Thursday, January 7, 2010

Palliative Care Best Practices Study.

7thSpace posts a study that looks at the universality of best care practices among palliative care givers and finds there is no there there.

Methods: The official documents by the most representative health organisations committed to the definition of policies and guidelines for palliative and end-of-life care had been considered. The documents were analysed through a framework of the components of end-of-life care derived from literature, which was composed of 4 main "areas"and of 12 "sub-areas".

Results: Overall, 34 organizations were identified, 7 international organisations, and 27 organisations operating on the national level in four different countries (Australia, Canada, UK and United States).

Up to 56 documents were selected and analysed. Most of them (38) are position statements.

Relevant quotations from the documents were presented by "areas"and "sub-areas". In general, the "sub-areas"of symptoms control as well as those referring to relational and social issues are more widely covered by the documents than the "sub-areas"related to "preparation"and to "existential condition".

Indeed, the consistency of end-of-life choices with the patient's wishes, as well as completion and meaningfulness at the end of life is given only a minor relevance.

Conclusions: An integrated model of the best palliative care practice is generally lacking in the documents. It might be argued that the lack of a fixed and coherent model is due to the relevance of unavoidable context issues in palliative care, such as specific cultural settings, patient-centred variables, and family specificity.

The implication is that palliative care staff have continuously to adapt their model of caring to the specific needs and values of each patient, more than applying a fixed, although maybe comprehensive, care model.

Is the need to tailor care to each patient a bad thing or a viable thing? However exhausting and difficult such practice is, is it a result of the nature of the profession or is it an issue of palliative care's burgeoning development? And how is this lack of ethical best practice guidelines like or unlike the care guidelines other medical doctors operate under?

I would love to know what hospice and palliative practitioners have to say!

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