Care At The Close Of Life Evidence And Experience

From one of the world’s leading medical journals comes the definitive evidence-based, full-color guide to end-of-life and palliative care "...represents an important milestone in the evolution of care for people with advanced disease—-for which its editors and authors and JAMA should be rightly proud. It is wonderful that JAMA had the foresight to publish a series on this topic, which, as medicine has become more technologically advanced and subspecialized, is often overlooked and, sometimes worse, avoided....this book will be invaluable for front-line clinicians, and indeed all health care practitioners—as care at the close of life is a part of almost all of medicine’s specialties and settings."--Irene J. Higginson, BMBS, PhD, FPPHM, FRCP; Dept. of Palliative Care, Policy, & Rehabilitation; Cicely Saunders Institute; King's College London (from the foreword) A new addition to the JAMAevidence series, Care at the Close of Life: Evidence and Experience offers evidence-based and clinical expert guidance on caring for patients with life-limiting illness, incorporating the words and perspectives of affected patients, their families, and treating clinicians. Organized by these actual clinical cases, the book is based on the acclaimed 7-year series of 42 articles, originally published in JAMA as “Perspectives on Care at the Close of Life,” and now thoroughly updated as chapters and featuring extensive never-before-published material. Care at the Close of Life covers are a wide range of clinical syndromes, disease processes, communication challenges, health-care delivery settings, and issues faced by patients, including withdrawal of dialysis and other life-sustaining measures, cross-cultural approaches, and the role of chemotherapy. Throughout the book, emphasis is on the principles of palliative care, with the patient and family at the center of care, and with attention given to all problems—physical, psychological, social, and spiritual. Reflecting this focus, each chapter begins with a patient case study to introduce the clinical problem, followed by “perspectives” that draw on extensive, real-world dialogue between clinicians, patients, and families. Internationally renowned authors then review the typical challenges illustrated by the case, offering state-of-the-art, evidence-based assessment and treatment approaches. Features Fully revised and updated text with new evidence and references, including the search methodology for each chapter’s update Evidence-based orientation presents the current state of knowledge in the care of terminally ill patients and support for their families and caregivers Practical clinical guidance and approaches from international experts in palliative care Self-assessment Q&A, for reinforcing your knowledge of each chapter’s content and for preparing for exams A useful Glossary of acronyms, terms, and tests Updated Resources for each chapter offer current, authoritative sources of diagnostic and treatment information that can help you optimize palliative care Medline PubMed ID numbers facilitate quick, convenient access to references

The world's leading source of evidence-based guidance on caring for patients at the end of life. Featuirng the content of the world's most widely read medical journal, plus completely new, never-before-published content. Perfect for medical students, trainees, and clinicians alike. Market / Audience Medical students: 18000/yr US, 250,000 global NP and PA students: 25,000/yr US, 50,000+ global IM and FP residents: 30,000 US, 60,000 global IM and FP clinicians: 140,000 US, 300,000+ global Palliative medicine: 3000 US Oncology: 20,000 US, 60,000 global Social workers About the Book In the tradition of the User's Guides to the Medical Literature, and The Rational Clinical Examination, JAMA/Care at the Close of Life is based on a widely successful series of articles appearing over the course of the last ten years in JAMA, the world's most widely read medical journal. The series is directed by Stephen McPhee, a leading authoriity of end of life care, and the chief editor of our market leading Current Medical Diagnosis and Treatment text. The articles in the series cover fundamental topics and challenges in caring for patients who have been given a terminal diagnosis. Featuring a strong focus on evidence-based medicine, and organized by clinical cases, the articles are widely read by faculty, medical students, and clinicians who, frankly, have not been given a solid educational experience on this very important medical issue. The book will be physically modeled after The Rational Clinical Examination, in a full color format that highlights the clinical cases. It will be well suited for use as an required or recommended textbook for medical, PA, and NO students, and as a clinical reference text for trainees and practicing physicians and nurses. Key Selling Features Based on highy regarded content from the world's most widely read medical journal All content is completely updated, and extensive new, never-before-published content has been added Case-based, and evidence-based, so its a perfect fit for the way medical students and residents like to learn Focuses on practical, real-world issues for primary care physicians, and avoids esoteric issues of interest only to specialists in palliative care Full color format, modeled after the highly regarded Rational Clinical Examination Includes multimedia materials available on line: Power Point slides for teaching, and video interviews with patients in end-of-life care, so that faculty and students get supplemental resources for learning the art and science of care at the end of life Evidence-based guidance from the world's leading medical journal, on a critical topic that has been neglected in medical education and training until recently. Author Profile JAMA is the world's most widely read medical journal, and has a reputation for excellence in evidence-based medicine. Stephen McPhee has high visbility on account of his editorship of CMDT, and for his driving role in enhancing end of life care in medical education and training programs. He is: Professor of Medicine, UCSF School of Medicine, San Francisco CA

For patients and their loved ones, no care decisions are more profound than those made near the end of life. Unfortunately, the experience of dying in the United States is often characterized by fragmented care, inadequate treatment of distressing symptoms, frequent transitions among care settings, and enormous care responsibilities for families. According to this report, the current health care system of rendering more intensive services than are necessary and desired by patients, and the lack of coordination among programs increases risks to patients and creates avoidable burdens on them and their families. Dying in America is a study of the current state of health care for persons of all ages who are nearing the end of life. Death is not a strictly medical event. Ideally, health care for those nearing the end of life harmonizes with social, psychological, and spiritual support. All people with advanced illnesses who may be approaching the end of life are entitled to access to high-quality, compassionate, evidence-based care, consistent with their wishes. Dying in America evaluates strategies to integrate care into a person- and family-centered, team-based framework, and makes recommendations to create a system that coordinates care and supports and respects the choices of patients and their families. The findings and recommendations of this report will address the needs of patients and their families and assist policy makers, clinicians and their educational and credentialing bodies, leaders of health care delivery and financing organizations, researchers, public and private funders, religious and community leaders, advocates of better care, journalists, and the public to provide the best care possible for people nearing the end of life.

Behavioral Intervention Research in Hospice and Palliative Care: Building an Evidence Base sets forth research considerations and guidelines to build evidence-based interventions to improve end-of-life care. It is an in-depth introduction to implementation research and showcases how a clinical need is identified to inform an intervention. The book extensively examines the various phases of intervention research, including design, implementation, evaluation, dissemination and translation. The book focuses on methodological, ethical and practical issues. The science behind the quality of hospice and palliative care lags behind that of traditional medical practice, despite the continuous growth of palliative care interdisciplinary teams. Researching, developing and testing strategies is essential to advancing the effectiveness and value of this care. Informs readers how to conduct intervention research toward identifying best care Advises readers on design, implementation and evaluation of research Provides step-by-step templates to develop an intervention study Includes mock protocols from successful intervention trials Synthesizes lessons learned by established intervention researchers in hospice and palliative care

The “essential” companion to the landmark Users' Guides to the Medical Literature - completely revised and updated! 5 STAR DOODY'S REVIEW! "This second edition is even better than the original. Information is easier to find and the additional resources that will be available at www.JAMAevidence.com will provide readers with a one-stop source for evidence-based medicine."--Doody's Review Service Evidence-based medicine involves the careful interpretation of medical studies and its clinical application. And no resource helps you do it better-and faster-than Users' Guides to the Medical Literature: Essentials of Evidence-Based Clinical Practice. This streamlined reference distills the most clinically-relevant coverage from the parent Users' Guide Manual into one highly-focused, portable resource. Praised for its clear explanations of detailed statistical and mathematical principles, The Essentials concisely covers all the basic concepts of evidence-based medicine--everything you need to deliver optimal patient care. It's a perfect at-a-glance source for busy clinicians and students, helping you distinguish between solid medical evidence and poor medical evidence, tailor evidence-based medicine for each patient, and much more. Now in its second edition, this carry-along quick reference is more clinically relevant--and more essential--than ever! FEATURES Completely revised and updated with all new coverage of the basic issues in evidence-based medicine in patient care Abundant real-world examples drawn from the medical literature are woven throughout, and include important related principles and pitfalls in using clinical research in patient care decisions Edited by over 60 internationally recognized editors and contributors from around the globe Also look for JAMAevidence.com, a new interactive database for the best practice of evidence based medicine.

Using a practical, question-and-answer approach, Evidence-Based Practice of Palliative Medicine, 2nd Edition, helps you provide optimal care for patients and families who are dealing with serious illness. This unique reference focuses on patient and family/caregiver-centered care, highlighting the benefits of palliative care and best practices for delivery. The highly practical, user-friendly format sets it apart from other texts in the field, with concise, readable chapters organized around clinical questions that you’re most likely to encounter in everyday care. Uniquely organized using a question-and-answer approach, making it easy to find answers to common questions asked by practitioners and patients. Up-to-date, reader-friendly chapters explore interventions, assessment techniques, treatment modalities, recommendations and guidelines, communication techniques, and available resources for palliative care. Expanded discussions on hospice in every chapter, and a new emphasis on pediatrics, with increased material on pediatric malignancies, developmental delays, cystic fibrosis, and perinatal palliative care. New chapters on wellness of the palliative care practitioner, patients with opioid use disorders, telehealth in palliative care, health disparities, rural palliative care, caring for people with hematologic malignancies, integrative and alternative therapies, LGBTQ+ populations, mobile health technologies, and national palliative care implementation strategies. High-quality evidence gathered and reviewed by leading experts in palliative medicine, including clinicians, educators, and researchers across a broad range of disciplines. Numerous algorithms throughout help you make informed decisions, and “take-home” points in every chapter provide a quick summary of key content. Any additional digital ancillary content may publish up to 6 weeks following the publication date.

A milestone resource for palliative care nurses that facilitates evidence-based compassionate and humanistic care of the dying A valuable contribution to the evolving field of palliative nursing care. It is authored by a model for this field, Bonnie Freeman, and brings to the bedside what her practice embodies--evidence-based clinically expert care...The CARES tool is a long-needed resource and we are all grateful to the author for moving her passion to paper. It will touch the lives and deaths of patients, families, and the nurses who care for them. --Betty Ferrell, PhD, RN, MA, FAAN, FCPN, CHPN Professor and Director, Division of Nursing Research and Education City of Hope National Medical Center From the Foreword This groundbreaking reference for palliative care nurses is the first to provide realistic and achievable evidence-based methods for incorporating compassionate and humanistic care of the dying into current standards of practice. It builds on the author's research-based CARES tool; a reference that synthesizes five key elements demonstrated to enable a peaceful death, as free from suffering as possible: comfort, airway management, management of restlessness and delirium, emotional and spiritual support, and selfcare for nurses. The book describes, step by step, how nurses can easily implement the basic tenets of the CARES tool into their end-of-life practice. It provides a clearly defined plan that can be individualized for each patient and tailored to specific family needs, and facilitates caring for the dying in the most respectful and humane way possible. The book identifies the most common symptom management needs in dying patients and describes, in detail, the five components of the CARES paradigm and how to implement them to enable a peaceful death and minimize suffering. It includes palliative care prompts founded on 29 evidence-based recommendations and the National Consensus Project for Palliative Care Clinical Practice Guidelines. The resource also addresses the importance of the nurse to act as a patient advocate, how to achieve compassionate communication with the patient and family, and barriers and challenges to compassionate care. Case studies emphasize the importance of compassionate nursing care of the dying and how it can be effectively achieved. Key Features: Provides nurses with a clear understanding of the most common needs of the dying and supplies practical applications to facilitate and improve care Clarifies the current and often complex literature on care of the dying Includes case studies illustrating the most common needs of dying patients and how these are addressed effectively by the CARES tool Based on extensive evidence as well as on the National Consensus Project for Palliative Care Clinical Practice Guidelines Bonnie Freeman, DNP, ANP, RN, ACHPN, is an adult nurse practitioner in the Department of Supportive Care Medicine at the City of Hope National Medical Center in Duarte, California. She is involved with treating the symptom management needs of many chronically and terminally ill individuals diagnosed with various forms of cancer. Dr. Freeman trained at such excellent facilities as the in-patient units at San Diego Hospice and the Institute of Palliative Medicine in San Diego, California, and the home care hospice program in Owensboro, Kentucky. While in Kentucky, she completed her advanced practice clinical training for adult nurse practitioners with a specialty focus on palliative care through Vanderbilt University in Nashville, Tennessee. This program exposed Dr. Freeman to current concepts in caring for the dying, and enhanced her already significant clinical experience caring for dying individuals acquired from over 30 years working in critical care. Dr. Freeman obtained her MSN from Indiana Wesleyan University, and her DNP from Azusa Pacific University in Azusa, California. Contributors Tracey Das Gupta, MN, RN, CON, is director of Interprofessional Practice at Sunnybrook Health Sciences Centre in Toronto, Ontario, Canada. She is also the colead of the Quality Dying Initiative with Dr. Jeff Myers. Tracey has been passionate about health care, quality of life, and leadership since becoming a nurse in 1991. Her decision to become a nurse was influenced by her father who lived with muscular dystrophy. Ms. Das Gupta has fulfilled various frontline nursing roles along the continuum of care and has had the opportunity to continue to grow in leadership roles such as educator, professional practice leader, and director of nursing practice. In her current role, she also provides leadership for the development and implementation of Sunnybrook's interprofessional care (IPC) strategy. Margaret Fitch, PhD, MScN, is a nurse researcher and holds an appointment at the Bloomberg Faculty of Nursing and School of Graduate Studies at the University of Toronto. She also serves as expert lead for cancer survivorship and patient experience for the Person-Centered Perspective Portfolio of the Canadian Partnership Against Cancer. She is also editor-in-chief for the Canadian Oncology Nursing Journal. Dr. Fitch has an extensive publication record based on her many years of research regarding patient perspectives, coping and adaptation with illness, and screening for psychosocial distress. She has particular expertise in measurement and evaluation, qualitative methods, and knowledge integration. During her career, she has held clinical and administrative positions and has maintained an ongoing role in education of both undergraduate and graduate students and health professionals in practice.

A milestone resource for palliative care nurses that facilitates evidence-based compassionate and humanistic care of the dying "A valuable contribution to the evolving field of palliative nursing care. It is authored by a model for this field, Bonnie Freeman, and brings to the bedside what her practice embodies--evidence-based clinically expert care...The CARES tool is a long-needed resource and we are all grateful to the author for moving her passion to paper. It will touch the lives and deaths of patients, families, and the nurses who care for them." --Betty Ferrell, PhD, RN, MA, FAAN, FCPN, CHPN Professor and Director, Division of Nursing Research and Education City of Hope National Medical Center From the Foreword This groundbreaking reference for palliative care nurses is the first to provide realistic and achievable evidence-based methods for incorporating compassionate and humanistic care of the dying into current standards of practice. It builds on the author's research-based CARES tool; a reference that synthesizes five key elements demonstrated to enable a peaceful death, as free from suffering as possible: comfort, airway management, management of restlessness and delirium, emotional and spiritual support, and selfcare for nurses. The book describes, step by step, how nurses can easily implement the basic tenets of the CARES tool into their end-of-life practice. It provides a clearly defined plan that can be individualized for each patient and tailored to specific family needs, and facilitates caring for the dying in the most respectful and humane way possible. The book identifies the most common symptom management needs in dying patients and describes, in detail, the five components of the CARES paradigm and how to implement them to enable a peaceful death and minimize suffering. It includes palliative care prompts founded on 29 evidence-based recommendations and the National Consensus Project for Palliative Care Clinical Practice Guidelines. The resource also addresses the importance of the nurse to act as a patient advocate, how to achieve compassionate communication with the patient and family, and barriers and challenges to compassionate care. Case studies emphasize the importance of compassionate nursing care of the dying and how it can be effectively achieved. Key Features: Provides nurses with a clear understanding of the most common needs of the dying and supplies practical applications to facilitate and improve care Clarifies the current and often complex literature on care of the dying Includes case studies illustrating the most common needs of dying patients and how these are addressed effectively by the CARES tool Based on extensive evidence as well as on the National Consensus Project for Palliative Care Clinical Practice Guidelines