Comparison of the high-tech service delivery experiences of hospice and non-hospice home health providers

This study examined the degree to which national samples of hospice and non-hospice home health care agencies (N = 154) present different organizational profiles and grapple with different patient capacity issues when delivering technology-enhanced services to incapacitated elderly. Hospice agencies employ more part-time staff, make more in-home visits, see more high-tech patients, and provide a wider range of high-tech services than non-hospice providers. Factor analysis of index data confirms that hospice staff have more experience (p < .05) addressing the legal/ethical dimensions of care. Specifically, hospices deal with "right to die" issues more often (p < .05), but not with "delegation of authority" and "patient rights" issues. More agencies of both types have policies for handling decisions about life-sustaining treatment than for dealing with patients having questionable decision-making capacity. Needed agency policies for dealing with limited patient decision-making capacity in hospice and non-hospice home care agencies are reviewed.     

Hospice the adjective, not the noun: The future of a national priority.

Reviews the development of the hospice movement and examines some current policy issues relating to hospice care, such as who is eligible for such care. Two issues related to who can receive hospice services are explored: the requirement for a lay primary caregiver and the diagnosis requirement for admission. Possible roles for psychologists as providers and researchers are considered, and the cognitive and personality behaviors of hospice patients are discussed. (7 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Considerations for ethical practice in managed care.

How does one maintain an ethical practice while facing the requirements and limits of a health care system that is dominated by managed care? Psychologists are increasingly raising such questions about ethical issues when working in or contracting with managed care organizations. The authors review the process involved in ethical decision making and problem solving and focus on 4 areas in which ethical dilemmas most commonly arise in a managed care context: informed consent, confidentiality, abandonment, and utilization management-utilization review. The need for sustained and organized advocacy efforts to ensure patient access to quality health care is discussed, as is the impact of managed care's competitive marketplace on professional relationships. Hypothetical examples of typical dilemmas psychologists face in the current practice environment are provided to illustrate systematic ethical decision making. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Metabotropic glutamate receptors and neuronal degenerative disorders

Spirituality plays an integral role in the care of the terminally ill. Hospice philosophy promotes patient/family centred care that is palliative, holistic and interdisciplinary. Historically, spiritual care has been a major component of hospice care that is consistent with these values. Some issues related to the role of spirituality in medicine and hospice care include the difference between spirituality and religion, the patient-physician relationship, provision of spiritual care, and who provides this care. Guidelines for spiritual caregiving include self-knowledge of one's own spiritual needs, authenticity and honesty and respect for the beliefs and practices of the patient and family.     

Current aspects and problems relating to medical ethics in oncology

A case history of a breast cancer patient is used to exemplify ethical dilemmas in medical oncology: information of a cancer patient and his family, ethical problems with genetic testing, ethical issues with do-not-resuscitate-orders, ethical dilemmas with limited resources, problems with insurance companies, ethical issues in clinical trials and questions in dying patients including physician-assisted suicide and active euthanasia. Medical oncologists have to develop skills in recognizing ethical dilemmas in patient care and must prepare to cope with the many and complex ethical issues in the care of oncology patients.     

Issues in prison hospice: toward a model for the delivery of hospice care in a correctional setting

This paper examines issues in prison hospice care based on the author's nine years experience as a prison hospice worker and trainer and on data gathered by the National Prison Hospice Association (NPHA) from a number of federal and state prison medical facilities with operational or developing hospice programs, including both scatter-bed and hospice unit models, employing inmate hospice volunteers and the services of outside community hospice agencies and volunteers. The paper discusses DNR orders and curative vs. palliative care decisions, pain management, AIDS care, interdisciplinary care teams, staff and volunteer training and supervision, and the need for compassionate early release and community placement programs. The author proposes a set of preliminary guidelines for the delivery of hospice care in the correctional setting.     

Integrating psychology and philosophy in teaching a graduate course in ethics.

Recent surveys of doctoral and master's programs in clinical psychology suggest that there are major gaps in the frequency and quality of ethical training. After describing a model of the ethical decision-making process, we present a thorough and formal course in ethical issues that integrates the perspectives of psychology and philosophy. The course was team taught by a philosopher and a psychologist to 10 second-year master's-level students in clinical psychology. The first section of the class addressed underlying philosophical issues, including ethical frameworks and principles; the second portion focused on a series of issues that had important value dimensions, including "health and disease," virtue, and several key ethical principles; and the final section focused on applications of these basic concepts to situations typically encountered by psychologists. A follow-up survey of those students engaged in clinical practice 3 months after the completion of the course revealed that they perceived the course to have had a positive impact both attitudinally and behaviorally. Suggestions for others planning to teach such courses are offered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Sacred Circle: a conceptual framework for spiritual care in hospice

Hospice care has consistently recognized the need to integrate spiritual care into holistic plans of care for dying patients and their families. Designing and implementing spiritual care interventions can be potentially difficult for hospice practitioners who have not had specific training in theology or pastoral care. Matthew Fox, a theologian, has developed a model of spiritual development that utilizes an ecumenical, ethical framework that can be directly applied to the care of hospice patients and families. This model employs a Sacred Circle approach that begins with an emphasis upon the sense of awe and wonder (the Via Positiva), moves into the next cycle by recognizing problems and negative emotions (the Via Negativa), that then flows into the creative solutions to problems (the Via Creativa), which finally transforms the problem into a new level of understanding (the Via Transformativa).     

A federal role in hospice care?

Discusses the advantages of hospice care for dying patients and how the federal government should support such care. Support could include the use of restricted drugs (such as heroin) to relieve pain in terminal illness, the allowance of Medicare patients to transfer their coverage from hospital to hospice if they so choose, and the initiation of a meaningful debate on the appropriate federal role in hospice funding and support. Current bills pending in Congress that concern such measures are described. (1 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychotherapy or massage parlor technology? Comments on the Zeiss, Rosen, and Zeiss treatment procedure.

Argues that there are numerous ethical, moral, philosophical, and social psychological issues involved in modern sex therapy. Psychologists have accorded sex therapy a warm reception into the field, but present ethical guidelines are insufficient to protect clients from psychological damage in the form of massive intrusions on privacy and reoriented moral and religious values. Further, the more explicit procedures seem to carry a message to society that "anything goes." The procedure employed by A. M. Zeiss et al (see record 1978-01520-001) is used as a reference point for discussing these issues. (22 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hospices: Perspectives on the public policy debate.

The public policy debate on hospice care centers on the appropriate mix of medical and supportive services for terminal cancer patients and how such services should be paid for within existing insurance programs. Past decisions to change health care reimbursement that are applicable to the hospice debate are reviewed, the benefits and costs of hospice care are examined, and the role of research in the formulation of social policy is discussed. (36 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

To supplant, supplement or support? Organisational issues for hospices

This paper provides an analysis of organisational issues in palliative care. Palliative care services have spread to many parts of the world and in the process have adapted to the context in which they are situated. This analysis draws on data from a small study of 18 hospices in the North Island of New Zealand. Key informants were interviewed about the organisation of health care workers, the range and nature of services offered and use of volunteers. Data collection and analysis were guided by the methodological principles of qualitative evaluation. Four main types of hospice were identified; (1) in-patient units with medical staff, (2) nurse led services, (3) volunteer led services which employed no health professionals and (4) hospital based palliative care teams. This paper proposes a conceptual analysis of the role of hospices in health care around three major issues: to supplant, supplement or support. Comparisons are drawn between the development and organisation of British and New Zealand hospices.     

The ethical practice of psychology in a managed-care framework.

With the rise of managed healthcare, psychologists face new challenges to their professional ethics. This article examines the dilemmas posed by managed care in 3 areas: client care, the handling of patient data, and issues surrounding membership in a managed-healthcare organization. Case examples of ethical dilemmas and strategies for dealing with these challenges are presented. In an attempt to summarize the strategies used to cope with the ethical dilemmas presented in the case examples, global solutions for the ethical practice of psychology in a managed-care framework are also reviewed. These strategies include understanding managed-care policies, clear communication with the client, additional training, increased advocacy by clinicians, and ultimately, psychologists' involvement in the formation of these organizations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Special not different: general practitioners' accounts of their care of dying people

In modern Britain the majority of terminal care occurs in people's own homes and many dying people and their carers would prefer the death itself to occur in the home. The quality of terminal care in the home and the possibility of a home death depend to a great extent upon the care provided by GPs and community nurses. This paper reports on GPs' experiences of caring for dying people and their attitudes towards such work. It is based on unstructured interviews with 25 GPs who graduated from the 1979 entry cohort to the University of Leicester medical school. The respondents were recruited via a questionnaire following up previous research with this cohort on 'fear of death'. Although self-selecting, interviewees were not significantly different from those who did not volunteer for interview in any of the statistical analyses of the questionnaire data. There were a number of similarities in their accounts of their care of dying people. Common themes were that the care of dying people was important, rewarding and satisfying; that the GPs saw themselves as part of a team of carers, frequently as team co-ordinators; good working relationships with district nurses but less satisfactory relationships with hospitals and social workers; that patient and family were both recipients of care; and honesty in communication with dying people, albeit tempered. Three issues of contemporary relevance were: tensions over the role of hospice and specialist terminal care services; care of people with chronic terminal illnesses other than cancer; and the role of GPs in the social construction of bereavement.     

Ethical dilemmas in psychological practice: Results of a national survey.

Surveyed 294 randomly selected psychologists who were members of Division 29 (Psychotherapy) of the American Psychological Association (APA) on the choices they would make in the face of specific ethical dilemmas. Ss were presented 10 vignettes, each representing a potential problem of professional ethics. They were asked to indicate their preferred resolution to the dilemma and their primary reason for choosing this alternative. Ss were also asked to rate the frequency with which they encountered each of 17 ethical/legal issues in their clinical practices and to rate each issue's severity. Ss also described dilemmas that they themselves had experienced in practice. Results show that the degree of consensus on the appropriate response to the 10 dilemmas varied considerably. Highest consensus was achieved on such issues as duty to warn potential victims of violence and avoidance of difficult bartering relationships. Lowest consensus was achieved on such issues as advertising practices and the boundaries of competence. Assessments of their own and their colleagues' competence and propriety were among the most troubling issues to Ss. It is suggested that work to further develop graduate course work in ethics should be pursued, with attention to real-world ethical problems involving confidentiality, competence, and colleagues' behavior. (12 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Contagious interest in genetics

This feature article is the first of a series of three articles on hospice/palliative care which will be published in future issues of Probe. The remaining two features discuss hospice care case scenarios and the role of the dental hygienist in palliative care.     

Ethical issues in rural mental health practice.

Argues that the unique characteristics of rural environments for mental health practice create potential ethical dilemmas for practitioners, including confidentiality, limits of competence, and multiple levels of relationships. These issues make practice in rural areas difficult, but close attention to the American Psychological Association's ethical principles and rural environments themselves reveals positive suggestions for solutions (e.g., the rural practitioner should examine the resources of the rural environment for solutions to problems that result from that environment). (13 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A call to armchairs.

Describes the current state of fragmentation in psychotherapy theory. Three tendencies in the mainstream of theoretical literature that perpetuate this fragmentation are identified: theoretical preciousness, terminal philosophical ambivalence, and philosophy by fiat. As a result of these tendencies, theory is reduced to ideology and dogma. A limited but important literature outside the mainstream is summarized that offers an alternative nondogmatic approach. It recognizes and accepts the philosophical nature of many issues in psychotherapy theory and employs the methods and literature of philosophy to deal with them. The benefits of such an approach are illustrated with specific reference to the ethical issues inherent in psychotherapy theory. It is recommended that future graduate training programs in the mental health fields include within their core curriculum a course of study on the philosophical analysis of theoretical issues in psychotherapy. The structure and function of such a course is briefly outlined. (40 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nurses' attitudes to sexuality in caring for cancer patients

The attitudes of hospice nurses towards psychosexual issues in palliative care were surveyed. Sexuality was acknowledged to be both important and relevant in hospice nursing. A high level of awareness of sexual and relationship issues was apparent, reflecting broadly liberal attitudes.