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"COMFORT is an acronym that stands for the basic principles of palliative care communication and comprises seven modules (Communication, Orientation/Opportunity, Mindfulness, Family, Openings, Relating, Team). These communication skills training modules are designed to highlight interprofessional care and communication. Each module of the COMFORT curriculum can stand alone as a teaching activity or can be integrated into a new or existing course. Modules C (narrative clinical communication) and F (family caregivers) provide beginner level instruction, while M (mindfulness), O/O (orientation), and T (team) provide intermediate instruction and O (openings) and R (relating) provide advanced communication skills and are intended for learners who have clinical observation experience."

"As I look around the world I see that about a billion people in the world have access to decent pain management and palliative care. That leaves almost 6 billion people with virtually no access to good analgesics or health care professionals who know how to appropriately administer them. To me this is a crisis." "

online

"WHAT TO DO WHEN A PATIENT LACKS CAPACITY - The degree and urgency with which to act on findings of impaired capacity depends on multiple factors, including the expected duration of impairment, the severity of the impairment, and the seriousness of the decision. Unless the urgency of a patient's medical condition requires that a substituted decision be made immediately, efforts should be made to identify and correct any reversible causes of the impairment [26]. This is particularly relevant in hospitalized patients with impaired capacity due to delirium. Treatment of the underlying causes of delirium may restore decision-making capacity. Patients with mild to moderate cognitive impairment that is not expected to fluctuate may benefit from more intensive efforts at education to improve understanding of the relevant facts, followed by reassessment of decision-making abilities. A randomized trial found that a memory and organizational aid given to patients with mild stage Alzheimer disease dementia (n = 80) improved performance on understanding, which in turn increased the likelihood of being judged capable of providing informed consent to enroll in a clinical trial [34]. This enhancement was also effective in a randomized trial with middle-aged and older adults with schizophrenia [35]. For patients whose impairments are severe enough that they are judged to lack the capacity to make a decision, there is a clear ethical obligation to seek out a substitute decision maker. Substitute or surrogate decision makers should ideally have been chosen by the patient in advance. In the absence of a designated surrogate, laws may vary in terms of which people can serve in this proxy role and their hierarchy; in general, the order is the spouse, adult children, parents, siblings, and other relatives. (See "Legal aspects in palliative and end of life care", section on 'Surrogate decision makers'.) When making a substituted decision, the proxy should take into consideration

"The home is an outstanding setting for education of medical students, providing wonderful opportunities to enrich students' appreciation of the patient-physician relationship; of interdisciplinary care; and of the challenging biomedical, psychosocial, and spiritual aspects of care."

"In a larger context, however, such activities may help to enhance our ability to interpret stories, and to see patients in the context of their own story, which is what makes the care of patients a human and humane endeavour. "