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ANAESTHESIOLOGY (121 journals)                     

Showing 1 - 121 of 121 Journals sorted alphabetically
Acta Anaesthesiologica Scandinavica     Hybrid Journal   (Followers: 62)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 6)
Acute Pain     Full-text available via subscription   (Followers: 16)
Advances in Anesthesia     Full-text available via subscription   (Followers: 31)
African Journal of Anaesthesia and Intensive Care     Full-text available via subscription   (Followers: 9)
Ain-Shams Journal of Anaesthesiology     Open Access   (Followers: 2)
Ain-Shams Journal of Anesthesiology     Open Access   (Followers: 1)
Ambulatory Anesthesia     Open Access   (Followers: 9)
Anaesthesia     Hybrid Journal   (Followers: 239)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 72)
Anaesthesia and Intensive Care     Full-text available via subscription   (Followers: 62)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 28)
Anaesthesia Reports     Hybrid Journal  
Anaesthesia, Pain & Intensive Care     Open Access  
Anaesthesiology Intensive Therapy     Open Access   (Followers: 9)
Analgesia & Resuscitation : Current Research     Hybrid Journal   (Followers: 7)
Anestesia Analgesia Reanimación     Open Access   (Followers: 1)
Anestesia en México     Open Access   (Followers: 1)
Anesthesia & Analgesia     Hybrid Journal   (Followers: 275)
Anesthesia : Essays and Researches     Open Access   (Followers: 10)
Anesthesia Progress     Hybrid Journal   (Followers: 6)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 2)
Anesthesiology     Hybrid Journal   (Followers: 232)
Anesthesiology and Pain Medicine     Open Access   (Followers: 23)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 25)
Anesthesiology Research and Practice     Open Access   (Followers: 15)
Angewandte Schmerztherapie und Palliativmedizin     Hybrid Journal  
Annales Françaises d'Anesthésie et de Réanimation     Full-text available via subscription   (Followers: 4)
Annals of Cardiac Anaesthesia     Open Access   (Followers: 15)
BDJ Team     Open Access   (Followers: 1)
Best Practice & Research Clinical Anaesthesiology     Hybrid Journal   (Followers: 15)
BJA : British Journal of Anaesthesia     Hybrid Journal   (Followers: 245)
BJA Education     Hybrid Journal   (Followers: 70)
BMC Anesthesiology     Open Access   (Followers: 18)
BMJ Supportive & Palliative Care     Hybrid Journal   (Followers: 47)
Brazilian Journal of Anesthesiology     Open Access   (Followers: 5)
Brazilian Journal of Anesthesiology (Edicion en espanol)     Open Access  
Brazilian Journal of Anesthesiology (English edition)     Open Access   (Followers: 1)
Brazilian Journal of Pain (BrJP)     Open Access  
British Journal of Pain     Hybrid Journal   (Followers: 28)
Canadian Journal of Anesthesia/Journal canadien d'anesthésie     Hybrid Journal   (Followers: 48)
Case Reports in Anesthesiology     Open Access   (Followers: 11)
Clinical Journal of Pain     Hybrid Journal   (Followers: 19)
Colombian Journal of Anesthesiology : Revista Colombiana de Anestesiología     Hybrid Journal   (Followers: 1)
Current Anaesthesia & Critical Care     Full-text available via subscription   (Followers: 36)
Current Anesthesiology Reports     Hybrid Journal   (Followers: 4)
Current Opinion in Anaesthesiology     Hybrid Journal   (Followers: 61)
Current Pain and Headache Reports     Hybrid Journal   (Followers: 2)
Der Anaesthesist     Hybrid Journal   (Followers: 9)
Der Schmerz     Hybrid Journal   (Followers: 4)
Der Schmerzpatient     Hybrid Journal  
Douleur et Analgésie     Hybrid Journal  
Egyptian Journal of Anaesthesia     Open Access   (Followers: 3)
Egyptian Journal of Cardiothoracic Anesthesia     Open Access  
EMC - Anestesia-Reanimación     Hybrid Journal  
EMC - Anestesia-Rianimazione     Hybrid Journal  
EMC - Urgenze     Full-text available via subscription  
European Journal of Anaesthesiology     Hybrid Journal   (Followers: 30)
European Journal of Pain     Full-text available via subscription   (Followers: 27)
European Journal of Pain Supplements     Full-text available via subscription   (Followers: 5)
Global Journal of Anesthesiology     Open Access   (Followers: 2)
Headache The Journal of Head and Face Pain     Hybrid Journal   (Followers: 5)
Indian Journal of Anaesthesia     Open Access   (Followers: 7)
Indian Journal of Pain     Open Access   (Followers: 2)
Indian Journal of Palliative Care     Open Access   (Followers: 8)
International Anesthesiology Clinics     Hybrid Journal   (Followers: 9)
International Journal of Clinical Anesthesia and Research     Open Access  
Itch & Pain     Open Access   (Followers: 2)
JA Clinical Reports     Open Access  
Journal Club Schmerzmedizin     Hybrid Journal  
Journal of Anesthesia & Clinical Research     Open Access   (Followers: 10)
Journal of Anaesthesiology Clinical Pharmacology     Open Access   (Followers: 8)
Journal of Anesthesia     Hybrid Journal   (Followers: 13)
Journal of Anesthesia History     Full-text available via subscription   (Followers: 1)
Journal of Anesthesiology and Clinical Science     Open Access   (Followers: 1)
Journal of Cellular and Molecular Anesthesia     Open Access  
Journal of Clinical Anesthesia     Hybrid Journal   (Followers: 13)
Journal of Critical Care     Hybrid Journal   (Followers: 42)
Journal of Headache and Pain     Open Access   (Followers: 3)
Journal of Neuroanaesthesiology and Critical Care     Open Access   (Followers: 3)
Journal of Neurosurgical Anesthesiology     Hybrid Journal   (Followers: 8)
Journal of Obstetric Anaesthesia and Critical Care     Open Access   (Followers: 22)
Journal of Pain     Hybrid Journal   (Followers: 19)
Journal of Pain and Symptom Management     Hybrid Journal   (Followers: 45)
Journal of Pain Research     Open Access   (Followers: 10)
Journal of Palliative Care     Full-text available via subscription   (Followers: 20)
Journal of Society of Anesthesiologists of Nepal     Open Access   (Followers: 2)
Journal of the Bangladesh Society of Anaesthesiologists     Open Access  
Jurnal Anestesi Perioperatif     Open Access  
Jurnal Anestesiologi Indonesia     Open Access  
Karnataka Anaesthesia Journal     Open Access   (Followers: 2)
Le Praticien en Anesthésie Réanimation     Full-text available via subscription   (Followers: 2)
Local and Regional Anesthesia     Open Access   (Followers: 8)
Medical Gas Research     Open Access   (Followers: 3)
Medycyna Paliatywna w Praktyce     Open Access   (Followers: 1)
OA Anaesthetics     Open Access   (Followers: 3)
Open Anesthesia Journal     Open Access  
Open Journal of Anesthesiology     Open Access   (Followers: 10)
Pain     Hybrid Journal   (Followers: 61)
Pain Clinic     Hybrid Journal   (Followers: 1)
Pain Management     Hybrid Journal   (Followers: 18)
Pain Medicine     Hybrid Journal   (Followers: 13)
Pain Research and Management     Open Access   (Followers: 7)
Pain Research and Treatment     Open Access   (Followers: 2)
Pain Studies and Treatment     Open Access   (Followers: 2)
Research and Opinion in Anesthesia and Intensive Care     Open Access   (Followers: 3)
Revista Chilena de Anestesia     Open Access   (Followers: 1)
Revista Colombiana de Anestesiología     Open Access   (Followers: 1)
Revista Cubana de Anestesiología y Reanimación     Open Access   (Followers: 1)
Revista da Sociedade Portuguesa de Anestesiologia     Open Access  
Revista Española de Anestesiología y Reanimación     Hybrid Journal  
Revista Española de Anestesiología y Reanimación (English Edition)     Full-text available via subscription   (Followers: 2)
Romanian Journal of Anaesthesia and Intensive Care     Open Access   (Followers: 1)
Saudi Journal of Anaesthesia     Open Access   (Followers: 7)
Scandinavian Journal of Pain     Hybrid Journal   (Followers: 1)
Southern African Journal of Anaesthesia and Analgesia     Open Access   (Followers: 8)
Sri Lankan Journal of Anaesthesiology     Open Access   (Followers: 2)
Survey of Anesthesiology     Full-text available via subscription   (Followers: 12)
Techniques in Regional Anesthesia and Pain Management     Hybrid Journal   (Followers: 11)
Topics in Pain Management     Full-text available via subscription   (Followers: 2)
Trends in Anaesthesia and Critical Care     Full-text available via subscription   (Followers: 23)


Similar Journals
Journal Cover
Journal of Palliative Care
Journal Prestige (SJR): 0.46
Citation Impact (citeScore): 1
Number of Followers: 20  
  Full-text available via subscription Subscription journal
ISSN (Print) 0825-8597 - ISSN (Online) 2369-5293
Published by Sage Publications Homepage  [1093 journals]
  • A Qualitative Study Exploring Patient, Family Carer and Healthcare
           Professionals’ Direct Experiences and Barriers to Providing and
           Integrating Palliative Care for Advanced Head and Neck Cancer
    • Authors: Catriona Rachel Mayland, Hannah C. Doughty, Simon N. Rogers, Anna Gola, Stephen Mason, Cathy Hubbert, Dominic Macareavy, Barbara A. Jack
      Abstract: Journal of Palliative Care, Ahead of Print.
      Objectives:To report on direct experiences from advanced head and neck cancer patients, family carers and healthcare professionals, and the barriers to integrating specialist palliative care.Methods:Using a naturalistic, interpretative approach, within Northwest England, a purposive sample of adult head and neck cancer patients was selected. Their family carers were invited to participate. Healthcare professionals (representing head and neck surgery and specialist nursing; oncology; specialist palliative care; general practice and community nursing) were recruited. All participants underwent face-to-face or telephone interviews. A thematic approach, using a modified version of Colazzi’s framework, was used to analyze the data.Results:Seventeen interviews were conducted (9 patients, 4 joint with family carers and 8 healthcare professionals). Two main barriers were identified by healthcare professionals: “lack of consensus about timing of Specialist Palliative Care engagement” and “high stake decisions with uncertainty about treatment outcome.” The main barrier identified by patients and family carers was “lack of preparedness when transitioning from curable to incurable disease.” There were 2 overlapping themes from both groups: “uncertainty about meeting psychological needs” and “misconceptions of palliative care.”Conclusions:Head and neck cancer has a less predictable disease trajectory, where complex decisions are made and treatment outcomes are less certain. Specific focus is needed to define the optimal way to initiate Specialist Palliative Care referrals which may differ from those used for the wider cancer population. Clearer ways to effectively communicate goals of care are required potentially involving collaboration between Specialist Palliative Care and the wider head and neck cancer team.
      Citation: Journal of Palliative Care
      PubDate: 2020-09-15T08:29:47Z
      DOI: 10.1177/0825859720957817
  • Music Therapy Interventions in Palliative Care: A Systematic Review
    • Authors: Miren Pérez-Eizaguirre, Esperanza Vergara-Moragues
      Abstract: Journal of Palliative Care, Ahead of Print.
      Background:Palliative care is an interdisciplinary medical approach for people with illnesses that are unresponsive to curative treatment. Music therapy has been gaining ground in this field since the 1970s, with a not-always-standardized range of interventions and musical techniques.Objective:The purpose of this systematic review is to analyze interventions with music therapy and new developments in this area in the field of palliative care.Methods:The primary source of data for this review was the online database Web of Science (WOS). We also used other databases such as Medline and Scopus. A systematic search was performed of the past 6 years following the PRISMA criteria.Results:From a selection of 310 documents, we reviewed 54 completed articles and included 19 studies in the review. The percentage of agreement in the selection of articles was 87.5% and the Cohen Kappa index of inter-rater reliability was 0.727. In 5 of the articles, the musical interventions were not specified. However, in the remaining 14 they were, including new developments such as use of the monochord and the body tambura, and adaptation of the RBL (Rhythm, Breath & Lullaby) method.Conclusions:There has been notable improvement in the specification of musical interventions during music therapy sessions in palliative care. However, articles in this field need to describe how these techniques are carried out and any new developments. All this without forgetting that the patient’s musical preferences are a fundamental aspect when performing music therapy sessions.
      Citation: Journal of Palliative Care
      PubDate: 2020-09-15T08:27:26Z
      DOI: 10.1177/0825859720957803
  • Care Considerations in a Patient- and Family-Centered Medical Assistance
           in Dying Program
    • Authors: Janine Brown, Donna Goodridge, Averi Harrison, Jordan Kemp, Lilian Thorpe, Robert Weiler
      Abstract: Journal of Palliative Care, Ahead of Print.
      Background:Medical Assistance in Dying (MAID) became legal in Canada in June 2016. As part of a project designed to improve end-of-life care for those requesting MAID, qualitative data from patients, families, and providers were used to assess opportunities to enhance patient-and family-centered care (PFCC) in this program.Methods:Thirty interviews were conducted with patients, families, and healthcare providers. Five patients who requested an assessment for MAID, 11 family members, and 14 healthcare providers were interviewed about their experiences in 2017. Comparative coding and thematic analysis were completed with the support of NVivo12.Results:Emotional PFCC considerations included: exploring and validating the emotional journey, navigating the uncertain, judgmental experiences, and the emotional impact on families and the care team. Physical PFCC considerations included: sensitivity in eligibility assessments, weaving in interdisciplinary care, provision of anticipatory guidance, and death location. Spiritual PFCC considerations included: honoring choice, listening to life stories, supporting spiritual needs, and acknowledging loss. Relational PFCC considerations included: defining the circle of support, supporting the circle, and relational investments.Conclusion:Fundamental to a PFCC MAID program, practitioners must be afforded time to provide holistic care. Program-related suggestions include incorporating interdisciplinary care early, and throughout the illness trajectory, consistency in care providers, appropriate anticipatory guidance, and bereavement supports for family, and dedicate space for MAID provisions. Patients and families must be included in the ongoing development and re-evaluation of MAID programs to ensure continued focus on quality end-of-life care.
      Citation: Journal of Palliative Care
      PubDate: 2020-08-28T08:53:29Z
      DOI: 10.1177/0825859720951661
  • “Guidebook on Doctors’ Behaviors for Death Diagnosis Created by
           Community Healthcare Providers” Changed Residents’ Mind for Death
    • Authors: Akihiko Kusakabe, Jyunko Nozato, Kazue Hirano, Naohiro Saitou, Keiko Ikenaga, Hukiko Mikan, Takaomi Kessoku, Tetuya Matuura, Asuka Yoshimi, Hironori Mawatari, Akemi Naito, Masato Okita, Mitsuyasu Ohta, Tatsuya Morita, Masahiko Inamori
      Abstract: Journal of Palliative Care, Ahead of Print.
      Background:Education regarding death diagnosis is not often included in the medical education.Objective:To investigate the change minds at the time of death diagnosis among residents after lectures based on our guidebook.Design:Uncontrolled, open-label, multi-center trial.Subjects:A total of 131 doctors undergoing their initial training were enrolled this study.Measurements:Questionnaires were administered to volunteers before and after the lecture by the clinical training instructor presented information regarding doctors’ behaviors at the death diagnosis based on our guidebook at each hospital.Results:The subjects had an average age of 27.1 years and comprised 76 men (58.0%) and 54 women (41.2%). A total of 83 subjects (63.4%) had learned how to diagnose death as medical students, and 52 subjects (39.7%) had experienced death diagnosis scenes as medical students. Among those who had difficulties related to death diagnoses, the highest number (88.4%) indicated that “I do not know what to say to the family after a death diagnosis”. Self-evaluation significantly increased after the lecture for many items concerning explanations to and considerations of the family: the effect size for “Give words of comfort and encouragement to family” increased significantly after the lecture to 0.9.Conclusions:Few of the residents felt that they had received education regarding death diagnoses; they reported difficulties with diagnosing death and responding to patients’ families. After the lecture using our guidebook, residents’ mind changed significantly for death diagnosis, suggesting that the guidebook at the time of death diagnosis may be useful.
      Citation: Journal of Palliative Care
      PubDate: 2020-08-25T08:04:59Z
      DOI: 10.1177/0825859720951698
  • “I Lost My Best Buddy Yesterday”
    • Authors: Jordana L. Meyerson
      Abstract: Journal of Palliative Care, Ahead of Print.

      Citation: Journal of Palliative Care
      PubDate: 2020-08-24T11:37:45Z
      DOI: 10.1177/0825859720951359
  • Interactions Between Intensive Care and Palliative Care Are Influenced by
           Training, Professionals’ Perceptions and Institutional Barriers
    • Authors: María Camila Calle, Sara Lucia Pareja, María Margarita Villa, Juan Pablo Román-Calderón, Mariantonia Lemos, Stella Navarro, Alicia Krikorian
      Abstract: Journal of Palliative Care, Ahead of Print.
      Background:There is growing interest in the use of a Palliative care approach in Intensive care. However, it tends to remain inconsistent, infrequent or non-existent, as does its acceptance by intensive care physicians. This study sought to explore the perceptions, level of knowledge, perceived barriers, and practices of physicians regarding palliative care practices (PC) in Intensive Care Units (ICU).Methods:Descriptive-correlational study. Participating physicians working in ICU in Colombia (n = 101) completed an ad hoc questionnaire that included subscales of perceptions, knowledge, perceived barriers, and PC practices in ICU. A Structural Equation Model (PLS-SEM) was used to examine the reciprocal relationships between the measured variables and those that could predict interaction practices between the 2 specialties.Results:First, results from the measurement model to examine the validity and reliability of the latent variables found (PC training, favorable perceptions about PC, institutional barriers, and ICU-PC interaction practices) and their indicators were obtained. Second, the structural model found that, a greater number of hours of PC training, a favorable perception of PC and a lower perception of institutional barriers are related to greater interaction between PC and ICU, particularly when emotional or family problems are detected.Conclusions:PC-ICU interactions are influenced by training, a positive perception of PC and less perceived institutional barriers. An integrated ICU-PC model that strengthens the PC training of those who work in ICU and provides clearer guidelines for interaction practices, may help overcome perceived barriers and improve the perception of the potential impact of PC.
      Citation: Journal of Palliative Care
      PubDate: 2020-08-19T09:21:29Z
      DOI: 10.1177/0825859720951361
  • Working at the Intersection of Palliative End-of-Life and Mental Health
           Care: Provider Perspectives
    • Authors: Tanya Park, Kathy Hegadoren, Bernadette Workun
      Abstract: Journal of Palliative Care, Ahead of Print.
      Objective:Palliative, end-of-life care (PEOLC) providers are poorly resourced in addressing the needs of patients with mental health challenges, and the dying experiences of this cohort—particularly those with a comorbid, chronic and persistent mental illness (CPMI)—are poorly documented. We sought to explore the experiences of PEOLC providers with regard to caring for patients with mental health challenges, and gather insights into ways of improving accessibility and quality of PEOLC for these patients.Method:Twenty providers of PEOLC, from different disciplines, took part in semi structured interviews. The data were coded and analyzed using a reflexive, inductive-deductive process of thematic analysis.Results:The most prominent issues pertained to assessment of patients and differential diagnosis of CPMI, and preparedness of caregivers to deliver mental health interventions, given the isolation of palliative care from other agencies. Among the assets mentioned, informal relationships with frontline caregivers were seen as the main support structure, rather than the formal policies and procedures of the practice settings. Strategies to improve mental health care in PEOLC centered on holistic roles and interventions benefiting the entire palliative population, illustrating the participants saw little point in compartmentalizing mental illness, whether diagnosed or not.Significance of Results:Continuity of care and personal advocacy can significantly improve quality of life for end-of-life patients with mental health challenges, but bureaucracy and disciplinary siloing tend to isolate these patients and their caregivers. Improved interdisciplinary connectivity and innovative, hybridized roles encompassing palliation and psychiatry are 2 strategies to address this disconnect, as well as enhanced training in core mental health care competencies for PEOLC providers.
      Citation: Journal of Palliative Care
      PubDate: 2020-08-18T11:19:02Z
      DOI: 10.1177/0825859720951360
  • An Active In-Home Physician Model of Palliative Care and Its Resulting
           Performance Indicators Related to Home Deaths, Unplanned Emergency
           Department Visits and Unplanned Hospital Admissions
    • Authors: Colleen Webber, Aurelia Ona Valiulis, Peter Tanuseputro, Valerie Schulz, Tavis Apramian, Gil Schreier, Kirk Hamilton
      Abstract: Journal of Palliative Care, Ahead of Print.
      Background:Limited research has characterized team-based models of home palliative care and the outcomes of patients supported by these care teams.Case presentation:A retrospective case series describing care and outcomes of patients managed by the London Home Palliative Care Team between May 1, 2017 and April 1, 2019.Case management:The London Home Palliative Care (LHPC) Team care model is based upon 3 pillars: 1) physician visit availability 2) active patient-centered care with strong physician in-home presence and 3) optimal administrative organization.Case outcomes:In the 18 month study period, 354 patients received care from the London Home Palliative Care Team. Most significantly, 88.4% (n = 313) died in the community or at a designated palliative care unit after prearranged direct transfer; no comparable provincial data is available. 21.2% (n = 75) patients visited an emergency department and 24.6% (n = 87) were admitted to hospital at least once in their final 30 days of life. 280 (79.1%) died in the community. These values are better than comparable provincial estimates of 62.7%, 61.7%, and 24.0%, respectively.Conclusion:The London Home Palliative Care (LHPC) Team model appears to favorably impact community death rate, ER visits and unplanned hospital admissions, as compared to accepted provincial data. Studies to determine if this model is reproducible could support palliative care teams achieving similar results.
      Citation: Journal of Palliative Care
      PubDate: 2020-08-18T09:34:34Z
      DOI: 10.1177/0825859720951368
  • Potential Measurement Properties of a Questionnaire for Eating-Related
           Distress Among Advanced Cancer Patients With Cachexia: Preliminary
           Findings of Reliability and Validity Analysis
    • Authors: Koji Amano, Tatsuya Morita, Mitsunori Miyashita
      Abstract: Journal of Palliative Care, Ahead of Print.
      Background:There are no validated tools for measuring eating-related distress among patients with advanced cancer. The aim of the study was to investigate the potential measurement properties of a questionnaire for eating-related distress.Methods:This is a secondary analysis. We performed an exploratory factor analysis for factorial validity and calculated Cronbach’s α for internal consistency. Patients were classified into the 2 groups categorized using the international cachexia criteria. The total scores of each factor and all items were calculated, and comparisons were performed for known-group validity. We performed statistical correlation analysis for concurrent validity, convergent validity, and discriminant validity using Pearson’s product moment correlation coefficient.Results:A total of 140 patients responded. Three factors were identified. The values of Cronbach’s α were 0.90, 0.89, and 0.86, respectively. Patients were classified into 2 groups: Non-cachexia/Pre-cachexia (n = 57) and Cachexia/Refractory cachexia (n = 83). Significant differences were observed in the total scores of each factor and all items: (factor 1) 7.5 vs. 11.0, p < 0.001; (factor 2) 8.0 vs. 13.0, p < 0.001; (factor 3) 5.0 vs. 10.0, p < 0.001; (all items) 20.0 vs. 35.0, p < 0.001, respectively. The total scores of each factor and all items significantly correlated with the Edmonton Symptom Assessment System-revised and the nutrition impact symptoms: 0.62 (p < 0.001) and 0.63 (p < 0.001), respectively. Scaling success rates were 100% in factor 1, 2, and 3.Conclusion:The questionnaire appears to be useful. Eating-related distress in patients with advanced cancer had 3 factors.
      Citation: Journal of Palliative Care
      PubDate: 2020-08-17T11:14:15Z
      DOI: 10.1177/0825859720951356
  • Symptom Burden and Unmet Needs in MPM: Exploratory Analyses From the
           RESPECT-Meso Study
    • Authors: Siao Nge Hoon, Iain Lawrie, Cathy Qi, Najib Rahman, Nick Maskell, Karen Forbes, Stephen Gerry, Leanne Monterosso, Anoop Chauhan, Fraser J. H. Brims
      Abstract: Journal of Palliative Care, Ahead of Print.
      Objective:Malignant Pleural Mesothelioma (MPM) has a poor prognosis and high symptom burden. RESPECT-Meso was a multicenter randomized study examining the role of early specialist palliative care (SPC) on quality of life (QoL) with MPM. This is a post-hoc exploratory analysis of the symptom burden and unmet needs identified from RESPECT-Meso participants.Methods:Exploratory analysis from 174 participants using the General Health Status (GHS) measure (from the EORTC QLQ-C30 QoL questionnaire) and 87 participants using validated assessment questionnaires in those randomized to SPC. Eligibility for the study included confirmed MPM with diagnosis
      Citation: Journal of Palliative Care
      PubDate: 2020-08-14T07:10:03Z
      DOI: 10.1177/0825859720948975
  • Hope in Palliative Care: A Thematic Analysis
    • Authors: Tan Seng Beng, Cheah Ai Xin, Yeoh Kee Ying, Lim Poh Khuen, Anne Yee, Sheriza Izwa Zainuddin, Loh Ee Chin, Lam Chee Loong
      Abstract: Journal of Palliative Care, Ahead of Print.
      Background:Hope is a positive coping mechanism that is important at all stages of illness, more so for palliative care patients.Purpose:To explore the experiences of hope of palliative care patients.Methods:A qualitative study was conducted at University of Malaya, Kuala Lumpur, Malaysia. Adult palliative care in-patients were recruited and interviewed with semi structured questions on hope. Transcripts from the interviews were thematically analyzed with qualitative data management software NVIVO.Findings:20 palliative care patients participated in the study. The themes generated from thematic analysis were (1) The notions of hope, (2) The sources and barriers of hope and (3) The contents of hope.Conclusion:Hope is an ever-present source of energy that gives people strength to carry on even in the most adverse situations. Understanding hope from the palliative care perspective may allow healthcare providers to develop strategies to better foster hope in the terminally ill.
      Citation: Journal of Palliative Care
      PubDate: 2020-08-14T07:09:33Z
      DOI: 10.1177/0825859720948976
  • Assessing the Palliative and End-of-Life Care
           Education-Practice-Competence Triad in Intensive Care Units: Content
           Validity, Feasibility, and Reliability of a New Tool
    • Authors: Sameh Eltaybani, Ayumi Igarashi, Noriko Yamamoto-Mitani
      Abstract: Journal of Palliative Care, Ahead of Print.
      Background:To date, a comprehensive, psychometrically robust instrument to assess palliative and end-of-life (PEOL) care education, practice, and perceived competence among intensive care unit (ICU) nurses does not exist.Objective:To examine content validity and reliability of a proposed instrument to assess the PEOL care education-practice- competence triad among ICU nurses.Methods:An international modified e-Delphi and a cross-sectional pilot questionnaire survey. The Delphi involved 23 panelists from 11 countries. The pilot study involved 40 staff nurses and 3 nurse managers from 3 adult ICUs in a randomly selected hospital in Egypt. An instrument was developed and judged for content validity by international panelists, and then pretested in a pilot study, where data were collected at 2 time points using self-administered questionnaires, followed by cognitive interviews. Test-retest reliability was examined using intraclass correlation (ICC), standard error of measurement (SEM), and repeatability coefficient (RC).Results:The panelists confirmed content validity of the proposed instrument, and staff nurses confirmed its comprehensibility. At the level of the instrument’s total scores, the lowest ICC was .9 (95% confidence interval: .8-.9); and the highest SEM and RC were 4.8 and 13.3, respectively.Conclusions:The PEOL Care Index is a comprehensive, comprehensible, content valid, and reliable instrument to assess the PEOL care education-practice-competence triad among ICU nurses. Construct and criterion validities need to be confirmed in future studies. Applicability of the PEOL Care Index in different settings and cultures needs to be examined.
      Citation: Journal of Palliative Care
      PubDate: 2020-08-11T09:32:25Z
      DOI: 10.1177/0825859720948972
  • Chemotherapy at the End of Life
    • Authors: Semiha Urvay, Burak Civelek, Ersin Özaslan, Aziz Ahmet Sürel
      Abstract: Journal of Palliative Care, Ahead of Print.
      Background and Objectives:The use of chemotherapy at the end of life in advanced cancer patients has increased and end of life care has become increasingly aggressive. The aim of this study is to evaluate patients receiving chemotherapy in the last 3 months of life and the aggressiveness of end-of-life support of these patients.Methods:All adult patients with solid tumors who received chemotherapy in their last 3 months of life and died in our hospital between January 2015 to June 2019 were included. Detailed information on chemotherapy and toxicity was collected in patient records.Results:A total of 182 patients included. Median age was 58,9 years. The median survival from the docementation of metastatic disease was 9,98 months (0,95-64,3). Of these 182 patients, 95 (52%) were treated with chemotherapy in the last month of life and 52 (29%) in the last 2 weeks of life. The median number of days between the last administration of chemotherapy and patient death was 29 (0-90). A new chemotherapy regimen was started in the last 3 months of life in 102 patients (56%), in the last month of life in 43 patients (23,6%) and in the last 2 weeks in 23 patients (12.6%).Discussion and Implications:There are many patients who received chemotherapy in the last 3 months of their life and the rates of chemotherapy initiation during this period are well above ideal rates. Whether such care has positive effects on survival or quality of life is questionable and deserves additional investigation.
      Citation: Journal of Palliative Care
      PubDate: 2020-08-07T06:16:32Z
      DOI: 10.1177/0825859720946505
  • At the Intersection of Palliative Care, Psychedelic Medicine, and
           Healthcare Reform: A Call for a New Hospice and Palliative Care Movement
    • Authors: Ilan Bernstein
      Abstract: Journal of Palliative Care, Ahead of Print.

      Citation: Journal of Palliative Care
      PubDate: 2020-08-05T06:10:24Z
      DOI: 10.1177/0825859720946898
  • Development of Voluntary Assisted Dying Training in Victoria, Australia: A
           Model for Consideration
    • Authors: Ben P. White, Lindy Willmott, Eliana Close, Jayne Hewitt, Rebecca Meehan, Laura Ley Greaves, Malcolm H. Parker, Patsy Yates
      Abstract: Journal of Palliative Care, Ahead of Print.
      Background:Voluntary assisted dying was legalized in Victoria, Australia in June 2019, and was the first jurisdiction internationally to legislatively mandate training for doctors conducting eligibility assessments of patients. Mandatory training was designed as a safeguard to ensure compliance within the system, so that only eligible patients would gain access to voluntary assisted dying.Objective:This article outlines the development of training mandated for doctors prior to undertaking eligibility assessments for voluntary assisted dying. The training addressed required legal knowledge, including doctors’ roles, duties and legal protections, and also provided instruction on relevant clinical skills.Design:Training design was based on 2 main principles: to comprehensively impart the legal duties imposed by the legislation; and to be readily accessible for busy doctors. The law was first mapped into a curriculum, and circulated to medical colleges, societies and professional organizations as well as international experts for feedback. The training was converted into an online e-learning format and tested at a focus group of doctors.Results:The training comprises 9 modules including an assessment module. While the predominant focus of the modules is on law, they also contain some clinical components and links to further resources. Modules also contain videos, case studies and interactive exercises. The assessment consists of 30 questions, selected randomly from a question bank, with a pass mark of 90%.Conclusion:The Victorian legislatively-mandated voluntary assisted dying training provides standardized baseline knowledge to enhance the quality and consistency of decision-making by doctors. While further evaluation of this training is needed, it may provide a model for other jurisdictions considering making voluntary assisted dying lawful.
      Citation: Journal of Palliative Care
      PubDate: 2020-08-05T06:10:00Z
      DOI: 10.1177/0825859720946897
  • A Lack of Palliative Therapy Use in Patients With Advanced Penile Cancer
    • Authors: Facundo M. Davaro, David Weinstein, Sameer A. Siddiqui, Zachary A. Hamilton
      Abstract: Journal of Palliative Care, Ahead of Print.
      Objectives:Advanced penile cancer is associated with a poor prognosis; therefore, providing patients with realistic expectations, addressing goals of care and offering palliative therapy when appropriate is critical. Our goal was to investigate the National Cancer Database (NCDB) and analyze the role and trends in use of palliative therapy in patients with advanced penile cancer.Methods:The NCDB 2004−2015 penile cancer data set was queried for patients with locally advanced, defined as cT4NanyM0 and cTanyN3M0, or metastatic disease regardless of tumor or nodal stage. Patients were categorized based on whether they did or did not receive palliative care. Palliative care was cataloged as pain management therapy, surgery, radiation or systemic treatment, any combination therapy or not otherwise specified (NOS). Our primary outcome was receiving palliative therapy. Secondary outcome was the temporal trends in palliative care. Logistic regression (LR) was performed.Results Obtained:385 and 279 patients were identified with locally advanced and metastatic penile cancer respectively. 27 (7.1%) and 49 (17.6%) patients received palliative care. Average age of patients accepting palliative care was 61.9 years old, about 5 years younger than their counterparts who declined therapy (p < 0.011) in the metastatic cohort. Other patient specific demographics and clinical tumor characteristics were not significantly different in either population. Of patients with locally advanced disease pursuing palliative therapy, radiation (29.6%), surgery (14.8%), systemic treatment (14.8%) and combination treatment (22.2%) were the more popular choices. In the metastatic population, radiation (32.7%) and systemic therapy (24.5%) were the most prevalent choices for palliative treatment followed by combination treatment (16.3%), surgery (12.2%), pain management (10.2%), or NOS (4.1%). LR for the receipt of “any palliative therapy” revealed that increasing age (OR 0.971, p = 0.032) decreased the likelihood of accepting palliative therapy in the metastatic population but not in the locally advanced group. Charlson score of 2 (OR 5.966, p = 0.025) and low income (OR 3.968, p = 0.002) predicted receipt of palliative therapy in the locally advanced group. In patients with metastatic disease, African-American race (OR 2.502, p = 0.025), Charlson score 1 (2.175, p = 0.047) and 3+ (5.386, p = 0.020) predicted an increased predilection for receiving palliative therapy. Interestingly, no statistically significant difference in mortality was noted in either cohort. No significant increase in the trend of palliative care administration was seen in locally advanced and metastatic penile cancer between 2004 to 2015 (p = 0.078 and p = 0.942, respectively).Conclusion:Locally advanced and metastatic penile cancer carry a high mortality rate yet only 11.4% of all patients studied received palliative care. Its use is more common in younger patients, those with co-morbidities and/or those of black race in the metastatic group. Locally advanced patients with low income or comorbidities were also more likely to opt for palliative therapy. Receipt of palliative care did not affect mortality. No increase in frequency of palliative therapy was seen, suggesting much improvement needs to be done in adopting and implementing palliative care in this patient population.
      Citation: Journal of Palliative Care
      PubDate: 2020-08-05T06:09:12Z
      DOI: 10.1177/0825859720946887
  • Knowledge, Attitudes, and Practices Regarding Palliative Care: A
           Mixed-Methods Study from Bihar, India
    • Authors: Mohit Nair, Pragya Kumar, Raman Mahajan, Amit Harshana, Karishma Krishna Kurup, Laura Moreto-Planas, Sakib Burza
      Abstract: Journal of Palliative Care, Ahead of Print.

      Citation: Journal of Palliative Care
      PubDate: 2020-07-30T05:53:58Z
      DOI: 10.1177/0825859720946514
  • Relationship Between Newly Established Perioperative DNR Status and
           Perioperative Outcomes in the Elderly Population: A NSQIP Database
    • Authors: Ethan Y. Brovman, Mark W. Motejunas, Lauren A. Bonneval, Edward E. Whang, Alan D. Kaye, Richard D. Urman
      Abstract: Journal of Palliative Care, Ahead of Print.
      Background:Health care practitioners have developed complex algorithms to numerically calculate surgical risk. We examined the association between the initiation of a new do-not-resuscitate (DNR) status during hospitalization and postoperative outcomes, including mortality. We hypothesized that new DNR status would be associated with similar complication rates, even though mortality rates may be higher.Methods:A retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Geriatric Surgery Research File. Two cohorts were defined by the presence of a new DNR status during the hospitalization that was not present on hospital admission. Multivariable logistic regression was used to control for differences between the DNR and non-DNR cohorts. The primary outcome was 30-day mortality. Secondary outcomes included rates of postoperative complications, including returning to the operating room, reintubation, failure to wean from ventilation, surgical site infections, dehiscence, pneumonia, acute kidney injury, renal failure, stroke, cardiac arrest, acute myocardial infarction, transfusion requirements, sepsis, urinary tract infections, venous thromboembolisms, total number of complications for each patient, and hospital length of stay.Results:In our geriatric population with a newly established DNR status, the mortality rate was 39.29%, significantly greater than the non-DNR population after multivariable regression. Secondary outcomes also occurred at an increased rate in the DNR cohort including surgical site infections (8.29% vs 4.04%), pneumonia (18% vs 2.26%), renal insufficiency (2.43% vs 0.35%), acute renal failure (5% vs 0.19%), stroke (3% vs 0.36%), acute myocardial infarction (6.29% vs 0.95%), and cardiac arrest (5.86% vs 0.51%).Conclusions:The initiation of a new DNR status during hospitalization is associated with a significantly higher burden of both morbidity and mortality. This contrasts with prior studies that did not show an increased rate of adverse outcomes and suggests that a new DNR status in postoperative patients may reflect a consequence of adverse postoperative events. The informed consent process in older patients at risk for adverse outcomes after surgery should include discussions regarding goals of care and acceptable risk.
      Citation: Journal of Palliative Care
      PubDate: 2020-07-28T08:45:52Z
      DOI: 10.1177/0825859720944746
  • A Novel Use of Topical Ketamine for the Treatment of Oral Pemphigus: A
           Case Report
    • Authors: Elizabeth A. Higgins, Julia Arana West
      Abstract: Journal of Palliative Care, Ahead of Print.
      Background:Paraneoplastic pemphigus (PNP) is a rare autoimmune blistering disease often associated with lymphoproliferative disorders. PNP causes hemorrhagic stomatitis of the lips, tongue, and cheeks which can be painful and difficult to treat.Case History:A 54-year-old man was referred to our hospital for treatment of Stage IV lymphoma and paraneoplastic pemphigus. Due to pain from oral stomatitis, he required a gastrostomy tube for delivery of nutritional tube feeds. He was placed on steroids and received both lidocaine mouthwash and opioids, but his pain persisted.Case Management and Outcome:A palliative care consult was obtained for management of his pain. The palliative team recommended topical ketamine for the treatment of the painful lip lesions. The patient felt immediate relief with the application of ketamine and his pain level was reduced to a 5/10. The following day, his pain was 0/10. Five days later, the opioids were discontinued and the pain relief continued.Conclusion:Painful stomatitis from PNP may be refractory to standard treatment. We found that the application of topical ketamine was very effective in this patient with hemorrhagic stomatitis from PNP.
      Citation: Journal of Palliative Care
      PubDate: 2020-07-27T08:42:02Z
      DOI: 10.1177/0825859720946504
  • Nobody Should Die Alone: A Father’s Message to a Physician Daughter
    • Authors: Naaz A. Hussain
      Abstract: Journal of Palliative Care, Ahead of Print.

      Citation: Journal of Palliative Care
      PubDate: 2020-07-15T06:52:04Z
      DOI: 10.1177/0825859720941972
  • Choosing Educational Resources to Build Interprofessional, Palliative Care
           Competency: A Replicable Review Methodology
    • Authors: Kathleen Yue, Carolyn Tayler
      Abstract: Journal of Palliative Care, Ahead of Print.
      Aim/Objective:The purpose of the project was to provide information to inform the choice of educational resources available in British Columbia to support palliative care competency development for 4 disciplines: nurses, physicians, health care assistants, and social workers/counsellors. This article will describe the process of resource review. Results of the review are available at The objectives were to (1) identify gaps common to all educational resources, (2) provide information on content addressing competencies as well as logistics such as time required, cost, delivery method, and training requirements for instructors, and (3) develop a reproducible process for assessment of educational resources which is unbiased, transparent, and competency based.Method:Sixteen educational resources were assessed for the percentage of competencies that were addressed. Gaps common to all resources were identified.Results:The review process is described and can be replicated when assessing future versions of these and other palliative continuing education courses. This is a reproducible methodology for review of competency-based educational resources which could be applied for any practice-related subject.Conclusion:This review process provided information which can inform a provincial interprofessional palliative education plan. The methodology may be used by others to assess and choose between competency-based education resources with a palliative population focus and other patient population foci.
      Citation: Journal of Palliative Care
      PubDate: 2020-07-02T07:32:44Z
      DOI: 10.1177/0825859720935218
  • Are You Prepared for End-of-Life Care' A Content Review of Canadian
           End-of-Life Care Standards and Competencies for Saskatchewan
    • Authors: Michelle Buness, Roslyn M. Compton, Madeline Press, Cindy Peternelj-Taylor
      Abstract: Journal of Palliative Care, Ahead of Print.
      Background:The provision of end-of-life care is receiving attention locally, provincially, and nationally in Canada. It is important to ensure that interprofessional standards and competencies are in place to provide quality end-of-life care that meets the needs of patients and their families. The purpose of this content review was to identify core standards and competencies essential to an interprofessional team providing end-of-life care.Methods:The researchers conducted a review of health professional associations and registration bodies that support professionals providing end-of-life care to identify existing standards and competencies. Key concepts were reviewed and organized using thematic analysis; relationships were developed; and core themes for interprofessional end-of-life care were identified.Results:Four themes essential to the provision of end-of-life care were common across all health professions: (1) access to care, (2) professional practice, (3) person-centered care, and (4) the process and delivery of care.Conclusions:Health professional associations need to ensure end-of-life care standards and competencies are in place for the provision of appropriate and holistic care. Aligning standards and competencies across professions improves the preparedness of health professionals to provide interprofessional end-of-life care.
      Citation: Journal of Palliative Care
      PubDate: 2020-06-23T06:59:30Z
      DOI: 10.1177/0825859720935231
  • Translating Pediatric Hospital Interpreters’ Feedback From Difficult
           Conversations into Improved Communication
    • Authors: Meaghann S. Weaver, Alicia Roeth, Hema Navaneethan, Valerie K. Shostrom, Melissa Contreras-Nourse
      Abstract: Journal of Palliative Care, Ahead of Print.
      Background:Medical interpreters are critical mediators in communication with pediatric subjects and families to include participation in difficult conversations.Objective:The objective of this pilot study was to provide suggestions from medical interpreters to palliative care teams as to how to effectively incorporate medical interpreters into end-of-life conversations.Subjects and Method:Participants included pediatric hospital-based medical interpreters who had interpreted for at least 1 end-of-life conversation in the pediatric hospital setting. A total of 11 surveys were completed by medical interpreters. The study consisted of a written 12-item survey with a follow-up focus group to further explore survey themes.Results:The translation of cultural contexts, awareness of the mixed messages the family received from health care teams, and the emotional intensity of the interactions were depicted as the most challenging aspects of the medical interpreter’s role. Despite these challenges, 9 interpreters reported they would willingly be assigned for interpreting “bad news” conversations if given the opportunity (82%). Medical interpreters recognized their relationship with the family and their helping role for the family as meaningful aspects of interpreting even in difficult conversations. Medical interpreters shared 7 thematic suggestions for improved communication in language-discordant visits: content review, message clarity, advocacy role, cultural understanding, communication dynamics, professionalism, and emotional support.Conclusions:As experts in cultural dynamics and message transmission, the insights of medical interpreters can improve communication with families.
      Citation: Journal of Palliative Care
      PubDate: 2020-06-12T06:06:01Z
      DOI: 10.1177/0825859720933112
  • Trends and Utilization of Inpatient Palliative Care Among Patients With
           Metastatic Bladder Cancer
    • Authors: Hedong Han, Feifei Yu, Cheng Wu, Lihe Dai, Yiming Ruan, Yang Cao, Jia He
      Abstract: Journal of Palliative Care, Ahead of Print.
      Objective:To explore the trends and utilization of palliative care (PC) service among inpatients with metastatic bladder cancer (MBC).Methods:A retrospective, cross-sectional analysis was performed using data from the 2003 to 2014 National Inpatient Sample. Palliative care was identified through International Classification of Diseases, Ninth Revision code V66.7. Demographics, comorbidities, hospital characteristics, tumor-related, and treatment-related factors were compared between patients with and without PC. Multivariable logistic regression was used to explore predictors of PC use.Results:Among 131 852 patients with MBC, 13 224 (10.03%) received PC. Rate of PC increased from 2.49% in 2003 to 28.39% in 2014 (P < .0001). Similarly, rate of PC in decedents increased from 7.02% in 2003 to 54.86% in 2014 (P < .0001). Patients receiving PC were older, tendered to be white, had more comorbidities, and higher all-patient refined diagnosis-related group mortality risk. Predictors of PC included age (odds ratio [OR]: 1.02; 95% CI: 1.01-1.02; P < .0001), Medicaid (OR: 1.87; 95%.CI: 1.54-2.26; P < .0001), and private (OR: 1.61; 95% CI: 1.40-1.84; P < .0001) insurance, hospitals in the West (OR: 1.33; 95% CI: 1.10-1.61; P = .0032), and Mid-west (OR: 1.46; 95% CI: 1.22-1.75; P = .0032), major (OR: 1.32; 95% CI: 1.11-1.49; P < .0001), and extreme (OR: 2.37; 95% CI: 2.04-2.76; P < .0001) mortality risk. Chemotherapy and mechanical ventilation were related with lower odds of PC use. Palliative care predictors in the decedents were similar to those in overall patients with bladder cancer.Conclusions:Palliative care encounter in MBC shows an increasing trend. However, it still remains very low. Disparities in PC use covered age, insurance, and hospital characteristics among metastatic bladder cancer in the United States.
      Citation: Journal of Palliative Care
      PubDate: 2020-05-14T11:36:54Z
      DOI: 10.1177/0825859720924936
  • Canada’s Evolving Medicare: End-of-Life Care
    • Authors: Nicole MacPherson, Terrence Montague, John Aylen, Lesli Martin, Amédé Gogovor, Sharon Baxter, Joanna Nemis-White
      Abstract: Journal of Palliative Care, Ahead of Print.
      A challenging issue in contemporary Canadian Medicare is the evolution of end-of-life care. Utilizing data from the 2016 and 2018 Health Care in Canada (HCIC) surveys, this paper compares the support and priorities of the adult public (n = 1500), health professionals (n = 400), and administrators (n = 100) regarding key components for end-of-life care just prior to and post legalization of medical assistance in dying (MAiD) in Canada. In 2016 and 2018, the public, health professionals and administrators strongly supported enhanced availability of all proposed end-of-life care options: pain management, hospice and palliative care, home care supports, and medically assisted death. In 2018, when asked which option should be top priority, the public rated enhanced medically assisted death first (32%), followed by enhanced hospice and palliative care (22%) and home care (21%). Enhanced hospice and palliative care was the top priority for health professionals (33%), while administrators rated enhanced medically assisted death first (26%). Despite legalization and increasing support for MAiD over time, health professionals have increasing fear of legal or regulatory reprisal for personal involvement in medically assisted death, ranging from 38% to 84% in 2018, versus 23% to 42% in 2016. While administrators fear doubled since 2016 (40%-84%), they felt the necessary system supports were in place to easily implement medically assisted death. Optimal management of end-of-life care is strongly supported by all stakeholders, although priorities for specific approaches vary. Over time, professionals increasingly supported MAiD but with a rising fear of legal/regulatory reprisal despite legalization. To enhance future end-of-life care patterns, continued measurement and reporting of implemented treatment options and their system supports, particularly around medically assisted death, are needed.
      Citation: Journal of Palliative Care
      PubDate: 2020-05-14T06:36:08Z
      DOI: 10.1177/0825859720924169
  • Death and End of Life: Perceptions Throughout The Career About Death,
           Palliative Care, and Educational Process
    • Authors: Maria Luiza Galoro Corradi, Etienne Duim, Cibele Isaac Saad Rodrigues
      Abstract: Journal of Palliative Care, Ahead of Print.
      Purpose:To evaluate the perception of attending physicians, medical residents, and undergraduate medical students about death and dying, the end of life (EoL), and palliative care (PC) during training and clinical practice, highlighting knowledge gaps, and the changes needed in medical school curricula.Method:Cross-sectional study of 12 attending physicians, residents, and undergraduate medical students randomly selected from a single teaching hospital in São Paulo, Brazil, 2018. Semi-structured interviews were conducted, transcripts were coded in depth, and categorizing analysis was carried out.Results:Three topical categories were recognized: Negative feelings about death and the EoL, importance of PC, and gaps in curricular structure hindering preparedness for PC and EoL communication. Besides differing perspectives depending on their years of experience, all participants strongly endorsed that the current medical school curriculum does not train and support physicians to handle EoL and PC.Conclusions:Medical education plays a fundamental role in the development of knowledge and skills on death, dying, and PC. Such practices should extend throughout the course and be continuously improved after graduates move to clinical practice.
      Citation: Journal of Palliative Care
      PubDate: 2020-05-11T05:32:41Z
      DOI: 10.1177/0825859720923435
  • Building a Medical Undergraduate Palliative Care Curriculum: Lessons
    • Authors: Shirley H. Bush, Valérie Gratton, Monisha Kabir, Paula Enright, Pamela A. Grassau, Jill Rice, Pippa Hall
      Abstract: Journal of Palliative Care, Ahead of Print.
      Previous literature demonstrates that current palliative care training is in need of improvement for medical students in global, European and Canadian contexts. The training of medical undergraduates is key to ensure that the ongoing and increasing need for enhanced access to palliative care across all settings and communities is met. We describe building a comprehensive palliative and end-of-life care curriculum for medical undergraduates at our university. As with recent European and US studies, we found that the process of university curriculum renewal provided a critical opportunity to integrate palliative care content, but needed a local palliative care champion already in place as an energetic and tireless advocate. The development and integration of a substantive bilingual (English and French) palliative and end-of-life care curriculum over the 4-year medical undergraduate program at our university has occurred over the course of 14 years, and required multiple steps and initiatives. Subsequent to the development of the curriculum, there has been a 13-fold increase in students selecting our palliative care clinical rotations. Critical lessons learned speak to the importance of having a team vision, interprofessional collaboration with a focus on vision, plans and implementation, and flexibility to actively respond and further integrate new educational opportunities within the curriculum. Future directions for our palliative care curriculum include shifting to a competency-based training and evaluation paradigm. Our findings and lessons learned may help others who are working to develop a comprehensive undergraduate medical education curriculum.
      Citation: Journal of Palliative Care
      PubDate: 2020-04-14T05:05:16Z
      DOI: 10.1177/0825859720916565
  • The Role of Hospice Palliative Care Volunteers With Respect to
           Conversations About Medical Assistance in Dying (MAiD)
    • Authors: Stephen Claxton-Oldfield
      Abstract: Journal of Palliative Care, Ahead of Print.

      Citation: Journal of Palliative Care
      PubDate: 2020-04-08T08:42:34Z
      DOI: 10.1177/0825859720916563
  • Transitioning to Life in a Nursing Home: The Potential Role of Palliative
    • Authors: Elizabeth Halifax, Nhat Minh Bui, Lauren J. Hunt, Caroline E. Stephens
      Abstract: Journal of Palliative Care, Ahead of Print.
      Background and Objectives:Transitioning to a nursing home (NH) is a major life event for 1.4 million NH residents in the United States. Most post-acute NH admissions plan for rehabilitation and discharge home, but with nearly 70% of NH residents being palliative care (PC) eligible, many evolve into long-term placements secondary to poor health and associated decline in function and/or cognition. This article describes the perceptions of NH PC-eligible residents and families transitioning to life in a NH.Methods:Residents at 3 NHs in Northern California (N = 228) were screened for PC eligibility. A convenience sample of PC-eligible residents and their family members (n = 28) participated in qualitative interviews that explored the experience of living as a NH resident with serious illness. Data were analyzed using grounded theory methodology.Results:Our study provides insights into the experiences of transitioning to a NH from the perspectives of PC-eligible residents and their families. These data describe how PC-eligible residents and their families experienced disempowerment as they perceived being left out of decisions to go to a NH, loss of autonomy once at the NH, dealt with the realization that they would not be going home, and described perceived barriers to going home.Discussion and Implications:The inclusive and person-centered model of care that PC provides naturally empowers residents and family members. Adequate provision of PC services, together with changes in policy related to NH culture and benefit management, could improve the experience of transitioning to a nursing home.
      Citation: Journal of Palliative Care
      PubDate: 2020-02-28T06:30:50Z
      DOI: 10.1177/0825859720904802
  • Hospice Utilization Among Residents in Long-Term Care Facilities
    • Authors: Beibei Xiong, Shannon Freeman, Davina Banner, Lina Spirgiene
      Abstract: Journal of Palliative Care, Ahead of Print.
      Background:Hospice care can improve quality of life for persons nearing end of life, yet little is known about utilization of hospice care among persons residing in long-term care facilities (LTCFs). Given the increasing number of deaths that occur in LTCFs, it is important to examine hospice care practices in LTCFs.Aim:The aim of the cross-sectional study was to describe residents who received hospice care in LTCFs and explore factors that can predict hospice use in LTCFs across Canada. This study included 185 715 residents aged 19 years or older in LTCFs in Canada in 2015.Results:Of all residents, 2.7% (n = 4973) received hospice care and 6.8% (n = 12 684) were profiled as having an end-stage disease. Among those who received hospice care, most were noted as end stage (89.5%) and had severe physical impairment (Activities of Daily Living Hierarchy Scale ≥ 5, 74.3%), mild-to-severe pain (Pain Scale ≥ 1, 76.0%), and moderate-to-severe health instability (Changes in Health, End-Stage Disease, Signs, and Symptoms Scale ≥3, 82.9%). Residents who received hospice care were in more severe and complex clinical conditions than those who did not receive hospice care.Conclusion:Only a small proportion of residents in LTCFs received hospice care. Further investigation of standardized assessment of terminal status is needed as accuracy of end-stage diagnosis continues to be challenging and criteria for hospice eligibility are narrow. Special attention should be paid to improve access to hospice care among residents with dementia or other progressive chronic diseases with severe and complex clinical needs.
      Citation: Journal of Palliative Care
      PubDate: 2020-02-25T06:54:42Z
      DOI: 10.1177/0825859720907415
  • Engaging Specialist Palliative Care in the Management of Amyotrophic
           Lateral Sclerosis: A Patient-, Family-, and Provider-Based Approach
    • Authors: Karla T. Washington, Klaudia Kukulka, Raghav Govindarjan, David R. Mehr
      Abstract: Journal of Palliative Care, Ahead of Print.
      Purpose:To describe key stakeholders’ perspectives on specialist palliative care and its integration into the management of amyotrophic lateral sclerosis (ALS).Methods:The study conducted was a qualitative, noninterventional, descriptive study. Data were collected via individual interviews of 42 stakeholders (n = 14 patients, n = 16 family caregivers, and n = 12 health-care providers). Transcribed interviews were analyzed using inductive thematic analysis techniques.Results:Stakeholders’ general impressions of specialist palliative care were highly variable. Many expressed limited or inaccurate understandings of palliative care’s definition and purpose. Perceptions of palliative care as hospice were common. Stakeholders generally supported the integration of specialist palliative care into ALS management, and many recognized the value of early integration of palliative services in both the community and the clinical setting.Conclusion:Key stakeholders readily identified a meaningful role for specialist palliative care in ALS management. Integration of specialist palliative care into existing systems of support would be facilitated by a more comprehensive understanding of the service among patients, family caregivers, and health-care providers.
      Citation: Journal of Palliative Care
      PubDate: 2020-02-18T04:42:03Z
      DOI: 10.1177/0825859719895827
  • Palliative Care and the Tragedy of the Commons
    • Authors: Lauren K. Hall, Randy Hebert
      First page: 203
      Abstract: Journal of Palliative Care, Ahead of Print.
      Many of the paradoxes of end-of-life care, including the combination of overtreatment and low quality of life, can be explained in part by the fact that the structure of end-of-life care is a tragedy of the commons, where no one provider “owns” the patient or is responsible for the outcomes of treatment. This article outlines the way in which applying frameworks from economics to end-of-life care can contribute to conversations about reform, particularly in terms of how to reform palliative care to harness its full potential to limit overtreatment, improve quality of life, and lower costs. The authors use principles from economics and political science to propose a series of possible reforms to end-of-life care, starting with reimbursement bundling and ending with pause points and more conscious ownership of care decisions by patients and their teams of providers.
      Citation: Journal of Palliative Care
      PubDate: 2020-03-05T09:21:40Z
      DOI: 10.1177/0825859720909555
  • To What Extent Does Clinically Assisted Nutrition and Hydration Have a
           Role in the Care of Dying People'
    • Authors: Adam Nicholas Carter
      First page: 209
      Abstract: Journal of Palliative Care, Ahead of Print.
      The question over whether to administer clinically assisted nutrition and hydration (CANH) to a dying patient is controversial, with much debate concerning this sensitive issue. The administration of CANH poses clinical and ethical dilemmas, with supporting and opposing views. Proposed positive effects of CANH include preventing thirst, delirium, hypercalcemia, and opioid toxicity. However, CANH has been shown to increase the risk of aspiration, pressure ulcers, infections, and hospital admissions as well as potentially causing discomfort to the patient. Guidance from several national bodies generally advises that the risks and burdens of CANH outweigh the benefits in the dying patient. However, an individualized approach is needed, and the patient’s wishes regarding CANH need consideration if they have capacity and can communicate. Otherwise, sensitive discussions are required with the family, enquiring about the patient’s prior wishes if there is no advanced care plan and acting in the patient’s best interests. The ethical principles of autonomy, beneficence, non-maleficence, and justice need to be applied being mindful of any cultural and religious beliefs and potential misperceptions.
      Citation: Journal of Palliative Care
      PubDate: 2020-03-04T11:08:01Z
      DOI: 10.1177/0825859720907426
  • Attitude and Barriers in Palliative Care and Advance Care Planning in
           Nonmalignant Chronic Lung Disease: Results From a Danish National Survey
    • Authors: Anita Rath Sørensen, Kristoffer Marsaa, Thomas Skovhus Prior, Elisabeth Bendstrup
      First page: 232
      Abstract: Journal of Palliative Care, Ahead of Print.
      Introduction:Patients with chronic obstructive pulmonary disease and interstitial lung disease have a significant burden of symptoms. Many are not offered palliative care (PC). Our aim was to investigate the attitudes to and barriers for PC among physicians.Method:A web-based survey was conducted among members of the Danish Respiratory Society. The questionnaire included contextual (gender, age, clinical experience, type of center, patient caseload) and outcome questions (knowledge and use of statements for PC and advance care planning [ACP], practice of communication about end-of-life decisions, practice for referral to PC, barriers regarding structural surroundings, clinical skills, and organization).Results:One hundred fifty-six (45%) physicians responded. Median age was 40 - 49 years and 55% were female. Fifty-two percent were specialists; 71% worked at a university hospital. The majority of physicians (60%) reported barriers for discussions about PC and ACP; 63% reported lack of time, 52% lack of multidisciplinary staff settings, 63% reported the unpredictability of the prognosis, and 20% insufficient awareness of patient’s culture, religion, or spirituality. Fewer specialists than nonspecialists reported barriers toward ACP. The majority had knowledge of guidelines in PC and ACP, but only a minority used these in daily clinical practice.Conclusion:The attitude toward PC and ACP conversations was positive and implementation was regarded as important, but only a minority performed these conversations in practice. Main barriers were lack of time and staff. Palliative care guidelines were known but only scarcely used. Structural changes at the organizational level to improve access to palliation for patients with nonmalignant chronic lung diseases are needed.
      Citation: Journal of Palliative Care
      PubDate: 2020-06-23T11:34:40Z
      DOI: 10.1177/0825859720936012
  • What Is Good Advance Care Planning According to Hospitalized Palliative
           Patients and Their Families' An Explorative Study
    • Authors: Birgit Vanderhaeghen, Inge Bossuyt, Johan Menten, Peter Rober
      First page: 236
      Abstract: Journal of Palliative Care, Ahead of Print.
      Background:Advance care planning is not well implemented in Belgian hospital practice. In order to obtain successful implementation, implementation theory states that the adopters should be involved in the implementation process. This information can serve as a basis for creating better implementation strategies.Aim:For this study, we asked hospitalized palliative patients and their families what they experienced as good advance care planning.Methods:Twenty-nine interviews were taken from patients and families, following the Tape Assisted Recall procedure of Elliot. These interviews were analyzed using content analysis based on grounded theory. To improve reliability, 3 independent external auditors audited the analysis.Results:Results show that hospitalized palliative patients and families want to have advance care planning communication about treatment and care throughout their disease and about different aspects: social, psychological, physical, practical, and medical. They prefer to have these conversations with their supervising physician. They report 4 important goals of advance care planning communication: establishing a trustful relationship with the physician, in which they feel the involvement of the physician; giving and receiving relevant information for the decision process, making a personal decision about which treatment and care are preferred; and finding consensus between the preferred decision of the physician, the patient and the family concerning the treatment and care policy.Conclusion:This study can contribute to advance care planning implementation in hospital practice because it gives in insight into which elements in advance care planning patients and families experience as necessary and when advance care planning is necessary to them.
      Citation: Journal of Palliative Care
      PubDate: 2020-07-08T07:36:02Z
      DOI: 10.1177/0825859720938583
  • Evaluation of a Video Decision Aid to Reduce Decisional Conflict in
           Physician Orders for Life-Sustaining Treatment (POLST) Decision-Making
    • Authors: Jarred V. Gallegos, Barry Edelstein, Alvin H. Moss
      First page: 243
      Abstract: Journal of Palliative Care, Ahead of Print.
      Background/Objectives:Physician Orders for Life-Sustaining Treatment (POLST) is recommended as a preferred practice for advance care planning with seriously ill patients. Decision aids can assist patients in advance care planning, but there are limited studies on their use for POLST decisions. We hypothesized that after viewing a POLST video, decision aid participants would demonstrate increased knowledge and satisfaction and decreased decisional conflict.Design:Pre-and postintervention with no control group.Setting/Participants:Fifty community-dwelling adults aged 65 and older asked to complete a POLST based on a hypothetical condition.Interventions:Video decision aid for Sections A and B of the POLST form.Measurements:Pre- and postintervention participant knowledge, decisional satisfaction, decisional conflict, and acceptability of video decision aid.Results:Use of the video decision aid increased knowledge scores from 11.24 ± 2.77 to 14.32 ± 2.89, P < .001, improved decisional satisfaction 10.14 ± 3.73 to 8.70 ± 3.00, P = .001, and decreased decisional conflict 12 ± 9.42 to 8.15 ± 9.13, P < .001. All participants reported that they were comfortable using the video decision aid, that they would recommend it to others, and that it clarified POLST decisions.Conclusions:Participants endorsed the use of a POLST video decision aid, which increased their knowledge of POLST form options and satisfaction with their decisions, and decreased their decisional conflict in POLST completion. This pilot study provides preliminary support for the use of video decision aids for POLST decision-making. Future research should evaluate a decision aid for the entire POLST form and identify patient preferences for implementing POLST decision aids into clinical practice.
      Citation: Journal of Palliative Care
      PubDate: 2020-05-06T11:50:29Z
      DOI: 10.1177/0825859720923437
  • Hearing and Heeding the Voices of those With Advanced Illnesses
    • Authors: Katherine M. Piderman, Carmen Radecki Breitkopf, Sarah M. Jenkins, Cory Ingram, Terin T. Sytsma, Maria I. Lapid, Beba S. Tata, Krishanu Chatterjee, Jason S. Egginton, Aminah Jatoi
      First page: 248
      Abstract: Journal of Palliative Care, Ahead of Print.
      Objectives:To describe the feasibility of a chaplain-led spiritually focused life review interview and the development of a spiritual legacy document (SLD) for patients with advanced diseases and to describe changes in spiritual well-being (SWB), spiritual coping strategies (SC), and quality of life (QOL) after receiving the SLD.Patients and Methods:In all, 130 patients and support person (SP) pairs were recruited from July 2012 to January 2019. Following enrollment, demographic information was gathered and baseline questionnaires were administered. Functional Assessment of Chronic Illness Therapy–Spiritual Well-Being Scale (FACIT-Sp-12) and a linear analog scale assessment (LASA) measured SWB. LASAs also measured QOL and emotional well-being (EWB). Positive Religious Coping Scale (RCOPE) measured SC. After completion of baseline forms, participants were interviewed (individually) by a chaplain. Interviews were digitally recorded, transcribed, and verified. Transcripts were edited and participants were given the opportunity to make adaptations. The participant-approved draft was then developed into a professionally printed SLD. Follow-up questionnaires were administered to assess change.Results:Significant improvements from baseline to post-SLD follow-up were found for patients on the LASAs: SWB (average 7.7-8.3, P = .01), QOL (average 6.7-7.3, P = .03), EWB (average 6.9-7.5, P = .01), and on the positive RCOPE (average 1.8-2.0, P = .007). Effect sizes were approximately 0.25. Considering any improvement, 61.0% improved their positive RCOPE score, 46.6% improved EWB, and 39.7% improved SWB. No significant changes were found on the FACIT-Sp-12. No significant changes were found for SPs.Conclusion:The results suggest that the primary participants who completed the study benefited by significantly increasing their QOL, SWB, EWB, and SC.
      Citation: Journal of Palliative Care
      PubDate: 2020-05-29T05:26:20Z
      DOI: 10.1177/0825859720928623
  • Gender Differences in End-of-Life Care in Older Mexican American Adults
    • Authors: Evangeline M. Ortiz-Dowling, Janice D. Crist, Kimberly Shea, Linda R. Phillips
      First page: 256
      Abstract: Journal of Palliative Care, Ahead of Print.
      Mexican Americans (MAs), 1 of 10 subgroups of Latinos, are the largest and fastest growing Latino subgroup in the United States; yet, their access to end-of-life (EOL) care using hospice services is low. An investigation was needed into extant research-based knowledge about factors influencing EOL care decisions among MAs to guide health-care professionals in assisting MAs to make timely, acceptable, and satisfactory EOL care decisions. To determine whether gender was an influence on EOL decision-making among older MAs, CINAHL and PubMed were searched for articles published between 1994 and 2018. Relevant sources were also identified through the reference lists of review articles. Reports were included if they were written in English, involved participants aged 50 years and older who identified themselves as MA, and data derived directly from participants. Reports in which MAs were not equally represented in the sample, large databases, and instrumentation development and testing articles were excluded. Of the 345 unduplicated articles identified in our electronic search and the 47 identified through review articles, 22 met the inclusion criteria. Content analysis was conducted using a priori codes from the Ethno-Cultural Gerontological Nursing Model (ECGNM). Only 8 (36%) of the 22 articles reported on MA older adults’ gendered experiences related to EOL decision-making. Results indicate an association between gender and EOL decision-making. As the older MA population grows, tackling disparities in EOL services use requires attention to how culture and gender influence EOL decision-making and care.
      Citation: Journal of Palliative Care
      PubDate: 2020-02-25T06:55:37Z
      DOI: 10.1177/0825859720907419
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