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.     

Ethics in hospice care.

Discusses 4 ethical issues that arise in hospice care: (1) What are the ethical responsibilities to the patient, family, and authorities when hospice workers discover that a patient has been given incompetent and shoddy care at a previous institution? (2) Hospices that advertise themselves as offering complete care should be prepared to deal with psychological and legal issues as well as medical ones. (3) The idea of treating the entire person must include responding to the likelihood that the patient and family may raise profound philosophical and religious questions. (4) Hospice staff should periodically examine themselves on a spiritual or philosophical level. (3 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparative study of death anxiety in hospice and emergency nurses

This paper describes a preliminary cross-sectional study which aimed to compare levels of death anxiety and coping responses in palliative care and accident and emergency (A & E) nurses. Forty-three nurses (23 from palliative care and 20 from A & E) were recruited from a district general hospital and nearby hospice. Both sites had the same mean annual death rate of 150 patients. Death anxiety was measured by the Death Attitude Profile-Revised Questionnaire and coping responses were elicited by a semi-structured interview. As hypothesized, hospice nurses had lower death anxiety and they were more likely to recall both good and difficult experiences related to patient care. Unlike the hospice nurses, a subgroup (20%) of A & E nurses reported that they were unable to discuss problems with colleagues. The study has implications for the development of institutional support for staff to enable nurses to provide good quality care for dying patients and bereaved people.     

Epilogue: Psychological interventions in the changing health care systems.

Psychotherapy has utility for a wide variety of circumstances that have significant economic, personal, and social consequences. This special issue is a small attempt to address some of these problems. There are important omissions, such as the frequent use of psychotropic medications in psychotherapy, psychological rehabilitation of patients and families with chronic health problems, and hospice care. The need for establishment of a national policy on how psychotherapy can be used to create more effective and humane solutions to societal problems has been identified. The challenge is how to fund the study of health and other social problems responsive to psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Criteria for enrolling dementia patients in hospice

OBJECTIVE: Because survival time varies greatly, it is difficult for dementia patients to meet a key criterion for eligibility for the Medicare hospice benefit: a 6-month survival time. We have developed criteria for the Medicare hospice benefit that include the characteristics of advanced dementia and related medical complications. The purpose of the study was to determine survival time among dementia patients who met these criteria. Additionally, because the National Hospice Organization (NHO) developed its own guidelines while the study was in progress, we retrospectively examined the application of these guidelines to our sample. DESIGN: Two cohorts of hospice patients were studied longitudinally, each for 2 years. SETTING: Nine Midwestern hospice programs. PARTICIPANTS: Forty-seven patients were enrolled in home hospice and institutional hospice settings. MEASUREMENTS: Survival time consisted of the number of days between enrollment in the hospice program and death or the end of the study. Other measures included Activities of Daily Living, ratings of Appetite, Nourishment, and Mobility, Functional Assessment Staging (FAST), a Medical Complications Checklist, and a care plan concerning the use of medications for acute illness. RESULTS: Our hospice enrollment criteria predicted a median survival time of 4 months and a mean survival time of 6.9 months; 38% of patients survived for more than 6 months. FAST scores and Mobility ratings were significantly related to survival time. However, 41% could not be scored on the FAST as their disease progression was not ordinal. Among patients who could be scored on the FAST and who had reached Stage Seven C, their mean survival time was 3.2 months compared with 18 months among those who could be scored and had not reached this stage and 8.6 months among patients whose disease progression was not ordinal, P < .001. When the palliative care plans were examined, less aggressive care plans resulted in shorter survival times, P < .01. CONCLUSION: Our hospice enrollment criteria identified a group with a median survival time of 4 months and a mean survival time of 6.9 months. Using NHO criteria relying on the FAST allows the identification of a subgroup with very high mortality and a short time until death. Although the FAST can identify a subgroup of appropriate candidates for hospice, sole reliance on this measure might decrease access to hospice care for many dementia patients.     

Spirituality and practice. Stories, barriers and opportunities. Interview by Laurence A. Savett

What are "spiritual matters?" Are "spiritual matters" the same as "religious matters?" What is spiritual inquiry? Are such questions appropriate for those of us in the caring professions, other than clergy, to consider? If we accept that role, how far should we go? When should we call for help? Whom should we call? We convened a gathering of a hospital chaplain, a social worker, a hospice nurse and a physician to discuss many of the dimensions of spirituality and then to apply their personal and professional paradigms of care to a discussion of an actual case. This article is a record of that conversation. It is actually several articles in one, for it deals with their own views of the meaning of spirituality, the degree to which their spirituality has impact on their practice, what they see as the merit of spiritual matters in the caring professions, barriers to collaboration among their professions and to addressing these issues with patients, and boundaries beyond which one should not go. One way to read this conversation is to include yourself; that is, to reflect on the points the participants make and the ways in which you might integrate their insights into your personal practice. We hope that you find this task worthwhile and that it provokes further thought and discussion. The discussion began with participant introductions.     

Feasible criteria for enrolling end-stage dementia patients in home hospice care

Hospice care is considered appropriate for end-stage dementia patients (Luchins & Hanrahan, 1993), yet less than 1 percent of hospice patients have a primary diagnosis of dementia (Hanrahan & Luchins, 1995). This pilot study tested the feasibility of providing palliative care for dementia patients. A common eligibility requirement for admission to hospice is that the patient is likely to die within six to seven months. The uncertain survival time of dementia patients thus prevents access to hospice programs. Therefore, enrollment criteria were developed based on the characteristics of advanced dementia and a history of medical complications. With these criteria established, it was then possible to enroll 11 patients over two years. The enrollment criteria proved successful in that the median survival time was five months, with an average of seven months. Eight of the 11 patients died during the study. Hospice care was well accepted by family caregivers and appeared to meet the patient's needs.     

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)     

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)     

What is the future of palliative medicine in Germany?

Traditional medical treatment approaches for incurably and terminally ill persons are often felt by the patients and their families to be lacking, since distressing physical and spiritual symptoms of the disease cannot be adequately addressed. In many cases, care in the final stage of life represents a complex medical challenge whose objective is to maintain an individually sufficient quality of life for the patient. New strategies for therapy and care evolving out of the international hospice movement have entered medical training programs under the heading of palliative medicine. Although palliative medicine has only recently enjoyed increasing acceptance in professional as well as lay circles in Germany, it is widespread in many Anglo-Saxon countries, where it also is offered as an academic discipline in research and teaching. According to the most recent American legal interpretations, palliative treatment has been approved as a constitutional right for patients with severely debilitating symptoms. Against the background of sweeping social restructuring, demographic and tumor-epidemiological developments are exerting increasing pressure on our modern societies to improve treatment approaches for incurable patients. In the public itself a changed and more open treatment of the topics of death and dying is becoming apparent, resulting in a demand as well for medical treatment options. From all this, as well as the fact that Germany has been strongly hesitant to establish palliative medicine facilities, it is apparent that there is a clear need to catch up in the area of palliative medicine treatment, research and teaching. The current mood of fiscal restraint in health care may delay medical progress, but it will not be able to prevent it.     

Dental care for the handicapped: general problems

In contrast to an increased oral health level in the Western countries, this improvement is not the case in age matched handicapped. The dental mutilation is generally related to periodontal problems (plaque, gingivitis, periodontitis, calculus), dental caries, traumatic injuries and self-injuring behaviour. Via a questionnaire, data from 88 institutions in Flanders were obtained. It became clear that there is a striking lack of oral health care and follow-up within institutions. There is a strong need for mouth hygiene instructions programmes for educators, parents, as well as for dentists involved in the special care of these patients.     

Psychologists and hospice: Where we are and where we can be.

Since the early days of the hospice movement, the role of psychologists in hospice care has been discussed. This study is based on questionnaire responses from hospice programs randomly drawn from those who were members of the National Hospice and Palliative Care Organization. The results clearly demonstrate the need for psychology's role in hospice, but there is much to do to clarify and develop this role. Although psychologists have much to offer in the hospice field and end-of-life care in general, this study found that there are not many psychologists actively working in these settings. Suggestions are made for how psychologists can become more involved in the provision of hospice and other end-of-life care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The spiritual work of the dying: a framework and case studies

This article describes a systematic approach to understanding the spiritual work of the dying. It begins by defining "spirituality," "spiritual care" and "spiritual work" in order to create a common vocabulary. The remainder of the article uses vignettes from clinical experience to create a framework for understanding not only the recurrent themes in the spiritual work being done by the terminally ill but the support and interventions of the spiritual counselor as well. These case experiences are clustered under four headings: "remembering," "reassessing," "reconciliation" and "reunion." The article gives serious attention to the "supernatural" experiences of the dying as experienced by the hospice team.     

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.     

Tumor cell recognition by lymphocytes: is the MHC always essential?

More than a year has passed since the Center to Improve Care of the Dying and the Corcoran Gallery of Art sponsored the symposium entitled: A Good Dying: Shaping Health Care for the Last Months of Life. Using the National Hospice Foundation sponsored exhibition, Hospice: A Photographic Inquiry, as a backdrop, the symposium included presentations on the current state of hospice care as well as the obstacles that limit access to hospice care. This article represents an update on many of the activities of the National Hospice Organization and the greater hospice community as we continue to improve access to quality hospice care.     

Nursing, healing and spirituality

The premise of this article is that nurses are healers, primarily through the caring relationships they form with patients. Caring calls out an individual's inner strengths. These strengths include spiritual resources which support integration or wholeness of body, mind and spirit. Many nurses are unsure about giving spiritual care. This author encourages nurses to reflect on their own spirituality and learn spiritual care skills. By addressing the spiritual dimension in patient care, nurses can truly be holistic practitioners and positively affect the mental and physical health of their patients.     

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)