Palliative care pain case studies - effects of bullying essay









palliative care pain case studies

palliative care pain case studiesPalliative care pain case studies -The patient still has five years left of a six-year prison term and is unlikely to get early release.Patients with Stage IV lung cancer have a median survival rate of less than four months.The clinician should then propose an appropriate follow-up plan.Chemotherapy for widely metastatic lung cancer is not curative and the effect on duration of survival is minimal.However, just because someone is depressed does not mean that he or she is not competent to make treatment decisions.In several studies of people with AIDS, black and Hispanic persons were less likely to communicate with their primary care clinicians about end-of-life care than Caucasian gay or bisexual men.Incarcerated patients often become concerned about inadequate pain treatment, especially since their complaints may be viewed with distrust by health care providers.Sarah was connected to a syringe driver to control her symptoms and the district nurses attended daily to replenish the syringe drugs, which our nurse, Rosie, monitored.Palliative medicine specialists help patients focus on what is most important to them, helping them find value and meaning as their lives come to a close. H., Assistant Professor of Medicine, University of Washington, and Director, Northwest Correctional Medicine Education Program, NW AIDS Education and Training Center. However, recent advances in chemotherapy and current regimens that are much less toxic than they were several years ago make it a worthwhile option to consider.The patient was seen by a community oncologist who explained treatment options and the prognosis.There are a number of issues unique to the correctional environment discussed in a recent publication from the HIV/AIDS Bureau of the Health Services and Resources Administration.Because discussing palliative care with patients is an important part of providing high-quality care for patients with terminal illness, plan ahead with the same care that you give to other medical procedures.A 52 year-old African-American male inmate with Class B2 AIDS (CD4 cell count 421, HIV RNA 5,790) was diagnosed with widely metastatic non-small cell carcinoma of the lung.People of color with AIDS are more likely to report that they don't like to talk about end-of-life care and are more likely to worry that talking about death could bring death closer than are Caucasian patients with AIDS.When should end-of-life issues be discussed and how?Since his depression may respond to treatment, his preferences for palliative care should be reassessed from time to time.- Psychosocial Pain Assessment Forms in Spanish (for adults and children/adolescents): Quality of Life Instruments - City of Hope, Duarte, CA - Bone Marrow Transplant Survivors - is an 84-item tool specific for use in BMT.He is very concerned about pain and wants to be assured that he will not suffer.A recent study showed that pain is an important concern among patients with HIV infection, particularly those with a history of drug addiction.palliative care pain case studiesData from the SUPPORT study suggest that when patients have a decrease in depressive symptoms, they are more likely to accept life-prolonging treatments.It is also important to be familiar with the inmate's social support network, both in prison and in his community; (2) Location: This discussion should take place in a quiet and private room, safe from interruptions -- admittedly difficult in a correctional facility; (3) Participants: If possible, ask the patient who should be present and what he or she would like to discuss; and (4) Plan for what is likely to happen after the discussion.The second issue is the patient's concern about pain.At the same time, it is important to avoid completely discouraging hope among patients or their significant others who want to remain hopeful.Culture and ethnicity are important factors to consider in patient-clinician communication, especially when discussing palliative care.This tool has been used extensively in pain and cancer survivorship research. - Quality Care at the End of Life Survey - for Quality Palliative Care Guidelines and was developed and used at the City of Hope as a tool for assessing quality care.Care providers must be assured that a patient's decisions are voluntary regarding access to and withholding of life-sustaining treatment.(1) Preparation: The clinician should review the patient's diagnoses, various treatment options, and likely prognosis with each type of treatment.Corrections officers may be involved in discussions with medical staff about patient care for security reasons.We quickly identified one of our Live-in Nurses with plenty of palliative cancer nursing experience and she was at Sarah’s home within 10 hours of the family’s initial contact.It is important to know what has been communicated to the patient by other members of the health care team.It also allows a chance for the patient to correct any misunderstanding the clinician may have about what the patient said. Sometimes, after what seems like a long silence, a patient will ask a particularly difficult question or express a difficult emotion.It can be helpful for the clinician to repeat what the patient has said to show that the clinician is listening.Used extensively by clinical settings for several years, this tool provides descriptive data regarding areas of needed pain education. The Mc Gill Quality of Life Instrument (MQOL) is a 20-item scale specifically developed to measure quality of life at the end of life.With increasing emphasis on patient autonomy and surrogate decision making, there may be a tendency for some clinicians to describe treatment options to a patient or significant other and then feel that they should not make a recommendation.Research their vast collection, covering 45 medical specialties while we are upgrading to include our more than 20,000 authentic algorithms and computational instructions, based on best practices, online or on mobile devices.Psychosocial Pain Assessment Form - City of Hope, Duarte, CA Developed by Shirley Otis-Green, MSW, LCSW.This tool can be useful in clinical practice as well as for research.It is impossible to be prescriptive about the "right" time to discuss palliative and end-of-life care.If they deem him competent, his wishes should be respected. palliative care pain case studies The MQOL assesses general domains applicable to all patients, incorporates the existential domain, balances physical and non-physical aspects of quality of life, and includes both positive and negative influences on quality of life.She and her family were reassured that they had the 24-hour support of a nursing professional.HRSA recently published A Clinical Guide for Supportive and Palliative Care for People with HIV/AIDS, available on the web at The Discussion First, review the treatment options and prognosis honestly and directly.Spend some time exploring feelings and listening to the patient's reactions about the discussion.He is currently taking multivitamins, citalopram (Celexa), and doxepin.Supported by Sarah’s GP, her family came to us to arrange Live-in Nursing care at home with the objectives of preventing hospital or hospice admission and to enable her to die with dignity at home.(Also see related articles under Pain Assessment Tools).The first issue I will address is this patient's history of depression.It has been used in various terminally ill patients.Is it possible to get a consult or assistance with end-of-life issues? - Breast Cancer Patient Version � is a 46-item tool specific for use in Breast Cance - - Patient/Cancer Survivor Version - is a 41-item ordinal scale that measures quality of life through physical, psychological, social, and spiritual domains.The instrument was designed to be general in nature in order to maintain brevity and to assure applicability to all patients.It is important that the clinician make recommendations during the discussion.There are five domains that include: physical well-being, physical symptoms, psychological, existential, and support.The MSAS is a 32-item verbal rating scale that measures psychological and physical symptoms with regard to their presence, frequency, severity, and degree of distress associated with them. Additionally, the MSAS assesses both physical and emotional symptoms. - City of Hope, Duarte, CA These tools have been used extensively in pain/QA efforts.Some surveys suggest that many patients want to discuss spiritual or religious issues with their primary care clinicians.Also, the issue of advance directives is delicate in penal situations, where self-determination is, by definition, abridged.The patient has been a devout Christian for the past year.For example, protecting an inmate's medical confidentiality can be difficult. palliative care pain case studies The second level, which provides significantly more information about the instruments, also includes review copies of over 500 original instruments, 170 user manuals and 1010 translations, most in PDF format. Pro Qolid is updated regularly in close collaboration with the instruments� authors with 40 new instruments added in 2008.He is being followed for depression by the psychiatrist at the prison.Caucasians are more likely to prefer a treatment approach that focuses on palliative care as opposed to extending life, and this association persists even after controlling for education, income and HIV risk behavior.She then offered comfort and bereavement counselling for the family for as long as was needed.The inter-quartile range on this estimate is relatively small, suggesting that this man is unlikely to survive more than six months.For information specific to customs of various ethnic and cultural groups, see Concluding the discussion, the clinician should summarize the major points and ask the patient if there are any questions.This section includes numerous clinical and research tools addressing quality of life, pain, psychosocial assessment, medical staff knowledge and attitudes, brief pain surveys, palliative care and needs assessments from various sources.What issues should the primary care provider deal with first?Studies suggest that clinicians are waiting for patients to bring it up, while patients are waiting for clinicians to do so.Rosie liaised closely with the Sarah’s GP and the district nursing team to review her medication and keep symptoms under control, and was responsible for administering morphine for pain relief.I would recommend that the primary care clinician and psychiatrist assess this patient's competency to make decisions.Pro Qolid describes more than 646 Patient-Reported Outcome instruments in a structured format and is now available in two levels.The primary issues for this patient appear to be his possible depressive symptoms and concern about pain management.This often includes an appointment for a future meeting, and a way for the patient to get a message to the clinician if questions arise before the next meeting.Patient Pain Questionnaire - City of Hope, Duarte, CA The Patient Pain Questionnaire (PPQ) is a sixteen-item ordinal scale that measures the knowledge and experience of a patient in managing chronic cancer is important to realize that statistical associations by race and ethnicity are not predictive of a particular individual's treatment preferences.After initiating palliative care and reassuring the patient that his pain will be treated and that his treatment preferences will be respected, it would be reasonable for the clinician to readdress the option of palliative chemotherapy and ask the patient if he is interested in discussing this option with another oncologist.It may be argued that depression can adversely influence a person's treatment decisions, and there is some evidence that depressed patients are more likely to choose to forego life-sustaining treatments.It was progressing rapidly and she had received a very short prognosis. palliative care pain case studies The clinician should then propose an appropriate follow-up plan. palliative care pain case studies

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