Basic Approach to Infection Control and Epidemiology
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- Go to chapter: Understanding the Adult Cancer Patient and Caregiver Perspective—The Illness Experience
This chapter offers theoretically and experientially based approaches to help oncology clinicians in their interactions with family caregivers of adult patients approaching their end-of-life (EOL). It presents a theoretical framework for use by clinicians to interpret and gain understanding of interactions with family caregivers of the dying adult oncology patient. It is vitally important for healthcare providers to broaden their understanding of the patient with cancer to the context in which the person lives as a parent, grandparent, spouse/partner, friend, employee, and community member. The chapter presents several compelling reasons to assess and support care partners or family caregivers. Family caregivers of adults can experience greater distress and anxiety than the patient over 40% of care partners and family caregivers report at least 10 unmet needs including gaps in illness management information and lack of emotional support.
This chapter provides an overview of the experience of caregivers, and interventions that can be implemented at various points throughout the trajectory of the illness. Caregivers are often called upon to understand complex medication regimens, contact 'hard to reach' medical providers, navigate a difficult health and legal system, advocate for services, negotiate with insurance companies, and/or manage the household, finances, and children. The needs of caregivers are often overlooked by healthcare providers, friends, and family members in the face of the complex needs of the person with cancer. A growing number of psychosocial interventions have been developed specifically to address the psychosocial burden on caregivers. However, as each caregiver and care situation is unique, interventions need to be tailored depending on the patient's medical condition, emotional and physical needs, and required medical/nursing tasks.
Performing a palliative care interview involves listening to the patient's life story and learning about what is important to the patient. This includes addressing the physical, psychosocial, and spiritual dimensions of the patient and his or her family, each of which affects the quality of life. Similar to the clinical interview with the adult living with a serious illness, identifying what matters most to the child and parent is critical. Domains to be assessed during a clinical interview are: quality of life; coping and adaptation; and communication. Ideally, initiation of conversations about serious illness occur before the terminal nature of a child's illness is known definitively. Some parents may want to protect their children from difficult conversations. This chapter explains why are clinical palliative care interviews so difficult for healthcare providers.
This book covers all dimensions of palliative care but with a special emphasis on primary palliative care. The book is organized into three parts comprising twenty two chapters. Part one provides the essential background and principles of supportive oncology and palliative care, including chapters on understanding the adult and pediatric patient and family illness experience, the roles and responsibilities of the palliative care team, and the art of the palliative care assessment interview. Part two covers symptom management and includes ten chapters considering the major physical and psychosocial symptoms a cancer patient may face—neurologic, cardiac, respiratory, gastrointestinal, genitourinary, psychiatric, sleep and fatigue, pain, and psychosocial and spiritual distress. Part three addresses special considerations and issues that an oncologist, physician, nurse or other healthcare provider often face in these settings, including chapters on intimacy, sexuality, and fertility issues, grief and bereavement, running a family meeting, care for the caregiver, and survivorship.
This chapter depicts the intergenerational nature of palliative care work with the goal of care phrased in developmentally informed steps. Healthcare providers foster dignity when adapting universal palliative care principles to a local community in a participatory and culturally, spiritually, and developmentally informed way. Eliciting goals of care and documenting quality of life goals in the patient's medical record represents a primary palliative care competency as a universal skill relevant for all healthcare providers. Palliative care brings humanistic principles that transcend into all cultures and settings. The basic principles of palliative care include: an attentiveness to family function; a stance of loving kindness and positive regard for the patient; a listening presence that prioritizes patient voice/patient perspective; a maximization of symptom management; a commitment to quality of life; a coordination of communication; a desire to alleviate suffering; and a recognition of the dignity and worth of each patient.
Chronic pain syndromes are composed of a multifactorial relationship between biologically based neurological triggers and pathways; psychologically mediated moods, emotions, and behaviors; and socially developed responses, interactions, and consequences. The complex interplay between these factors can devastate a patient’s quality of life, as well as make the diagnoses, treatment, and ongoing management of chronic pain syndromes by health care professionals exceedingly difficult, resulting in psychological and physical disability. In chronic pain, the imprinted signals and perceived pain may persist for several weeks, months, or even years after the original injury has healed. Treatment of chronic pain creates yet another dimension of complexity, as it requires a multimech-anistic, multimodal, or multidisciplinary approach for effective management. Chronic pain often is mixed nociceptive and neuropathic or primarily neuropathic and is associated with imprinted neuroanatomical and chemical changes in the peripheral and central nervous systems, which results in abnormal processing.
Chronic renal failure poses a singular challenge for health professionals who deal with illness-related disability and rehabilitation. The course of progressive chronic kidney disease (CKD) leading to renal failure often spans many years; during the period before dialysis or renal transplantation is undertaken, the patient may experience disabilities related to cardiovascular disease, anemia, malnutrition, metabolic bone disease, neuropathy, muscle wasting, and acid-base and electrolyte disturbances. Dialysis treatment and transplantation significantly prolong the lives of patients with renal failure. A better understanding of the pathophysiological basis for many of the disabling aspects of chronic renal failure has led to therapies that may reduce the frequency and/or severity of these aspects of the disease. Prevention of disability and rehabilitation has become increasingly important as the number of patients treated with dialysis therapy and renal transplantation has become more common.
The Society for Immunotherapy of Cancer (
SITC) has expanded efforts to respond to the exponential growth of educational needs by offering primers at the Annual Meeting, itinerant courses to health care providers domestically and internationally, topical meetings and task forces addressing salient questions related to the field, specifying guidelines for patient toxicity management, policy and quality benchmark development, and informing on other themes as they emerge through the SITCportal. In this context, SITCleadership decided to update, refine, and broaden the legacy established by the first edition of this textbook by providing a second edition that targets primarily young basic and clinical investigators but is informative to as many other constituencies as possible. The new edition of Cancer Immunotherapy Principles and Practice updates chapters of the first edition while introducing new ones to cover emerging concepts. Chapters for textbooks can be painstakingly overbearing, but all contributors managed to complete their part to bring together cutting-edge insights that every translational investigator and practicing clinician needs to know about tumor immunology and immunotherapy. The textbook is divided into five sections: Basic Principles of Tumor Immunology, Cancer Immunotherapy Targets and Classes, Immune Function in Cancer Patients, Disease-Specific Treatments and Outcomes, and Regulatory Aspects of Cancer Immunotherapy. These sections cover the continuum from basic principles to practical and clinically relevant information to allow critical understanding of the development and testing of novel therapeutics, companion diagnostics, and useful biomarkers, and inform about the regulatory processes that support the safe and efficient delivery of immunotherapy to patients with cancer. In addition, the chapter on the history of immunotherapy was not only preserved but updated to honor and recognize those who pioneered and championed the field.
Exercise can provide strength, power, and endurance needed to maintain function, independence, health, and well-being from the time of injury and then extending throughout the life span for spinal cord injury (SCI). This chapter investigates the advantages of exercise, present recommendations regarding the design of an SCI-specific exercise prescription. It discusses unique physiological responses to physical activity, and identifies risks of imprudent exercise. The chapter defines and describes a variety of practical and efficacious options through which persons with SCI can enhance their independence and life satisfaction, while not promoting injury or the hastening of future disability. It then provides guidance in developing an exercise prescription for persons with SCI. Protocols and authoritative guidelines have been established that target reconditioning of muscles spared by SCI and lessen the risk for secondary medical complications affecting the CV and endocrine systems. Health practitioners should be aware of these protocols and guidelines.Source: