Abstract
In contrast to the numerous maladies described elsewhere in this textbook, successful care of the dying patient is not measured in terms of convalescence but rather in achievement of a “good death.” While the circumstances of death among the seriously ill in US hospitals are well defined – a high prevalence of pain and frequency of invasive procedures – the characteristics of a “good death” vary between patient, family, and provider [1, 2]. Frequently cited characteristics of a “good death” include control of severe pain, reduction of stress and anxiety, provider compassion, and the perceived knowledge and expertise of the physician [3]. However, patients with terminal conditions often report a sense of abandonment by their primary provider [4]. Increased end-of-life education among family physicians is critical in shifting patient deaths out of the hospital and into the comforts of home in effort to improve end-of-life care [5].
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References
A controlled trial to improve care for seriously ill hospitalized patients. The study to understand prognoses and preferences for outcomes and risks of treatments (SUPPORT). The SUPPORT Principal Investigators. JAMA. 1995;274:1591–8.
Hales S, Zimmerman C, Rodin G. Review: the quality of dying and death: a systematic review of measures. Palliat Med. 2010;24(2):127–44.
Cagle JG, et al. Correlates of a good death and the impact of hospice involvement: findings from the national survey of households affected by cancer. Support Care Cancer. 2014;23(3):809–18.
Back AL, Young JP, McCown E, et al. Abandonment at the end of life from patient, caregiver, nurse, and physician perspectives: loss of continuity and lack of closure. Arch Intern Med. 2009;169(5):474–9.
Reyniers T, Houttekier D, Pasman HR, et al. The family physician’s perceived role in preventing and guiding hospital admissions at the end of life: a focus group study. Ann Fam Med. 2014;12:441–6.
NHPCO. Facts and figures: hospice care in America. Alexandria: National Hospice and Palliative Care Organization; 2014.
Connor SR, Pyenson B, Fitch K, Spence C, Iwasaki K. Comparing hospice and nonhospice patient survival among patients who die within a three-year window. J Pain Symptom Manag. 2007;33:238–46.
Mack JW, Smith TJ. Reasons why physicians do not have discussions about poor prognosis, why it matters, and what can be improved. J Clin Oncol. 2012;30(22):2715–17.
Wright AA, Zhang B, Ray A, et al. Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. JAMA. 2008;300(14):1665–73.
Baile WF, Buckman R, Lenzi R, Glober G, Beale EA, Kudelka AP. SPIKES – a six-step protocol for delivering bad news: application to the patient with cancer. Oncologist. 2000;5(4):302–11.
Glare P, Virik K, Jones M, et al. A systematic review of physicians’ survival predictions in terminally ill cancer patients. BMJ. 2003;327:195–8.
Weeks JC, Catalano PJ, Cronin A, et al. Patients’ expectations about effects of chemotherapy for advanced cancer. N Engl J Med. 2012;367:1616–25.
Anderson F, Downing MG, Hill J, Casorso L, Lerch N. Palliative performance scale (PPS): a new tool. J Palliat Care. 1996;12(1):5–11.
Lau F, Cloutier-Fisher D, Kuziemsky C, Black F, Downing M, et al. A systematic review of prognostic tools for estimating survival time in palliative care. J Palliat Care. 2007;23:93–112.
Reisberg B. Functional assessment staging (FAST). Psychopharmacol Bull. 1988;24:653–9.
Ripamonti CI, Santini D, Maranzano E, Berti M, Roila F. ESMO guidelines working group management of cancer pain: ESMO clinical practice guidelines. Ann Oncol. 2012;23 Suppl 7:139–54.
World Health Organization. Cancer pain relief. 2nd ed. Geneva: World Health Organization; 1996. Available from: http://whqlibdoc.who.int/publications/9241544821.pdf. Accessed 4 Dec 2014.
Arbaiza D, Vidal O. Tramadol in the treatment of neuropathic cancer pain: a double-blind, placebo-controlled study. Clin Drug Invest. 2007;27(1):75–83.
Saarto T, Wiffen PJ. Antidepressants for neuropathic pain. Cochrane Database Syst Rev. 2007(4). Art. No.: CD005454. doi: 10.1002/14651858.CD005454.pub2.
Caraceni A, Zecca E, Bonezzi C, et al. Gapabentin for neuropathic cancer pain: a randomized controlled trial from the Gabapentin Cancer Pain Study Group. J Clin Oncol. 2004;22(14):2909–17.
Mercadante SL, Berchovich M, Casuccio A, et al. A prospective randomized study of corticosteroids as adjuvant drugs to opioids in advanced cancer patients. Am J Hosp Palliat Care. 2007;24:13–9.
Wong RKS, Wiffen PJ. Bisphosphonates for the relief of pain secondary to bone metastases. Cochrane Database Syst Rev. 2002; (2). Art. No.: CD002068.
Widera EW, Block SD. Managing grief and depression at the end of life. Am Fam Physician. 2012;86(3):259–64.
Massie MJ. Prevalence of depression in patients with cancer. J Natl Cancer Inst Monogr. 2004;32:57–71.
Jereczek-Fossa BA, Marsiglia HR, Orecchia R. Radio-therapy related fatigue. Crit Rev Oncol Hematol. 2002;41(3):317–25.
Sood A, Barton DL, Loprinzi CL. Use of methyphenidate in patients with cancer. Am J Hosp Palliat Care. 2006;23(1):35–40.
Ripamonti C, Bruera E. Dyspnea: pathophysiology and assessment. J Pain Symptom Manage. 1997;13(4):220–32.
Ferris FD, Danilychev M, Siegel A. Last hours of living. In: Emanuel LL, Librach SL, editors. Palliative care: core skills and clinical competencies. 2nd ed. St. Louis: Saunders; 2011. p. 319–42.
National POLST. http://www.polst.org/. Accessed 28 Nov 2014.
Bomba PA, Kemp M, Black JS. POLST: an improvement over traditional advance directives. Cleve Clin J Med. 2012;79(7):457–64.
Sykes N, Thorns A. Sedative use in the last week of life and the implications for end-of-life decision making. Arch Intern Med. 2003;163:341–4.
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Berkey, F.J. (2017). Care of the Dying Patient. In: Paulman, P., Taylor, R., Paulman, A., Nasir, L. (eds) Family Medicine. Springer, Cham. https://doi.org/10.1007/978-3-319-04414-9_69
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DOI: https://doi.org/10.1007/978-3-319-04414-9_69
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