Abstract
Letter to the Editor
Clinical challenges concerning collaboration between palliative care consultants and nonpalliative health care professionals. (page 1178)
Brief Report
Methylphenidate hydrochloride, a central nervous system stimulant has been used to palliate fatigue; a pilot study to establish standard dose. (page 1193)
Fast Facts and Concepts
#212 Phantom Limb Pain
#218 Managing Wound Odor
(page 1285)
Personal Reflection
Being in the hospice business does not give one a get-out-of-mourning-free card. (page 1288)
Case Discussions in Palliative Medicine
Forty-seven-year old man with locally advanced, chemorefractory hepatocellular carcinoma with malignant extension, successfully treated with external beam radiation therapy. (page 1293)
Book and Media Reviews
(page 1296)
Recent Literature
(page 1297)
Institutional Alignment
Palliative care programs must consider how best to align their mission with that of their institution. Five case studies demonstrate how successful programs identify and address institutional needs to create opportunities for palliative care program growth. These case studies can serve as models for other programs seeking to develop or expand their palliative care services. (page 1205)
Day Care
Specialist palliative day care has long been a feature of U.K. practice. An exploratory methodology (Interpretative Phenomenological Analysis [IPA]) was used to analyze the qualitative data from 11 patients to allow for an in-depth investigation. Emerging themes suggest that day care provides an environment in which patients are helped to cope with stressors through a sense of self, belonging, acceptance of the reality of death. and a focus on life. (page 1211)
Neonatologists' Spirituality and Care
How neonatologists' belief systems affect care delivery for critically ill newborns is unexplored. Of 298 neonatologists responses to a survey, 66.4% consider themselves very or moderately spiritual, 40.8% very or moderately religious. In response to a hypothetical prenatal consultation for a fetus at 23 1/7 weeks gestation, 96.3% agreed that the physician has a moral obligation to present all options to parents, including the provision of comfort care. More than 95% had no objection to withholding or withdrawing life-sustaining treatment, with religion playing almost no part in these decisions. Thirty-eight percent of participants reported no objection to resuscitating an infant with trisomy 13 or 18. Differences in critical care practice cannot be attributed to personal religious or spiritual views. (page 1219)
Young Caregivers
In an Australian study, most care was provided by older, close family members, but large numbers of young people (ages 15–29) also provided assistance to individuals with advanced life-limiting illness. They comprised 14.4% of those undertaking “hands-on” care on a daily or intermittent basis. Over half of those engaged in hands-on care indicated the experience to be worse or much worse than expected, with young people more frequently reporting dissatisfaction thereof. Young caregivers also exhibited an increased perception of the need for assistance with grief. (page 1225)
Clinical Instruments for Quality
Databases from 1990 through February 2007 for studies of instruments measuring physical, psychological, social, cultural, spiritual, or ethical aspects of palliative care, structure and process of care, continuity of care, prognosis or function were combed. Manuscripts provided information on 129 instruments that were evaluated using a structured scoring guide for psychometric properties. Reviewers recommended 39 instruments scoring near or above the 75th percentile. Most instruments covered multiple domains or focused on physical, psychological or social aspects of care. Few instruments were available to measure spiritual or cultural aspects of care, structure, and process of care, and continuity of care. (page 1237)