American Journal of Hospice and Palliative Medicine®

An increase in requests for volunteer services compounded by waning numbers of volunteers is a challenge to nonprofit organizations that are faced with the daunting task of recruiting and maintaining a large volunteer pool. This study explores alternate volunteer sources and suggests methods to be taken into account when recruiting male volunteers in various settings.

Although Aboriginal Australians experience morbidity and mortality rates far greater than that of the wider Australian population, to date, their access to culturally appropriate palliative care services has remained unexplored. This article provides findings from an Australian National Health and Medical Research funded study that documents the availability of palliative care services to Aboriginal peoples of the Northern Territory, Australia. The data were collected through a series of open-ended, qualitative interviews with a cross section of Aboriginal peoples and health professionals conducted during a 2-year period. The findings provide an overview of the palliative care services that are presently available and reflect a serious lack of local, culturally appropriate palliative care services. This research shows the similarities in the struggles and difficulties faced by Australian Aboriginals and Indigenous peoples worldwide. The hope is that the suggestions put forward for improvement will one day be useful for the world's Indigenous peoples.

The objective of this study was to elaborate aspects of prevention in palliative care on the basis of available literature sources. We analyzed 223 articles from 145 different journals covering the period from April 2001 to April 2006. Subject-related categories were derived from the contents of these articles. Each article was subsequently allocated to one of the categories. In addition, we performed a free search in 6 selected text books on palliative care. The results revealed that the main textual emphasis had been placed on pain therapy and controlling the symptoms of bone metastasis. Altogether, the focus was on measures of tertiary prevention, whereas measures of primary prevention and preventive medicine received little attention. Therefore, the accentuation of the preventive aspect in the World Health Organization definition of palliative care is only rudimentarily reflected in the literature.

This study discusses the unique characteristics of a comprehensive community-based model for hospice care. The data demonstrate that community-based hospice programs serve a population composed primarily of Medicare patients 75 years and older. It also addresses the primary clinical diagnoses for hospice patients, which include lung cancer, cognitive disability, cerebrovascular disease, congestive heart failure, chronic airway obstruction, colon cancer, renal failure, and prostrate cancer. Finally, the study found that the primary caregiver for community-based hospice patients is the spouse, followed by other family members.

Delay in referral of cancer patients to hospice until very near the end of life may deny patients and families optimal palliative care. A variety of factors may contribute to these delays. This article describes how the proliferation of newer anticancer therapies, although desirable overall, may further increase these delays. It is important for hospice personnel to understand these changes in medical oncology and to work to optimize palliative care delivery concomitantly with disease-remitting therapies.

The purpose of this study was to assess the impact of an elective geriatric palliative care course on medical students' attitudes, knowledge, and behaviors regarding communication with terminally ill patients. Surveys were administered at the beginning and end of the elective. Despite a significant increase in knowledge about geriatric and palliative medicine (F = 24.80; P < .001), there were no significant changes in students' self-reported behaviors when applying curriculum-based communication strategies. However, the qualitative analysis of open-ended questions showed that the curriculum intervention did result in an improvement in empowering message strategies for breaking bad news. The evaluation of the end-of-life curriculum needs to exceed the measurement of attitudes and knowledge and include behavioral assessment of end-of-life communication skills.

Primary care providers are positioned to identify patients, well in advance of their deaths, who could benefit from palliative care services, but little is known about how to correctly identify these upstream palliative care patients. This article reports on efforts to devise a methodology for identifying such patients and to offer preliminary estimates of their prevalence in urban, primary care practices. The data presented here suggest 2 conclusions: (1) that electronic databases may be used to create a preliminary screen to assist clinicians in the early identification of patients in need of palliative care, and (2) that 1% to 3% of patients in primary care practices may benefit from palliative care services. Currently, there are no standards regarding the role of primary care providers in end-of-life care and it is hoped that this article will contribute to developing such standards.

A patient with a stutter caused by the trauma of the death of a loved one was able to recover normal speech 1 week before her death, which resulted from intestinal obstruction caused by ovarian cancer. The stutter appeared to have been overcome using a combination therapy of sophrology, self-regulation, and drug therapy. During a genuine resilience process, the patient was able to overcome an earlier existential fracture. In this final phase of life, health professionals and the family fully respected the patient's independence to remain in control of events. She repeatedly refused to have a nasogastric tube inserted to extract fecal matter from the stomach. This patient consequently repossessed her own language of expression in a body that was shattered by cancerous illness and the consequences of treatments. She thus managed to find a successful balance between the body, the spirit, and the brain.

Advanced-stage malignancies are often characterized by systemic complications related to primary tumor progression. Pulmonary complications such as cough and dyspnea are relatively common and can dramatically reduce quality of life and lead to inpatient or intensive care unit admission. Although cancer-induced cough can be improved with radiation therapy or chemotherapy, or both, it is often best managed with central-acting opioids. Dyspnea can arise from a range of etiologies that may or may not be related to the underlying malignant pulmonary disease. Recent advances in the management of malignant pleural effusion, central airway obstruction, and superior vena cava syndrome have allowed relatively noninvasive interventions to be performed that can significantly reduce dyspnea, minimize inpatient hospitalization, and improve the quality of life in patients where the major focus is palliative care.

The history of surgery is rich with accomplishments in wound care, a legacy that recently has been abandoned by many surgeons only to be taken up by nonsurgical providers. When dealing with advanced wounds at the end of life, such as pressure ulcers or venous stasis ulcers, goals of treatment are relief of pain, elimination of odor, and control of wound exudates and infection. Benefits and risks of surgical intervention must be discussed with the patient and family in terms of the patient's perceived prognosis, extent of tissue necrosis and infection, the rate of deterioration, and the underlying wound pathogenesis. When appropriate, the role of surgery looms large in the treatment of chronic, advanced wounds, especially when minimally invasive surgical techniques are used.