The Role of Anesthesiologists in Palliative Medicine : What Specific Roles Should Anesthesiologists Play in the Palliative Care Unit and Team in Major Medical Centers?

Codeine is designated as one of the essential medicines of palliative care for symptoms such as pain and diarrhea. Essential drugs for palliative care are drugs that are effective for the treatment of common symptoms in palliative medicine, easily available, and are affordable. Codeine is recommended for the management of mild to moderate pain and is available as a combination product or as a stand-alone opioid. It is a prodrug and exhibits an affinity to μ-opioid receptors 200 times lower than morphine. Codeine is metabolized in the liver to inactive metabolites, which account for 90 percent of the transformed product, and morphine, which accounts for 10 percent of the transformed product and provides the main analgesic effect. The production of morphine is dependent on cytochrome oxidase 2D6 enzyme activity, which may not be fully active in some populations. The purpose of this review is to examine the efficacy of codeine for common symptoms encountered in palliative medicine, which has led to its designation as an essential medicine for palliative care.

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Malignant diseases

10.1093/med/9780198745457.003.0016 ◽

2016 ◽

Author(s):

Richard D.W. Hain ◽

Satbir Singh Jassal

Keyword(s):

Central Nervous System ◽

Palliative Care ◽

Nervous System ◽

Palliative Medicine ◽

Detailed Examination ◽

Solid Tumours ◽

Malignant Diseases ◽

Central Nervous System Tumours ◽

Palliative Phase

With respect to palliative medicine, malignant diseases can be considered in three broad groups: haemopoietic malignancies, central nervous system tumours, and other solid tumours. The likelihood of needing referral for specialist palliative medicine is influenced by prognosis, as well as by incidence, and therefore change as outcomes improve. This chapter includes an easy-to-assimilate list of the commonest symptoms experienced by children with cancer, broken down by incidence. A detailed examination of the interface between oncology and palliative care is provided, with discussion of the primary fears experienced by patients and families, the transition from a curative to a palliative phase, and the role of chemotherapy in palliative cases.

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Qualitative research

10.1093/med/9780199656097.003.0194 ◽

2015 ◽

Author(s):

Kate Flemming

Keyword(s):

Qualitative Research ◽

Palliative Care ◽

Palliative Medicine ◽

Mixed Methods Research ◽

Evidence Based Practice ◽

Evidence Based ◽

Methodological Development ◽

Clinical Questions ◽

Developing Area

This chapter outlines the importance of qualitative research as a method to provide answers to clinical questions arising in palliative medicine. Rather than being a chapter about how to ‘do’ qualitative research, it is a chapter that seeks to outline the role and purpose of qualitative research for palliative care by looking at the kind of questions qualitative research can answer, exploring qualitative research and its relationship to evidence-based practice, the role of qualitative research within mixed methods research, and the developing area of the synthesis of qualitative research. It addresses some of the more practical aspects of searching for qualitative research and undertaking an appraisal of its quality, whilst acknowledging that these are contested areas undergoing methodological development. In exploring these issues it firmly establishes a place for qualitative research within evidence-based practice and for palliative medicine in particular.

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Changing hospital culture: the role of an acute palliative care unit

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2012-000196.260 ◽

2012 ◽

Vol 2 (Suppl 1) ◽

pp. A88.3-A89

Author(s):

Fiona Paterson ◽

Deans Buchanan ◽

Frances MacIvor ◽

Susan Lundie ◽

Pamela Levack ◽

...

Keyword(s):

Palliative Care ◽

Palliative Care Unit ◽

Hospital Culture

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Snapshot of an acute palliative care unit in a tertiary cancer hospital

Palliative & Supportive Care ◽

10.1017/s1478951513000722 ◽

2013 ◽

Vol 12 (4) ◽

pp. 331-337 ◽

Cited By ~ 2

Author(s):

Akhila Reddy ◽

Marieberta Vidal ◽

Maxine de la Cruz ◽

Sriram Yennurajalingam ◽

Eduardo Bruera

Keyword(s):

Palliative Care ◽

The United States ◽

Palliative Care Unit ◽

Psychosocial Issues ◽

Special Report ◽

Working Together ◽

Consultation Services ◽

Specialized Unit

AbstractMost palliative care (PC) programs in the United States provide consultation services that assist the primary medical team with issues ranging from controlling patients' symptoms to initiating end-of-life discussions. This approach may be sufficient to address many patients' needs. However, for certain patients with complex medical and psychosocial issues, a better alternative is a more streamlined approach that can be provided in an acute palliative care unit (APCU), where the PC staff assumes the role of the primary team. An APCU is a specialized unit that delivers highly sophisticated care with professionals from various disciplines working together to improve the quality of life of patients and their families. However, descriptions of the process of delivering PC in the APCU are limited. In this special report, we portray a single day with a series of patients whose care was managed at our APCU to illustrate the unique components of an APCU that allow holistic care for patients with multiple complex medical and psychosocial issues.

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Branding Palliative Care Units by Avoiding the Terms “Palliative” and “Hospice”

INQUIRY The Journal of Health Care Organization Provision and Financing ◽

10.1177/0046958016686449 ◽

2017 ◽

Vol 54 ◽

pp. 004695801668644 ◽

Cited By ~ 6

Author(s):

Ying-Xiu Dai ◽

Tzeng-Ji Chen ◽

Ming-Hwai Lin

Keyword(s):

Palliative Care ◽

Public Hospitals ◽

Palliative Care Unit ◽

Private Hospitals ◽

Religiously Affiliated ◽

Negative Perceptions ◽

Palliative Care Units ◽

The Government ◽

Patient Referrals

The term “palliative care” has a negative connotation and may act as a barrier to early patient referrals. Rebranding has thus been proposed as a strategy to reduce the negative perceptions associated with palliative care. For example, using the term “supportive care” instead of “palliative care” in naming palliative care units has been proposed in several studies. In Taiwan, terms other than “palliative” and “hospice” are already widely used in the names of palliative care units. With this in mind, this study investigated the characteristics of palliative care unit names in order to better understand the role of naming in palliative care. Relevant data were collected from the Taiwan Academy of Hospice Palliative Medicine, the National Health Insurance Administration of the Ministry of Health and Welfare, and the open database maintained by the government of Taiwan. We found a clear phenomenon of avoiding use of the terms “palliative” and “hospice” in the naming of palliative care units, a phenomenon that reflects the stigma attached to the terms “palliative” and “hospice” in Taiwan. At the time of the study (September, 2016), there were 55 palliative care units in Taiwan. Only 20.0% (n = 11) of the palliative care unit names included the term “palliative,” while 25.2% (n = 14) included the term “hospice.” Religiously affiliated hospitals were less likely to use the terms “palliative” and “hospice” (χ2 = 11.461, P = .001). There was also a lower prevalence of use of the terms “palliative” and “hospice” for naming palliative care units in private hospitals than in public hospitals (χ2 = 4.61, P = .032). This finding highlights the strong stigma attached to the terms “palliative” and “hospice” in Taiwan. It is hypothesized that sociocultural and religious factors may partially account for this phenomenon.

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Models of paediatric palliative care

10.1093/med/9780198745457.003.0002 ◽

2016 ◽

Author(s):

Richard D.W. Hain ◽

Satbir Singh Jassal

Keyword(s):

Palliative Care ◽

Palliative Medicine ◽

The Other ◽

Paediatric Palliative Care ◽

Other Hand ◽

The World ◽

The Uk

The UK has a variety of resources for children with life-limiting conditions that are perhaps unrivalled in the world. This is both good and bad. It offers the potential for children and their families to have choices about the location of their care. On the other hand, a multiplicity of agencies brings with it the risk of miscommunication and internecine strife. This chapter summarizes ideal models of palliative care, defining the four categories of life-limiting conditions in childhood and the role of paediatric palliative medicine specialists.

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