Palliative care - Knowledge

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healthcare provider is delivering the news including privacy, sitting, time, and the inclusion of family members. What to say should also be considered, as well as rehearsed. It is important to understand how a patient is receiving the information by asking open ended questions and asking them to repeat what they learned in their own words, which is perception aspect of the framework. The healthcare provider should seek an invitation from the patient to disclose additional information before doing so in order to prevent overwhelming or distressing the patient further. In order to ensure the patient understands what is being told, knowledge must be used. This includes speaking in a way that the patient will understand, using simple words, not being excessively blunt, giving information in small chunks and checking in with the patient to confirm that they understand, and not providing poor information that may not be completely true. In order to alleviate some of a patient's distress it is crucial to be empathetic in the sense of understanding how a patient is feeling and the reactions they are having. This can allow one to change how they are delivering information, allow the patient to have time to process the information, or console them if needed. Connecting with patients is an important step in delivering bad news; maintaining eye contact proves that the healthcare provider is present and the patient and family has their full attention. Furthermore, the provider may make a connection by touching the patients shoulder or hand, giving them a physical connection to know that they are not alone. Finally, it is important to summarize all the information given in order to ensure the patient fully understands and takes away the major points. Additionally, patients who have a clear plan for the future are less likely to feel anxious and uncertain, but it is important to ask people if they are ready for that information before providing them with it.

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team regarding goals and options for care. Often, these conversations occur within the context of family meetings, which are formal meetings between families and the child's multidisciplinary medical team. Prior to the family meeting, providers often meet to discuss the child's overall case, reasonably expected prognosis, and options for care, in addition to clarifying specific roles each provider will take on during the family meeting. During this meeting, the multidisciplinary medical team may also discuss any legal or ethical considerations related to the case. Palliative care providers often facilitate this meeting and help synthesize its outcome for children and their families. Experts in optimized communication, palliative care providers may opt to hold the family meeting in a quiet space where the providers and family can sit and address concerns during a time when all parties are not constrained. Additionally, parents' preferences regarding information exchange with the sick child present should be clarified. If the child's guardians are resistant to disclosing information in front of their child, the child's provider may explore parental concerns on the topic. When excluded from family meetings and moments of challenging information exchange, adolescents, in particular, may have challenges with trusting their medical providers if they feel critical information is being withheld. It is important to follow the child's lead when deciding whether to disclose difficult information. Additionally, including them in these conversations can help the child fully participate in their care and medical decision making. Finally, it is important to prioritize the family's agenda while additionally considering any urgent medical decisions needed to advance the child's care.

145:(WHO) describes palliative care as "an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain, illnesses including other problems whether physical, psychosocial, and spiritual". In the past, palliative care was a disease specific approach, but today the WHO takes a broader patient-centered approach that suggests that the principles of palliative care should be applied as early as possible to any chronic and ultimately fatal illness. This shift was important because if a disease-oriented approach is followed, the needs and preferences of the patient are not fully met and aspects of care, such as pain, quality of life, and social support, as well as spiritual and emotional needs, fail to be addressed. Rather, a patient-centered model prioritizes relief of suffering and tailors care to increase the quality of life for terminally ill patients. 839:

ultimate goals of care. Equally important to consider, families may vary in the level of responsibility they want in this decision-making process. Their preference may range from wanting to be the child's sole decision makers, to partnering with the medical team in a shared decision making model, to advocating for full deferral of decision-making responsibility to the clinician. Palliative care providers clarify a family's preferences and support needs for medical decision making by providing context, information, and options for treatment and medical palliation. In the case of critically ill babies, parents are able to participate more in decision making if they are presented with options to be discussed rather than recommendations by the doctor. Utilizing this style of communication also leads to less conflict with doctors and might help the parents cope better with the eventual outcomes.

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few symptoms assessment tools trialed among older children receiving palliative care include the Symptom Distress Scale, and the Memorial Symptom Assessment Scale, and Childhood Cancer Stressors Inventory. Quality of life considerations within pediatrics are unique and an important component of symptoms assessment. The Pediatric Cancer Quality of Life Inventory-32 (PCQL-32) is a standardized parent-proxy report which assesses cancer treatment-related symptoms (focusing mainly on pain and nausea). But again, this tool does not comprehensively assess all palliative are symptoms issues. Symptom assessment tools for younger age groups are rarely utilized as they have limited value, especially for infants and young children who are not at a developmental stage where they can articulate symptoms.

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potentially distressing conversations, naming emotions witnessed to create opportunities to discuss complex emotional responses to illness, actively listening, and allowing for invitational silence. The palliative care provider may iteratively assess the child and family's emotional responses and needs during challenging conversations. At times, the medical team may be hesitant to discuss a child's prognosis out of fear of increasing distress. This sentiment is not supported by the literature; among adults, end of life discussions are not associated with increased rates of anxiety or depression. Though this topic is not well studied in pediatric populations, conversations about prognosis have the potential to increase in parental hope and peace of mind.

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When a patient has their needs met then they are more likely to be open to the idea of hospice or treatments outside comfort care. Having a psychosocial assessment allows the medical team to help facilitate a healthy patient-family understanding of adjustment, coping and support. This communication between the medical team and the patients and family can also help facilitate discussions on the process of maintaining and enhancing relationships, finding meaning in the dying process, and achieving a sense of control while confronting and preparing for death. For adults with anxiety, medical evidence in the form of high-quality randomized trials is insufficient to determine the most effective treatment approach to reduce the symptoms of anxiety.

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Strategies for communication are complex as the pediatric palliative care practitioners must facilitate a shared understanding of and consensus for goals of care and therapies available to the sick child amongst multiple medical teams who often have different areas of expertise. Additionally, pediatric palliative care practitioners must assess both the sick child and their family's understanding of complex illness and options for care, and provide accessible, thoughtful education to address knowledge gaps and allow for informed decision making. Finally, practitioners are supporting children and families in the queries, emotional distress, and decision making that ensues from the child's illness.

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with the pediatric patient and their family by first asking the child how they would describe themself and what is important to them, communicating in an age and developmentally cognizant fashion. The provider may then gather similar information from the child's caregivers. Questions practitioners may ask include 'What does the child enjoy doing? What do they most dislike doing? What does a typical day look like for the child?' Other topics potentially addressed by the palliative care provider may also include familial rituals as well as spiritual and religious beliefs, life goals for the child, and the meaning of illness within the broader context of the child and their family's life.

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regarding their child's care. A framework often employed by pediatric palliative care providers is 'ask, tell, ask' where the provider asks the patient and their family for a question to identify their level of comprehension of the situation, and then subsequently supplements the family's knowledge with additional expert knowledge. This information is often conveyed without jargon or euphemism to maintain trust and ensure understanding. Providers iteratively check for comprehension of this knowledge supplementation by asking questions related to previous explanations, as information retention can be challenging when undergoing a stressful experience.

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service, with or without an acute inpatient palliative care unit. Palliative care may also be provided in the dying person's home as a "bridge" program between traditional US home care services and hospice care or provided in long-term care facilities. In contrast over 80% of hospice care in the US is provided at home with the remainder provided to people in long-term care facilities or in free standing hospice residential facilities. In the UK hospice is seen as one part of the speciality of palliative care and no differentiation is made between 'hospice' and 'palliative care'.

751:, poor appetite, difficulty with feeding, and diarrhea. In older children with neurologic and neuromuscular manifestations of disease, there is a high burden of anxiety and depression that correlates with disease progression, increasing disability, and greater dependence on carers. From the caregiver's perspective, families find changes in behavior, reported pain, lack of appetite, changes in appearance, talking to God or angels, breathing changes, weakness, and fatigue to be the most distressing symptoms to witness in their loved ones. 260:). An individual's hospice benefits are not revoked if that individual lives beyond a six-month period. In the United States, in order to be eligible for hospice, patients usually forego treatments aimed at cure, unless they are minors. This is to avoid what is called concurrent care, where two different clinicians are billing for the same service. In 2016 a movement began to extend the reach of concurrent care to adults who were eligible for hospice but not yet emotionally prepared to forego curative treatments. 667:. A commonly held myth is that premature and neonatal infants do not experience pain due to their immature pain pathways, but research demonstrates pain perception in these age groups is equal or greater than that of adults. With this said, some children experiencing intolerable pain present with 'psychomotor inertia', a phenomenon where a child in severe chronic pain presents overly well behaved or depressed. These patients demonstrate behavioral responses consistent with pain relief when titrated with 1174:

resource showing which services were available and grouped them according to their intended purpose and benefit to the patient. They also stated that currently in the UK palliative services are only available to patients with a timeline to death, usually 12 months or less. They found these timelines to often be inaccurate and created barriers to patients accessing appropriate services. They call for a more holistic approach to end of life care which is not restricted by arbitrary timelines.

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different avenues of funding. Over 40% of all dying patients in the United States currently undergo hospice care. Most of the hospice care occurs at a home environment during the last weeks/months of their lives. Of those patients, 86.6% believe their care is "excellent". Hospice's philosophy is that death is a part of life, so it is personal and unique. Caregivers are encouraged to discuss death with the patients and encourage spiritual exploration (if they so wish).

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chronic care, as many people in palliative care lose the ability to swallow. A common alternative route of administration is subcutaneous, as it is less traumatic and less difficult to maintain than intravenous medications. Other routes of administration include sublingual, intramuscular and transdermal. Medications are often managed at home by family or nursing support.

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populations put increasing pressure on existing resources, long-term palliative care for patients' non-communicable, chronic conditions has emerged as a necessary approach to increase these patient's quality of life, through prevention and relief by identifying, assessing, and treating the source of pain and other psychosocial and spiritual problems.

152:. It is provided by an interdisciplinary team which can include physicians, nurses, occupational and physical therapists, psychologists, social workers, chaplains, and dietitians. Palliative care can be provided in a variety of contexts, including hospitals, outpatient, skilled-nursing, and home settings. Although an important part of 747:

with speech, headache, excess secretions, anemia, pressure area problems, anxiety, fever, and mouth sores. The most common end of life symptoms in children include shortness of breath, cough, fatigue, pain, nausea and vomiting, agitation and anxiety, poor concentration, skin lesions, swelling of the extremities,

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advanced illnesses of a chronic nature. Spiritual beliefs and practices can influence perceptions of pain and distress, as well as quality of life among advanced cancer patients. Spiritual needs are often described in literature as including loving/being loved, forgiveness, and deciphering the meaning of life.

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In the United States, hospice and palliative care represent two different aspects of care with similar philosophies, but with different payment systems and location of services. Palliative care services are most often provided in acute care hospitals organized around an interdisciplinary consultation

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Once the immediate physical pain has been dealt with, it is important to remember to be a compassionate and empathetic caregiver that is there to listen and be there for their patients. Being able to identify the distressing factors in their life other than the pain can help them be more comfortable.

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Palliative care interventions in care homes may contribute to lower discomfort for residents with dementia and to improve family members' views of the quality of care. However, higher quality research is needed to support the benefits of these interventions for older people dying in these facilities.

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Many people with chronic pain are stigmatized and treated as opioid addicts. Patients can build a tolerance to drugs and have to take more and more to manage their pain. The symptoms of chronic pain patients do not show up on scans, so the doctor must go off trust alone. This is the reason that some

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Despite significant progress that has been made to increase access to palliative care within the United States and other countries, many countries have not yet considered palliative care as a public health problem, and therefore do not include it in their public health agenda. Resources and cultural

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child to ascertain these parties' baseline understanding of the child's situation. Assessing for baseline knowledge allows the palliative care provider to identify knowledge gaps and provide education on those topics. Through this process, families can pursue informed, shared medical decision making

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An essential component of a provider's ability to provide individualized palliative care is their ability to obtain an intimate understanding of the child and family's preferences and overall character. On initial consultation, palliative care providers often focus on affirming a caring relationship

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As discussed above, within the field of adult palliative medicine, validated symptoms assessment tools are frequently utilized by providers, but these tools lack essential aspects of children's symptom experience. Within pediatrics, there is not a comprehensive symptoms assessment widely employed. A

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As with palliative care for adults, symptom assessment and management is a critical component of pediatric palliative care as it improves quality of life, gives children and families a sense of control, and prolongs life in some cases. The general approach to assessment and management of distressing

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Physical pain can be managed using pain medications as long as they do not put the patient at further risk for developing or increasing medical diagnoses such as heart problems or difficulty breathing. Patients at the end of life can exhibit many physical symptoms that can cause extreme pain such as

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In the United Kingdom, Palliative Medicine specialist training is delivered alongside Internal Medicine stage two training over an indicative four years. Entry into Palliative medicine training is possible following successful completion of both a foundation programme and a core training programme.

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Within the realm of pediatric medical care, the palliative care team is tasked with facilitating family-centered communication with children and their families, as well as multidisciplinary pediatric caregiving medical teams to forward coordinated medical management and the child's quality of life.

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Many terminally ill people cannot consume adequate food or drink. Providing medically assisted food or drink to prolong their life and improve the quality of their life is common, however there have been few high quality studies to determine best practices and the effectiveness of these approaches.

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first introduced the term "total pain" to describe the heterogenous nature of pain. This is the idea that a patient's experience of total pain has distinctive roots in the physical, psychological, social and spiritual realm but that they are all still closely linked to one another. Identifying the

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quality of life or increases caregiver burden, through pain and symptom management, identification and support of caregiver needs, and care coordination. Palliative care can be delivered at any stage of illness alongside other treatments with curative or life-prolonging intent and is not restricted

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Palliative care is able to improve healthcare quality in three sectors: Physical and emotional relief, strengthening of patient-physician communication and decision-making, and coordinated continuity of care across various healthcare settings, including hospital, home, and hospice. The overall goal

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Essential to facilitating supportive, clear communication around potentially distressing topics such as prognosis and goals of care for seriously ill pediatric patients is optimizing the setting where this communication will take place and developing informed consensus among the child's caregiving

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As part of developing a shared understanding of a child's illness and character, palliative providers will assess both the child and their family's symbolic and emotional relationship to disease. As both the somatic and psychologic implications of illness can be distressing to children, palliative

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Identify and assess symptoms through history taking (focusing on location, quality, time course, as well as exacerbating and mitigating stimuli). Symptoms assessment in children is uniquely challenging due to communication barriers depending on the child's ability to identify and communicate about

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Medications used in palliative care can be common medications but used for a different indication based on established practices with varying degrees of evidence. Examples include the use of antipsychotic medications, anticonvulsants, and morphine. Routes of administration may differ from acute or

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Cancer Center in Ohio which later expanded to become the training site of the first palliative care clinical and research fellowship as well as the first acute pain and palliative care inpatient unit in the United States. The program evolved into The Harry R. Horvitz Center for Palliative Medicine

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refers specifically to a benefit provided by the federal government since 1982. Hospice care services and palliative care programs share similar goals of mitigating unpleasant symptoms, controlling pain, optimizing comfort, and addressing psychological distress. Hospice care focuses on comfort and

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In the UK palliative care services offer inpatient care, home care, day care and outpatient services, and work in close partnership with mainstream services. Hospices often house a full range of services and professionals for children and adults. In 2015 the UK's palliative care was ranked as the

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The most common symptoms in children with severe chronic disease appropriate for palliative care consultation are weakness, fatigue, pain, poor appetite, weight loss, agitation, lack of mobility, shortness of breath, nausea and vomiting, constipation, sadness or depression, drowsiness, difficulty

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conditions. Forty million people each year are expected to need palliative care, with approximately 78% of this population living in low and middle income countries. However, only 14% of this population is able to receive this kind of care, with a majority in high-income countries, making this an

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about prescribing could help people manage their symptoms at home. A named professional to support and guide patients and carers through the healthcare system could also improve the experience of care at home at the end of life. A synthesised review looking at palliative care in the UK created a

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A significant role of the pediatric palliative care provider is to help support children, their families, and their caregiving teams through the emotional stress of illness. Communication strategies the palliative care provider may employ in this role are asking for permission when engaging with

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According to the Clinical Practice Guidelines for Quality Palliative Care, spirituality is a "dynamic and intrinsic aspect of humanity" and has been associated with "an improved quality of life for those with chronic and serious illness", especially for patients who are living with incurable and

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Physicians practicing palliative care do not always receive support from the people they are treating, family members, healthcare professionals or their social peers. More than half of physicians in one survey reported that they have had at least one experience where a patient's family members,

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Medical decision making in a pediatric setting is unique in that it is often the child's legal guardians, not the patient, who ultimately consent for most medical treatments. Yet within a palliative care setting, it is particularly consequential to incorporate the child's preferences within the

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High-certainty evidence supports the finding that implementation of home-based end-of-life care programs may increase the number of adults who will die at home and slightly improve patient satisfaction at a one-month follow-up. The impact of home-based end-of-life care on caregivers, healthcare

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The focus on a person's quality of life has increased greatly since the 1990s. In the United States today, 55% of hospitals with more than 100 beds offer a palliative-care program, and nearly one-fifth of community hospitals have palliative-care programs. A relatively recent development is the

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usually refers to a building or institution that specializes in palliative care. These institutions provide care to patients with end of life and palliative care needs. In the common vernacular outside the United States, hospice care and palliative care are synonymous and are not contingent on

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Evidence supports the efficacy of a palliative care approach in improvement of a person's quality of life. Palliative care's main focus is to improve the quality of life for those with chronic illnesses. It is commonly the case that palliative care is provided at the end of life, but it can be

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Pediatric palliative care practitioners receive specialized training in family-centered, developmental and age-appropriate skills in communication and facilitation of shared decision making; assessment and management of pain and distressing symptoms; advanced knowledge in care coordination of

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Evidence that providing palliative care in tandem with standard oncologic care among patients with advanced cancer is associated with lower rates of depression, increased quality of life, and increased length of survival compared to those receiving standard oncologic care and may even prolong

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With the transition in the population toward lower child mortality and lower death rates, countries around the world are seeing larger elderly populations. In some countries, this means a growing burden on national resources in the shape of social security and health care payments. As aging

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This is a framework that is designed to assist healthcare workers deliver bad news. The acronym stands for: setting, perception, invitation, knowledge, empathy, and summarize/strategy. When giving bad news it is important to consider the setting, which considers the environment in which the

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psychological support and curative therapies are not pursued. Under the Medicare Hospice Benefit, individuals certified by two physicians to have less than six months to live (assuming a typical course) have access to specialized hospice services through various insurance programs (

1158:(NIHR) has addressed these areas of need. Examples highlight inequalities faced by several groups and offers recommendations. These include the need for close partnership between services caring for people with severe mental illness, improved understanding of barriers faced by 2726:

Kathryn Batson et al. "The Effect of a Therapy Dog on Socialization and Physiological Indicators of Stress in Persons Diagnosed with Alzheimer's Disease" in 'Companion Animals in Human Health' Editors – Cindy C. Wilson and Dennis C. Turner, Sage Publications 1998,

951:; the relief of distressing symptoms; the coordination of interdisciplinary care in diverse settings; the use of specialized care systems including hospice; the management of the imminently dying patient; and legal and ethical decision making in end of life care. 625:

Pediatric palliative care is family-centered, specialized medical care for children with serious illnesses that focuses on mitigating the physical, emotional, psychosocial, and spiritual suffering associated with illness to ultimately optimize quality of life.

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recommends that patients with advanced cancer should be "referred to interdisciplinary palliative care teams that provide inpatient and outpatient care early in the course of disease, alongside active treatment of their cancer" within eight weeks of diagnosis.

928:, and caregivers. In some countries, additional members of the team may include certified nursing assistants and home healthcare aides, as well as volunteers from the community (largely untrained but some being skilled medical personnel), and housekeepers. 958:, are crucial to the palliative care system. Caregivers and people being treated often form lasting friendships over the course of care. As a consequence caregivers may find themselves under severe emotional and physical strain. Opportunities for caregiver 767:

Many frameworks for communication have been established within the medical literature, but the field of pediatric palliative care is still in relative infancy. Communication considerations and strategies employed in a palliative setting include:

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A review states that by restricting referrals to palliative care only when patients have a definitive time line for death, something that the study found to often be inaccurate, can have negative implications for the patient both when accessing

502:"). Radiation is commonly used with palliative intent to alleviate pain in patients with cancer. As an effect from radiation may take days to weeks to occur, patients dying a short time following their treatment are unlikely to receive benefit. 1134:, talked about the importance of good palliative care, being able to express wishes about the last months of life, and good tuition (nutrition?) and education about end of life care generally. The letter went viral after David Bowie's son 782:

The establishment of shared knowledge between medical providers, patients, and families is essential when determining palliative goals of care for pediatric patients. Initially, practitioners often elicit information from the patient

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is an additional practice that can further aid alleviating the physical and mental pain from the child and their family. By allowing the caregiving to ensue by other qualified individuals, it allows the family time to rest and renew

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Doctrine of Catholic Church, as a traditional reference, accepts and supports the use of palliative care. Most of main religions in the world (and the biggest in amount of believers) are concordant with this point of view.

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Varni JW, Katz ER, Seid M, Quiggins DJ, Friedman-Bender A, Castro CM (April 1998). "The Pediatric Cancer Quality of Life Inventory (PCQL). I. Instrument development, descriptive statistics, and cross-informant variance".

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Dixon KC, Ferris R, Kuhn I, Spathis A, Barclay S (February 2021). "Gypsy, Traveller and Roma experiences, views and needs in palliative and end of life care: a systematic literature review and narrative synthesis".

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Foley P, Hampton J, Hampton A, Hampton R, Oleksy D, Oliver D, et al. (August 2012). "Lesley's story: a case report, and discussion of challenges faced in end-of-life care for progressive neurological disease".

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America's Care of Serious Illness: A State-by-State Report Card on Access to Palliative Care in Our Nation's Hospitals. Center to Advance Palliative Care and the National Palliative Care Research Center. September

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The selection and use of essential medicines : report of the WHO Expert Committee, March 2011 (including the 17th WHO model list of essential medicines and the 3rd WHO model list of essential medicines for

607:. A score of 0 indicates absence of the symptom, and a score of 10 indicates the worst possible severity. The instrument can be completed by the patient, with or without assistance, or by nurses and relatives. 451:

For many patients, end of life care can cause emotional and psychological distress, contributing to their total suffering. An interdisciplinary palliative care team consisting of a mental health professional,

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care practitioners look for opportunities to establish meaning and dignity regarding the child's illness by contextualizing disease within a broader framework of the child's life. Derived from the fields of

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began an Advanced Certification Program for Palliative Care that recognizes hospital inpatient programs demonstrating outstanding care and enhancement of the quality of life for people with serious illness.

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Evidence that palliative care services increase the likelihood of dying at home and reduce symptom burden without impacting on caregiver grief among the vast majority of Americans who prefer to die at home.

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Advances in palliative care have since inspired a dramatic increase in hospital-based palliative care programs. Notable research outcomes forwarding the implementation of palliative care programs include:

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Pritchard M, Burghen E, Srivastava DK, Okuma J, Anderson L, Powell B, et al. (May 2008). "Cancer-related symptoms most concerning to parents during the last week and last day of their child's life".

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attitudes both play significant roles in the acceptance and implementation of palliative care in the health care agenda. A study identified the current gaps in palliative care for people with severe

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Appropriately engaging palliative care providers as a part of patient care improves overall symptom control, quality of life, and family satisfaction of care while reducing overall healthcare costs.

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as with any other medical speciality. Nurses, in the United States and internationally, can receive continuing education credits through Palliative Care specific trainings, such as those offered by

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Thuné-Boyle IC, Stygall JA, Keshtgar MR, Newman SP (July 2006). "Do religious/spiritual coping strategies affect illness adjustment in patients with cancer? A systematic review of the literature".

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are some of the services hospices provide to promote caregiver well-being. Respite may last a few hours up to several days (the latter being done by placing the primary person being cared for in a

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Dy SM, Apostol C, Martinez KA, Aslakson RA (April 2013). "Continuity, coordination, and transitions of care for patients with serious and advanced illness: a systematic review of interventions".

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Most spiritual interventions are subjective and complex. Many have not been well evaluated for their effectiveness, however tools can be used to measure and implement effective spiritual care.

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Ferrell BR, Virani R, Grant M, Rhome A, Malloy P, Bednash G, et al. (February 2005). "Evaluation of the End-of-Life Nursing Education Consortium undergraduate faculty training program".

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Mack JW, Hilden JM, Watterson J, Moore C, Turner B, Grier HE, et al. (December 2005). "Parent and physician perspectives on quality of care at the end of life in children with cancer".

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are other medications that are sometimes prescribed to help alleviate nausea and vomiting, however further research is also required to understand how effective these medications may be.

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for everyone regardless of who they are, where they live or their circumstances, and the need to maximise comfort and wellbeing. Informed and timely conversations are also highlighted.

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McSherry W, Smith J. Spiritual care. In: McSherry W, McSherry R, Watson R, editors. In care in nursing – principles, values and skills. New York: Oxford University Press, 2012;117–31.

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Present treatment options to the family proactively, based on care options and resources available in each of the aforementioned care settings. Ensuing management should anticipate

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Savedra MC, Tesler MD, Holzemer WL, Wilkie DJ, Ward JA (October 1989). "Pain location: validity and reliability of body outline markings by hospitalized children and adolescents".

6511: 1428:"Impact of Interdisciplinary Outpatient Specialty Palliative Care on Survival and Quality of Life in Adults With Advanced Cancer: A Meta-Analysis of Randomized Controlled Trials" 5808: 3545:

Bruera E, Kuehn N, Miller MJ, Selmser P, Macmillan K (1991). "The Edmonton Symptom Assessment System (ESAS): a simple method for the assessment of palliative care patients".

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Candy B, Jones L, Varagunam M, Speck P, Tookman A, King M (May 2012). "Spiritual and religious interventions for well-being of adults in the terminal phase of disease".

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Palliative care can be initiated in a variety of care settings, including emergency rooms, hospitals, hospice facilities, or at home. For some severe disease processes,

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of palliative care is to improve quality of life of individuals with serious illness, any life-threatening condition which either reduces an individual's daily function

6276:"Supporting patient access to medicines in community palliative care: on-line survey of health professionals' practice, perceived effectiveness and influencing factors" 1065:

services people with SMI's faced a number of barriers to accessing timely and appropriate palliative care. They called for a multidisciplinary team approach, including

1760: 5872: 464:, can play important roles in helping people and their families cope using various methods such as counseling, visualization, cognitive methods, drug therapy and 5349: 2088: 395:

Over 90% of US hospitals with more than 300 beds have palliative care teams, yet only 17% of rural hospitals with 50 or more beds have palliative care teams.

6325: 1053:, murder or killing" during the last five years. A quarter of them had received similar comments from their own friends or family member, or from a patient. 148:

Palliative care is appropriate for individuals with serious illnesses across the age spectrum and can be provided as the main goal of care or in tandem with

5265: 6361:"An exploration of the experiences of professionals supporting patients approaching the end of life in medicines management at home. A qualitative study" 3727:

Gauvain-Piquard A, Rodary C, Rezvani A, Serbouti S (June 1999). "The development of the DEGR(R): A scale to assess pain in young children with cancer".

2453: 656:. With this said, children as young as four years of age can indicate the location and severity of pain through visual mapping techniques and metaphors. 519:

Spirituality is a fundamental component of palliative care. Moreover, hospices where palliative care is administered have usually available chaplains.

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Hockenberry-Eaton M, Manteuffel B, Bottomley S (July 1997). "Development of two instruments examining stress and adjustment in children with cancer".

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Garwick AW, Patterson J, Bennett FC, Blum RW (September 1995). "Breaking the news. How families first learn about their child's chronic condition".

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Consider both pharmacologic and non-pharmacologic treatment modalities (education and mental health support, administration of hot and cold packs,

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The Tata Memorial Centre in Mumbai has offered a physician's course in palliative medicine since 2012, the first one of its kind in the country.

5022: 292: 7796: 6161: 2587:"The effectiveness and cost-effectiveness of hospital-based specialist palliative care for adults with advanced illness and their caregivers" 5958: 5838: 5551: 1584:"A Systematic Review in Support of the National Consensus Project Clinical Practice Guidelines for Quality Palliative Care, Fourth Edition" 989:-approved procedure. More than 50 fellowship programs provide one to two years of specialty training following a primary residency. In the 4836: 671:. Finally, because children behaviorally respond to pain atypically, a playing or sleeping child should not be assumed to be without pain. 4495:"Parents are meaningfully involved in decisions on the care of their critically ill baby when they are given options not recommendations" 2813: 1639: 5350:"In-Home Palliative Care Allows More Patients to Die at Home, Leading to Higher Satisfaction and Lower Acute Care Utilization and Costs" 6829: 4654:

Snethen JA, Broome ME, Knafl K, Deatrick JA, Angst DB (June 2006). "Family patterns of decision-making in pediatric clinical trials".

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Evidence that hospital palliative care consult teams are associated with significant hospital and overall health system cost savings.

85: 6041: 4740:"Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment" 1032:

In 2021 the UK's National Palliative and End of Life Care Partnership published their six ambitions for 2021–26. These include fair

5994:"End of life care for people with severe mental illness: Mixed methods systematic review and thematic synthesis (the MENLOC study)" 5599:"End of life care for people with severe mental illness: Mixed methods systematic review and thematic synthesis (the MENLOC study)" 5292: 3873:

Stockman JA (January 2008). "Symptoms Affecting Children With Malignancies During the Last Month of Life: A Nationwide Follow-up".

1107:

and Jeffrey Friedman about terminally ill patients in a San Francisco hospital and features the work of palliative care physician,

998: 700:

of palliative care settings to afford seamless continuity of service provision across health, education, and social care settings.

7436: 6769: 6121:"Estimating the prevalence of chronic conditions in children who die in England, Scotland and Wales: a data linkage cohort study" 1246: 5894: 3025:

Silva RS, Caldeira S, Coelho AN, Apóstolo JL (November 2020). "Forgiveness facilitation in palliative care: a scoping review".

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pharmacologic options are suggested to help alleviate these symptoms. For people who do not respond to first-line medications,

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Goldstein P, Walsh D, Horvitz LU (September 1996). "The Cleveland Clinic Foundation Harry R. Horvitz Palliative Care Center".

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palliative care has been a full specialty of medicine since 1989 and training is governed by the same regulations through the

663:

of the child. Special attention to the child's behavioral response to exam components, particularly in regards to potentially

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Buchan EJ, Haywood A, Syrmis W, Good P (December 2023). "Medically assisted hydration for adults receiving palliative care".

2288:"Effectiveness and cost-effectiveness of home palliative care services for adults with advanced illness and their caregivers" 1950: 1230: 974: 373: 257: 214: 209:

recommend initiating palliative care at the time of diagnosis or when disease-directed options would not improve a patient's

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Saunders C (14 February 1964). "Care of patients suffering from terminal illness at St Joseph's Hospice, Hackney, London".

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After the implementation of therapeutic interventions, involve both the child and family in the reassessment of symptoms.

7619: 5405: 239:

The distinction between palliative care and hospice differs depending on global context. In the United States, the term

7624: 7205: 6547: 5106: 5049: 1829:"A systematic review of communication quality improvement interventions for patients with advanced and serious illness" 1560: 634:

resources available to patients and families; and psychologically supporting children and families through illness and

6193:"Place of death of children and young adults with a life-limiting condition in England: a retrospective cohort study" 5212:"Assessment of status of patients receiving palliative home care and services provided in a rural area-kerala, India" 4422: 2732: 1013: 322: 234: 4251:"Communicating with children and families: from everyday interactions to skill in conveying distressing information" 2239:"Hospice enrollment saves money for Medicare and improves care quality across a number of different lengths-of-stay" 2110:

LeGrand SB, Walsh D, Nelson KA, Davis MP (July 2003). "A syllabus for fellowship education in palliative medicine".

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Kain M, Bennett H, Yi M, Robinson B, James M (August 2020). "30-day mortality following palliative radiotherapy".

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may be used, however there have been insufficient clinical trials to assess the effectiveness of this medication.

7823: 7791: 2442:"Advanced Certification for Palliative Care Programs". Joint Commission. 30 April 2014. Retrieved 17 August 2014. 1023:

best in the world "due to comprehensive national policies, the extensive integration of palliative care into the

944: 399:

has been a board certified sub-specialty of medicine in the United States since 2006. Additionally, in 2011, The

396: 230: 6241:"Nurses and pharmacists are key to improving access to end of life medicines for people being cared for at home" 5375: 7532: 7323: 7195: 6629: 5959:"Team work and proactive healthcare could help people with severe mental illness receive good end-of-life care" 5474: 1376:"Association Between Palliative Care and Patient and Caregiver Outcomes: A Systematic Review and Meta-analysis" 982: 95: 4451:

Hinds PS (September 2004). "The hopes and wishes of adolescents with cancer and the nursing care that helps".

7769: 7754: 7492: 1999:

Werner D (31 January 2011). "Communicating About Health: Current Issues and Perspectives, by Athena du Pre".

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was established in 2006 to provide expertise in the care of people with life-limiting, advanced disease, and

446: 6042:"A highly personalised approach to end of life care is needed to help Gypsy, Traveller and Roma communities" 5170: 4885:"End-of-life planning and its relevance for patients' and oncologists' decisions in choosing cancer therapy" 739:

Assess how the child perceives their symptoms (based on personal views) to create individualized care plans.

534:

Nausea and vomiting are common in people who have advanced terminal illness and can cause distress. Several

7744: 7175: 5778: 5383: 1198: 904:

In most countries, hospice care and palliative care is provided by an interdisciplinary team consisting of

830:

What is the meaning of this (illness) experience for you? Do you ever think about why this happened to you?

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Varni JW, Seid M, Kurtin PS (2001). Pediatric Quality of Life Inventory 4.0 Generic Core Scales (Report).

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Morrison RS, Penrod JD, Cassel JB, Caust-Ellenbogen M, Litke A, Spragens L, et al. (September 2008).

7774: 6819: 5050:"Perspectives of Major World Religions regarding Euthanasia and Assisted Suicide: A Comparative Analysis" 4064:

Hinds PS, Quargnenti AG, Wentz TJ (April 1992). "Measuring symptom distress in adolescents with cancer".

1069:, with a point of contact co-ordinating the appropriate support for the individual. They also state that 994: 803:, the palliative care provider may explore the following questions with the sick child and their family: 664: 1045:

palliative-care team, a dedicated health care team that is entirely geared toward palliative treatment.

7853: 6799: 5190: 3522: 3070:"Improving the spiritual dimension of whole person care: reaching national and international consensus" 675: 206: 195: 17: 6274:

Latter S, Campling N, Birtwistle J, Richardson A, Bennett MI, Ewings S, et al. (September 2020).

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The field of palliative care grew out of the hospice movement, which is commonly associated with Dame

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Hilton T, Orr RD, Perkin RM, Ashwal S (May 1993). "End of life care in Duchenne muscular dystrophy".

3826: 369: 142: 2045:

Clark D (May 2007). "From margins to centre: a review of the history of palliative care in cancer".

7883: 7813: 7677: 7416: 7020: 6942: 6937: 6857: 6617: 245: 1876: 344: 7712: 7000: 6974: 6516: 5925:"End of life care: research highlights the importance of conversations and need for equal access" 5469:

Sick to death and not going to take it anymore!: reforming health care for the last years of life

3785:

Wolfe J, Grier HE, Klar N, Levin SB, Ellenbogen JM, Salem-Schatz S, et al. (February 2000).

2384:

Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, et al. (August 2010).

2335:

Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, et al. (August 2010).

1120: 1025: 457: 360: 5428:"Ambitions for Palliative and End of Life Care: A national framework for local action 2021-2026" 1582:

Ahluwalia SC, Chen C, Raaen L, Motala A, Walling AM, Chamberlin M, et al. (December 2018).

973:; recently this was changed to be done through any of 11 different speciality boards through an 7749: 6592: 6540: 4828: 481:

cause of pain can help guide care for some patients, and impact their quality of life overall.

2805: 1631: 7738: 7639: 7243: 7129: 7102: 7075: 7027: 6981: 6676: 6332:(Plain English summary). National Institute for Health and Care Research. 16 September 2020. 5478: 4932:

O'Leary KJ, Kulkarni N, Landler MP, Jeon J, Hahn KJ, Englert KM, et al. (January 2010).

1550: 1548: 1049:

another physician or another health care professional had characterized their work as being "

780:

Developing a shared understanding of the child's condition with the patient and their family.

6048:(Plain English summary). National Institute for Health and Care Research. 17 December 2021. 5965:(Plain English summary). National Institute for Health and Care Research. 28 February 2022. 5152: 4335:"SPIKES-A six-step protocol for delivering bad news: application to the patient with cancer" 3659:

Anand KJ, Hickey PR (November 1987). "Pain and its effects in the human neonate and fetus".

7840: 7808: 7732: 7426: 7411: 7362: 7263: 7223: 7090: 6904: 6899: 6879: 6814: 6666: 2538:"Interventions for improving palliative care for older people living in nursing care homes" 1374:, Corbelli J, Zhang D, Dionne-Odom JN, Ernecoff NC, Hanmer J, et al. (November 2016). 1139: 1099: 728: 724: 660: 465: 304: 203: 141:

illnesses. Within the published literature, many definitions of palliative care exist. The

48: 3166:"Evaluation of spiritual needs of patients with advanced cancer in a palliative care unit" 1545: 845:

Optimizing the environment for effective conversations around prognosis and goals of care.

348: 8: 7716: 7343: 7285: 7268: 6927: 6644: 6417:(Plain English summary). National Institute for Health and Care Research. 26 April 2022. 6326:"Terminally ill patients and their families may need more help to manage their medicines" 5931:(Plain English summary). National Institute for Health and Care Research. 31 March 2022. 5779:"Stream It Or Skip It: 'End Game' On Netflix, A Short Documentary About Dying Gracefully" 4308: 955: 948: 679: 604: 572: 300: 133:, or 'to cloak') is an interdisciplinary medical caregiving approach aimed at optimizing 6247:(Plain English summary). National Institute for Health and Care Research. 15 June 2021. 6162:"Most children with life-limiting conditions still die in hospital, not home or hospice" 5288: 4501:(Plain English summary). National Institute for Health and Care Research. 9 March 2021. 1827:

Fawole OA, Dy SM, Wilson RF, Lau BD, Martinez KA, Apostol CC, et al. (April 2013).

1707:"Integration of primary palliative care into geriatric care from the Indian perspective" 821:

What are the particular things you would like your family to know or remember about you?

7702: 7477: 7441: 7233: 7190: 7180: 6969: 6922: 6889: 6884: 6634: 6612: 6478: 6426: 6387: 6360: 6341: 6302: 6275: 6256: 6217: 6192: 6173: 6145: 6120: 6101: 6057: 6018: 5993: 5992:

Edwards D, Anstey S, Coffey M, Gill P, Mann M, Meudell A, et al. (December 2021).

5974: 5940: 5755: 5738: 5707: 5673: 5623: 5598: 5597:

Edwards D, Anstey S, Coffey M, Gill P, Mann M, Meudell A, et al. (December 2021).

5567: 5528: 5503: 5238: 5211: 5082: 4958: 4933: 4909: 4884: 4764: 4739: 4715: 4690: 4560: 4510: 4476: 4209: 4107:

Collins JJ, Byrnes ME, Dunkel IJ, Lapin J, Nadel T, Thaler HT, et al. (May 2000).

4089: 4002: 3752: 3570: 3497: 3472: 3409: 3384: 3360: 3335: 3311: 3286: 3190: 3165: 3094: 3069: 3050: 2997: 2972: 2948: 2923: 2901: 2782: 2765: 2663: 2638: 2611: 2586: 2562: 2537: 2473: 2415: 2366: 2312: 2287: 2263: 2238: 2178: 2135: 2024: 1853: 1828: 1733: 1706: 1687: 1613: 1529: 1502: 1452: 1427: 1400: 1375: 1348: 1321: 1254: 1188: 1112: 917: 191: 149: 79: 4789:"Communicating about prognosis: ethical responsibilities of pediatricians and parents" 4161: 4125: 4108: 4041: 4024: 3918: 3901: 3886: 2704: 2687: 2058: 1600: 1583: 1554: 1297: 1280: 7649: 7634: 7629: 7536: 7406: 7401: 7329: 7303: 7185: 7155: 7134: 7097: 7080: 6995: 6959: 6949: 6844: 6764: 6708: 6671: 6656: 6597: 6564: 6533: 6482: 6470: 6430: 6392: 6345: 6307: 6260: 6222: 6208: 6177: 6150: 6105: 6093: 6061: 6023: 5978: 5944: 5760: 5711: 5677: 5665: 5628: 5571: 5533: 5482: 5467: 5331: 5243: 5134: 5126: 5087: 5069: 5004: 4963: 4914: 4863: 4810: 4769: 4720: 4671: 4636: 4601: 4564: 4552: 4548: 4514: 4468: 4428: 4418: 4392: 4382: 4356: 4312: 4272: 4201: 4165: 4130: 4081: 4046: 4006: 3994: 3958: 3954: 3923: 3855: 3845: 3808: 3744: 3709: 3699: 3676: 3672: 3641: 3606: 3596: 3562: 3502: 3453: 3414: 3365: 3316: 3267: 3236: 3195: 3134: 3099: 3054: 3042: 3002: 2973:"Drug therapy for symptoms associated with anxiety in adult palliative care patients" 2953: 2905: 2893: 2858: 2787: 2728: 2709: 2668: 2616: 2585:

Bajwah S, Oluyase AO, Yi D, Gao W, Evans CJ, Grande G, et al. (September 2020).

2567: 2407: 2358: 2317: 2268: 2219: 2170: 2127: 2062: 2028: 2016: 1946: 1858: 1809: 1738: 1679: 1605: 1534: 1457: 1405: 1353: 1302: 1226: 1089:

wait to consult their doctor and endure sometimes years of pain before seeking help.

913: 909: 800: 748: 697: 690: 584: 4738:

Wright AA, Zhang B, Ray A, Mack JW, Trice E, Balboni T, et al. (October 2008).

4691:"Compassionate silence in the patient-clinician encounter: a contemplative approach" 4480: 4213: 4093: 3756: 3574: 3130: 2477: 2139: 1691: 1675: 1617: 1061:(SMI's). They found that due to the lack of resources within both mental health and 363:

in Winnipeg. In 1987, Declan Walsh established a palliative medicine service at the

178:. Historically, palliative care services were focused on individuals with incurable 7888: 7726: 7667: 7573: 7396: 7313: 7005: 6990: 6867: 6742: 6698: 6460: 6418: 6382: 6372: 6333: 6297: 6287: 6248: 6212: 6204: 6165: 6140: 6132: 6085: 6049: 6013: 6005: 5966: 5932: 5750: 5699: 5655: 5618: 5610: 5559: 5523: 5515: 5323: 5233: 5223: 5118: 5077: 5061: 4994: 4953: 4945: 4904: 4896: 4800: 4759: 4751: 4710: 4702: 4663: 4628: 4591: 4544: 4502: 4460: 4346: 4304: 4262: 4228: 4193: 4157: 4120: 4073: 4036: 4020: 3986: 3950: 3913: 3882: 3835: 3798: 3736: 3668: 3633: 3554: 3492: 3488: 3484: 3449: 3445: 3441: 3404: 3400: 3396: 3355: 3351: 3347: 3306: 3302: 3298: 3263: 3259: 3226: 3185: 3177: 3126: 3089: 3081: 3034: 2992: 2988: 2984: 2943: 2935: 2885: 2848: 2777: 2699: 2658: 2654: 2650: 2606: 2602: 2598: 2557: 2553: 2549: 2465: 2419: 2397: 2370: 2348: 2307: 2303: 2299: 2258: 2250: 2209: 2182: 2162: 2119: 2054: 2008: 1938: 1848: 1840: 1799: 1791: 1728: 1718: 1671: 1595: 1524: 1514: 1447: 1439: 1395: 1387: 1343: 1333: 1292: 1193: 1082: 1070: 1062: 925: 827:

Are you frightened by all of this? What, in particular, are you most frightened of?

796: 720: 413: 400: 364: 175: 153: 138: 6465: 6452: 6089: 5660: 5647: 4351: 4334: 3336:"Haloperidol for the treatment of nausea and vomiting in palliative care patients" 1162:

communities, the provision of flexible palliative care services for children from

7867: 7583: 7542: 7508: 7333: 7278: 7139: 7124: 7107: 7042: 6986: 6964: 6661: 6607: 6587: 6506: 5197: 5177: 3529: 2214: 2197: 2012: 1371: 1183: 969:

In the US, board certification for physicians in palliative care was through the

653: 631: 539: 477: 336: 134: 6136: 5171:

ABMS Establishes New Subspecialty Certificate in Hospice and Palliative Medicine

3803: 3786: 3038: 2198:"Cost savings associated with US hospital palliative care consultation programs" 1476:"What is Palliative Care? | Definition of Palliative Care | Get Palliative Care" 7672: 7657: 7528: 7165: 7119: 6932: 6862: 6681: 6292: 5065: 4528:

Marlow N, Shaw C, Connabeer K, Aladangady N, Gallagher K, Drew P (March 2021).

4077: 3558: 2386:"Early palliative care for patients with metastatic non-small-cell lung cancer" 2337:"Early palliative care for patients with metastatic non-small-cell lung cancer" 2123: 1942: 1723: 1116: 990: 630:

multidisciplinary pediatric caregiving medical teams; referral to hospital and

468:

to address their needs. Palliative pets can play a role in this last category.

356: 6377: 6009: 5614: 5504:"Prevalence of formal accusations of murder and euthanasia against physicians" 4197: 2254: 1844: 7877: 7446: 7431: 7421: 7248: 7037: 7032: 6894: 6834: 6737: 6501: 5936: 5895:"Benedict Cumberbatch read out a letter to Bowie by a palliative care doctor" 5397: 5228: 5130: 5073: 4999: 4982: 4755: 4432: 4396: 4333:

Baile WF, Buckman R, Lenzi R, Glober G, Beale EA, Kudelka AP (2 March 2000).

3859: 3713: 3610: 3385:"Droperidol for treatment of nausea and vomiting in palliative care patients" 2020: 1519: 1338: 1143: 1074: 1058: 1033: 921: 453: 352: 183: 4805: 4788: 4632: 4596: 4579: 2889: 1391: 1169:

Other research suggests that giving nurses and pharmacists easier access to

7759: 7692: 7687: 7593: 7568: 7523: 7253: 7238: 7064: 6789: 6639: 6624: 6570: 6474: 6396: 6311: 6226: 6154: 6097: 6027: 5764: 5669: 5632: 5537: 5502:

Goldstein NE, Cohen LM, Arnold RM, Goy E, Arons S, Ganzini L (March 2012).

5335: 5327: 5247: 5138: 5122: 5091: 5008: 4967: 4918: 4814: 4773: 4724: 4675: 4640: 4605: 4556: 4472: 4464: 4360: 4276: 4267: 4250: 4134: 4050: 3998: 3990: 3927: 3812: 3748: 3740: 3637: 3506: 3457: 3418: 3369: 3320: 3271: 3240: 3199: 3138: 3103: 3046: 3006: 2957: 2897: 2862: 2791: 2713: 2672: 2620: 2571: 2411: 2362: 2321: 2272: 2223: 2131: 2066: 1862: 1813: 1742: 1683: 1609: 1556: 1538: 1461: 1409: 1357: 1306: 1135: 1131: 963: 959: 876: 732: 716: 708: 620: 499: 440: 5739:"Acknowledging stigma: Its presence in patient care and medical education" 5519: 5286: 4949: 4706: 4316: 4205: 4169: 4085: 3962: 3680: 3645: 3566: 3181: 3085: 2939: 2853: 2836: 2402: 2385: 2353: 2336: 2174: 1804: 1795: 1029:, a strong hospice movement, and deep community engagement on the issue". 160:

helpful for a person of any stage of illness that is critical or any age.

7385: 7112: 7057: 6954: 6809: 6784: 6602: 6359:

Wilson E, Caswell G, Latif A, Anderson C, Faull C, Pollock K (May 2020).

4530:"End-of-life decisions in neonatal care: a conversation analytical study" 2806:"Palliative care – shortness of breath: MedlinePlus Medical Encyclopedia" 1443: 1127: 1104: 932:

There are two core training programmes for Palliative Medicine training:

712: 543: 6337: 6252: 6169: 6053: 5970: 5563: 5023:"Magisterial teaching on end-of-life issues - Texas Catholic Conference" 4506: 1475: 985:) in the United States through four medical specialty boards through an 182:, but this framework is now applied to other diseases, including severe 91:

UK: Certificate of Completion of Specialist Training (4 years full-time)

7603: 7563: 7200: 7085: 7052: 6824: 6774: 6759: 6754: 6747: 6732: 6722: 6453:"Timely community palliative and end-of-life care: a realist synthesis" 6422: 5809:"How This Doctor Is Bringing Human Connection Back to End-of-Life Care" 5703: 5648:"Timely community palliative and end-of-life care: a realist synthesis" 5376:"Quality of Death Index 2015: Ranking palliative care across the world" 4900: 4858:

du Pre A (2017). "Social Support, Family Caregivers, and End of Life".

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Good P, Richard R, Syrmis W, Jenkins-Marsh S, Stephens J (April 2014).

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Hall S, Kolliakou A, Petkova H, Froggatt K, Higginson IJ (March 2011).

2469: 2237:

Kelley AS, Deb P, Du Q, Aldridge Carlson MD, Morrison RS (March 2013).

2166: 1557:"Clinical Practice Guidelines for Quality Palliative Care, 4th edition" 1159: 1097:

Palliative care was the subject of the 2018 Netflix short documentary,

1050: 977:-approved procedure. Additionally, board certification is available to 600: 592: 547: 535: 491: 137:

and mitigating suffering among people with serious, complex, and often

4667: 4244: 4242: 3770:

Committee on Bioethics (August 2000). "Palliative Care for Children".

3231: 3214: 2286:

Gomes B, Calanzani N, Curiale V, McCrone P, Higginson IJ (June 2013).

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which was designated as an international demonstration project by the

156:, palliative care is not limited to individuals near the end of life. 7598: 7482: 7273: 7015: 7010: 6874: 6852: 6727: 6691: 4883:

Saraiya B, Bodnar-Deren S, Leventhal E, Leventhal H (December 2008).

4882: 1933:

Sibson K, Craig F, Goldman A (2005). "Palliative Care for Children".

1281:"Palliative Care: the World Health Organization's global perspective" 1108: 905: 872: 616: 436: 210: 27:

Area of healthcare that focuses on relieving and preventing suffering

4147: 4025:"A different perspective to approaching cancer symptoms in children" 3726: 2195: 1370: 7518: 7472: 7462: 6779: 6556: 4239: 3787:"Symptoms and suffering at the end of life in children with cancer" 1632:"Heart failure – palliative care: MedlinePlus Medical Encyclopedia" 1066: 668: 596: 495: 461: 249: 112: 60: 6451:

Petrova M, Wong G, Kuhn I, Wellwood I, Barclay S (December 2021).

6273: 5646:

Petrova M, Wong G, Kuhn I, Wellwood I, Barclay S (December 2021).

2636: 1969: 987:

American Osteopathic Association Bureau of Osteopathic Specialists

7682: 7578: 7467: 7258: 6718: 6686: 6579: 4983:"Palliative care in India: Situation assessment and future scope" 4862:. New York, New York: Oxford University Press. pp. 208–209. 3698:(2nd ed.). Philadelphia: Lippincott Williams & Wilkins. 3473:"Medically assisted nutrition for adult palliative care patients" 2637:

Shepperd S, Gonçalves-Bradley DC, Straus SE, Wee B (March 2021).

1426:

Hoerger M, Wayser GR, Schwing G, Suzuki A, Perry LM (June 2019).

704: 683: 652:

symptoms. Thus, both the child and caregivers should provide the

641: 588: 264: 5552:"How to improve end-of-life care for people with mental illness" 3116: 7513: 6520: 5839:"Thank you letter to David Bowie from a palliative care doctor" 3975: 2454:"Tackling the Challenges of Clinical Trials in Palliative Care" 1902:"Medicare Care Choices Model (MCCM): The First Two Years | CMS" 1555:

National Consensus Project for Quality Palliative Care (2018).

792:

Establishing meaning and dignity regarding the child's illness.

773:

Developing supportive relationships with patients and families.

689:

Anticipate symptoms based on the typical disease course of the

580: 179: 116: 7354: 4931: 3470: 647:

symptoms in children by a palliative care team is as follows:

4689:

Back AL, Bauer-Wu SM, Rushton CH, Halifax J (December 2009).

4527: 2383: 2334: 1503:"Palliative care in India: current progress and future needs" 1322:"Palliative care in India: current progress and future needs" 1278: 1138:

shared it. The letter was subsequently read out by the actor

635: 291:

deal primarily with the United States and do not represent a

5352:. Agency for Healthcare Research and Quality. 3 April 2013. 4934:"Hospitalized patients' understanding of their plan of care" 4537:

Archives of Disease in Childhood. Fetal and Neonatal Edition

3287:"Levomepromazine for nausea and vomiting in palliative care" 3215:"Concept Analysis of Spirituality: An Evolutionary Approach" 2688:"Existential pain—an entity, a provocation, or a challenge?" 2535: 2285: 6525: 4860:

Communicating About Health: Current Issues and Perspectives

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Sepúlveda C, Marlin A, Yoshida T, Ullrich A (August 2002).

1225:. American Association of Hospice and Palliative Medicine. 758: 576: 6411:"End of life care should not wait for prediction of death" 6358: 5692:"End of life care should not wait for prediction of death" 4688: 4653: 3383:

Storrar J, Hitchens M, Platt T, Dorman S (November 2014).

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as an Integrated Center of Oncology and Palliative Care.

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British Medical Journal Supportive & Palliative Care

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Puchalski CM, Vitillo R, Hull SK, Reller N (June 2014).

1581: 1077:

needs to be included in the training for professionals.

6450: 5991: 5645: 5596: 5501: 5313: 4332: 3431: 2109: 2081:"Why Quality of Life Matters, Even in Your Final Hours" 1757:"Hospice and Palliative Medicine Specialty Description" 494:(dry mouth), nausea and vomiting, constipation, fever, 6191:

Gibson-Smith D, Jarvis SW, Fraser LK (December 2020).

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Strang P, Strang S, Hultborn R, Arnér S (March 2004).

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Dubin RE, Kaplan A, Graves L, Ng VK (December 2017).

5289:"American Academy of Hospice and Palliative Medicine" 4182: 4109:"The measurement of symptoms in children with cancer" 3940: 2875: 2764:

Rome RB, Luminais HH, Bourgeois DA, Blais CM (2011).

2152: 2112:

The American Journal of Hospice & Palliative Care

943:

In the United States, the physician sub-specialty of

359:

became the director of a new "terminal care" unit at

5435:

National Palliative and End of Life Care Partnership

4063: 3693: 939:

Acute Care Common Stem - Internal Medicine (ACCS-IM)

5736: 5209: 4417:(2nd ed.). New York: Oxford University Press. 3784: 2970: 2451: 5466: 5287:American Academy of Hospice, Palliative Medicine. 5264:. American Osteopathic Association. 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See 4328: 4326: 4248: 3872: 3694:Schechter N, Berde CB, Yaster M (2003). 3154: 3013: 2743: 2452:Currow D, Agar MR, Abernethy AP (2011). 1964: 1962: 1039: 999:End-of-Life Nursing Education Consortium 759:Communication with children and families 731:) when addressing distressing symptoms. 5189:American Board of Medical Specialties, 5169:American Board of Medical Specialties, 4412: 3513: 2924:"Palliative Care for the Seriously Ill" 900:Certification and training for services 809:Where do you find strength and support? 355:coined the term "palliative care". and 14: 7876: 4857: 4113:Journal of Pain and Symptom Management 4029:Journal of Pain and Symptom Management 3906:Journal of Pain and Symptom Management 2922:Kelley AS, Morrison RS (August 2015). 2692:Journal of Pain and Symptom Management 1998: 1588:Journal of Pain and Symptom Management 1285:Journal of Pain and Symptom Management 1126:In 2016, an open letter to the singer 1111:. The film's executive producers were 529: 225:Palliative care vis-à-vis hospice care 199:important sector to pay attention to. 7722:Artificial intelligence in healthcare 7358: 6529: 5905:from the original on 28 December 2021 5875:from the original on 28 December 2021 5849:from the original on 28 December 2021 5398:"UK end-of-life care 'best in world'" 4981:Kar SS, Subitha L, Iswarya S (2015). 4450: 4323: 4150:Journal of Pediatric Oncology Nursing 4066:Journal of Pediatric Oncology Nursing 3834:. Geneva: World Health Organization. 3591:Faull C, Carter Y, Daniels L (2005). 2514:from the original on 20 February 2011 2044: 1959: 1563:from the original on 23 December 2019 1130:written by a palliative care doctor, 975:American Board of Medical Specialties 562: 374:European Society for Medical Oncology 215:American Society of Clinical Oncology 188:chronic obstructive pulmonary disease 7309: 7070:Physical medicine and rehabilitation 6457:BMJ Supportive & Palliative Care 6078:BMJ Supportive & Palliative Care 5652:BMJ Supportive & Palliative Care 4309:10.1001/archpedi.1995.02170220057008 2484:from the original on 11 January 2012 1833:Journal of General Internal Medicine 1763:from the original on 27 October 2020 343:for the terminally ill in 1967, and 275: 263:Outside the United States, the term 7319: 5191:ABMS Guide to Physician Specialties 4578:Mack JW, Grier HE (February 2004). 4381:. 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WHO technical report series;965. 1642:from the original on 3 August 2019 25: 7900: 7824:(Category Health care by country) 6514:to help reach a consensus. › 6493: 5819:from the original on 26 June 2020 5578:from the original on 23 June 2022 5386:from the original on 17 June 2020 5216:Indian Journal of Palliative Care 2705:10.1016/j.jpainsymman.2003.07.003 2091:from the original on 29 June 2021 1980:from the original on 21 June 2020 1601:10.1016/j.jpainsymman.2018.09.008 1507:Indian Journal of Palliative Care 1326:Indian Journal of Palliative Care 1014:Hospice care in the United States 815:How do you like to be thought of? 674:Identify the place of treatment ( 569:Edmonton Symptom Assessment Scale 235:Hospice care in the United States 7861: 7836: 7835: 7338: 7328: 7318: 7308: 7299: 7298: 6444: 6403: 6352: 6318: 6267: 6233: 6209:10.1136/archdischild-2020-319700 6197:Archives of Disease in Childhood 6184: 6068: 6034: 5951: 5917: 5887: 5861: 5831: 5801: 5771: 5730: 5718:from the original on 5 July 2022 5684: 5544: 5495: 5458: 5449: 5420: 5368: 5342: 5307: 5280: 5254: 5203: 5183: 5163: 5145: 5098: 4839:from the original on 4 July 2020 4656:Research in Nursing & Health 4549:10.1136/archdischild-2020-319544 3902:"The symptoms of dying children" 3673:10.1097/00132586-198808000-00042 3626:Research in Nursing & Health 2816:from the original on 5 June 2020 1759:. American Medical Association. 1482:from the original on 5 July 2020 571:(ESAS), which consists of eight 484: 347:who published her seminal work " 280: 254:health maintenance organizations 7384: 7339: 5380:The Economist Intelligence Unit 5041: 5025:. 3 August 2023. Archived from 5015: 4974: 4925: 4876: 4851: 4821: 4780: 4731: 4682: 4647: 4612: 4571: 4521: 4487: 4220: 4141: 4100: 4057: 4013: 3969: 3934: 3893: 3866: 3819: 3778: 3763: 3720: 3687: 3652: 3617: 3464: 3425: 3376: 3327: 3278: 3247: 3206: 3145: 3131:10.1016/j.socscimed.2005.11.055 3110: 3061: 2964: 2828: 2798: 2737: 2720: 2679: 2578: 2496: 2445: 2436: 2426: 2377: 2328: 2279: 2230: 2189: 2146: 2103: 2073: 1992: 1894: 1869: 1820: 1775: 1749: 1698: 1676:10.1136/practneurol-2012-000263 1654: 1624: 945:hospice and palliative medicine 936:Internal Medical Training (IMT) 885: 514: 397:Hospice and palliative medicine 231:Hospice and palliative medicine 7533:Academic health science centre 7196:Doctor of Osteopathic Medicine 6630:Oral and maxillofacial surgery 5508:Journal of Palliative Medicine 5475:University of California Press 5316:Journal of Palliative Medicine 5111:Journal of Palliative Medicine 5054:Journal of Religion and Health 4695:Journal of Palliative Medicine 4186:Journal of Behavioral Medicine 3772:American Academy of Pediatrics 3489:10.1002/14651858.CD006274.pub3 3446:10.1002/14651858.CD006273.pub4 3401:10.1002/14651858.CD006938.pub3 3352:10.1002/14651858.CD006271.pub3 3303:10.1002/14651858.CD009420.pub3 3264:10.1002/14651858.CD007544.pub2 3170:Journal of Palliative Medicine 3074:Journal of Palliative Medicine 2989:10.1002/14651858.CD004596.pub3 2655:10.1002/14651858.CD009231.pub3 2603:10.1002/14651858.CD012780.pub2 2554:10.1002/14651858.CD007132.pub2 2304:10.1002/14651858.CD007760.pub2 1784:Journal of Palliative Medicine 1468: 1364: 1239: 1008:Regional variation in services 852:Supporting emotional distress. 801:meaning-centered psychotherapy 476:In the 1960s, hospice pioneer 96:Doctor of Osteopathic medicine 13: 1: 7770:Health information management 7755:health information technology 7493:Health information management 6499: 6466:10.1136/bmjspcare-2021-003066 6090:10.1136/bmjspcare-2020-002676 5661:10.1136/bmjspcare-2021-003066 4352:10.1634/theoncologist.5-4-302 4162:10.1016/S1043-4542(97)90054-0 4126:10.1016/S0885-3924(00)00127-5 4042:10.1016/S0885-3924(03)00285-9 3919:10.1016/S0885-3924(03)00202-1 3887:10.1016/S0084-3954(08)70519-0 3119:Social Science & Medicine 2202:Archives of Internal Medicine 2059:10.1016/S1470-2045(07)70138-9 1970:"Hospice Facts & Figures" 1432:Annals of Behavioral Medicine 1298:10.1016/S0885-3924(02)00440-2 1204: 894: 506:Psychosocial pain and anxiety 447:Distress in cancer caregiving 127:(derived from the Latin root 33:Palliative medicine physician 7745:Translational bioinformatics 7176:Bachelor of Medical Sciences 6943:Neurosurgical anesthesiology 6555: 4621:Journal of Clinical Oncology 4584:Journal of Clinical Oncology 3955:10.1016/0887-8994(93)90080-V 2215:10.1001/archinte.168.16.1783 2013:10.1080/10410236.2011.527626 1199:Health Insurance Innovations 1154:Research funded by the UK's 954:Caregivers, both family and 7: 7775:Consumer health informatics 6137:10.1136/bmjopen-2014-005331 3804:10.1056/NEJM200002033420506 3593:Handbook of palliative care 3039:10.11124/JBISRIR-D-19-00286 1935:Handbook of Palliative Care 1177: 1149: 1092: 995:Royal College of Physicians 818:What are you most proud of? 431:Pain, distress, and anxiety 408:Practice of palliative care 303:, discuss the issue on the 10: 7905: 6293:10.1186/s12904-020-00649-3 5066:10.1007/s10943-022-01498-5 4078:10.1177/104345429200900238 3559:10.1177/082585979100700202 3547:Journal of Palliative Care 2124:10.1177/104990910302000410 1943:10.1002/9780470755877.ch15 1724:10.4103/jfmpc.jfmpc_399_22 1171:electronic patient records 1034:access to end of life care 1011: 870: 614: 444: 434: 411: 271: 228: 207:professional organizations 7831: 7785: 7765:Public health informatics 7701: 7678:Electronic health records 7648: 7612: 7556: 7548:Supervised injection site 7501: 7488:Allied health professions 7455: 7392: 7294: 7216: 7154: 6915: 6843: 6798: 6707: 6578: 6563: 6459:: bmjspcare–2021–003066. 6378:10.1186/s12904-020-0537-z 6084:: bmjspcare–2020–002676. 6010:10.1177/02692163211037480 5743:Canadian Family Physician 5615:10.1177/02692163211037480 3827:World Health Organization 2255:10.1377/hlthaff.2012.0851 2155:Supportive Care in Cancer 1845:10.1007/s11606-012-2204-4 1223:Primer of Palliative Care 1160:Gypsy, Traveller and Roma 867:Geriatric palliative care 611:Pediatric palliative care 370:World Health Organization 341:St. Christopher's Hospice 143:World Health Organization 104: 71: 66: 54: 42: 37: 7130:Transplantation medicine 7021:Clinical neurophysiology 6938:Obstetric anesthesiology 6858:Interventional radiology 6618:Digestive system surgery 6512:templates for discussion 5937:10.3310/collection_49245 5229:10.4103/0973-1075.105693 5176:16 November 2010 at the 5000:10.4103/0019-509x.175578 4987:Indian Journal of Cancer 4756:10.1001/jama.300.14.1665 3729:European Journal of Pain 2504:"Palliative Medications" 1520:10.4103/0973-1075.105683 1339:10.4103/0973-1075.105683 163: 7713:Medical image computing 7663:Artificial intelligence 7001:Intensive care medicine 6975:Mass gathering medicine 6820:Maternal–fetal medicine 6517:Palliative Care Nursing 5105:Kinzbrunner BM (2004). 4938:Mayo Clinic Proceedings 4895:(12 Suppl): 3540–3547. 4806:10.1542/peds.2013-3608E 4633:10.1200/JCO.2005.04.010 4597:10.1200/JCO.2004.04.078 4249:Levetown M (May 2008). 4198:10.1023/a:1018779908502 2890:10.1111/1754-9485.13073 1392:10.1001/jama.2016.16840 1121:Shoshana R. Ungerleider 1026:National Health Service 729:complementary therapies 678:versus local hospital, 554:Hydration and nutrition 361:Saint Boniface Hospital 7750:Translational medicine 6593:Cardiothoracic surgery 5328:10.1089/jpm.2005.8.107 5123:10.1089/jpm.2004.7.558 4465:10.1188/04.ONF.927-934 4453:Oncology Nursing Forum 4268:10.1542/peds.2008-0565 3991:10.1542/peds.2007-2681 3875:Yearbook of Pediatrics 3741:10.1053/eujp.1999.0118 3638:10.1002/nur.4770120506 3027:JBI Evidence Synthesis 1132:Professor Mark Taubert 979:osteopathic physicians 691:hypothesized diagnosis 372:and accredited by the 129: 7739:Computational biology 7640:Universal precautions 7244:Personalized medicine 7103:Reproductive medicine 7028:Occupational medicine 6982:Evolutionary medicine 5520:10.1089/jpm.2011.0234 5465:Lynn, Joanne (2004). 4950:10.4065/mcp.2009.0232 4707:10.1089/jpm.2009.0175 4377:Chochinov HM (2012). 3182:10.1089/jpm.2013.0569 3086:10.1089/jpm.2014.9427 2940:10.1056/nejmra1404684 2854:10.1056/NEJMra1411746 2403:10.1056/NEJMoa1000678 2354:10.1056/NEJMoa1000678 1796:10.1089/jpm.2012.0317 1040:Acceptance and access 412:Further information: 345:Elisabeth Kübler-Ross 7733:Behavior informatics 7264:Traditional medicine 7224:Alternative medicine 7091:Addiction psychiatry 6905:Transfusion medicine 6900:Medical microbiology 6815:Gynecologic oncology 6667:Reproductive surgery 5558:. 28 February 2022. 5196:31 July 2017 at the 4829:"John Hausdorff, MD" 4799:(Suppl 1): S24–S30. 3528:31 July 2017 at the 2047:The Lancet. Oncology 2001:Health Communication 1877:"History of Hospice" 1221:Zhukovsky D (2019). 1140:Benedict Cumberbatch 725:occupational therapy 573:visual analog scales 351:" in 1969. In 1974, 301:improve this section 174:to people receiving 88:(e.g. MBBS or MBChB) 7717:imaging informatics 7625:Cultural competence 7286:History of medicine 7269:Veterinary medicine 7076:Preventive medicine 6928:Adolescent medicine 6770:Infectious diseases 6365:BMC Palliative Care 6338:10.3310/alert_41179 6280:BMC Palliative Care 6253:10.3310/alert_46494 6170:10.3310/alert_46991 6054:10.3310/alert_48747 5998:Palliative Medicine 5971:10.3310/alert_49015 5871:. 18 January 2016. 5845:. 16 January 2016. 5603:Palliative Medicine 5564:10.3310/alert_49015 4507:10.3310/alert_45227 4413:Cassell EJ (2004). 3943:Pediatric Neurology 2770:The Ochsner Journal 1664:Practical Neurology 1166:or deprived areas. 949:catastrophic injury 713:distraction therapy 680:intensive care unit 659:Perform a thorough 605:shortness of breath 530:Nausea and vomiting 213:. For example, the 34: 7703:Health informatics 7478:Healthcare science 7234:Molecular oncology 7191:Doctor of Medicine 7181:Master of Medicine 7098:Radiation oncology 6970:Emergency medicine 6923:Addiction medicine 6890:Clinical chemistry 6885:Clinical pathology 6677:Transplant surgery 6635:Orthopedic surgery 6613:Colorectal surgery 6423:10.3310/post_50369 6159:; Lay summary in: 5815:. 29 August 2018. 5704:10.3310/post_50369 5404:. 6 October 2015. 5382:. 6 October 2015. 4901:10.1002/cncr.23946 4833:pub.hematology.org 4580:"The Day One Talk" 4261:(5): e1441–e1460. 4233:10.1037/t54487-000 3985:(5): e1301–e1309. 2470:10.1007/bf03256842 2167:10.1007/bf01788838 1444:10.1093/abm/kay077 1189:Health care reform 1146:at public events. 1113:Steven Ungerleider 1075:mental health care 918:nursing assistants 812:What inspires you? 563:Symptom assessment 466:relaxation therapy 349:On Death and Dying 192:multiple sclerosis 150:curative treatment 80:Doctor of Medicine 73:Education required 32: 7849: 7848: 7613:Skills / training 7537:Teaching hospital 7352: 7351: 7186:Master of Surgery 7150: 7149: 7135:Tropical medicine 7081:Prison healthcare 6996:Hospital medicine 6960:Disaster medicine 6950:Aviation medicine 6765:Hospital medicine 6672:Surgical oncology 6657:Pediatric surgery 6651: 6598:Endocrine surgery 6004:(10): 1747–1760. 5698:. 26 April 2022. 5609:(10): 1747–1760. 5488:978-0-520-24300-2 5268:on 13 August 2015 4869:978-0-19-027568-6 4750:(14): 1665–1673. 4701:(12): 1113–1117. 4668:10.1002/nur.20130 4627:(36): 9155–9161. 4388:978-0-19-517621-6 3851:978-92-4-120965-6 3705:978-0-7817-2644-3 3667:(21): 1321–1329. 3602:978-0-470-75587-7 3232:10.1111/nuf.12128 3033:(11): 2196–2230. 2847:(26): 2549–2561. 2208:(16): 1783–1790. 1952:978-0-470-75587-7 1386:(20): 2104–2114. 1257:on 4 October 2003 1232:978-1-889296-08-1 1164:ethnic minorities 333: 332: 325: 204:medical specialty 196:neurodegenerative 122: 121: 16:(Redirected from 7896: 7866: 7865: 7864: 7857: 7839: 7838: 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3775: 3767: 3761: 3760: 3724: 3718: 3717: 3691: 3685: 3684: 3656: 3650: 3649: 3621: 3615: 3614: 3588: 3579: 3578: 3542: 3533: 3520: 3511: 3510: 3500: 3468: 3462: 3461: 3452: 10720602. 3440:(12): CD006273. 3429: 3423: 3422: 3412: 3395:(11): CD006938. 3380: 3374: 3373: 3363: 3346:(11): CD006271. 3331: 3325: 3324: 3314: 3297:(11): CD009420. 3282: 3276: 3275: 3251: 3245: 3244: 3234: 3210: 3204: 3203: 3193: 3161: 3152: 3149: 3143: 3142: 3114: 3108: 3107: 3097: 3065: 3059: 3058: 3022: 3011: 3010: 3000: 2968: 2962: 2961: 2951: 2919: 2910: 2909: 2873: 2867: 2866: 2856: 2832: 2826: 2825: 2823: 2821: 2802: 2796: 2795: 2785: 2761: 2750: 2749: 2741: 2735: 2724: 2718: 2717: 2707: 2683: 2677: 2676: 2666: 2634: 2625: 2624: 2614: 2582: 2576: 2575: 2565: 2533: 2524: 2523: 2521: 2519: 2500: 2494: 2493: 2491: 2489: 2449: 2443: 2440: 2434: 2430: 2424: 2423: 2405: 2381: 2375: 2374: 2356: 2332: 2326: 2325: 2315: 2283: 2277: 2276: 2266: 2234: 2228: 2227: 2217: 2193: 2187: 2186: 2150: 2144: 2143: 2107: 2101: 2100: 2098: 2096: 2077: 2071: 2070: 2042: 2033: 2032: 1996: 1990: 1989: 1987: 1985: 1966: 1957: 1956: 1930: 1917: 1916: 1914: 1912: 1898: 1892: 1891: 1889: 1887: 1873: 1867: 1866: 1856: 1824: 1818: 1817: 1807: 1779: 1773: 1772: 1770: 1768: 1753: 1747: 1746: 1736: 1726: 1717:(9): 4913–4918. 1702: 1696: 1695: 1658: 1652: 1651: 1649: 1647: 1628: 1622: 1621: 1603: 1579: 1573: 1572: 1570: 1568: 1552: 1543: 1542: 1532: 1522: 1498: 1492: 1491: 1489: 1487: 1472: 1466: 1465: 1455: 1423: 1414: 1413: 1403: 1368: 1362: 1361: 1351: 1341: 1317: 1311: 1310: 1300: 1276: 1267: 1266: 1264: 1262: 1253:. Archived from 1243: 1237: 1236: 1218: 1194:Health insurance 1083:end of life care 859:SPIKE framework. 721:physical therapy 654:clinical history 603:, and sometimes 414:End-of-life care 401:Joint Commission 365:Cleveland Clinic 328: 321: 317: 314: 308: 284: 283: 276: 258:private insurers 176:end-of-life care 154:end-of-life care 132: 56:Activity sectors 35: 31: 21: 7904: 7903: 7899: 7898: 7897: 7895: 7894: 7893: 7884:Palliative care 7874: 7873: 7872: 7862: 7860: 7852: 7850: 7845: 7827: 7781: 7780: 7779: 7697: 7644: 7608: 7584:Overutilization 7552: 7543:Pharmacy school 7509:Assisted living 7497: 7451: 7388: 7383: 7353: 7348: 7290: 7279:Chief physician 7212: 7157: 7146: 7140:Travel medicine 7125:Sports medicine 7108:Sexual medicine 7048:Palliative care 7043:Pain management 6987:Family medicine 6965:Diving medicine 6911: 6839: 6801: 6794: 6710: 6703: 6662:Plastic surgery 6608:General surgery 6588:Cardiac surgery 6569: 6567: 6559: 6554: 6515: 6496: 6491: 6490: 6449: 6445: 6435: 6433: 6409: 6408: 6404: 6357: 6353: 6324: 6323: 6319: 6272: 6268: 6239: 6238: 6234: 6189: 6185: 6160: 6117: 6113: 6073: 6069: 6040: 6039: 6035: 5990: 5986: 5957: 5956: 5952: 5923: 5922: 5918: 5908: 5906: 5901:. 6 June 2016. 5893: 5892: 5888: 5878: 5876: 5867: 5866: 5862: 5852: 5850: 5837: 5836: 5832: 5822: 5820: 5807: 5806: 5802: 5792: 5790: 5777: 5776: 5772: 5749:(12): 906–908. 5735: 5731: 5721: 5719: 5690: 5689: 5685: 5644: 5640: 5595: 5591: 5581: 5579: 5550: 5549: 5545: 5500: 5496: 5489: 5463: 5459: 5454: 5450: 5440: 5438: 5430: 5426: 5425: 5421: 5411: 5409: 5396: 5389: 5387: 5374: 5373: 5369: 5359: 5357: 5348: 5347: 5343: 5312: 5308: 5298: 5296: 5285: 5281: 5271: 5269: 5260: 5259: 5255: 5208: 5204: 5198:Wayback Machine 5188: 5184: 5178:Wayback Machine 5168: 5164: 5151: 5150: 5146: 5103: 5099: 5046: 5042: 5032: 5030: 5021: 5020: 5016: 4979: 4975: 4930: 4926: 4881: 4877: 4870: 4856: 4852: 4842: 4840: 4835:. 1 July 2017. 4827: 4826: 4822: 4785: 4781: 4736: 4732: 4687: 4683: 4652: 4648: 4617: 4613: 4576: 4572: 4532: 4526: 4522: 4493: 4492: 4488: 4449: 4440: 4425: 4411: 4404: 4389: 4375: 4368: 4331: 4324: 4293: 4284: 4247: 4240: 4225: 4221: 4181: 4177: 4146: 4142: 4105: 4101: 4062: 4058: 4018: 4014: 3974: 3970: 3939: 3935: 3898: 3894: 3871: 3867: 3852: 3824: 3820: 3783: 3779: 3768: 3764: 3725: 3721: 3706: 3692: 3688: 3657: 3653: 3622: 3618: 3603: 3589: 3582: 3543: 3536: 3530:Wayback Machine 3521: 3514: 3483:(4): CD006274. 3469: 3465: 3430: 3426: 3381: 3377: 3332: 3328: 3283: 3279: 3258:(5): CD007544. 3252: 3248: 3211: 3207: 3162: 3155: 3150: 3146: 3115: 3111: 3066: 3062: 3023: 3014: 2983:(6): CD004596. 2969: 2965: 2920: 2913: 2874: 2870: 2833: 2829: 2819: 2817: 2810:medlineplus.gov 2804: 2803: 2799: 2762: 2753: 2742: 2738: 2725: 2721: 2684: 2680: 2649:(3): CD009231. 2635: 2628: 2597:(9): CD012780. 2583: 2579: 2548:(3): CD007132. 2534: 2527: 2517: 2515: 2502: 2501: 2497: 2487: 2485: 2450: 2446: 2441: 2437: 2431: 2427: 2382: 2378: 2333: 2329: 2298:(6): CD007760. 2284: 2280: 2235: 2231: 2194: 2190: 2151: 2147: 2108: 2104: 2094: 2092: 2087:. 29 May 2019. 2079: 2078: 2074: 2043: 2036: 1997: 1993: 1983: 1981: 1968: 1967: 1960: 1953: 1931: 1920: 1910: 1908: 1900: 1899: 1895: 1885: 1883: 1875: 1874: 1870: 1825: 1821: 1780: 1776: 1766: 1764: 1755: 1754: 1750: 1703: 1699: 1659: 1655: 1645: 1643: 1636:medlineplus.gov 1630: 1629: 1625: 1580: 1576: 1566: 1564: 1553: 1546: 1499: 1495: 1485: 1483: 1474: 1473: 1469: 1424: 1417: 1369: 1365: 1318: 1314: 1277: 1270: 1260: 1258: 1245: 1244: 1240: 1233: 1219: 1212: 1207: 1184:Health Advocate 1180: 1152: 1142:and the singer 1095: 1042: 1016: 1010: 902: 897: 888: 879: 869: 797:dignity therapy 761: 665:painful stimuli 644: 623: 613: 599:, sensation of 565: 556: 540:levomepromazine 532: 517: 508: 487: 478:Cicely Saunders 449: 443: 433: 416: 410: 337:Cicely Saunders 329: 318: 312: 309: 298: 285: 281: 274: 237: 227: 166: 135:quality of life 125:Palliative care 109: 107: 74: 57: 45: 44:Occupation type 28: 23: 22: 15: 12: 11: 5: 7902: 7892: 7891: 7886: 7871: 7870: 7847: 7846: 7844: 7843: 7832: 7829: 7828: 7826: 7821: 7816: 7811: 7806: 7804:United Kingdom 7801: 7800: 7799: 7789: 7787: 7783: 7782: 7778: 7777: 7772: 7767: 7762: 7757: 7752: 7747: 7742: 7736: 7730: 7724: 7719: 7709: 7708: 7707: 7705: 7699: 7698: 7696: 7695: 7690: 7685: 7680: 7675: 7673:Digital health 7670: 7665: 7660: 7658:3D bioprinting 7654: 7652: 7646: 7645: 7643: 7642: 7637: 7632: 7627: 7622: 7620:Bedside manner 7616: 7614: 7610: 7609: 7607: 7606: 7601: 7596: 7591: 7586: 7581: 7576: 7571: 7566: 7560: 7558: 7554: 7553: 7551: 7550: 7545: 7540: 7529:Medical school 7526: 7521: 7516: 7511: 7505: 7503: 7499: 7498: 7496: 7495: 7490: 7485: 7480: 7475: 7470: 7465: 7459: 7457: 7453: 7452: 7450: 7449: 7444: 7439: 7434: 7429: 7424: 7419: 7414: 7409: 7404: 7399: 7393: 7390: 7389: 7382: 7381: 7374: 7367: 7359: 7350: 7349: 7347: 7346: 7336: 7326: 7316: 7306: 7295: 7292: 7291: 7289: 7288: 7283: 7282: 7281: 7271: 7266: 7261: 7256: 7251: 7246: 7241: 7236: 7231: 7226: 7220: 7218: 7217:Related topics 7214: 7213: 7211: 7210: 7209: 7208: 7198: 7193: 7188: 7183: 7178: 7173: 7168: 7166:Medical school 7162: 7160: 7152: 7151: 7148: 7147: 7145: 7144: 7143: 7142: 7132: 7127: 7122: 7120:Sleep medicine 7117: 7116: 7115: 7105: 7100: 7095: 7094: 7093: 7083: 7078: 7073: 7067: 7062: 7061: 7060: 7050: 7045: 7040: 7035: 7030: 7025: 7024: 7023: 7013: 7008: 7003: 6998: 6993: 6984: 6979: 6978: 6977: 6967: 6962: 6957: 6952: 6947: 6946: 6945: 6940: 6933:Anesthesiology 6930: 6925: 6919: 6917: 6913: 6912: 6910: 6909: 6908: 6907: 6902: 6897: 6892: 6887: 6882: 6872: 6871: 6870: 6865: 6863:Neuroradiology 6860: 6849: 6847: 6841: 6840: 6838: 6837: 6832: 6827: 6822: 6817: 6812: 6806: 6804: 6800:Obstetrics and 6796: 6795: 6793: 6792: 6787: 6782: 6777: 6772: 6767: 6762: 6757: 6752: 6751: 6750: 6740: 6735: 6730: 6725: 6715: 6713: 6705: 6704: 6702: 6701: 6696: 6695: 6694: 6684: 6682:Trauma surgery 6679: 6674: 6669: 6664: 6659: 6654: 6653: 6652: 6645:Otolaryngology 6642: 6637: 6632: 6627: 6622: 6621: 6620: 6615: 6605: 6600: 6595: 6590: 6584: 6582: 6573: 6571:subspecialties 6561: 6560: 6553: 6552: 6545: 6538: 6530: 6524: 6523: 6495: 6494:External links 6492: 6489: 6488: 6443: 6402: 6351: 6317: 6266: 6232: 6203:(8): 780–785. 6183: 6131:(8): e005331. 6111: 6067: 6033: 5984: 5950: 5916: 5886: 5860: 5830: 5800: 5785:. 7 May 2018. 5770: 5729: 5683: 5638: 5589: 5543: 5514:(3): 334–339. 5494: 5487: 5457: 5448: 5419: 5367: 5341: 5322:(1): 107–114. 5306: 5279: 5253: 5222:(3): 213–218. 5202: 5182: 5162: 5144: 5117:(4): 558–573. 5097: 5040: 5014: 4973: 4924: 4875: 4868: 4850: 4820: 4779: 4730: 4681: 4662:(3): 223–232. 4646: 4611: 4590:(3): 563–566. 4570: 4543:(2): 184–188. 4520: 4486: 4459:(5): 927–934. 4438: 4423: 4402: 4387: 4366: 4345:(4): 302–311. 4339:The Oncologist 4322: 4303:(9): 991–997. 4282: 4238: 4219: 4192:(2): 179–204. 4175: 4156:(3): 178–185. 4140: 4119:(5): 363–377. 4099: 4056: 4035:(3): 800–817. 4012: 3968: 3949:(3): 165–177. 3933: 3912:(1): 594–603. 3892: 3865: 3850: 3818: 3797:(5): 326–333. 3777: 3762: 3735:(2): 165–176. 3719: 3704: 3686: 3651: 3632:(5): 307–314. 3616: 3601: 3580: 3534: 3512: 3463: 3424: 3375: 3326: 3277: 3246: 3205: 3176:(5): 592–600. 3153: 3144: 3125:(1): 151–164. 3109: 3080:(6): 642–656. 3060: 3012: 2963: 2934:(8): 747–755. 2911: 2884:(4): 570–579. 2868: 2827: 2797: 2776:(4): 348–352. 2751: 2746:Nursing Mirror 2736: 2719: 2698:(3): 241–250. 2678: 2626: 2577: 2525: 2495: 2444: 2435: 2425: 2396:(8): 733–742. 2376: 2347:(8): 733–742. 2327: 2278: 2249:(3): 552–561. 2243:Health Affairs 2229: 2188: 2161:(5): 329–333. 2145: 2118:(4): 279–289. 2102: 2072: 2053:(5): 430–438. 2034: 1991: 1958: 1951: 1918: 1893: 1868: 1839:(4): 570–577. 1819: 1805:2027.42/140114 1790:(4): 436–445. 1774: 1748: 1697: 1670:(4): 244–248. 1653: 1623: 1594:(6): 831–870. 1574: 1544: 1513:(3): 149–154. 1493: 1467: 1438:(7): 674–685. 1415: 1372:Kavalieratos D 1363: 1332:(3): 149–154. 1312: 1268: 1238: 1231: 1209: 1208: 1206: 1203: 1202: 1201: 1196: 1191: 1186: 1179: 1176: 1151: 1148: 1117:David C. Ulich 1094: 1091: 1059:mental illness 1041: 1038: 1009: 1006: 991:United Kingdom 941: 940: 937: 922:social workers 901: 898: 896: 893: 887: 884: 868: 865: 864: 863: 856: 849: 841: 840: 833: 832: 831: 828: 825: 822: 819: 816: 813: 810: 807: 789: 777: 760: 757: 744: 743: 740: 737: 701: 694: 687: 672: 657: 643: 640: 612: 609: 564: 561: 555: 552: 531: 528: 516: 513: 507: 504: 486: 483: 432: 429: 409: 406: 393: 392: 388: 385: 357:Paul Henteleff 339:, who founded 331: 330: 295:of the subject 293:worldwide view 288: 286: 279: 273: 270: 226: 223: 165: 162: 120: 119: 110: 105: 102: 101: 100: 99: 92: 89: 83: 75: 72: 69: 68: 64: 63: 58: 55: 52: 51: 46: 43: 40: 39: 26: 9: 6: 4: 3: 2: 7901: 7890: 7887: 7885: 7882: 7881: 7879: 7869: 7859: 7858: 7855: 7842: 7834: 7833: 7830: 7825: 7822: 7820: 7817: 7815: 7812: 7810: 7807: 7805: 7802: 7798: 7795: 7794: 7793: 7792:United States 7790: 7788: 7784: 7776: 7773: 7771: 7768: 7766: 7763: 7761: 7758: 7756: 7753: 7751: 7748: 7746: 7743: 7741:in healthcare 7740: 7737: 7735:in healthcare 7734: 7731: 7729:in healthcare 7728: 7725: 7723: 7720: 7718: 7714: 7711: 7710: 7706: 7704: 7700: 7694: 7691: 7689: 7686: 7684: 7681: 7679: 7676: 7674: 7671: 7669: 7666: 7664: 7661: 7659: 7656: 7655: 7653: 7651: 7647: 7641: 7638: 7636: 7633: 7631: 7628: 7626: 7623: 7621: 7618: 7617: 7615: 7611: 7605: 7602: 7600: 7597: 7595: 7592: 7590: 7587: 7585: 7582: 7580: 7577: 7575: 7572: 7570: 7567: 7565: 7562: 7561: 7559: 7555: 7549: 7546: 7544: 7541: 7538: 7534: 7530: 7527: 7525: 7522: 7520: 7517: 7515: 7512: 7510: 7507: 7506: 7504: 7500: 7494: 7491: 7489: 7486: 7484: 7481: 7479: 7476: 7474: 7471: 7469: 7466: 7464: 7461: 7460: 7458: 7454: 7448: 7445: 7443: 7440: 7438: 7435: 7433: 7430: 7428: 7425: 7423: 7420: 7418: 7415: 7413: 7410: 7408: 7405: 7403: 7400: 7398: 7395: 7394: 7391: 7387: 7380: 7375: 7373: 7368: 7366: 7361: 7360: 7357: 7345: 7337: 7335: 7331: 7327: 7325: 7317: 7315: 7307: 7305: 7297: 7296: 7293: 7287: 7284: 7280: 7277: 7276: 7275: 7272: 7270: 7267: 7265: 7262: 7260: 7257: 7255: 7252: 7250: 7249:Public health 7247: 7245: 7242: 7240: 7237: 7235: 7232: 7230: 7229:Allied health 7227: 7225: 7222: 7221: 7219: 7215: 7207: 7204: 7203: 7202: 7199: 7197: 7194: 7192: 7189: 7187: 7184: 7182: 7179: 7177: 7174: 7172: 7169: 7167: 7164: 7163: 7161: 7159: 7153: 7141: 7138: 7137: 7136: 7133: 7131: 7128: 7126: 7123: 7121: 7118: 7114: 7111: 7110: 7109: 7106: 7104: 7101: 7099: 7096: 7092: 7089: 7088: 7087: 7084: 7082: 7079: 7077: 7074: 7071: 7068: 7066: 7063: 7059: 7056: 7055: 7054: 7051: 7049: 7046: 7044: 7041: 7039: 7038:Oral medicine 7036: 7034: 7033:Ophthalmology 7031: 7029: 7026: 7022: 7019: 7018: 7017: 7014: 7012: 7009: 7007: 7004: 7002: 6999: 6997: 6994: 6992: 6988: 6985: 6983: 6980: 6976: 6973: 6972: 6971: 6968: 6966: 6963: 6961: 6958: 6956: 6953: 6951: 6948: 6944: 6941: 6939: 6936: 6935: 6934: 6931: 6929: 6926: 6924: 6921: 6920: 6918: 6914: 6906: 6903: 6901: 6898: 6896: 6895:Cytopathology 6893: 6891: 6888: 6886: 6883: 6881: 6878: 6877: 6876: 6873: 6869: 6866: 6864: 6861: 6859: 6856: 6855: 6854: 6851: 6850: 6848: 6846: 6842: 6836: 6835:Urogynecology 6833: 6831: 6828: 6826: 6823: 6821: 6818: 6816: 6813: 6811: 6808: 6807: 6805: 6803: 6797: 6791: 6788: 6786: 6783: 6781: 6778: 6776: 6773: 6771: 6768: 6766: 6763: 6761: 6758: 6756: 6753: 6749: 6746: 6745: 6744: 6741: 6739: 6738:Endocrinology 6736: 6734: 6731: 6729: 6726: 6724: 6720: 6717: 6716: 6714: 6712: 6706: 6700: 6697: 6693: 6690: 6689: 6688: 6685: 6683: 6680: 6678: 6675: 6673: 6670: 6668: 6665: 6663: 6660: 6658: 6655: 6648: 6647: 6646: 6643: 6641: 6638: 6636: 6633: 6631: 6628: 6626: 6623: 6619: 6616: 6614: 6611: 6610: 6609: 6606: 6604: 6601: 6599: 6596: 6594: 6591: 6589: 6586: 6585: 6583: 6581: 6577: 6574: 6572: 6566: 6562: 6558: 6551: 6546: 6544: 6539: 6537: 6532: 6531: 6528: 6522: 6518: 6513: 6509: 6508: 6503: 6498: 6497: 6484: 6480: 6476: 6472: 6467: 6462: 6458: 6454: 6447: 6432: 6428: 6424: 6420: 6416: 6415:NIHR Evidence 6412: 6406: 6398: 6394: 6389: 6384: 6379: 6374: 6370: 6366: 6362: 6355: 6347: 6343: 6339: 6335: 6331: 6330:NIHR Evidence 6327: 6321: 6313: 6309: 6304: 6299: 6294: 6289: 6285: 6281: 6277: 6270: 6262: 6258: 6254: 6250: 6246: 6245:NIHR Evidence 6242: 6236: 6228: 6224: 6219: 6214: 6210: 6206: 6202: 6198: 6194: 6187: 6179: 6175: 6171: 6167: 6163: 6156: 6152: 6147: 6142: 6138: 6134: 6130: 6126: 6122: 6115: 6107: 6103: 6099: 6095: 6091: 6087: 6083: 6079: 6071: 6063: 6059: 6055: 6051: 6047: 6046:NIHR Evidence 6043: 6037: 6029: 6025: 6020: 6015: 6011: 6007: 6003: 5999: 5995: 5988: 5980: 5976: 5972: 5968: 5964: 5963:NIHR Evidence 5960: 5954: 5946: 5942: 5938: 5934: 5930: 5929:NIHR Evidence 5926: 5920: 5904: 5900: 5896: 5890: 5874: 5870: 5864: 5848: 5844: 5840: 5834: 5818: 5814: 5810: 5804: 5788: 5784: 5780: 5774: 5766: 5762: 5757: 5752: 5748: 5744: 5740: 5733: 5717: 5713: 5709: 5705: 5701: 5697: 5696:NIHR Evidence 5693: 5687: 5679: 5675: 5671: 5667: 5662: 5657: 5653: 5649: 5642: 5634: 5630: 5625: 5620: 5616: 5612: 5608: 5604: 5600: 5593: 5577: 5573: 5569: 5565: 5561: 5557: 5556:NIHR Evidence 5553: 5547: 5539: 5535: 5530: 5525: 5521: 5517: 5513: 5509: 5505: 5498: 5490: 5484: 5480: 5476: 5471: 5470: 5461: 5452: 5436: 5429: 5423: 5407: 5403: 5399: 5385: 5381: 5377: 5371: 5355: 5351: 5345: 5337: 5333: 5329: 5325: 5321: 5317: 5310: 5294: 5291:. Aahpm.org. 5290: 5283: 5267: 5263: 5257: 5249: 5245: 5240: 5235: 5230: 5225: 5221: 5217: 5213: 5206: 5199: 5195: 5192: 5186: 5179: 5175: 5172: 5166: 5158: 5154: 5148: 5140: 5136: 5132: 5128: 5124: 5120: 5116: 5112: 5108: 5101: 5093: 5089: 5084: 5079: 5075: 5071: 5067: 5063: 5059: 5055: 5051: 5044: 5028: 5024: 5018: 5010: 5006: 5001: 4996: 4993:(1): 99–101. 4992: 4988: 4984: 4977: 4969: 4965: 4960: 4955: 4951: 4947: 4943: 4939: 4935: 4928: 4920: 4916: 4911: 4906: 4902: 4898: 4894: 4890: 4886: 4879: 4871: 4865: 4861: 4854: 4838: 4834: 4830: 4824: 4816: 4812: 4807: 4802: 4798: 4794: 4790: 4783: 4775: 4771: 4766: 4761: 4757: 4753: 4749: 4745: 4741: 4734: 4726: 4722: 4717: 4712: 4708: 4704: 4700: 4696: 4692: 4685: 4677: 4673: 4669: 4665: 4661: 4657: 4650: 4642: 4638: 4634: 4630: 4626: 4622: 4615: 4607: 4603: 4598: 4593: 4589: 4585: 4581: 4574: 4566: 4562: 4558: 4554: 4550: 4546: 4542: 4538: 4531: 4524: 4516: 4512: 4508: 4504: 4500: 4499:NIHR Evidence 4496: 4490: 4482: 4478: 4474: 4470: 4466: 4462: 4458: 4454: 4447: 4445: 4443: 4434: 4430: 4426: 4424:1-60256-743-3 4420: 4416: 4409: 4407: 4398: 4394: 4390: 4384: 4380: 4373: 4371: 4362: 4358: 4353: 4348: 4344: 4340: 4336: 4329: 4327: 4318: 4314: 4310: 4306: 4302: 4298: 4291: 4289: 4287: 4278: 4274: 4269: 4264: 4260: 4256: 4252: 4245: 4243: 4234: 4230: 4223: 4215: 4211: 4207: 4203: 4199: 4195: 4191: 4187: 4179: 4171: 4167: 4163: 4159: 4155: 4151: 4144: 4136: 4132: 4127: 4122: 4118: 4114: 4110: 4103: 4095: 4091: 4087: 4083: 4079: 4075: 4071: 4067: 4060: 4052: 4048: 4043: 4038: 4034: 4030: 4026: 4022: 4016: 4008: 4004: 4000: 3996: 3992: 3988: 3984: 3980: 3972: 3964: 3960: 3956: 3952: 3948: 3944: 3937: 3929: 3925: 3920: 3915: 3911: 3907: 3903: 3896: 3888: 3884: 3880: 3876: 3869: 3861: 3857: 3853: 3847: 3842: 3837: 3833: 3828: 3822: 3814: 3810: 3805: 3800: 3796: 3792: 3788: 3781: 3773: 3766: 3758: 3754: 3750: 3746: 3742: 3738: 3734: 3730: 3723: 3715: 3711: 3707: 3701: 3697: 3690: 3682: 3678: 3674: 3670: 3666: 3662: 3655: 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May 2021 4793:Pediatrics 4255:Pediatrics 3979:Pediatrics 3553:(2): 6–9. 2518:28 October 2085:The Walrus 2007:(1): 110. 1911:12 January 1886:12 January 1767:22 October 1261:4 December 1205:References 1051:euthanasia 1012:See also: 956:volunteers 906:physicians 895:In society 871:See also: 736:themselves 632:ambulatory 615:See also: 601:well-being 593:drowsiness 585:depression 548:droperidol 536:antiemetic 492:xerostomia 472:Total pain 445:See also: 435:See also: 229:See also: 194:and other 108:employment 94:(US only) 38:Occupation 18:Palliative 7814:Australia 7635:Education 7630:Diagnosis 7483:Dentistry 7427:Providers 7402:Equipment 7397:Economics 7274:Physician 7158:education 7016:Neurology 7011:Narcology 6875:Pathology 6853:Radiology 6728:Angiology 6692:Andrology 6483:245013480 6431:249936671 6371:(1): 66. 6346:242429298 6261:241904445 6178:242843746 6106:231992307 6062:245290694 5979:247180312 5945:247873633 5712:249936671 5678:245013480 5572:247180312 5412:8 October 5390:8 October 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