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The Division of Palliative Care Medicine focuses on the assessment and management of physical and psychosocial- spiritual issues experienced by patients with advanced cancer and other palliative care patient populations. This often also includes the needs of formal & informal family caregivers. These complex and devastating problems can affect approximately 8.
Clinical activity continues to expand to include palliative care for patients with non- malignant diseases. The Division of Palliative Care Medicine is interprofessional and is supported by Alberta Health Services, Covenant Health, and the University of Alberta. Division members are located at the Division office, Regional Palliative Care Program office and the Tertiary Palliative Care Unit at the Grey Nuns Hospital, the University of Alberta and Royal Alexandra Hospitals, the Cross Cancer Institute and the University of Alberta campus. Liebert Author Advocacy Program; Librarians; Press; Advertise. Undergraduate Medical Palliative Care Education. The Edmonton Regional Palliative Care Program was established in July 1995 to measure the access of patients with. Miller MJ, Selmser P, Macmillan K. The Edmonton Symptom Assessment System (ESAS): a simple method for the. ![]() 2 PALLIATIVE CARE CONFERENCE. Edmonton Zone Palliative Home Care, Alberta Health Services. She became the bereavement manager for the Regional Palliative Care Program with the Capital Health. Division of Palliative Care Medicine (R.L.F., K.F.), Department of Oncology, and Faculty of Nursing (C.B.), University of Alberta, Edmonton; Capital Health Regional Palliative Care Program (C.B.), Edmonton; and Integrated. Clinical activity covers 2. Edmonton Zone, as well as providing the attending service on the 2. Tertiary Palliative Care unit at the Grey Nuns Hospital. Physicians and Ph. D's from the Division are involved in teaching and research centered on multi- dimensional assessment of physical and psychosocial- spiritual issues, as well as on pharmacological and non- pharmacological treatment approaches. Research programs of Division Members include cancer pain classification, cancer cachexia, health economics and access to end of life care, pain and symptom control, psychosocial support and palliative care for non- cancer populations. ![]() Edmonton Regional Palliative Care Program: impact on patterns of terminal cancer care . Neumann, MSc; Bruno Gagnon, MD; Carleen Brenneis, RN, MHSA; Patricia Kneisler, ISP; Pat Selmser, RN, BSc. N; John Hanson, MSc. CMAJ 1. 99. 9; 1. The Edmonton Regional Palliative Care Program was established in July 1. In this retrospective study the authors compared the pattern of care and site of deaths before establishment of the program (1. Significantly more cancer- related deaths occurred in acute care facilities in 1. The number of inpatient days decreased, from 2. More cancer patients saw a palliative care consult team in 1. The shift from deaths in acute care facilities to palliative hospices suggests that the establishment of an integrated palliative care program has increased access of patients with terminal cancer to palliative care. Most cancer patients die in acute care facilities after medium to long- term stays. The resulting increased cost and inappropriate care occurs because staff in these institutions are not trained in the management of the physical and psychosocial complications of terminal cancer. One of the perceived reasons why patients die in acute care facilities in Edmonton is the limited involvement of family physicians in their care. In the Edmonton region in 1. Therefore, most of these admissions took place under the care of a specialist. Previously existing elements include a 1. These 2 components were maintained at the same level of funding. A palliative hospice (palliative continuing care unit) was set up in 3 continuing care hospitals, providing a total of 5. Four full- time salaried teams, consisting of a consultant palliative care physician and nurse, provide consultations for palliative care patients at home, in the 3 hospices, in the region's 3 community hospitals and in the continuing care facilities. Funding to the Regional Home Care Program was increased for the delivery of 2. Another team (consultant palliative care physician and nurse) was added to the existing team to serve patients in the region's 2 tertiary care hospitals. Finally, a registry of family physicians willing to deliver palliative care to new patients was begun and widely publicized among the city's family physicians. In addition, an increased fee for the delivery of palliative care at home or in hospice was established for family physicians. In addition, a common protocol was used in all settings for the management of various physical and psychosocial symptoms. All physicians licensed in the region were notified by mail about the program and the procedure for consultations, a monthly update on the management of specific symptoms was mailed with a reminder about the consultation procedure, and a description of the program was presented during medical rounds at the cancer centre and all family medicine programs and was posted on the University of Alberta's family medicine home page (www. The number and location of cancer- related deaths in acute care facilities (tertiary care hospitals, community hospitals and the cancer centre), palliative hospices, continuing facilities (including regular continuing care facilities, auxiliary hospitals and nursing homes) and at home are summarized in Table 1. There was a significant shift in location from acute care facilities to continuing care facilities and home over that period. Post hoc comparisons showed that, between 1. They did not change over time in the tertiary palliative care unit. In 1. 99. 6/9. 7, 3. Of these, 2. 87 (7. Edmonton region. The remaining 2. Although we reported only patients' last stay in these facilities before death, it is unlikely that a decrease in this time (in our experience, the longest stay) after the inception of the program would be offset by an increase in the duration of earlier stays. It is our impression that increased access to palliative care and improved planning of care have resulted in a decrease in total inpatient bed use. However, our patient data systems were not able to test this hypothesis, and further studies are required to measure the overall utilization of acute care beds. According to the latter, the total number of deaths in acute care hospitals was 9. Table 2), as compared with 1. Alberta Cancer Registry (Table 1). This discrepancy is probably due in large part to different definitions of cause of death. However, data from both sources confirm a large and significant shift in the number of deaths from acute care facilities to palliative hospices and home. We found that 2. 87 (3. Edmonton region consulted the program regarding their own patients during 1. July 1. 99. 5. Family physician involvement in palliative care is likely higher than reported here because some physicians may be delivering care to their patients without consulting the program. These findings suggest that palliative care programs in which primary care is delivered by palliative care specialists may not be necessary as long as adequate reimbursement, education, consultant support and access to beds are available to family physicians. In addition, these programs make it necessary for patients and their families to establish a new relationship with a different treating physician, and they may delay and decrease the rate of referrals by primary practitioners or specialists who want to remain the treating physician. On the other hand, the main limitation of a palliative care program in which primary care is delivered by fami- . Edmonton region, where there are 8. However, our program deals with this potential problem by providing physician. However, there is strong evidence that the delivery of palliative care to patients in hospital by oncologists and specialists is frequently inappropriate. The shift of patients from acute care facilities to palliative hospices and home under the program most likely improved comfort for patients and their families. Future research should also address cost of care. Because inpatient services are the most expensive mode of care for terminally ill patients,2. Bruera is currently with the Department of Symptom Control and Palliative Care, University of Texas MD Anderson Cancer Center, Houston, Tex. Eduardo Bruera, Director, Palliative Care Program, Grey Nuns Community Hospital and Health Centre, 1. Youville Dr. W, Edmonton AB T6. L 5. X8. Higginson I, Webb D, Lessof L. Reducing hospital beds for patients with advanced cancer . Factors associated with location of death (home or hospital) of patients referred to a palliative care team. CMAJ 1. 99. 5; 1. Trends in the terminal care of cancer patients: South Australia, 1. Aust N Z J Med 1. Treatment of pain and other symptoms in cancer patients: patterns in a North American and a South American hospital. J Pain Symptom Manage 1. The assessment and management of cancer pain in a tertiary care Canadian teaching hospital . Clin Invest Med 1. Suppl): B9. 0. Symptom control during the last week of life on a palliative care unit. J Palliat Care 1. Character of terminal illness in the advanced cancer patient: pain and other symptoms during the last 4 weeks of life. J Pain Symptom Manage 1. Symptom prevalence in the last week of life. J Pain Symptom Manage 1. Pain and its treatment in outpatient with metastatic cancer. N Engl J Med 1. 99. Changing pattern in the treatment of pain and other symptoms in patients with advanced cancer. International Union Against Cancer World Congress of Cancer; 1. Aug 1. 1. A Canadian survey of issues in cancer pain management. J Pain Symptom Manage 1. Innovative palliative care in Edmonton. Can Fam Physician 1. The Edmonton Symptom Assessment System (ESAS): a simple method for the assessment of palliative care patients. J Palliat Care 1. Cognitive assessment of cancer patients. Cancer 1. 98. 4; 5. Suppl 1. 0): 2. 25. The frequency of alcoholism among patients with pain due to terminal cancer. J Pain Symptom Manage 1. The Edmonton Functional Assessment Tool: preliminary development and evaluation for use in palliative care. J Pain Symptom Manage 1. The Edmonton staging system for cancer pain: preliminary report. A prospective multi- center assessment of the Edmonton Staging System for cancer pain. J Pain Symptom Manage 1. Edmonton: University of Alberta; 1. An investigation of general practitioner referrals to palliative care services. Palliat Med 1. 99. Physicians' use of health resources for terminal cancer patients: clinical setting versus physician specialty. South Med J 1. 98. Practising physicians' experiences of treating patients with cancer pain. Acta Oncol 1. 98. The study to understand prognoses and preferences for outcomes and risks of treatments . A comparison of hospice and hospital care for people who die: views of the surviving spouse. Palliat Med 1. 99. Cost savings in hospice: final results of the National Hospice Study. Health Serv Res 1. Classical, Loanable- Fund, and Keynesian Interest Theories. Click here to contact the Editorial Office. ![]() ![]() Download as Word Doc (.doc /.docx), PDF File (.pdf), Text File (.txt). Interest rate determination. Interest rate theories. Classical, Loanable-Fund, and Keynesian Interest Theories. Full Text (PDF) Classifications. Article metrics; Alert me when cited; Alert me if. 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Be sure to refer to our Resources section for more information and answers to your study abroad questions. |
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