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Council on Scientific Affairs, American Medical Association: Good care of the dying patient. JAMA 1996; 275:474_8.

McMillan S: Pain and pain relief experienced by hospice patients with cancer. Cancer Nurs 1996; 19:298_307.

Higginson I: Palliative care: A review of past changes and future trends. J Public Health Med 1933; 15:3_8.

Thalbuber W: Overcoming physician barriers to hospice care. Minn Med 1995; 78:25_8.

Manion J: Cancer pain management in the hospice setting. Minn Med 1995; 78:25_8.

Schonwetter R: Care of the dying geriatric patient. Clin Geriatr 1996; 12:253_65.

Von Guten C, Twaddle M: Terminal care for noncancer patients. Clin Geriatr 1996; 12:349_58.

Long MC: Death and dying and recognizing approaching death. Clin Geriatr 1996; 12:259_68.

Robinson B, Pham H: Cost effectiveness of hospice care. Clin Geriatr 1996; 12:417_28.

Eng M: The hospice interdisciplinary team: A synergistic approach to the care of dying patients and their families. Holistic Nurs Practice 1993; 7:49-56.

Raudonis B: The meaning and impact of empathic relationships in hospice nursing. Cancer Nurs 1993; 16:304_9.

Berry Z, Lynn J: Hospice medicine. JAMA 1993; 270:221-2.

Jackson A: Source of knowledge. Nurs Times 1995; 91:55_7.

Praill D: Approaches to spiritual care. Nurs Times 1995; 91:55_7.

Bone R: Hospice and palliative care. Dis Mon 1995; 41:769_842.

Corless IB: Dying well: Symptom control within hospice care. Ann Rev Nurs Res 1994; 12: 125_46.

Christakis NA, Escarce JJ: Survival of Medicare patients after enrollment in hospice programs. N Eng J Med 1996; 335:172_8.

Emanuel EJ, Emanuel LL: Economics of dying: The illusion of cost savings at the end of life. N Eng J Med 1994; 330:540_4.

Anonymous: Home health and hospice care—U.S. 1992 MMWR 1993; 42:820_4.

Kliska J: Hospice: Beyond boundaries. Conn Med 1994; 58:349_52.

Vladeck B C: From the health care financing administration. JAMA 1996; 274:449.

Emanuel E: Cost savings at the end of life: What do the data show? JAMA 1996; 275:1907_14.

Randal J: Preparing for life's end: Do health professionals need more training? J Natl Cancer Inst 1997; 89:15_6.

Bradshaw A: The spiritual dimension of hospice: The secularization of an ideal. Soc Sci Med 1996; 43:409-19.

Sheahan P: Psychological pain and care. Nurs Times 1996; 92:63,66,68.

Field M, Cassel C: Approaching death: Improving care at the end of life. Institute of Medicine Executive Summary. 1997. Washington D.C.: National Academy Press.

Reichel W: Care of the elderly: Clinical Aspects of Aging. 2nd ed. Baltimore, Maryland: Williams & Wilkins; 1995:647.

McMillan SC, Mahon M: A study of the quality of life of hospice patients on admissions. Cancer Nurs 1994; 17:52_60.

Gordon M, Singer PA: Decisions and care at the end of life. Lancet 1994; 17:52_60.

Miles SH, Weber EP, Koepp R: End of life treatment in managed care: Potential and peril. West J Med 1995; 163:162_305.

Hogan J: Seeking a better way to di. Scientific American 1997; 276: 100_5.

Dawson N: Need satisfaction in terminal care settings. Soc Sci Med 1991; 32:83_7.

Moinpour C, Polissar L: Factors affecting place of death of hospice and nonhospice cancer patients. Am J Public Health 1989; 79: 1549_51.

Berry P, Ward S : Barriers to pain management in hospice: A study of family caregivers. Hospice J 1995; 10:19_33.

Melvin T, Ozbek IN, Eberle DE: Recognition of depression. Hospice J 1995; 10:39_46.

Maurer Baack C: Nursing's role in the nutritional care of the terminally ill: Weathering the storm. Hospice J 1993; 9:113.

Seale C: A comparison of hospice and conventional care. Soc Sci Med 1991; 32:147_52.

Sontag M: A comparison of hospice programs based on

Medicare certification status. Am J Hospice Palliat Care 1996; 13:32_41.

Abyad A: Palliative care: The future. Am J Hospice Palliat Care 1993; 10:23-8.

Enck R: A review of pain management. Am J Hospice Palliat Care 1992; 8:6_9.

Wholihan D: The value of reminiscence in hospice care. Am J Hospice Palliat Care 1992; 9:33_5.

Cooke M: The challenge of hospice nursing in the 90's. Am J Hospice Palliat Care 1992; 9:34_7.

Von Guten C, Von Roenn J, Neely K, et al: Hospice and palliative care: Attitudes and practices of the physician faculty of an academic hospital. Am J Hospice Palliat Care 1995; 12:38_42

Appleton M: Hospice medicine: A Different perspective. Am J
Hospice Palliat Care
1996; 13:7_9

Bergevin P, Bergevin R: Recognizing delirium in hospice patients. Am J Hospice Palliat Care 1996; 13:28_9

O'Callaghan C: Complimentary therapies in terminal care: Pain, music creativity, and music therapy in palliative care. Am J Hospice Palliat Care 1996; 13:43_9.

Paton L: The sacred circle: A different perspective. Am J Hospice Palliat Care 1996; 13:7_9.

Gordon A: An interdisciplinary team approach toward death education. Am J Hospice Palliat Care 1996; 13:21.

Greipp M: SUPPORT study results—lmplications for hospice care. Am J Hospice Palliat Care 1996; 13:38_45.

Van der Poel C: Ethical aspects in palliative care. Am Hospice Palliat Care 1996; 13:49_55.

Grey R: The psychospiritual matrix: A new paradigm for hospice care giving. Am J Hospice Palliat Care 1996; 13:19-25

Paton L, Wicks M: The growth of the hospice movement in Japan.

Am J Hospice Palliat Care 1996; 13:26_8.

Greipp M: Decisions to utilize hospice—pilot study results. Am J Hospice Palliat Care 1996; 13:27_30.

Watt K: Hospice and the elderly: A changing perspective. Am J Hospice Palliat Care 1996; 13:47_8.

Snyder J: Therapeutic touch and the terminally ill: Healing power through the hands. Am J Hospice Palliat Care 1997; 14:83_7.

Bergevin P, Bergevin R: Recognizing depression. Am Hospice Palliat Care 1995; 12:22_3.
Herth K: Engendering hope in the chronically and terminally ill: Nursing interventions. Am J Hospice Palliat Care 1995; 12:31_9.

Byock 1: Patient refusal of nutrition and hydration: Walking the ever fine line. Am J Hospice Palliat Care 1995; 12:813.

Byock 1: Ethics from a hospice perspective. Am J Hospice Palliat Care 1994; 11:9_11.

Morgan A, Lindley C, Berry J: Assessment of pain and patterns of analgesic use in hospice patients. Am J Hospice Palliat Care 1994; 11:22_5.


Dudley J, Smith C, Millison M: Unfinished business: Assessing the spiritual needs of hospice clients. Am J Hospice Palliat Care 1995; 121:30_7.

Meares CJ: Terminal dehydration: A review. Am J Hospice Palliat Care 1994; 11:10_14.

Tierney J, Wilson D: Hospice versus home health care: Regulatory distinctions and program intent. Am J Hospice Palliat Care 1994; 11: 14_22.

Storey P: What is the role of the hospice physician? Am Hospice Palliat Care 1993; 10:2_3.

Fainsinger R, Miller M, Bruera E, et al: Symptom control during the last week of life on a palliative care unit. Am Hospice Palliat Care 1991; 7:5_11.

Turner K, Chye R, Aggarwal G, et al: Dignity in dying: A preliminary study of patients in the last three days of life. Am J Hospice Palliat Care 1996; 12:7_13.

Prigerson H: Determinants of hospice utilization among terminally ill geriatric patients. Home Health Ser Q 1991; 12:81-112.

Wilson S: The family as caregivers: Home hospice care. Fam Community Health 1992; 15:71_80.

Spence R: Nutrition in hospice care. Caring 1988; 7:50_1.

Bohnet N: Hospice concepts in home care. Caring 1996; 15:44_50.

Gurfolino V, Dumas L: Hospice nursing: The concept of palliative care. Nurs Clin North Am 1994; 29:533_46.

Austin C, Cody C, Eyres P, et al: Hospice home care pain manage-ment: Four critical variables. Cancer Nurs 1986; 9:58_65.
Feuz A, Rapin C: An observational study of the role of pain control and food adaptation of elderly patients with terminal cancer. J Am Diet Assoc 1994; 94:767_70.

Hohl D: Patient satisfaction in home care/hospice. Nurs Manage 1994; 25:52_4.

McCann R, Hall W, Groth-Juncker A: Comfort care for terminally ill patients: The appropriate use of nutrition and hydration. JAMA 1994; 272:1263_6.

Storey P: Symptom control in advanced cancer. Semin Oncol 1994: 21:748_53.

Willis W: Hyperalgesia and allodynia: Summary and overview. Hyperalgesia and Allodynia Willis WD, ed: New York, NY: Raven Press Ltd; 1992:1_11.

Khoo D, Hall E, Motson R, et al: Palliation of malignant intestinal obstruction using octreotide. Eur J Cancer 1994; 30A:28_30.

Baines M: Intestinal obstruction. Cancer Surv 1994; 21:227_35.

Palliative Medicine: Problem areas in pain and symptom management. 1994. 21:1-3.

Lamberts S, Van Der Lely A, De Herder W, Hofland L: Octreotide. N Eng J Med 1996; 334:246_9.

Johnson Hurzeler R, Barnum E, K limas S, Michael E: Hospice Care. Handbook of Home Health Care administration. Garthersburg, MD: Aspen Publishers; 1997:782-9.

Hospice Fact Sheet, National Hospice Organization. Arlington, Virginia: NHO Web Page: <>; 1996.

Cancer pain relief and palliative care. Technical Reports Series 804, World Health Organization, Geneva; 1990.

Hospice Facts and Statistics 1996, Hospice Association of America.

O'Sullivan Maillet J, King D: Nutritional care of the terminally ill adult. Nutrition and Hydration in Hospice Care. Binghamton, N.Y.: The Haworth Press; 1993.

Fifield M: Relieving constipation and pain in the terminally ill. Am J Nurs 1991; 7:18_23.

Dobratz M: Analysis of variables that impact psychological adaptation in home hospice patients. Hospice J 1995; l0:75_88.

Holden C: Nutrition and hydration in the terminally ill cancer patient: The nurse's role in helping patients and families cope. Nutrition and Hydration in Hospice Care. Binghamton, N.Y.: The Haworth Press, Inc; 1993.



Stjernsward J, Colleau S, Ventafridda V: The World Health Organization cancer pain and palliative care program: Past, present, and future. J Pain Symptom Manage 1996; 12:12_4.

Infeld D, Crum G, Koshuta M: Characteristics of patients in a long-term care hospice setting. HospiceJ 1990; 6:1_2.

Willert M, Beckwith B, Holm J, Beckwith S: A preliminary study of the impact of terminal illness on spouses: Social support and coping strategies. Hospice J 1995; 10:35_48.

Dobratz M: The life closure scale: A Measure of psychosocial adaptation in death and dying. Hospice J 1990; 6:11_15.

Zerwekh J: A family caregiving model for hospice nursing. Hospice J 1995; 10:27_44.

Millison M: The importance of spirituality in hospice work: A study of hospice professionals. Hospice J 1990; 6:63_5,78.

Millison M: A review of the research on spiritual care and hospice. Hospice J 1995; 10:3_18.

Davis C, Hardy J: Current issues in cancer: Palliative care. Br Med J 1994; 308:1359_62.

Appendix 1.—Helpful Reading in Palliative Care


Doyle D, Hanks GWC, MacDonald N: The Oxford textbook of palliative medicine. Oxford Medical Publications, Oxford, 1993. The gold standard in palliative care in the English-speaking world (and probably elsewhere).

Saunders C, Sykes N: The management of terminal malignant dis-ease, 3rd ed: Edward Arnold, London, 1993. A shorter view with some excellent insights.

Twycross R: Symptom management. Radcliffe Medical Press, Oxford, 1995. (A rather cut and dried approach from one of the founders of the English hospice movement but will give you a quick access to at least one medical approach with an emphasis on pharmacology).

Articles and book chapters

Breitbart W: Psycho-oncology: Depression, anxiety, delirium. Semin Oncol 1994; 21:754_69. (Excellent guide for practitioners).

Brescia F: Specialized care of the terminally ill. In: Cancer: Principles and practice of Oncology, 4th ed: DeVita VT Jr., Hellman S, Rosenberg SA (eds): Philadelphia, Penn: JB Lippincott Co; 1993:2501_7.

Coyle N, Adelhartdt J, Foley KM, Partenoy RK: Character of terminal illness in the advanced cancer patient: Pain and other symptoms during the last four weeks of life. J Pain Symptom Manage 1989; 5:83_93. (Introduction to the prevalent symptoms in a home care program).

Kotlowitz R: From my wife's room. New York Times Magazine, 4 December 1994, pp. 84_89. (Care for the terminally ill from the patient's and family's point of view).

Lederberg ML, Massie MJ: Psychosocial and ethical issues in the care of cancer patients. In: Cancer: Principles and practice of Oncology, 4th ed: DeVita VT Jr., Hellman S, Rosenberg SA (eds): Philadelphia, Penn: JB Lippincott Co; 1993:2448_63.

Sammarno D: Dealing with the dying patient. In: Cancer: Principles and practice of Oncology, 4th ed: DeVita VT Jr., Hellman S, Rosenberg SA (eds): Philadelphia, Penn: JB Lippincott Co; 1993:2508_513.

Saunders C: Introduction—"History and Challenge." In: The management of terminal malignant disease. 3rd ed: London: Saunders C, Sykes N: Edward Arnold; 1993:213_25.

Stoutz ND, Tapper M, Fainsinger RL: Reversible delirium in terminally ill patients. J Pain Symptom Manage 1989; 10:249_53. (Delirium with medically treatable causes).

Twycross RG, Lichter I: The terminal phase. In: The Oxford Textbook of Palliative Medicine. Doyle D, Hanks GWC, MacDonald N: Oxford, England: Oxford Medical Publications; 1993:651_61

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