Bio

Bio


VJ Periyakoil, MD , Clinical Associate Professor of Medicine at Stanford University School of Medicine; Director, Stanford Palliative Care Education & Training Program & the Stanford Hospice & Palliative Medicine Fellowship Program. A nationally recognized leader in geriatrics and palliative care, Periyakoil founded and directs Stanford eCampus ( http://ecampus.stanford.edu), the Ethno-geriatrics & end-of-life Successful Aging Project ( http://geriatrics.stanford.edu ), and Stanford End-of-life (http://endoflife.stanford.edu ). She serves as the Editor-in-Chief of the AAHPM Quarterly of the American Academy of Hospice and Palliative Medicine, as Senior Associate Editor of the Journal of Palliative Medicine, the Vice Chair of the Ethnogeriatrics Committee of the American Geriatrics Society and the Chair of the American Board of Internal Medicine?s Hospice & Palliative Medicine SEP Committee. Her work has been and is funded by grants from NIH, HRSA, foundations as well as the Department of Veterans Affairs. Clinically, she serves as the Associate Director of Palliative Care Services at the VA Palo Alto Health Care Center. Her research focuses on wellbeing of multi-cultural persons in the context of geriatrics, ethno-geriatrics and hospice , palliative care & end-of-life care. She has presented in numerous national meetings including the recent End-of-Life meeting of the Institute of Medicine. ( periyakoil@stanford.edu ; office: 650-493-5000 x 65039).

Clinical Focus


  • Hospice and Palliative Medicine
  • Geriatrics

Academic Appointments


Administrative Appointments


  • Director of Palliative Care Education and Training, Stanford University (2008 - Present)
  • Director, Stanford University Hospice and Palliative Medicine Fellowship Program, Stanford University (2008 - 2015)
  • Director, Stanford e-Campus, Stanford University (2008 - 2015)
  • Director, VA Interprofessional Fellowship in Palliative Care, VA Palo Alto Health Care System System (2005 - 2015)
  • Associate Director, Palliative Care Services, VA Palo Alto Health Care System System (2003 - 2015)

Honors & Awards


  • Clinical Teaching Award, Department of Medicine (2013)
  • Vice Chair, Ethno Geriatrics Committee, American Geriatrics Society (2013-)
  • Member, Public Health: Care, Prevention, and Disparities Committee,, Interagency Pain Research Coordinating Committee (IPRCC) Department of Health and Human Services (2013-)
  • Member, Council of Faculty and Academic Societies (CFAS)., Association of American Medical Colleges (2013-)
  • Member, Publications Committee, American Academy of Hospice and Palliative Medicine (2012-)
  • Chair, Self Evaluation Process for Hospice and Palliative Medicine, American Board of Internal Medicine (2012)
  • Editor-in-Chief, AAHPM Quarterly, American Academy of Hospice and Palliative Medicine (2012)
  • Member of the Program Planning Committee, American Geriatrics Society (2012)
  • Senior Associate Editor for Social Media, Journal of Palliative Medicine (2011)
  • Member, Primary Palliative Care Committee, American Board of Internal Medicine (2011)
  • Member of the National Planning Committee on end of life care, Institute of Medicine (2011)
  • Member, National Priorities Partnership (NPP) Palliative and end-of-life Convening Workshop, National Quality Forum (2010)
  • Clinical Teaching Award, Division of General Internal Medicine (2010)
  • Certificate of Merit for service, American Cancer Society Santa Clara Chapter (2010)
  • Award for Outstanding Service to Palliative Care, Department of Veterans Affairs (2008)
  • Outstanding service award:, American Geriatrics Society: Ethnogeriatrics committee (2008)
  • Young investigator award, American Association of Hospice and Palliative Medicine (2007)

Professional Education


  • Internship:San Joaquin General Hospital - GME OFFICE (06/95) CA
  • Residency:San Joaquin General Hospital - GME OFFICE (6/1997) CA
  • Board Certification, American Board of Internal Medicine, Geriatric Medicine (2010)
  • Board Certification: Hospice and Palliative Medicine, American Board of Internal Medicine (2008)
  • Fellowship:Stanford University - CAPS (6/2000) CA
  • Medical Education:University of Madras
  • Board Certification: Geriatric Medicine, American Board of Internal Medicine (2000)

Community and International Work


  • Member, Board of Directors, American Cancer Society Santa Clara County Unit, Campbell, CA, Campbell, California

    Topic

    Advocacy through ACS community-based cancer outreach, advocacy, and volunteer efforts.

    Partnering Organization(s)

    American Cancer Society

    Populations Served

    Cancer patients in Santa Clara County

    Location

    Bay Area

    Ongoing Project

    Yes

    Opportunities for Student Involvement

    Yes

Research & Scholarship

Current Research and Scholarly Interests


My work is in two areas
1. I study research problems where biological, psychosocial and cultural aspects meet in the care of persons with chronic and serious illnesses.

2. I study the pedagogy of health e-learning using multi-media and Web 2.0 techniques with a special interest in the science of Social Media ( blogs, micro-blogs, etc) and videos to foster learning behaviors and change

Teaching

2013-14 Courses


Graduate and Fellowship Programs


Publications

Journal Articles


  • The flipped classroom paradigm for teaching palliative care skills. The virtual mentor : VM Periyakoil, V. S., Basaviah, P. 2013; 15 (12): 1034-1037
  • The patient perspective and physician's role in making decisions on instituting dialysis. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association Kurella Tamura, M., Periyakoil, V. S. 2013; 28 (11): 2663-2666

    View details for DOI 10.1093/ndt/gft379

    View details for PubMedID 24009286

  • Unmet quality indicators for metastatic cancer patients admitted to intensive care unit in the last two weeks of life. Journal of palliative medicine Blechman, J. A., Rizk, N., Stevens, M. M., Periyakoil, V. S. 2013; 16 (10): 1285-1289

    Abstract

    The majority of U.S. cancer patients express the desire to die at home, though most do not, and are often subjected to ineffective therapies near the end of life (EOL). In 2008 the U.K. Department of Health and National Health Care Service implemented a set of 10 quality markers to improve EOL care (EOLC) for seriously ill persons. Data show that this intervention has had a positive impact on patients' EOLC.The study assessed the quality of EOLC received by terminally ill cancer patients admitted to the intensive care unit (ICU) in the last two weeks of life.A retrospective chart review was done of the electronic medical record (EMR) of 2498 patients admitted to the ICU from January to August 2011. The six U.K. quality indicators pertaining to patients were used to assess quality of EOLC.The setting was a tertiary academic medical center with 663 beds and 66 adult ICU beds in northern California.EMR analysis identified 2498 patients admitted to the ICU during the study period--232 died within two weeks of admission. Sixty-nine decedents had metastatic cancer. Of the patients, 58% were male, average age 59.8 years (range 25-91).Quality indicators were met in a relatively small percentage of patients admitted to the ICU in the last two weeks of life: prognostication 67%, advance care planning 32%, goals of care 42%, caregiver needs 0%, coordination of care across organizational boundaries 7%, and standardized care pathway implementation 58%. Palliative care consultations occurred in 28 patients.Quality indicators for EOLC were unmet in cancer patients admitted to the ICU in the last two weeks of life. Hospital-wide provider education about the need for early advance care planning with all seriously ill patients has been implemented in an effort to improve quality of care at EOL.

    View details for DOI 10.1089/jpm.2013.0257

    View details for PubMedID 24020919

  • Frailty as a terminal illness. American family physician Periyakoil, V. S. 2013; 88 (6): 363-368

    View details for PubMedID 24134043

  • Caring for oneself to care for others: physicians and their self-care. The journal of supportive oncology Sanchez-Reilly, S., Morrison, L. J., Carey, E., Bernacki, R., O'Neill, L., Kapo, J., Periyakoil, V. S., Thomas, J. d. 2013; 11 (2): 75-81

    Abstract

    It is well known that clinicians experience distress and grief in response to their patients' suffering. Oncologists and palliative care specialists are no exception since they commonly experience patient loss and are often affected by unprocessed grief. These emotions can compromise clinicians' personal well-being, since unexamined emotions may lead to burnout, moral distress, compassion fatigue, and poor clinical decisions which adversely affect patient care. One approach to mitigate this harm is self-care, defined as a cadre of activities performed independently by an individual to promote and maintain personal well-being throughout life. This article emphasizes the importance of having a self-care and self-awareness plan when caring for patients with life-limiting cancer and discusses validated methods to increase self-care, enhance self-awareness and improve patient care.

    View details for PubMedID 23967495

  • Multicultural Long-Term Care Nurses' Perceptions of Factors Influencing Patient Dignity at the End of Life JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Periyakoil, V. S., Stevens, M., Kraemer, H. 2013; 61 (3): 440-446

    Abstract

    The goal of this mixed-methods study was to characterize the perceptions of multicultural long-term care nurses about patient dignity at the end-of-life (EOL). The study was conducted in a large, urban, long-term care (LTC) facility. Participants were 45 long-term care nurses and 26 terminally ill nursing home residents. Nurses completed an openended interview about their perceptions of the concept of dying with dignity, and the data were analyzed using grounded theory methods. Main themes identified as promoting resident dignity at the EOL included treating them with respect, helping them prepare for the EOL, promoting shared decision-making, and providing high-quality care. The nurses? cultural and religious backgrounds influenced their perceptions of what constitutes dignity-conserving care. Foreign-born nurses stressed the need for EOL rituals, but this was strikingly absent in the statements of U.S.-born nurses. Foreign-born Catholic nurses stated that the dying experience should not be altered using analgesics to relieve suffering or by attempts to hasten death by forgoing curative therapy or by other means. Nurses and terminally ill individuals completed the Dignity Card-sort Tool (DCT). A comparison of the DCT responses of the LTC nurses cohort with those of the terminally ill participants revealed that the nurses felt patient dignity was eroded when patient wishes were not followed and when they were treated without respect. In contrast, dying LTC residents felt that poor medical care and loss of ability to choose care options were the most important factors leading to erosion of dignity.

    View details for DOI 10.1111/jgs.12145

    View details for Web of Science ID 000316334900019

    View details for PubMedID 23496266

  • What Would Osler Do? : Editorial Journal of Palliative Medicine Periyakoil, V. 2013; 16 (2): 118-119
  • Measuring Grief and Depression in Seriously III Outpatients Using the Palliative Grief Depression Scale JOURNAL OF PALLIATIVE MEDICINE Periyakoil, V. S., Kraemer, H. C., Noda, A. 2012; 15 (12): 1350-1355

    View details for DOI 10.1089/jpm.2012.0280

    View details for Web of Science ID 000311937500011

    View details for PubMedID 23066859

  • Differentiating Grief and Depression in Patients Who Are Seriously Ill AMERICAN FAMILY PHYSICIAN Periyakoil, V. S. 2012; 86 (3): 232-?

    View details for Web of Science ID 000307152500004

    View details for PubMedID 22962985

  • Citalopram for agitation in Alzheimer's disease: Design and methods ALZHEIMERS & DEMENTIA Drye, L. T., Ismail, Z., Porsteinsson, A. P., Rosenberg, P. B., Weintraub, D., Marano, C., Pelton, G., Frangakis, C., Rabins, P. V., Munro, C. A., Meinert, C. L., Devanand, D. P., Yesavage, J., Mintzer, J. E., Schneider, L. S., Pollock, B. G., Lyketsos, C. G. 2012; 8 (2): 121-130

    Abstract

    Agitation is one of the most common neuropsychiatric symptoms of Alzheimer's disease (AD), and is associated with serious adverse consequences for patients and caregivers. Evidence-supported treatment options for agitation are limited. The citalopram for agitation in Alzheimer's disease (CitAD) study was designed to evaluate the potential of citalopram to ameliorate these symptoms.CitAD is a randomized, double-masked, placebo-controlled multicenter clinical trial, with two parallel treatment groups assigned in a 1:1 ratio and randomization stratified by clinical center. The study included eight recruiting clinical centers, a chair's office, and a coordinating center located in university settings in the United States and Canada. A total of 200 individuals having probable AD with clinically significant agitation and without major depression were recruited for this study. Patients were randomized to receive citalopram (target dose of 30 mg/d) or matching placebo. Caregivers of patients in both treatment groups received a structured psychosocial therapy. Agitation was compared between treatment groups using the NeuroBehavioral Rating Scale and the AD Cooperative Study- Clinical Global Impression of Change, which are the primary outcomes. Functional performance, cognition, caregiver distress, and rates of adverse and serious adverse events were also measured.The authors believe the design elements in CitAD are important features to be included in trials assessing the safety and efficacy of psychotropic medications for clinically significant agitation in AD.

    View details for DOI 10.1016/j.jalz.2011.01.007

    View details for Web of Science ID 000301991600005

    View details for PubMedID 22301195

  • Assessment of Factors Influencing Preservation of Dignity at Life's End: Creation and the Cross-Cultural Validation of the Preservation of Dignity Card-Sort Tool JOURNAL OF PALLIATIVE MEDICINE Periyakoil, V. S., Noda, A. M., Kraemer, H. C. 2010; 13 (5): 495-500

    Abstract

    Preserving patient dignity is a sentinel premise of palliative care. This study was conducted to gain a better understanding of factors influencing preservation of dignity in the last chapter of life.We conducted an open-ended written survey of 100 multidisciplinary providers (69% response rate) and responses were categorized to identify 2 main themes, 5 subthemes, and 10 individual factors that were used to create the preservation of dignity card-sort tool (p-DCT). The 10-item rank order tool was administered to a cohort of community dwelling Filipino Americans (n = 140, age mean = 61.3, 45% male and 55% female). A Spearman correlation matrix was constructed for all the 10 individual factors as well as the themes and subthemes based on the data generated by the subjects.The individual factors were minimally correlated with each other indicating that each factor was an independent stand-alone factor. The median, 25th and 75th percentile ranks were calculated and "s/he has self-respect" (intrinsic theme, self-esteem subtheme) emerged as the most important factor (mean rank 3.0 and median rank 2.0) followed by "others treat her/him with respect" (extrinsic theme, respect subtheme) with a mean rank = 3.6 and median = 3.0.The p-DCT is a simple, rank order card-sort tool that may help clinicians identify patients' perceptions of key factors influencing the preservation of their dignity in the last chapter of life.

    View details for DOI 10.1089/jpm.2009.0279

    View details for Web of Science ID 000277973800004

    View details for PubMedID 20420549

  • Creation and the Empirical Validation of the Dignity Card-Sort Tool To Assess Factors Influencing Erosion of Dignity at Life's End JOURNAL OF PALLIATIVE MEDICINE Periyakoil, V. S., Kraemer, H. C., Noda, A. 2009; 12 (12): 1125-1130

    Abstract

    Patients often experience erosion of dignity as they cope with the dying process. Preserving patient dignity is a sentinel premise of palliative care. This study was conducted to gain a better understanding of factors influencing erosion of dignity at the end of life. We conducted an open-ended written survey of 100 multidisciplinary providers (69% response rate) and responses were categorized to identify 18 themes that were used to create a card-sort tool. The initial 18-item tool was administered to nurses (n = 83), nonhospice community-dwelling subjects (n = 190) and hospice patients (n = 26) and a principal component analysis (PCA) was used to identify the 6 primary factors. The key item in each factor as identified by the PCA was used to create the final 6-item dignity card-sort tool (DCT). The DCT was also administered to physicians caring for palliative care patients (n = 21). For each of the final 6 items, the correlation between the respondents (nurses, physicians, nonterminally ill subjects, and subjects receiving hospice care) was calculated using the Spearman's correlation coefficient. The nurses were very highly positively correlated with the physicians (correlation coefficient = 0.94) and the community-dwelling nonterminally ill subjects were highly positively correlated with the subjects receiving hospice care (correlation coefficient = 0.67). More importantly, both the nurses and physicians were negatively correlated with both community dwelling nonterminally ill subjects and the subjects receiving hospice care. The health professionals in the study felt that treating a patient with disrespect and not carrying out their wishes resulted in erosion of dignity. In contrast patients thought that poor medical care and untreated pain were the most important factors leading to erosion of dignity at life's end. The DCT is a promising tool that may help clinicians identify key factors resulting in perceptions of erosion of dignity in adult palliative care patients.

    View details for DOI 10.1089/jpm.2009.0123

    View details for Web of Science ID 000272525200017

    View details for PubMedID 19708793

  • Change Management: The Secret Sauce of Successful Program Building JOURNAL OF PALLIATIVE MEDICINE Periyakoil, V. S. 2009; 12 (4): 329-330

    View details for DOI 10.1089/jpm.2009.9645

    View details for Web of Science ID 000264626700015

    View details for PubMedID 19327068

  • Education techniques in palliative care Center for advancement of palliative care: http://campus.capc.org/PalliativeCareCourses/EducationTechniquesinPalliativeCare V.S. Periyakoil, MD, Weissman.D 2009
  • Consultation etiquette: Marketing and patient referrals Center for Advancement of Palliative Care Campus Online: http://campus.capc.org/PalliativeCareCourses/ConsultationEtiquette Periyakoil VS, Weissman D 2009
  • Marketing for palliative care programs Center for advancement of palliative care: http://campus.capc.org/PalliativeCareCourses/MarketingforPalliativeCarePrograms Periyakoil V.S., Weissman D 2009
  • Organizational change Center for advancement of palliative care: http://campus.capc.org/PalliativeCareCourses/OrganizationalChange Periyakoil V.S., Weissman D 2009
  • Using metaphors in medicine JOURNAL OF PALLIATIVE MEDICINE Periyakoil, V. S. 2008; 11 (6): 842-844

    View details for DOI 10.1089/jpm.2008.9885

    View details for Web of Science ID 000258896100011

    View details for PubMedID 18715175

  • Geography decides destiny JOURNAL OF PALLIATIVE MEDICINE Periyakoil, V. S. 2008; 11 (5): 694-695

    View details for DOI 10.1089/jpm.2008.9905

    View details for Web of Science ID 000257535100009

    View details for PubMedID 18588399

  • The role of international medical graduates in the future of palliative care JOURNAL OF PALLIATIVE MEDICINE Periyakoil, V. S. 2008; 11 (4): 563-564

    View details for DOI 10.1089/jpm.2008.9925

    View details for Web of Science ID 000256241300007

    View details for PubMedID 18454607

  • On the endangered species list: Palliative care junior faculty JOURNAL OF PALLIATIVE MEDICINE Periyakoil, V. S. 2008; 11 (3): 431-433

    View details for DOI 10.1089/jpm.2008.9955

    View details for Web of Science ID 000254651800009

    View details for PubMedID 18363484

  • Growing pains: Health care enters "team"-age JOURNAL OF PALLIATIVE MEDICINE Periyakoil, V. S. 2008; 11 (2): 171-175

    View details for DOI 10.1089/jpm.2008.9975

    View details for Web of Science ID 000254651600011

    View details for PubMedID 18333730

  • Borders without doctors JOURNAL OF PALLIATIVE MEDICINE Periyakoil, V. S. 2008; 11 (1): 31-32

    View details for DOI 10.1089/jpm.2008.9995

    View details for Web of Science ID 000252559900008

    View details for PubMedID 18370889

  • Wrap your worthy cause in a corporate image JOURNAL OF PALLIATIVE MEDICINE Periyakoil, V. S. 2007; 10 (6): 1256-1257

    View details for DOI 10.1089/jpm.2007.9845

    View details for Web of Science ID 000252157200011

    View details for PubMedID 18095802

  • Declaration of interdependence: The need for mosaic mentoring in palliative care JOURNAL OF PALLIATIVE MEDICINE Periyakoil, V. S. 2007; 10 (5): 1048-1049

    View details for DOI 10.1089/jpm.2006.9911

    View details for Web of Science ID 000251086100012

    View details for PubMedID 17985959

  • First, do not abandon JOURNAL OF PALLIATIVE MEDICINE Periyakoil, V. S. 2007; 10 (4): 865-866

    View details for DOI 10.1089/jpm.2007.9932

    View details for Web of Science ID 000249251700014

    View details for PubMedID 17803405

  • Taming wicked problems in modern health care systems JOURNAL OF PALLIATIVE MEDICINE Periyakoil, V. S. 2007; 10 (3): 658-659

    View details for DOI 10.1089/jpm.2007.9955

    View details for Web of Science ID 000247498900013

    View details for PubMedID 17592976

  • Panic disorder at the end of life # 145 JOURNAL OF PALLIATIVE MEDICINE Periyakoil, V. S. 2007; 10 (2): 483-484

    View details for DOI 10.1089/jpm.2006.9977

    View details for Web of Science ID 000246275900032

    View details for PubMedID 17472520

  • "Be nice-until it is time not to be nice". Journal of palliative medicine Periyakoil, V. S. 2007; 10 (2): 308-?

    View details for PubMedID 17472500

  • Quality of care in a veterans affairs' nursing home-based hospice unit JOURNAL OF PALLIATIVE MEDICINE Hallenbeck, J., Hickey, E., Czarnowski, E., Lehner, L., Periyakoil, V. S. 2007; 10 (1): 127-135

    Abstract

    To report on quality of care in a Veterans Affairs (VA) dedicated hospice unit.Mortality follow-back survey of bereaved family members, using a quality of care instrument.A VA inpatient hospice unit.Bereaved family members.Satisfaction with care as perceived by family members using a telephone survey.159 family members were contacted with 102 completing full and 37 completing abbreviated surveys. (Overall response rate: 87.4%, complete responses: 64.2%) 98% of all respondents reported overall quality of care as Excellent or Very Good.High levels of satisfaction were reported by family members. Implications of this initiative for the provision of hospice care in nursing homes are discussed, including replication of the model in both VA and non-VA nursing home settings.

    View details for DOI 10.1089/jpm.2006.0141

    View details for Web of Science ID 000244135100021

    View details for PubMedID 17298261

  • Mainstreaming palliative care JOURNAL OF PALLIATIVE MEDICINE Periyakoil, V. S., von Gunten, C. F. 2007; 10 (1): 40-42

    View details for DOI 10.1089/jpm.2006.9993

    View details for Web of Science ID 000244135100011

    View details for PubMedID 17298251

  • The development and initial validation of the Terminally Ill Grief or Depression Scale (TIGDS) INTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH Periyakoil, V. S., Kraemer, H. C., Noda, A., Moos, R., Hallenbeck, J., Webster, M., Yesavage, J. A. 2005; 14 (4): 202-212

    Abstract

    Patients often experience 'preparatory-grief' as they cope with the dying process. Some may be depressed. The Terminally Ill Grief or Depression Scale (TIGDS), comprising grief and depression sub-scales, is a new self-report measure designed to differentiate between preparatory-grief and depression in adult inpatients. The initial 100-item inventory was assembled based on literature review, interviews with clinicians and dying patients and then shortened to 42 items based on consensus expert opinion. Validity and reliability were tested in a sample of 55 terminally ill adults. The consensus clinical opinion was used as the gold standard to differentiate between preparatory grief and depression. The intra-class correlation coefficient was high (it was calculated to estimate the test-retest reliability for the 47 patients who had completed the TIGDS twice--retest was administered 2 to 7 days after the initial test), ranging from 0.86 (grief) to 0.97 (depression). The validity of TIGDS was assessed using a receiver operating characteristic curve analysis, comparing the first test with the clinical criterion. The first and only variable and cut-point was the depression score (chi-square = 18.4, p < 0.001, cut point = 3). The sensitivity of the TIGDS was 0.727 and specificity was 0.886 for the depression = 3 cutoff score. The construct validity of the TIGDS was tested by comparing with the Hospital Anxiety and Depression Scale (HADS). The TIGDS depression subscale showed strong convergent validity and the TIGDS grief subscale showed strong discriminant validity with the HADS total score.

    View details for DOI 10.1002/mpr.8

    View details for Web of Science ID 000234094000003

    View details for PubMedID 16395873

  • Kappa coefficients in medical research STATISTICS IN MEDICINE Kraemer, H. C., Periyakoil, V. S., Noda, A. 2002; 21 (14): 2109-2129

    Abstract

    Kappa coefficients are measures of correlation between categorical variables often used as reliability or validity coefficients. We recapitulate development and definitions of the K (categories) by M (ratings) kappas (K x M), discuss what they are well- or ill-designed to do, and summarize where kappas now stand with regard to their application in medical research. The 2 x M(M>/=2) intraclass kappa seems the ideal measure of binary reliability; a 2 x 2 weighted kappa is an excellent choice, though not a unique one, as a validity measure. For both the intraclass and weighted kappas, we address continuing problems with kappas. There are serious problems with using the K x M intraclass (K>2) or the various K x M weighted kappas for K>2 or M>2 in any context, either because they convey incomplete and possibly misleading information, or because other approaches are preferable to their use. We illustrate the use of the recommended kappas with applications in medical research.

    View details for DOI 10.1002/sim.1180

    View details for Web of Science ID 000176726900009

    View details for PubMedID 12111890

  • Identifying and managing preparatory grief and depression at the end of life AMERICAN FAMILY PHYSICIAN Periyakoil, V. S., Hallenbeck, J. 2002; 65 (5): 883-890

    Abstract

    Grief and depression present similarly in patients who are dying. Conventional symptoms (e.g., frequent crying, weight loss, thoughts of death) used to assess for depression in these patients may be imprecise because these symptoms are also present in preparatory grief and as a part of the normal dying process. Preparatory grief is experienced by virtually all patients who are dying and can be facilitated with psychosocial support and counseling. Ongoing pharmacotherapy is generally not beneficial and may even be harmful to patients who are grieving. Evidence of disturbed self-esteem, hopelessness, an active desire to die and ruminative thoughts about death and suicide are indicative of depression in patients who are dying. Physicians should have a low threshold for treating depression in patients nearing the end of life because depression is associated with tremendous suffering and poor quality of life.

    View details for Web of Science ID 000174255800009

    View details for PubMedID 11898960

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