Hospital palliative care teams have been established in rapidly increasing numbers over the last 20 years, as it has been recognised that hospices can never transfer the philosophy and practice of palliative care into the acute sector by simply existing; they often work as 'stand alone units' and remain outside mainstream medicine. However it has become apparent that improving access to palliative care for patients in acute hospitals is not as easy as employing external palliative care specialists as consultants. Even setting up a team of professionals who work solely in a hospital will often not improve the care of the great majority of patients being treated there. Based on the extensive experience and knowledge of three clinicians in the area who have developed palliative care services in acute settings, this book provides those facing the same challenges with practical guidance and down to earth advice on a range of problems they might encounter. Using a problem focused and practical approach, Palliative Care in the Acute Hospital Setting: a practical guide is filled with case-based problems to help readers identify realistic, usable, everyday solutions. It also covers the skills and knowledge needed to help teams make progress in the hospital as well as outlining the best training to help them continue to flourish. Written in an accessible style with short and focussed chapters, this clearly laid out book helps readers find the information they need to tackle particular problems easily and with confidence. With a supportive outlook and covering the non-clinical management aspects of palliative care, this book is the ideal guide for palliative care specialists making the transfer from hospice to hospital, and for those setting up palliative care teams in the acute hospital setting.

For patients and their loved ones, no care decisions are more profound than those made near the end of life. Unfortunately, the experience of dying in the United States is often characterized by fragmented care, inadequate treatment of distressing symptoms, frequent transitions among care settings, and enormous care responsibilities for families. According to this report, the current health care system of rendering more intensive services than are necessary and desired by patients, and the lack of coordination among programs increases risks to patients and creates avoidable burdens on them and their families. Dying in America is a study of the current state of health care for persons of all ages who are nearing the end of life. Death is not a strictly medical event. Ideally, health care for those nearing the end of life harmonizes with social, psychological, and spiritual support. All people with advanced illnesses who may be approaching the end of life are entitled to access to high-quality, compassionate, evidence-based care, consistent with their wishes. Dying in America evaluates strategies to integrate care into a person- and family-centered, team-based framework, and makes recommendations to create a system that coordinates care and supports and respects the choices of patients and their families. The findings and recommendations of this report will address the needs of patients and their families and assist policy makers, clinicians and their educational and credentialing bodies, leaders of health care delivery and financing organizations, researchers, public and private funders, religious and community leaders, advocates of better care, journalists, and the public to provide the best care possible for people nearing the end of life.

Based on the extensive experiences and knowledge of three clinicians in the area who have developed palliative care services in acute settings, this book provides those facing the same challenges with practical guidance and down to earth advice on a range of problems they might encounter.

'The Textbook of Palliative Care Communication' is the authoritative text on communication in palliative care. Uniquely developed by an interdisciplinary editorial team to address an array of providers including physicians, nurses, social workers, and chaplains, it unites clinicians and academic researchers interested in the study of communication.

Ageing populations mean that palliative and end of life care for older people must assume greater priority. Indeed, there is an urgent need to improve the experiences of older people at the end of life, given that they have been identified as the 'disadvantaged dying'. To date, models of care are underpinned by the ideals of specialist palliative care which were developed to meet the needs of predominantly middle-aged and 'young old' people, and evidence suggests these may not be adequate for the older population group. This book identifies ways forward for improving the end of life experiences of older people by taking an interdisciplinary and international approach. Providing a synergy between the currently disparate literature of gerontology and palliative care, a wide range of leading international experts contribute to discussions regarding priority areas in relation to ageing and end of life care. Some authors take a theoretical focus, others a very practical approach rooted in their clinical and research experience. The issues covered are diverse, as are the countries in which discussions are contextualised. Those working in both palliative care and gerontology will find the issues and advice discussed in this book hugely topical and of real practical value.

Based on the extensive experience of three clinicians in the area, this book provides those setting up palliative care services in hospitals with practical guidance and down to earth advice on the range of problems they might encounter.

The first comprehensive, clinically focused guide to help hospitalists and other hospital-based clinicians provide quality palliative care in the inpatient setting. Written for practicing clinicians by a team of experts in the field of palliative care and hospital care, Hospital-Based Palliative Medicine: A Practical, Evidence-Based Approach offers: Comprehensive content over three domains of inpatient palliative care: symptom management, communication and decision making, and practical skills, Detailed information on assessment and management of symptoms commonly experienced by seriously ill patients, Advise on the use of specific communication techniques to address sensitive topics such as prognosis, goals of care, code status, advance care planning, and family meetings in a patient- and family-centered manner, Targeted content for specific scenarios, including palliative care emergencies, care at the end of life, and an overview of post-hospital palliative care options, Self-care strategies for resilience and clinician wellness which can be used to help maintain an empathic, engaged, workforce and high quality patient care, A consistent chapter format with highlighted clinical pearls and pitfalls, ensuring the material is easily accessible to the busy hospitalist and associated hospital staff. This title will be of use to all hospital clinicians who care for seriously ill patients and their families. Specialist-trained palliative care clinicians will also find this title useful by outlining a framework for the delivery of palliative care by the patient’s front-line hospital providers. Also available in the in the Hospital-Based Medicine: Current Concepts series: Inpatient Anticoagulation Margaret C. Fang, Editor, 2011 Hospital Images: A Clinical Atlas Paul B. Aronowitz, Editor, 2012 Becoming a Consummate Clinician: What Every Student, House Officer, and Hospital Practitioner Needs to Know Ary L. Goldberger and Zachary D. Goldberger, Editors, 2012 Perioperative Medicine: Medical Consultation and Co-Management Amir K. Jaffer and Paul J. Grant, Editors, 2012 Clinical Care Conundrums: Challenging Diagnoses in Hospital Medicine James C. Pile, Thomas E. Baudendistel, and Brian J. Harte, Editors, 2013 Inpatient Cardiovascular Medicine Brahmajee K. Nallamothu and Timir S. Baman, Editors 2013

Background The concept of a "good death" has informed the philosophy of palliative care. Supporting preferences for place of care and enabling death at home surrounded by family and friends remains the pinnacle of good palliative care. Evidence suggests that home remains the preferred place of care and place of death for most people. Yet, many people will spend a significant amount of time in hospital during the last year of their life and, in many countries, a majority will die in a hospital setting. With pressure on health funding, the way in which hospitals are being used in the last year of life is being increasingly scrutinised by leaders, clinicians and policy makers. "Inappropriate" or "potentially avoidable" hospital admissions are seen as opportunities for cost savings. However, there is a paucity of evidence regarding the experiences of people with palliative care needs, which focuses on both the positive and negative aspects of being in hospital. In addition, little is known about how these experiences influence a preference to return to hospital. Aim To explore the benefits and burdens of hospital admissions for people with palliative care needs and examine how these experiences influence a preference to return to hospital. Methods A two-phase, sequential mixed methods study. Findings Patients experience of benefit extended beyond the treatment they received to include: getting/feeling better, relief for family, getting help to manage at home, and feeling safe. Those living in high deprivation and those with cancer experienced more benefit being in hospital. Significantly more burden related to being in hospital was experienced by Chinese and Pacific participants. Most participants expressed a preference to be in hospital rather than remain at home even if the care they had received in hospital could have been provided at home. In addition, feeling safe was a significant predictor of a preference to return to hospital. Despite most being involved with community-based services at the time of admissions, participants did not perceive services such as the general practitioner and community hospice as enablers to remain at home. Conclusion This study confirms that people with palliative care needs view acute hospitals as playing an important role in their care, contrary to policy assumptions. These findings have significant implications for practice and policy internationally, notably in relation to which models of care are developed and funded. In particular, the findings indicate that in many countries there is currently a risk of developing a model of care that is not in line with the preferences and experiences of people with palliative care needs and that could result in them being unable to access hospital care when needed. The findings also demonstrate that if people with palliative care needs are to be cared for at home, more research is needed to understand what they require to feel safe at home during a period of acute illness or deterioration, rather than assuming that what is required is more access to community services. Finally, further investigation is required to gain an understanding of what feeling safe in hospital means for patients from different socio-demographic groups across multiple care settings.

Palliative and end of life care are concerned with the physical, social, psychological and spiritual care of people with advanced disease. It currently has a poorly developed research base, but the need to improve this is increasingly recognised. One of the reasons for the lack of research - and the variable quality of the research that is undertaken - is the difficulty of conducting research with very ill and bereaved people. Standard and well-established research methods may need to be adapted to work in this context. This means that existing research methods textbooks may be of limited use to palliative care practitioners seeking to do research for the first time, or to more experienced researchers wanting to apply their knowledge in palliative care settings. This research methods textbook is the first to be written specifically for palliative care. It has been edited by four experienced palliative care academics with acknowledged expertise and international reputations in this field. It encompasses methods used in both clinical and health services research in palliative care, with sections on clinical, epidemiological, survey and qualitative research, as well as a section covering skills needed in any research project. Each chapter provides readers with an up to date overview of the research method in question, an understanding of its applicability to palliative care and of the particular challenges of using it in this setting. It is essential reading for all palliative care researchers.