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Showing 1 - 200 of 1085 Journals sorted alphabetically
AADE in Practice     Hybrid Journal   (Followers: 6)
Abstracts in Anthropology     Full-text available via subscription   (Followers: 21)
Academic Pathology     Open Access   (Followers: 5)
Accounting History     Hybrid Journal   (Followers: 17, SJR: 0.527, CiteScore: 1)
Acta Radiologica     Hybrid Journal   (Followers: 2, SJR: 0.754, CiteScore: 2)
Acta Radiologica Open     Open Access   (Followers: 3)
Acta Sociologica     Hybrid Journal   (Followers: 37, SJR: 0.939, CiteScore: 2)
Action Research     Hybrid Journal   (Followers: 49, SJR: 0.308, CiteScore: 1)
Active Learning in Higher Education     Hybrid Journal   (Followers: 345, SJR: 1.397, CiteScore: 2)
Adaptive Behavior     Hybrid Journal   (Followers: 9, SJR: 0.288, CiteScore: 1)
Administration & Society     Hybrid Journal   (Followers: 14, SJR: 0.675, CiteScore: 1)
Adoption & Fostering     Hybrid Journal   (Followers: 23, SJR: 0.313, CiteScore: 0)
Adsorption Science & Technology     Open Access   (Followers: 7, SJR: 0.258, CiteScore: 1)
Adult Education Quarterly     Hybrid Journal   (Followers: 214, SJR: 0.566, CiteScore: 2)
Adult Learning     Hybrid Journal   (Followers: 41)
Advances in Dental Research     Hybrid Journal   (Followers: 7, SJR: 1.791, CiteScore: 4)
Advances in Developing Human Resources     Hybrid Journal   (Followers: 30, SJR: 0.614, CiteScore: 2)
Advances in Mechanical Engineering     Open Access   (Followers: 134, SJR: 0.272, CiteScore: 1)
Advances in Methods and Practices in Psychological Science     Full-text available via subscription   (Followers: 10)
Advances in Structural Engineering     Full-text available via subscription   (Followers: 45, SJR: 0.599, CiteScore: 1)
Advances in Tumor Virology     Open Access   (Followers: 3, SJR: 0.108, CiteScore: 0)
AERA Open     Open Access   (Followers: 10)
Affilia     Hybrid Journal   (Followers: 4, SJR: 0.496, CiteScore: 1)
Agrarian South : J. of Political Economy     Hybrid Journal   (Followers: 2)
Air, Soil & Water Research     Open Access   (Followers: 13, SJR: 0.214, CiteScore: 1)
Alexandria : The J. of National and Intl. Library and Information Issues     Full-text available via subscription   (Followers: 64)
AlterNative : An Intl. J. of Indigenous Peoples     Full-text available via subscription   (Followers: 13, SJR: 0.194, CiteScore: 0)
Alternative Law J.     Hybrid Journal   (Followers: 10, SJR: 0.176, CiteScore: 0)
Alternatives : Global, Local, Political     Hybrid Journal   (Followers: 12, SJR: 0.351, CiteScore: 1)
American Behavioral Scientist     Hybrid Journal   (Followers: 22, SJR: 0.982, CiteScore: 2)
American Economist     Hybrid Journal   (Followers: 7)
American Educational Research J.     Hybrid Journal   (Followers: 207, SJR: 2.913, CiteScore: 3)
American J. of Alzheimer's Disease and Other Dementias     Hybrid Journal   (Followers: 18, SJR: 0.67, CiteScore: 2)
American J. of Cosmetic Surgery     Hybrid Journal   (Followers: 6)
American J. of Evaluation     Hybrid Journal   (Followers: 16, SJR: 0.646, CiteScore: 2)
American J. of Health Promotion     Hybrid Journal   (Followers: 32, SJR: 0.807, CiteScore: 1)
American J. of Hospice and Palliative Medicine     Hybrid Journal   (Followers: 41, SJR: 0.65, CiteScore: 1)
American J. of Law & Medicine     Full-text available via subscription   (Followers: 11, SJR: 0.204, CiteScore: 1)
American J. of Lifestyle Medicine     Hybrid Journal   (Followers: 5, SJR: 0.431, CiteScore: 1)
American J. of Medical Quality     Hybrid Journal   (Followers: 11, SJR: 0.777, CiteScore: 1)
American J. of Men's Health     Open Access   (Followers: 8, SJR: 0.595, CiteScore: 2)
American J. of Rhinology and Allergy     Hybrid Journal   (Followers: 9, SJR: 0.972, CiteScore: 2)
American J. of Sports Medicine     Hybrid Journal   (Followers: 193, SJR: 3.949, CiteScore: 6)
American Politics Research     Hybrid Journal   (Followers: 33, SJR: 1.313, CiteScore: 1)
American Review of Public Administration     Hybrid Journal   (Followers: 19, SJR: 2.062, CiteScore: 2)
American Sociological Review     Hybrid Journal   (Followers: 307, SJR: 6.333, CiteScore: 6)
American String Teacher     Full-text available via subscription   (Followers: 2)
Analytical Chemistry Insights     Open Access   (Followers: 25, SJR: 0.224, CiteScore: 1)
Angiology     Hybrid Journal   (Followers: 3, SJR: 0.849, CiteScore: 2)
Animation     Hybrid Journal   (Followers: 13, SJR: 0.197, CiteScore: 0)
Annals of Clinical Biochemistry     Hybrid Journal   (Followers: 10, SJR: 0.634, CiteScore: 1)
Annals of Otology, Rhinology & Laryngology     Hybrid Journal   (Followers: 15, SJR: 0.807, CiteScore: 1)
Annals of Pharmacotherapy     Hybrid Journal   (Followers: 52, SJR: 1.096, CiteScore: 2)
Annals of the American Academy of Political and Social Science     Hybrid Journal   (Followers: 46, SJR: 1.225, CiteScore: 3)
Annals of the ICRP     Hybrid Journal   (Followers: 4, SJR: 0.548, CiteScore: 1)
Anthropocene Review     Hybrid Journal   (Followers: 9, SJR: 3.341, CiteScore: 7)
Anthropological Theory     Hybrid Journal   (Followers: 42, SJR: 0.739, CiteScore: 1)
Antitrust Bulletin     Hybrid Journal   (Followers: 11)
Antiviral Chemistry and Chemotherapy     Open Access   (Followers: 2, SJR: 0.635, CiteScore: 2)
Antyajaa : Indian J. of Women and Social Change     Hybrid Journal  
Applied Biosafety     Hybrid Journal   (SJR: 0.131, CiteScore: 0)
Applied Psychological Measurement     Hybrid Journal   (Followers: 23, SJR: 1.17, CiteScore: 1)
Applied Spectroscopy     Full-text available via subscription   (Followers: 26, SJR: 0.489, CiteScore: 2)
Armed Forces & Society     Hybrid Journal   (Followers: 19, SJR: 0.29, CiteScore: 1)
Arts and Humanities in Higher Education     Hybrid Journal   (Followers: 42, SJR: 0.305, CiteScore: 1)
Asia Pacific Media Educator     Hybrid Journal   (Followers: 1, SJR: 0.23, CiteScore: 0)
Asia-Pacific J. of Management Research and Innovation     Full-text available via subscription   (Followers: 3)
Asia-Pacific J. of Public Health     Hybrid Journal   (Followers: 9, SJR: 0.558, CiteScore: 1)
Asian and Pacific Migration J.     Full-text available via subscription   (Followers: 105, SJR: 0.324, CiteScore: 1)
Asian Cardiovascular and Thoracic Annals     Hybrid Journal   (Followers: 2, SJR: 0.305, CiteScore: 0)
Asian J. of Comparative Politics     Hybrid Journal   (Followers: 4)
Asian J. of Legal Education     Full-text available via subscription   (Followers: 4)
Asian J. of Management Cases     Hybrid Journal   (Followers: 6, SJR: 0.101, CiteScore: 0)
ASN Neuro     Open Access   (Followers: 2, SJR: 1.534, CiteScore: 3)
Assessment     Hybrid Journal   (Followers: 17, SJR: 1.519, CiteScore: 3)
Assessment for Effective Intervention     Hybrid Journal   (Followers: 15, SJR: 0.578, CiteScore: 1)
Australasian Psychiatry     Hybrid Journal   (Followers: 9, SJR: 0.433, CiteScore: 1)
Australian & New Zealand J. of Psychiatry     Hybrid Journal   (Followers: 20, SJR: 1.801, CiteScore: 2)
Australian and New Zealand J. of Criminology     Hybrid Journal   (Followers: 523, SJR: 0.612, CiteScore: 1)
Australian J. of Career Development     Hybrid Journal   (Followers: 4)
Australian J. of Education     Hybrid Journal   (Followers: 42, SJR: 0.403, CiteScore: 1)
Australian J. of Management     Hybrid Journal   (Followers: 13, SJR: 0.497, CiteScore: 1)
Autism     Hybrid Journal   (Followers: 325, SJR: 1.739, CiteScore: 4)
Autism & Developmental Language Impairments     Open Access   (Followers: 11)
Behavior Modification     Hybrid Journal   (Followers: 12, SJR: 0.877, CiteScore: 2)
Behavioral and Cognitive Neuroscience Reviews     Hybrid Journal   (Followers: 26)
Bible Translator     Hybrid Journal   (Followers: 12)
Biblical Theology Bulletin     Hybrid Journal   (Followers: 18, SJR: 0.184, CiteScore: 0)
Big Data & Society     Open Access   (Followers: 48)
Biochemistry Insights     Open Access   (Followers: 7)
Bioinformatics and Biology Insights     Open Access   (Followers: 12, SJR: 1.141, CiteScore: 2)
Biological Research for Nursing     Hybrid Journal   (Followers: 7, SJR: 0.685, CiteScore: 2)
Biomarker Insights     Open Access   (Followers: 1, SJR: 0.81, CiteScore: 2)
Biomarkers in Cancer     Open Access   (Followers: 10)
Biomedical Engineering and Computational Biology     Open Access   (Followers: 12)
Biomedical Informatics Insights     Open Access   (Followers: 8)
Bioscope: South Asian Screen Studies     Hybrid Journal   (Followers: 3, SJR: 0.235, CiteScore: 0)
BMS: Bulletin of Sociological Methodology/Bulletin de Méthodologie Sociologique     Hybrid Journal   (Followers: 4, SJR: 0.226, CiteScore: 0)
Body & Society     Hybrid Journal   (Followers: 25, SJR: 1.531, CiteScore: 3)
Bone and Tissue Regeneration Insights     Open Access   (Followers: 2)
Brain and Neuroscience Advances     Open Access  
Breast Cancer : Basic and Clinical Research     Open Access   (Followers: 9, SJR: 0.823, CiteScore: 2)
British J. of Music Therapy     Hybrid Journal   (Followers: 8)
British J. of Occupational Therapy     Hybrid Journal   (Followers: 195, SJR: 0.323, CiteScore: 1)
British J. of Pain     Hybrid Journal   (Followers: 25, SJR: 0.579, CiteScore: 2)
British J. of Politics and Intl. Relations     Hybrid Journal   (Followers: 32, SJR: 0.91, CiteScore: 2)
British J. of Visual Impairment     Hybrid Journal   (Followers: 13, SJR: 0.337, CiteScore: 1)
British J.ism Review     Hybrid Journal   (Followers: 17)
Building Acoustics     Hybrid Journal   (Followers: 4, SJR: 0.215, CiteScore: 1)
Building Services Engineering Research & Technology     Hybrid Journal   (Followers: 3, SJR: 0.583, CiteScore: 1)
Bulletin of Science, Technology & Society     Hybrid Journal   (Followers: 7)
Business & Society     Hybrid Journal   (Followers: 12)
Business and Professional Communication Quarterly     Hybrid Journal   (Followers: 8, SJR: 0.348, CiteScore: 1)
Business Information Review     Hybrid Journal   (Followers: 16, SJR: 0.279, CiteScore: 0)
Business Perspectives and Research     Hybrid Journal   (Followers: 3)
Cahiers Élisabéthains     Hybrid Journal   (Followers: 1, SJR: 0.111, CiteScore: 0)
Calcutta Statistical Association Bulletin     Full-text available via subscription   (Followers: 1)
California Management Review     Hybrid Journal   (Followers: 30, SJR: 2.209, CiteScore: 4)
Canadian J. of Kidney Health and Disease     Open Access   (Followers: 6, SJR: 1.007, CiteScore: 2)
Canadian J. of Nursing Research (CJNR)     Hybrid Journal   (Followers: 13)
Canadian J. of Occupational Therapy     Hybrid Journal   (Followers: 134, SJR: 0.626, CiteScore: 1)
Canadian J. of Psychiatry     Hybrid Journal   (Followers: 28, SJR: 1.769, CiteScore: 3)
Canadian J. of School Psychology     Hybrid Journal   (Followers: 11, SJR: 0.266, CiteScore: 1)
Canadian Pharmacists J. / Revue des Pharmaciens du Canada     Hybrid Journal   (Followers: 3, SJR: 0.536, CiteScore: 1)
Cancer Control     Open Access   (Followers: 1)
Cancer Growth and Metastasis     Open Access   (Followers: 1)
Cancer Informatics     Open Access   (Followers: 4, SJR: 0.64, CiteScore: 1)
Capital and Class     Hybrid Journal   (Followers: 7, SJR: 0.282, CiteScore: 1)
Cardiac Cath Lab Director     Full-text available via subscription  
Cardiovascular and Thoracic Open     Open Access  
Career Development and Transition for Exceptional Individuals     Hybrid Journal   (Followers: 8, SJR: 0.44, CiteScore: 1)
Cartilage     Hybrid Journal   (Followers: 5, SJR: 0.889, CiteScore: 3)
Cell and Tissue Transplantation and Therapy     Open Access   (Followers: 2)
Cell Transplantation     Open Access   (Followers: 4, SJR: 1.023, CiteScore: 3)
Cephalalgia     Hybrid Journal   (Followers: 7, SJR: 1.581, CiteScore: 3)
Child Language Teaching and Therapy     Hybrid Journal   (Followers: 31, SJR: 0.501, CiteScore: 1)
Child Maltreatment     Hybrid Journal   (Followers: 9, SJR: 1.22, CiteScore: 3)
Child Neurology Open     Open Access   (Followers: 6)
Childhood     Hybrid Journal   (Followers: 18, SJR: 0.894, CiteScore: 2)
Childhood Obesity and Nutrition     Open Access   (Followers: 11)
China Information     Hybrid Journal   (Followers: 7, SJR: 0.767, CiteScore: 2)
China Report     Hybrid Journal   (Followers: 10, SJR: 0.221, CiteScore: 0)
Chinese J. of Sociology     Full-text available via subscription   (Followers: 4)
Christianity & Literature     Full-text available via subscription   (Followers: 8)
Chronic Illness     Hybrid Journal   (Followers: 6, SJR: 0.672, CiteScore: 2)
Chronic Respiratory Disease     Hybrid Journal   (Followers: 9, SJR: 0.808, CiteScore: 2)
Chronic Stress     Open Access  
Citizenship, Social and Economics Education     Full-text available via subscription   (Followers: 6, SJR: 0.145, CiteScore: 0)
Cleft Palate-Craniofacial J.     Hybrid Journal   (Followers: 7, SJR: 0.757, CiteScore: 1)
Clin-Alert     Hybrid Journal   (Followers: 1)
Clinical and Applied Thrombosis/Hemostasis     Open Access   (Followers: 16, SJR: 0.49, CiteScore: 1)
Clinical and Translational Neuroscience     Open Access  
Clinical Case Studies     Hybrid Journal   (Followers: 3, SJR: 0.364, CiteScore: 1)
Clinical Child Psychology and Psychiatry     Hybrid Journal   (Followers: 45, SJR: 0.73, CiteScore: 2)
Clinical EEG and Neuroscience     Hybrid Journal   (Followers: 6, SJR: 0.552, CiteScore: 2)
Clinical Ethics     Hybrid Journal   (Followers: 10, SJR: 0.296, CiteScore: 1)
Clinical Medicine Insights : Arthritis and Musculoskeletal Disorders     Open Access   (Followers: 3, SJR: 0.537, CiteScore: 2)
Clinical Medicine Insights : Blood Disorders     Open Access   (SJR: 0.314, CiteScore: 2)
Clinical Medicine Insights : Cardiology     Open Access   (Followers: 6, SJR: 0.686, CiteScore: 2)
Clinical Medicine Insights : Case Reports     Open Access   (Followers: 1, SJR: 0.283, CiteScore: 1)
Clinical Medicine Insights : Circulatory, Respiratory and Pulmonary Medicine     Open Access   (Followers: 3, SJR: 0.425, CiteScore: 2)
Clinical Medicine Insights : Ear, Nose and Throat     Open Access   (Followers: 1)
Clinical Medicine Insights : Endocrinology and Diabetes     Open Access   (Followers: 32, SJR: 0.63, CiteScore: 2)
Clinical Medicine Insights : Oncology     Open Access   (Followers: 3, SJR: 1.129, CiteScore: 3)
Clinical Medicine Insights : Pediatrics     Open Access   (Followers: 3)
Clinical Medicine Insights : Psychiatry     Open Access   (Followers: 9)
Clinical Medicine Insights : Reproductive Health     Open Access   (Followers: 2, SJR: 0.776, CiteScore: 0)
Clinical Medicine Insights : Therapeutics     Open Access   (Followers: 1, SJR: 0.172, CiteScore: 0)
Clinical Medicine Insights : Trauma and Intensive Medicine     Open Access   (Followers: 4)
Clinical Medicine Insights : Urology     Open Access   (Followers: 2)
Clinical Medicine Insights : Women's Health     Open Access   (Followers: 4)
Clinical Nursing Research     Hybrid Journal   (Followers: 29, SJR: 0.471, CiteScore: 1)
Clinical Pathology     Open Access   (Followers: 3)
Clinical Pediatrics     Hybrid Journal   (Followers: 22, SJR: 0.487, CiteScore: 1)
Clinical Psychological Science     Hybrid Journal   (Followers: 11, SJR: 3.281, CiteScore: 5)
Clinical Rehabilitation     Hybrid Journal   (Followers: 70, SJR: 1.322, CiteScore: 3)
Clinical Risk     Hybrid Journal   (Followers: 5, SJR: 0.133, CiteScore: 0)
Clinical Trials     Hybrid Journal   (Followers: 22, SJR: 2.399, CiteScore: 2)
Clothing and Textiles Research J.     Hybrid Journal   (Followers: 24, SJR: 0.36, CiteScore: 1)
Common Law World Review     Full-text available via subscription   (Followers: 18)
Communication & Sport     Hybrid Journal   (Followers: 8, SJR: 0.385, CiteScore: 1)
Communication and the Public     Hybrid Journal   (Followers: 1)
Communication Disorders Quarterly     Hybrid Journal   (Followers: 15, SJR: 0.458, CiteScore: 1)
Communication Research     Hybrid Journal   (Followers: 20, SJR: 2.171, CiteScore: 3)
Community College Review     Hybrid Journal   (Followers: 9, SJR: 1.451, CiteScore: 1)
Comparative Political Studies     Hybrid Journal   (Followers: 226, SJR: 3.772, CiteScore: 3)
Compensation & Benefits Review     Hybrid Journal   (Followers: 8)
Competition & Change     Hybrid Journal   (Followers: 11, SJR: 0.843, CiteScore: 2)
Competition and Regulation in Network Industries     Full-text available via subscription   (Followers: 8, SJR: 0.143, CiteScore: 0)
Concurrent Engineering     Hybrid Journal   (Followers: 3, SJR: 0.642, CiteScore: 2)
Conflict Management and Peace Science     Hybrid Journal   (Followers: 35, SJR: 2.441, CiteScore: 1)
Contemporary Drug Problems     Full-text available via subscription   (Followers: 3, SJR: 0.609, CiteScore: 2)
Contemporary Education Dialogue     Hybrid Journal   (Followers: 5, SJR: 0.102, CiteScore: 0)
Contemporary Issues in Early Childhood     Full-text available via subscription   (Followers: 6, SJR: 0.766, CiteScore: 1)
Contemporary Review of the Middle East     Full-text available via subscription   (Followers: 12)
Contemporary Sociology : A J. of Reviews     Full-text available via subscription   (Followers: 34, SJR: 0.195, CiteScore: 0)
Contemporary Voice of Dalit     Full-text available via subscription   (Followers: 1)
Contexts     Hybrid Journal   (Followers: 6)
Contributions to Indian Sociology     Hybrid Journal   (Followers: 4, SJR: 0.376, CiteScore: 0)
Convergence The Intl. J. of Research into New Media Technologies     Hybrid Journal   (Followers: 50, SJR: 0.521, CiteScore: 1)

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Similar Journals
Journal Cover
American Journal of Hospice and Palliative Medicine
Journal Prestige (SJR): 0.65
Citation Impact (citeScore): 1
Number of Followers: 41  
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1049-9091 - ISSN (Online) 1938-2715
Published by Sage Publications Homepage  [1084 journals]
  • Trends of Hospital Palliative Care Utilization and Its Associated Factors
           Among Patients With Systemic Lupus Erythematosus in the United States From
           2005 to 2014
    • Authors: Kaylee G. Yu, Jay J. Shen, Pearl C. Kim, Sun Jung Kim, Se Won Lee, David Byun, Ji Won Yoo, Jinwook Hwang
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Objective:To investigate trends and associated factors of utilization of hospital palliative care among patients with systemic lupus erythematosus (SLE) and analyze its impact on length of hospital stay, hospital charges, and in-hospital mortality.Methods:Using the 2005-2014 National Inpatient Sample in the United States, the compound annual growth rate was used to investigate the temporal trend of utilization of hospital palliative care. Multivariate multilevel logistic regression analyses were performed to analyze the association with patient-related factors, hospital factors, length of stay, in-hospital mortality, and hospital charges.Results:The overall proportion of utilization of hospital palliative care for the patient with SLE was 0.6% over 10 years. It increased approximately 12-fold from 0.1% (2005) to 1.17% (2014). Hospital palliative care services were offered more frequently to older patients, patients with high severity illnesses, and in urban teaching hospitals or large size hospitals. Patients younger than 40 years, the lowest household income group, or Medicare beneficiaries less likely received palliative care during hospitalization. Hospital palliative care services were associated with increased length of stay (β = 1.407, P < .0001) and in-hospital mortality (odds ratio, 48.18; 95% confidence interval, 41.59-55.82), and reduced hospital charge (β = −0.075, P = .009).Conclusion:Hospital palliative care service for patients with SLE gradually increased during the past decade in US hospitals. However, this showed disparities in access and was associated with longer hospital length of stay and higher in-hospital mortality. Nevertheless, hospital palliative care services yielded a cost-saving effect.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-12-03T01:08:40Z
      DOI: 10.1177/1049909119891999
  • Exploring Quality of Life in End-of-Life Discussions
    • Authors: Terry Eggenberger, Heather Howard, Dana Prescott, George Luck
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Advance directives (ADs) allow individuals to legally determine their preferences for end-of-life (EOL) medical treatment and designate a health-care proxy to act on their behalf prior to losing the cognitive ability to make informed decisions for themselves. An interprofessional group of researchers (law, nursing, medicine, and social work) conducted an exploratory study to identify the differences in quality-of-life (QOL) language found within the AD state statutes from 50 US states and the District of Columbia. Data were coded using constant comparative analysis. Identified concepts were grouped into 2 focus areas for EOL discussions: communication/awareness of surroundings and activities of daily living. Language regarding communication/awareness of surroundings was present in the half of the statutes. Activities of daily living were addressed in only 18% of the statutes. Only 3 states (Arkansas, Nevada, and Tennessee) specifically addressed QOL. Patients are best served when professionals, regardless of discipline, can share and transform knowledge for patients in times of crisis and loss in ways that are empathetic and precise. Interprofessional collaborative practice (IPCP) comprises multiple health workers from different professional backgrounds working together with patients, families, and communities to deliver the highest quality of care. One of the major competencies of IPCP encompasses values and ethics. Interprofessional collaborative practice is offered as the means to deliver person-centered value-based care when facilitating these crucial dialogs and making recommendations for change.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-11-28T10:55:20Z
      DOI: 10.1177/1049909119890606
  • Applying M-Health to Palliative Care: A Systematic Review on the Use of
           M-Health in Monitoring Patients With Chronic Diseases and its
           Transposition in Palliative Care
    • Authors: Florent Bienfait, Marie Petit, Romain Pardenaud, Clément Guineberteau, Aude Pignon
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background:The major growth of mobile technologies in the recent years has led to the development of medical-monitoring applications, particularly on smartphones.Aim:The aim of this study was to review the use of m-health in the monitoring of patients with chronic pathologies in order to consider what could be adapted for palliative care patients at home.Design:A systematic review of the English and French literature was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. Date Sources: The review screened the following databases: PUBMED, SCOPUS, COCHRANE, SCIENCE DIRECT, SUDOC, and EM-Premium, screening studies published between 2008 and 2018. The selection of articles was done by the main investigator. All studies concerning the use of m-Health apps for patients with chronic diseases were included.Results:From the 337 selected publications, 8 systematic reviews and 14 original studies were included. The main uses of m-Health apps were biological and clinical monitoring (particularly concerning the symptoms) in 75% of the applications, disease self-management in 64% of the applications, and therapeutic patient education in 50% of the applications, with remote monitoring.Conclusions:The development of an m-Health application could become a complementary monitoring tool during palliative care. However, it seems important to question the impact of technique in the professional–patient relationship and avoid the pitfalls of standardizing palliative care and reducing the patient to a “sick” health technician. A future step would then be to define which health-care professional would be in charge of this “m-monitoring.”
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-11-27T10:32:16Z
      DOI: 10.1177/1049909119885655
  • Does Family Caregiver Burden Differ Between Elderly and Younger Caregivers
           in Supporting Dying Patients With Cancer' An Italian Study
    • Authors: Roberta Spatuzzi, Maria Velia Giulietti, Marcello Ricciuti, Fabiana Merico, Francesca Romito, Giorgio Reggiardo, Loredana Birgolotti, Paolo Fabbietti, Letizia Raucci, Gerardo Rosati, Domenico Bilancia, Anna Vespa
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Context:The aging of the world’s population increasingly calls on older people to care for their cancer relatives. This scenario confronts clinicians involved with end-of-life care with an imposing challenge: elderly family caregivers could have a different perception of the burdens associated with assistance compared to their younger counterparts. Palliativists need to know what limits and resources of these new age categories of caregivers could be for a global management of dying patients with cancer and their family.Objectives:To evaluate the caregiver burden in family caregivers supporting dying patients with cancer in order to compare the differences between 2 different caregivers age groups (younger vs elderly population).Methods:This is a cross-sectional study. A total of 174 family caregivers of hospice patients were interviewed through the Caregiver Burden Inventory (CBI). The sample group was divided into 2 subgroups aged
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-11-25T04:09:32Z
      DOI: 10.1177/1049909119890840
  • Managing Opioids, Including Misuse and Addiction, in Patients With Serious
           Illness in Ambulatory Palliative Care: A Qualitative Study
    • Authors: Jessica S. Merlin, Sarah R. Young, Robert Arnold, Hailey W. Bulls, Julie Childers, Lynn Gauthier, Karleen F. Giannitrapani, Dio Kavalieratos, Yael Schenker, J. Deanna Wilson, Jane M. Liebschutz
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background:Pain and opioid management are core ambulatory palliative care skills. Existing literature on how to manage opioid misuse/use disorder excludes patients found in palliative care settings, such as individuals with serious illness or those at the end of life.Objectives:We conducted an exploratory study to: (1) Identify the challenges palliative care clinicians face when prescribing opioids in ambulatory settings and (2) explore factors that affect opioid decision-making.Methods:We recruited palliative care clinicians who prescribe opioids in ambulatory settings, which included open-ended questions and was conducted online. Results were analyzed qualitatively using a content analysis-based approach.Results:Eighty-three palliative care clinicians (mostly MDs/DOs) participated. Challenges faced when prescribing opioids included clinician differences in approach to care (eg, transitioning from another clinician with more permissive opioid prescribing), medication access (eg, inadequate pharmacy supply), resource constraints (eg, access to mental health and addiction expertise), managing problems outside the typical palliative care scope (eg addiction). Participants also discussed factors that influenced their opioid prescribing decisions, such as opioid-related harms and risks that they need to weigh; they also spoke about the necessity of considering other factors like the patient’s environment, disease, treatment, and prognosis.Conclusion:This study highlights the challenge of opioid management in patients with serious illness, particularly when misuse or substance use disorder is present, and suggests areas for future research focus. Our next step will be to establish consensus on approaches to opioid prescribing decision-making and policy in seriously ill patients presenting to ambulatory palliative care.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-11-25T04:00:02Z
      DOI: 10.1177/1049909119890556
  • Resource Utilization in Hospitalized Patients With Cancer From Hospice
           Decision to Discharge and Provider-Type Differences
    • Authors: Ruchi J. Shah, Deborah Korenstein, Jessica R. Flynn, Douglas J. Koo
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Aggressive resource utilization for patients with cancer at the end of life has been associated with poor outcomes for patients and their families. To our knowledge, no previous studies have characterized resource utilization as a proxy for quality end-of-life care in hospitalized patients awaiting discharge to hospice by physician and advanced practice providers (APPs). We conducted a retrospective cohort study to examine resource utilization and the quality metrics for end-of-life care in patients at Memorial Sloan Kettering Cancer Center from the date of hospice decision to discharge. Patients under the care of APP teams were less likely to receive laboratory testing (50% vs 59%, P = .046) and received fewer tests than those with house staff teams, though performance on end-of-life quality metrics was similar. Our findings suggest APPs may improve quality of end-of-life care by avoiding unnecessary or aggressive measures compared to house staff.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-11-21T01:15:41Z
      DOI: 10.1177/1049909119889289
  • Autism and Advance Directives: Determining Capability and the Use of
           Health-Care Tools to Aid in Effective Communication and Decision-Making
    • Authors: Valerie Satkoske, Joann M. Migyanka, David Kappel
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      With the growing number of individuals with Autism Spectrum Disorder (ASD) reaching the age of consent, health-care providers must be prepared to bridge gaps in their knowledge of ASD. This is especially true for clinicians who may have to determine if a person with ASD has the capacity to engage in end-of-life decision making, complete advance directives, or act as a surrogate decision maker for someone else. This paper provides an overview of the unique characteristics of autism as related to the communication, cognitive processing, and the capability to participate in advance care planning and, when acting as a surrogate decision maker, to consider the values and preferences of others. In addition, we examine the roles and responsibilities of clinician as facilitator of shared health-care decision making communication with the individual who has autism. Consideration is given to determining capacity, planning for atypical responses, the impact or lack of influence of the framing effect, and strategies for presenting information. Finally, we will offer health-care providers information and examples for adapting their existing end-of-life decision-making tools and conversation guides to meet the communication needs of persons with ASD.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-11-21T01:13:50Z
      DOI: 10.1177/1049909119888621
  • A Worldwide Bibliometric Analysis of Publications on Advance Care Planning
           in the Past 3 Decades
    • Authors: Chia-Jen Liu, Te-Chun Yeh, Ming-Hsuan Hsieh, Lin-Chung Woung, Sheng-Jean Huang, Ming-Chih Chen, Chih-Kuang Liu
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background:In recent decades, issues related to end-of-life care and advance care planning (ACP) have attracted popular attention. Advance care planning has been broadly discussed as one of the potential solutions to protect a patient’s rights, autonomy, and dignity at the end of life. To better understand publishing on this topic, we conducted this study to demonstrate the worldwide research productivity, trends, and citations of ACP in the past 3 decades by bibliometric analysis.Methods:Articles published on ACP were retrieved from the Web of Science Core Collection database, and the subject terms included “advance directive,” or “advance care planning.”Results:Overall, 2126 publications on ACP were retrieved until January 22, 2019. North America, Western Europe, and Australia were the most productive regions. The top 15 countries published 95.9% of the total number of articles. The United States accounted for approximately three-fifths (61.0%) of all publications. When adjusted for population size, Australia had the highest number of articles per million persons (6.64), followed by the Netherlands (6.14) and Belgium (4.61). The most productive authors were Sudore (n = 37), Deliens (n = 29), and Green (n = 24).Conclusions:The current study revealed that research in terms of publications on ACP has rapidly increased over the past 3 decades. Developed countries, especially the United States, were more concerned with the ACP research field than developing countries were.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-11-21T01:12:07Z
      DOI: 10.1177/1049909119886305
  • Systemic Inflammation and Nutritional Status in Patients on Palliative
           Cancer Care: A Systematic Review of Observational Studies
    • Authors: Luisa de Araújo Fonseca Cordeiro, Thiago Huaytalla Silva, Lívia Costa de Oliveira, José Firmino Nogueira Neto
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Objective:This systematic literature review explores the results of studies that have analyzed the association between inflammation and nutritional status in patients with cancer in palliative care.Methods:The bibliographic research was performed in May 2019, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Group guidelines. The inclusion criteria were papers that (1) had an online abstract available, (2) were original, (3) used a cohort or cross-sectional design, (4) involved patients with advanced cancer in palliative care, and (5) assessed the association between inflammation and nutritional status. The quality assessment was performed using the Newcastle-Ottawa Scale.Results:Nine studies were selected. Weight loss (WL; n = 7) was the most common nutritional marker employed and C-reactive protein (CRP; n = 6) was the most common inflammatory marker. There was considerable variability (39.0%-92.2%) in the proportion of patients who had WL in a 6-month period, while CRP>5 mg/dL was common in 45.3% to 73.9% of patients. Systemic inflammation was related to nutritional status, highlighting the relationship between CRP and WL and lean mass (LM). Patients with CRP>10 mg/L have been found to have a lower LM (P < .001) and a faster rate of loss of LM at a faster rate during the disease trajectory (P = .030).Conclusion:Nutritional status is associated with systemic inflammatory response. Inflammatory markers should be considered an additional parameter for the nutritional diagnosis of patients with cancer in palliative care.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-11-18T10:11:53Z
      DOI: 10.1177/1049909119886833
  • Use of the Core Bereavement Items in Adults Aged 50 and Older: A
           Psychometric Evaluation
    • Authors: Kathryn Levy
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      The Core Bereavement Items (CBI) is a commonly used measure that assesses core grief and bereavement experiences. Although previous psychometric testing has been conducted, no studies have assessed its use specifically aimed at adults aged 50 and older or for those who lost a loved one who was hospice care. This is critical, as losses and additional obstacles in bereavement compound throughout the aging process. The present study investigated reliability, content validity, and internal structure of the CBI in bereaved adults aged 50 and older whose loved one died while in hospice care (N = 205). Associations based on age, marital status, and relationship with the died patients were consistent with preexisting research. Results of a Cronbach α reliability test found that the CBI has excellent reliability in this population. Further, content validity was established based on the judgment of subject matter experts. Exploratory factor analysis supported a 1-factor structure, with all items loading as General Grief Experiences. Based on this analysis, the CBI is a valid and reliable tool when used with adults aged 50 and older.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-11-18T10:09:12Z
      DOI: 10.1177/1049909119888181
  • Quality Indicators of End-of-Life Care Among Privately Insured People With
           Cancer in Brazil
    • Authors: Luiz Guilherme L. Soares, Renato V. Gomes, Alberto Palma, André M. Japiassu
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Purpose:To examine quality indicators of end-of-life (EOL) care among privately insured people with cancer in Brazil.Methods:We evaluated medical records linked to health insurance databank to study consecutive patients who died of cancer. We collected information about demographics, cancer type, and quality indicators of EOL care including emergency department (ED) visits, intensive care unit (ICU) admissions, chemotherapy use, medical imaging utilization, blood transfusions, home care support, days of inpatient care, and hospital deaths.Results:We included 865 patients in the study. In the last 30 days of life, 62% visited the ED, 33% were admitted to the ICU, 24% received blood transfusions, and 51% underwent medical imaging. Only 1% had home care support in the last 60 days of life, and 29% used chemotherapy in the last 14 days of life. Patients had an average of 8 days of inpatient care and 52% died in the hospital. Patients with advanced cancer who used chemotherapy were more likely to visit the ED (78% vs 59%; P < .001), undergo medical imaging (67% vs 51%; P < .001), and die in the hospital (73% vs 50%; P = .03) than patients who did not use chemotherapy. In the multivariate analysis, chemotherapy use near death and advanced cancer were associated with ED visits and ICU admissions, respectively (odds ratio>1).Conclusion:Our study suggests that privately insured people with cancer receive poor quality EOL care in Brazil. Further research is needed to assess the impact of improvements in palliative care provision in this population.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-11-15T05:34:26Z
      DOI: 10.1177/1049909119888180
  • Exposure of Medical Students to Palliative Care
    • Authors: Amrit Kaur Kooner, Abiya Amna Ahmed, Roshni Mitra
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.

      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-11-12T03:50:32Z
      DOI: 10.1177/1049909119887373
  • End-of-Life Care of Persons With Alzheimer Disease: An Update for
    • Authors: Eric Trinh, Andrew Lee, Kye Y. Kim
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      While end-of-life (EOL) care has been a relatively common option for patients with terminal cancer, the utilization of EOL care in Alzheimer disease and other dementias has become available more recently. By the time end-stage dementia is present, the clinicians and caregivers become faced with multiple clinical issues—their inability to provide subjective complaints of pain and discomfort, behavioral symptoms, delirium, food refusal, and so on. In addition to providing quality EOL care to the patients, clinicians need to work with their families in an open and empathic manner, assuring that their loved ones will receive supportive measures to keep them comfortable.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-11-12T03:50:13Z
      DOI: 10.1177/1049909119885881
  • Palliative Care for Patients With Hematologic Malignancies in a Low-Middle
           Income Country: Prevalence of Symptoms and the Need for Improving Quality
           of Attention at the End of Life
    • Authors: José Carlos Jaime-Pérez, Grecia Abigayl Turrubiates-Hernández, Teresa Nava-Obregón, Blanca Coronado-Hernández, Homero Gutiérrez-Aguirre, Olga Graciela Cantú-Rodríguez, José Luis Herrera-Garza, David Gómez-Almaguer
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background:Palliative care (PC) for patients with malignant hematological diseases is scarcely documented, particularly in low- and middle-income countries. This study aimed to document PC provided to patients with hematologic malignancies.Methods:Bidirectional study conducted from July 2016 to June 2019 at the hematology and palliative care departments at a reference center in Northeast Mexico for low-income open population uninsured patients. Clinical records and electronic files of patients with malignant hematological diseases of both sexes and all ages attending an academic hematology center were reviewed. Statistical analysis was performed with the SPSS version 22 program. Acute and chronic leukemias, multiple myeloma, Hodgkin lymphoma, non-Hodgkin lymphoma, and others were included.Results:Five-hundred ten patients were studied, of which 148 (29%) died. Eighty-one (15.88%) patients including 31 (20.9%) who died received PC. Median age at palliative diagnosis was 42 (2-91) years. The most common symptom was pain (69.7%). The most frequent reason for palliative referral was treatment-refractory disease (39%). During the last week of life, 19 (95%) of 20 patients had blood sampling; 17 (85%) received antibiotics; 16 (80%) had a urinalysis performed; 16 (80%) received analgesia, including paracetamol (11, 35.5%) and buprenorphine (7, 22.6%); 10 (50%) received blood products; 9 (45%) were intubated; and central venous catheters were inserted in 5 (25%) patients.Conclusions:Palliative care was provided to a minority of patients with hematologic malignancies and considerable improvement is required in its timely use and extension.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-11-12T02:05:30Z
      DOI: 10.1177/1049909119887951
  • “I Just Feel Like I Always Did”: Inotropic Dependency at End
           of Life
    • Authors: Abigail Latimer, Natalie D. Pope, Jessica M. McFarlin
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background:Patients not considered for mechanical circulatory support or heart transplant may be dependent on inotropic therapy at end of life. End-of-life conversations in advanced heart failure can be challenging for providers, but guidelines recommend frequent goals-of-care conversations when inotropes are used as a palliative treatment. The purpose of this study was to identify aspects of care pertinent for health-care professionals working with patients in end-stage heart failure who are receiving continuous inotropic support.Methods:Qualitative analysis was used to examine 3 audio-recorded semistructured interviews with 1 patient, her family, and her cardiologist. The selected patient was an older adult, diagnosed with advanced heart failure, and dependent on continuous inotropic therapy with no other advanced treatment options available.Results:The analysis revealed that (1) reliance on others, (2) contending with uncertainty, and (3) deciding when to discontinue inotropic support were identified as themes central to the patient’s and provider’s experience.Conclusion:This study offers insight into how to best support and communicate with patients having advanced heart failure who are dependent on continuous inotropic therapy at end of life.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-11-12T02:01:52Z
      DOI: 10.1177/1049909119886302
  • Natural Language Processing to Assess Palliative Care and End-of-Life
           Process Measures in Patients With Breast Cancer With Leptomeningeal
    • Authors: Kate Brizzi, Sophia N. Zupanc, Brooks V. Udelsman, James A. Tulsky, Alexi A. Wright, Hanneke Poort, Charlotta Lindvall
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background:Palliative care consultation during serious life-limiting illness can reduce symptom burden and improve quality of care. However, quantifying the impact of palliative care is hindered by the limitations of manual chart review and administrative coding.Objectives:Using novel natural language process (NLP) techniques, we examined associations between palliative care consultations and performance on nationally endorsed metrics for high-quality end-of-life (EOL) care in patients with leptomeningeal disease (LMD) secondary to metastatic breast cancer.Methods:Patients with breast cancer with LMD were identified using administrative billing codes and NLP review of magnetic resonance imaging reports at 2 tertiary care centers between 2010 and 2016. Next, NLP was used to review clinical notes to (1) determine the presence of palliative care consultations and (2) determine the performance of process measures associated with high-quality EOL care, including discussions of goals of care, code status limitations, and hospice. Associations between palliative care consultation and documentation of EOL process measures were assessed using logistic regression.Results:We identified 183 cases of LMD. Median age was 56 (interquartile range [IQR]: 46-64) years and median survival was 150 days (IQR: 67-350). Within 6 months of diagnosis, 88.5% of patients had documentation of ≥1 process measure, including discussions of goals of care (63.4%), code status limitations (62.8%), or hospice (72.1%). Palliative care consultation was a predictor of subsequent documentation of goals of care (odds ratio [OR], 3.15; 95% confidence interval [CI], 1.58-6.27) and hospice discussions (OR, 4.61; 95% CI, 2.12-10.03).Conclusion:Palliative care involvement is associated with increased performance of EOL process measures in patients with breast cancer with LMD.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-11-08T04:00:49Z
      DOI: 10.1177/1049909119885585
  • Buprenorphine for Cancer Pain in Patients With Nonmedical Opioid Use: A
           Retrospective Study at a Comprehensive Cancer Center
    • Authors: Eric Hansen, Chitra Nadagoundla, Chong Wang, Austin Miller, Amy Allen Case
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background:Outpatients with cancer commonly have nonmedical opioid use (NMOU) behaviors and use opioids to dull emotional and existential suffering. Buprenorphine is often used for cancer pain due to less reported euphoria when compared to other opioids.Methods:A retrospective review was done in patients who were prescribed buprenorphine for cancer pain. Pain scores were reported on a Likert pain scale of 1 to 10. Nonmedical opioid use was defined as patients taking opioids for emotional pain at or above the maximum prescribed amount.Results:For 16 patients, the mean pain score prior to buprenorphine (pain pre) was 8.3 (Standard deviation (Std) 1.6), and the mean pain score on follow-up post-buprenorphine (pain post) was 6.1 (Std 2.3) with a reduction in mean pain score (pain change) of −2.0 (Std 2.9, P = .059). Those patients without NMOU had a pain prescore of 9.5 (Std 1.0) and pain post of 4.3 (Std 2.5) with a mean pain change of −5.0 (Std 1.7, P = .20). The mean pain change in those with chemical coping (−1.3/Std 2.7), illicit drug use (−2.8/Std 1.0), or psychiatric comorbidity (−2.4/Std 2.7) were reduced after buprenorphine, however, not statistically significant. Outpatient rotation to buprenorphine was well tolerated.Conclusions:The pain score in those patients without NMOU was significantly lower after rotation to buprenorphine than those with NMOU. We deduce that in those with NMOU, it is more challenging to achieve pain relief with buprenorphine. Overall, for all patients, rotation to buprenorphine resulted in a marginally significantly reduced pain score.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-11-08T04:00:08Z
      DOI: 10.1177/1049909119884358
  • Examining the Knowledge, Awareness, and Perceptions of Palliative Care in
           the General Public Over Time: A Scoping Literature Review
    • Authors: Priya Patel, Laura Lyons
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background:The field of palliative care (PC) is growing as the world population ages and burden of chronic diseases increases. Thus, it is important that the general public is knowledgeable about PC and the benefits PC provides.Objective:The aim of this study is to describe the public’s knowledge, awareness, and perceptions of PC and determine whether these have changed over time.Methods:A scoping literature review was conducted from 1968 to May 2019 using PubMed, EMBASE, and MEDLINE databases.Results:Thirteen studies met inclusion criteria that originated from the United States, Canada, Scotland, Italy, New Zealand, Ireland, United Kingdom, Korea, and Sweden between years 2003 and 2019. Participants were adults and mostly younger than 64 years, women, and Caucasian. The majority of studies reported the public having poor knowledge (7/9 articles) and awareness (4/6 articles) of PC over the past 16 years. Top characteristics associated with increased levels of knowledge and/or awareness of PC included women (6/8 articles), age 40+ (6/8 articles), experience with a close friend and/or relative requiring PC (4/8 articles), and working in health-care and/or PC (4/8 articles). The most common perceptions of PC were associated with patients who have terminal illnesses and end-of-life care. Participants commonly received information about PC from the media, having a close friend or relative requiring PC, and working in a health-care setting.Conclusions:The public has poor knowledge and awareness about PC and several misperceptions exist. These findings have remained constant over time despite growth in the field of PC, which highlights the strong need for focused educational interventions.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-11-06T04:07:10Z
      DOI: 10.1177/1049909119885899
  • Gone But Here
    • Authors: Talal Hilal
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.

      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-10-31T04:15:35Z
      DOI: 10.1177/1049909119885653
  • “Farewell” to Prognosis in Shared Decision-Making
    • Authors: Robert F. Johnson
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Whether because of a cultural pattern or personal preference, palliative care clinicians encounter persons approaching the end of life who wish to limit or forego prognostic information relating to their situation. This scenario has received attention in a recent motion picture as well as a newly available advance directive modification—the Prognosis Declaration form. The ordinary expectation for end-of-life shared decision-making with a capable person is clinician disclosure of the best effort at prognostic assessment. The optimal match between the expressed values, goals, and preferences of the person with available clinician expertise is hopefully achieved. For the clinician, a person’s choice to modify information disclosure and participation in shared decision-making represents a significant challenge of balancing key ethical principles of intervention with tolerance and compassion for these different preferences. Attention to communication strategies that elicit and appropriately reassess individual information and decision-making wishes, flexibility in information disclosure patterns with capable persons and their representatives, and recognition that a respect for autonomy includes the choice to opt out can approach this challenge while providing compassionate and ethical end-of-life care.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-10-31T04:14:55Z
      DOI: 10.1177/1049909119885323
  • End-of-Life Communication Between Providers and Family Caregivers of Home
           Hospice Patients in a Rural US-Mexico Border Community: Caregivers’
           Retrospective Perspectives
    • Authors: Eunjeong Ko, Dahlia Fuentes
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Introduction:Family caregiver–provider communication is essential to making an effective hospice care transition for patients. Despite the importance of this topic, there is little information about how caregivers in rural US-Mexico border regions navigate hospice care transition and their needs. This study explores the family caregivers’ experience relating to their end-of-life (EOL) communication and needs for hospice care transition.Methods:In-depth interviews using qualitative methods were conducted with 28 informal caregivers of patients who are enrolled in home hospice care in a rural US-Mexico border region. Thematic analysis was applied to analyze the data.Results:Qualitative themes that emerged include (1) lack of/insufficient EOL communication and (2) informational needs, including (a) signs of symptom changes, (b) EOL treatment options and goals of care, and (c) hospice care and its benefits. Limited caregiver–provider EOL communication was observed, in which the majority of the caregivers (n = 22, 78.6%) were informed of the patient’s terminal condition, but only half (n = 15, 53.6%) had a discussion with the providers about hospice care.Conclusion:Timely EOL communication between caregivers and the providers is key to the patient’s optimal transition to hospice care. Providers need to be aware of the caregivers’ informational needs relating to patient symptoms and health condition as well as hospice care. It is important to be aware of the impact of cultural values on hospice care placement. A clear explanation about the purpose and functions of hospice care and its benefit can better guide the family caregivers in making hospice care decisions.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-10-31T04:13:54Z
      DOI: 10.1177/1049909119885099
  • Definition of a Good Death, Attitudes Toward Death, and Feelings of
           Interconnectedness Among People Taking Care of Terminally ill Patients
           With Cancer: An Exploratory Study
    • Authors: Andrea Bovero, Francesco Gottardo, Rossana Botto, Chiara Tosi, Marta Selvatico, Riccardo Torta
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      The concept of a good death is crucial in palliative care, but its relationship with attitudes toward death and feelings of interconnectedness needs to be further deepened. The first aim of this study was to explore the concept of good death, attitudes toward death, and feelings of interconnectedness among family caregivers (FCs) and health-care providers (HCPs) of terminally ill patients with cancer. The second aim was to analyze associations of good death concept with attitudes toward death and feelings of interconnectedness. Participants were asked to assess the importance of features that characterize a good death. To explore each person’s attitude toward death and feelings of interconnectedness, 3 open questions were used. The sample consisted of 49 participants: 24 (48.98%) FCs and 25 (51.02%) HCPs. Nine good death features were considered essential by more than 70% of participants. These referred to the physical (eg, symptoms control), social (eg, loved ones’ presence), emotional (eg, sharing emotions), and spiritual (eg, inner peace) dimensions. Importance attributed to components of a good death such as patient’s awareness and acceptance of death, meaning, respect for the patient’s wishes, and inner peace were found to be associated with lack of avoidance and acceptance toward death and feelings of interconnectedness. Given the importance of FCs and HCPs in providing care and their impact on the patients’ dying process, it is necessary to reflect upon how their personal attitudes and previous experiences influence the care of dying patients.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-10-25T04:40:45Z
      DOI: 10.1177/1049909119883835
  • Association Between the Timing of Goals-of-Care Discussion and
           Hospitalization Outcomes in Patients With Metastatic Cancer
    • Authors: Oluwadunni E. Emiloju, Djeneba Audrey M. Djibo, Jean G. Ford
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background:Patients with cancer often require acute hospitalizations, many of which are unplanned. These hospitalizations have been shown to increase in frequency near the end of life. The American College of Physicians recommends that goals-of-care (GOC) discussions be initiated early for metastatic cancers. We hypothesized that discussing GOC during hospitalization could help reduce readmissions. Our aim was to examine the association between the timing of GOC discussion, length of hospital stay, and the time to readmission.Methods:We conducted a retrospective review of medical records of patients with stage IV cancers hospitalized between August 2017 and July 2018. We recorded timing of GOC discussion, use of palliative care services, and hospital readmissions within 90 days. χ2 tests were used to identify independent associations with GOC discussion, and logistic regression was used to examine association with readmission within 90 days.Results:Of all study patients (N = 241), 40.6% were female, 46% (n = 112) had a GOC discussion, and 34% (n = 82) had a palliative care consultation. Having a palliative care consult and being admitted to critical care were independently associated with having a GOC discussion. Early timing of GOC discussion was inversely associated with admission to critical care units (P < .05). Thirty-eight percent (n = 92) had unplanned hospital readmission within 90 days. Having a GOC discussion was independently associated with a reduction in the odds of an unplanned hospital readmission within 90 days by 79% (odds ratio = 0.21, 95% confidence interval: 0.12-0.37).Conclusion:Among hospitalized patients with stage IV cancer, performing an early GOC discussion has an important association with lower hospital readmission rates and increased rates of goal-congruent patient care.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-10-22T04:08:39Z
      DOI: 10.1177/1049909119882891
  • CORRIGENDUM to Forgiveness and Reconciliation Processes in Dying Patients
           With Cancer
    • Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.

      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-10-17T04:09:19Z
      DOI: 10.1177/1049909119884407
  • Cultural Humility: A Way to Reduce LGBTQ Health Disparities at the End of
    • Authors: Petra Sprik, Danielle Gentile
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Sexual and gender minorities experience disparities throughout the life course. These are especially detrimental at the end-of-life and can include disenfranchised grief, homophobia and transphobia from medical staff, and forced outing. The best healthcare training approach to ameliorate health disparities is debated. Cultural competency trainings for clinicians have been commonly proposed by major medical institutions and certifying bodies to ameliorate lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ) health disparities. However, cultural competency trainings have limitations, including (1) false competence, (2) measurement issues, and (3) ecological fallacy (i.e., assuming individuals conform to the norms of their cultural group). The purpose of this commentary is to describe the limitations of cultural competency training and argue for healthcare systems to implement cultural humility trainings as a way to reduce LGBTQ health disparities at the end-of-life. The strengths of cultural humility training include focus on (1) individuals instead of their cultural groups, (2) self-reflection, and (3) active listening. While there are challenges to implementing cultural humility trainings in the health-care system, we assert that these trainings align with the aims of healthcare systems and can be an essential tool in reducing LGBTQ health disparities. We suggest practical components of successful cultural humility trainings including leadership buy-in, appropriate outcome measurements, multiple training sessions, and fostering a safe reflection space.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-10-14T03:55:51Z
      DOI: 10.1177/1049909119880548
  • Querying Patients With Cancer About Sexual Health and Sexual and Gender
           Minority Status: A Qualitative Study of Health-Care Providers
    • Authors: Elizabeth Cathcart-Rake, Jennifer M. O’Connor, Jennifer L. Ridgeway, Carmen Radecki Breitkopf, Lois J. Mc Guire, Eric A. Olson, Judith S. Kaur, Konstantinos Leventakos, Aminah Jatoi
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background:Although national organizations advocate that health-care providers ask patients about sexual health and sexual and gender minority status—to learn, for example, about side effects of treatment and to understand patients’ social support—these conversations often do not occur. This study explored health-care providers’ reasons for having/not having these conversations.Methods:This single-institution study recruited health-care providers from medical oncology, hematology, radiation oncology, and gynecology. Face-to-face interviews were recorded, transcribed, and analyzed qualitatively.Results:Three main themes emerged: (1) patient-centric reasons for discussing/not discussing sexual health and sexual and gender minority status (“So I think just the holistic viewpoint is important”); (2) health-care provider–centric reasons for discussing/not discussing these issues (“That’s going to take more time to talk about and to deal with…” or “I was raised orthodox, so this is not something we talk about…”; and (3) reasons that appeared to straddle both of the above themes (eg, acknowledgment of the sometimes taboo nature of these topics).Conclusion:Although many health-care providers favor talking with patients with cancer about sexual health and sexual and gender minority status, limited time, personal reluctance, and the taboo nature of these topics appear at times to hamper the initiation of these conversations.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-10-11T03:57:58Z
      DOI: 10.1177/1049909119879129
  • Prevalence and Predictors of Distress, Anxiety, Depression, and Quality of
           Life in Bereaved Family Caregivers of Patients With Advanced Cancer
    • Authors: Karin Oechsle, Anneke Ullrich, Gabriella Marx, Gesine Benze, Feline Wowretzko, Youyou Zhang, Lisa-Marie Dickel, Julia Heine, Kim Nikola Wendt, Friedemann Nauck, Carsten Bokemeyer, Corinna Bergelt
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Objective:To investigate prevalence and predictors of postloss distress, depressive and anxiety symptoms, and quality of life among bereaved family caregivers of patients with advanced cancer.Methods:Prospective multicenter study. Family caregivers (N = 160, mean age 56.8 years, 66% female) completed validated outcome measures (Distress Thermometer, Generalized Anxiety Disorder 7-item scale, Patient Health Questionnaire depression module 9-item scale, SF-8 Health Survey Questionnaire) 6 months after patient’s discharge or death at specialist inpatient palliative care ward.Results:Clinically relevant distress was observed in 82% with sadness (89%), exhaustion (74%), sleeping problems (68%), loneliness (53%), and sorrows (52%) being the most common distress-causing problems. Moderate/severe anxiety and depressive symptoms were observed in 27% and 35%, respectively. Compared to an adjusted norm sample, quality of life was significantly impaired with exception of “bodily pain” and physical component score. Preloss caregiving (odds ratio [OR] 2.195) and higher preloss distress (OR 1.345) predicted high postloss distress. Utilization of psychosocial support services (OR 2.936) and higher preloss anxiety symptoms (OR 1.292) predicted moderate/severe anxiety symptoms, lower preloss physical quality of life (OR 0.952), and higher preloss depressive symptoms (OR 1.115) predicted moderate/severe depressive symptoms.Conclusion:Preloss mental burden showed to be a consistent predictor for postloss burden and should be addressed during palliative care. Future research should examine specific caregiver-directed interventions during specialist palliative care.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-10-09T01:53:31Z
      DOI: 10.1177/1049909119872755
  • Reciprocal Dynamics of Dignity in End-of-Life Care: A Multiperspective
           Systematic Review of Qualitative and Mixed Methods Research
    • Authors: Ping Ying Choo, Geraldine Tan-Ho, Oindrila Dutta, Paul Victor Patinadan, Andy Hau Yan Ho
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background:Preserving terminally ill patients’ dignity and well-being through dignified and holistic care has become the overarching goal in palliative care services. However, dignity is a multifaceted concept with a wide range of interpretations under different cultural contexts.Aim:The aim of this review is to understand the variations in subjective interpretations and constitutions of dignity in palliative or end-of-life care via an integrative worldview.Design:This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline and used SPIDER tool to screen for appropriate and relevant articles for analysis.Data Sources:Four major databases were searched including CINAHL, ERIC, Medline, and PsycARTICLES between 2009 and 2018. Forty-eight qualitative studies that examined dignity from the perspectives of patients, family caregivers, and health-care professionals were selected for full text data analysis using thematic synthesis.Results:Analysis of the various concepts of dignity revealed 18 themes that were further categorized into 7 conceptual categories: (1) self-determination, (2) existential liberty, (3) relational connectedness, (4) caregiving revitalization, (5) mindful humanity, (6) patient–family care, and (7) sustainable culture. These 7 categories span across individual, familial, and institutional dimensions, forming a new Dynamic Reciprocity of Dignity model.Conclusions:The Dynamic Reciprocity of Dignity model highlights the importance of adopting a systemic lens to address dignity-related needs and concerns at the end of life, while providing insights on how compassionate care and self-compassion can serve as the foundation of dignified care, which in turn serve as a buffer against patients’ existential suffering as well as caregivers’ burnout and fatigue. Recommendations for clinical practice and future research directions are discussed.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-10-04T04:11:07Z
      DOI: 10.1177/1049909119878860
  • The Experience of Pediatric Palliative Caregiving: A Qualitative Analysis
           From the Photographs of Meaning Program
    • Authors: Kathryn Levy, Pei C. Grant, Kelly E. Tenzek, Rachel M. Depner, Megan E. Pailler, Lynda K. Beaupin
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      The Photographs of Meaning Program for pediatric palliative caregivers (POM-PPCG) is an innovative, meaning-based intervention utilizing photovoice and social media components. In 2017, 9 pediatric palliative caregivers participated in this intervention. During the social media portion of the POM-PPCG, participants were presented with weekly themes based on a meaning-making curriculum. In response, they took photographs, applied either audio or typed narratives, and shared them via social media. Ninety-five photographs with narratives were produced during the intervention. Through thematic qualitative analysis with consensual qualitative research components, 5 themes were identified: Love, Challenges, Loss, Coping, and The New Normal. This study adds to existing literature by shedding light on the experiences of caregivers of children with palliative care needs. Findings from this research contribute not only to the innovative use of qualitative methods but also to the clinical knowledge and practice regarding the pediatric palliative caregiver experience.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-10-03T04:26:49Z
      DOI: 10.1177/1049909119879413
  • Impact of Hospice on Spending and Utilization Among Patients With Lung
           Cancer in Medicare
    • Authors: Yamini Kalidindi, Joel Segel, Jeah Jung
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Objectives:To compare patterns and understand drivers of spending and utilization by month in the last 6 months of life between patients with lung cancer who used hospice versus those who did not.Study Design:Retrospective cohort analysis using 2009 to 2013 Medicare claims.Methods:We used a 10% random sample of Medicare fee-for-service beneficiaries with lung cancer who died between 2010 and 2013 (43 789 beneficiaries). Patients were assigned to 2 groups depending on whether they used hospice care in the last 6 months of life. The following outcomes were constructed by month: (1) all-cause Medicare spending, (2) indicator of hospitalization, (3) indicator of emergency department (ED) visit, (4) number of part B chemotherapy claims, and (5) number of radiation therapy sessions. We used a combination of propensity score matching and regression analysis to compare outcomes between the 2 groups.Results:Patients who used hospice had significantly lower spending in the last month of life compared to nonusers (US$16 907 vs US$26 906, P < .00). The spending differences in the last month of life between the 2 groups were largely driven by lower likelihood of hospitalization (54% vs 80%, P < .01) and ED visits (15% vs 22%, P < .01) and fewer chemotherapy (0.12 vs 0.32, P < .01) and radiation therapy sessions (0.80 vs 1.26, P < .01). During the other months in the 6-month period, spending was similar between the 2 groups.Conclusions:Timely hospice enrollment of patients with lung cancer—the group suffering from high morbidity and mortality among patients with cancer—may lead to significant cost savings.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-09-30T03:59:16Z
      DOI: 10.1177/1049909119878446
  • Attitudes and Other Factors Influencing End-of-Life Discussion by
           Physicians, Nurses, and Care Staff: A Nationwide Survey in Japan
    • Authors: Jun Hamano, Kyoko Hanari, Nanako Tamiya
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Context:Better understanding about the attitudes of health-care providers toward end-of-life discussion would facilitate the development of systematic strategies for improving end-of-life care.Objective:To clarify attitudes toward end-of-life discussion with patients near death and explore the factors influencing these attitudes among physicians, nurses, and care staff.Methods:This study was part of a nationwide cross-sectional anonymous survey of the public attitudes toward end-of-life medical care performed in December 2017. The participants were physicians, nurses, and care staff from randomly selected facilities, including hospitals, clinics, home-visit nursing offices, nursing homes, and long-term care facilities throughout Japan. The questionnaire was sent to 4500 physicians, 6000 nurses, and 2000 care staff. We assessed attitudes about end-of-life discussion with patients near death, identification of the proxy decision maker, and sharing documented information on end-of-life discussion with the multidisciplinary team.Results:We analyzed responses from 1012 physicians, 1824 nurses, and 749 care staff. The number of responders who considered they had adequate end-of-life discussion with patients near death was 281 (27.8%), 324 (17.8%), and 139 (18.6%), respectively. Participation in a nationwide education program and caring for at least 1 dying patient per month were factors that showed a significant association with adequate end-of-life discussion and identification of the proxy decision maker.Conclusions:The percentages of physicians, nurses, and care staff involved in adequate end-of-life discussion with patients near death were not high. Participation in a structured education program might have a positive influence on end-of-life discussion with patients.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-09-30T03:58:17Z
      DOI: 10.1177/1049909119876568
  • Polypharmacy Increases Risk of Dyspnea Among Adults With Serious,
           Life-Limiting Diseases
    • Authors: Kathleen M. Akgün, Supriya Krishnan, Shelli L. Feder, Janet Tate, Jean S. Kutner, Kristina Crothers
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background:Polypharmacy is associated with dyspnea in cross-sectional studies, but associations have not been determined in longitudinal analyses. Statins are commonly prescribed but their contribution to dyspnea is unknown. We determined whether polypharmacy was associated with dyspnea trajectory over time in adults with advanced illness enrolled in a statin discontinuation trial, overall, and in models stratified by statin discontinuation.Methods:Using data from a parallel-group unblinded pragmatic clinical trial (patients on statins ≥3 months with life expectancy of 1 month to 1 year, enrolled in the parent study between June 3, 2011, and May 2, 2013, n = 308/381 [81%]), we restricted analyses to patients with available baseline medication count and ≥1 dyspnea score. Polypharmacy was assessed by self-reported chronic medication count. Dyspnea trajectory group, our primary outcome, was determined over 24 weeks using the Edmonton Symptom Assessment System.Results:The mean age of the patients was 73.8 years (standard deviation [SD]: ±11.0) and the mean medication count was 11.6 (SD: ±5.0). We identified 3 dyspnea trajectory groups: none (n = 108), mild (n = 130), and moderate–severe (n = 70). Statins were discontinued in 51.8%, 48.5%, and 42.9% of patients, respectively. In multivariable models adjusting for age, sex, diagnosis, and statin discontinuation, each additional medication was associated with 8% (odds ratio [OR] = 1.08 [1.01-1.14]) and 16% (OR = 1.16 [1.08-1.25]) increased risk for mild and moderate–severe dyspnea, respectively. In stratified models, polypharmacy was associated with dyspnea in the statin continuation group only (mild OR = 1.12 [1.01-1.24], moderate–severe OR = 1.24 [1.11-1.39]) versus statin discontinuation (mild OR = 1.03 [0.95-1.12], and moderate–severe OR = 1.09 [0.98-1.22]).Conclusion:Polypharmacy was strongly associated with dyspnea. Prospective interventions to decrease polypharmacy may impact dyspnea symptoms, especially for statins.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-09-25T04:26:46Z
      DOI: 10.1177/1049909119877512
  • Palliative Caregivers’ Spirituality, Views About Spiritual Care, and
           Associations With Spiritual Well-Being: A Mixed Methods Study
    • Authors: Clare O’Callaghan, Davinia Seah, Josephine M. Clayton, Martina Welz, David Kissane, Ekavi N. Georgousopoulou, Natasha Michael
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background:Spiritual care is integral to palliative care. It engenders a sense of purpose, meaning, and connectedness to the sacred or important and may support caregiver well-being.Aim:To examine caregivers’ spirituality, religiosity, spiritual well-being, and views on spiritual/religious support.Design:A mixed-methods study across 4 Australian sites, recruiting caregivers of patients with a life expectancy of under 12 months. The anonymous semistructured questionnaire used included research team developed and adapted questions examining religion/spirituality’s role and support and views on hospitals supporting spiritual/religious requirements. It additionally included the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp-12).Results:One hundred nine caregivers participated (47.4% responded). Median spiritual well-being was 30.5 on FACIT-Sp-12. Religious affiliation was associated with higher Faith subscores (P < .001). Spirituality was very important to 24.5%, religiosity to 28.2%, and unimportant to 31.4% and 35.9%, respectively. Caregivers prayed (P = .005) and meditated (P = .006) more following patients’ diagnoses, gaining comfort, guidance, and strength. Caregivers whose spiritual/religious needs were met to moderate/full extent by external religious/faith communities (23.8%) reported greater spiritual well-being (P < .001). Hospitals supported moderate/full caregiver spiritual needs in 19.3%. Pastoral care visits comforted 84.4% of those who received them (n = 32) but elicited discomfort in 15.6%. Caregivers also emphasized the importance of humane staff and organizational tone in supporting spiritual care.Conclusions:Hospital-based spiritual care providers should seek to identify those who seek pastoral or religiously orientated care. Genuine hospitality of showing concern for the other ensures the varied yet inevitably humanist requirements of the caregiver community are met.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-09-25T04:25:38Z
      DOI: 10.1177/1049909119877351
  • University Students’ Attitudes Toward Palliative Care
    • Authors: Helen B. Miltiades
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      This study examines the experiences and beliefs of university students which affect attitudes toward palliative care. A total of 322 students responded to a survey on palliative care and end-of-life attitudes. Almost 40% of the students reported not having enough knowledge about options at the end of life. Results of multiple regression indicate students who have more negative attitudes toward palliative care did not believe in end-of-life care planning. Female students and those who had a family member or friend who used palliative care had more positive attitudes toward palliative care. Understanding student perceptions of palliative care allows for developing curriculum sensitive to learners’ needs and addressing misconceptions.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-09-20T04:30:20Z
      DOI: 10.1177/1049909119876911
  • The Effect of a Standardized Triage Process on Efficiency and Productivity
           of an Inpatient Palliative Care Team
    • Authors: Lynn S. Frendak, Scott M. Wright, David Shih Wu
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Context:Studies have shown that palliative care involvement delivers a multitude of benefits to patients and caregivers. The existing palliative care workforce is inadequate to meet growing demand. Innovative strategies to triage inpatient consults are necessary.Objectives:To describe the implementation of a new palliative care triage process and to demonstrate its impact on efficiency, teamwork, and patient care.Methods:A quasi-experimental study design, comparing clinical consult data from a 6-month period before and a 6-month period after implementation of the novel consult triage model.Results:Across the 2 study periods, consult demand increased by 44% while the physician staffing (full time equivalent [FTE]) decreased by 38%. Penetration rate per clinical FTE increased (from 1.9%-2.4%; P = .004). Monthly physician work relative value units (RVUs) per FTE increased from 909 to 1678. Physician encounters with hospitalized patients increased from 284 to 353, and total team visits increased from 596 to 891 (P < .001). Average time to consult decreased by 2.4 hours (P = .54).Conclusion:An efficient and streamlined consult triage process had a positive impact on our palliative care team’s ability to reach patients. We were able to generate more physician visits and RVUs despite a decrease in physician clinical time, and our penetration rate per physician clinical FTE improved. Our findings highlight the importance of thoughtful and appropriate triage, not to mention teamwork, in helping to augment patient access to palliative care.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-09-19T05:00:27Z
      DOI: 10.1177/1049909119876928
  • Nonprescription Medication Use in Hospice Patients
    • Authors: Alan P. Baltz, Laura E. Gressler, Ryan C. Costantino, Mary Lynn McPherson
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Objective:Patients admitted to hospice are more vulnerable to age-related physiologic changes, polypharmacy, and inappropriate medication use and monitoring. The objective of this study was to characterize the utilization of nonprescription medications in a hospice population.Methods:This was a retrospective study designed to characterize nonprescription or over-the-counter medication use in hospice patients. Data for this study were provided by Seasons Hospice & Palliative Care, a national hospice organization with licenses to operate in 19 states and collected from January 1 to December 31, 2016. The most frequently utilized nonprescription medications, therapeutic classes, and the frequency of patients with at least 1 claim within a therapeutic class were summarized.Results:The final study population included 62 639 orders representing 15 164 patients. The average age was 79.31 years with a standard deviation of 13.31 years. The average length of stay was 26.80 days with a standard deviation of 44.14 days. The top 5 most common medications were as follows: acetaminophen (25.15%), bisacodyl (21.69%), senna (8.35%), omeprazole (4.51%), and docusate (4.46%). Approximately 13 714 (29.67%) of patients were exposed to analgesics, 13 469 (29.14%) to laxatives, and 3535 (7.65%) to antacids or antigas medications.Conclusion:This study highlights numerous opportunities for improvement in the use of nonprescription medications among hospice patients. Reducing the use of nonprescription medications that are ineffective or produce unwanted side effects can contribute to improving the quality of care that patients receive.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-09-18T05:00:35Z
      DOI: 10.1177/1049909119876259
  • A Multidisciplinary Team-Based Approach to Improve Communication With
           Surrogates of Patients With Chronic Critical Illness
    • Authors: Jared A. Greenberg, James Gerhart, Jacqueline N. Horst, Elaine Chen, Rebecca L. Hunter, Sean O’Mahony, Mei-Ean Yeow, Laura Fosler, Lisa A. LaGorio, Edita Meksraityte, Tyler T. Weiss, Kristen Nowak, Jacqueline Geddes, Stacy S. Lambe, Kara Fenton, Raj C. Shah
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background:Clinicians need to deliver prognostic information to surrogates of nondecisional, critically ill patients so that surrogates can make informed medical decisions that reflect the patient’s values. Our objective was to implement a new approach for communicating with surrogates of patients with chronic critical illness.Methods:Surrogate decision makers of patients who were difficult to liberate from mechanical ventilation were prospectively enrolled. Surrogates met with different members of the intensive care unit treatment team for sequential 15-minute appointments to receive patient-specific assessments and education on chronic critical illness. The feasibility and acceptability of this approach were determined. A 24-question comprehension instrument was developed to assess a participant’s understanding that a family member was displaying features of chronic critical illness. Each question was scored from 1 to 5, with larger scores indicating greater comprehension.Results:Over a 15-week period, educational sessions for 9 mechanically ventilated patients were conducted. On average, 2 surrogates per patient (range: 1-4) and 6 members of the interdisciplinary team (range: 4-6) were at each meeting. Surrogates and clinicians had very positive impressions of the communication intervention. The average preintervention comprehension score was 85 of 120 (standard deviation [SD]: 8, range: 71-101). The postintervention comprehension score was greater by 5 points on average (SD: 9, range: −11 to +20 points, P = .04).Conclusions:Surrogates of critically ill patients approved of this novel communication approach and had a greater understanding of the patient’s medical condition after the intervention.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-09-17T05:14:11Z
      DOI: 10.1177/1049909119876606
  • Corrigendum to Primary Palliative Care Education Programs: Review and
    • Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.

      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-09-05T04:43:31Z
      DOI: 10.1177/1049909119877070
  • Immediate Effect of Fan Therapy in Terminal Cancer With Dyspnea at Rest: A
    • Authors: Jun Kako, Masamitsu Kobayashi, Yasufumi Oosono, Kohei Kajiwara, Mika Miyashita
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background:Dyspnea is a common distressing symptom in patients with malignant and nonmalignant diseases. Fan therapy, which uses a fan to blow air toward the patient’s face, can alleviate dyspnea; however, its efficacy remains unclear.Aim:To examine the immediate efficacy of fan therapy for alleviation of dyspnea at rest.Design:Meta-analysis.Data sources:We searched the Cochrane Central Register of Controlled Trials in the Cochrane Library, MEDLINE EBSCO, CINAHL EBSCO, and Scopus from January 1, 1987, to August 21, 2018 (PROSPERO-CRD42018108610). In addition, we hand-searched studies and used the similar articles feature on PubMed to search for articles. Randomized controlled trials comparing the effects of fan therapy with placebo or other interventions to alleviate dyspnea at rest, in which patients were aged ≥18 years, were eligible for inclusion in the review. We excluded articles on long-term intervention involving fan therapy and complex intervention (including fan therapy). The risk of bias assessment was conducted using the Cochrane tool, and the meta-analysis was performed using RevMan version 5.3.Results:We identified a total of 218 studies; 2 met our criteria for inclusion in the meta-analysis. Fan therapy significantly improved dyspnea at rest in terminally ill patients with cancer compared to control groups (mean difference: −1.31, 95% confidence interval: −1.79 to −0.83, P < .001). There were no studies that met the inclusion criteria regarding fan therapy for patients with nonmalignant disease.Conclusions:This meta-analysis demonstrated that fan therapy may be an effective intervention for dyspnea at rest in patients with terminal cancer.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-09-05T04:43:09Z
      DOI: 10.1177/1049909119873626
  • Lessons From the Development and Implementation of a Palliative Care
           Elective for Fourth-Year Medical Students: A Pilot Study
    • Authors: Katelyn D. Stepanyan, Timothy E. Weiss, Antonio M. Pessegueiro, Christopher J. Pietras
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background:Although palliative care is recognized as an important component of medical school curricula, the content and structure of education in the field is variable and often lacks outpatient exposure. We aimed to develop and implement a palliative care clinical elective for fourth-year medical students incorporating both inpatient and outpatient learning.Methods:Fourteen medical students participated in a palliative care elective which included 2 weeks on an inpatient consult service and 1 week of outpatient clinic and home hospice visits. The elective was evaluated using a focus group and previously validated surveys assessing self-rated competency and attitudes toward caring for palliative care patients. Data were analyzed using paired t tests to compare survey response means before and after the elective.Results:Of the 14 participating students, 7 completed both the pre- and postelective surveys. Significant improvements in self-rated competency were seen in pain and symptom management (P < .001), communication (P < .001), and advance care planning (P < .01). Survey results also showed improvement in attitudes toward caring for dying patients (P < .001), with lower scores at the end of the elective suggesting reduced emotional distress. Although the outpatient component was hypothesized to be a major benefit of the curriculum, qualitative data revealed the most highly valued component to be direct observation and feedback during inpatient time.Conclusion:Given the highlighted importance of direct observation and feedback as a unique and powerful learning experience, future work should be targeted toward enhancing the quality and timeliness of feedback delivered by the palliative care interdisciplinary team.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-09-03T02:51:19Z
      DOI: 10.1177/1049909119872976
  • Improving Advance Care Planning in a Resident Primary Care Clinic
    • Authors: Nicholas J. Nassikas, Grayson L. Baird, Christine M. Duffy
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Introduction:Two-thirds of chronically ill patients do not have an advance directive. The primary aim of this study was to develop an intervention to increase the documentation of advance directives in elderly adults in an internal medicine resident primary care clinic. The secondary aims were to improve resident confidence in discussing advance care planning and increase the number of discussions.Methods:The study was a pre- and postintervention study. The study intervention was a 30-minute educational session on advance care planning. Study participants were patients aged 65 years and older who were seen in an internal medicine residency primary care clinic over a 6-month period and internal medicine residents. Clinic encounters were reviewed for the presence of advance care planning discussions before and after the intervention. Resident confidence was measured on a Likert scale.Results:Two hundred ninety-five eligible patients were seen in the clinic from January 1, 2017, to June 30, 2017, and included in the analysis performed between 2017 and 2018. The mean number of documented advance care planning discussions increased from 2.24 (95% confidence interval [CI]: 1.0-4.9) during the preintervention period to 8.94 (95% CI: 5.94-13.24]) during the postintervention period (P = .0011). Following the intervention, residents overall reported increased confidence in discussing advance care planning.Conclusion:A relatively modest intervention to increase advance care planning discussions is feasible in an internal medicine primary care clinic and can improve the confidence of residents with end-of-life discussion.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-09-03T02:50:59Z
      DOI: 10.1177/1049909119872757
  • Characterizing the Financial Value of In-Home Palliative Care for
           Patients, Payers, and Hospitals
    • Authors: Saad Akhtar, Vamshek Srinivasan, Carol Weisse, Phil DiSorbo
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background:The holistic and multidisciplinary approach of in-home palliative care (IHPC) is known to offer high-quality and cost-effective care for patients at the end of life. However, the financial benefits of upstream IHPC programs to hospitals, patients, and payers have not been fully characterized for patients with comorbid chronic conditions.Aim:To characterize the financial benefits that upstream IHPC offers to patients with multiple chronic conditions.Methods:A structured retrospective patient record review was conducted on the number of emergency department (ED) visits, number of inpatient hospitalizations, hospital length of stay (LOS), and payments made to the hospital for all patients (N = 71) enrolled in an IHPC program between January 1, 2016, and June 30, 2016. Discharge history from each patient’s medical record was also assessed. Comparisons were drawn between patients’ LOS on IHPC and an equivalent time period prior to enrollment in IHPC.Results:After patients enrolled in IHPC, average ED and inpatient utilization declined significantly by 41% (P = .01) and 71% (P < .001), respectively. The payers for health-care services realized a significant decline of US$2,201 (P < .001) in hospital payments per patient per month. Inpatient LOS was also significantly lower than expected once patients enrolled in the program (P = .01).Conclusions:As the need for chronic disease management continues to grow, managers of health systems, managed care organizations, and home health agencies should be cognizant of the financial value that IHPC has to offer.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-09-03T02:50:19Z
      DOI: 10.1177/1049909119872486
  • Providing Data-Driven Equitable Palliative and End-of-Life Care for
           Structurally Vulnerable Populations: A Pilot Survey of Information
           Management Strategies
    • Authors: Akshay Rajaram, Trevor Morey, Sonam Shah, Naheed Dosani, Muhammad Mamdani
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background:Considerable gains are being made in data-driven efforts to advance quality improvement in health care. However, organizations providing hospice-oriented palliative care for structurally vulnerable persons with terminal illnesses may not have the enabling data infrastructure or framework to derive such benefits.Methods:We conducted a pilot cross-sectional qualitative study involving a convenience sample of hospice organizations across North America providing palliative care services for structurally vulnerable patients. Through semistructured interviews, we surveyed organizations on the types of data collected, the information systems used, and the challenges they faced.Results:We contacted 13 organizations across North America and interviewed 9. All organizations served structurally vulnerable populations, including the homeless and vulnerably housed, socially isolated, and HIV-positive patients. Common examples of collected data included the number of referrals, the number of admissions, length of stay, and diagnosis. More than half of the organizations (n = 5) used an electronic medical record, although none of the record systems were specifically designed for palliative care. All (n = 9) the organizations used the built-in reporting capacity of their information management systems and more than half (n = 6) augmented this capacity with chart reviews.Discussion:A number of themes emerged from our discussions. Present data collection is heterogeneous, and storage of these data is highly fragmented within and across organizations. Funding appeared to be a key enabler of more robust data collection and use. Future work should address these gaps and examine opportunities for innovative ways of analysis and reporting to improve care for structurally vulnerable populations.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-08-30T03:55:42Z
      DOI: 10.1177/1049909119872756
  • Spirituality, Religion, and Medicine Education for Internal Medicine
    • Authors: Gina M. Piscitello, Shannon Martin
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Purpose:Spirituality and religion affect patient health. This topic is often not included in medical resident education. We aimed to evaluate resident knowledge, attitudes, and skill regarding spirituality, religion, and medicine and to develop, implement, and evaluate a curriculum to improve these measures.Methods:Internal medicine residents at a large, urban academic center were surveyed to determine their baseline knowledge, attitudes, and skill regarding spirituality and religion (37.4% response rate, n = 46/123). A lecture and discussion-based curriculum was implemented over 1 year, followed by another survey (41.4% response rate, n = 51/123); χ2 statistic was used to compare pre- and postsurveys to evaluate the curriculum.Results:Baseline resident attitudes toward spirituality, religion, and medicine were high with most agreeing chaplains are valuable in patient care (93.5%) and that patient spiritual and religious beliefs can affect health (93.5%). Resident self-reported knowledge and skill were low with few knowing the training chaplains receive (4.3%) or reporting competence taking a spiritual history (15.2%). After the curriculum, resident self-reported knowledge increased regarding the role of chaplains (56.5%-80.4%, P = .011) and the training chaplains receive (4.3%-27.5%, P = .002). No significant postcurriculum change was seen in attitudes or skill.Conclusions:Most internal medicine residents have positive attitudes toward spirituality, religion, and medicine. They do not have adequate knowledge or skill to care for patients in this area, however. Implementation of a curriculum in spirituality, religion, and medicine improved resident self-reported knowledge. Future work should focus on revising the curriculum to better improve resident knowledge and skill.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-08-29T04:54:14Z
      DOI: 10.1177/1049909119872752
  • Survey on Barriers to Critical Care and Palliative Care Integration
    • Authors: Kwadwo Kyeremanteng, Weiwei Beckerleg, Cynthia Wan, Brandi Vanderspank-Wright, Gianni D’Egidio, Stephanie Sutherland, Michael Hartwick, Valérie Gratton, Aimee J. Sarti
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Purpose:It has been shown that integrating palliative care (PC) in intensive care unit (ICU) improves end-of-life care (EOLC), but very few Canadian hospitals have adopted this practice. Our study aims to evaluate the perceived quality of EOLC at participating institutions and explore barriers toward ICU-PC integration.Materials and Methods:A self-administered questionnaire was developed by a multidisciplinary team. Survey items were extracted from published quality indicators in EOLC and barriers to ICU-PC integration. The study took place at 2 academic institutions. Participants consisted of physicians and nurses, ICU administrators, and allied health workers.Results:An overall response of 45% was achieved. Of total, 85% of the respondents were ICU nurses. The following main themes were identified: (1) There is a poor presence of PC in the ICU and 78% of respondents felt that increasing ICU-PC integration will improve quality of EOLC; (2) the main barrier to integration was unrealistic patient and/or family expectations; and (3) criteria-triggered consultation to PC was the most feasible way to achieve integration.Conclusion:Our findings indicate that the majority of respondents perceive that the presence of PC in ICU will improve EOLC. Future quality improvement initiatives can focus on developing a set of criteria for triggering PC consults.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-08-16T03:18:36Z
      DOI: 10.1177/1049909119867658
  • Keys to Recruiting and Retaining Seriously Ill African Americans With
           Sickle Cell Disease in Longitudinal Studies: Respectful Engagement and
    • Authors: Marie L. Suarez, Judith M. Schlaeger, Veronica Angulo, David A. Shuey, Jesus Carrasco, Keesha L. Roach, Miriam O. Ezenwa, Yingwei Yao, Zaijie Jim Wang, Robert E. Molokie, Diana J. Wilkie
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Objectives:Sickle cell disease (SCD) is a serious illness with disabling acute and chronic pain that needs better therapies, but insufficient patient participation in research is a major impediment to advancing SCD pain management. The purpose of this article is to discuss the challenges of conducting an SCD study and approaches to successfully overcoming those challenges.Design:In a repeated-measures, longitudinal study designed to characterize SCD pain phenotypes, we recruited 311 adults of African ancestry. Adults with SCD completed 4 study visits 6 months apart, and age- and gender-matched healthy controls completed 1 visit.Results:We recruited and completed measures on 186 patients with SCD and 125 healthy controls. We retained 151 patients with SCD with data at 4 time points over 18 months and 125 healthy controls (1 time point) but encountered many challenges in recruitment and study visit completion. Enrollment delays often arose from patients’ difficulty in taking time from their complicated lives and frequent pain episodes. Once scheduled, participants with SCD cancelled 49% of visits often because of pain; controls canceled 30% of their scheduled visits. To facilitate recruitment and retention, we implemented a number of strategies that were invaluable in our success.Conclusion:Patients’ struggles with illness, chronic pain, and their life situations resulted in many challenges to recruitment and completion of study visits. Important to overcoming challenges was gaining the trust of patients with SCD and a participant-centered approach. Early identification of potential problems allowed strategies to be instituted proactively, leading to success.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-08-09T04:19:42Z
      DOI: 10.1177/1049909119868657
  • Selecting the Best Instrument to Measure Family Perceptions of End-of-Life
           Communication in Intensive Care Units
    • Authors: Chiahui Chen, Scott T. Meier
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background:Good communication with the family is a clinical imperative for high quality end-of-life (EOL) care in intensive care unit (ICU). Many interventions aim to improve EOL communication, and the choice of an outcome instrument has important implications for evaluating interventions. The purpose of this project is to search and review available instruments’ psychometric properties and determine which best measures family–clinician communication in the ICU.Method:A stepwise method was used by searching 2 databases (PsycInfo and Web of Science) to identify instruments and articles that provide information about scale psychometric properties.Instruments:Three instruments were identified, including Family Inpatient Communication Survey, Family Perception of Physician–Family Caregiver Communication, and Quality of Communication (QOC).Results:Reliability estimates were high (≥ 0.79) in all 3 instruments. The QOC’s convergent validity estimates exceed its discriminant validity values, and the QOC is an intervention-sensitive measure used to examine families’ treatment response in randomized control trials.Conclusion:Quality of Communication is the most suitable instrument to measure family’s perceptions of EOL communication in the ICU. Quality of Communication scores provide a deeper understanding of family–clinician communication and data about how to improve EOL care in ICUs.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-08-08T04:03:44Z
      DOI: 10.1177/1049909119867623
  • Differential Utilization of Palliative Care Consultation Between Medical
           and Surgical Services
    • Authors: Minh-Thuy Nguyen, Timothy Feeney, Chanmin Kim, F. Thurston Drake, Suzanne E. Mitchell, Magdalena Bednarczyk, Sabrina E. Sanchez
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      There is a paucity of data regarding the utilization of palliative care consultation (PCC) in surgical specialties. We conducted a retrospective review of 2321 adult patients (age ≥18) who died within 6 months of admission to Boston Medical Center from 2012 to 2017. Patients were included for analysis if their length of stay was more than 48 hours and if, based on their diagnoses as determined by literature review and expert consensus, they would have benefited from PCC. Bayesian regression was used to estimate the odds ratio (OR) and 99% credible intervals (CrI) of receiving PCC adjusted for age, sex, race, insurance status, median income, and comorbidity status. Among the 739 patients who fit the inclusion criteria, only 30% (n = 222) received PCC even though 664 (90%) and 75 (10%) of these patients were identified as warranting PCC on medical and surgical services, respectively. Of the 222 patients who received PCC, 214 (96%) were cared for by medical services and 8 (4%) were cared for by surgical services. Patients cared for primarily by surgical were significantly less likely to receive PCC than primary patients of medical service providers (OR, 0.19, 99% CrI, 0.056-0.48). At our institution, many surgical patients appropriate for PCC are unable to benefit from this service due to low consultation numbers. Further investigation is warranted to examine if this phenomenon is observed at other institutions, elucidate the reasons for this disparity, and develop interventions to increase the appropriate use of PCC throughout all medical specialties.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-08-07T03:19:10Z
      DOI: 10.1177/1049909119867904
  • Forgiveness and Reconciliation Processes in Dying Patients With Cancer
    • Authors: M. Renz, D. Bueche, O. Reichmuth, M. Schuett Mao, U. Renz, R. Siebenrock, F. Strasser
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      This article studies forgiveness and reconciliation (F/R) in patients with cancer. It focuses on the end of life, when family conflicts resurface and unfinished business challenges patients and causes spiritual distress. Forgiveness and reconciliation may intensify patient–family relationships and facilitate peace of mind and peaceful death. Existing forgiveness models and interventions focus on coping in life, yet no study has examined F/R processes until death. Our mixed-method exploratory study hypothesized that F/R processes occur in phases, repeatedly, and are spurred by approaching death. Three interdisciplinary units at a major Swiss hospital observed 50 dying patients with cancer experiencing severe conflicts with relatives, themselves, and/or with fate/God. Participant observation was combined with interpretative phenomenological analysis and descriptive statistical analysis. A semi-structured observation protocol was developed based on a 5-phase model. The protocol included space for notes (emotions, interventions, effects on dying processes). It was assessed by 20 professionals for 1 year. Analysis was supported by international interdisciplinary experts. We found that conflicts were complex and involved relational, biographical, and spiritual layers. In 62% of patients, F/R processes occurred repeatedly. Many patients died after finding F/R (22 within 48 hours). Patients indicated that imminent death, a mediating third party, acceptance, and experiences of hope motivated them to seek F/R. Although deep relationships may support F/R processes, our limited data on near-death experience/spiritual experiences restrict interpretation. Forgiveness and reconciliation processes oscillate between 5 phases: denial, crisis, experience of hope, decision, and finding F/R. Understanding F/R processes, empathy, hope, and a neutral third party may support patients in seeking forgiveness.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-08-06T04:20:52Z
      DOI: 10.1177/1049909119867675
  • Referral Characteristics of Palliative Care Service in Patients With
           Advanced Non-Small Cell Lung Cancer in a Tertiary Cancer Center
    • Authors: Xiaoli Gu, Menglei Chen, Minghui Liu, Zhe Zhang, Weiwei Zhao, Wenwu Cheng
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background:The American Society of Clinical Oncology recently recommends patients with metastatic non-small cell lung cancer (NSCLC) should be offered palliative care services earlier. We sought to investigate the timing of palliative care referral of Chinese patients with NSCLC in our center.Method:Retrospective medical data including demographic characteristics and referral information were collected for analysis. Overall survival (OS) was calculated as the time since cancer diagnosis till patient’s death. The time interval from palliative care (PC) referral to a patient’s death (PC-D) was calculated. The PC-D/OS ratio was calculated to illustrate the comparison of the duration of PC in the overall length of disease.Results:The mean age of 155 patients with advanced NSCLC was 62.83 years. Before referral to PC, 128 patients received anticancer treatment including surgeon (46.5%). Sixty-three (40.6%) patients died in palliative care unit. The median OS of 144 patients with end cutoff was 19 months (mean = 31.49, 95% confidence interval [CI] = 25.86-37.12). The median PC-D was 41 days (mean = 73.84, 95% CI = 60.37-87.40). The mean interval of PC-D/OS of 144 patients with definitely death time was 0.22 (SD: 0.27, 95% CI: 0.17-0.26). The median interval was 0.089. More than half of patients (n = 75, 51.8%) underwent PC less than 1% time (PC-D/OS < 0.1) of their whole disease course. Patients who were indigenous to Shanghai (P = .013) and who had brain metastasis (P = .072) had the potential longer PC-D/OS ratio. A high proportion of patients reported loss of appetite (92.8%) and fatigue (91.4%) at the initial of referral to PC.Conclusion:This retrospective study, in a population of patients with advanced NSCLC, gave detailed information about PC services in a tertiary cancer center.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-08-05T03:14:44Z
      DOI: 10.1177/1049909119867281
  • Mindfulness Training Supports Quality of Life and Advance Care Planning in
           Adults With Metastatic Cancer and Their Caregivers: Results of a Pilot
    • Authors: Shelley A. Johns, Kathleen Beck-Coon, Patrick V. Stutz, Tasneem L. Talib, Kelly Chinh, Ann H. Cottingham, Karen Schmidt, Cleveland Shields, Madison E. Stout, Timothy E. Stump, Patrick O. Monahan, Alexia M. Torke, Paul R. Helft
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background:Emotional distress often causes patients with cancer and their family caregivers (FCGs) to avoid end-of-life discussions and advance care planning (ACP), which may undermine quality of life (QoL). Most ACP interventions fail to address emotional barriers that impede timely ACP.Aim:We assessed feasibility, acceptability, and preliminary effects of a mindfulness-based intervention to facilitate ACP for adults with advanced-stage cancer and their FCGs.Design:A single-arm pilot was conducted to assess the impact of a 6-week group mindfulness intervention on ACP behaviors (patients only), QoL, family communication, avoidant coping, distress, and other outcomes from baseline (T1) to post-intervention (T2) and 1 month later (T3).Participants:Eligible patients had advanced-stage solid malignancies, limited ACP engagement, and an FCG willing to participate. Thirteen dyads (N = 26 participants) enrolled at an academic cancer center in the United States.Results:Of eligible patients, 59.1% enrolled. Attendance (70.8% across 6 sessions) and retention (84.6% for patients; 92.3% for FCGs) through T3 were acceptable. Over 90% of completers reported high intervention satisfaction. From T1 to T3, patient engagement more than doubled in each of 3 ACP behaviors assessed. Patients reported large significant decreases in distress at T2 and T3. Family caregivers reported large significant improvements in QoL and family communication at T2 and T3. Both patients and FCGs reported notable reductions in sleep disturbance and avoidant coping at T3.Conclusions:The mindfulness intervention was feasible and acceptable and supported improvements in ACP and associated outcomes for patients and FCGs. A randomized trial of mindfulness training for ACP is warranted. The study is registered at with identifier NCT02367508 (
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-08-05T03:14:04Z
      DOI: 10.1177/1049909119862254
  • Managing Palliative Patients in Inpatient Rehabilitation Through a Short
           Stay Family Training Program
    • Authors: Suzette Smith, Christopher M. Wilson, Christine Lipple, Meghan Avromov, John Maltese, Eliezer Siwa, Reyna Colombo, Janet Wiechec Seidell
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Study Design:Retrospective Analysis of a Quality Improvement Program.Purpose:To describe the development, implementation, and outcomes of an inpatient rehabilitation-based Short Stay Family Training (SSFT) program for patients with life-limiting conditions.Background:Patients with terminal illnesses often have functional limitations that prohibit discharge home after hospitalization, but their condition limits their ability to participate in rehabilitation in an inpatient setting.Methods and Measures:After a needs assessment, an interdisciplinary team developed an SSFT program to empower patients, caregivers, and family members by giving them the tools to be independent in caring for a patient with a life-limiting condition. Patients qualifying for the program were tracked in terms of acute care physical therapy and occupational therapy discharge recommendations, diagnosis, inpatient rehabilitation unit length of stay (LoS), caregiver involvement, and discharge location. Data were retrospectively analyzed from patients over the first 16 months.Results:Since program implementation, 30 patients and their family members participated in the program. Overall, these patients experienced decreased LoS, increased discharge to home, and increased palliative care involvement in the plan of care.Conclusion:Short Stay Family Training is a viable alternative to traditional inpatient rehabilitation to allow patients with life-limiting conditions to discharge home safely with caregiver support.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-08-02T02:59:57Z
      DOI: 10.1177/1049909119867293
  • Retrospective Prognostic Study of Death at Home or Hospice Versus at a
           Hospital Among Patients With Advanced Non-Small Cell Lung Cancer
    • Authors: Yoichiro Hamamoto, Tatsuya Ibe, Hiroaki Kodama, Atsuto Mouri, Masamichi Mineshita
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background:Patients with advanced non-small cell lung cancer greatly care about where they will die. Most people in Japan preferred their location of death as their homes. But only 8.2% of patients with cancer spend their last days at home with palliative care in Japan. Many patients with cancer are still going to spend their last days at a hospital (81.7%).Objective:We examined the survival times of such patients according to their place of death; that is, whether they died at home, at a hospice, or at a hospital, and investigated patient characteristics.Results:Among the 313 patients recruited, 214 were analyzed in this study: 90, 49, and 75 received hospital-based, home-based, and hospice-based palliative care, respectively. The patients who died at a hospice exhibited significantly longer survival than those who died at hospital (estimated median survival time, 420 days [95% confidence interval [CI]: 325-612 days] versus 252 days [95% CI: 201-316 days]; P < .0001). The characteristics of patients did not differ significantly according to place of death.Conclusions:Patients who died at a hospice or at home exhibited significantly longer survival than those who died at a hospital for advanced non-small cell lung cancer.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-08-01T03:46:49Z
      DOI: 10.1177/1049909119865865
  • Characteristics of Hospitalized Patients Screening Positive for Delirium
    • Authors: Trinh H. Nguyen, Rabia S. Atayee, Katrina L. Derry, Jeremy Hirst, Anthony Biondo, Kyle P. Edmonds
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background:Delirium in the hospitals leads to worse outcomes for patients. There were no previous studies that characterize patients with delirium from multiple hospital locations.Objective:To describe patient characteristics screening positive for delirium and identify any correlations with hospital location and medication use.Design, Settings, Patients:Retrospective chart review of 227 hospitalized patients from a large, academic, tertiary referral, 2-campus health system. Patients were ≥18 years old and had delirium for at least ≥24 hours. Validated delirium screening tools were utilized.Measurements:Patients’ demographics, inpatient stay information, delirium episodes characteristics, drugs, and palliative and psychiatry teams’ involvement.Results:Most patients were older with a mean age of 64.1 years. The most common primary diagnoses were infection, cardiac, and pulmonary. Average length of delirium was 7.2 days (standard deviation [SD] = 8.2), and average length of stay (LOS) was 18.7 days (median = 10.5, SD = 35.1, 95% confidence interval = 14.1-23). Thirty-day readmission rate was 24.8% (65/262 hospitalizations); 12.8% of patients died in the hospital (29/227). Around one-third of hospitalizations had involvement of palliative care, palliative psychiatry, or general psychiatry team. There was a decrease in the number of medications administered 24 hours after the first recording of delirium compared to the immediate preceding 48 hours. Those hospitalizations where delirium first occurred in the intensive care unit (ICU) did have a longer LOS (average = 22.9, SD = 45.7) than those where delirium first occurred outside the ICU (average = 14.8, SD = 20.5). Patients were likely to have received an opioid within 48 hours in 51% of hospitalizations and to have received benzodiazepines in 16% of hospitalizations.Conclusion:In our study, we found that delirium significantly impacted length of delirium episode, number of episodes of delirium, length of hospital admission, and mortality. The population most sensitive to the impacts of delirium were elderly patients.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-07-31T04:09:02Z
      DOI: 10.1177/1049909119867046
  • Analysis of Inpatient Palliative Care Consultations for Patients With
           Metastatic Prostate Cancer
    • Authors: Neil A. Mistry, Syed Johar Raza, Sameer A. Siddiqui
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Objective:To characterize the use of palliative care for patients with metastatic prostate cancer and identify its associations with costs, hospital course, and discharge.Materials and Methods:Using the National Inpatient Sample database from 2012 to 2013, we identified 99 070 patients with metastatic prostate cancer and analyzed the data from their hospital admissions using descriptive statistics, χ2 analysis, and regression modeling.Results:Palliative care services were consulted in 10.4% (10 300) of metastatic prostate cancer admissions. These admissions were associated with nonelective origin, acute complications, and reduced surgical procedures and chemotherapy. Patients in private, investor-owned hospitals had a 51.6% less consultations (P < .001), while nonprofit and government, nonfederal hospitals had 4.7% and 7.8% more consultations (P < .001). Median costs and charges were only marginally less (2.1% and 5.6%, respectively, P < .001), length of stay was 22% higher (P < .001), and in-house mortality was 147.2% higher in the consultation group (P < .001). Controlling for other factors, patients seen by palliative care were more likely to have do-not-resuscitate orders (odds ratio [OR]: 5.25, P < .001) and be transferred to another facility like hospice (OR: 3.90, P < .001) or to home health (OR: 3.85, P < .001).Conclusions:Palliative care consultation could improve care for patients with metastatic prostate cancer in a different manner than observed in other diseases. With our characterization of the incidence and patient and hospital factors, we can conclude that there is room to expand palliative care’s role beyond uninsured patients in large, urban teaching hospitals.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-07-24T08:45:47Z
      DOI: 10.1177/1049909119864576
  • Loratadine for Paclitaxel-Induced Myalgias and Arthralgias
    • Authors: Caleb Smith, Andrea Wahner Hendrickson, Megan Grudem, Carolyn Klampe, Erin Deering, Aminah Jatoi
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background:Seventy percentage of patients who receive paclitaxel have diffuse, refractory myalgias, and arthralgias. Based on anecdotal reports, this study explored whether loratadine, an antihistamine, palliates these symptoms.Methods:The medical records of postoperative ovarian and patients with endometrial cancer were studied, as these patients are routinely prescribed paclitaxel. Records were screened for patients who received paclitaxel and loratadine concurrently.Results:Forty patients are the focus of this report. Eight had paclitaxel-induced myalgias and arthralgias and then took loratadine; of these, 6 (75%; 95% confidence interval: 35%, 97%) manifested evidence of symptom improvement: “She did experience some migrating generalized body aches and pains…but this has resolved.” Of those already receiving loratadine but with no myalgias and arthralgias, only 11 of 32, or 34% (95% confidence interval: 19%, 53%), developed myalgias and arthralgias (in contrast to the previously reported symptom rate of 70%). No adverse events were clearly attributed to loratadine.Conclusion:These preliminary data support further study of loratadine for paclitaxel-induced myalgias and arthralgias.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-07-18T04:51:23Z
      DOI: 10.1177/1049909119864083
  • Palliative Care Consultation Is Underutilized in Critically Ill General
           Surgery Patients
    • Authors: Brooke A. Evans, Megan C. Turner, Jared N. Gloria, Lisa C. Pickett, Anthony N. Galanos
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background:American College of Surgeons recommends palliative care and surgeons collaborate on the care of patients with poor prognoses. These collaborations are done to discuss symptom management and goals of care. However, contemporary practice patterns of palliative care consultation for surgical patients are poorly defined. We aim to describe the use of palliative care consultation for patients admitted to our institution’s surgical services who died during their index hospital admission.Methods:The Duke Enterprise Data Unified Content Explorer 2014 to 2016 was queried for patients admitted to general surgery services who died during their admission. Secondary measures included length of stay, time spent in consultation, days from consultation to death, and execution of a care plan.Results:Of the 105 patients identified, 6 died on the day of admission, and 39 (37%) received palliative care consultation. Our data showed that patients who received consultation were generally older, white, and insured. Median number of days between palliative consult and death was 3 days (interquartile range: 1-8). Goals-of-care conversations were the indication for consultation in 62.5% of patients. The proposed plan by the consultants was congruent with the primary team in 66.7% of cases.Conclusions:Palliative care consultations were underutilized in surgical patients who died while admitted to the general surgical service at our institution. When palliative care is consulted, the plan of the primary surgical team and the palliative team align. Identification of barriers to consultation and promotion of the benefits of palliative care among surgical teams is warranted.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-07-18T04:50:20Z
      DOI: 10.1177/1049909119864025
  • Immune Checkpoint Inhibitor Use Near the End of Life Is Associated With
           Poor Performance Status, Lower Hospice Enrollment, and Dying in the
    • Authors: Chad Glisch, Yuya Hagiwara, Stephanie Gilbertson-White, Yubo Gao, Laurel Lyckholm
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background:Immune checkpoint inhibitors have changed the landscape of cancer care by increasing progression-free and overall survival in some patients with cancer. We evaluated use and variables contributing to immune checkpoint inhibitor treatment near the end of life.Methods:We studied 157 patients who received immune checkpoint inhibitors and died between January 2015 and December 2018. All patients had a palliative care consult any time between starting an immune checkpoint inhibitor and death. Univariate and multivariate models were used to examine variables related to immune checkpoint inhibitor use near the end of life.Results:Among 157 patients studied, 42 (27%) received a dose of immune checkpoint inhibitor in the last 30 days of life. Those who received treatment in the last 30 days of life had lower hospice enrollment (19 [45%] vs 78 [69%], P = .007) and higher rates of dying in the hospital (23 [56%] vs 33 [29%], P = .002). The percentage of patients with Eastern Cooperative Oncology Group (ECOG) ≥3 at the time of last immune checkpoint inhibitor dose was higher in the group that received immune checkpoint inhibitor treatment in the last 30 days of life (11 [26%] vs 9 [8%], P = .003). Lack of traditional chemotherapy after immune checkpoint inhibitor, ECOG ≥3, and lack of hospice enrollment were independently associated with receiving immune checkpoint inhibitor in the last 30 days of life.Conclusion:Immune checkpoint inhibitor use in the last 30 days of life is common and associated with poor performance status, lower hospice enrollment, and dying in the hospital.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-07-16T03:46:37Z
      DOI: 10.1177/1049909119862785
  • Effectiveness of a Volunteer Training Program on the Learning Support of
           Children in Hospice Palliative Care
    • Authors: Kazuteru Niinomi, Masakazu Soejima, Kentaro Hiraga, Shoko Kodama, Shin Okazaki, Shigeki Nakao
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background:Volunteers are expected to play a key role in children’s hospice. However, there is a lack of information about how to cultivate effective volunteer training programs.Objective:To verify the effect of a training program on volunteers’ confidence in providing learning support and sharing experiences with children with life-threatening conditions and their families in a children’s hospice.Methods:In this pre–post study, participants were 48 undergraduate and graduate students from 3 universities in Japan. They received 5 lectures on children’s hospice learning support. They evaluated the training program by rating their self-confidence in meeting each of the 15 program goals on a questionnaire.Results:An exploratory factor analysis of the questionnaire yielded 12 goals in 4 factors: understanding of one’s own and others’ mental state, accommodating the learning needs of children with life-threatening conditions, understanding and accommodating the physical state of children with life-threatening conditions, and understanding the significance of children’s hospice. A paired t test revealed that participants’ self-confidence had increased significantly in 3 of these 4 factors after the program. However, the score for accommodating the learning needs of children with life-threatening conditions decreased but not significantly.Conclusion:Although it needs some improvements, the program was effective for improving volunteers’ self-confidence in and understanding of learning support and sharing experiences with children with life-threatening conditions.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-07-05T04:46:07Z
      DOI: 10.1177/1049909119860249
  • A New Competency-Based Instrument to Assess Resident Knowledge and
           Self-Efficacy in Primary Palliative Care
    • Authors: Kristen M. Moyer, Laura J. Morrison, John Encandela, Catherine Kennedy, Matthew S. Ellman
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Context:There is a need to improve both primary palliative care (PPC) education and its assessment in graduate medical education (GME). We developed an instrument based on published palliative care (PC) competencies to assess resident competency and educational interventions.Objectives:To describe the development and psychometric properties of a novel, competency-based instrument to measure resident knowledge and self-efficacy in PPC.Methods:We created a 2-part instrument comprised of a knowledge test (KT) and a self-efficacy inventory (SEI) addressing 18 consensus, core PC resident competencies across 5 domains: pain and symptom management; communication; psychosocial, spiritual, and cultural aspects of care; terminal care and bereavement; and PC principles and practice. The instrument was distributed to 341 internal medicine residents during academic years 2015 to 2016 and 2016 to 2017. A standard item analysis was performed on the KT. Internal consistency (Cronbach α) and variable relationships (factor analysis) were measured for the SEI.Results:One hundred forty-four residents completed the survey (42% response). For 15 KT items, difficulty ranged from 0.17 to 0.98, with 7 items ranging 0.20 to 0.80 (typical optimum difficulty); discrimination ranged from 0.03 to 0.60 with 10 items ≥0.27 (good to very good discrimination). Cronbach α was 0.954 for 35 SEI items. Factor analysis of combined 2015 to 2016 items yielded 4 factors explaining the majority of variance for the entire set of variables.Conclusion:Our instrument demonstrates promising psychometric properties and reliability in probing the constructs of PC and can be further utilized in PC GME research to assess learners and evaluate PPC educational interventions.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-06-19T02:39:35Z
      DOI: 10.1177/1049909119855612
  • Development of a Community Advance Care Planning Guides Program and the
           RELATE Model of Communication
    • Authors: Carey Candrian, Susan Lasker Hertz, Daniel Matlock, Lierin Flanagan, Channing Tate, Jean S. Kutner, Hillary D. Lum
      First page: 5
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.

      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-04-29T04:20:26Z
      DOI: 10.1177/1049909119846116
  • Intellectual Equipoise and Challenges: Accruing Patients With Advanced
           Cancer to a Trial Randomizing to Surgical or Nonsurgical Management (SWOG
    • Authors: Gary B. Deutsch, Jeremiah L. Deneve, Mazin F. Al-kasspooles, Valentine N. Nfonsam, Camille C. Gunderson, Angeles Alvarez Secord, Phillip Rodgers, Samantha Hendren, Eric J. Silberfein, Marcia Grant, Jeff Sloan, Virginia Sun, Kathryn B. Arnold, Garnet L. Anderson, Robert S. Krouse
      First page: 12
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.

      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-05-24T04:36:06Z
      DOI: 10.1177/1049909119851471
  • Improving Advanced Care Planning through Physician Orders for
           Life-Sustaining Treatment (POLST) Expansion across the United States:
           Lessons Learned from State-Based Developments
    • Authors: Deborah S. Mack, David Dosa
      First page: 19
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.

      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-05-24T04:37:06Z
      DOI: 10.1177/1049909119851511
  • Increased Length of Stay Associated With Antibiotic Use in Older Adults
           With Advanced Cancer Transitioned to Comfort Measures
    • Authors: Rupak Datta, Mojun Zhu, Ling Han, Heather Allore, Vincent Quagliarello, Manisha Juthani-Mehta
      First page: 27
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background:Antibiotic use may increase hospital length of stay (LOS) among older patients with advanced cancer who are transitioned to comfort measures.Methods:We studied a cohort of patients with advanced cancer aged ≥65 years who were transitioned to comfort measures during admission from July 1, 2014, through November 30, 2016. We evaluated the association between antibiotic exposure and LOS using a Poisson regression model adjusted for age, gender, cancer type, comorbidities, infection, and intensive care unit admission.Results:Among 461 patients with advanced cancer, median age was 74 years (range: 65-99), 49.0% (n = 226) were female, and 20.6% (n = 95) had liquid tumors. Overall, 82.9% (n = 382) received ≥1 antibiotic and 64.6% (n = 298) had ≥1 infection diagnosis during hospitalization. Infection diagnoses commonly included sepsis (35%, n = 161/461), pneumonia (25%, n = 117/461), and urinary tract infection (14%, n = 66/461). Among those receiving antibiotics, the most common choices included vancomycin (79%, n = 300/382), cephalosporins (63%, n = 241/382), and penicillins (45%, n = 172/382). In a multivariable Poisson regression model, LOS was 34% longer (count ratio = 1.34, [95% confidence interval: 1.20-1.51]) among those exposed versus unexposed to antibiotics.Conclusions:Antibiotic use among patients with advanced cancer who are transitioned to comfort measures is associated with longer LOS. These data illustrate the importance of tradeoffs associated with antibiotic use, such as unintended increased LOS, when striving for goal-concordant care near the end of life.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-06-12T01:44:23Z
      DOI: 10.1177/1049909119855617
  • Cancer-Related Fatigue: Perception of Effort or Task Failure'
    • Authors: Carlos Fernandez, Shagufta Firdous, Waqas Jehangir, Bertrand Behm, Zankhana Mehta, Andrea Berger, Mellar Davis
      First page: 34
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.

      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-05-14T04:43:05Z
      DOI: 10.1177/1049909119849420
  • A Curriculum in Quality Improvement for Interprofessional Palliative Care
    • Authors: Joshua R. Lakin, Elise N. Brannen, Rachelle E. Bernacki, Emma Jones
      First page: 41
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.

      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-05-17T04:08:28Z
      DOI: 10.1177/1049909119850794
  • Advance Care Plan and Factors Related to Disease Progression in Patients
           With Spinocerebellar Ataxia Type 1: A Cross-Sectional Study in Thailand
    • Authors: Patama Gomutbutra, Megan Brandeland
      First page: 46
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.

      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-05-15T04:36:59Z
      DOI: 10.1177/1049909119850797
  • Deactivating a Pacemaker in Home Care Hospice: Experiences of the Family
           Caregivers of a Terminally Ill Patient
    • Authors: Gregory R. Kutcher, Jacek T. Soroka
      First page: 52
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Objectives:Although the experiences of family members who care for relatives at the end of life have been researched extensively, little is known about the needs and experiences of families caring for hospice patients with pacemakers.Aim:To better understand the experiences of family caregivers of a terminally ill patient who received hospice care at home and chose deactivation of a pacemaker.Design:The exploratory, cross-sectional design involved semistructured, in-depth interviews. A narrative analysis focusing on form and content was chosen to analyze the data.Participants:Five bereaved caregivers from the Midwestern United States who provided care and participated in the deactivation of their family member’s pacemaker.Results:Four storylines that described, gave meaning to, and contextualized the caregivers’ experiences were identified: “I am done. I am not doing it anymore”; “Whatever you decide, I’ll support you”; “It is really difficult to watch, but you want to be there”; and “I will not have part of this.” Caregivers struggled with lack of support, understanding, and acceptance from medical providers when their family member decided to have her pacemaker deactivated, and they believed that the hospice model of care was appropriate to support and help them in that process.Conclusions:This research aids in understanding the ramifications of family-provided end-of-life care to a patient whose pacemaker has been deactivated. This can help to increase hospice clinicians’ knowledge regarding caregivers’ experiences facing deactivation of a pacemaker, before and after the patient’s death.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-06-13T04:29:13Z
      DOI: 10.1177/1049909119855608
  • Medical Assistance in Dying (MAiD): A Descriptive Study From a Canadian
           Tertiary Care Hospital
    • Authors: Debbie Selby, Sally Bean, Elie Isenberg-Grzeda, Blair Henry D. Bioethics, Amy Nolen
      First page: 58
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background:In June 2016, the Government of Canada passed Bill C-14 decriminalizing medically assisted death. Increasing numbers of Canadians are accessing medical assistance in dying (MAiD) each year, but there is limited information about this population.Objective:To describe the characteristic outcomes of MAiD requests in a cohort of patients at an academic tertiary care center in Toronto, Ontario, Canada.Methods:A retrospective chart review of patients making a formal request for a MAiD eligibility assessment from July 16 to September 18. Data extracted included demographics, diagnosis, psychosocial characteristics, information relating to the MAiD request, and clinical outcome.Results:We received 107 formal requests for MAiD assessment. Ninety-seven patients were found eligible, of whom 80 received MAiD. Cancer was the primary diagnosis for 78% and median age was 74 years. The majority of patients (64%) cited “functional decline or inability to participate in meaningful activities” as the main factor motivating their request for MAiD. Half of patients who received MAiD (46%) described their request as consistent with a long-standing, philosophical view predating their illness. The 10-day reflection period was reduced for 39% of provisions due to impending loss of capacity. Our cohort was very similar demographically to those described both nationally and internationally.Conclusion:Patients seeking MAiD at our institution were similar to those described in other jurisdictions where assisted dying is legal and represent a group for whom autonomy and independence is critical. We noted a very high rate of risk of loss of capacity, suggesting a need for both earlier assessments and regular monitoring.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-07-01T04:18:20Z
      DOI: 10.1177/1049909119859844
  • Exploring End-of-Life Care Team Communication: An Interprofessional
           Simulation Study
    • Authors: Megan Lippe, Alexandra Stanley, Allison Ricamato, Anne Halli-Tierney, Robert McKinney
      First page: 65
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Effective team communication is necessary for the provision of high-quality health care. Yet, recent graduates from diverse health-care disciplines report inadequate training in communication skills and end-of-life care. This study explored the impact of a withdrawal of life-sustaining measures interprofessional simulation on team communication skills of students representing medicine, nursing, and social work. The 3-phase simulation required teams to communicate with the patient, family, and one another in the care of a seriously ill patient at the end of life. Team communication in the filmed simulations was analyzed via the Gap-Kalamazoo Communication Checklist. Results revealed fair to good communication across the 9 communication domains. Overall team communication was strongest in “shares information” and lowest in “understands the patient’s and family’s perspective” domains. Field notes revealed 5 primary themes—Team Dynamics, Awkwardness, Empathy is Everything, Build a Relationship, and Communicating Knowledge When You Have It—in the course of the data analysis. Logistical challenges encountered in simulation development and implementation are presented, along with proposed solutions that were effective for this study. This simulation provided an opportunity for interprofessional health-care provider students to learn team communication skills within an end-of-life care context.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-07-26T08:49:50Z
      DOI: 10.1177/1049909119865862
  • A Mother in Jeopardy: The Ethics of Pregnancy and Chemotherapy
    • Authors: Steven J. Baumrucker, Wendy H. Vogel, Robert M. Stolick, Russell W. Adkins, Heather Holland, Gregg VandeKieft, Angela Eastridge
      First page: 72
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.

      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-04-29T04:21:26Z
      DOI: 10.1177/1049909119846861
  • Integrating Ethics Education and Training Into Palliative Medicine
           Fellowships: A Response to Vig and Merel
    • Authors: Jordan Potter, Pamela Gordon, Jason Lesandrini
      First page: 79
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      In a recent American Journal of Hospice and Palliative Medicine article entitled “Ethics Education During Palliative Medicine Fellowship,” Dr Elizabeth Vig and Dr Susan Merel detail the ethics curriculum of the University of Washington School of Medicine’s Palliative Medicine Fellowship, including their efforts in the past several years to increase and bolster the fellowship’s ethics curriculum. This letter builds upon this topic and discusses some other strategies and methods for ethics education and training that fellowship programs may consider adopting to bolster their ethics curriculum.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-10-10T06:53:48Z
      DOI: 10.1177/1049909119879968
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