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Skills Palliative and end-of-life care is holistic and needs doctors to use a wide range of skills.
Hospice nurses are educated in pain control and symptom management, spiritual assessment, and
assessment and management of family needs. Deciding about mechanical ventilation in end-stage
chronic obstructive pulmonary disease: How respirologists perceive their role. However, the
additional impact of palliative and end-of-life care is that there is only one chance to get it right and
the significance of the associated emotional burden. Physiologic reactions include sleeping problems,
changes in appetite, physical problems, and illness. The practitioners should be adequately informed
about the cultural beliefs. However, no papers were excluded based on the quality assessment as
being of poor quality. Methods Search strategy A search strategy was devised in collaboration with a
professional medical librarian (IK). These suggestions may provide some help to clinicians when
approaching patients with COPD. The overall estimated median survival time from onset of
dementia to death is 4.1 years for men and 4.6 years for women, with longer survival times in those
with early-onset dementia. Cheyne-Stokes respiration is a pattern of breathing characterized by
alternating periods of apnea and deep, rapid breathing. Primary palliative care for the general
internist: integrating goals of care discussions into the outpatient setting. Spiritual integrity is also
important for provision of end of life care. To our knowledge no such review has been previously
undertaken. Use of solution-focused brief therapy to enhance therapeutic communication in patients
with COPD. Aim The aim was to undertake a systematic review and narrative synthesis of the
international literature concerning junior doctors and end-of-life care focusing on the following:
What is their experience of providing care. Guidance on the Conduct of Narrative Synthesis in
Systematic Reviews - A Product from the ESRC Methods Programme. 2006. ? Janssen DJ, Spruit
MA, Schols JM, et al. Physical Manifestations at End of Life As death approaches, metabolism is
reduced and the body gradually slows down until all functions end. This review offers evidence
gathered from virtually all relevant health-related databases and websites, presents evidence
developed from 1996 to 2015 and places equal importance on all types of literature, includes only
papers with moderate-to-high quality and systematically analyses the data gathered from all papers.
A randomized trial to improve communication about end-of-life care among patients with COPD.
You also have the option to opt-out of these cookies. Given the relationship between conversations
about care and the meeting of patient preferences, this lack of optimal communication between
clinicians and patients is likely to impact upon care quality, patient satisfaction and, ultimately, the
likelihood of a “good death”. All titles, abstracts and full-text papers were screened by the first
reviewer (AB), with a sample of abstracts and full-text papers screened by the second reviewer
(TM). There is also a considerable lack of training among the care staff regarding the cultural belief
and communication skills. Patient-clinician communication about end-of-life care for Dutch and US
patients with COPD. You will receive the results of your assessment immediately upon completion.
Of these patients, the most common diagnosis is cancer. AB and IK designed the literature search
terms, with AB conducting the literature search from January 2000 to January 2018 and IK
conducting the database search from January 2018 to August 2019. Conclusion In conclusion, the
current literature suggests that despite evidence of real benefit when conducted, the frequency and
quality of palliative care conversations between patients and healthcare professionals is poor. Since
the development of technology that assists in supporting life, controversies have arisen over the exact
definition of death.
A second limitation is the small number of papers, especially the lack of controlled trials and
objective comparisons of approaches and their influence on outcomes for patients. As part of the
inclusion criteria, a topic list to objectively search papers was outlined. Communication among the
patient, family, and palliative health care team is important to provide optimal care. All researchers
discussed and reached a consensus regarding the themes. Most of these data were generated from
quantitative research, yet much could be gained from in-depth qualitative research specifically
collecting information from patients describing the most appropriate timing, place and person to
discuss palliative care, describing the reasons behind their choices and suggesting ways to achieve
their preferences at all times. According to the World Health Organization (WHO), palliative care is
an approach that improves the quality of life of patients and their families who face problems
associated with life-threatening illness. Conclusion Medical education needs to change in order to
better prepare and support junior doctors for their role in caring for dying patients. Communication
about palliative care for patients with chronic obstructive pulmonary disease. The search was initially
run until January 2018 and then subsequently updated in August 2019 to ensure that any additional
papers were captured within this review. Palliative care extends into the period of EOL care;
bereavement care follows the patient’s death 2 ( Fig. 10-2 ). FIG. 10-2 Integrated model of curative
care, palliative and end-of-life care, and bereavement care. Of these 39 papers, 23 were from the UK
and 7 from Canada, with 9 from across the globe; 17 used quantitative methods, 18 qualitative
methods and 4 mixed methods. Any opinions or recommendations discussed are solely those of the
author(s) and are not endorsed by BMJ. However, the chapter is brief and you may want further
reading. Now palliative care focuses on maintaining and improving the quality of life for all patients
and their families during any stage of a life-limiting illness, whether acute, chronic, or terminal. The
eBook is optimized for e-reader devices and apps, which means that it offers a much better digital
reading experience than a PDF, including resizable text and interactive features (when available).
There are now a huge number of strategies and policies that support and highlight the need for person
cantered, high quality care for the people with dementia approaching towards the end of life. Many
times at the end of life, patients question their beliefs about a higher power, their journey through
life, religion, and an afterlife ( Fig. 10-7 ). Some patients may choose to pursue a spiritual path. The
last search was conducted on the February 2, 2016. These actions included: a very objective search
strategy outlined in the literature review protocol; all authors reviewed and agreed on the inclusion
of all papers and on the exclusion of papers that raised some uncertainty, and lastly, the reference list
of all the papers included and of excluded papers about palliative care in COPD was thoroughly
screened. BODE-Index vs HADO-score in chronic obstructive pulmonary disease: Which one to use
in general practice. Participants stated that the preferred clinician with whom to have the
conversation was their general practitioner and the best place was within outpatient clinics or general
practitioner appointments. Hence, the little impact of interventions in improving discussions. An
initial scoping search strategy was reviewed against the inclusion and exclusion criteria, following
which the definitive search strategy was developed ( figure 1 ). TABLE 10-4 KUBLER-ROSS
MODEL OF GRIEF Stage What Person May Say Characteristics Denial No, not me. The topics
outlined represent what a palliative care discussion should include. The hypothetical explanation that
led these patients to participate in the studies was that the studies targeted mainly healthcare
professionals, instead of patients themselves. Dexter PR, Wolinsky FD, Gramelspacher GP, et al. The
practitioners should be adequately informed about the cultural beliefs. Discussing an uncertain
future: end-of-life care conversations in chronic obstructive pulmonary disease. They perceive
palliative care as receiving a lower curricular priority than other aspects of medicine at both
undergraduate and postgraduate levels, with specific knowledge gaps identified in symptom control,
communication and the dying process.
Adapted from Kubler-Ross E: On death and dying, New York, 1969, Macmillan. (Classic) Another
model of grief is the grief wheel ( Fig. 10-6 ). After a person experiences the loss, he or she feels
shock (numbness, denial, inability to think straight). However, the lack of accurate prognostic tools
in COPD makes it difficult for clinicians to judge when the ideal time to initiate palliative care
discussions is. The review is limited to the UK, Ireland, Canada, New Zealand and Australia, where
there is greater commonality in postgraduate medical training and healthcare systems, permitting
synthesis of the data. GPs’ attitudes to discussing prognosis in severe COPD: an Auckland (NZ) to
London (UK) comparison. The major difference between palliative care and hospice care is that
palliative care allows a person to simultaneously receive curative and palliative treatments. Use of
solution-focused brief therapy to enhance therapeutic communication in patients with COPD.
Communication among the patient, family, and palliative health care team is important to provide
optimal care. Participants stated that the preferred clinician with whom to have the conversation was
their general practitioner and the best place was within outpatient clinics or general practitioner
appointments. AB, SB and BW contributed to interpretation and critical revision of the article.
These cookies will be stored in your browser only with your consent. Contributors AB designed and
had the concept of the work. Given the importance of communication about palliative care between
COPD patients and healthcare professionals, it was sought to systematically review the literature on
palliative and end-of-life care discussions between healthcare professionals and patients with COPD
in order to identify best practice, as well as the barriers, facilitators, challenges and meaning of these
conversations. As part of the inclusion criteria, a topic list to objectively search papers was outlined.
How well do we care for patients with end stage chronic obstructive pulmonary disease (COPD).
When discussions do take place, they do so at an advanced stage of disease, often in a busy, acute
and stressful environment and often with clinicians who do not have an established relationship with
the patient. The overall estimated median survival time from onset of dementia to death is 4.1 years
for men and 4.6 years for women, with longer survival times in those with early-onset dementia.
Acceptance Yes me, but it is okay Anger, sadness, and mourning have tapered off. However, several
differences between patients with COPD and cancer were highlighted when considering these
discussions. This is basically due to the fact that dementia is still not considered as terminal illness
and also because of the fact that the practitioners and the carers are still not certain on when to
initiate end of life care plan. Therefore, actions to limit the impact of having one researcher screening
the databases were adopted. Frequently patients, families, physicians, and other health care providers
lack information about hospice care. Grief is dynamic and includes both psychologic and physiologic
responses following a loss. The total number of papers included in this review was 37 (see
Supplement 2). 14 were quantitative studies, 11 were qualitative studies and 12 were diverse
including narrative and systematic reviews, and comparative studies. This Proceedings of a
Workshop-in Brief summarizes the key points made by the workshop participants during the
presentations and discussions. Therefore, early conversations about all aspects of the disease should
be held and these should include discussions about palliative care interventions, as well as
preferences for end-of-life care. It is estimated that one in five bereaved individuals experiences
prolonged grief disorder. When comparing COPD and cancer patients with regards to open
awareness to end-of-life issues, various differences were evident. I would strongly reccomend
chapter three, which deals with those difficult converstions and ways to approach this and the
barriers. Honesty in answering questions and giving information is essential. Indeed, if a patient in
hospice survives beyond 6 months, Medicare and other reimbursement organizations will continue to
reimburse for more extended periods of treatment if the patient still meets enrollment criteria.
Is hospitalisation for COPD an opportunity for advance care planning. Palliative care for patients
with chronic obstructive pulmonary disease. There is a growing international movement to embed
palliative care education in medical student and junior doctor education. The Effective Public Health
Practice Project (EPHPP), 1998. Schmidt M, Demoule A, Deslandes-Boutmy E, et al. Hospice care
is provided once a person decides to forgo curative treatments. Hospice programs provide care with
an emphasis on symptom management, advance care planning, spiritual care, and family support. 4
FIG. 10-3 Relationship of palliative care, end-of-life care, and hospice care. FIG. 10-4 Hospice care
is designed to provide compassion, concern, and support for the dying. Clinicians in those studies
reported several reasons behind this, such as the unpredictability of COPD, the fear of destroying
patients' hope and the lack of understanding about palliative care and COPD by patients and
physicians. Morris, RN, EdD, CNE, Distinguished Teaching Associate Professor of Nursing, Auburn
University Montgomery, Montgomery, Alabama. Palliative care understanding and end-of-life
decisions in chronic obstructive pulmonary disease. The hypothetical explanation that led these
patients to participate in the studies was that the studies targeted mainly healthcare professionals,
instead of patients themselves. We publish prepublications to facilitate timely access to the
committee's findings. Discussion of feelings helps both the patient and the family work toward
resolution of the grief process. The majority of the papers generated from the USA (a total of 14 out
of 20) were from the geographic area of Seattle, WA. Skills Palliative and end-of-life care is holistic
and needs doctors to use a wide range of skills. A second limitation is the small number of papers,
especially the lack of controlled trials and objective comparisons of approaches and their influence
on outcomes for patients. Patients receive palliative care services in the home and in long-term and
acute care facilities. What type of spiritual or religious support do you desire? 6. If you have
questions or comments concerning the Marketplace service, please contact. Of these patients, the
most common diagnosis is cancer. This is the first review to systematically review and synthesise the
international literature concerning junior doctors’ experience in providing palliative and end-of-life
care, which reflects a varied weight of evidence and quality of the literature, with a range of research
methods employed. There is also detailed view of the Pepsicola and combined with patient care. The
family’s response depends in part on the type and length of the illness and their relationship with the
person. This information was generated from papers including qualitative and quantitative studies
with moderate and high quality, papers which compared COPD patients and patients with other
diseases and narrative reviews. These interventions were widely accepted and considered meaningful
by the majority of participants. The following list describes license reuses offered by the NAP
through Marketplace. There are now a huge number of strategies and policies that support and
highlight the need for person cantered, high quality care for the people with dementia approaching
towards the end of life. Only papers written in English were included which may have excluded
important information, potentially leading to cultural and demographic bias; however, only two
papers fell into this category and had poor quality. Decision making in provision of care plan during
the end of life is very much essential in order to provide a personhood care but in practice a little
application is seen. Then comes the protest stage where a person experiences anger, guilt, sadness,
fear, and searching.