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Publisher: Sage Publications   (Total: 1079 journals)

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Showing 1 - 200 of 1079 Journals sorted alphabetically
AADE in Practice     Hybrid Journal   (Followers: 5)
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: 48, SJR: 0.308, CiteScore: 1)
Active Learning in Higher Education     Hybrid Journal   (Followers: 335, SJR: 1.397, CiteScore: 2)
Adaptive Behavior     Hybrid Journal   (Followers: 10, SJR: 0.288, CiteScore: 1)
Administration & Society     Hybrid Journal   (Followers: 14, SJR: 0.675, CiteScore: 1)
Adoption & Fostering     Hybrid Journal   (Followers: 22, SJR: 0.313, CiteScore: 0)
Adsorption Science & Technology     Open Access   (Followers: 7, SJR: 0.258, CiteScore: 1)
Adult Education Quarterly     Hybrid Journal   (Followers: 202, SJR: 0.566, CiteScore: 2)
Adult Learning     Hybrid Journal   (Followers: 39)
Advances in Dental Research     Hybrid Journal   (Followers: 7, SJR: 1.791, CiteScore: 4)
Advances in Developing Human Resources     Hybrid Journal   (Followers: 29, SJR: 0.614, CiteScore: 2)
Advances in Mechanical Engineering     Open Access   (Followers: 131, SJR: 0.272, CiteScore: 1)
Advances in Methods and Practices in Psychological Science     Full-text available via subscription   (Followers: 9)
Advances in Structural Engineering     Full-text available via subscription   (Followers: 46, SJR: 0.599, CiteScore: 1)
Advances in Tumor Virology     Open Access   (Followers: 3, SJR: 0.108, CiteScore: 0)
AERA Open     Open Access   (Followers: 9)
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: 14, SJR: 0.214, CiteScore: 1)
Alexandria : The J. of National and Intl. Library and Information Issues     Full-text available via subscription   (Followers: 63)
AlterNative : An Intl. J. of Indigenous Peoples     Full-text available via subscription   (Followers: 11, SJR: 0.194, CiteScore: 0)
Alternative Law J.     Hybrid Journal   (Followers: 9, 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: 5)
American Educational Research J.     Hybrid Journal   (Followers: 198, 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: 31, 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: 10, 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: 185, 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: 18, SJR: 2.062, CiteScore: 2)
American Sociological Review     Hybrid Journal   (Followers: 296, 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: 9, 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: 51, 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: 41, SJR: 0.739, CiteScore: 1)
Antitrust Bulletin     Full-text available via subscription   (Followers: 10)
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: 16, SJR: 0.29, CiteScore: 1)
Arts and Humanities in Higher Education     Hybrid Journal   (Followers: 40, 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: 99, 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: 16, 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: 18, SJR: 1.801, CiteScore: 2)
Australian and New Zealand J. of Criminology     Hybrid Journal   (Followers: 518, 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: 12, SJR: 0.497, CiteScore: 1)
Autism     Hybrid Journal   (Followers: 308, SJR: 1.739, CiteScore: 4)
Autism & Developmental Language Impairments     Open Access   (Followers: 10)
Behavior Modification     Hybrid Journal   (Followers: 12, SJR: 0.877, CiteScore: 2)
Behavioral and Cognitive Neuroscience Reviews     Hybrid Journal   (Followers: 25)
Bible Translator     Hybrid Journal   (Followers: 12)
Biblical Theology Bulletin     Hybrid Journal   (Followers: 18, SJR: 0.184, CiteScore: 0)
Big Data & Society     Open Access   (Followers: 47)
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: 9)
Biomedical Engineering and Computational Biology     Open Access   (Followers: 13)
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)
Breast Cancer : Basic and Clinical Research     Open Access   (Followers: 8, SJR: 0.823, CiteScore: 2)
British J. of Music Therapy     Hybrid Journal   (Followers: 8)
British J. of Occupational Therapy     Hybrid Journal   (Followers: 174, 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: 31, 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: 7, SJR: 0.348, CiteScore: 1)
Business Information Review     Hybrid Journal   (Followers: 15, SJR: 0.279, CiteScore: 0)
Business Perspectives and Research     Hybrid Journal   (Followers: 2)
Cahiers Élisabéthains     Hybrid Journal   (Followers: 1, SJR: 0.111, CiteScore: 0)
Calcutta Statistical Association Bulletin     Full-text available via subscription  
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: 123, SJR: 0.626, CiteScore: 1)
Canadian J. of Psychiatry     Hybrid Journal   (Followers: 26, 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 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: 7)
Chronic Illness     Hybrid Journal   (Followers: 6, SJR: 0.672, CiteScore: 2)
Chronic Respiratory Disease     Hybrid Journal   (Followers: 6, 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 Case Studies     Hybrid Journal   (Followers: 3, SJR: 0.364, CiteScore: 1)
Clinical Child Psychology and Psychiatry     Hybrid Journal   (Followers: 44, 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: 69, SJR: 1.322, CiteScore: 3)
Clinical Risk     Hybrid Journal   (Followers: 5, SJR: 0.133, CiteScore: 0)
Clinical Trials     Hybrid Journal   (Followers: 21, SJR: 2.399, CiteScore: 2)
Clothing and Textiles Research J.     Hybrid Journal   (Followers: 23, SJR: 0.36, CiteScore: 1)
Common Law World Review     Full-text available via subscription   (Followers: 18)
Communication & Sport     Hybrid Journal   (Followers: 7, 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: 19, SJR: 2.171, CiteScore: 3)
Community College Review     Hybrid Journal   (Followers: 8, SJR: 1.451, CiteScore: 1)
Comparative Political Studies     Hybrid Journal   (Followers: 217, 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: 2, 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  
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)
Cooperation and Conflict     Hybrid Journal   (Followers: 21, SJR: 0.945, CiteScore: 2)
Cornell Hospitality Quarterly     Hybrid Journal   (Followers: 8, SJR: 1.198, CiteScore: 2)
Counseling Outcome Research and Evaluation     Hybrid Journal   (Followers: 12, SJR: 0.279, 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  [1079 journals]
  • 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
  • Exploring End-of-Life Care Team Communication: An Interprofessional
           Simulation Study
    • Authors: Megan Lippe, Alexandra Stanley, Allison Ricamato, Anne Halli-Tierney, Robert McKinney
      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
  • 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
  • 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
      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
  • 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
  • Deactivating a Pacemaker in Home Care Hospice: Experiences of the Family
           Caregivers of a Terminally Ill Patient
    • Authors: Gregory R. Kutcher, Jacek T. Soroka
      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
  • 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
      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
  • 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
      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
  • 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
      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
  • A Curriculum in Quality Improvement for Interprofessional Palliative Care
    • Authors: Joshua R. Lakin, Elise N. Brannen, Rachelle E. Bernacki, Emma Jones
      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
      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
  • Cancer-Related Fatigue: Perception of Effort or Task Failure'
    • Authors: Carlos Fernandez, Shagufta Firdous, Waqas Jehangir, Bertrand Behm, Zankhana Mehta, Andrea Berger, Mellar Davis
      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 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
      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
  • 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
      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
  • The Timing of Family Meetings in the Medical Intensive Care Unit
    • Authors: Gina M. Piscitello, William M. Parham, Michael T. Huber, Mark Siegler, William F. Parker
      First page: 1049
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.

      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-04-15T05:11:55Z
      DOI: 10.1177/1049909119843133
  • Understanding Underuse of Advance Care Planning Among a Cohort of African
           American Patients With Advanced Cancer: Formative Research That Examines
           Gaps in Intent to Discuss Options for Care
    • Authors: Ramona L. Rhodes, Nkemdirim C. E. Ukoha, Kimberly A. Williams, Bryan Elwood, Tori Knox-Rice, Simon C. Lee, Jasmin A. Tiro, Celette Sugg Skinner, Ethan A. Halm
      First page: 1057
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.

      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-04-22T04:51:27Z
      DOI: 10.1177/1049909119843276
  • Depression as a Mediator or Moderator Between Preparatory Grief and Sense
           of Dignity in Patients With Advanced Cancer
    • Authors: Efi Parpa, Sotiria Kostopoulou, Eleni Tsilika, Antonis Galanos, Kyriaki Mystakidou
      First page: 1063
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.

      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-04-24T05:02:21Z
      DOI: 10.1177/1049909119844783
  • Where and How Centenarians Die' The Role of Hospice Care
    • Authors: Yang-Ching Chen, Hsiao-Yun Hu, Hsien-Yu Fan, Wei-Shih Kao, Hsiang-Yin Chen, Sheng-Jean Huang
      First page: 1068
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.

      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-04-30T03:56:58Z
      DOI: 10.1177/1049909119845884
  • Ethics Education During Palliative Medicine Fellowship
    • Authors: Elizabeth K. Vig, Susan E. Merel
      First page: 1076
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background:Palliative care clinicians frequently encounter situations in which there are ethical dilemmas about the right thing to do. Palliative medicine fellowships are required to include education about ethics. Our fellowship increased fellows’ ethics education through monthly didactics, lectures in a professional development series, and a month-long ethics rotation.Methods:We sought input from graduates of our palliative medicine fellowship about the content and amount of the ethics education they received. Fellowship graduates were invited via e-mail to complete an online survey about the ethics education they received during fellowship. They were asked questions about their work environment, frequency with which they encounter ethical dilemmas, their perspectives on the ethics content, the amount of ethics education they received during fellowship, and their input on ways to improve the ethics education within the fellowship.Results:Twenty-eight (82%) of 34 fellowship graduates completed the survey; 93% noted that they encounter ethical dilemmas in their work, with half encountering these on a daily or weekly basis, and 86% noted that colleagues ask them questions about ethics because of their palliative medicine training. None responded that they had received too much ethics education. Fellowship graduates identified ethics content that has been useful since completing fellowship and suggested ways to improve ethics education for future fellows.Conclusion:Graduates of a palliative medicine fellowship encounter ethical dilemmas often and frequently are asked questions about ethics. Palliative medicine fellowships may want to examine their ethics curriculum to ensure that graduating fellows are learning about relevant ethics topics and are comfortable discussing ethical dilemmas with others.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-07-25T09:14:18Z
      DOI: 10.1177/1049909119864300
  • End-of-Life Cancer Care Redesign: Patient and Caregiver Experiences in a
           Lay Health Worker–Led Intervention
    • Authors: Manali I. Patel, David Moore, Tumaini R. Coker
      First page: 1081
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.

      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-05-03T03:49:51Z
      DOI: 10.1177/1049909119847967
  • The Impact of Advance Care Planning on End-of-Life Care: Do the Type and
           Timing Make a Difference for Patients With Advanced Cancer Referred to
    • Authors: Laura C. Prater, Thomas Wickizer, Julie K. Bower, Seuli Bose-Brill
      First page: 1089
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.

      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-05-15T04:35:39Z
      DOI: 10.1177/1049909119848987
  • Enhancing Medical Learners’ Knowledge of, Comfort and Confidence in
           Holding Serious Illness Conversations
    • Authors: Vivian Tam, John J. You, Rachelle Bernacki
      First page: 1096
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Objectives:Having early discussions with seriously ill patients about their priorities and values can improve their peace of mind and family outcomes during bereavement; however, physicians and medical students report feeling underprepared to hold serious illness conversations. We evaluated the impact of the Serious Illness Care Program clinician training workshop on medical learners’ knowledge of comfort and confidence in holding such conversations.Methods:Eligible learners were penultimate- or final-year medical students or first-year residents of generalist programs (Family Medicine, Internal Medicine). Learners participated in a 2.5-hour workshop involving reflection on serious illness discussions, didactic teaching and demonstration of the Serious Illness Conversation Guide (SICG), role play with standardized patients, direct observation, and feedback from experts. Participants completed pre- and post-intervention questionnaires with Likert-type scale and open-ended questions, which were analyzed using paired t tests and qualitative content analysis, respectively.Results:We enrolled 25 learners. The intervention was associated with an increase in knowledge (P < .001) and self-efficacy (P < .001). All learners reported gaining new skills, with a majority specifically identifying a framework for structuring serious illness conversations in the qualitative analysis (n = 14, 56%). Participants stated the workshops would improve their comfort in holding serious illness conversations (n = 24, 96%), and that it would be valuable to integrate the workshops into their formal curricula (n = 23, 92%).Conclusions:Training on the use of the SICG is novel for medical students and first-year residents and associated with the improvement in their knowledge of and perceived capacity to hold serious illness conversations. This study suggests that the integration of SICG training into medical curricula may have educational value.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-07-22T04:12:47Z
      DOI: 10.1177/1049909119857988
  • Ten-Year Trends of Utilization of Palliative Care Services and
           Life-Sustaining Treatments and Hospital Costs Associated With Patients
           With Terminally Ill Lung Cancer in the United States From 2005 to 2014
    • Authors: Jinwook Hwang, Jay Shen, Sun Jung Kim, Sung-Youn Chun, Mutsumi Kioka, Faizan Sheraz, Pearl Kim, David Byun, Ji Won Yoo
      First page: 1105
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.

      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-05-24T04:37:46Z
      DOI: 10.1177/1049909119852082
  • Informal Caregivers’ Perceptions of Needs From Hospice Providers: An
           Integrative Review
    • Authors: Ruth Anne Engbers
      First page: 1114
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.

      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-04-17T04:44:06Z
      DOI: 10.1177/1049909119842365
  • A Systematic Literature Review of the Current State of Knowledge Related
           to Interventions for Bereaved Parents
    • Authors: Nancy Dias, Verna L. Hendricks-Ferguson, Holly Wei, Elizabeth Boring, Kerry Sewell, Joan E. Haase
      First page: 1124
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Aims:The purpose of this systematic literature review is to describe the interventions for bereaved parents, evaluate intervention effectiveness through study methodology rigor, replicability, and theoretical foundations.Methods:We searched MEDLINE via PubMed (1966-2018), CINAHL (1937-present), PsycINFO (1887-present), and Embase (1947-present) using various search words and MeSH terms related to the study purpose. A blinded screening of title/abstract was performed, with conflicting inclusion decisions resolved through group discussions. Matrices for remaining articles were created and discussed among the team. The levels of evidence of the 9 records were rated from very low to high based on the Grading of Recommendations Assessment, Development, and Evaluation guidelines.Results:Our initial pool included 1025 articles. After the screening of titles/abstracts, 63 articles were retained for full-text reviews. Evaluated based on the inclusion/exclusion criteria, 9 records met the review criteria. Of the 9 records, 1 was graded as very low, 3 low, and 5 low to moderate. The interventions for bereaved parents varied from using single-model interventions such as expressive arts therapy and telephone support to multimodal interventions that combined resources (ie, peer support, resource packets, and health-care support). Only 1 study explicitly illustrated how its bereavement intervention was designed based on the proposed theoretical model.Conclusions:This review highlights the need for individualized, well-tested, and effective bereavement care interventions to support bereaved parents. In summary, the state of the science on interventions for bereaved parents is poor and much work needs to be done to effectively address the needs of bereaved parents, including both their physical and emotional health needs.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-07-04T03:54:32Z
      DOI: 10.1177/1049909119858931
  • The Potential Benefits of Palmitoylethanolamide in Palliation: A
           Qualitative Systematic Review
    • Authors: Mellar P. Davis, Bertrand Behm, Zankhana Mehta, Carlos Fernandez
      First page: 1134
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.

      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-05-22T04:25:46Z
      DOI: 10.1177/1049909119850807
  • The Forgotten
    • Authors: Jennifer Tsai
      First page: 1155
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.

      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2019-04-08T08:07:02Z
      DOI: 10.1177/1049909119839984
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