Nurse Practitioners as Disruptive Innovators in Palliative Medicine.

As the population ages, the corresponding rise in people living with life-limiting illnesses will lead to a greater need for clinician experts in palliative medicine. There are not enough physicians available to care for the growing number of patients, however. We believe that nurse practitioners are well positioned to meet this demand.

Palliative Care Education in Nurse Practitioner Programs: A Survey of Academic Deans.

The need for clinicians trained in palliative care will increase as more Americans live with life-limiting illness. Although multiple studies have described the nature of palliative care education in prelicensure programs, there have been no similar studies of nurse practitioner programs. We surveyed 101 nurse practitioner programs.

Correlates of Family Satisfaction with Hospice Care: General Inpatient Hospice Care versus Routine Home Hospice Care.

Background: The quality of communication and support provided to families is associated with greater satisfaction with hospice care. Prior work has not explored whether the predictors of family satisfaction are different in different hospice care settings.

Objective: The study objective was to explore whether correlates of family satisfaction are different in general inpatient hospice care versus routine home hospice care.

The Stanford Prison Experiment: Implications for the Care of the "Difficult" Patient.

Approximately 15% of patients are perceived by clinicians as "difficult." Early theories about difficult patients focused on patients' and clinicians' characteristics, often underemphasizing the influence of the environment on patients' behavior. The Stanford Prison Experiment, a classic experiment in the psychology of human behavior, provides a broader systems approach for understanding the environmental influences on patient behavior.

Nurse practitioners and the growth of palliative medicine.

As Americans live longer they are likely to suffer from chronic, life-limiting illness. Because there are not enough hospice and palliative medicine (HPM) trained physicians to care for these people, there have been recent calls to increase the number of HPM trained physicians. We, however, believe that greater involvement of nurse practitioners (NPs) is a step in remedying this deficit.

Treatment of lower extremity oedema by subcutaneous drainage in a home hospice patient.

Lower extremity oedema is common in patients with advanced illness and can normally be managed with oral diuretics and elevation of the involved extremities. The management of oedema can be more complicated in home hospice patients, however. They tend to be more frail and are often less able to tolerate usual interventions.

Measuring the experience and perception of suffering.

Purpose: assess psychometric properties of scales developed to assess experience and perception of physical, psychological, and existential suffering in older individuals.

Design And Methods: scales were administered to 3 populations of older persons and/or their family caregivers: individuals with Alzheimer's disease (AD) and their family caregivers (N = 105 dyads), married couples in whom 1 partner had osteoarthritis (N = 53 dyads), and African American and Hispanic caregivers of care recipients with AD (N = 121). Care recipients rated their own suffering, whereas caregivers provided ratings of perceived suffering of their respective care recipients.

Positive and negative religious coping and well-being in women with breast cancer.

Background: Although religions is important to many people with cancer, few studies have explored the relationship between religious coping and well-being in a prospective manner, using validated measures, while controlling for important covariates.

Methods: One hundred ninety-eight women with stage I or II and 86 women with stage IV stage breast cancer were recruited. Standardized assessment instruments and structured questions were used to collect data at study entry and 8 to 12 months later.

Spousal suffering and partner's depression and cardiovascular disease: the Cardiovascular Health Study.

Objectives: To assess the effects of suffering in a spouse on prevalent and incident psychiatric (depression) and physical morbidity (cardiovascular disease [CVD]) in their partner, controlling for known risk factors for depression and CVD.

Design: Descriptive longitudinal study.

Participants: A total of 1,330 older married couples enrolled in the Cardiovascular Health Study, a large epidemiologic study of the elderly.

Preparing family caregivers for death and bereavement. Insights from caregivers of terminally ill patients.

Many family caregivers are unprepared for the death of their loved one and may suffer from worse mental health as a result. We therefore sought to determine the factors that family caregivers believe are important to preparing for death and bereavement. Focus groups and ethnographic interviews were conducted with 33 family caregivers (bereaved or current) of terminally ill patients.

Dementia patient suffering and caregiver depression.

Cross-sectional and longitudinal analyses were carried out to assess the relationship between dementia patient suffering, caregiver depression, and antidepressant medication use in 1222 dementia patients and their caregivers. We assessed the prevalence of 2 types of patient suffering, emotional and existential distress, and examined their independent associations with caregiver depression and antidepressant medication use when controlling for sociodemographic characteristics of caregivers and patients, cognitive and physical disability of the patient, the frequency of patient memory problems and disruptive behaviors, and the amount of time spent caring for the patient. Multiple linear regression models showed that both aspects of perceived patient suffering independently contribute to caregiver depression (emotional distress: beta=1.

What questions do family caregivers want to discuss with health care providers in order to prepare for the death of a loved one? An ethnographic study of caregivers of patients at end of life.

Objectives: To determine what questions family caregivers want to discuss with health care providers (HCPs) in order to prepare for the death of a loved one.

Methods: Ethnographic interviews and focus groups were used to collect data from current and bereaved caregivers (n=33) of terminally ill patients. Caregivers were asked about: (1) the questions they believe are important to discuss with HCPs in order to prepare for the death, (2) which questions they asked HCPs, and (3) which questions they did not discuss with HCPs.

Bereavement after caregiving.

Approximately 20% of bereaved caregivers will experience a variety of psychiatric symptoms including depression and/or complicated grief, a disorder characterized by persistently high levels of distress that impair functioning in important life domains. We identify prebereavement risk factors for poor adjustment after the death of a loved one along with preventive strategies that can be implemented prior to death as well as diagnostic procedures and therapeutic strategies that can be used to identify and treat individuals who develop complicated grief disorder after death.

Improving well-being in caregivers of terminally ill patients. Making the case for patient suffering as a focus for intervention research.

Family caregivers are integral to the care of patients with physical or mental impairments. Unfortunately, providing this care is often detrimental to the caregivers' health. As a result, in the last decade, there has been a proliferation of interventions designed to improve caregivers' well-being.

Patient suffering and caregiver compassion: new opportunities for research, practice, and policy.

The purpose of this article is to stimulate discussion and research about patient suffering and caregiver compassion. It is our view that these constructs are central to understanding phenomena such as family caregiving, and that recognizing their unique role in the caregiving experience provides new directions for intervention research, clinical practices, and social policy. We first define and characterize these constructs, review empirical evidence supporting the distinct role of suffering and compassion in the context of caregiving, and then present a conceptual model linking patient suffering with caregiver compassion.

Religious beliefs and practices are associated with better mental health in family caregivers of patients with dementia: findings from the REACH study.

Objective: Providing care to a loved one with dementia and the death of that loved one are generally considered two of the most stressful human experiences. Each puts family caregivers at risk of psychologic morbidity. Although research has suggested that religious beliefs and practices are associated with better mental health, little is known about whether religion is associated with better mental health in family caregivers.

Caregiving at the end of life.

This paper provides a review of family caregiving for adult patients with serious, lifethreatening illness. Areas covered include the (1) epidemiology of family caregiving, (2) cross-cultural issues in caregiving, (3) impact of caregiving on families, (4) similarities and differences involved in providing care for patients with various illnesses, and (5) interventions for family caregivers. The importance of family caregiving to palliative care practice is emphasized.