case of epidural morphine injection].

Pain management at home for a terminal gastric cancer patient unable to take medications orally was made possible by a combination of serial morphine drip infusion and epidural anesthesia with morphine on a continuing basis using a disposal syringe. Before the patient was discharged, a conference was held to prepare for home care. Besides the patient and family, it was attended by the primary care doctor, ward nurse, home nurse, pharmacy staff, pain clinic doctor and hospital office personnel. The patient was duly informed of the disease by name and, thanks to fine cooperation from the medical staff, had achieved a good understanding, and spent his remaining time meaningfully. Morphine dosages upon discharge were 80 mg/day by drip infusion and 90 mg/day epidurally. For times of increased pain, the patient was instructed in how to self-administer 0.5% Mepivacaine (5 ml/time) with a syringe using an epidural catheter equipped with a 3-way stopcock. When this proved insufficient to control the pain, the patient was instructed to come for outpatient treatment on an emergency basis. With one visit per week to the hospital and home visits by a nurse once or twice a week, the patient managed at home for 82 days before increased pain resulted in rehospitalization. After the pain was brought under control and the patient was discharged, he was again hospitalized 5 days later. The pain control up until the time of death was by drip infusion of up to 1,200 mg/day morphine.

Adult↗
PubMed1995

Using advance directives effectively in the intensive care unit. Terminating care in the presence--or absence--of directives.

When a patient is admitted to the ICU, determine whether the person has decisional capacity and whether an advance directive exists. If so, discuss treatment options and the directive with the patient--as well as with family members and appointed surrogates; clarify the patient's wishes. If no directive has been drawn up, encourage the patient to do so. If a patient lacks decisional capacity but has a directive, determine whether it applies to the current situation. If it does, follow its instructions. If no directive exists or if it does not apply, consult with family members to determine the patient's wishes, and ascertain whether these substitute judgments meet state laws.

Advance Directives↗