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Rounds in the General Hospital

Clinical Challenges to the Delivery of End-of-Life Care

Jennifer A. Woo, BA; Guy Maytal, MD; Theodore A. Stern, MD

Published: December 15, 2006

Article Abstract

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End-of-life care presents many challenges (e.g., the management ofpain and suffering) for clinicians, as well as for patients and their families. Moreover, the care of the dying patient must be consideredwithin the context of the psychological, physical, and social experiencesof a person’s life.1 Foremost among those who require end-of-life careare the elderly, who are prone to loneliness, who frequently underreportpain, and who have a greater sensitivity to drugs and to drug-drug interactions.2 Unfortunately, clinicians who are responsible for the treatmentof patients at the end of life commonly lack adequate training to helpguide end-of-life decisions and to deliver bad news to patients and families.3,4 They must also face their own discomfort with discussions aboutdeath and deal with poor compensation for the time spent discussingend-of-life care with patients and families. Given the unique process ofeach person’s death, algorithmic strategies are often inadequate to guidepatients, their families, and the clinicians who care for them through thiscomplex and emotionally challenging process.

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