Palliative or hospice care? Understanding the similarities and differences.

University of Cincinnati, OH, USA.
Rehabilitation nursing: the official journal of the Association of Rehabilitation Nurses (Impact Factor: 0.85). 03/2010; 35(2):60-4. DOI: 10.1002/j.2048-7940.2010.tb00032.x
Source: PubMed

ABSTRACT With advances in health care and medical technology, the focus of medical care has been on curing. As people live longer, the possibility of experiencing chronic and life-limiting disease not only increases but also spurs the ethical question "Is length of life or quality of life most important?" Palliative care may be confused with hospice care, as both focus on symptom management and improved quality of life for those with chronic life-limiting disease. A better understanding of each healthcare option is needed for appropriate and timely patient referral. The purpose of this article is to identify the similarities and differences between these two options, clarify when referral is appropriate for hospice or palliative care services, and discuss the nurse's role in caring for patients with chronic disease.

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    ABSTRACT: Purpose Commonly used terms such as “supportive care,” “best supportive care,” “palliative care,” and “hospice care” were rarely and inconsistently defined in the palliative oncology literature. We conducted a systematic review of the literature to further identify concepts and definitions for these terms. Methods We searched MEDLINE, PsycInfo, EMBASE, and CINAHL for published peer-reviewed articles from 1948 to 2011 that conceptualized, defined, or examined these terms. Two researchers independently reviewed each citation for inclusion and then extracted the concepts/definitions when available. Dictionaries/textbooks were also searched. Results Nine of 32 “SC/BSC,” 25 of 182 “PC,” and 12 of 42 “HC” articles focused on providing a conceptual framework/definition. Common concepts for all three terms were symptom control and quality-of-life for patients with life-limiting illness. “SC” focused more on patients on active treatment compared to other categories (9/9 vs. 8/37) and less often involved interdisciplinary care (4/9 vs. 31/37). In contrast, “HC” focused more on volunteers (6/12 vs. 6/34), bereavement care (9/12 vs. 7/34), and community care (9/12 vs. 6/34). Both “PC” and “SC/BSC” were applicable earlier in the disease trajectory (16/34 vs. 0/9). We found 13, 24, and 17 different definitions for “SC/BSC,” “PC,” and “HC,” respectively. “SC/BSC” was the most variably defined, ranging from symptom management during cancer therapy to survivorship care. Dictionaries/textbooks showed similar findings. Conclusion We identified defining concepts for “SC/BSC,” “PC,” and “HC” and developed a preliminary conceptual framework unifying these terms along the continuum of care to help build consensus toward standardized definitions.
    Supportive Care Cancer 03/2012; 21(3). DOI:10.1007/s00520-012-1564-y · 2.50 Impact Factor
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    ABSTRACT: The purpose of this study was to gain insight into how a brief clinical observation encounter contributed to students' experiences in an interdisciplinary palliative care course. This course was required of all graduate nursing students and was available as an elective for medical and other healthcare professions students at a healthcare sciences university. The students were required to spend approximately 8 to 12 hours attending interdisciplinary team meetings or accompanying a team on rounds and patient visits. The students' summary narratives of their observation experience were analyzed in this qualitative study that focused on six categories of feedback: (1) patients' and families' reactions, (2) communication issues with patients and families, (3) how the palliative care team speaks with the patient and family, (4) communication within the interdisciplinary team, (5) students' reflections, and (6) students' suffering. This study demonstrated that a clinical observation activity can be a valuable introduction to palliative care principles for healthcare students in an interdisciplinary course. Students benefited from gaining insight into family/practitioner communications regarding difficult issues, interdisciplinary roles and cooperation, and application of palliative care principles to clinical practice. Further research is required to identify appropriate interventions to deal with student distress resulting from such early career clinical encounters. In 2006, an interdisciplinary palliative care course re-quired of all graduate nursing students and optional for medical and other allied healthcare students was ini-tiated at a large academic medical center. This course focuses on developing students' knowledge and appli-cation of palliative care and interdisciplinary team con-cepts by engagement in online content and discussions, simulation laboratory exercises, and clinical observation (Table 1). The course is a graduate-level, two-credit course offered multiple times throughout the year. One of the course activities is a clinical observation of palliative care services where students spend approximately 8 to 12 hours attending an interdisciplinary team meeting and/or ac-companying a palliative care team on rounds and/or ac-companying a team member on patient visits to inpatient and/or outpatient settings. The objectives of this course activity are to (1) describe how interdisciplinary palliative care team principles can be applied in a clinical setting, (2) identify characteristics of a palliative approach in the care of patients, and (3) identify the team members' role in incorporating a palliative approach to care. Afterward, each student composed a brief summary narrative of their observation. ''Interdisciplinary'' is a term used in three different con-texts. Interdisciplinary is used when referring to palliative care teams as defined by the National Consensus Project for Quality Palliative Care as ''a core group of professionals from medicine, nursing, and social work and may include some combination of volunteer coordinators; bereavement coordinators; chaplains; psychologists; pharmacists; nurs-ing assistants and home attendants; dietitians; speech and language pathologists; physical, occupational, art, play, music, and child-life therapists; case managers; and trained volunteers.'' 1 It also refers to an interdisciplinary palliative care course that includes degree-seeking students from different disciplines (nursing, medicine, and other allied healthcare programs). Finally, the faculty Feature Article this course is referred to as interdisciplinary and consists of nurses, physicians, chaplains, and other allied health-care professionals. PURPOSE The purpose of this study was to gain insight into how a brief clinical observation activity contributed to stu-dents' experiences in an interdisciplinary palliative care course. Two key questions were asked: Is a brief clinical observation activity meaningful to students in an inter-disciplinary palliative care course, and what do students self-identify as learning that occurred? To explore these questions, students' summary narratives of their obser-vations were studied. METHODS A university institutional review board approval was ob-tained. At the beginning of the course, each student re-ceived a description of the assignment, including the objectives, anticipated time, and a list of participating palliative and hospice care sites. Students then selected a site and arranged for their clinical observation. At the selected site, students accompanied a team or team member engaged in palliative care work. After their ob-servation, the students were to prepare a brief summary narrative of the site and activities, including any ''lessons learned,'' and post in a designated discussion board sec-tion within the online course shell. These broad, nondi-rected instructions were designed to allow students flexibility in addressing aspects of the observation that were of greatest significance to them. These summary narratives were gathered for the period of January to August 2010. The study period coincided with the initia-tion of a new online teaching system. At that time, the course was well established with earlier revisions already incorporated, ensuring to the degree possible that faculty, course activities, and expectations of students remained consistent over time. Participants The summary narratives for this study originated from 207 nursing, medicine, and other allied healthcare stu-dents taking this course in 2010. There was a diversity of participants, the sample size was adequate for qualita-tive data collection, and the clinical settings were experi-enced in working with students completing the summary narrative of their observation activity associated with this course. Students were predominately female (81.2%) and en-rolled in postlicensure advanced practice nursing (n = 106), prelicensure generalist entry master's program in nursing (n = 55), medical students in their clerkship (n = 42), or other healthcare programs (n = 4). Students' palliative care observations occurred in a variety of settings: hospitals (n = 141), hospices (n = 64), and other settings (a nursing home and a retirement residence) (n = 2).
    Journal of Hospice and Palliative Nursing 01/2012; 14(4):274-281. DOI:10.1097/NJH.0b013e3182491539 · 0.73 Impact Factor


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