Palliative Care E-Book , livre ebook

Palliative Care
Core Skills and Clinical Competencies
Second Edition

Linda L. Emanuel, MD, PhD
Buehler Professor of Medicine, Director, Buehler Center on Aging, Health & Society Principal, The Education in Palliative and End-of-Life Care (EPEC) Project, Northwestern University Feinberg School of Medicine, Chicago, Illinois

S. Lawrence Librach, MD, CCFP, FCFP
W. Gifford-Jones Professor, Professor and Head, Division of Palliative Care Department of Family and Community Medicine University of Toronto; Director, Temmy Latner Centre for Palliative Care, Mount Sinai Hospital Toronto, Ontario, Canada
Saunders
Front Matter

Palliative Care
Core Skills and Clinical Competencies
SECOND EDITION
LINDA L. EMANUEL, MD, PhD
Buehler Professor of Medicine
Director, Buehler Center on Aging, Health & Society Principal, The Education in Palliative and End-of-life Care (EPEC) Project
Northwestern University Feinberg School of Medicine
Chicago, Illinois
S. LAWRENCE LIBRACH, MD, CCFP, FCFP
W. Gifford-Jones Professor
Professor and Head, Division of Palliative Care Department of Family and Community Medicine University of Toronto
Director, Temmy Latner Centre for Palliative Care
Mount Sinai Hospital Toronto, Ontario, Canada
Copyright
3251 Riverport Lane
St. Louis, Missouri 63043
PALLIATIVE CARE: CORE SKILLS AND CLINICAL COMPETENCIES EXPERT CONSULT ONLINE AND PRINT, SECOND EDITION ISBN: 978-1-4377-1619-1
Copyright © 2011, 2007 by Saunders, an imprint of Elsevier Inc.
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This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein).

Notices
Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein.
Library of Congress Cataloging-in-Publication Data
Palliative care : core skills and clinical competencies / [edited by] Linda L. Emanuel, S. Lawrence Librach. — 2nd ed.
p. ; cm.
“Expert consult online and print.”
Includes bibliographical references and index.
ISBN 978-1-4377-1619-1 (pbk.)
1. Palliative treatment. I. Emanuel, Linda L. II. Librach, S. Lawrence. [DNLM: 1. Palliative Care. 2. Clinical Competence. WB 310]
R726.8.P3427 2011
616′.029—dc22
2011006018
Acquisitions Editor: Pamela Hetherington
Developmental Editor: Jessica Pritchard
Publishing Services Manager: Anne Altepeter
Project Manager: Jessica Becher
Design Manager: Ellen Zanolle
Printed in the United States of America
Last digit is the print number: 9 8 7 6 5 4 3 2 1
Dedication


Courtesy St. Christopher’s Hospice, London, UK

“The last stages of life should not be seen as defeat, but rather as life’s fulfillment. It is not merely a time of negation but rather an opportunity for positive achievement. One of the ways we can help our patients most is to learn to believe and to expect this.”
Cicely Saunders, 1965–First published in American Journal of Nursing; republished in Cicely Saunders: selected writings by David Clark Oxford University Press, 2006
We dedicate this book to the memory of Dame Cicely Saunders. In its pages, we have sought to provide for the core skills that a clinician needs to make it possible for every man, woman, and child that, when dying is necessary, it becomes life’s fulfillment.
Linda L. Emanuel, S. Lawrence Librach
Contributors

Carla S. Alexander, MD, Assistant Professor of Medicine, Department of Medicine, University of Maryland School of Medicine, Institute of Human Virology, Baltimore, Maryland
HIV/AIDS

Wendy G. Anderson, MD, MS, Assistant Professor, Division of Hospital Medicine and Palliative Care Program, University of California, San Francisco, San Francisco, California
Withholding and Withdrawing Life-Sustaining Therapies

Peter Angelos, MD, PhD, Professor and Chief of Endocrine Surgery, Associate Director of the MacLean Center for Clinical Medical Ethics, Department of Surgery, University of Chicago, Chicago, Illinois
Principles of Palliative Surgery

Robert M. Arnold, MD, Professor of Medicine, Division of General Internal Medicine, Chief, Section of Palliative Care and Medical Ethics, Director, Institute for Doctor-Patient Communication, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania Leo H. Criep Chair in Patient Care, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
Withholding and Withdrawing Life-Sustaining Therapies

F. Amos Bailey, MD, Associate Professor Division of Geriatrics, Gerontology and Palliative Care, Internal Medicine, University of Alabama, Birmingham, AlabamaDirector, Safe Harbor Palliative Care Program, Internal Medicine, Birmingham VA Medical Center, Birmingham, Alabama, Veterans, Veterans Administration Health Care, and Palliative Care

Al B. Benson, III, MD, FACP, Professor of Medicine Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
Gastrointestinal Malignancies

Ann M. Berger, MD, MSN, Bethesda, Maryland
Nausea and Vomiting

Richard H. Bernstein, MD, FACP, Adjunct Associate Professor, Baruch/Mount Sinai MBA Program in Health Care Administration, Zicklin School of Business of the City University of New York, New York, New York Associate Professor of Clinical Medicine, Department of Medicine, Associate Professor of Clinical Preventive Medicine, Department of Preventive Medicine, The Mount Sinai School of Medicine, New York, New York Chief Medical Officer, VNSNY CHOICE Health Plan, Visiting Nurse Service of New York, New York, New York
Integrating Palliative Care Guidelines into Clinical Practice

Susan Blacker, MSW, Adjunct Lecturer, Division of Palliative Care, Department of Family and Community Medicine, University of Toronto Director, Cancer Services Planning & Performance, St. Michael’s Hospital, Toronto, Ontario, Canada
Supporting the Family in Palliative Care

Alexander A. Boni-Saenz, JD, MSc, Skadden Fellow/Staff Attorney, Chicago Medical-Legal Partnership for Seniors, Legal Assistance Foundation of Metropolitan Chicago, Chicago, Illinois
The Economic Burden of End-of-Life Illness

Robert O. Bonow, MD, Max and Lily Goldberg Distinguished Professor of Cardiology, Chicago, Illinois Vice Chairman, Department of Medicine, Chicago, Illinois Director, Center for Cardiovascular Innovation, Chicago, Illinois Northwestern University Feinberg School of Medicine, Chicago, Illinois
Heart Failure and Palliative Care

Kerry W. Bowman, MSW, PhD, Assistant Professor, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada Clinical Bioethicist, Department of Bioethics, Mount Sinai Hospital, Toronto, Ontario, Canada
Understanding and Respecting Cultural Differences

Eduardo Bruera, MD, Professor, Department of Palliative Care and Rehabilitation Medicine, Chair, Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
Palliative Care in Developing Countries

Robert Buckman, MB, PhD, Professor, Department of Medicine, University of Toronto, Toronto, Ontario, Canada Adjunct Professor, The University of Texas MD Anderson Cancer Center, Houston, Texas Medical Oncologist, Department of Medical Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada
Communication Skills

Toby C. Campbell, MD, MSCI, Assistant Professor, Department of Medicine, University of Wisconsin, Madison, Wisconsi