Introducing the discussion about palliative care is assessed within the MDC team on an individual basis dependent upon the patient’s advancing illness and their hopes for the future. To ensure that GPs participated in the planning phase, with a view to their participation in MDC meetings, focus groups were held at clinics in the regional area and through the Division of General Practice in two rural health services. Attendance at these meetings was impressive and though the attendees identified many obstacles to attendance at MDC meetings, they were enthusiastic about participating. The need to discuss with the patient issues associated with awareness and ‘diagnosis’ of a palliative state such as worsening symptoms, failure of treatments due to progressive disease or recurrent disease. Effective communication within the health care team to help determine appropriate and timely referral to the palliative care team is crucial. The referral is introduced to the patient and their carers by the designated care coordinator explaining the role of palliative care as one of active care that delivers specialised health care to maximise quality of life, whether that be symptom management, pain relief or spiritual, emotional, and psychological support. The initial discussion occurs at a time when the patient is not unwell or under stress (e.g. it is not appropriate when diagnosis is first given to them). It is explained to the patient that a discussion about NFR orders is best done before admission occurs. An explanation of the meaning of NFR and the processes involved with resuscitation is given. The issues relating to medical advice, appropriateness of treatment, the patient’s right to choice and medical futility can be undertaken as needed. Written information will be provided to all. Admitting doctors should check the patient’s ‘NFR status’ at each admission and ask the patient if they would like to change their status. It is suggested that their status is included in a card also recording their medications. Due to the pharmacokinetics of DCA (half-life that increases with repeated dosing) we find a cyclic course of 1- 3 weeks on followed by 1 week off to be useful. Side effects can also be managed by natural supplements like R alpha lipoic acid and vitamin B1 (thanks to a surgeon from Indiana for his suggestion to combine lipoic acid with DCA). Firstly, we are thankful to all the patients and their families who gave permission for their cases to be published on our website for doctors and patients around the world to see. Although our DCA case reports were accepted for publication from a recognized medical journal, after much deliberation we decided to publish them on our website instead. The purpose was to reach as wide an audience as possible (to reach patients, not just doctors), with the belief that we may give support and encouragement to other cancer patients everywhere. These case reports are for information only and should not be used as a guide to self medicate We have written the reports with thorough medical details so doctors can read them with interest sample outlines for thesis papers, and may explore treatment with off-label drugs in cases where conventional cancer therapies have been exhausted. Patients in the above cases responded to DCA within 2 to 4 weeks of taking at least 20mg/kg/d. Lower doses than 20mg/kg body weight seemed to have less or delayed response. Higher doses may have the advantage of a more dramatic positive response, but in our experience are limited by the severity of side effects, and result in drug discontinuation. It appears that the response to DCA varies just like an individual’s response to conventional chemotherapy varies. Trainees master 14 learning objectives a personal essay is, with information provided through lectures by oncologists and other providers, tours of cancer care facilities, web-based training on cancer resources, “talk story” sessions with patients and their families, interactive sessions with practicing navigators and primary care physicians, role playing, and quizzes. 12 Faculty are experts in their fields and volunteer their time. For example, the section on Palliative Care has been taught by a palliative care advanced practice nurse and, another time, by a radiation oncologist promoting the healing effect of symptom palliation. Meeting the state's cancer-care experts and touring facilities also help trainees develop relationships and a network of people to contact in their work. Over the Ho‘okele training, each trainee builds a resource binder to help them navigate cancer patients to and through care. While trainees come from different settings (community-based settings and clinical settings) and come into the training with different health-related skills (nursing, allied health, community outreach), the curriculum has proven to be well received by all and applicable in all settings. The patients described in the 18 case studies ranged in age from under 20 to over 80 years, with a mean age of 54 years. Twelve of the patients were female, and 6 were male. Eleven were of Native Hawaiian ancestry, 3 were Filipino, 3 were Caucasian, and 1 was Japanese. Seventeen lived on neighbor islands (not O‘ahu, where the majority of cancer care services are located), and 16 lived in a rural (vs urban) community. Cancer types included lung, breast help with paper app, colon, lymphoma, neck and throat, osteosarcoma, prostate essay of racial profiling, and thyroid cancers. Despite use of convenience sampling, the cases include a diversity of cancer types, ages, ethnic groups, and residences. 9. Battaglia TA, Roloff K, Posner MA, et al. Improving follow-up to abnormal breast cancer screening in an urban population: a patient navigation intervention. Cancer. 2007; 109 (2 Suppl):359–367. [PubMed ] 3. Braun KL good thesis statements topics, Allison A, Tsark J. Using community-based research methods to design cancer patient navigation training. Progress in Community Health Partnerships. 2008; 4 :329–340. [PMC free article ] [PubMed ] 6. Robinson-White S, Conroy B, Slavish KH, et al. Patient navigation in breast cancer: a systematic review. Cancer Nurs. 2010; 33 (2):127–140. [PubMed ] This article describes the activities performed by cancer patient navigators in community-based and hospital settings. The case study demonstrates the depth and breadth of navigation activities and illustrates how hospital-based and community-based navigators work together to help individuals access cancer care and complete cancer treatment. ‘Imi Hale's 48-hour Ho‘okele i ke Ola (Ho‘okele ) training curriculum focuses on cancer knowledge, resources, patient advocacy, and communications and has been offered to lay health workers. Mastery of the material is assessed through pre- and post-tests, and the curriculum is evaluated by trainees and Ho‘okele graduates. Information is added paper you can write on online, clarified, or otherwise improved as indicated through these tests and evaluations. 12 5. Hede K. Agencies look to patient navigators to reduce cancer care disparities. J Natl Cancer Inst. 2006; 98 (3):157–159. [PubMed ] The reported outcomes of each case were grouped into 3 categories: (1) improved access to care; (2) improved timeliness and completion of care; and (3) improved feelings of control and confidence ( Table 3 ). In all 18 cases, the navigator linked patients to services that improved their access to cancer care, most importantly insurance, financial assistance customs writing com, and transportation. Without these linkages, individuals would not have been able to access the cancer care system. This case illustrates how a hospital-based navigator helped a middle-aged Japanese man living on a neighbor island diagnosed with lung cancer. The navigator assigned to the patient assisted with transportation to and from O‘ahu. To reduce patient burden and travel costs, the navigator coordinated same-day appointments with the radiation oncologist, medical oncologist, and surgeon. She also worked closely with the patient's wife, answering her questions and empowering her to help and advocate for her husband. The navigator also obtained travel assistance so the patient's wife could accompany him to appointments and arranged accommodations for the patient's wife while he was hospitalized for surgery and post-surgical care. After treatment was completed, the navigator also helped schedule the patient's follow-up appointments with physicians for the same day to continue to minimize travel burden and cost, and referred the patient to a survivorship program. Although all navigators want to help patients through the cancer care continuum (from screening, suspicious finding, diagnosis, treatment, post-treatment, and survivorship), generally hospital-based navigators accrue clients at the point of suspicious finding or cancer diagnosis and discharge them after treatment, unless they have specific screening or survivorship navigation programs. Community-based navigators essay service writing, on the other hand, may work with clients to get them to screening, work in concert with hospital-based navigators through diagnosis and treatment, and then follow through with the clients and their families post-treatment ( Figure 1 ). Both clinic and community-centered navigation programs operate in Hawai‘i. The purpose of this article is to describe and illustrate through case studies the complementary roles of clinical and community-based cancer patient navigation. 1. Freeman HP professional essay writers for hire, Muth BJ, Kerner JF. Expanding access to cancer screening and clinical follow-up among the medically underserved. Cancer Pract. 1995; 3 :19–30. [PubMed ] 4. Freund KM. Patient navigation: The promise to reduce health disparities. J Gen Intern Med. 2011; 26 (2):110–112. [PMC free article ] [PubMed ] Activities performed by cancer patient navigators in communitybased and hospital settings have been described. The case study methodology demonstrates the depth and breadth of navigation activities and illustrates how hospital-based and community-based navigators can work together to help individuals access cancer care and complete cancer treatment. On average, the navigator provided six actions per case to help patients resolve the barriers they confronted. Almost all of the patients (16 of 18) needed referrals to appropriate services, for example financial resources, physicians, hospice and palliative care services, and emotional support services ( Table 2 ). In 8 cases cover letters resume samples, the navigator scheduled appointments for screening, diagnosis, or treatment, and navigators accompanied 7 of the 18 patients to at least one appointment. At the appointment, the navigator often took notes and then reviewed information with the patient to assure understanding. In 13 cases, the navigator provided the patient with emotional support, and in the majority of cases this support was provided over several months of treatment and post-treatment. Navigators are trained to support the patient by listening to and validating his/her concerns and helping the patient identify and get answers to his/her questions from the physician or other providers. In 3 cases, the navigator was the patient's sole support at the time of diagnosis because the patient did not want to “burden” family members. In these cases, navigators encouraged patients to share their diagnosis with their family and friends, who were then enlisted to help the patient schedule and get to appointments, and to help the patient with childcare, shopping, cooking, and housework. In 3 cases, the navigator also provided emotional support to caregivers and referred them to counseling services. After one of the patients died, the community navigator comforted grieving family members and encouraged surviving family members to participate in cancer screening. 12. Braun KL, Allison A, Tsark J. Using community-based research methods to design cancer patient navigation training. Progress Community Health Partners. 2008; 4 :329–340. [PMC free article ] [PubMed ] Request an Appointment Chronic disease and poverty - a vicious cycle Chronic disease affects rich people Chronic diseases custom research papers review, like cancer, affect mainly high income countries
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