ITEMS IN AFP WITH KEYWORD:
End of Life Care
Debility not otherwise specified (NOS) has surpassed lung cancer as the most common diagnosis in hospices. In August 2013, the Centers for Medicare and Medicaid Services issued a rule that debility NOS and adult failure to thrive can no longer be listed as principal hospice diagnoses, but rather, secondary comorbid conditions.
Patients prepare advance directives in an effort to maintain autonomy during periods of incapacity or at the end of life. Advance directive documents are specific to the state in which the patient lives, but an effective strategy in the family physician’s office involves more than filling out a form...
Dec 1, 2011 Issue
Management of Constipation in Patients Receiving Palliative Care [Cochrane for Clinicians]
There is insufficient evidence to recommend one laxative over another for the treatment of constipation in patients receiving palliative care. Methylnaltrexone can increase the frequency of bowel movements at four hours (odds ratio = 7.0; 95% confidence interval, 3.8 to 12.6) and at 24 hours (odds r...
May 1, 2011 Issue
Palliative Sedation for a Patient with Terminal Illness [Curbside Consultation]
A patient has the right to make an informed decision about discontinuing life-prolonging treatments. The patient in this scenario is requesting palliative sedation to control her anxiety while electrolyte replacement is stopped.
As the Medicare population expands with the baby boomer generation, the need for greater mastery of clinical and interpersonal skills regarding end-of-life care is essential for meeting the wishes and needs of patients.
As death approaches, a gradual shift in emphasis from curative and life prolonging therapies toward palliative therapies can relieve significant medical burdens and maintain a patient's dignity and comfort. Pain and dyspnea are treated based on severity, with stepped interventions, primarily opioids...
Nov 1, 2008 Issue
ACP Releases Recommendations for Palliative Care at the End of Life [Practice Guidelines]
The Clinical Efficiency Assessment Subcommittee of the American College of Physicians (ACP) has released guidelines to improve palliative care for patients with seriously disabling or symptomatic chronic conditions at the end of life.
Hospice is available for any patient who is terminally ill and chooses a palliative care approach. Because of the close relationship that primary care physicians often have with their patients, they are in a unique position to provide end-of-life care, which includes recognizing the need for and rec...
When patients are diagnosed with cancer, primary care physicians often must deliver the bad news, discuss the prognosis, and make appropriate referrals. When delivering bad news, it is important to prioritize the key points that the patient should retain. Physicians should assess the patient's emoti...