Ethical challenges of palliative care research
Humans; Research; Ethics; Death and Euthanasia; Palliative Care/ethics; Biomedical and Behavioral Research
2003
Casarett DJ; Knebel A; Helmers K
Journal Of Pain And Symptom Management
2003
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1016/s0885-3924(03)00058-7" target="_blank" rel="noreferrer">10.1016/s0885-3924(03)00058-7</a>
Does a palliative care clinic have a role in improving end-of-life care? Results of a pilot program
Female; Humans; Male; United States; Adult; Aged; Middle Aged; Pilot Projects; Program Development; Program Evaluation; Survival Analysis; Hospitals; Proportional Hazards Models; 80 and over; Outpatient Clinics; Hospice Care/methods/trends; Hospital/organization & administration; Palliative Care/methods/organization & administration/trends; Veterans/organization & administration
OBJECTIVE: To assess the efficacy of a palliative care clinic (PCC), which provided some of the interdisciplinary services and expertise of an inpatient consult service to outpatients, in traditional clinic sessions. DESIGN: Chart review. SETTING: A large urban Veterans Administration Medical Center. PATIENTS: One hundred patients referred to clinic. INTERVENTIONS: Palliative care clinic. OUTCOME MEASURES: Patients' reported needs, Global Distress Index (GDI) subscale, hospice eligibility, and time to death. RESULTS: The most common diagnosis was cancer (n = 85). Most patients (n = 89) had at least one need for services that the team provided (median, 2; range, 0-4), the most common of which was a desire for information about prognosis (n = 84). In a Cox proportional hazards model, predictors of enrollment in hospice included white ethnicity (hazard ratio, 3.42; p < 0.001), a need for help around the home (hazard ratio, 3.26; p = 0.002), and insufficient money left at the end of the month (hazard ratio, 2.39; p = 0.014). CONCLUSIONS: The experience of the PCC described here offers a unique approach to improving end-of-life care for those outpatients who may not be well served by existing structures of care such as palliative care consult services and who have not yet enrolled in hospice.
2002
Casarett DJ; Hirschman KB; Coffey JF; Pierre L
Journal Of Palliative Medicine
2002
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1089/109662102320135270" target="_blank" rel="noreferrer">10.1089/109662102320135270</a>
Are special ethical guidelines needed for palliative care research?
Humans; Guidelines as Topic; Research; Ethics; Medical; Death and Euthanasia; Palliative Care/standards; Biomedical and Behavioral Research; Multi-site Ethics
Recent studies have made it clear that there are substantial opportunities to improve end-of-life care. Doing so will require solid evidence on which to base clinical and policy decisions and this, in turn, will require a focused research effort. However, research that involves patients near the end of life creates numerous ethical challenges. Moreover, the inclusion of dying patients in research may make many providers uncomfortable. In short, there seems to be something ethically unique, and uniquely challenging, about palliative care research. This paper considers 4 arguments for this unique status: 1) dying patients are especially vulnerable; 2) adequate informed consent may be difficult to obtain; 3) balancing research and clinical roles is particularly difficult; and 4) the risks and benefits of palliative research are difficult to assess. We conclude that the first three of these arguments are weak, and that special guidelines are not needed. We suggest, however, that the fourth argument may have some merit, and should be the focus of discussion among investigators, providers, and patients.
2000
Casarett DJ; Karlawish J
Journal Of Pain And Symptom Management
2000
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1016/s0885-3924(00)00164-0" target="_blank" rel="noreferrer">10.1016/s0885-3924(00)00164-0</a>