Science and Profession (Magill’s Medical Guide, Sixth Edition)
Palliative medicine is a specialty that spans disciplines. The goal is to comfort and support patients as they face life-threatening illnesses, not only relieving their suffering but also addressing their emotional and spiritual needs. Although palliative medicine is typically associated with the final stages of life-threatening conditions, patients may also benefit from the care while they are still undergoing active treatment. In that case, symptom relief and other interventions to improve their quality of life helps improve their strength and stamina to endure additional cycles of therapy.
Palliative care may be provided in a long-term care facility, a hospital, or the patient’s home. Care is provided by a team consisting of general practice physicians, specialists in the patient’s condition (for example, oncologists, cardiologists, or pulmonologists), nurses, social workers, mental health specialists (psychologists, psychiatrists, or counselors), nutritionists, and clergy. The level and type of care provided are guided by the wishes and needs of the patient. Pain management is often the greatest need, but the patient may also require relief of other symptoms associated with the condition or its treatment, such as nausea, constipation or diarrhea, fatigue, depression, or inability to eat.
Palliative medicine is recognized as a basic human right in the International Bill of Human Rights of the United...
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Diagnostic and Treatment Techniques (Magill’s Medical Guide, Sixth Edition)
Patient care is traditionally disease-oriented. Specialists in particular tend to focus narrowly on a specific organ or body system. Palliative care, however, takes a holistic, patient-centered approach. The emphasis is on communicating with the patient and family to assess the patient’s specific needs and desires.
Palliative care can be divided into primary and secondary teams. The primary team is responsible for assessing and managing symptoms, communicating with the patient and family, and providing expertise regarding psychosocial services. This team consists of generalists trained in palliative care. If, however, the patient’s condition worsens and the primary team can no longer manage the symptoms, a specialist in the patient’s condition is called. The disease specialist may consult on specific issues as needed or become a core member until the patient’s death.
The whole-patient assessment begins with the patient’s description of symptoms and level of function. Diagnostic tests may be used to evaluate symptom severity, but diagnosis is not the purpose. The emphasis is always on symptom relief.
Pain is a significant issue that must be managed properly. Inadequately controlled pain may reduce the effectiveness of treatment and wear the patient down psychologically. Proper pain management involves communication with and education of the patient and family members as well as...
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Perspective and Prospects (Magill’s Medical Guide, Sixth Edition)
In the span of two decades, palliative medicine progressed from haphazard training through chance experiences to a recognized specialty. A 1998 member survey by ASCO revealed 90 percent of the oncologists who responded had no formal training in palliative medicine. Rather, they indicated they learned through “trial and error.” Alarmingly, more than one-third claimed that their education in palliative medicine was from a “traumatic experience” with a patient. Most had little training in how to discuss a poor prognosis with patients and their families, and only 10 percent had completed clinical training in palliative care.
Since that survey, ASCO and other professional societies have incorporated palliative medicine into their continuing education curricula. More important, national and international groups have formally recognized the importance of palliative medicine in preserving the dignity and well-being of patients nearing the end of their lives. Within the next decade, palliative medicine is expected to be incorporated as a routine part of comprehensive cancer care plans in the United States.
Despite these advances, much work remains. The need for palliative medicine is increasing. The population is growing older while the prevalence of cancer is rising. Cancer treatments are becoming more effective. Although cancer death rates are declining, more people are living longer with the disease,...
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For Further Information: (Magill’s Medical Guide, Sixth Edition)
Chochinov, Harvey M., and William Breitbart. Handbook of Psychiatry in Palliative Medicine. New York: Oxford University Press, 2000. Discussion of the role of psychiatry in palliative medicine.
Doyle, Derek, et al., eds. Oxford Textbook of Palliative Medicine. New York: Oxford University Press, 2005. Comprehensive text on palliative medicine, including the role of different medical specialties in patient care.
Field, M. J., and C. K. Cassel, eds. Approaching Death: Improving Care at the End of Life. Washington, D.C.: National Academies Press, 1997. The documents from the Institute of Medicine establishing the role of palliative medicine in comprehensive cancer care.
Woodruff, Roger. Palliative Medicine: Evidence-Based Symptomatic and Supportive Care for Patients with Advanced Cancer. 4th ed. New York: Oxford University Press, 2004. Review of recent research in the principles of palliative medicine and related ethical issues.
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