Family physicians have traditionally prided themselves on comprehensive and continuous provision of care throughout the human life cycle. When managing the terminal phases of illness, however, most clinicians have had little formal education directed at the experience of human suffering and dying. For many physicians the task and challenge of caring for a dying patient can seem overwhelming. The aging of America, development and widespread use of life-prolonging technologies, the ascendency of managed care emphasizing the central role of the primary care physician, media attention, growing discomfort with futile treatment, and the public’s demand for better palliation have all fueled a growing need for physicians to master the art and science of helping patients achieve death with dignity.
KeywordsPalliative Care Neuropathic Pain Cancer Pain Advance Directive Terminal Illness
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- 1.Schonwetter RS, editor. Care of the terminally ill patient. Clin Geriatr Med 1996;12:237–433.Google Scholar
- 2.Cassel CK, Omenn GS, editors. Special issue: caring for patients at the end of life. West J Med 1995;163:224–305.Google Scholar
- 4.Callahan D. The troubled dream of life: living with mortality. New York: Simon & Schuster, 1993.Google Scholar
- 9.Buckman R. How to break bad news: a guide for health care professionals. Baltimore: Johns Hopkins University Press, 1992.Google Scholar
- 12.Kubler-Ross E. On death and dying. New York: Macmillan, 1969.Google Scholar
- 14.World Health Organization. Cancer pain relief and palliative care. Geneva: WHO, 1990. Technical Report Series 804.Google Scholar
- 16.National Hospice Organization. Standards of hospice program of care. Arlington, VA: NHO, 1993.Google Scholar
- 21.The Patient Self-Determination Act of 1990, §§ 4206, 4751 of the Omnibus Reconciliation Act of 1990, Pub L No. 101–508, November 5,1990.Google Scholar
- 26.Jacox AK, Carr DB, Payne R, et al. Management of cancer pain: clinical practice guidelines. Rockville, MD: Agency for Health Care Policy and Research, 1994. AHCPR Publ. No. 94–0592.Google Scholar
- 27.American Pain Society. Principles of analgesic use in the treatment of acute pain and cancer pain. 3rd ed. Skokie, IL: APS, 1992.Google Scholar