This work evaluates Medicare Hospice Benefit (MHB) eligibility standards that are referenced throughout this work as either "Medicare prognostic criteria," or "Local Medical Review Policies." Following the Chapter 1 overview of prognosis in end-stage disease, association between the Medicare clinical predictors and survival outcomes in dementing, cardiovascular and cerebrovascular illnesses are described in Chapter 2. Chapter 3 examines the prognostic belief systems of multidisciplinary hospice personnel. Chapter 4 seeks to improve the predictive performance of the Medicare prognostic criteria for dementia. The fifth and final chapter critiques the Medicare prognostic criteria from conceptual, methodological, and applied perspectives and suggests related research and policy directions. The Chapter 2 sample comprised 453 medical records of terminally ill persons; Chapter 4 sample, 187 medical records. Thirty-seven hospice personnel comprised the respondent sample in the Chapter 3 study. Chapter 2 assesses the scientific validity of federally sanctioned Medicare "severe illness/end-stage illness" demarcations in three non-cancer disease catregories. Calculation of measures of predictive validity revealed striking and consistent imbalances of false negative and false positive errors across the three diagnostic categories studied, suggesting inequitable distribution of the costs and benefits of regulatory reform among public health payers, consumers and providers. Chapter 3 qualitatively examines the belief systems of experienced hospice personnel regarding physical and non-physical time-to-death influences in end-stage disease. Non-physical survival influences were believed by these expert informants to have more survival impact in non-cancer as opposed to cancer end-stage diseases, and at remote as compared to imminent death proximities. Chapter 3 highlights the enormous complexity of time-to-death influences as well as the importance of non-physical influences on duration of survival in end-stage disease. Chapter 4 demonstrates that dropping one of the three prognostic criteria for dementia (the medical complications criteria) may improve predictive validity. This finding demonstrates that, in dementing illnesses at least, functional debility may better identify 6-month survival prognosis and thus hospice eligibility, than the composite Medicare prognostic criteria. The merit of parsimony in objective definitions of terminality is implied. Chapter 5 critiques the Medicare prognostic criteria, and suggests policy alternatives that are both prognostically- and non-prognostically-based. Peripheral findings of this work and suggestions for future end-of-life research conclude the dissertation.

The goal of this study was to explore the nature and extent of palliative care in the Nairobi Hospice, in Kenya. Owing to the limited information available on this subject, the study is based on a research question that seeks to deepen understanding of the experiences of palliative care services by patients facing life-threatening illnesses. In answering the research question, the study employed a variety of methods. First, it used qualitative research approach in order to unearth personal experiences of the value of services received. Second, it employed applied research with the aim of using results to influence the formulation and improvement of palliative care programs in Nairobi. Further, the study employed the case study method as the research strategy. Focus group interviews were utilised as the data collection technique. The researcher used an interview schedule and administered semi-structured questions on a group basis. Availability sampling method was used to draw a sample of 20 patients receiving palliative care at the Nairobi Hospice. Confirmation from the study indicated that patients receive medical care, counselling, and spiritual care as well as day care services, usually provided by the hospice staff. The study further confirmed the value of palliative care. Services provided offered a number of benefits for the patients for instance, enhanced hope, mobility, as well as improved state of health for these patients. At the same time the study underscored the value of spiritual guidance. However this was provided as an additional service, being offered outside the hospice. Measures to integrate this service would improve the value of palliative care services in general. Further, it was noted that there was no particular time frame for receiving palliative care at the hospice since patients receive care at different intervals. The study also disclosed that patients’ illnesses impacted on their families negatively for example, a number of these patients were either abandoned or separated from their families, their families suffered financial strains while others were in denial and felt very desperate about the whole situation. The study conclusively indicated that social workers can play a vital role in palliative care provision by either conducting regular home visits, educating and creating awareness as well as offering counselling services to both the patients and their families. / Dissertation (MSW)--University of Pretoria, 2008. / Social Work and Criminology / MSW (Health Care) / Unrestricted

This thesis presents an ethnographic study of the experiences of men living with and dying from serious illness in prison, with a particular focus on the kinds of care they receive and the ways in which they experience that care. The dissertation draws on extensive ethnographic fieldwork conducted over two years in U.S. state prisons in Maine, presented in three standalone papers. The first paper outlines how the prison and its health care system shape the illness experiences of older and ageing prisoners and asks, what does it mean when the lives of prisoners collide with contracted for-profit medical care and how might their lives be constituted as unworthy of care? The stakes lie in applied policy and practical solutions for custodial services. The second paper explores the experience of caring and being cared for in the context of a prison hospice program, in which incarcerated men provide care to peers who are ill or dying. Through tracing one man’s end of life journey, this chapter considers how hospice caring makes and remakes death and life in prison, and the ways in which this “nefarious” form of escape from disciplinary power translates in the repressive penal regime. The final paper has its roots in sensory ethnography and the emerging field of sensory penality. This is a reflexive piece in which I probe my sensorial subjectivity and particularly touch as a medium of inquiry to explore the sensations of life, death, and dis/connection experienced in a prison infirmary. The observed feel of life and death illuminates new ways of understanding care in custody as a space of simultaneous brutality, beauty, indignity and intimacy. Taken together, the papers shed light on constellations of care in prison, the contingency of relations and personhood, and points of friction between care and custody. / Dissertation / Doctor of Philosophy (PhD) / At a time when the prison population is rapidly ageing and more people than ever are dying in custody, this thesis explores what it is like to experience serious or terminal illness in prison, the kinds of care prisoners receive and how they experience that care. Based on ethnographic fieldwork in U.S. state prisons, three themes are examined: 1) how the prison and its privatized health care system shape the illness experiences of older prisoners; 2) how prisoners mediate the experience of dying in prison through a peer- based prison hospice program; and 3) how the senses and especially touch elicit new ways of knowing and understanding end of life in prison. Taken together, the three papers shed light on forms of care in prison, the mutability of relations and life, and points of friction between care and custody.

No description available.

The impression existed that nurses were not always compassionate and caring when they had to nurse terminally ill patients and the question arose whether they were adequately trained for this task. This study focused on the most frequent diseases that cause the death of patients in a province of Angola, and set out to determine what preparation nurses in a specific hospital received to equip them to care for terminally ill patients. A quantitative approach was adopted, using an exploratory and descriptive design, and a self-developed questionnaire was applied as data-collection instrument for a sample of 100 medium- and basic level nurses in a specific hospital in a province of Angola. From the results of the study it was evident that the nurse respondents were well informed as to what it entailed to be terminally ill, which factors affected the patient's comfort, safety and self image needs but only half of the respondents indicated that they received training pertaining to palliative care. Recommendations were made in view of better preparing nurses to care for the terminally ill patient. / Health Studies / M.A. (Health Studies)

<p> </p><p>Background: Euthanasia means help to die. Some terminally ill patients wish for euthanasia. Purpose: Illuminating terminally ill patients' desire for voluntary euthanasia. Method: A general literature study. Seven articles were reviewed and analyzed. Results: Patients do not want to live a painful life or die a painful death, patients want control over their lives and feel involved in decisions affecting their lives and the patients want to feel quality of life despite their illness or treatment. The result showed that pain, loss of control and lost quality of life were the major reasons for the terminally ill patients’ wish for euthanasia. Discussion: To understand why these patients wished for euthanasia there was a need to go to the root causes. Pain was the major cause of desire for euthanasia and needs to be illuminated as it was the basis for the two other discoveries, quality of life and control over the patients’ lives. Conclusion: To get terminally ill patients pain-free and meet their individual health needs can change their wish for euthanasia.</p><p> </p> / <p>Bakgrund: Eutanasi är idag synonymt med aktiv dödshjälp. En del obotligt sjuka patienter har en önskan om att avsluta sina liv. Syftet: Belysa obotligt sjuka patienters önskan om frivillig eutanasi. Metod: Allmän litteraturstudie. Sju artiklar granskades och analyserades. Resultat: Patienter vill inte leva ett plågsamt liv eller dö en plågsam död, patienter vill ha kontroll över sitt liv och känna sig delaktiga i beslut som rör deras liv och patienter vill känna livskvalité trots sin sjukdom eller behandling. Resultatet visar att smärta, förlorad kontroll och förlorad livskvalité var de stora orsakerna till att obotligt sjuka önskade eutanasi. Diskussion: För att förstå varför dessa patienter önskade eutanasi bör man gå till de underliggande orsakerna. Smärta som var främsta orsaken till önskan om dödshjälp bör framhävas då den ligger till grund för de andra fynden, livskvalité och kontroll över sitt liv. Slutsats: Att få obotligt sjuka patienter smärtfria och tillgodose deras individuella vårdbehov kan få deras önskan om eutanasi att ändras.</p>

Background: Euthanasia means help to die. Some terminally ill patients wish for euthanasia. Purpose: Illuminating terminally ill patients' desire for voluntary euthanasia. Method: A general literature study. Seven articles were reviewed and analyzed. Results: Patients do not want to live a painful life or die a painful death, patients want control over their lives and feel involved in decisions affecting their lives and the patients want to feel quality of life despite their illness or treatment. The result showed that pain, loss of control and lost quality of life were the major reasons for the terminally ill patients’ wish for euthanasia. Discussion: To understand why these patients wished for euthanasia there was a need to go to the root causes. Pain was the major cause of desire for euthanasia and needs to be illuminated as it was the basis for the two other discoveries, quality of life and control over the patients’ lives. Conclusion: To get terminally ill patients pain-free and meet their individual health needs can change their wish for euthanasia. / Bakgrund: Eutanasi är idag synonymt med aktiv dödshjälp. En del obotligt sjuka patienter har en önskan om att avsluta sina liv. Syftet: Belysa obotligt sjuka patienters önskan om frivillig eutanasi. Metod: Allmän litteraturstudie. Sju artiklar granskades och analyserades. Resultat: Patienter vill inte leva ett plågsamt liv eller dö en plågsam död, patienter vill ha kontroll över sitt liv och känna sig delaktiga i beslut som rör deras liv och patienter vill känna livskvalité trots sin sjukdom eller behandling. Resultatet visar att smärta, förlorad kontroll och förlorad livskvalité var de stora orsakerna till att obotligt sjuka önskade eutanasi. Diskussion: För att förstå varför dessa patienter önskade eutanasi bör man gå till de underliggande orsakerna. Smärta som var främsta orsaken till önskan om dödshjälp bör framhävas då den ligger till grund för de andra fynden, livskvalité och kontroll över sitt liv. Slutsats: Att få obotligt sjuka patienter smärtfria och tillgodose deras individuella vårdbehov kan få deras önskan om eutanasi att ändras.

This study examines the attitudes and opinions of ALS patients toward mass messages about their condition. Six focus groups of ALS patient support groups viewed and responded to public relations messages, charity advertisements, and a news story. Results suggest that mass messages remind participants of the need for public ALS awareness. Participants also said they shared in the narratives and identify closely with the characters in the messages they viewed, and participants expressed concern with disease depictions. These concerns included a tension between positive and realistic portrayals, identification of message inaccuracies, and a desire for more specific disease information. The ALS disease as it relates to mass communication has not yet been explored in scholarly literature. This study highlights the importance of the thoughts and opinions of ALS patients toward mass communication about their disease, and it provides a rich understanding of the participants' desires for their disease experience to be recognized and understood.

The impression existed that nurses were not always compassionate and caring when they had to nurse terminally ill patients and the question arose whether they were adequately trained for this task. This study focused on the most frequent diseases that cause the death of patients in a province of Angola, and set out to determine what preparation nurses in a specific hospital received to equip them to care for terminally ill patients. A quantitative approach was adopted, using an exploratory and descriptive design, and a self-developed questionnaire was applied as data-collection instrument for a sample of 100 medium- and basic level nurses in a specific hospital in a province of Angola. From the results of the study it was evident that the nurse respondents were well informed as to what it entailed to be terminally ill, which factors affected the patient's comfort, safety and self image needs but only half of the respondents indicated that they received training pertaining to palliative care. Recommendations were made in view of better preparing nurses to care for the terminally ill patient. / Health Studies / M.A. (Health Studies)

Death is a drastic event in one’s life. Through grief, mourning and bereavement, people heal the hurt of their loss of a loved one. Little research exists on bereavement in Black transitional societies of South Africa. As such, the objective of this study was to explore how widows in South African transitional societies, whose husbands have died of terminal illnesses, experience bereavement, and how they cognitively process and cope with the loss. The Participants’ bereavement process was defined as starting when they become aware of their husbands’ anticipated death (anticipatory bereavement). Unstructured and structured interviews were conducted with 10 widows from the community under study and a thematic analysis was performed on the data. Five themes emerged concerning the Participants’ personal characteristics, their challenges and how they dealt with them, their experiences of stressors, and coping. Although the Participants responded to the news of the deaths of their husbands in a similar manner, there were differences in other responses, reflecting individual differences in coping strategies. Some Participants seemed more adaptive, with greater openness and flexibility in social cognition and greater problem-focused coping, while others showed more negative emotions in social interaction, greater loneliness, and expressed relatively closed and inflexible social cognition. However, positive or negative responses and coping did not necessarily determine whether bereavement would be functional or dysfunctional. It was found that the Participants’ anticipatory bereavement did not ease or shorten their sense or period of bereavement after their husband’s death. A model of the cognitive-affective-motivational-behavioural network of bereavement was developed, taking into account the role of culture and how each Participant’s cognition, affect, and the kind of attachment to their husbands motivated their behaviours in particular ways in coping effectively or ineffectively with their bereavement. / Thesis (DPhil)--University of Pretoria, 2010. / Psychology / unrestricted