Palliative Care for Non-cancer Patients

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Publisher :
ISBN 13 :
Total Pages : 328 pages
Book Rating : 4.3/5 (91 download)

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Book Synopsis Palliative Care for Non-cancer Patients by : Julia M. Addington-Hall

Download or read book Palliative Care for Non-cancer Patients written by Julia M. Addington-Hall and published by . This book was released on 2001 with total page 328 pages. Available in PDF, EPUB and Kindle. Book excerpt: The specialty of palliative care has traditionally grown out of oncology and there has been little research into the needs of patients dying from causes other than cancer. Few non-cancer patients receive hospice in-patient, home care or day care although a good proportion of hospices say that their services are available to non-cancer patients. As a result, the importance of palliative care for non-cancer patients is now being increasingly recognized internationally, and in the UK a committee reporting to the Department of Health recommended that palliative care should be accessible to all patients who need such care. Palliative Care for Non-Cancer Patients considers the needs and experiences of patients dying from, for example, stroke, heart disease or dementia by,drawing on a range of disciplines and specialties in medicine. The provision of palliative care for patients dying from causes other than cancer raises a number of important questions for policy makers and purchasers. This book summarizes what is known about the needs of and appropriate service provision for people dying of causes other than cancer and begins to set a research agenda.

Palliative Care in Non-Cancer Patients

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Author :
Publisher : Leya
ISBN 13 : 9725406389
Total Pages : 157 pages
Book Rating : 4.7/5 (254 download)

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Book Synopsis Palliative Care in Non-Cancer Patients by : Manuel Luís Capelas;Gwyther (ed.)

Download or read book Palliative Care in Non-Cancer Patients written by Manuel Luís Capelas;Gwyther (ed.) and published by Leya. This book was released on 2019-03-14 with total page 157 pages. Available in PDF, EPUB and Kindle. Book excerpt: This is the first of two volumes dedicated to palliative care for patients with non-cancer diseases, to help health professionals, students and society in general, to find strategies to provide better care to these patients. Were invited professionals and researchers of recognized international merit, who have collaborated with the Universidade Católica Portuguesa in the training in palliative care of our students. In this first volume, we will address the interventions among patients with progressive neurological disease, AIDS and the critical patient (emergency and intensive care). In the second issue, we will cover palliative care in patients with chronic heart, respiratory and renal disease. Manuel Luís Capelas, PhD, Assistant Professor at the Institute of Health Sciences of UCP and Codirector of the Portuguese Observatory for Palliative Care This work is a relevant and timely contribution in strengthening knowledge about Palliative Care in groups of patients traditionally excluded from our services, such as those with non-cancer and degenerative diseases, but including those who use services as diverse as intensive care and emergency services. It is important, on this occasion, to leave a word of deep thanks and appreciation to the experts involved in the preparation of this book. Duarte Soares, President of the Portuguese Association for Palliative Care

Palliative Care in Oncology

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Publisher : Springer
ISBN 13 : 3662462028
Total Pages : 302 pages
Book Rating : 4.6/5 (624 download)

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Book Synopsis Palliative Care in Oncology by : Bernd Alt-Epping

Download or read book Palliative Care in Oncology written by Bernd Alt-Epping and published by Springer. This book was released on 2015-03-26 with total page 302 pages. Available in PDF, EPUB and Kindle. Book excerpt: Palliative care provides comprehensive support for severely affected patients with any life-limiting or life-threatening diagnosis. To do this effectively, it requires a disease-specific approach as the patients’ needs and clinical context will vary depending on the underlying diagnosis. Experts in the field of palliative care and oncology describe in detail the needs of patients with advanced cancer in comparison to those with non-cancer disease and also identify the requirements of patients with different cancer entities. Basic principles of symptom control are explained, with careful attention to therapy for pain associated with either the cancer or its treatment and to symptom-guided antineoplastic therapy. Complex therapeutic strategies for palliative cancer patients are highlighted that involve both cancer- and symptom-directed options and address a range of therapeutic aims. Issues relating to drug use in palliative cancer care are fully explored, and a separate section is devoted to care in the final phase. A range of organizational and policy issues are also discussed, and the book concludes by considering likely future developments in palliative care for cancer patients. Palliative Care in Oncology will be of particular interest to palliative care physicians who are interested in broadening the scope of their disease-specific knowledge, as well as to oncologists who wish to learn more about modern palliative care concepts relevant to their day-to-day work with cancer patients.

Palliative Care in Non-Cancer Patients

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Publisher : Leya
ISBN 13 : 9725406591
Total Pages : 121 pages
Book Rating : 4.7/5 (254 download)

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Book Synopsis Palliative Care in Non-Cancer Patients by : Tara;Schulz Lohmann

Download or read book Palliative Care in Non-Cancer Patients written by Tara;Schulz Lohmann and published by Leya. This book was released on 2019-11-11 with total page 121 pages. Available in PDF, EPUB and Kindle. Book excerpt: According the Worldwide Palliative Care Alliance, Stephen Connor and Xavier Gomez-Batiste, the heart failure, the chronic lung disease (namely the chronic obstructive pulmonary disease) and the end-stage renal disease are, respectively, the first, third and sixth disease which the people with palliative care need are more prevalent. This, second of two books dedicated to palliative care for non-cancer patients aims to help health professionals, students and society in general, to find strategies to provide the best possible care to patients and their families. Namely, in this book, we approach the intervention to improve the quality of life of the patients who live with chronic heart, lung or kidney disease. The authors are professionals and researchers of recognized international merit, who have collaborated with the Universidade Catolica Portuguesa in the training in palliative care of its students. Manuel Luis Capelas, PhD Assistant Professor at the Institute of Health Sciences of UCP and Codirector of the Portuguese Observatory for Palliative Care Palliative This work is a relevant and timely contribution in strengthening knowledge about Palliative Care in groups of patients traditionally excluded from our services, such as those with organ failure. It is important, on this occasion, to leave a word of deep thanks and appreciation to the experts involved in the preparation of this book. Duarte Soares President of the Portuguese Association for Palliative Care

Palliative Care for Chronic Cancer Patients in the Community

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Publisher : Springer Nature
ISBN 13 : 3030545261
Total Pages : 566 pages
Book Rating : 4.0/5 (35 download)

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Book Synopsis Palliative Care for Chronic Cancer Patients in the Community by : Michael Silbermann

Download or read book Palliative Care for Chronic Cancer Patients in the Community written by Michael Silbermann and published by Springer Nature. This book was released on 2020-10-29 with total page 566 pages. Available in PDF, EPUB and Kindle. Book excerpt: The new global cancer data suggests that the global burden has risen to 18.1 million new cases per year and 9.6 million cancer deaths per year. A number of factors appear to be driving this increase, in particular, a growing and aging global population and an increase of exposure to cancer risk factors linked to social and economic development. For rapidly-growing economies, the data suggests a shift from poverty- or infection-related cancers to those associated with lifestyles more typical in industrialized countries. There is still large geographical diversity in cancer occurrence and variations in the magnitude and profile of the disease between and within world regions. There are specific types of cancer that dominate globally: lung, female breast and colorectal cancer, and the regional variations in common cancer types signal the extent to which societal, economic and lifestyle changes interplay to deferentially impact on the profile of this most complex group of diseases. Unfortunately, despite advances in cancer care, a significant proportion of patients at home, experience sub-optimal outcomes. Barriers to successful treatment outcomes include, but are not limited to: access to oncologists in the primary health centers, non-adherence, lack of experienced oncology and palliative care nurses in the community, inadequate monitoring and the lack of training of family and pediatric physicians. Telemedicine approaches, including telephone triage/education, telemonitoring, teleconsultation and status tracking through mobile applications, have shown promise in further improving outcomes, in particular for chronic cancer patients following their hospitalization. Lessons can be learned from existing hospices in North America, the United Kingdom, Australia, Centers of Excellence in African (Uganda) and modern community services in India (Kerala). An important goal of this book is to describe and encourage professionals to develop new community programs in palliative care, which include training and empowering physicians and nurses in the community on the principles of palliative care. The Middle East Cancer Consortium (MECC) together with the American Society of Clinical Oncology (ASCO) and the American Oncology Nursing Society (ONS) have conducted multiple courses ranging from basic palliative care to more specialized training in palliative care for multiple nationalities in Europe, Asia and Africa. Our experience clearly indicates that, to promote such activities, one needs strong leadership and confirmed political will to support the endeavor. The new book will emphasize the importance of having a core of multiple stakeholders including community leaders, government, NGOs and media to be actively involved in advocating for the cause and generating public awareness. This text will provide the reader with a comprehensive understanding of the outside-of-the-hospital treatment of cancer patients by medical, paramedical and volunteer personnel. In doing so, this text will encourage the creation of new palliative care services improving upon the existing ones and stimulate further research in this field. Part 1 of the text will begin with an overview of the current state of affairs of services provided to cancer patients while being cared for by primary health centers. It will also review the current literature regarding medical and psychological-based therapy options in the community for cancer patients at different stages of their disease. Part 2 will address the unique role of the community nurse, within the framework of the multidisciplinary team treating the patient, in the attempt to provide optimal evaluation and care in very challenging situations (such as with terminal patients). Part 3 will provide insightful models of this new discipline and serve as a valuable resource for physicians, nurses, social workers and others involved in the care of cancer patients. The book will take a multidisciplinary approach, integrating clinical and environmental data for practical management to enhance the efficacy of treatment while relieving suffering. Part 4 will also discuss the application of modern technological approaches to track symptoms, quality of life, diet, mobility, duration of sleep and medication use (including pain killers) in chronic cancer patients in the community. Part 5 of the book will also be devoted to modes of developing a collaborative program between governmental and non-governmental organization sectors. This includes volunteer workers in close collaboration with medical professionals for providing emotional and spiritual support, nursing care, nutritional support and empowering family caregivers. Such a model makes palliative care in the community a “people’s movement”, thus transferring part of the responsibility and ownership to the community.

Cancer Control

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Publisher : World Health Organization
ISBN 13 : 9241547111
Total Pages : 57 pages
Book Rating : 4.2/5 (415 download)

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Book Synopsis Cancer Control by : World Health Organization

Download or read book Cancer Control written by World Health Organization and published by World Health Organization. This book was released on 2007 with total page 57 pages. Available in PDF, EPUB and Kindle. Book excerpt: In 2005, 7.6 million people died of cancer. More than 70% of those deaths occured in low and middle income countries. WHO has developed a series of six modules that provides practical advice for programme managers and policy-makers on how to advocate, plan and implement effective cancer control programmes, particularly in low and middle income countries.The WHO guide is a response to the World Health Assembly resolution on cancer prevention and control (WHA58.22), adopted in May 2005, which calls on Member States to intensify action against cancer by developing and reinforcing cancer control programmes.

Improving Palliative Care for Cancer

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Publisher : National Academies Press
ISBN 13 : 0309074029
Total Pages : 344 pages
Book Rating : 4.3/5 (9 download)

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Book Synopsis Improving Palliative Care for Cancer by : National Research Council

Download or read book Improving Palliative Care for Cancer written by National Research Council and published by National Academies Press. This book was released on 2001-10-19 with total page 344 pages. Available in PDF, EPUB and Kindle. Book excerpt: In our society's aggressive pursuit of cures for cancer, we have neglected symptom control and comfort care. Less than one percent of the National Cancer Institute's budget is spent on any aspect of palliative care research or education, despite the half million people who die of cancer each year and the larger number living with cancer and its symptoms. Improving Palliative Care for Cancer examines the barriersâ€"scientific, policy, and socialâ€"that keep those in need from getting good palliative care. It goes on to recommend public- and private-sector actions that would lead to the development of more effective palliative interventions; better information about currently used interventions; and greater knowledge about, and access to, palliative care for all those with cancer who would benefit from it.

The Comprehensive Cancer Center

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Publisher : Springer Nature
ISBN 13 : 3030820521
Total Pages : 192 pages
Book Rating : 4.0/5 (38 download)

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Book Synopsis The Comprehensive Cancer Center by : Mahmoud Aljurf

Download or read book The Comprehensive Cancer Center written by Mahmoud Aljurf and published by Springer Nature. This book was released on 2021-10-28 with total page 192 pages. Available in PDF, EPUB and Kindle. Book excerpt: This open access book provides a valuable resource for hospitals, institutions, and health authorities worldwide in their plans to set up and develop comprehensive cancer care centers. The development and implementation of a comprehensive cancer program allows for a systematic approach to evidence-based strategies of prevention, early detection, diagnosis, treatment, and palliation. Comprehensive cancer programs also provide a nexus for the running of clinical trials and implementation of novel cancer therapies with the overall aim of optimizing comprehensive and holistic care of cancer patients and providing them with the best opportunity to improve quality of life and overall survival. This book's self-contained chapter format aims to reinforce the critical importance of comprehensive cancer care centers while providing a practical guide for the essential components needed to achieve them, such as operational considerations, guidelines for best clinical inpatient and outpatient care, and research and quality management structures. Intended to be wide-ranging and applicable at a global level for both high and low income countries, this book is also instructive for regions with limited resources. The Comprehensive Cancer Center: Development, Integration, and Implementation is an essential resource for oncology physicians including hematologists, medical oncologists, radiation oncologists, surgical oncologists, and oncology nurses as well as hospitals, health departments, university authorities, governments and legislators.

Suggestions for Addressing Clinical and Non-Clinical Issues in Palliative Care

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Author :
Publisher : BoD – Books on Demand
ISBN 13 : 1839691522
Total Pages : 348 pages
Book Rating : 4.8/5 (396 download)

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Book Synopsis Suggestions for Addressing Clinical and Non-Clinical Issues in Palliative Care by : Marco Cascella

Download or read book Suggestions for Addressing Clinical and Non-Clinical Issues in Palliative Care written by Marco Cascella and published by BoD – Books on Demand. This book was released on 2021-07-21 with total page 348 pages. Available in PDF, EPUB and Kindle. Book excerpt: Data from the World Health Organization indicate that about 40 million people worldwide require palliative care each year. We must face this enormous problem with appropriate welfare policies and training of up-to-date and competent personnel. In this context, a book that collects the experiences of authors with diverse backgrounds, and operating in different settings of palliative care, can be added to the many editorial products on the subject. Over five sections, this volume addresses such topics as palliative care in children, infants, and gynecologic oncology patients; the role of the caregiver; the use of drugs; and ethics, organization, and policy issues. Although this book should not be considered as an exhaustive treatise on palliative care, the many topics covered and the experience and competence of the authors involved make it a useful tool for those who are already experts in the field as well as those who are studying this field.

Dying in America

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Publisher : National Academies Press
ISBN 13 : 0309303133
Total Pages : 470 pages
Book Rating : 4.3/5 (93 download)

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Book Synopsis Dying in America by : Institute of Medicine

Download or read book Dying in America written by Institute of Medicine and published by National Academies Press. This book was released on 2015-03-19 with total page 470 pages. Available in PDF, EPUB and Kindle. Book excerpt: For patients and their loved ones, no care decisions are more profound than those made near the end of life. Unfortunately, the experience of dying in the United States is often characterized by fragmented care, inadequate treatment of distressing symptoms, frequent transitions among care settings, and enormous care responsibilities for families. According to this report, the current health care system of rendering more intensive services than are necessary and desired by patients, and the lack of coordination among programs increases risks to patients and creates avoidable burdens on them and their families. Dying in America is a study of the current state of health care for persons of all ages who are nearing the end of life. Death is not a strictly medical event. Ideally, health care for those nearing the end of life harmonizes with social, psychological, and spiritual support. All people with advanced illnesses who may be approaching the end of life are entitled to access to high-quality, compassionate, evidence-based care, consistent with their wishes. Dying in America evaluates strategies to integrate care into a person- and family-centered, team-based framework, and makes recommendations to create a system that coordinates care and supports and respects the choices of patients and their families. The findings and recommendations of this report will address the needs of patients and their families and assist policy makers, clinicians and their educational and credentialing bodies, leaders of health care delivery and financing organizations, researchers, public and private funders, religious and community leaders, advocates of better care, journalists, and the public to provide the best care possible for people nearing the end of life.

Multidisciplinary Approach to Surgical Oncology Patients

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Publisher : Springer Nature
ISBN 13 : 9811576998
Total Pages : 358 pages
Book Rating : 4.8/5 (115 download)

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Book Synopsis Multidisciplinary Approach to Surgical Oncology Patients by : M. D. Ray

Download or read book Multidisciplinary Approach to Surgical Oncology Patients written by M. D. Ray and published by Springer Nature. This book was released on 2021-03-02 with total page 358 pages. Available in PDF, EPUB and Kindle. Book excerpt: The book covers the basic concept of surgical and oncosurgical disciplines as a whole, as well as the management of surgical patients from pre-op preparation to discharge, i.e., all the basics needed for a successful outcome for oncosurgical patients. It covers surgical safety, the consumer protection act, medico-legal aspects, the importance of documentation, research and publications, and managing complications. The respective chapters cover pre-operative, intra-operative, and ICU management of cancer patients, based on a multi-disciplinary approach. Additionally, they highlight recent advances in surgical oncology and so-called incurable cancers. Edited and written by an interdisciplinary team of experts in oncology and palliative care, the book is intended as a clinically useful guide to the overlapping topics of pain management in cancer patients and the treatment of cancer in patients with multiple co-morbidities like cardiovascular, respiratory disease, hypertension and diabetes mellitus. Given its scope, it will benefit multi-disciplinary oncologists, pain, palliative and intensive care experts, as well as students of surgical disciplines, from MBBS, MS and DNB, to MRCS, MCh and FRCS.

Comprehensive Cervical Cancer Control

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Author :
Publisher : World Health Organization
ISBN 13 : 9241547006
Total Pages : 284 pages
Book Rating : 4.2/5 (415 download)

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Book Synopsis Comprehensive Cervical Cancer Control by : World Health Organization

Download or read book Comprehensive Cervical Cancer Control written by World Health Organization and published by World Health Organization. This book was released on 2006 with total page 284 pages. Available in PDF, EPUB and Kindle. Book excerpt: Most women who die from cervical cancer, particularly in developing countries, are in the prime of their life. They may be raising children, caring for their family, and contributing to the social and economic life of their town or village. Their death is both a personal tragedy, and a sad and unnecessary loss to their family and their community. Unnecessary, because there is compelling evidence, as this Guide makes clear, that cervical cancer is one of the most preventable and treatable forms of cancer, as long as it is detected early and managed effectively. Unfortunately, the majority of women in developing countries still do not have access to cervical cancer prevention programmes. The consequence is that, often, cervical cancer is not detected until it is too late to be cured. An urgent effort is required if this situation is to be corrected. This Guide is intended to help those responsible for providing services aimed at reducing the burden posed by cervical cancer for women, communities and health systems. It focuses on the knowledge and skills needed by health care providers, at different levels of care.

Palliative Care and Rehabilitation of Cancer Patients

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Publisher : Springer Science & Business Media
ISBN 13 : 1461550033
Total Pages : 321 pages
Book Rating : 4.4/5 (615 download)

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Book Synopsis Palliative Care and Rehabilitation of Cancer Patients by : Charles F. von Gunten

Download or read book Palliative Care and Rehabilitation of Cancer Patients written by Charles F. von Gunten and published by Springer Science & Business Media. This book was released on 2012-12-06 with total page 321 pages. Available in PDF, EPUB and Kindle. Book excerpt: Introduction The prevailing model of medical care for patients with cancer emphasizes the curative efforts of medical technology toward the eradication of the disease. Yet the suffering of the patient as a result of both the disease and our efforts to treat it is often overlooked. If we are to improve the survival of patients with cancer, it will be through intensive research into the molecular under pinnings of the disease and clinical trials of new therapies. However, it is essen tial to recognize and address the suffering of cancer patients as they are being treated. It is the purpose of this book to illuminate and advance the preven tion and treatment of suffering as part of the continuum of care for patients with cancer. Fundamental concepts Since the time of Hippocrates in the fifth century B.c., there have been two overall goals for the physician: • Cure of disease • Relief of suffering From our vantage point in the late twentieth century looking back at previ ous centuries, it is easy to observe that, aside from surgery, much of the medical care administered to patients with cancer was aimed at relieving the suffering associated with illness. It wasn't until the concept of disease (as opposed to illness) was elucidated and the scientific method was applied to understand ing and eradicating cancer that significant strides were made to improve the physician's ability to cure cancer.

Palliative Care

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Publisher : CRC Press
ISBN 13 : 1315358573
Total Pages : 133 pages
Book Rating : 4.3/5 (153 download)

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Book Synopsis Palliative Care by : Geoff Mitchell

Download or read book Palliative Care written by Geoff Mitchell and published by CRC Press. This book was released on 2018-05-08 with total page 133 pages. Available in PDF, EPUB and Kindle. Book excerpt: Series Editors: Moira Stewart, Judith Belle Brown and Thomas R Freeman As the population in western cultures ages, more people suffer chronic, ultimately life-limiting diseases and medical professionals need to be equipped to cope with the ever growing pressure of palliative care. This book gives guidance on how to approach patients with life limiting illness. While the problems most people present to the doctor appear relatively straightforward, a whole person approach to understanding the complex interaction between the person, their illness and their environment should lead to a more complete consideration of the illness and better health outcomes. For issues of palliative care, such an approach is essential to identify and meet the many needs of desperately ill people. Palliative Care offers a fresh look at the management of patients. With international, evidence-based contributions, the book suggests practical and challenging ways to care for the dying. It is ideal for all healthcare professionals working in palliative care, General Practitioners and medicine and healthcare students.

Palliative Care in Patients with Noncancer Illness

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Author :
Publisher :
ISBN 13 :
Total Pages : 0 pages
Book Rating : 4.:/5 (133 download)

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Book Synopsis Palliative Care in Patients with Noncancer Illness by : Kieran Lewis Quinn

Download or read book Palliative Care in Patients with Noncancer Illness written by Kieran Lewis Quinn and published by . This book was released on 2021 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: The evidence base for palliative care is heavily skewed toward patients with cancer, despite the fact that there are twice as many patients with palliative care needs and noncancer illness. This thesis seeks to establish the evidence for clinical practice and policy development for palliative care programs to improve end-of-life care. The first study was a systematic review and meta-analysis of randomized clinical trials of patients with primarily noncancer illness. We found that receipt of palliative care, compared with usual care, was significantly associated with less acute healthcare use and modestly lower symptom burden, and no significant difference in quality of life. The second study measured the association between newly initiated palliative care in the last 6 months of life, healthcare use and location of death in a cohort of adults dying from noncancer illness; and compared these associations with those who die from cancer. We found that among those dying of chronic organ failure, palliative care was associated with a reduction in the rate of emergency department use, hospitalizations and ICU admissions. Palliative care was associated with increased rates of emergency department use and hospitalization in patients dying of dementia, which differed depending upon whether they lived in the community or in a nursing home. In our third study, we measured the association between physician rates of referral to palliative care and location of death in hospitalized adults with serious illness, which include patients dying of cancer and noncancer illness. We found that patients who were cared for by physicians with higher rates of referral to palliative care were less likely to die in hospital and more likely to die at home. Standardizing referral to palliative care may help reduce physician-level variation in referral as a barrier to access. Collectively, these thesis findings highlight the potential benefits of palliative care in patients with select noncancer illness and identify further knowledge gaps for other common noncancer illnesses. Scaling existing palliative care to increase access through sustained investment in physician training and current models of collaborative palliative care may improve end-of-life care, which have significant implications for health policy.

Palliative Care for Non-cancer Patients in Ireland

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Author :
Publisher :
ISBN 13 :
Total Pages : 348 pages
Book Rating : 4.:/5 (129 download)

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Book Synopsis Palliative Care for Non-cancer Patients in Ireland by : Norma O'Leary

Download or read book Palliative Care for Non-cancer Patients in Ireland written by Norma O'Leary and published by . This book was released on 2007 with total page 348 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Handbook of Palliative Care in Cancer

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Author :
Publisher :
ISBN 13 :
Total Pages : 604 pages
Book Rating : 4.3/5 (91 download)

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Book Synopsis Handbook of Palliative Care in Cancer by : Alexander Waller

Download or read book Handbook of Palliative Care in Cancer written by Alexander Waller and published by . This book was released on 2000 with total page 604 pages. Available in PDF, EPUB and Kindle. Book excerpt: Practical and comprehensive text on the management of the wide range of symptoms that plague terminal cancer patients * Updates have been made to every chapter to include data from the most current studies * Contains clear, user-friendly format that enables quick access to information * Includes new chapters on principles of palliative medicine, approach to common pain syndromes, and bereaved * Provides more information throughout the book on the care of the family Praise for the First Edition: "The authors have obviously had much experience in this field and have used their experience to develop an easy and logical approach to a patient with a variety of symptoms. This is not a book for detailed background and historical perspectives, but if offers simple and practical advice for those physicians involved in this expanding field of treating terminally ill patients. It provides a simple and logical approach to most problems that arise at this time...it will be difficult to pass up."Anesthesia and Analgesia