By Stephen McPhee, Margaret A. Winker, Michael W. Rabow, Steven Z. Pantilat, Amy J. Markowitz
From one of many world’s major clinical journals comes the definitive evidence-based, full-color advisor to end-of-life and palliative care "...represents an enormous milestone within the evolution of deal with individuals with complex disease—-for which its editors and authors and JAMA can be rightly proud. it really is remarkable that JAMA had the foresight to put up a sequence in this subject, which, as drugs has turn into extra technologically complex and subspecialized, is usually missed and, occasionally worse, avoided....this publication might be priceless for front-line clinicians, and certainly all well-being care practitioners—as care on the shut of lifestyles is part of just about all of medicine’s specialties and settings."--Irene J. Higginson, BMBS, PhD, FPPHM, FRCP; Dept. of Palliative Care, coverage, & Rehabilitation; Cicely Saunders Institute; King's collage London (from the foreword) a brand new addition to the JAMAevidence sequence, Care on the shut of existence: facts and adventure deals evidence-based and medical specialist assistance on taking good care of sufferers with life-limiting disorder, incorporating the phrases and views of affected sufferers, their households, and treating clinicians. equipped by way of those genuine scientific situations, the ebook relies at the acclaimed 7-year sequence of forty two articles, initially released in JAMA as “Perspectives on Care on the shut of Life,” and now completely up-to-date as chapters and that includes vast never-before-published fabric. Care on the shut of lifestyles covers are quite a lot of medical syndromes, sickness procedures, communique demanding situations, health-care supply settings, and concerns confronted via sufferers, together with withdrawal of dialysis and different life-sustaining measures, cross-cultural ways, and the position of chemotherapy. through the publication, emphasis is at the rules of palliative care, with the sufferer and kin on the middle of care, and with consciousness given to all problems—physical, mental, social, and non secular. Reflecting this concentration, every one bankruptcy starts off with a sufferer case examine to introduce the scientific challenge, through “perspectives” that draw on wide, real-world discussion among clinicians, sufferers, and households. the world over well known authors then assessment the common demanding situations illustrated via the case, delivering state of the art, evidence-based evaluate and therapy methods. good points absolutely revised and up-to-date textual content with new proof and references, together with the quest method for every chapter’s replace Evidence-based orientation provides the present nation of data within the care of terminally sick sufferers and help for his or her households and caregivers useful medical assistance and ways from overseas specialists in palliative care Self-assessment Q&A, for boosting your wisdom of every chapter’s content material and for getting ready for tests an invaluable word list of acronyms, phrases, and checks up to date assets for every bankruptcy supply present, authoritative assets of diagnostic and remedy info which may assist you optimize palliative care Medline PubMed identification numbers facilitate fast, handy entry to references
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Additional resources for Care at the Close of Life: Evidence and Experience
26 • Patients or families inquire about hospice. Hospice questions may be a subtext for exploring specific fears about the future or a sign that a patient wants to reconsider the goals of treatment or address unrecognized suffering. • Patients recently hospitalized for severe progressive illness. Hospitalizations, particularly when repeated, suggest that death may be approaching and can prompt a discussion of prognosis and preparing for the end. 16 When clinicians feel uncomfortable approaching or treating a patient because of clearly evident suffering, end-of-life issues may have been ignored.
PMID: 12614110] 33. Quill TE. A Midwife Through the Dying Process: Stories of Healing and Hard Choices at the End of Life. Baltimore, MD: Johns Hopkins University Press; 1996. 34. Quill TE, Cassel CK. Nonabandonment: a central obligation for physicians. Ann Intern Med. 1995;122(5):368-374. [PMID: 7847649] Initiating End-of-Life Discussions With Seriously Ill Patients 35. Pantilat SZ, Alpers A, Wachter RM. A new doctor in the house: ethical issues in hospitalist systems. JAMA. 1999;282(2):171-174.
8 for initiating discussion in a variety of domains. The physician should keep questions straightforward, listen carefully to answers, and then follow the patient’s lead by asking focused follow-up questions incorporating the patient’s language when possible. ”42 Usually, these general explorations of values, goals, and expectations precede discussions about particular methods of treatment. DR G: I was worried that [our DNR discussion] would get back to his kids. I felt in some ways I was buffering him a little bit from his kids.