Current Status Of Palliative Care Research Articles

The current status of palliative care among Japanese gynecologists in tertiary referral hospitals: A questionnaire survey of Kansai Clinical Oncology Group (KCOG)

The current status of palliative care among Japanese gynecologists in tertiary referral hospitals: A questionnaire survey of Kansai Clinical Oncology Group (KCOG)

Managing beyond an uncertain illness trajectory: palliative care in advanced heart failure

A lack of comprehensive and effective palliative care is clearly evident in a number of studies describing the end of life for patients with advanced heart failure. These patients have been portrayed as experiencing a wide array of poorly managed symptoms. The primary rationale for the lack of care has been the uncertain illness trajectory that characterizes living with advanced heart failure. Nurses must manage care beyond the illness trajectory from an emphasis of palliative care as each of these patients may face significant illness burden and even sudden death. The purpose of this paper is to: discuss the current status of palliative care for patients with advanced heart failure; explain the basic pathophysiology and resulting signs and symptoms of advanced heart failure; describe pharmacological and non-pharmacological symptom management strategies for patients with advanced heart failure.

A palliative care needs assessment of health care institutions in Wisconsin.

In 1999 the Wisconsin Coalition to Improve Palliative Care (WCIPC) conducted a palliative care needs assessment of health care institutions throughout the state of Wisconsin to document the current status of palliative care and identify institutional barriers and opportunities for improvement. A survey instrument was developed to assess provisions of palliative care in the following areas: services currently provided, staff education programs offered in the previous year, barriers to the delivery of palliative care, and resources that would be useful to the participating institutions. Surveys were mailed to 881 health care institutions in Wisconsin; 318 (36%) surveys were returned. The three most common end-of-life care services present included a program to promote advance care planning, a contractual relationship with one or more hospice programs, and an interdisciplinary care program for dying patients. Pain management and advance directives were the two most common topics of educational programs offered in the past year. The most frequently cited barriers to good end-of-life care included a lack of knowledge among patients/families, a lack of provider knowledge about pain and symptom control, and poor reimbursement for end-of-life care. Resources that institutions felt would be useful included newsletters, a speaker's bureau, and information about establishing quality improvement programs for palliative care. While health care institutions in Wisconsin provide a variety of palliative care services and offer educational programs that address areas of palliative care, institutional barriers do exist. This needs assessment provides valuable descriptive data that will guide efforts to improve palliative care throughout the state of Wisconsin.

Uganda: Current Status of Palliative Care

Palliative care was first introduced to Uganda in 1993 with the start of Hospice Uganda (HU). At that time, there was already supportive care for HIV/AIDS patients with home care from TASO (the AIDS Support organization) and many other home care programs. These organizations supported “clients” and their families with mainly counseling; they encouraged living positively with HIV. TASO in particular made a huge impact on attitudes to HIV/AIDS in the country and to education towards prevention of the disease. This is now having positive effects, with a reduction in the infection rates among pregnant women in several centers in the country. Recently, palliative care has been attracting funds. Like many other countries, Uganda’s AIDS support organizations are now described as having palliative care, yet they do not have the modern methods of pain and symptom control introduced through the modern hospice movement by Dame Cicely Saunders, and researched since 1967. Nurses are the backbone of palliative care. The emphasis on counseling by donor agencies, with provision of salaries higher than for nurses, has taken nurses from their profession to become counselors. Counselors are frustrated when faced with a patient in severe pain and neither the patient nor family can be counseled due to their distress from the pain. Uganda is now trying to address this problem and the great need for palliative care in HIV/AIDS and/or cancer by grafting pain and symptom control onto already existing support organizations. Palliative care is also being introduced throughout the existing health systems in the country, with support from the Ministry of Health, using HU as their technical experts. Palliative care is now part of essential clinical services for HIV/AIDS patients in the five-year Strategic health Plan from 2000– 2005. 1

Promoting quality of life near the end of life in Argentina. Interview by Karen S. Heller.

DR. MARIELA BERTOLINO discusses the current status of palliative care in Buenos Aires, Argentina and ongoing efforts to improve this care in her country. In the following interview with Innovations Associate Editor Karen S. Heller, Dr. Bertolino comments on the use of the Edmonton Symptom Assessment Scale for measuring quality of life in her palliative care program, based in Tornu Hospital-FEMEBA Foundation, a public hospital in Buenos Aires. Her program serves approximately 350 patients a year on an outpatient basis and has 6 inpatient beds, which are the first specifically designated palliative care beds in a country of 30 million people. This interview is excerpted from the thematic issue, “Quality of Life” Volume 2, Number 6, 2000 of the online journal Innovations in End-of-Life Care at www.edc.org/lastacts/