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Dignity therapy is a unique, individualised, short-term psychotherapy that was developed for patients (and their families) living with life-threatening or life-limiting illness. We investigated whether dignity therapy could mitigate distress or bolster the experience in patients nearing the end of their lives. Patients (aged ≥18 years) with a terminal prognosis (life expectancy ≤6 months) who were receiving palliative care in a hospital or community setting (hospice or home) in Canada, USA, and Australia were randomly assigned to dignity therapy, client-centred care, or standard palliative care in a 1:1:1 ratio. Randomisation was by use of a computer-generated table of random numbers in blocks of 30. Allocation concealment was by use of opaque sealed envelopes. The primary outcomes—reductions in various dimensions of distress before and after completion of the study—were measured with the Functional Assessment of Chronic Illness Therapy Spiritual Well-Being Scale, Patient Dignity Inventory, Hospital Anxiety and Depression Scale, items from the Structured Interview for Symptoms and Concerns, Quality of Life Scale, and modified Edmonton Symptom Assessment Scale. Secondary outcomes of self-reported end-of-life experiences were assessed in a survey that was undertaken after the completion of the study. Outcomes were assessed by research staff with whom the participant had no previous contact to avoid any possible response bias or contamination. Analyses were done on all patients with available data at baseline and at the end of the study intervention. This study is registered with ClinicalTrials.gov, number NCT00133965. 165 of 441 patients were assigned to dignity therapy, 140 standard palliative care, and 136 client-centred care. 108, 111, and 107 patients, respectively, were analysed. No significant differences were noted in the distress levels before and after completion of the study in the three groups. For the secondary outcomes, patients reported that dignity therapy was significantly more likely than the other two interventions to have been helpful (χ 2=35·50, df=2; p<0·0001), improve quality of life (χ 2=14·52; p=0·001), increase sense of dignity (χ 2=12·66; p=0·002), change how their family saw and appreciated them (χ 2=33·81; p<0·0001), and be helpful to their family (χ 2=33·86; p<0·0001). Dignity therapy was significantly better than client-centred care in improving spiritual wellbeing (χ 2=10·35; p=0·006), and was significantly better than standard palliative care in terms of lessening sadness or depression (χ 2=9·38; p=0·009); significantly more patients who had received dignity therapy reported that the study group had been satisfactory, compared with those who received standard palliative care (χ 2=29·58; p<0·0001). Although the ability of dignity therapy to mitigate outright distress, such as depression, desire for death or suicidality, has yet to be proven, its benefits in terms of self-reported end-of-life experiences support its clinical application for patients nearing death. National Cancer Institute, National Institutes of Health.

\"In this moving and compassionate book, hospice nurses Maggie Callanan and Patricia Kelley share their intimate experiences with patients at the end of life, drawn from more then twenty years experience tending the terminally ill.\"--P. [4] of cover.

Objective To investigate the impact of advance care planning on end of life care in elderly patients.Design Prospective randomised controlled trial.Setting Single centre study in a university hospital in Melbourne, Australia.Participants 309 legally competent medical inpatients aged 80 or more and followed for six months or until death.Interventions Participants were randomised to receive usual care or usual care plus facilitated advance care planning. Advance care planning aimed to assist patients to reflect on their goals, values, and beliefs; to consider future medical treatment preferences; to appoint a surrogate; and to document their wishes.Main outcome measures The primary outcome was whether a patient’s end of life wishes were known and respected. Other outcomes included patient and family satisfaction with hospital stay and levels of stress, anxiety, and depression in relatives of patients who died.Results 154 of the 309 patients were randomised to advance care planning, 125 (81%) received advance care planning, and 108 (84%) expressed wishes or appointed a surrogate, or both. Of the 56 patients who died by six months, end of life wishes were much more likely to be known and followed in the intervention group (25/29, 86%) compared with the control group (8/27, 30%; P<0.001). In the intervention group, family members of patients who died had significantly less stress (intervention 5, control 15; P<0.001), anxiety (intervention 0, control 3; P=0.02), and depression (intervention 0, control 5; P=0.002) than those of the control patients. Patient and family satisfaction was higher in the intervention group.Conclusions Advance care planning improves end of life care and patient and family satisfaction and reduces stress, anxiety, and depression in surviving relatives.Trial registration Australian New Zealand clinical trials registry ACTRN12608000539336.

Evidence is growing that people can benefit from palliative care earlier in their illness, say Scott Murray and colleagues, but care must be tailored to different conditions

Jules is confronted headlong and all at once by a series of challenges to his principles, livelihood, and home, forcing him to grapple with his complex past and find a way forward. He risks fraud to save his terminally ill infant grandson, matches wits with a renegade insurance investigator, is drawn into an act of savage violence, and falls deeply, excitingly in love with a young cellist a third his age. He forges a denouement that is staggering in its humanity, elegance, and truth.

When a child is diagnosed with a life-threatening condition, one of the most challenging tasks facing health-care professionals is how to communicate this to the child, and to their parents or caregivers. Evidence-based guidelines are urgently needed for all health-care settings, from tertiary referral centres in high-income countries to resource limited environments in low-income and middle-income countries, where rates of child mortality are high. We place this Review in the context of children's developing understanding of illness and death. We review the effect of communication on children's emotional, behavioural, and social functioning, as well as treatment adherence, disease progression, and wider family relationships. We consider the factors that influence the process of communication and the preferences of children, families, and health-care professionals about how to convey the diagnosis. Critically, the barriers and challenges to effective communication are explored. Finally, we outline principles for communicating with children, parents, and caregivers, generated from a workshop of international experts.

Presents a story in which a husband must try to keep his ill wife alive by constantly surrounding her with fresh flowers.

The death of a loved one in an intensive care unit is an emotionally trying experience. These investigators compared a proactive end-of-life conference with family members, including the provision of an informational brochure, with a customary conference; outcomes were reported by family members 90 days after the loved one's death. Family members who participated in the intervention conference had improved outcomes, as compared with those who participated in the standard conference. These investigators compared a proactive end-of-life conference with a customary conference. Family members who participated in the proactive conference had improved outcomes. Having a loved one die in the intensive care unit (ICU) is an extraordinarily stressful event. 1 The patient is usually unable to communicate with the family or with ICU staff. Qualitative and quantitative studies of families in this situation 2 have identified effective communication between caregivers and families and support from caregivers throughout the decision-making process as important to family members. 3 – 9 In many ICUs, an end-of-life family conference, which is rooted in findings from epidemiologic and interventional studies on communicating with families of dying patients, is an important part of ICU practice. 10 In these conferences, family members and ICU staff . . .