Talk:Palliative care
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[edit] Article Title and proposed merge with Children's hospice
There is a difference between the two specialities of Hospice Care and Palliative Care. I think it's appropriate to have an article about Palliative Care, but Palliative Care is not synonymous with Hospice Care. Hospice Care is not a sub-speciality of Palliative Care which one would almost assume, considering the redirect. The two would certainly share some links, but they are not one in the same. I do get the feeling that some in the newer Palliative Care field would like to blur the distinctions, but there are pro's and con's to each speciality that patients should be aware of. Nightngle 18:01, 27 February 2006 (UTC)
- The more I'm thinking about this, I'm wondering if it would be better to title this article "End Of Life Care" and have sections on each specialty and a discussion of how the two are similar and different. Additionally, care in a variety of countries could be discussed as wel, since culture, methods of reimbursement, societal attitudes, etc. all play a part in how end of life care is approached. Nightngle 18:49, 27 February 2006 (UTC)
I think End of Life Care would be a good title because it is more inclusive of these types of care for the elderly. Either way, this article should NOT be merged with children's palliative care. This is because the type of palliative care provided depends on who receives the care. Let's not generalize topics, but elaborate on them! —The preceding unsigned comment was added by 134.121.151.113 (talk • contribs) 10:28, 6 December 2006 (UTC).
- I too think that palliative care for children's should have its own article. - Introvert • ~ 02:17, 19 December 2006 (UTC)
I'm saddened that there are views that we should be separating parts of the palliative care community.
1) Palliative v. Hospice: As a palliative care physician who started 25 years ago in the field I can reassure folks that palliative care and hospice care sit together, not seperately. I'm not sure what is meant by the 'newer' field of palliative care means since it first became a speciality (in the UK anyway) nearly 20 years ago in 1989, and was driven by professionals working in many environments, but especially those from hospice. Palliative care is now used as a broad term, recognised by the WHO, to describe any service run by professionals trained in the interdisciplinary care of people with life-threatening and life-limiting illness.
2) Children's v adult palliative care: as a physician working in a hospice with both an adult and a children's unit, I have found it invaluable to have the two services working together, talking to each other and sharing experiences. There are more similarities between us than differences, but we also have much to learn from each other. It is also important to remember that many children with life-threatening and life-limiting illness are now living longer into adulthood. Only by talking together will we be able to help them with these transitions.
A plea- lets keep talking about working together, not about seperating each other! --Claud Regnard 15:21, 29 December 2006 (UTC)
I have found this article because I have had a relative in a hospital under palliative care - and not in a hospice. I knew full well what a hospice was, but not the more euphamistic term "palliative". One can work in palliative care, but not in a hospice, and the term is thus deserving of its own entry. The common misspelling "pallative" (without the 'i') should also be mentioned to aid those searching for information on this topic. Not to be emotional about this, but those who are in need of this information are likely to want as much detailed information about each separate medical term they encounter as possible, rather than read conglomerated articles. 86.137.5.67 01:07, 5 January 2007 (UTC)AC 5 Jan 07
One can receive palliative care without being in a hospice care program (which requires a 6-month prognosis). While the two are interrelated, and should be linked, they are not interchangeable. Jan 22, 2006 —The preceding unsigned comment was added by 66.31.79.81 (talk • contribs) 16:56, 22 January 2007 (UTC).
I suspect there is a simple communication issue here. Hospice, in some settings, is a stand-alone service with no links to other services. Some hospital and community services can also be stand-alone. Clearly each provides a different service that is funded and organised very differently.
However, in many settings around the world these services work in an integrated fashion, cross working with the same professionals and in many places organised by a single service. Indeed, some hospital and community services are called 'hospice', while there are hospices who call themselves 'palliative care' units!
There is now an international acceptance of the term 'palliative care' as un umbrella term to describe any services caring for people with progressive life-threatening or life-limiting illness. It has become accepted that this term applies wherever the services are based and however they are organised.
--Claud Regnard 23:37, 4 February 2007 (UTC)
[edit] Alt med
So some areas of alt med like to get involed in palative care. So what? this can be listed on there own pages.Geni 23:10, 8 Jun 2004 (UTC)
My feeling, too. And the Amer. Board of Hospice/Palliative med should not have been dropped. The development of a speciality board for the field is a milestone in the progress that has been seen in the field. Stephen Holland, M.D., Kd4ttc 00:36, 9 Jun 2004 (UTC)
[edit] Intro
The introduction needs a lot of work. At the moment it consists of about four very slightly different definitions taken from different sources. It should be rewritten as one single definition, with links to the sources if necessary. -- ALargeElk | Talk 10:27, 9 Jun 2004 (UTC)
- And, would you mind writing the correct and complete definition while you are at it? -- [[User:Mr-Natural-Health|John Gohde | Talk]] 10:40, 9 Jun 2004 (UTC)
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- I've just done it. Since there is a consensus about what PC is I don't see any need to have any references. So I removed them all, combined the definitions and added a little bit on how cure is still considered more important than comfort by many(most) doctors. theresa knott 11:08, 9 Jun 2004 (UTC)
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- I think there is a need for links to some of the references, as it seems to me there is some argument about what palliative care is. The WHO definition focuses specifically on incurable diseases; the others imply more about using it in addition to curative treatment. Having all four definitions in full doesn't work, purely in terms of readability, but I think it's important to discuss this issue in the intro. I'll have a go when the heat dies down a bit. -- ALargeElk | Talk 11:17, 9 Jun 2004 (UTC)
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- That was pretty good, but I just did a somewhat drastic edit which I think is a little more clear & concise. I left in the 1990 definition, but the WHO now also uses the term in the more general sense. I dropped the other 2 references, because they seemed redundant as well as misplaced (they were talking about incurable diseases). I also added a paragraph clarifying why we don't say "palliative" for all incurable diseases; rewrote the last paragraph of the intro slightly to clarify that the concept isn't really new, just newly respected; and added a sentence to lead into the Hospice section. --Hob 05:56, 27 Jul 2004 (UTC)
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- Also, in the Hospice section: it is (as far as I know) fairly rare to call palliative care in a hospital setting "hospice", so I reworded the first sentence. I struck the last sentence ("The main difference between hospice care and palliative care is that the former is more about nursing while the latter is the physicians' term") because I think it's neither an accurate summary nor really necessary - palliative & hospice were already defined adequately above. --Hob 06:12, 27 Jul 2004 (UTC)
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[edit] Vickers, 2004 : "Palliative Care and Alternative Medicine"
I am glad to see that Mr-Natural-Health has resumed putting CAM-related content here (when he takes a break from "laughing" at fellow Wikipedians.... sigh ....) Unfortunately, a simple copy-&-paste from "Vickers, 2004" is a copyvio. Please at least take off those numbers and modify the sentences a little. Thanks. -- PFHLai 13:13, 2004 Jun 9 (UTC)
- No it's fine to quote as long as it is clearly attributed. ( comes under "fair use") Never the less the numbers should come off as they make no sense here. theresa knott 13:28, 9 Jun 2004 (UTC)
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- I'd changed this before I read your message, Theresa. Nevertheless, the link to the research had to go, as it specifically states that "Complementary therapies for cancer-related symptoms were not part of this review" - the research is purely into proposed complementary cures. Incidentally, that research makes interesting reading - it debunks the effectiveness of the vast majority of proposed alternative treatments for cancer, and might make an interesting link from another article somewhere. But it's inappropriate for this one.-- ALargeElk | Talk 13:45, 9 Jun 2004 (UTC)
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- I notice that MNH had made the point earlier that this was in many ways an anti-Alt Med article, and I can understand that it might have been included as an admirable attempt at compromise. But I really can't see that it improves Wikipedia to have a link to research almost entirely unrelated to palliative care in a palliative care article. -- ALargeElk | Talk 14:06, 9 Jun 2004 (UTC)
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- It doesn't surprise me in the least bit the MNH would quote an article that was not actually saying what he implied it was. I've had a lot of experience with him over the last few months on alternative medicine and iridology and I believe that everything he quotes needs to be thoroughly checked. I didn't check the quote before making my comment though mainly because i wanted to point out that quoting small sectons of works does not make a copyvio. Anyway no harm done as you were clearly on the ball. theresa knott 14:16, 9 Jun 2004 (UTC)
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- So it's not a copyvio, eh ? Okay, thank you. -- PFHLai 14:32, 2004 Jun 9 (UTC)
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- You're always fine quoting small sections of articles as long as you put it in quotation marks and say who said it. It's only if you cut and paste then pretend it's your own work, or if you you quote very large chunks or even the whole work that you run into problems. theresa knott 14:54, 9 Jun 2004 (UTC)
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- If you look at this edit (and especially the edit summary) you'll see that MNH doesn't deny that the bulk of the article is anti-alt med. But it's still not relevant to this article. It's cited as well in Alternative medicine - it might also make sense to cite it in Oncology or something like that.-- ALargeElk | Talk 15:43, 9 Jun 2004 (UTC)
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The Vickers quote was the wrong citation. That cite showed the ineffectiveness of a number of Alternative Medicine Treatments. The article in the discussion section quoted several studies that supported approaches to palliation that were not discussed in the results section. The correct citations for this article would be the citations referenced by the paper. If the papers are valid it would make a nice addition to this article. Kd4ttc 15:24, 9 Jun 2004 (UTC)
- Check out Alternative medicine. All my citations reference the abstract or the full text of the research paper online. The citation that I referenced here provided the full text of the research paper online. I made a direct quote from it. You guys managed to destroy a direct quote. Totally amazing, yet totally predictable. -- [[User:Mr-Natural-Health|John Gohde | Talk]] 02:00, 11 Jun 2004 (UTC)
[edit] Treatment of Distress
This section starts with "The key to effective palliative care is to provide a safe place for the individual to express their distress." This sounds like psycho-babble to me. What does this statement mean? 1. What is a "safe place"? - Palliative care is a philosophy that must not be dependant on place. It is rather about the relationship between the patient, their family (however "family" is constructed), the individual clinician and the health care organisation structure. 2. Expression of distress - philosophically "distress" is a construct that does not exist, necessarily, within an individual. Practically, much distress has a physiological aetiology; vomiting, for example. Using vomiting as an exemplar of distress, what does "The key to effective palliative care is to provide a safe place for the individual to express their distress" mean? - Nothing. This initial statement should be removed. Ravenswater 22:18, 11 January 2006 (UTC)
- I agree that this section needs some work and perhaps a modification of sub-title. Better might be explaining the role of the interdisciplinary team regarding symptom management. When a patient exhibts a physiological symptom, there is often a psychological, social, and/or spiritual component to that symptom. The chaplain, social worker, and couselors can play a role in helping the patient and family cope with these symptoms, rather than depending on the medical/pharmacologic interventions alone. Perhaps this is what the original author is shooting for. Nightngle 18:10, 27 February 2006 (UTC)
Safe place:
This is an odd phrase isn't it? As the person responsible for putting it in I should explain it in more detail:
It was first coined in 1987 in the journal Palliative Medicine by Averil Stedeford, a psychiatrist with extensive palliative care experience at a hospice in Oxford, UK. She described it as follows:
A safe place to suffer:
'Place' is not a physical environment, but the relationship between a person and their carer.
'Suffer' describes the distress that is left after you have helped any physical, social, or psychiatric problems. It is about the loss that person has, or is going to, experience. Although there are no magic pills or therapies to ease this grief, it is therapeutic for the person to be able to express their distress. However, they will only do so if they are free of troublesome symptoms and, as importantly, they feel it is safe to do so. So this is about trust, good symptom control and listening in a therapeutic relationship.
So not really psycho-babble, but perhaps one of the best definitions of palliative care?
--Claud Regnard 15:35, 29 December 2006 (UTC)
[edit] Dead link
During several automated bot runs the following external link was found to be unavailable. Please check if the link is in fact down and fix or remove it in that case!
- http://www.pain.remedica.com
- In Palliative care on Sun Jul 16 21:24:00 2006, Socket Error: (-2, 'Name or service not known')
- In Pain on Mon Jul 17 15:19:09 2006, Socket Error: (-2, 'Name or service not known')
- In Palliative care on Mon Jul 17 17:19:26 2006, Socket Error: (-2, 'Name or service not known')
- In Pain on Thu Jul 27 00:46:01 2006, Socket Error: (-2, 'Name or service not known')
maru (talk) contribs 05:07, 27 July 2006 (UTC)
- Thanks again, Maru ~ I am removing this link which I think should've been http://pain.remedica.com; deletion explained at Talk:Pain#dead_link.
[edit] Proposing ext links cleanup
In fact, I am inclined to cut the list of links down to just a few (if any), leaving only links to those sites, which clearly provide valuable additional information not yet in the article, as opposed to linking to various "join us" association sites or to professional only, paid subscription magazines. I am concerned that this list is growing out of control and no longer carries any practical value. Any objections, please post away - Introvert • ~ 08:25, 27 July 2006 (UTC)
[edit] curative/palliative
First paragraph reads:
providing that the curative therapy will not cause additional morbidity.
Shouldn't this be:
providing that the palliative therapy will not cause additional morbidity.
Seems more logical.
- Agreed. -- Steved424 18:36, 9 October 2006 (UTC)
- Oh no, but the whole point of that statement in the opening paragraph is exactly that the treatment used must be a delicate one.
- I am sure you'd agree if you looked in at the paragraph one more time to see the quoted phrase in its entirety, in the context:
- ...palliative care ... concentrates on reducing the severity of the symptoms of a disease... rather than provide a cure... it may occasionally be used in conjunction with curative therapy, providing that the curative therapy will not cause additional morbidity.
- In other words, the intent of palliative treatment is to support, to relieve a sufferer who may no longer have enough resources for a true curative treatment. Whereas curative therapy can be too aggresive due precisely to its intent to eliminate the disease rather than to just alleviate the symptoms, and extra care should be taken to make sure that the chosen treatment shall not cause more harm than good. - Introvert • ~ 20:23, 10 October 2006 (UTC)
- The whole sentence was "However, it may occasionally be used in conjunction with curative therapy, providing that the curative therapy will not cause additional morbidity."
I think that makes sense, and does not need to be changed... It's refering to the cureative treatment, as long as this treatment does not cuase the additional morbidity.
[edit] http://www.euthanasiaprocon.org/palliativesub.htm link
I've just done a bit of tidy up on the article, including the external links section. In doing so noticed the above link. It seems to be about a very specific question that this article does not really touch on. And as such I think it's inappropriate for the article. Other opinions? -- Siobhan Hansa 20:02, 8 April 2007 (UTC)
