The hospice: its meaning to patients and their physicians

A Scoping Review of Perinatal Palliative Care: Allowing Parents to Be Parents

OBJECTIVE

Perinatal palliative care (PPC) is an option for patients who discover that their infant has a life-limiting fetal condition, which decreases the burden of the condition using a multidisciplinary approach.

STUDY DESIGN

This review discusses the landmark literature in the past two decades, which have seen significant growth and development in the concept of PPC.

RESULTS

The literature describes the background, quality, and benefits of offering PPC, as well as the ethical principles that support its being offered in every discussion of fetal life-limiting diagnoses.

CONCLUSION

PPC shares a similar risk profile to other options after life-limiting diagnosis, including satisfaction with choice of continuation of pregnancy. The present clinical opinion closes by noting common barriers to establishing PPC programs and offers a response to overcome each one.

KEY POINTS

· Perinatal palliative care serves patients who continue pregnancies with life-limiting fetal anomaly.. · Perinatal palliative care has a risk profile similar to other options such as termination.. · Health care providers can serve as champions to extend PPC to patients in their region..

Palliative care in pulmonary arterial hypertension: an underutilised treatment

Pulmonary arterial hypertension (PAH) is a condition characterised by increased pulmonary vascular resistance which can lead to right heart failure and premature death. It imposes a significant burden on patients' lives, affecting their physical, emotional and social wellbeing. Pharmacological therapies are the mainstay of treatment; while they are not curative, they can alleviate patient suffering, improve quality of life and delay disease progression. Despite these therapies, disease progresses in a significant number of patients, who are faced with the debilitating symptoms of PAH and treatment adverse effects. Palliative care is focused on providing relief from symptoms caused by a chronic illness. Palliative care aims to improve the health-related quality of life for patients and families, and although it is deemed appropriate at any stage of disease, it is most helpful when explored early in the course of disease. Importantly, palliative care can be provided in concert with pharmacological treatment. Despite its potential benefits, palliative care is frequently underutilised. There is a paucity of clinical studies testing the impact of palliative care in PAH which prompted us to summarise the available evidence, recognise obstacles in its utilisation and identify areas for future research.

Palliative care remains an underutilised treatment option in PAH. This article attempts to highlight its importance in the management of PAH and highlight the barriers faced by both physicians and patients in seeking palliative care.http://ow.ly/quBH30mt9Pl

The significance of lifeworld and the case of hospice

Questions on what it means to live and die well are raised and discussed in the hospice movement. A phenomenological lifeworld perspective may help professionals to be aware of meaningful and important dimensions in the lives of persons close to death. Lifeworld is not an abstract philosophical term, but rather the opposite. Lifeworld is about everyday, common life in all its aspects. In the writings of Cicely Saunders, known as the founder of the modern hospice movement, facets of lifeworld are presented as important elements in caring for dying patients. Palliative care and palliative medicine today are, in many ways, replacing hospices. This represents not only a change in name, but also in the main focus. Hospice care was originally very much about providing support and comfort for, and interactions with the patients. Improved medical knowledge today means improved symptomatic palliation, but also time and resources spent in other ways than before. Observations from a Nordic hospice ward indicate that seriously ill and dying persons spend much time on their own. Different aspects of lifeworld and intersubjectivity in the dying persons' room is presented and discussed.

Toward the adoption of complexity science in health care: implications for risk-taking and decision-making activities

This article explores the issues of risk taking and decision making in health care. An analysis of various sociocultural and psychological influences is provided for understanding of the dominant mind set in this industry. In tandem with this analysis, the evolution of system theories is described so as to promote understanding of the relative merits of the mechanistic and complexity philosophies. These philosophies are at odds with each other, conceptually and practically speaking; however, it seems that the complexity approach offers more promising strategies for the growth and development of health care. Recommendations for improving employee competencies and the organizational structure and culture in health care are offered in light of this analysis. These recommendations are relevant to activities that are clinical and administrative in nature.

Perinatal Hospice: Compassionate and Comprehensive Care for Families with Lethal Prenatal Diagnosis

When the diagnosis of a lethal anomaly has been established, many patients will choose to continue to their pregnancy. Until recently, there has been a lack of medical literature addressing the specific management of the families who find themselves in this unique situation. Since 1996, we have proposed a model of care that involves the strength of prenatal diagnosis, perinatal grief management, and hospice care to address the needs of these families. This article describes how to identify patients who benefit from this care; the multidisciplinary team approach; and the aspects of antepartum, intrapartum, and postpartum care. The literature to date is discussed, and barriers to implementation described.

A reflection on Cicely Saunders' views on a good death through the philosophy of Charles Taylor

In her writings, Cicely Saunders has developed a total framework of caring for seriously ill people. Saunders' reaction to what she has experienced as bad contemporary post-war health care is to be found in her hospice philosophy. In this article this philosophy is analysed through the writings of Charles Taylor. Taylor is a Canadian philosopher who has delivered important views on what it means to live a 'good' and 'authentic' life in a modern society. By focusing on Saunders' writings from Taylor's perspective it becomes apparent that Saunders has created a very modern theory. The author has found that different aspects of a good and authentic life are important values in Saunders' good and authentic death. These findings are followed by one question: is Saunders' hospice philosophy too focused on values such as individuality, control and autonomy, giving too little attention to fragility and dependency?

Perinatal hospice

When the prenatal diagnosis of a lethal fetal anomaly has been established, some patients choose to continue their pregnancy. Currently, there is a paucity of medical literature addressing the specific management of families in this unique circumstance. We propose a model of care that incorporates the strengths of prenatal diagnosis, perinatal grief management, and hospice care to address the needs of these families. We discuss the identification of candidates for this form of care; the multidisciplinary team approach; and the aspects of antepartum, intrapartum, and postpartum care. Finally, we discuss some barriers that might need to be overcome when attempting to implement perinatal hospice care.

Hospice at the crossroads: the physician director

The Medicare regulations for hospice haveallowedthe development of two types of programs. The physician-supervised model, in which the hospice provides a physician to oversee a general program with no requirement of his direct involvement with patient care. The second model is physician-directed, where the care of the patient is assumed by the hospice physician. This report reviews the implications of each model with an examination of their benefits and disadvantages. It is our feeling that the physiciandirected modelof hospice care has so many advantagesto this movement that it should be favored.

An alternative in terminal care: results of the National Hospice Study

Hospice is a program of supportive services for terminally ill patients and their families, provided either at home or in designated inpatient settings, which is purported to improve patient and family quality of life at lower cost than conventional terminal care. The National Hospice Study was a multi-site, quasi-experimental study to compare the experiences of terminal cancer patients and their families in hospices with those of similar patients and families receiving conventional terminal care. The results indicate that, although care is different in hospices, e.g. lesser utilization of aggressive interventional therapy and diagnostic testing, patients' quality of life is similar in the hospice and conventional care systems with the exception of pain and symptom control, which may be better in the inpatient hospice setting. Hospice patients are more likely to die at home and their families are satisfied with that outcome. Otherwise, no consistent superiority of family outcome was associated with the hospice approach. The cost of hospice care is less than that of conventional terminal care for patients in hospices without inpatient facilities, but the cost of hospice appears to be equivalent to conventional care for patients in hospices having beds.

The hospice concept. Comfort care for dying patients

The hospice movement is a relatively new but fast-growing approach to caring for the terminally ill. Central to the hospice concept is a team of care-givers who provide care at all levels, not only to the patient but to the family as well. Although the physician serves as adviser, the patient or family makes the final decisions regarding care. The patient is permitted to maintain control as long as possible, thus preserving the right to die with dignity. Home care is a goal of the hospice concept, but in some situations hospital or nursing home care is required. Hospice care does not end with the death of the patient but extends to helping the family during the bereavement period.