bluuebunny/crossref_metadata_2025 huggingface dataset:
A systematic review on chaplains and community-based clergy in three palliative care journals: 1990 - 1999
Authors: Flannelly Kevin J. , Weaver Andrew J. , Smith Walter J. , Oppenheimer Julia E.
Published: May 2006

A systematic review of all articles appearing between 1990 and 1999 in the American Journal of Hospice and Palliative Care, the Hospice Journal, and the Journal of Palliative Care was conducted. Articles citing at least one reference were categorized as scholarly, included in the study, and divided into either research or nonresearch categories. Scholarly articles were classified as research if they contained clearly defined methods and results sections, even if these headings were not used. Research and nonresearch articles were subdivided into qualitative and quantitative research and general reviews or program descriptions, respectively. All scholarly articles were read to see if they mentioned clergy, including the terms rabbi, priest, minister, pastor, imam, chaplain, or other religious professionals. Of 838 scholarly articles published between 1990 and 1999 in the three journals, 348 (41.5 percent) were research articles, 417 (49.8 percent) were reviews, and 73 (8.7 percent) were program descriptions. Forty-seven (5.6 percent) of all 838 scholarly articles mentioned clergy or chaplains in some way. Clergy and chaplains were more likely to be an integral part of research articles, whereas mention of them in nonresearch articles tended to be incidental (chi-square = 16.8, p < .001). Moreover, quantitative articles were more likely to include clergy as an integral aspect of the article than were qualitative articles (Fischer’s exact probability test, p = .088). The results are discussed with respect to the mutual roles hospice chaplains and community-based clergy play in providing spiritual care at the end of life.
The business of palliative medicine—Part 3: The development of a palliative medicine program in an academic medical center
Authors: Nelson Kristine A. , Walsh Declan
Published: May 2006

Palliative medicine is the total continuing care of patients with cancer. Most resources for cancer care focus on curative attempts while often ignoring the symptoms created by the disease and its treatment. Attempts at curative treatment of the malignancy must be coupled with pain and symptom relief, psychosocial and spiritual care, and support for the patient and family extending from the time of diagnosis through the bereavement period. To accomplish this important goal, we must establish comprehensive palliative medicine programs in cancer centers throughout the world. These programs must include education, research, and patient care and must work through an interdisciplinary team. The Cleveland Clinic Foundation palliative medicine program (PMP) is composed of a primary inpatient service, consult service, outpatient clinic, hospice homecare, and cancer homecare services. In this article, we describe the structure and development of the program and suggest future avenues for growth.
Advance care planning among residents in long-term care
Authors: McAuley William J. , Travis Shirley S.
Published: May 2006

This study was conducted to determine whether two types of advance directives exist for individuals residing in long-term care facilities. Findings were based on data from the Medical Expenditure Panel Study-Nursing Home Component (MEPSNHC), a survey using a two-stage stratified probability sample of nursing homes and residents to produce valid national estimates of the nursing home population in the United States. The two types of advance directives included basic, i.e., living will or do-not-resuscitate (DNR) order, and progressive (do-not-hospitalize order or orders restricting feeding, medication, or other treatment). Approximately 59 percent of long-term care residents had a basic advance directive, 9 percent have a progressive directive, and 60 percent have some type of directive. Logistic regression results indicate that the factors associated with the likelihood of each type of directive differ considerably, and only two variables (African American ethnicity and less time in the facility) were associated with a reduced likelihood of having either type of directive. Our results indicate that the two proposed types of advance directives are distinct with regard to the variables predicting each.
An analysis of provider attitudes toward end-of-life decision-making
Authors: Rutsohn Phil , Ibrahim Nabil
Published: May 2006

The explosion of technological and biomedical interventions over the past half century appears to have enhanced the medical profession’s ability to prolong life at a faster pace than society’s ability to develop comprehensive bioethical laws governing end-of-life decisions. This study was conducted to determine if there was a correlation between educational and occupational backgrounds and participants’ perceptions of end-of-life care. Study participants came from various areas and levels of healthcare at a large federal healthcare facility and included nurses, doctors, pharmacists, dietitians, administrators, and others. Participants completed a questionnaire providing both sociodemographic information and perceptions of end-of-life care. Respondents were classified by type of education or background (technical, professional, or medical) and by level of involvement with patient care (direct or indirect). While the results showed a general consensus about the importance of respecting patients’ end-of-life wishes, there were differences among respondents in regard to specific issues.
Treatable complications of cancer patients referred to an in-patient hospice
Authors: Morita Tatsuya , Tei You , Shishido Hideki , Inoue Satoshi
Published: May 2006

This paper illustrates the importance of accurate diagnoses and treatments of complications in terminally ill cancer patients. The paper reports on five hospice in-patients who completely recovered from life-threatening complications; three of them had been incorrectly labeled as “imminently dying” by the referring physicians.

The paper concludes that it would be beneficial for patients to receive examinations and a trial of medical treatment in their continuing treatment settings.
Job satisfaction among hospice interdisciplinary team members
Authors: DeLoach Roenia
Published: May 2006

The purpose of this study was to investigate job satisfaction among hospice interdisciplinary team (IDT) members. Interdisciplinary team members (N = 76) from several hospices in Ohio participated in the study. Pearson product-moment correlations (p < .05) revealed that there were significant relationships between job satisfaction and autonomy, role ambiguity, role conflict, supervisory support, task significance, routinization, positive affectivity, negative affectivity, and team functioning. Multiple regression analysis (p < .05) revealed that supervisory support, positive affectivity, role ambiguity, autonomy, and routinization were significant predictors of job satisfaction.
Cultural competence in hospice
Authors: Doorenbos Ardith Z. , Schim Stephanie Myers
Published: May 2006

Research shows that ethnic minorities access hospice care significantly less often than Caucasians. In part, this has been attributed to the lack of cultural competence among hospice staff. To assess cultural competence among hospice workers, this article evaluates the results of a descriptive, exploratory survey that was submitted to 125 interdisciplinary hospice employees and completed by 113 of those employees. Cultural-competence behavior scores varied widely based on two factors: increased education and previous cultural-diversity training. The results of this study provide information regarding cultural competence in hospice. In their efforts to provide culturally appropriate end-of-life care, hospices can use the information in this study to implement intervention plans aimed at increasing cultural competence among hospice staff.
Educational needs of hospice social workers: Spiritual assessment and interventions with diverse populations
Authors: Wesley Carol , Tunney Kathleen , Duncan Ella
Published: May 2006

Based on a national survey, this study analyzes the roles and educational needs of hospice social workers regarding assessment and intervention in spirituality, religion, and diversity of their patients. Sixty-two social workers responded to the survey. Results suggest that spiritual care is shared among hospice team members and that most social workers feel comfortable in addressing these issues. However, role conflict and role ambiguity also exist. Respondents to the survey often felt ill-prepared to deal with some complex faith-based conflicts related to diversity. They saw themselves in need of assessment models and end-of-life decision-making interventions regarding assisted suicide and euthanasia. This study provides recommendations for social work practice, education, and research.
Current use of guidelines, protocols, and care pathways for symptom management in hospice
Authors: Johnson Daniel C. , Kassner Cordt T. , Kutner Jean S.
Published: May 2006

Evidence-based guidelines or care pathways for symptom management could provide a means to reduce symptom distress in dying patients. We surveyed directors of nursing from hospices affiliated with the Population-based Palliative Care Research Network (PoPCRN) regarding their hospices’ current use of and attitudes toward written symptom management materials. A majority (53/78, 68 percent) of participating hospices reported use of written materials, such as guidelines, protocols, or care pathways, for one or more symptoms. Materials were based on multiple sources and varied from simple medication orders to more comprehensive, multicategory symptom management resources. Regardless of the composition, these materials were perceived as helpful. Given this favorable view, variations in the use and content of written materials may signify an opportunity to decrease symptom distress in hospice through the implementation of evidence-based symptom management resources.
Intravesical lidocaine for formalin-induced suprapubic pain: Case report
Authors: Mishra Seema , Singhal Amit Kumar , Kannan T. R. , Bhatnagar Sushma
Published: May 2006

This case report describes the management of intravesical formalin induced suprapubic pain using intravesical lidocaine.
Dying with dignity: The good patient versus the good death
Authors: Proulx Kathryn , Jacelon Cynthia
Published: May 2006

Death is a unique experience for each human being, yet there is tremendous societal pressure on a dying person to be a “good patient” while trying to experience the “good death.” These pressures shape patient, caregiver, and family choices in end-of-life situations.

The purpose of this literature review was twofold: first, to develop an understanding of “dying with dignity” to enhance the end-of-life care received by dying patients, and second, to contribute to a concept analysis of dignity to improve the clarity and consistency of future research related to dignity in aging individuals. Articles pertaining to dying with dignity from the disciplines of nursing, medicine, ethics, psychology, and sociology were reviewed using a matrix method. 1

A dichotomy surrounding dying with dignity emerged from this review. The definition of dignity in dying identifies not only an intrinsic, unconditional quality of human worth, but also the external qualities of physical comfort, autonomy, meaningfulness, usefulness, preparedness, and interpersonal connection. For many elderly individuals, death is a process, rather than a moment in time, resting on a need for balance between the technology of science and the transcendence of spirituality.
A focus group for caregivers of hospice patients with severe dyspnea
Authors: Moody Linda E. , Webb Mary , Cheung Robyn , Lowell Janice
Published: May 2006

The use of focus groups has grown in all aspects of our society, including the areas of politics and business. More recently, clinical research investigators have begun using focus groups to acquire important information from potential study subjects, such as patients and caregivers. Researchers use focus groups to help them design and test data collection measures, assess responses to proposed interventions, and obtain guidance on recruitment and retention methods for clinical trials. This report explains the basic requirements and methods for conducting focus groups. The authors conducted a focus group study based on six former caregivers of hospice patients with severe dyspnea. The paper describes the results of this study and illustrates how caregivers assisted in evaluating potential interventions for dyspnea, which will be tested in a future clinical trial. Subsequently, the researchers used the focus group data to adapt the guided-imagery intervention to the lifestyle and culture of the study subjects and their caregivers.
Institutional patterns of symptomatic medication in hospitalized patients with advanced cancer
Authors: Panico Kevin , Manfredi Paolo
Published: May 2006

Although standards for palliative treatment of cancer patients at end of life are available, their use is perceived to vary among institutions depending on the prevailing philosophy of care. In this retrospective study, we reviewed the treatment of dying cancer patients receiving intravenous morphine transferred from a cancer center to a palliative care hospital. We recorded the dose of morphine and the use of other palliative medications, including adjuvant analgesic drugs. Although morphine doses tended to decrease after the transfer, the use of palliative medications was similar in the two institutions.
Telehospice in Michigan: Use and patient acceptance
Authors: Whitten Pamela , Doolittle Gary , Mackert Michael
Published: May 2006

Telehospice, the use of telemedicine technologies to provide services to hospice patients, offers an innovative solution to the challenges of providing high-quality, cost-effective end-of-life care. Specifically, the technology allows caregivers to transmit video images of patients, which provide off-site nurses with the information they need to assist the caregiver. Our telehospice project was conducted in urban and rural Michigan between 2000-2002 and collected data from 187 patients receiving telehospice services in their homes during this study. Overall, nurses were the primary providers of telehospice services and initiated the majority of routine televisits. Often, patients who described themselves as “overwhelmed” at the time of enrollment declined telehospice. However, patients were extremely satisfied with telehospice and often expressed frustration that nurses did not use the telehospice equipment more frequently.
Hospice referral decisions: The role of physicians
Authors: Sanders Brenda S. , Burkett Tracy L. , Dickinson George E. , Tournier Robert E.
Published: May 2006

In our study, we collected and evaluated the opinions of physicians in the Lowcountry of South Carolina (Berkeley, Charleston, and Dorchester counties) regarding their referrals to hospice programs and the extent of influence that their patients and families had on the decision. The research questionnaire was sent to 362 physicians who made referrals to hospice (53 percent response rate) and to 337 physicians who did not make referrals (40 percent response rate). Results revealed that medical doctors take the initiative in referrals. They felt that late referrals were due to reluctance on the part of the patient and the patient’s family to admit that death was imminent. No differences were found in age, sex, medical specialty, percent of terminally ill patients per practice, or initiative taken. However, when the age and sex of physicians were evaluated, a statistically significant difference was found; females younger than 45 years of age were more likely to make referrals than younger males. Younger physicians were more likely to perceive that the family’s reluctance to admit that death was near was a barrier to hospice referrals.
Reduction of edema of lower extremities by subcutaneous, controlled drainage: Eight cases
Authors: Clein Lawrence J. , Pugachev Eglee
Published: May 2006

This paper discusses the pathophysiology and modern treatment of edema. Dissatisfied with the treatment available, the authors report on the use of a closed, controlled drainage procedure in eight patients with severe edema of the lower limbs. It is important to note that this technique is used as a palliative procedure. Seven out of the eight patients considered the procedure to have been worthwhile, experienced improvement, and died comfortably.

Apart from actual pain and consequent insomnia, the discomfort and misery produced by the constant leaden drag of the paralyzed, inflexible, and bolster-like limbs are important factors in the sum total of misery produced by the disease. 1

W. Sampson Handley, 1908 1
The use of music in facilitating emotional expression in the terminally ill
Authors: Clements-Cortés Amy
Published: May 2006

The expression and discussion of feelings of loss and grief can be very difficult for terminally ill patients. Expressing their emotions can help these patients experience a more relaxed and comfortable state. This paper discusses the role of music therapy in palliative care and the function music plays in accessing emotion. It also describes techniques used in assisting clients to express their thoughts and feelings. Case examples of three in-patient palliative care clients at Baycrest Centre for Geriatric Care are presented. The goals set for these patients were to decrease depressive symptoms and social isolation, increase communication and self-expression, stimulate reminiscence and life review, and enhance relaxation. The clients were all successful in reaching their individual goals.
Companion animals in palliative care: Stories from the bedside
Authors: Geisler Annette M.
Published: May 2006

Research has shown that a companion animal or pet can help a person better cope with stressful life events, prevent loneliness, decrease depression, improve activities of daily living (ADLs), and increase social interactions. Pets in nursing homes have been associated with decreased psychotropic medication usage and a greater than 50 percent reduction in healthcare costs. Despite research in other areas of healthcare, there is limited data concerning the use of companion animals in palliative care. This article presents an overview of companion-animal-associated medical research as well as patient stories that illustrate the roles of companion animals in end-of-life care.
Hospice pharmaceutical cost trends
Authors: Nowels David , Kutner Jean S. , Kassner Cordt , Beehler Connie
Published: May 2006

Hospices are required to provide pharmaceuticals under the Medicare Hospice Benefit. Since there are no data describing these costs for hospice programs, this study analyzes data from a cross-sectional survey of 34 hospices concerning their pharmaceutical cost trends. Most respondents reported higher pharmaceutical-related costs between 1998 and 2002, but a significant minority reported that their costs had decreased. Pharmaceutical costs varied by patient setting, but long-acting opioids and continuous-infusion delivery systems were the two most significant contributors. A variety of mechanisms were employed to control drug costs.
Radiopharmaceuticals for palliation of painful osseous metastases
Authors: Smith Howard , Navani Annu , Fishman Scott M.
Published: May 2006

Bone metastases represent the most common etiology of pain for patients with advanced cancer. In the United States, the most common treatment for pain caused by bone metastases in late-stage cancer cases is external beam radiotherapy in conjunction with opioids. An alternative or adjuvant to external radiotherapy is intravenous radiopharmaceutical treatment. This review explores the pros and cons of different radiopharmaceutical options, their advantages over traditional external beam radiotherapy, and the conditions for optimal efficacy.
Pastoral care, spirituality, and religion in palliative care journals
Authors: Hermsen Maaike A. , ten Have Henk A.M.J.
Published: May 2006

With the growth and development of palliative care, interest in pastoral care, spirituality, and religion also seems to be growing. The aim of this article is to review the topic of pastoral care, spirituality, and religion appearing in the journals of palliative care, between January 1984 and January 2002.
Communication in palliative medicine: A pilot study of a problem list to capture complex medical information
Authors: Walsh Declan , Zhukovsky Donna S.
Published: May 2006

We developed a one-page, structured problem list to facilitate communication of complex patient information in palliative medicine. The problem list was developed to provide a concise record of the complex problems presented by patients with advanced disease. It was also seen as a mechanism to facilitate interdisciplinary and multidisciplinary communication and continuity of care in the hospital and in the community. One hundred consecutive patients, who were newly referred to our palliative medicine program, were prospectively surveyed to gain clinical experience with the problem list. Ninety patients had cancer diagnoses. The median age was 69 (range 20-90 years), the male to female ratio was 2:1, and the median Eastern Cooperative Oncology Group (ECOG) performance status was 3 (range 0-4). The population was 78 percent Caucasian. The median number of symptoms per patient was 5 (range 0-13), which was similar for cancer and noncancer patients. Overall, gastrointestinal symptoms and pain were the most common symptoms. Pain was more common in cancer patients, and respiratory problems were the most common among noncancer patients. Noncancer patients had better performance status. Based on this experience, we believe a problem list facilitates succinct communication of complex patient information essential to optimal patient care. Proposed modifications are discussed.
Identifying barriers to psychosocial spiritual care at the end of life: A physician group study
Authors: Chibnall John T. , Bennett Mary Lou , Videen Susan D. , Duckro Paul N. , Miller Douglas K.
Published: May 2006

Objective. The recent literature addresses the need to improve care for dying patients. The purpose of this study was to identify barriers to the psychosocial spiritual care of these patients by their physicians. Psychosocial spiritual care is defined as aspects of care concerning patient emotional state, social support and relationships, and spiritual well-being. The study was an exploratory means for generating hypotheses and identifying directions for interventions, research, and training in care for the dying.

Design and participants. The study used a qualitative group discussion format. Seventeen physicians at a university-based health sciences center representing 10 areas of medical specialty—including internal medicine, oncology, pediatrics, and geriatrics—met in two groups for 20 75-minute discussion sessions over the course of one year. Discussions were recorded, analyzed, and categorized.

Results. Barriers to psychosocial spiritual care were grouped into three domains and seven themes. The cultural domain included the themes of training, selection, medical practice environment, and debt/delay. Participants believed that medical selection and training combine to marginalize psychosocial spiritual approaches to patient care, while the practice environment and debt/delay augment emotional isolation and dampen idealism. The organizational domain included the themes of dissatisfaction and time/busyness. Physicians indicated that the current reimbursement climate and time pressures contribute to dissatisfaction and the tendency to avoid patient psychosocial spiritual issues. The clinical domain included the theme of communication. Physicians were concerned about their ability to communicate nonmedical issues effectively and manage the patient’s reactions and needs in the psychosocial spiritual arena.

Conclusions. This study suggests that research and educational approaches to improving the psychosocial spiritual care of the dying by physicians should address barriers at the cultural, organizational, and clinical levels. Suggestions for interventions at various levels are offered.
Hematology in palliative medicine
Authors: Davis Mellar P.
Published: May 2006

Advanced cancer and life-limiting chronic nonmalignant diseases are associated with a number of hematological problems. Anemia and coagulation disorders, principally venous thrombosis and thrombocytopenia, are most commonly observed. Patients undergoing chemotherapy and bone marrow transplant have unique problems that include neutropenias and chemotherapy-induced drug toxicities, which will not be covered in this article.
The use of motion sickness bands to control nausea and vomiting in a group of hospice patients
Authors: Wright Leonard D.
Published: May 2006

Objective: To explore the potential benefits of using motion sickness bands (MSBs) to control nausea and vomiting in a hospice-based patient population.

Methods: A nonblinded, yearlong observational study.

Results: From February 2003 to February 2004, 33 patients entered into the study. The mean age of the study cohort was 67 years, with a predominance of females to males and cancer as the most common admitting diagnosis. Twenty-nine of the 33 patients studied showed a positive response to the intervention for a response rate of 88 percent.

Conclusions: MSBs demonstrated efficacy in controlling nausea and vomiting in a group of hospice patients. Added benefits of patient empowerment and financial savings also were noted. Further study is warranted.
Modafinil to treat fatigue in amyotrophic lateral sclerosis: An open label pilot study
Authors: Carter Gregory T. , Weiss Michael D. , Lou Jau-Shin , Jensen Mark P. , Abresch R. Ted , Martin Tara K. , Hecht Thomas W. , Han Jay J. , Weydt Patrick , Kraft George H.
Published: May 2006

An open label trial of modafinil was conducted to determine whether it would be tolerated and effective in treating fatigue for people with amyotrophic lateral sclerosis (ALS). Fifteen patients with ALS were treated for two weeks with either 200 mg or 400 mg of modafinil. Reported side effects of the medication were mild and included diarrhea, headache, nervousness, and insomnia. Side effects did not result in any study dropouts. Following treatment, mean scores on the Fatigue Severity Scale (FSS) decreased from 51.3 (SD 9.2) to 42.8 (SD 10.2). On the Epworth Sleepiness Scale (ESS), mean scores decreased from 8.2 (SD 2.0) to 4.5 (SD 2.4). Reductions in both the FSS and the ESS were significant at p < 0.001. Mean scores on the self-report version of the Functional Independence Measure (FIM-SR) increased from 115.2 (SD 5.6) to 118.1 (SD 5.4), with p < 0.01. This pilot study suggests that modafinil is well-tolerated and may reduce symptoms of fatigue in ALS. Further blinded, controlled studies of modafinil in larger numbers of ALS patients are warranted.
The quality of life of hospice patients: Patient and provider perceptions
Authors: Steele Linda L. , Mills Beth , Hardin Sonya R. , Hussey Leslie C.
Published: May 2006

The purposes of this study were to describe the quality of life (QOL) of terminally ill patients in a home-based hospice program and to examine the relationship between QOL data and patients’ symptom distress, ability to function, interpersonal communication (support from family and friends), well-being (their affairs in order), and transcendence (religious comfort/support) as recorded in their charts. QOL was measured by the Missoula-Vitas Quality of Life Index (MVQOLI), an instrument designed specifically for use with terminally ill patients. The study was conducted over a three-year period with 129 terminally ill patients enrolled in a home-based hospice program of care. The MVQOLI was administered to patients within 20 days of their admission to hospice. A retrospective chart review was conducted to determine patients’ levels of symptom distress, ability to function, social support, whether or not their affairs were in order, and religious comfort/support.

The mean age of participants in this study was 67, with 54.3 percent male and 45.7 percent female. Cancer was the primary diagnosis for 92.2 percent of the sample, and 35 percent of these patients had a diagnosis of lung cancer. Of the 7.8 percent non-cancer diagnoses, five were diagnosed with AIDS, four with chronic obstructive pulmonary disease, and one with chronic heart failure.

The results of this study revealed positive scores on the five dimensions of the MVQOLI QOL scale, indicating that within 20 days of admission to hospice, patients rated their QOL as good to very good. Data obtained from the chart review also indicated that patients did not experience a great deal of symptom distress (e.g., pain, nausea, shortness of breath, and restlessness). A significant correlation existed between age and QOL; number of interventions and pain levels; and marital status, well-being, interpersonal relationships, and transcendence. Shortness of breath and well-being were significantly correlated with QOL. There was no significant correlation between gender, race, or closeness to death and the five dimensions of the MVQOLI and chart review assessments.
A self-care plan for hospice workers
Authors: Jones Sally Hill
Published: May 2006

Caring for dying patients and their families is a fulfilling, enriching, and meaningful experience. It can also be extremely stressful. Maintaining the balance between the output and input of energy in a caregiver’s professional and personal life is an ongoing process. Clinical staff members often formulate plans of care for patients. To prevent worker burnout, hospice caregivers must develop a plan of self-care to balance their own needs with the needs of their patients.

The goal of this article is to provide an overview of ways for hospice care-givers to relieve stress and develop an individualized self-care plan within the context of their work.
Deep vein thrombosis (DVT) in advanced cancer patients with lower extremity edema referred for assessment
Authors: Kirkova Jordanka , Oneschuk Doreen , Hanson John
Published: May 2006

Lower extremity edema is a common complication in advanced cancer patients, and deep vein thrombosis (DVT) is one among many causes. Clinical signs and symptoms are known to be unreliable, and radiographic investigations are often required in diagnosing DVT. A retrospective chart review was conducted on 46 advanced cancer patients with lower extremity edema. Researchers analyzed 52 venous duplex scans to determine the radiographic incidence of DVT, the reliability of other clinical signs and symptoms in diagnosing DVT, apart from leg edema, and to assess other potential causes of lower extremity edema and their correlation to DVT. Twenty-three (44 percent) of 52 scans were positive for DVT. The most common presentation of edema in the patients with positive scans was bilateral asymmetric edema (11/23, 48 percent). There was limited documentation of other clinical signs and symptoms suggesting DVT. Other variables such as serum albumin (p = 0.46) and creatinine (p = 0.11) were not statistically different in patients who had positive and negative scans. Of other potential causes of lower extremity edema, such as previous surgery, radiotherapy, tumor, or lymph node compression, a number of patients had a coexisting DVT with bilateral asymmetric edema as the most common presentation. The results of this study suggest that advanced cancer patients with bilateral asymmetric lower extremity edema of potentially multifactorial origin have a high incidence of DVT.
Clinical indicators of treatment futility and imminent terminal decline as discussed by multidisciplinary teams in long-term care
Authors: Travis Shirley S. , Moore Sharon , Larsen Pamala D. , Turner Michael
Published: May 2006

Focus group methodology was used to describe how members of multidisciplinary teams in long-term care facilities recognize when residents are approaching end-stage disease, document evidence that associated treatment futility has occurred, and convey this information to the residents, each other, and family members. In addition to the typical clinical indicators of treatment futility found in the literature (e.g., recurrent infections, weight loss, falls, functional decline), team members described a set of physical and affective changes that were apparent to them as their residents approached trajectories of imminent terminal decline. While more difficult to quantify and measure, these other indicators have a significant impact on the ways that team members assess and interpret a person’s survival potential. Using these indicators of both treatment failure and imminent decline requires knowledge of a resident’s history, clinical condition, course of care, and individual idiosyncrasies. Together, the indicators offer important cues that are needed for the identification of persons who might benefit from earlier transitions to palliative care.
Hyperalgesia and opioid switching
Authors: Mercadante Sebastiano , Arcuri Edoardo
Published: May 2006

Opioids, intended to abolish pain, can unexpectedly produce hyperalgesia, particularly during rapid opioid escalation. Opioid switching could be a therapeutic option in a condition of opioid-induced tolerance or hyperalgesia, but conversion ratios between opioids are difficult to apply in this context and require strict surveillance and expertise.

This situation is challenging, because the rapid escalation of opioid doses, possibly due to the development of opioid-induced tolerance, can cause hyperalgesia. To avoid this adverse effect, clinicians need to refine their assessment of pain treatment and consider opioid switching. The authors present a case report in which switching from fentanyl to methadone was effective in a patient who developed hyperalgesia as a consequence of a rapid opioid escalation. Regardless of the expected clinical improvement of opioid switching using lower doses of the second opioid, the final dose of the second opioid was exaggeratedly low, probably as a consequence of the disappearance of hyperalgesia induced by the first opioid.

The results of this case and others like it may help practitioners develop a meaningful approach during opioid escalation, possibly anticipating the need for opioid switching or other alternative measures for patients with uncontrolled cancer pain.
The therapeutic application of melatonin in supportive care and palliative medicine
Authors: Mahmoud Fade , Sarhill Nabeel , Mazurczak Miroslaw A.
Published: May 2006

Melatonin is a hormone produced mainly in the pineal gland. Plasma levels exhibit a circadian variation with the highest concentration occurring at night. The human biologic effects of melatonin depend upon the time of day it is made available. One of these effects is the setting and resetting of circadian clocks (chronobiotic effect). Additionally, it may be a potent antioxidant and immunomodulator and has been shown to have anti-tumor, anticytokine, anti-insomnia, and anticachexia effects. Melatonin has also been shown to improve survival and performance status in patients with advanced cancer. Objective tumor response occurs with melatonin alone or when combined with interleukin-2 (IL-2). Further, melatonin reduces radiation- and chemotherapeutic-induced toxicity. Symptomatic and circadian disruption is linked to increased cancer risk. The chronobiotic capacity of melatonin to reset circadian clocks may provide a verifiable strategy to reduce cancer risk and enhance quality of life by diminishing cancer-induced circadian disruption.
Dying dementia patients: Too much suffering, too little palliation
Authors: Aminoff Bechor Zvi , Adunsky Abraham
Published: May 2006

Patient suffering is a pathological syndrome traditionally viewed as encompassing psychological distress, spiritual concerns, and various aspects of physical pain. There is insufficient clinical evidence for suffering in dying dementia patients, which may lead to inappropriate evaluation and insufficient palliative treatment. Our objective was to evaluate the suffering of terminal dementia patients over time, from admission to a geriatric ward to the last day of life. The study included consecutive end-stage dementia patients in a general geriatric department of a tertiary hospital. Patients were evaluated weekly by the Mini Suffering State Examination scale (MSSE) which measures many domains related to suffering. Seventy-one patients were studied. Mean survival of patients was 38.0 ± 5.1 days. MSSE increased during hospital stay from 5.62 ± 2.31 to 6.89 ± 1.95 (p < 0.001). According to MSSE scale, 63.4 percent and 29.6 percent of patients died with a high and intermediate level of suffering, respectively. Only 7 percent of the patients died with a low level of suffering. In particular, patients were restless (p < 0.001), had pressure sores (p = 0.01), and were considered medically unstable (p < 0.001). We concluded that, despite traditional medical and nursing care, a large proportion of dying dementia patients experience an increasing amount of suffering as they approach death. New palliative treatment approaches should be developed for these patients.
Hospice and palliative care: An educational intervention for healthcare professionals in a rural community
Authors: Kaufman Jemery , Forman Walter B.
Published: May 2006

The purpose of the study was to increase the awareness and availability of hospice care in rural communities. In Taos, New Mexico, a community of about 30,000 people, we developed an educational intervention that introduced the topic of end-of-life care and hospice to their healthcare professionals. We targeted nurses, physicians, and other related health-care professionals. The nurses and allied health professionals received a half-day seminar. The physicians attended a grand round about hospice and palliative care lead by the local hospice medical director. This individual was an important member of the local medical staff and was certified in hospice and palliative medicine. After the intervention, we were able to demonstrate an increase in the hospice annual census by 85 percent (p < 0.001). Average length of stay was not altered (27.3 percent enrolled for six days or less preintervention, 29.5 percent enrolled for six days or less postintervention; p = 0.97). Similarly, the number of patients admitted with a non-cancer diagnosis was not affected (54.6 percent preintervention, 44.3 percent postintervention; p = 0.34). We concluded that the educational intervention significantly increased the number of patients referred for hospice care. However, it did not affect the length of stay or increase enrollment for people with a non-cancer diagnosis. The educational intervention was inexpensive, locally run, and very effective as demonstrated by the increase in hospice referrals. Exporting the model to other rural sites appears to be feasible.
Building successful coalitions to promote advance care planning
Authors: Marchand Lucille , Fowler Kathryn J. , Kokanovic Obrad
Published: May 2006

This qualitative study explored the challenges and successes of an advance care planning (ACP) coalition formed at the University of Wisconsin called Life Planning 2000. Data were obtained from key informant interviews (n = 24) and grounded theory. Major themes included commitment (the need for leadership, recruitment of key persons, and funding); cohesiveness (disparate groups collaborating toward a common purpose); and outcomes (including educational tool development). Coalitions need to define short-, intermediate-, and long-term goals that result in measurable outcomes and an evaluation process. Resources must be commensurate with goals. Results indicate that strong leadership, paid staff, adequate funding, and the collaboration of diverse groups working toward a common goal are essential if a coalition promoting end-of-life (EOL) care planning is to be successful.
A prospective randomized controlled clinical trial of zoledronic acid for bone metastases
Authors: Mystakidou Kyriaki , Katsouda Emmanuela , Parpa Efi , Kouskouni Evangelia , Chondros Costas , Tsiatas Marinos L. , Galanos Antonis , Vlahos Lambros
Published: May 2006

In this study, we assessed the safety, tolerability, and effectiveness of two therapeutic regimens relating to the frequency of zoledronic acid (ZOL) infusion. Sixty adult patients with bone metastases were randomly assigned to two study groups. The first group (group A) received 4 mg ZOL every two weeks, and the second group (group B) received 4 mg ZOL every four weeks. Assessment measures included C-telopeptide (CTX) rate, the Greek Brief Pain Inventory (GBPI), the linear analogue scale assessment (LASA) of quality of life, and biochemical markers. Assessments were made at weeks 12, 24, 36, and 48. Clinical endpoints included effective decrease in bone resorption markers, pain relief, and improvement of mobility status. The follow-up period was 48 weeks. No statistically significant differences between groups A and B were found in overall profile of biochemical markers, Eastern Cooperative Oncology Group (ECOG) performance status, and GBPI score at the end of the follow-up period. Assessment of bone metastases revealed a slight difference between the two groups, however this difference was not statistically significant. These findings indicate that administering zoledronic acid at four rather that two weeks has no significant impact on overall outcome.
St.Joseph's hospice and the role of the social worker
Authors: Pollock Larry D. , Pollock Martha Isacson
Published: May 2006

This article was written after interviewing Shirley Richards, a social worker at St. Joseph's Hospice, London, England. It briefly describes St. Joseph's hospice and its treatment team and, in more depth, discusses the role and necessaty qualifications of social workers there. The authors appreciate Richards' assistance in the development of this article.
Hospice patients without caregivers
Authors: Holman Mary
Published: May 2006

A report of this research was made at the Annual Meeting of the National Hospice Organization, October 1985.

The projectwas supported by the USAdministration on Aging, The Philip Graham Fun4 The Community Foundation and Westmoreland United Church of Christ.
Taking care of the caregiver
Authors: Daleo Roxanne E.
Published: May 2006

Over the past decade, the daily pressures for the hospice team member have escalated as the demands to meet patient needs became more intense. Identifying strategies to successfully cope with this high stress job is not only a logical approach, it is now a necessity for improving one's physical and psychological well-being. Education in stress reduction begins with self-care. Ifwe can learn to heal ourselves, we will more effectively heal our patients. Healing beyond the physical sense.
Analysis of a Hospital-Based Hospice Program For Terminally Ill Cancer Patients
Authors: Lyons John S. , Silberman Margaret , Hammer Jeffrey S. , Johns Judith
Published: May 2006

The present paper describes a program analysis of a hospitalbased program for terminally ill cancer patients. Using a management information system developed for collaborative use across all psychosocial care providers in the hospital, it was possible to detail program characteristics and patient variables important to the understanding of a complex program.
An approach to hospice program evaluation
Authors: Richie Nicholas D.
Published: May 2006

In an attempt to suggest a generalized approach to hospice program evaluation, the “structure-process-outcome” framework for assessing quality care, about which Dr. Avedis Donabedian has written extensively is applied to hospice settings. Examples of variables depicting hospice structure, process and outcome are presented, along with examples of their measurement. Refinements of this approach, requiring analysis of the interaction among such variables and identification of causal relationships among them, are suggested as areas for future development.
Creation and evolution of the hospice staff support group: Lessons from four long-term groups
Authors: Hunsberger Peter
Published: May 2006

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.
The role of the hospice social worker
Authors: Quig Lois
Published: May 2006

This paper describes the principal contributions of the hospice social worker. It enumerates professional duties of the social worker and the components of the family assessment. It describes the roles and responsibilities of the social worker asa member of the interdisciplinary hospice team.
Hospice day care
Authors: Thompson Barbara
Published: May 2006

Hospice day care is a cost-effective way to expand the range of services available to hospice patients and families. Additionally, day care can increase continuity of care between in-patient and homecare settings, and-ease the burden of responsibility on the homecare component of hospice.
Self-esteem and hospice: Applying principles to practice
Authors: Korda Lois J. , Pancrazio James J.
Published: May 2006

Maintenance of a healthy degree of self-esteem is essential to the goal of helping patients and their significant others to live as fully as possible. It is important for hospice caregivers to be aware of factors which tend to diminish self-esteem in hospice care recipients as well as in themselves. A knowledge of basic principles about self-esteem and the application of interventions based on these principles can aid in the preservation and enhancement of self-esteem in hospice caregivers and recipients.
Regulations vs. ideals: A case history of a hospice closure
Authors: Bulkin Wilma , Wald Florence , O'Brien-Butler Jean
Published: May 2006

The cost of health care and health insurance and the increasing number of Americans without access to basic health services has become a primary issue in today' society. Leading politicians, economists, planners, and private individuals recognize the essential need to re-design the system and provide coverage to all Americans. However; the history ofprograms strangling in the red tape created by inflexible regulatory efforts to set standards, monitor performance, and control costs, therebydenying access to individuals they were specifically designed to serve, points to the need for an equally new approach to planning such a system. The authors have attempted to illustrate, through the case history of the closure of a hospice serving a poor socioeconomic area of New York City, the need for government regulators, program planners, and caregivers to recognize and define common goals and develop flexible and cooperative working relationships.
The hospice volunteer: A person of hospitality
Authors: Welk Thomas A.
Published: May 2006

Volunteers are integral members of the hospice interdisciplinary team. They are distinguished from other members of the team only by role, not by expectation. The distinction is not between “volunteer” and “ professional, “because every team member is to be professional in the best sense of that word. Ifa distinction is to be made, it is that some hospice staff members are salaried while others donate their services. Volunteer staff members are expected to be as responsible and accountable asevery othermember of the team. ALL staff members must realize the importance of taking care ofpersonal needs in order to be able to care for others. Even though the following article deals primarily with the volunteer hospice staff member the points outlined canjust aseasily be applied to the salaried staff member