What "best practice" could be in Palliative Care: an analysis of statements on practice and ethics expressed by the main Health Organizations

<p>Abstract</p> <p>Background</p> <p>In palliative care it would be necessary to refer to a model. Nevertheless it seems that there are no official statements which state and describe that model. We carried out an analysis of the statements on practice and ethics of palliative care expressed by the main health organizations to show which dimensions of end-of-life care are taken into consideration.</p> <p>Methods</p> <p>The official documents by the most representative health organisations committed to the definition of policies and guidelines for palliative and end-of-life care had been considered. The documents were analysed through a framework of the components of end-of-life care derived from literature, which was composed of 4 main "areas" and of 12 "sub-areas".</p> <p>Results</p> <p>Overall, 34 organizations were identified, 7 international organisations, and 27 organisations operating on the national level in four different countries (Australia, Canada, UK and United States). Up to 56 documents were selected and analysed. Most of them (38) are position statements. Relevant quotations from the documents were presented by "areas" and "sub-areas". In general, the "sub-areas" of symptoms control as well as those referring to relational and social issues are more widely covered by the documents than the "sub-areas" related to "preparation" and to "existential condition". Indeed, the consistency of end-of-life choices with the patient's wishes, as well as completion and meaningfulness at the end of life is given only a minor relevance.</p> <p>Conclusions</p> <p>An integrated model of the best palliative care practice is generally lacking in the documents. It might be argued that the lack of a fixed and coherent model is due to the relevance of unavoidable context issues in palliative care, such as specific cultural settings, patient-centred variables, and family specificity. The implication is that palliative care staff have continuously to adapt their model of caring to the specific needs and values of each patient, more than applying a fixed, although maybe comprehensive, care model.</p

The effects of dissection-room experiences and related coping strategies among Hungarian medical students

Background: Students get their first experiences of dissecting human cadavers in the practical classes of anatomy and pathology courses, core components of medical education. These experiences form an important part of the process of becoming a doctor, but bring with them a special set of problems. Methods: Quantitative, national survey (n = 733) among medical students, measured reactions to dissection experiences and used a new measuring instrument to determine the possible factors of coping. Results: Fifty per cent of students stated that the dissection experience does not affect them . Negative effects were significantly more frequently reported by women and students in clinical training (years 3,4,5,6). The predominant factor in the various coping strategies for dissection practicals is cognitive coping (rationalisation, intellectualisation). Physical and emotional coping strategies followed, with similar mean scores. Marked gender differences also showed up in the application of coping strategies: there was a clear dominance of emotional-based coping among women. Among female students, there was a characteristic decrease in the physical repulsion factor in reactions to dissection in the later stages of study. Conclusions: The experience of dissection had an emotional impact on about half of the students. In general, students considered these experiences to be an important part of becoming a doctor. Our study found that students chiefly employed cognitive coping strategies to deal with their experiences. Dissection-room sessions are important for learning emotional as well as technical skills. Successful coping is achieved not by repressing emotions but by accepting and understanding the negative emotions caused by the experience and developing effective strategies to deal with them. Medical training could make better use of the learning potential of these experiences