A Guide to Primary Care of People with HIV/AIDS - Canadian Public ...

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A Guide to Primary Care of People with HIV/AIDS Chapter 15: Palliative and End-of-Life Care KEY POINTS Palliative medicine is the discipline devoted to the relief of suffering and the promotion of quality of life. Palliative care has often been thought to be limited to end-of-life or hospice care; it is rather a more general term for the type of supportive care needed throughout the trajectory of HIV disease. Advance care planning is an attempt to identify a decisionmaker should the patient become unable to communicate his or her own wishes. Deciding when to make the transition from curative/restorative mode to one of comfort measures only and having the skills to communicate this to the patient are probably the greatest challenges facing the provider. There are multiple physical, psychosocial, and spiritual issues that need resolution in order for the patient to die peacefully and to leave satisfactory memories for family and friends. The focus of providers tends to be on caring for others. Providers who suffer from the death of more than one patient over a short time period can experience symptoms of post-traumatic stress disorder. They need to take the time to effectively grieve. SUGGESTED RESOURCES Alexander C. Palliative and end-of-life care. In Anderson J, ed. A Guide to the Clinical Care of Women with HIV. Rockville, MD: Health Resources and Services Administration; 2001. Available at http://www.hab.hrsa.gov. Doyle D, Hanks GWC, Cherny N, and Calman K, eds. The Oxford Textbook of Palliative Medicine, 3rd ed. New York: Oxford University Press; 2003. O’Neill, JF, Selwyn, PA, and Schietinger, H, eds. The Clinical Guide to Supportive and Palliative Care for HIV/AIDS. Rockville, MD: Health Resources and Services Administration; 2002. Available at http://www.hab.hrsa.gov. Selwyn PA, Rivard M. Palliative care for AIDS: Challenges and opportunities in the era of highly active antiretroviral therapy. J Palliat Med. 2003;6:475-487. 15 130 U.S. Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau
A Guide to Primary Care of People with HIV/AIDS Chapter 15: Palliative and End-of-Life Care REFERENCES Agency for Health Care Policy and Research. Clinical Practice Guideline Number 9: Management of Cancer Pain. AHCPR Publication #94-0592. Rockville, MD: Agency for Health Care Policy and Research; 1994. American Pain Society. Principles of Analgesic Use in the Treatment of Acute Pain and Cancer Pain, 5th ed. Glenville IL: American Pain Society; 2003. Baile W, Buckman R. Practical Guide to Communication Skills in Clinical Practice. Niagara Falls, NY: Medical Audio Visual Communications, Inc; 1998. Curtis JR. Patient-Clinician Communication. In O’Neill JF, Selwyn PS, and Schietinger H, eds. A Clinical Guide to Supportive and Palliative Care for HIV/AIDS. Rockville, MD: Health Resources and Services Administration; 2003. Education for Physicians on End-of-Life Care (EPEC) Curriculum. Chicago, IL: American Medical Association; 2003. Available at http://www.ama-assn.org/ama/pub/category/ 2910.html Kearnes B. Gone from My Sight. Depoe Bay, OR: BK Books; 1995. Available at http://www.bkbooks.com. Mathews W, McCutcheon JA, Asch S, et al. National estimates of HIV-related symptom prevalence from the HIV Cost and Services Utilization Study. Med Care. 2000;38;750-762. O’Neill JF, McKinney M. Caring for the caregiver. O’Neill JF, Selwyn PA, and Schietinger H, Eds. The Clinical Guide to Supportive and Palliative Care for HIV/AIDS. Rockville, MD: Health Resources and Services Administration; 2003. Vogl D, Rosenfeld B, Breitbart W, et al. Symptom prevalence, characteristics, and distress in AIDS outpatients. J Pain Symptom Manage. 1999;18:253-262. World Health Organization. Cancer Pain Relief and Palliative Care, Report of a WHO Expert Committee. Publication #1100804. Geneva: World Health Organization; 1990. 15 U.S. Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau 131
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