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NURSES AND NURSING (367 journals)                  1 2 | Last

Showing 1 - 200 of 368 Journals sorted alphabetically
A&A Case Reports     Hybrid Journal   (Followers: 2)
ACORN : The Journal of Perioperative Nursing in Australia     Full-text available via subscription   (Followers: 19)
Acta Paulista de Enfermagem     Open Access   (Followers: 3)
Advanced Emergency Nursing Journal     Hybrid Journal   (Followers: 40)
Advanced Healthcare Materials     Hybrid Journal   (Followers: 16)
Advances in Family Practice Nursing     Full-text available via subscription   (Followers: 1)
Advances in Nursing     Open Access   (Followers: 37)
Advancing Nursing Research     Open Access   (Followers: 46)
Africa Journal of Nursing and Midwifery     Full-text available via subscription   (Followers: 15)
American Journal of Critical Care     Full-text available via subscription   (Followers: 49)
American Journal of Hospice and Palliative Medicine     Hybrid Journal   (Followers: 43)
American Journal of Nursing     Hybrid Journal   (Followers: 81)
American Journal of Nursing Research     Open Access   (Followers: 5)
American Journal of Occupational Therapy     Partially Free   (Followers: 229)
American Nurse Today     Partially Free   (Followers: 8)
Anadolu Hemşirelik ve Sağlık Bilimleri Dergisi     Open Access   (Followers: 2)
Annals of Rehabilitation Medicine     Open Access  
Annual Review of Nursing Research     Hybrid Journal   (Followers: 17)
AORN Journal     Hybrid Journal   (Followers: 26)
Aporia : The Nursing Journal     Open Access   (Followers: 10)
Applied Nursing Research     Hybrid Journal   (Followers: 60)
Aquichán     Open Access   (Followers: 2)
Archives of Nursing Practice and Care     Open Access   (Followers: 2)
Archives of Nursing Research     Open Access  
Asia-Pacific Journal of Oncology Nursing     Open Access   (Followers: 5)
Asian Nursing Research     Open Access   (Followers: 5)
Asian/Pacific Island Nursing Journal     Open Access   (Followers: 1)
Australasian Emergency Care     Hybrid Journal   (Followers: 12)
Australasian Journal of Neuroscience     Open Access   (Followers: 2)
Australian Journal of Advanced Nursing     Full-text available via subscription   (Followers: 16)
Australian Journal of Cancer Nursing     Full-text available via subscription   (Followers: 10)
Australian Journal of Rural Health     Hybrid Journal   (Followers: 17)
Australian Nursing and Midwifery Journal     Full-text available via subscription   (Followers: 11)
Australian Nursing Journal : ANJ     Full-text available via subscription   (Followers: 6)
Avances en Enfermería     Open Access   (Followers: 3)
Bariatric Surgical Practice and Patient Care     Hybrid Journal   (Followers: 9)
Belitung Nursing Journal     Open Access   (Followers: 3)
Biological Research for Nursing     Hybrid Journal   (Followers: 7)
BMC Nursing     Open Access   (Followers: 28)
BMJ Supportive & Palliative Care     Hybrid Journal   (Followers: 45)
Boromarajonani College of Nursing, Uttaradit Journal     Open Access  
British Journal of Anaesthetic and Recovery Nursing     Full-text available via subscription   (Followers: 8)
British Journal of Cardiac Nursing     Full-text available via subscription   (Followers: 12)
British Journal of Community Nursing     Full-text available via subscription   (Followers: 45)
British Journal of Mental Health Nursing     Full-text available via subscription   (Followers: 23)
British Journal of Midwifery     Full-text available via subscription   (Followers: 92)
British Journal of Neuroscience Nursing     Full-text available via subscription   (Followers: 13)
British Journal of Nursing     Full-text available via subscription   (Followers: 284)
British Journal of School Nursing     Full-text available via subscription   (Followers: 14)
Canadian Journal of Nursing Research (CJNR)     Hybrid Journal   (Followers: 13)
Canadian Oncology Nursing Journal / Revue canadienne de soins infirmiers en oncologie     Open Access   (Followers: 3)
Cancer Nursing     Hybrid Journal   (Followers: 34)
Cancer Nursing Practice     Full-text available via subscription   (Followers: 19)
CANNT Journal     Full-text available via subscription  
Caring Nursing Journal (CNJ)     Open Access   (Followers: 1)
Ciencia y Enfermeria - Revista Iberoamericana de Investigacion     Open Access   (Followers: 3)
Clinical Lactation     Open Access   (Followers: 22)
Clinical Nurse Specialist     Hybrid Journal   (Followers: 29)
Clinical Nursing Research     Hybrid Journal   (Followers: 31)
Clinical Nursing Studies     Open Access   (Followers: 10)
Clinical Scholars Review     Hybrid Journal   (Followers: 1)
Clinical Simulation in Nursing     Hybrid Journal   (Followers: 16)
Collegian: Journal of the Royal College of Nursing Australia     Full-text available via subscription   (Followers: 8)
Comprehensive Child and Adolescent Nursing     Hybrid Journal   (Followers: 5)
Contemporary Nurse : A Journal for the Australian Nursing Profession     Hybrid Journal   (Followers: 7)
COPING (Community of Publishing in Nursing)     Open Access  
Creative Nursing     Hybrid Journal   (Followers: 8)
Critical Care Nurse     Full-text available via subscription   (Followers: 38)
Critical Care Nursing Clinics of North America     Full-text available via subscription   (Followers: 21)
Critical Care Nursing Quarterly     Full-text available via subscription   (Followers: 16)
Critical, Medical and Surgical Nursing Journal     Open Access  
Cultura de los cuidados     Open Access   (Followers: 4)
Cumhuriyet Hemşirelik Dergisi     Open Access  
Curationis     Open Access   (Followers: 1)
Current Opinion in Supportive and Palliative Care     Hybrid Journal   (Followers: 26)
Dental Nursing     Full-text available via subscription   (Followers: 3)
Dermatological Nursing     Full-text available via subscription   (Followers: 2)
Dimensions of Critical Care Nursing     Full-text available via subscription   (Followers: 9)
EAU Heritage Journal Science and Technology     Open Access  
Ege Üniversitesi Hemşirelik Fakültesi Dergisi / Journal of Ege University Nursing Faculty     Open Access  
Egyptian Nursing Journal     Open Access  
Emergency Nurse     Full-text available via subscription   (Followers: 20)
Ene : Revista de Enfermería     Open Access  
Enfermagem Revista     Open Access  
Enfermería : Cuidados Humanizados     Open Access  
Enfermería Clínica (English Edition)     Hybrid Journal   (Followers: 1)
Enfermería Global     Open Access   (Followers: 3)
Enfermería Intensiva     Full-text available via subscription   (Followers: 2)
Enfermería Universitaria     Open Access  
Escola Anna Nery     Open Access  
Estima : Brazilian Journal of Enterestomal Therapy     Open Access  
European Diabetes Nursing     Hybrid Journal   (Followers: 7)
Evidence-Based Nursing     Hybrid Journal   (Followers: 71)
Fisioterapia e Pesquisa     Open Access  
Fisioterapia em Movimento     Open Access  
Florence Nightingale Journal of Nursing     Open Access  
Frontiers of Nursing     Open Access   (Followers: 1)
Fundamental and Management Nursing Journal     Open Access  
Gastroenterology Nursing     Hybrid Journal   (Followers: 7)
Gazi Sağlık Bilimleri Dergisi     Open Access  
Geriatric Care     Open Access   (Followers: 5)
Geriatric Nursing     Hybrid Journal   (Followers: 22)
Gerokomos     Open Access   (Followers: 1)
Global Journal of Nursing Research     Open Access   (Followers: 5)
Global Journal of Surgery Nursing     Open Access   (Followers: 1)
Global Qualitative Nursing Research     Open Access   (Followers: 4)
Green Care     Full-text available via subscription  
Hacettepe Üniversitesi Hemşirelik Fakültesi Dergisi     Open Access  
Hacettepe University Faculty of Health Sciences Journal     Open Access  
Hayat : Journal of Faculty of Nursing and Midwifery, Tehran University of Medical Sciences     Open Access   (Followers: 1)
HIV Nursing     Full-text available via subscription   (Followers: 2)
HIV/AIDS - Research and Palliative Care     Open Access   (Followers: 19)
Holistic Nursing Practice     Hybrid Journal   (Followers: 6)
Idea Nursing Journal     Open Access  
Independent Nurse     Full-text available via subscription   (Followers: 3)
Indian Journal of Palliative Care     Open Access   (Followers: 8)
Indonesian Journal of Nursing Practices     Open Access  
Intensive and Critical Care Nursing     Hybrid Journal   (Followers: 33)
International Diabetes Nursing     Hybrid Journal   (Followers: 4)
International Emergency Nursing     Hybrid Journal   (Followers: 11)
International Journal of Advanced Nursing Studies     Open Access   (Followers: 14)
International Journal of Africa Nursing Sciences     Open Access  
International Journal of Cardiovascular Nursing     Full-text available via subscription  
International Journal of Care Scholars     Open Access  
International Journal of Childbirth     Hybrid Journal   (Followers: 8)
International Journal of Community Based Nursing and Midwifery     Open Access   (Followers: 5)
International Journal of Health Sciences Education     Open Access   (Followers: 2)
International Journal of Immunological Nursing     Open Access  
International Journal of Mental Health Nursing     Hybrid Journal   (Followers: 29)
International Journal of Neurological Nursing     Full-text available via subscription  
International Journal of Nurse Practitioner Educators     Open Access   (Followers: 12)
International Journal of Nursing     Open Access   (Followers: 19)
International Journal of Nursing and Midwifery     Open Access   (Followers: 26)
International Journal of Nursing Critical Care     Open Access   (Followers: 1)
International Journal of Nursing Education Scholarship     Hybrid Journal   (Followers: 9)
International Journal of Nursing Knowledge     Hybrid Journal   (Followers: 5)
International Journal of Nursing Practice     Hybrid Journal   (Followers: 12)
International Journal of Nursing Science     Open Access   (Followers: 1)
International Journal of Nursing Science Practice and Research     Open Access  
International Journal of Nursing Sciences     Open Access   (Followers: 2)
International Journal of Nursing Student Scholarship     Open Access   (Followers: 2)
International Journal of Nursing Studies     Hybrid Journal   (Followers: 17)
International Journal of Nursing Terminologies and Classifications     Hybrid Journal   (Followers: 1)
International Journal of Obstetrics, Perinatal and Neonatal Nursing     Full-text available via subscription  
International Journal of Occupational Health and Public Health Nursing     Open Access   (Followers: 7)
International Journal of Older People Nursing     Hybrid Journal   (Followers: 14)
International Journal of Orthopaedic and Trauma Nursing     Hybrid Journal   (Followers: 11)
International Journal of Palliative Nursing     Full-text available via subscription   (Followers: 32)
International Journal of Pediatric Nursing     Full-text available via subscription   (Followers: 1)
International Journal of Physiotherapy and Research     Open Access   (Followers: 32)
International Journal of Positive Behavioural Support     Full-text available via subscription   (Followers: 38)
International Journal of Urological Nursing     Hybrid Journal  
International Nursing Review     Hybrid Journal   (Followers: 8)
International Paramedic Practice     Full-text available via subscription   (Followers: 13)
Investigacion en Enfermeria: Imagen y Desarrollo     Open Access   (Followers: 2)
Investigación y Educación en Enfermería     Open Access   (Followers: 1)
Iranian Journal of Nursing and Midwifery Research     Open Access   (Followers: 3)
Issues in Mental Health Nursing     Hybrid Journal   (Followers: 25)
Japan Journal of Nursing Science     Hybrid Journal  
JMIR Nursing     Open Access  
Journal for Nurse Practitioners     Hybrid Journal   (Followers: 15)
Journal for Nurses in Professional Development     Hybrid Journal   (Followers: 13)
Journal of Addictions Nursing     Hybrid Journal   (Followers: 7)
Journal of Aesthetic Nursing     Full-text available via subscription   (Followers: 1)
Journal of Applied Hermeneutics     Open Access   (Followers: 1)
Journal of Boromarajonani College of Nursing, Bangkok     Open Access  
Journal of Boromarajonani College of Nursing, Surin     Open Access  
Journal of Cardiovascular Nursing     Hybrid Journal   (Followers: 19)
Journal of Caring Sciences     Open Access   (Followers: 1)
Journal of Christian Nursing     Hybrid Journal   (Followers: 2)
Journal of Clinical Nursing     Hybrid Journal   (Followers: 51)
Journal of Community Health Nursing     Hybrid Journal   (Followers: 18)
Journal of Compassionate Health Care     Open Access   (Followers: 3)
Journal of Continuing Education in Nursing     Full-text available via subscription   (Followers: 9)
Journal of Emergency Nursing     Hybrid Journal   (Followers: 30)
Journal of Evidence-based Care     Open Access   (Followers: 8)
Journal of Family Nursing     Hybrid Journal   (Followers: 3)
Journal of Geriatric Physical Therapy     Hybrid Journal   (Followers: 11)
Journal of Gerontological Nursing     Full-text available via subscription   (Followers: 12)
Journal of Health Science Boromarajonani College of Nursing Sunpasitthiprasong     Open Access  
Journal of Health Science Research     Open Access  
Journal of Health Visiting     Full-text available via subscription   (Followers: 9)
Journal of Holistic Nursing     Hybrid Journal   (Followers: 3)
Journal of Holistic Nursing Science     Open Access  
Journal of Hospice & Palliative Nursing     Hybrid Journal   (Followers: 30)
Journal of Human Lactation     Hybrid Journal   (Followers: 29)
Journal of Infusion Nursing     Hybrid Journal   (Followers: 4)
Journal of Midwifery     Open Access   (Followers: 3)
Journal of Midwifery and Reproduction     Open Access   (Followers: 5)
Journal of Midwifery and Reproductive Health     Open Access   (Followers: 15)
Journal of Neonatal Nursing     Hybrid Journal   (Followers: 20)
Journal of Neuroscience Nursing     Hybrid Journal   (Followers: 8)
Journal of Nursing & Interprofessional Leadership in Quality & Safety     Open Access   (Followers: 5)
Journal of Nursing Administration     Hybrid Journal   (Followers: 32)
Journal of Nursing and Health     Open Access   (Followers: 2)
Journal of Nursing and Midwifery Sciences     Open Access  
Journal of Nursing Care Quality     Hybrid Journal   (Followers: 22)
Journal of Nursing Education     Full-text available via subscription   (Followers: 31)
Journal of Nursing Education and Practice     Open Access   (Followers: 25)
Journal of Nursing Law     Hybrid Journal   (Followers: 5)

        1 2 | Last

Similar Journals
Journal Cover
American Journal of Hospice and Palliative Medicine
Journal Prestige (SJR): 0.65
Citation Impact (citeScore): 1
Number of Followers: 43  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1049-9091 - ISSN (Online) 1938-2715
Published by Sage Publications Homepage  [1090 journals]
  • Cultivating Cultural Competence: How Are Hospice Staff Being Educated to
           Engage Racially and Ethnically Diverse Patients'
    • Authors: Nathan A. Boucher, Kimberly S. Johnson
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background:Compared to Whites, racial/ethnic minorities are less likely to enroll in hospice and if they enroll, more likely to experience poor quality care. Building cultural competence (CC) among hospice staff is a strategy that may reduce disparities.Objective:To describe the state of CC training across hospices.Design:National survey of hospices’ practices to promote CC.Results:A total of 197 hospices participated; most were not-for-profit (80%) with an average daily census less than 100 (47%); 73% offered staff cultural competence training (CCT). There were no differences in characteristics of hospices who offered CCT and those that did not. Of hospices offering CCT, 61% held it annually. Most trainings were 1 hour (60%); content was delivered via web (58%) and/or lecture (58%). While over 90% of staff (i.e., nurses, social workers, chaplains) completed CCT, a smaller proportion of medical directors (64%), senior leaders (71%) and board members (26%) did so. Most common topics were: cross-cultural communication, death/illness beliefs, spirituality’s role, and healthcare disparities. The majority focused on African-Americans (83%), Hispanics (76%), and Asians (62%)—the most common U.S. minority groups. Almost 30% reported no effectiveness assessment of CCT, while 51% reported a quiz at the end of training. Most hospices offered some CCT.Conclusions:CCT has been shown to improve healthcare providers’ knowledge and skills in caring for diverse patients and it is associated with increased patient satisfaction. Future research should evaluate effectiveness of CCT in improving the ability of hospices to deliver high quality end-of-life care to diverse groups of older adults.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-07-31T12:23:29Z
      DOI: 10.1177/1049909120946729
       
  • Relationship Between Tramadol Response and Cancer Cachexia: A
           Retrospective Cohort Study
    • Authors: Kayoko Morio, Kazuhiro Yamamoto, Ikuko Yano
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Objective:It was reported that the administration of tramadol in patients with cancer pain who have a higher interleukin 6 (IL-6) serum level led to insufficient pain relief. Cytokines produced by tumors, including IL-6, are associated with cancer cachexia. However, whether nonresponse to tramadol is related to cancer cachexia is unknown. The purpose of this study was to examine the relationship between tramadol response and cancer cachexia in patients with cancer pain.Methods:We conducted a retrospective cohort study of patients with cancer who received tramadol treatment for mild to moderate pain from January 2016 to June 2019. Patients who experienced
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-07-31T11:58:00Z
      DOI: 10.1177/1049909120945570
       
  • How Should We Assess Pain: Do Patients Prefer a Quantitative or
           Qualitative Scale' A Study of Patient Preferences
    • Authors: Shagufta Firdous, Andrea Berger, Waqas Jehangir, Carlos Fernandez, Bertrand Behm, Zankhana Y. Mehta, Akhila Reddy, Mellar Davis
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background:Pain perception is a subjective experience and is influenced by a variety of factors. Pain assessment tools, included the numeric pain rating scale (NRS) and the visual analog scale (VAS). A VAS qualitative (VASQ) scale asks patients their current pain level along a continuum of “Good Day,” “Average Day,” or “Bad Day.” We had patients complete both scales and asked them their preference and reason for their choice.Methods:We identified patients 18 years of age and older, seen by Palliative medicine at Geisinger, who had cancer-associated pain of at least one-month duration. Patients filled out the study questionnaire composed of 2 questions. Characteristics of patients who preferred the VASQ were compared to those who preferred the NRS using a 2-sample t tests or Wilcoxon rank-sum tests and Pearson χ2 or Fisher exact tests. The relationship between the NRS and the VASQ used the Pearson correlation coefficient.Results:One hundred forty-six patients completed the questionnaire, 52.1% were female; 63.7% preferred the NRS, 31.5% preferred the VASQ. Patients who preferred the NRS reported a higher NRS rating than patients who preferred the VASQ (mean NRS rating of 6.0 compared to 5.3) but the difference was not statistically significant (P = .1531). Visual analog scale qualitative ratings were higher among patients who preferred the NRS, but the difference was not statistically different (mean rating of 5.2 vs 4.8, P = .3669).Conclusion:Patients preferred the NRS over VASQ for pain assessment. Patients tend to rate their pain at a higher level when using NRS compared to VASQ.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-07-28T11:11:23Z
      DOI: 10.1177/1049909120945599
       
  • COVID-19 Pandemic Response: Development of Outpatient Palliative Care
           Toolkit Based on Narrative Communication
    • Authors: Benjamin Roberts, Scott M. Wright, Colleen Christmas, Mariah Robertson, David Shih Wu
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Context:The coronavirus disease 2019 (COVID-19) pandemic laid bare the immediate need for primary palliative care education for many clinicians. Primary care clinicians in our health system reported an urgent need for support in advance care planning and end-of-life symptom management for their vulnerable patients. This article describes the design and dissemination of palliative care education for primary care clinicians using an established curriculum development method.Objectives:To develop a succinct and practical palliative care toolkit for use by primary care clinicians during the COVID-19 pandemic, focused on 2 key elements: (i) advance care planning communication skills based on the narrative 3-Act Model and (ii) comfort care symptom management at the end of life.Results:The toolkit was finalized through an iterative process involving a team of end-users and experts in palliative care and primary care, including social work, pharmacy, nursing, and medicine. The modules were formatted into an easily navigable, smartphone-friendly document to be used at point of care. The toolkit was disseminated to our institution’s primary care network with practices spanning our state. Early feedback has been positive.Conclusion:While we had been focused primarily on the inpatient setting, our palliative care team at Johns Hopkins Bayview Medical Center pivoted existing infrastructure and curriculum development expertise to meet the expressed needs of our primary care colleagues during the COVID-19 pandemic. Through collaboration with an interprofessional team including end-users, we designed and disseminated a concise palliative care toolkit within 6 weeks.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-07-28T09:18:10Z
      DOI: 10.1177/1049909120944868
       
  • Trends in Published Palliative Care Research: A 15-Year Review
    • Authors: Ambereen K. Mehta, Rishi Patel, Dheer Patel, Mellar P. Davis
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background:There has been a call for palliative care (PC) published research to support the impact and need for more specialty PC services.Objective:The purpose of this study was to characterize research in PC over a 15-year period in 3 PC journals published in the United States.Design:The authors reviewed every issue of the Journal of Pain and Symptom Management, Journal of Palliative Medicine, and American Journal of Hospice and Palliative Medicine from 2004 through 2018. Studies included were original articles and brief reports. Study type (qualitative, quantitative), author (first and last), gender, and professional degree of the author (first and last) were recorded.Results:A total of 4881 articles were included in this study. The proportion of quantitative papers significantly increased across 3 time points from 63% to 67% to 78%. The proportion of women first authors increased across all 3 time points (54%, 2004-2008; 57%, 2009-2013; 60%, 2014-2018), and the proportion of women last authors increased across all time points (38%, 2004-2008; 44%, 2009-2013; 46%, 2014-2018). More than 40% of authors were physicians.Conclusions:Published PC studies are increasingly quantitative in design. Gender authorship is female dominant for the first authors and increasingly equal across genders for the last authors.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-07-24T10:04:13Z
      DOI: 10.1177/1049909120944863
       
  • Comparison of Patient Self-Reported Quality of Life and Health Care
           Professional-Assessed Symptoms in Terminally ill Patients With Cancer
    • Authors: Chikako Matsumura, Nanako Koyama, Morito Sako, Hideo Kurosawa, Takehisa Nomura, Yuki Eguchi, Kazuki Ohba, Yoshitaka Yano
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background:Few studies evaluated whether health care professionals accurately assess several symptoms for patients with cancer in palliative care units. We determined the agreement level for several symptoms related to quality of life (QOL) between patient-reported QOL assessment and health care professional-assessed symptoms based on the Support Team Assessment Schedule (STAS).Method:An observational study was performed with terminally ill patients with cancer hospitalized in the palliative care unit between June 2018 and December 2019. Patients and health care professionals independently assessed 7 symptoms at the time of hospitalization and after 1 week. Patients completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C15-PAL). In examining the proportions of exact agreement, “exact agreement” referred to the pairs of the scores (QLQ-C15-PAL vs STAS) being (1 vs 0), (2 vs 1), (3 vs 2 or 3), or (4 vs 4). The relationships of physical functioning between QLQ-C15-PAL and Palliative Performance Scale (PPS) were examined.Results:Of 130 patients, approximately 60% had PPS scores from 40 to 60. The highest mean score on QLQ-C15-PAL was for fatigue (63.8). The exact agreement on symptoms between patients and health care professionals ranged from 15.4% (fatigue) to 57.7% (nausea and vomiting). The mean of the transformed QLQ-C15-PAL and proportions of exact agreement were negatively correlated (R 2 = 0.949, P < .05). The physical function scores in QLQ-C15-PAL for each PPS group showed no differences.Conclusion:We expect patient-reported outcomes including QLQ-C15-PAL to be added to health care professionals’ assessment of serious symptoms such as fatigue in terminally ill patients with cancer.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-07-24T09:58:48Z
      DOI: 10.1177/1049909120944157
       
  • Palliative Care During COVID-19: Data and Visits From Loved Ones
    • Authors: Laura Heath, Sharon Yates, Matthew Carey, Mary Miller
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Objectives:A vital component of the coronavirus response is care of the dying COVID-19 patient. We document the demographics, symptoms experienced, medications required, effectiveness observed, and challenges to high-quality holistic palliative care in 31 patients. This will aid colleagues in primary and secondary care settings anticipate common symptoms and formulate management plans.Methods:A retrospective survey was conducted of patients referred to the hospital palliative care service in a tertiary hospital, south east of England between March 21 and April 26, 2020. Patients included had a confirmed laboratory diagnosis of COVID-19 via reverse transcription polymerase chain reaction nasopharyngeal swab for SARS-Cov-2 or radiological evidence of COVID-19.Results:The thirty-one patients included were predominantly male (77%), elderly (median [interquartile range]: 84 [76-89]), and had multiple (4 [3-5]) comorbidities. Referral was made in the last 2 [1-3] days of life. Common symptoms were breathlessness (84%) and delirium (77%). Fifty-eight percent of patients received at least 1 “as required” dose of an opioid or midazolam in the 24 hours before death. Sixty percent of patients needed a continuous subcutaneous infusion and the median morphine dose was 10 mg S/C per 24 hours and midazolam 10 mg S/C per 24 hours. Nineteen percent of our cohort had a loved one or relative present when dying.Conclusion:We provide additional data to the internationally reported pool examining death arising from infection with SARS-CoV-19. The majority of patients had symptoms controlled with low doses of morphine and midazolam, and death was rapid. The impact of low visitation during dying needs exploring.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-07-24T09:48:37Z
      DOI: 10.1177/1049909120943577
       
  • “Palliative Pandemic Plan,” Triage and Symptoms Algorithm as a
           Strategy to Decrease Providers’ Exposure, While Trying to Increase Teams
           Availability and Guidance for Goals of Care (GOC) and Symptoms Control
    • Authors: Santiago Lopez, Gene Decastro, Katlynn M. Van Ogtrop, Sindee Weiss-Domis, Samuel R. Anandan, Christopher J. Magalee, Regina Roofeh, Tara A. Liberman
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      As the spread of the novel coronavirus disease 2019 (COVID-19) continues worldwide, health care systems are facing increased demand with concurrent health care provider shortages. This increase in patient demand and potential for provider shortages is particularly apparent for palliative medicine, where there are already shortages in the provision of this care. In response to the developing pandemic, our Geriatrics and Palliative (GAP) Medicine team formulated a 2-team approach which includes triage algorithms for palliative consults as well as acute symptomatic management for both patients diagnosed with or under investigation (PUI) for COVID-19. These algorithms provided a delineated set of guidelines to triage patients in need of palliative services and included provisions for acute symptoms management and the protection of both the patient care team and the families of patients with COVID-19. These guidelines helped with streamlining care in times of crisis, providing care to those in need, supporting frontline staff with primary-level palliative care, and minimizing the GAP team’s risk of infection and burnout during the rapidly changing pandemic response.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-07-21T09:15:18Z
      DOI: 10.1177/1049909120942494
       
  • Specialist Palliative Care Activity at an Acute Care Tertiary Hospital and
           Its Representation in Administrative Data
    • Authors: Joanne M. Stubbs, Hassan Assareh, Helen M. Achat, Sally Greenaway, Poorani Muruganantham
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Objective:To quantify and examine specialist palliative care (SPC) in-hospital activity and compare it to routinely collected administrative data on palliative care (PC).Methods:All patients discharged from a large acute care tertiary hospital in New South Wales, Australia, between July 1 and December 31, 2017, were identified from the hospital’s data warehouse. Administrative data were supplemented with information from the electronic medical record for hospital stays which were assigned the PC additional diagnosis code (Z51.5); had a “palliative care” care type; or included SPC consultation.Results:Of 34 653 hospital stays, 524 were coded as receiving PC—based on care type (43%) and/or diagnosis code Z51.5 (100%). Specialist palliative care provided 1717 consultations over 507 hospital stays. Patients had 2 (median; interquartile range: 1-4) consultations during an average stay of 15.3 days (SD 15.78; median 10); the first occurred 7.0 days (SD 12.13; median 3) after admission. Of patient stays with an SPC consultation, 70% were assigned the PC Z51.5 code; 60% were referred for symptom management; 68% had cancer. One hundred forty-one patients were under a palliative specialist—either from initial hospital admission (49.6%) or later in their stay.Conclusions:Palliative care specialists provide expert input into patient management, benefitting patients and other clinicians. Administrative data inadequately capture their involvement in patient care, especially consultations, and are therefore inappropriate for reporting SPC activity. Exclusion of information related to SPC activity results in an incomplete and distorted representation of PC services and fails to acknowledge the valuable contribution made by SPC.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-07-14T10:08:13Z
      DOI: 10.1177/1049909120939861
       
  • Happiness at the End of Life: A Qualitative Study
    • Authors: Anne O’Callaghan, Ben Bickford, Conor RAE, Antonio Fernando, Phillipa Malpas
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background:Happiness is a core ingredient of health and well-being, yet relatively little is known about what happiness means for individuals near the end of life, and whether perceptions of happiness change as individuals approach the end of their lives.Aim:The aim of this study was to explore, through interviews, how individuals experiencing hospice care understood and conceptualized happiness.Design:Qualitative interviews with hospice patients were analyzed thematically.Setting/Participants:Adult patients (n = 20) in a New Zealand hospice who were receiving palliative care and who could give their informed consent were invited by hospice nurse coordinators to an interview.Results:Four themes emerged from analysis of the transcribed interviews. Participants defined happiness most frequently and in most depth in relation to connection with others. They identified being in the present moment, particularly in relation to nature, and that happiness had become less associated with money, status, or possessions. They had an attitude of determination to focus on what mattered now.Conclusion:Patients receiving palliative care were generally happy with their lives, appreciated the simpler aspects of life away from the material. There was a common exhortation to young people to avoid focusing too much on acquisition and the internet and to prioritize instead social connection and engagement with the natural world.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-07-14T09:28:51Z
      DOI: 10.1177/1049909120939857
       
  • Polypharmacy, Medication Possession, and Deprescribing of Potentially
           Non-Beneficial Drugs in Hospice Patients
    • Authors: Ian Duncan, Terri L Maxwell, Nhan Huynh, Marisa Todd
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Patients frequently have comorbidities that when combined with their primary diagnosis qualifies the patient for hospice. Consequently, patients are at risk for polypharmacy due to the number of medications prescribed to treat both the underlying conditions and the related symptoms. Polypharmacy is associated with negative consequences, including increased risk for adverse drug events, drug–drug and drug–disease interactions, reduced functional status and falls, multiple geriatric syndromes, medication nonadherence, and increased mortality. Polypharmacy also increases the complexity of medication management for caregivers and contributes to the cost of prescription drugs for hospices and patients. Deprescribing or removing nonbeneficial or ineffective medications can reduce polypharmacy in hospice. We study medication possession ratios and rates of deprescribing of commonly prescribed but potentially nonbeneficial classes of medication using a large hospice pharmacy database. Prevalence of some classes of potentially inappropriate medications is high. We report possession ratios for 10 frequently prescribed classes, and, because death and prescription termination are competing events, we calculate prescription termination rates using Cumulative Incidence Functions. Median duration of antifungal and antiviral medications is brief (5 and 7 days, respectively), while statins and diabetes medications have slow discontinuance rates (median termination durations of 93 and 197 days). Almost all patients with a proton pump inhibitor prescription have the drug for their entire hospice stay. Data from this study identify those drug classes that are commonly deprescribed slowly, suggesting drug classes and diagnoses that hospices may wish to focus on more closely, as they act to limit polypharmacy and reduce prescription costs.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-07-14T09:16:05Z
      DOI: 10.1177/1049909120939091
       
  • Comparison of Web-Based and Paper Advance Directives: A Pilot Randomized
           Clinical Trial
    • Authors: Joshua A. Rolnick, Francisca Oredeko, Elizabeth Cooney-Zingman, David A. Asch, Scott D. Halpern
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background:Digital tools to document care preferences in serious illnesses are increasingly common, but their impact is unknown. We developed a web-based advance directive (AD) featuring (1) modular content eliciting detailed care preferences, (2) the ability to electronically transmit ADs to the electronic health record (EHR), and (3) use of nudges to promote document transmission and sharing.Objective:To compare a web-based, EHR-transmissible AD to a paper AD.Methods:Patients with gastrointestinal and lung malignancies were randomized to the web or paper AD. The primary outcome was the proportion of patients with newly documented advance care plans in the EHR at 8 weeks. Secondary outcomes assessed through an e-mail survey included the change in satisfaction with end-of-life plans, AD acceptability, and self-reported sharing with a surrogate.Results:Ninety-one participants were enrolled: 46 randomly allocated to the web AD and 45 to paper. Thirteen patients assigned to web AD (28%) had new documentation versus 7 (16%) assigned to paper (P = .14). Adjusted for demographic factors and primary diagnosis, the odds ratio of new documentation with web AD was 3.7 (95% CI: 0.8-17.0, P = .10). Satisfaction with advance care planning and AD acceptability were high in both groups and not significantly different. Among patients completing web ADs, 79% reported sharing plans with their caregivers, compared with 65% of those completing paper ADs (P = .40).Conclusion:Web-based ADs hold promise for promoting documentation and sharing of preferences, but larger studies are needed to quantify effects on these intermediate end points and on patient-centered outcomes.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-07-10T10:23:13Z
      DOI: 10.1177/1049909120940210
       
  • Patients With Fibrotic Interstitial Lung Disease Receive Supportive and
           Palliative Care Just Prior to Death
    • Authors: Natasha Smallwood, Jennifer Mann, Hui Guo, Nicole Goh
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background:Fibrotic interstitial lung diseases (f-ILDs) are often progressive and incurable. As patients experience significant symptoms and have a poor prognosis, early palliative care referral is recommended.Objective:To examine the care delivered to patients with f-ILD during the terminal hospital admission and the past 2 years of life.Methods:A retrospective audit was performed for consecutive patients who died from f-ILD at 2 Australian teaching hospitals between January 1, 2012, and December 31, 2016.Results:Of 67 patients, 44 (66%) had idiopathic pulmonary fibrosis. Median age was 78 years. Median respiratory function: forced expiratory volume in 1 second 69.0% predicted (interquartile range [IQR]: 58.0%-77.0%), forced vital capacity 64.0% predicted (IQR = 46.8%-74.3%), and diffusing capacity of carbon monoxide 36.0% predicted (IQR = 31.0%-44.0%). In the 2 years prior to the terminal admission, 38 (57%) patients reported severe breathlessness and 17 (25%) used opioids for symptom relief. Twenty-four (36%) patients received specialist palliative care (SPC) and 11 (16%) completed advance care planning. During the terminal admission, 10 (15%) patients were admitted directly under SPC. A further 33 (49%) patients were referred to SPC, on average 1 day prior to death. Sixty-three (94%) patients received opioids and 49 (73%) received benzodiazepines for symptom management. Median starting and final opioid doses were 10 and 23 mg oral morphine equivalent/24 hours, respectively. Opioids were commenced on average 2 (IQR 1-3) days prior to death.Conclusions:Although most patients were identified as actively dying in the final admission, referral to SPC and use of palliative medications occurred late. Additionally, few patients accessed symptom palliation earlier in their illness.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-07-10T09:56:52Z
      DOI: 10.1177/1049909120938629
       
  • A Mixed-Methods Quasi-Experimental Study on Perspectives Among Physicians
           and Nurses Regarding Use of Palliative Care Teams in the Pediatric
           Intensive Care Unit After Out-of-Hospital Cardiac Arrest
    • Authors: Alia Broman, Cydni Williams, Robert Macauley, Patricia A. Carney
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background:Nationally, only one-third of children survive to hospital discharge after initial presentation with out-of-hospital cardiac arrest (OHCA). Of those children who survive, less than 25% leave the hospital at their functional baseline. Given these poor outcomes, such patients could benefit from palliative care involvement.Aims:To characterize the existing use and identify barriers to seeking palliative care consults in children admitted to the Pediatric Intensive Care Unit (PICU) with OHCA.Design:Mixed-methods quasi-experimental study.Participants:Physicians (MD/DO), nurse practitioners, and registered nurses who provide care in the PICU.Results:Overall, nurses felt palliative care was consulted “not nearly enough” (43%), while the majority of physicians (53.9%) perceived palliative care services are requested either “just the right amount” (30.8%) or “too often” (23.1%). The top 3 desired palliative services were (1) patient and family psychosocial support, (2) assistance with determining goals of care, and (3) counseling and education. Barriers to consults were forgetting/not thinking about consulting, and family refusal of palliative care consult. No statistical differences among participant groups were found for likelihood to consult palliative care, unless the patient faced imminent death.Conclusions:Pediatric Intensive Care Unit providers desire assistance from palliative care teams for help with identifying goals of care, providing psychosocial support, as well as education to the patients and their families. Unfortunately, there remains a large discrepancy between physicians and nurses when it comes to how often palliative care is, and should, be consulted.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-07-08T09:58:14Z
      DOI: 10.1177/1049909120937454
       
  • Reflections of Hospice Staff Members About Educating Hospice Family
           Caregivers Through Telenovela
    • Authors: Dulce M. Cruz-Oliver, Martha Abshire, Chakra Budhathoki, Debra Parker Oliver, Angelo Volandes, Thomas J. Smith
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Objective:Hospice family caregivers are seeking additional information related to patient care, pain and symptom management, and self-care. This study interviewed hospice staff about the potential dissemination of bilingual telenovelas to address these caregiver needs.Methods:Qualitative structured phone interviews were conducted with 22 hospice professionals from 17 different hospice organizations in 3 different Midwest states. The interviews were conducted from October to December 2019. Hospice staff volunteers were recruited from conferences, then individual interviews were audio-recorded, transcribed, and thematic analysis was conducted to gain an in-depth understanding of how to best implement telenovela video education into hospice care.Results:Most participants were hospice nurses (36%) located primarily in Missouri (91%), with a mean of 9 years of experience. Three discrete themes emerged, the educational resources currently provided to patient/families, perceptions of the usefulness of telenovelas for education, and practical suggestions regarding the dissemination of telenovelas. The development of 4 telenovela videos covering different topics is described.Conclusion:Hospice staff responded favorably to the concept of telenovelas and identified important keys for dissemination.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-07-08T09:37:14Z
      DOI: 10.1177/1049909120936169
       
  • Trends in the Utilization of Palliative Care in Patients With Gynecologic
           Cancer Who Subsequently Died During Hospitalization
    • Authors: Anthony Milki, Amandeep Kaur Mann, Austin Gardner, Daniel Stuart Kapp, Diana English, John K. Chan
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Objective:To determine factors associated with the utilization of palliative care (PC) in patients with metastatic gynecologic cancer who died while hospitalized.Methods:Data were abstracted from the National Inpatient Sample database for patients with cervical, uterine, and ovarian cancers from 2005 to 2011. Chi-squared and logistic regression models were used for statistical analyses.Results:Of 4559 women (median age: 65 years; range: 19-102), 1066 (23.4%) utilized PC. Patients were 24.9% low socioeconomic status (SES), 23.9% low-middle, 23.7% middle-high, and 25.1% high SES. Medicare, Medicaid, and private insurance coverage were listed at 46.2%, 37.5%, 11.3% of patients; 36.2%, 21.1%, 18.1%, 24.6% were treated in the South, West, Midwest, and Northeast. Over the 7 year study period, the use of PC increased from 12% to 45%. Older age (odds ratio [OR]: 1.36; 95% CI: 1.11-1.68; P = .003), high SES (OR: 1.41; 95% CI: 1.12-1.78; P = .003), more recent treatment (OR: 9.22; 95% CI: 6.8-12.51; P < .0001), private insurance (OR: 1.81; 95% CI: 1.46-2.25; P < .001), and treatment at large-volume hospitals (OR: 1.36; 95% CI: 1.04-1.77; P = .02), Western (OR: 2.00; 95% CI: 1.61-2.49; P < .001) and Midwestern hospitals (OR: 1.35; 95% CI: 1.08-1.68; P = .001) were associated with higher utilization of PC.Conclusions:The use of inpatient PC for patients with gynecologic cancer increased over time. The lower utilization of PC for terminal illness was associated with younger age, lower SES, government-issued insurance coverage, and treatment in Southern and smaller volume hospitals, and warrants further attention.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-07-07T09:14:20Z
      DOI: 10.1177/1049909120935038
       
  • Is the Emergency Department an Inappropriate Venue for Code Status
           Discussions'
    • Authors: Daniel G. Miller, J. Priyanka Vakkalanka, Morgan B. Swanson, Andrew S. Nugent, Yuya Hagiwara
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background:Historically, it has been assumed that the Emergency Department (ED) is a place for maximally aggressive care and that Emergency Medicine Providers (EMPs) are biased towards life-prolonging care. However, emphasis on early recognition of code status preferences is increasingly making the ED a venue for code status discussions (CSDs). In 2018, our hospital implemented a policy requiring EMPs to place a code status order (CSO) for all patients admitted through the ED. We hypothesized that if EMPs enter CSDs with a bias toward life-prolonging care, or if the venue of the ED biases CSDs towards life-prolonging care, then we would observe a decrease in the percentage of patients selecting DNR status following our institution’s aforementioned CSO mandate.Methods:We present a retrospective analysis of rates of DNR orders placed for patients admitted through our ED comparing six-month periods before and after the implementation of the above policy.Results:Using quality improvement data, we identified patients admitted through the ED during pre (n=7,858) and post (n=8,069) study periods. We observed the following: after implementation DNR preference identified prior to hospital admission from the ED increased from 0.4% to 5.3% (relative risk (RR) 12.5; 95% CI: 5.2-29.9), defining CS in the ED setting at the time of admission increased from 2.4% to 98.6% (p
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-07-02T10:14:51Z
      DOI: 10.1177/1049909120938332
       
  • A Retrospective Thematic Analysis of Patient, Family, and Staff Creative
           Art Tiles Developed on a Tertiary Palliative Care Unit
    • Authors: Andrew Collins, Sandy Ayre, Tiffany Brulotte, Kim Crowe, Cheryl Nekolaichuk
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Objectives:Clinical use of the creative arts in palliative care is well established, yet there are few evaluation studies of these programs.Methods:In this first phase of a 3-phase evaluation of a creative arts program entitled “Tile Tales,” we conducted a retrospective thematic analysis of 85 painted tiles and accompanying stories that were publically displayed on a tertiary palliative care unit. Each story was independently coded, using content analysis. Themes were derived through consensus, using the constant comparative method.Results:Tiles were created by staff (n = 36, 42%), family (n = 32, 38%), patients (n = 9, 11%), or patients and family (n = 8, 9%). Six major themes emerged from the artwork: “Spirituality,” “Relationships,” “Journey,” “Story,” “Symbolism,” and “Paradox.”Significance of Results:These results illustrate how the creative arts can support the expression of diverse palliative care experiences, for patients, their families and palliative care staff, when words alone may not suffice.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-06-29T09:39:47Z
      DOI: 10.1177/1049909120935833
       
  • Exploring Family Caregiver Communication Difficulties and Caregiver
           Quality of Life and Anxiety
    • Authors: Elaine Wittenberg, Anna M. Kerr, Joy Goldsmith
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background:When family caregivers are involved in patient care, both patients and caregivers experience better clinical outcomes. However, caregivers experience communication difficulties as they navigate a complex health care system and interact with health care providers. Research indicates that caregivers experience a communication burden that can result in topic avoidance and distress; however, little is known about how burden stemming from communication difficulties with health care providers relates to caregiving outcomes.Objectives:To investigate how family caregiver communication difficulties with health care providers influence caregiver quality of life and anxiety.Methods:Data were collected in a cross-sectional online survey of 220 caregivers with communication difficulties resulting from caregiver avoidance of caregiving-related topics, inadequate reading and question-asking health literacy, and low communication self-efficacy.Results:Caregiver outcomes were not affected by reading health literacy level but did differ based on question-asking health literacy level. Adequate question-asking health literacy was associated with lower anxiety and a higher quality of life. Caregivers who avoided discussing caregiving topics reported higher anxiety and lower quality of life and caregivers with increased communication self-efficacy reported a higher quality of life.Conclusion:Involvement of family caregivers in care is likely to require tailored approaches that address caregiver communication and health literacy skills. Findings from this study suggest that hospice and palliative care providers should identify and provide support for caregiver communication difficulties in order to positively influence caregiver quality of life and anxiety.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-06-26T09:09:51Z
      DOI: 10.1177/1049909120935371
       
  • The Efficacy of a Single Session of 20-Minute Mindful Breathing in
           Reducing Dyspnea Among Patients With Acute Decompensated Heart Failure: A
           Randomized Controlled Trial
    • Authors: Diana Leh-Ching Ng, Chee-Shee Chai, Kok-Leng Tan, Kok-Han Chee, Yu-Zhen Tung, Suet-Yen Wai, Wei-Ting Joyce Teo, Bin-Ting Ang, Min-Ai Lim, Seng-Beng Tan
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Heart failure is the leading cause of morbidity and mortality worldwide. Standard treatment for heart failure includes pharmacotherapy and cardiac device implants. However, supportive approaches in managing dyspnea in heart failure are limited. This study aimed to test the efficacy of 20-minute mindful breathing in reducing dyspnea among patients admitted for acute decompensated heart failure. We conducted a parallel-group, non-blinded, randomized controlled trial of a single session of 20-minute mindful breathing plus standard care versus standard care alone among patients admitted for moderate to severe dyspnea due to acute decompensated heart failure, using the dyspnea score based on the Edmonton Symptom Assessment System (ESAS), at the Cardiology Unit of University Malaya Medical Centre in Malaysia. Thirty participants were randomly assigned to a single session of 20-minute mindful breathing plus standard care (n = 15) or standard care alone (n = 15), with no difference in their demographic and clinical characteristics. There was statistically significant reduction in dyspnea in the intervention group compared to the control group at minute 20 (U = 49.5, n1 = 15, n2 =15, median reduction in ESAS dyspnea score 1 = 2, median reduction in ESAS dyspnea score 2 = 0, mean rank 1 = 11.30, mean rank 2 = 19.70, z = −2.692, r = 0.4, P = 0.007). Our results provided evidence that a single session of 20-minute mindful breathing was efficacious in reducing dyspnea for patients admitted for acute decompensated heart failure.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-06-26T09:08:31Z
      DOI: 10.1177/1049909120934743
       
  • Hospice Patient Care Goals and Medical Students’ Perceptions: Evidence
           of a Generation Gap'
    • Authors: Kathryn Levy, Pei C. Grant, Christopher W. Kerr, David J. Byrwa, Rachel M. Depner
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background:The ability to perceive care goals of the dying may be an indicator of future quality patient-centered care. Research conducted on end-of-life goals indicates discrepancies between patients and physicians.Objective:The aim of this study is to compare end-of-life care goals of hospice patients and medical student perceptions of patient care goals.Design:Hospice patients and medical students were surveyed on their care goals and perceptions, respectively, using an 11-item survey of goals previously identified in palliative care literature. Medical student empathy was measured using the Interpersonal Reactivity Index.Settings/Participants:Eighty hospice patients and 176 medical students (97 first-year and 79 third-year) in a New York State medical school.Results:Medical students ranked 7 of the 11 care goals differently than hospice patients: not being a burden to family (p < .001), time with family and friends (p = .002), being at peace with God (p < .001), dying at home (p = .004), feeling that life was meaningful (p < .001), living as long as possible (p < .001), and resolving conflicts (p < .001). Third-year students were less successful than first-year students in perceiving patient care goals of hospice patients. No significant differences in medical student empathy were found based on student year.Conclusions:Medical students, while empathetic, were generally unsuccessful in perceiving end-of-life care goals of hospice patients in the psychosocial and spiritual domains. Differences impeding the ability of medical students to understand these care goals may be generationally based. Increased age awareness and sensitivity may improve future end-of-life care discussions. Overall, there is a need to recognize the greater dimensionality of the dying in order to provide the most complete patient-centered care.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-06-26T09:06:51Z
      DOI: 10.1177/1049909120934737
       
  • Corrigendum to Outcomes of Airway Stents in the Palliative Care of
           Patients With Cancer
    • Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.

      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-06-24T10:37:52Z
      DOI: 10.1177/1049909120936412
       
  • Integrating Culturally Competent Advance Care Planning for Korean
           Immigrants: An Integrative Review
    • Authors: Sojung Suk, Sharon L. Kozachik, Valerie T. Cotter
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Aims:This review aims to explore the extant literature on the current utilization of ACP in Kisin order to obtain a comprehensive understanding of their health disparities and to determineevidence-based best practices to integrate culturally-competent ACP for EOL care of KIs.Design:A systematic integrative review of the literature Data Sources:  Four electronic databases including PubMed, the Cumulative Index of Nursing and Allied Health Literature, the Cochrane Library, and Embase.Method:The detailed search strategy for databases implicated a combination of MeSHkeywords and associated terms, which can be found in Table A.Results: Three themes emerged in relation to fundamental components in the integration of culturally-competent ACP for EOL of KIs: (1) cultural characteristics of KIs; (2) disparities in ethnic-oriented ACP and EOL care resources in KIs; and (3) KIs’ perspectives on ACP.Conclusion:The findings of this review indicate that culturally-competent ACP resources for KIsare presently quite insufficient. It is determined that much future research is needed on howculturally-competent ACP can best augment the quality of EOL care for KIs, and on howspecific interventions can effectively implement ACP in community settings. Impact: Such ongoing research dedicated to the development of feasible culturally competent practice guidelines is anticipated to markedly reduce health disparities and promote ACP in KIs. The recommendations in this review may support Korean primary HCPs, Korean health care center administrators, Korean health maintenance organizations (HMOs), Korean advance care nurse practitioners in hospice and palliative care, and nurse researchers in their work.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-06-19T08:28:15Z
      DOI: 10.1177/1049909120933856
       
  • Improving Care Experiences for Patients and Caregivers at End of Life: A
           Systematic Review
    • Authors: Denise D. Quigley, Sara G. McCleskey
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background:End-of-life care is increasing as the US population ages. Approaches to providing high-quality end-of-life care vary across setting, diseases, and populations. Several data collection tools measure patient and/or caregiver care experiences at end of life and can be used for quality improvement. Previous reviews examined palliative care improvements or available measures but none explicitly on improving care experiences. We reviewed literature on improving patient and/or caregiver end-of-life care experiences.Design:We searched U.S. English-language peer-reviewed and grey literature after 2000 on adult end-of-life care experiences. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for quantitative studies, Enhancing Transparency in Reporting the Synthesis of Qualitative Research approach for qualitative studies, and Assessment of Multiple Systematic Reviews tool for the literature reviews.Setting:Palliative and hospice care.Population:Full-text abstraction of 84 articles, identifying 16 articles.Measures:Patient and/or caregiver end-of-life care experiences (captured through administrative data or direct report).Results:Articles examined palliative care experiences across settings; none studied hospice care experiences. Patients and/or caregivers assessed overall care experiences, clinician–staff interactions, provider communication, respect and trust, timeliness of care, spiritual support, caregiver knowledge of care plans, or bereavement support. Efforts aimed at improving end-of-life care experiences are limited and show mixed results.Conclusions:Literature on improving patient and/or caregiver end-of-life care experiences is emerging and focused on palliative care experiences. Evidence on improving hospice care experiences is lacking. Research on strategies for improving end-of-life care experiences should go beyond overall care experiences to include specific aspects of palliative and hospice care experiences.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-06-19T08:26:52Z
      DOI: 10.1177/1049909120931468
       
  • The Concerns and Experience of Decision-Making Regarding
           Do-Not-Resuscitate Orders Among Caregivers in Hospice Palliative Care
    • Authors: Ching-Chun Chiang, Shu-Chuan Chang, Sheng-Yu Fan
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      A do-not-resuscitate (DNR) order is an important end-of-life decision. In Taiwan, family caregivers are also involved in this decision-making process. This study aimed to explore the concerns and experiences regarding DNR decisions among caregivers in Taiwan. Qualitative study was conducted. Convenience sampling was used, and 26 caregivers were recruited whose patients had a DNR order and had received hospice care or hospice home care. Semi-structured interviews were used for data collection, including the previous experiences of DNR discussions with the patients and medical staff and their concerns and difficulties in decision-making. The data analysis was based on the principle of thematic analysis. Four themes were identified: (1) Patients: The caregivers respected the patients’ willingness and did not want to make them feel like “giving up.” (2) Caregivers’ self: They did not want to intensify the patients’ suffering but sometimes found it emotionally difficult to accept death. (3) Other family members: They were concerned about the other family members’ opinions on DNR orders, their blame, and their views on filial impiety. (4) Medical staff: The information and suggestions from the medical staff were foundational to their decision-making. The caregivers needed the health care professionals’ supports to deal with the concerns from patients and other family members as well as their emotional reactions.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-06-17T08:45:20Z
      DOI: 10.1177/1049909120933535
       
  • Keeping the Family in Family Medicine
    • Authors: Amelita Woodruff
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      In this personal reflection, as a Family Medicine resident at an Academic Center in Northeast Florida, as well as being a chronic illness patient myself, I explore the notion of dying alone and away from family. Although COVID-19 has changed the practice of medicine in many ways, prior to that, and before the instillation of hospital no-visitor policies and stay at home orders, I experienced a case of a patient dying alone in the hospital. These chronicles that case and the impact it had on me afterward in regard to my own family and how I hope the future of medicine can address this.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-06-15T08:26:22Z
      DOI: 10.1177/1049909120933273
       
  • An Adapted Conceptual Model Integrating Palliative Care in Serious Illness
           and Multiple Chronic Conditions
    • Authors: Komal Patel Murali, John D. Merriman, Gary Yu, Allison Vorderstrasse, Amy Kelley, Abraham A. Brody
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Objective:Seriously ill adults with multiple chronic conditions (MCC) who receive palliative care may benefit from improved symptom burden, health care utilization and cost, caregiver stress, and quality of life. To guide research involving serious illness and MCC, palliative care can be integrated into a conceptual model to develop future research studies to improve care strategies and outcomes in this population.Methods:The adapted conceptual model was developed based on a thorough review of the literature, in which current evidence and conceptual models related to serious illness, MCC, and palliative care were appraised. Factors contributing to patients’ needs, services received, and service-related variables were identified. Relevant patient outcomes and evidence gaps are also highlighted.Results:Fifty-eight articles were synthesized to inform the development of an adapted conceptual model including serious illness, MCC, and palliative care. Concepts were organized into 4 main conceptual groups, including Factors Affecting Needs (sociodemographic and social determinants of health), Factors Affecting Services Received (health system; research, evidence base, dissemination, and health policy; community resources), Service-Related Variables (patient visits, service mix, quality of care, patient information, experience), and Outcomes (symptom burden, quality of life, function, advance care planning, goal-concordant care, utilization, cost, death, site of death, satisfaction).Discussion:The adapted conceptual model integrates palliative care with serious illness and multiple chronic conditions. The model is intended to guide the development of research studies involving seriously ill adults with MCC and aid researchers in addressing relevant evidence gaps.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-06-08T10:25:57Z
      DOI: 10.1177/1049909120928353
       
  • Conversations on Cancer Chemotherapy Cessation in Patients With Advanced
           Cancer: Qualitative Findings From a Multi-Institutional Study
    • Authors: Jeremiah Stout, Ashok Kumbamu, Jon Tilburt, Cara Fernandez, Gail Geller, Barbara Koenig, Heinz-Josep Lenz, Aminah Jatoi
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Purpose:As many as 20% of oncology patients receive chemotherapy in the last 14 days of their lives. This study characterized conversations between patients and cancer clinicians on chemotherapy cessation in the setting of advanced cancer.Methods:This 3-site study captured real-time, audio-recorded interviews between oncology clinicians and patients with cancer during actual clinic visits. Audio-recordings were reviewed for discussion of chemotherapy cessation and were analyzed qualitatively.Results:Among 525 recordings, 14 focused on stopping chemotherapy; 14 patients participated with 11 different clinicians. Two types of nonmutually exclusive conversation elements emerged: direct and specific elements that described an absence of effective therapeutic options and indirect elements. An example of a direct element is as follows: “…You know this is…always really tough…But I—I think that you may need more help…I think we’re close to stopping chemotherapy…And hospice is really helpful to have in place…” In contrast, the second conversation element was more convoluted: “…transplant is not an option and surgery is not an option…The options…are taking a pill…It doesn’t shrink the tumor…It may help you live a little longer. But I’m worried if [you] had the pill, it’s still a therapy and it still has side effects. I [am] worried if I give it to you now, that you’re so weak, it will make you worse.” No relationship seemed apparent between conversation elements and chemotherapy cessation.Conclusions:Conversations on chemotherapy cessation are complex; multiple factors appear to drive the decision to stop.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-06-04T10:31:51Z
      DOI: 10.1177/1049909120930710
       
  • A Review and Considerations on Palliative Care Improvements for African
           Americans With Cancer
    • Authors: Kimberley T. Lee, Marshalee George, Sarah Lowry, Kimlin T. Ashing
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Hospice and Palliative care benefits are infrequently realized by African American patients with cancer. With the increasing recognition of the critical role of early utilization of palliative services for optimal and quality patient care, it is important to acknowledge disparities and barriers to access that minority patients may face. The purpose of this paper is to discuss the status of palliative care delivery for African American patients within the structure and framework of the clinical practice guideline domains established by the National Consensus Project for Palliative Care. This perspectives paper describes the different aspects of palliative care and the interplay with African American culture. Here, we also attempt to identify the multilevel barriers (health care system and provider level) to palliative care among African Americans as a required step toward decreasing the disparities in access, coverage, utilization, and benefit of palliative care. Furthermore, this paper may serve as an educational guide for health care workers who care for African American patients with cancer.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-06-03T10:35:15Z
      DOI: 10.1177/1049909120930205
       
  • Palliative Care for the Asian American Adult Population: A Scoping Review
    • Authors: In Seo La, Mei Ching Lee, Katherine A. Hinderer, Iris Chi, Ruotong Liu, Mandong Liu, Yunting Fu
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background:The Asian American (AA) population is rapidly becoming one of the largest racial/ethnic groups in the United States. Despite this growth and advances in palliative care (PC) programs in the United States, the scope and nature of the literature regarding PC for AAs remains unclear. This review provides an overview of existing research on PC for AAs, identifies gaps in the research with recommendations for future research and delineates practice implications.Methods:A scoping review of studies published in English was conducted. Electronic Databases (PubMed, Embase, CINAHL, and PsycINFO databases) were searched up to December 2019. No starting date limit was set. Arksey and O’Malley’s methodological framework was followed for scoping reviews.Results:Of 2390 publications initially identified, 42 studies met our inclusion criteria for this review. Southeast AA subgroups remain understudied compared to East and South AAs. Most studies were descriptive; a few (n = 3) evaluated effectiveness of PC interventions for AAs. Research synthesized in this review addresses the following topics and includes considerations in PC related to care recipients and their relatives: treatment choice discussions (73%), coordination of care with health care providers (26%), symptom management (14%), and emotional support (10%). This review identified various factors around PC for AAs, specifically the influence of cultural aspects, including levels of acculturation, traditional norms and values, and religious beliefs.Conclusion:A culturally inclusive approach is vital to providing appropriate and accessible PC for AAs. Further research is needed concerning core PC components and effective interventions across diverse AA subgroups.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-06-03T09:46:39Z
      DOI: 10.1177/1049909120928063
       
  • CORRIGENDUM to Courvoisier’s Law (updated to Cheyne-Stokes
           Breathing)
    • Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.

      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-05-28T11:38:17Z
      DOI: 10.1177/1049909120931994
       
  • A Systematic Review of Clinical Interventions Facilitating End-of-Life
           Communication Between Patients and Family Caregivers
    • Authors: Min Young Jung, Alicia K. Matthews
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Communication between patients and family caregivers plays a key role in successful end-of-life (EOL) care. In the majority of cases, health-care providers (HCP) are responsible for leading this communication in clinical settings. This systematic review aimed to examine the evidence for the efficacy of HCP-led interventions in enhancing communication between patients and family caregivers. The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and involved a search of MEDLINE via PubMed, CINAHL, Scopus, Embase, and PsycINFO as well as a manual search for additional articles on Google Scholar without date restrictions. Of 2955 articles retrieved, 8 meeting the eligibility criteria were included in the review. A quality appraisal of the selected studies was performed using the van Tulder Scale, with 5 of 8 studies rated as high quality. All 8 studies employed psychoeducational interventions involving both patients and surrogate/family caregivers. Common elements of the interventions reviewed included encouraging participant dyads to share their concerns about the patient’s medical condition, clarify their goals and values for EOL care, and discuss their EOL care preferences. Of 8 interventions reviewed, 6 measured EOL care preference congruence within dyads as a primary outcome, and all 6 interventions were effective in increasing congruence. Secondary outcomes measured included decisional conflict and relationship quality, with mixed outcomes reported. This review suggests that HCP-led EOL communication interventions show promise for improving EOL care preference congruence. However, further studies with improved methodological rigor are needed to establish the optimal timing, intensity, and duration of interventions.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-05-28T11:36:36Z
      DOI: 10.1177/1049909120929323
       
  • Prevalence and Inpatient Hospital Outcomes of Malignancy-Related Ascites
           in the United States
    • Authors: Venkataraghavan Ramamoorthy, Muni Rubens, Anshul Saxena, Chintan Bhatt, Sankalp Das, Sandeep Appunni, Emir Veledar, Peter McGranaghan, Nancy Shehadeh, Ana Viamonte-Ros, Yuliya Linhares, Yazmin Odia, Rupesh Kotecha, Minesh P. Mehta
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Objective:Malignancy-related ascites (MRA) is the terminal stage of many advanced cancers, and the treatment is mainly palliative. This study looked for epidemiology and inpatient hospital outcomes of patients with MRA in the United States using a national database.Methods:The current study was a cross-sectional analysis of 2015 National Inpatient Sample data and consisted of patients ≥18 years with MRA. Descriptive statistics were used for understanding demographics, clinical characteristics, and MRA hospitalization costs. Multivariate regression models were used to identify predictors of length of hospital stay and in-hospital mortality.Results:There were 123 410 MRA hospitalizations in 2015. The median length of stay was 4.7 days (interquartile range [IQR]: 2.5-8.6 days), median cost of hospitalization was US$43 543 (IQR: US$23 485-US$82 248), and in-hospital mortality rate was 8.8% (n = 10 855). Multivariate analyses showed that male sex, black race, and admission to medium and large hospitals were associated with increased hospital length of stay. Factors associated with higher in-hospital mortality rates included male sex; Asian or Pacific Islander race; beneficiaries of private insurance, Medicaid, and self-pay; patients residing in large central and small metro counties; nonelective admission type; and rural and urban nonteaching hospitals.Conclusions:Our study showed that many demographic, socioeconomic, health care, and geographic factors were associated with hospital length of stay and in-hospital mortality and may suggest disparities in quality of care. These factors could be targeted for preventing unplanned hospitalization, decreasing hospital length of stay, and lowering in-hospital mortality for this population.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-05-28T11:33:36Z
      DOI: 10.1177/1049909120928980
       
  • Pediatric Cardiac Critical Care Transport and Palliative Care: A Case
           Series
    • Authors: Xiomara Garcia, Elizabeth Frazier, Janie Kane, Amber Jones, Carrie Brown, Tonja Bryant, Parthak Prodhan
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Objective:To present our center’s experience with terminal extubation in 3 palliative critical care home transports from the Pediatric Cardiac Intensive Unit.Design:All cases were identified from our Cardiovascular intensive care unit ( CVICU). Patients were terminally ill children with no other surgical or medical option who were transported home between 2014 and 2018, for terminal extubation and end-of-life care according to their families’ wishes.Interventions:The patients were 7, 9 months, and 19 years; and they had very complex and chronic conditions. The families were approached by the CVICU staff during multidisciplinary meetings, where goals of care were established. Parental expectations were clarified, and palliative care team was involved, as well as home hospice was arranged pre transfer. The transfer process was discussed and all the needs were established. All patients had unstable medical conditions, with needs for transport for withdrawal of life support and death at home. Each case needed a highly trained team to support life while in transport. The need of these patients required coordination with home palliative care services, as well as community resources due to difficulty to get in their homes.Conclusions:Transportation of pediatric cardiac critical care patients for terminal extubation at home is a relatively infrequent practice. It is a feasible alternative for families seeking out of the hospital end-of-life care for their critically ill and technology dependent children. Our single-center experience supports the need for development of formal programs for end-of-life critical care transports.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-05-28T11:12:16Z
      DOI: 10.1177/1049909120928280
       
  • Outcomes of Airway Stents in the Palliative Care of Patients With Cancer
    • Authors: Maria Joana Pereira Catarata, Sandra Saleiro, Vânia Sá Araújo
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Introduction:A significant proportion of patients with advanced primary or metastatic intrathoracic malignancy will eventually develop central airway obstruction. The morbidity associated with malignant airway obstruction (MAO) is considerable and the management is difficult. Our aim was to evaluate the outcomes of tracheobronchial stenting in patients with MAO and its role in palliative care.Material and Methods:This retrospective study involved a consecutive case series of patients with advanced cancer with MAO who underwent tracheobronchial stenting between August 2014 and August 2019. The European Cooperative Oncology Group (ECOG) scale was used to evaluate patient functional status before and after tracheobronchial stenting. Univariate survival analysis included Kaplan-Meier curves with Log-Rank test, while Cox regression was used as a multivariate analysis.Results:We included 28 patients with median age of 55.0 years (interquartile range = 49.3-66.5) and 89.3% male. The most frequent primary tumour was the esophagus followed by lungs. The majority of the patients (75%) expressed immediate symptom relief after stenting and there was a significant improvement in the mean ECOG performance status (PS; P = .005). There was no intraprocedure mortality and complications were observed in 6 patients. The median survival after airway stenting was 39.0 days (95% CI = 32.2-45.8) with poorer PS after stent insertion associated with lower overall survival (hazard ratio = 2.3 [95% CI = 1.1-4.9], P = .030) on multivariate analysis.Conclusion:Airway stent is a safe and effective procedure that offers rapid palliation of symptoms with no major complications. Therefore, stent placement should be considered as part of the treatment of patients with terminal cancer.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-05-26T11:30:57Z
      DOI: 10.1177/1049909120926466
       
  • Role of the Rapid Response System in End-of-Life Care Decisions
    • Authors: Jung Soo Kim, Man Jong Lee, Mi Hwa Park, Jae Yoen Park, Ah Jin Kim
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Purpose:An important role of the rapid response system (RRS) is to provide opportunities for end-of-life care (EOLC) decisions to be appropriately operationalized. We investigated whether EOLC decisions were made after the RRS-recommended EOLC decision to the primary physician.Materials and Methods:We studied whether patients made EOLC decisions consistent with the rapid response team’s (RRT) recommendations, between January 1, 2017, and February 28, 2019. The primary outcome was the EOLC decision after the RRT’s recommendation to the primary physician. The secondary outcome was the mechanism of EOLC decision-making: through institutional do-not-resuscitate forms or the Korean legal forms of Life-Sustaining Treatment Plan (LSTP).Results:Korean LSTPs were used in 26 of the 58 patients who selected EOLC, from among the 75 patients for whom the RRS made an EOLC recommendation. Approximately 7.2% of EOLC decisions for inpatients were related to the RRT’s interventions in EOLC decisions. Patients who made EOLC decisions did not receive cardiopulmonary resuscitation, mechanical ventilation, or dialysis.Conclusion:The timely intervention of the RRS in EOLC facilitates an objective assessment of the patient’s medical conditions, the limitation of treatments that may be minimally beneficial to the patient, and the choice of a higher quality of care. The EOLC decision using the legal process defined in the relevant Korean Act has advantages, wherein patients can clarify their preference, the family can prioritize the patient’s preference for EOLC decisions, and physicians can make transparent EOLC decisions based on medical evidence and informed patient consent.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-05-26T10:57:03Z
      DOI: 10.1177/1049909120927372
       
  • Early Integrated Palliative Care Bundle Impacts Location of Death in
           Interstitial Lung Disease: A Pilot Retrospective Study
    • Authors: Nathan Archibald, Jeffrey A. Bakal, Janice Richman-Eisenstat, Meena Kalluri
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background:Interstitial lung diseases (ILDs) comprise a heterogeneous group of fibrotic, progressive pulmonary diseases characterized by poor end-of-life care and hospital deaths. In 2012, we launched our Multidisciplinary Collaborative (MDC) ILD clinic to deliver integrated palliative approach throughout disease trajectory to improve care. We sought to explore the effects of palliative care and other factors on location of death (LOD) of patients with ILD.Methods:The MDC-ILD clinic implemented a palliative care bundle including advance care planning (ACP), opiates use, allied health home care engagement, and use of supplemental oxygen and early caregiver engagement in care. Data from patients with ILD who attended the clinic and died between 2012 and 2019 were used to generate scores representing the components and duration of palliative care (palliative care bundle score) and caregiver involvement (caregiver engagement score). We examined the impact of these scores on patients’ LOD.Results:A total of 92 MDC-ILD clinic patients were included, 57 (62%) had home or hospice deaths. Patients who died at home or hospice had higher palliative care bundle scores (10.0 ± 4.0 vs 7.8 ± 3.9, P = .01) and caregiver engagement scores (1.7 ± 0.6 vs 1.3 ± 0.7, P = .01) compared to those who died in hospital. Patients were 1.13 times more likely to die at home or hospice following a 1-point increase in palliative care bundle score (95% CI: 1.01-1.29, P = .04) and 2.38 times more likely following a 1-point increase in caregiver engagement score (95% CI: 1.17-5.15, P = .02).Conclusions:Home and hospice deaths are feasible in ILD. Early initiation of palliative care bundle components such as ACP discussions, symptom self-management, caregiver engagement, and close collaboration with allied health home care supports can promote adherence to patient preference for home or hospice deaths.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-05-20T09:38:21Z
      DOI: 10.1177/1049909120924995
       
  • Characteristics and Outcomes of Patients Referred to an Emergency
           Department-Based End-of-Life Care Service in Hong Kong: A Retrospective
           Cohort Study
    • Authors: Chun Yat Chan, Marc L. C. Yang, Hiu Fai Ho
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background:This study describes the characteristics and outcomes of patients referred to an emergency department (ED)-based end-of-life (EOL) service in a tertiary acute hospital in Hong Kong. We examine how emergency physicians (EPs) perform in recognizing and managing dying patients.Methods:From September 2010 to April 2018, patients referred to this EOL service in this hospital were included. A group of 5 EPs assessed whether the referred patient would die within a few days. Dying patients (EOL group) were admitted to ED-based EOL service whereas those not likely dying within few days (non-EOL group) would continue management in respective specialty wards. Baseline characteristics of these 2 groups were compared. The time-to-death and use of opioids and anticholinergics were compared.Results:In total, 783 of 830 patients assessed were recognized as being in dying phase, with 688 admitted under ED-based EOL care. Their demographics and characteristics were described. Mean time from assessment to death (time-to-death) was significantly less in EOL group (38.93 hours) than in non-EOL group (250.36 hours; P = .004). Mean time-to-death was not significantly different between those under EP-based EOL service or not. The ED-based EOL care had significantly more patients receiving symptomatic treatment.Interpretation:The characteristics of patients under an ED-based EOL service are described. Emergency physicians are capable of recognizing dying patients. Emergency department-based EOL service does not alter the dying process and offers adequate palliation of symptoms. Emergency physician should assume a more active role in providing adequate EOL care to suitable patients.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-05-19T09:49:49Z
      DOI: 10.1177/1049909120926148
       
  • The Development and Implementation of a Cardiac Home Hospice Program:
           Results of a RE-AIM Analysis
    • Authors: Lizeyka Jordan, David Russell, Dawon Baik, Frances Dooley, Ruth M. Masterson Creber
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background:Use of hospice has grown among patients with heart failure; however, gaps remain in the ability of agencies to tailor services to meet their needs.Aim:This study describes the implementation of a cardiac home hospice program and insights for dissemination to other hospice programs.Design:We conducted a multimethod analysis structured around the Reach Effectiveness Adoption Implementation and Maintenance (RE-AIM) framework.Settings/Participants:We used electronic medical records for our quantitative data source and interviews with hospice clinicians from a not-for-profit hospice agency (N = 32) for our qualitative data source.Results:Reach—A total of 1273 participants were enrolled in the cardiac home hospice program, of which 57% were female and 42% were black or Hispanic with a mean age was 86 years. Effectiveness—The cardiac home hospice program increased hospice enrollment among patients with heart failure from 7.9% to 9.5% over 1 year (2016-2017). Adoption—Institutional factors that supported the program included the acute need to support medically complex patients at the end of life and an engaged clinical champion. Implementation—Program implementation was supported by interdisciplinary teams who engaged in care coordination. Maintenance—The program has been maintained for over 3 years.Conclusion:The cardiac home hospice program strengthened hospice clinicians’ ability to confidently provide care for patients with heart failure, expanded awareness of their symptoms among clinicians, and was associated with increased enrollment of patients with heart failure over the study period. This RE-AIM evaluation provides lessons learned and strategies for future adoption, implementation, and maintenance of a cardiac home hospice program.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-05-18T04:27:08Z
      DOI: 10.1177/1049909120925432
       
  • Pilot of the Life-Sustaining Treatment Decisions Initiative Among Veterans
           With Serious Illness
    • Authors: Karleen F. Giannitrapani, Anne M. Walling, Ariadna Garcia, MaryBeth Foglia, Jill S. Lowery, Natalie Lo, David Bekelman, Cati Brown-Johnson, Marie Haverfield, Natalia Festa, Scott T. Shreve, Randall C. Gale, Lisa Soleymani Lehmann, Karl A. Lorenz
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background:Prior to national spread, the Department of Veterans Affairs implemented a pilot of the life-sustaining treatment decisions initiative (LSTDI) to promote proactive goals of care conversations (GoCC) with seriously ill patients, including policy and practice standards, an electronic documentation template and order set, and implementation support.Aim:To describe a 2-year pilot of the LSTDI at 4 demonstration sites.Design:Prospective observational study.Setting/Participants:A total of 6664 patients who had at least one GoCC.Results:Descriptive statistics characterized patient demographics, goals of care, LST decisions, and risk of hospitalization or mortality among patients with at least one GoCC. Participants were on average 71.4 years old, 93.2% male, 87.1% white, and 64.7% urban; 27.3% died by the end of the pilot period. Fifteen percent lacked decision-making capacity (DMC). Nonmutually exclusive goals included to be cured (7.6%), to prolong life (34%), to improve/maintain quality of life (61.5%), to be comfortable (53%), to obtain support for family/caregiver (8.4%), to achieve life goals (2.1%), and other (10.5%). Many GoCCs resulted in a do not resuscitate (DNR) order (58.8%). Patients without DMC were more likely to have comfort-oriented goals (77.3% vs 48.8%) and a DNR (84% vs 52.6%). Chart abstraction supported content validity of GoCC documentation.Conclusion:The pilot demonstrated that standardizing practices for eliciting and documenting GoCCs resulted in customized documentation of goals of care and LST decisions of a large number of seriously ill patients and established the feasibility of spreading standardized practices throughout a large integrated health care system.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-05-08T09:38:03Z
      DOI: 10.1177/1049909120923595
       
  • Supporting Pediatric Patients and Their Families at the End of Life:
           Perspectives From Bereaved Parents
    • Authors: Laura K. Sedig, Jessica L. Spruit, Trisha K. Paul, Melissa K. Cousino, Harlan McCaffery, Kenneth Pituch, Raymond Hutchinson
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background:Cancer remains the leading cause of death by disease for children in the United States. It is imperative to optimize measures to support patients and families facing the end of a child’s life. This study asked bereaved parents to reflect on their child’s end-of-life care to identify which components of decision-making, supportive services, and communication were helpful, not helpful, or lacking.Methods:An anonymous survey about end-of-life experiences was sent to families of children treated at a single institution who died of a malignancy between 2010 and 2017.Results:Twenty-eight surveys were returned for a 30.8% response rate. Most of the bereaved parents (61%) reported a desire for shared decision-making; this was described by 52% of families at the end of their child’s life. There was a statistically significant association between how well death went and whether the parental perception of actual decision-making aligned with desired decision-making (P = .002). Families did not utilize many of the supportive services that are available including psychology and psychiatry (only 22% used). Respondents felt that additional services would have been helpful.Conclusions:Health care providers should strive to participate in decision-making models that align with the preferences of the patient and family and provide excellent communication. Additional resources to support families following the death of a child should be identified for families or developed and funded if a gap in available services is identified.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-05-06T09:42:04Z
      DOI: 10.1177/1049909120922973
       
  • Racial Disparities in Utilization of Palliative Care Among Patients
           Admitted With Advanced Solid Organ Malignancies
    • Authors: Kimberley Lee, Faiz Gani, Joseph K. Canner, Fabian M. Johnston
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background:There is increasing recognition of the importance of early incorporation of palliative care services in the care of patients with advanced cancers. Hospice-based palliative care remains underutilized for black patients with cancer, and there is limited literature on racial disparities in use of non-hospice-based palliative care services for patients with cancer.Objective:The primary objective of this study is to describe racial differences in the use of inpatient palliative care consultations (IPCC) for patients with advanced cancer who are admitted to a hospital in the United States.Design:This retrospective cohort study analyzed 204 175 hospital admissions of patients with advanced cancers between 2012 and 2014. The cohort was identified through the National Inpatient Dataset. International Classification of Disease, Ninth Revision codes were used to identify receipt of a palliative care consultation.Results:Of this, 57.7% of those who died received IPCC compared to 10.5% who were discharged alive. In multivariable logistic regression models, black patients discharged from the hospital, were significantly less likely to receive a palliative care consult compared to white patients (odds ratio [OR] black: 0.69, 95% CI: 0.62-0.76).Conclusions:Death during hospitalization was a significant modifier of the relationship between race and receipt of palliative care consultation. There are significant racial disparities in the utilization of IPCC for patients with advanced cancer.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-05-06T09:40:01Z
      DOI: 10.1177/1049909120922779
       
  • Courvoisier’s Law
    • Authors: Kacper Niburski
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.

      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-04-30T09:33:36Z
      DOI: 10.1177/1049909120922776
       
  • General Practitioners’ Perspectives on General and Specialized
           Palliative Home Care in North Rhine, Germany: An Explorative Focus Group
           Study
    • Authors: Sophie Peter, Anna Maria Volkert, Holger Pfaff, Lukas Radbruch, Roman Rolke, Raymond Voltz, Nadine Scholten
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background:General practitioners (GPs) are important providers and coordinators of palliative home care (PHC). Through this double role, their perspectives and their treatment decisions influence PHC fundamentally. This study aims to gain deeper insights into GPs’ perspectives regarding PHC in North Rhine, Germany.Methods:An explorative, semistructured focus group was conducted with 7 doctors. The researchers performed content analysis. Main topics were GPs’ role definition in PHC and GPs’ medical activities in PHC.Results:Participating GPs describe their role in PHC, based on high motivation and positive attitudes toward PHC as a hybrid role: coordinator, provider (mostly in general PHC), and referrer (gateway to palliative care [PC] specialists). According to GPs’ medical activity, participants describe moderate expertise, demanding tasks, and elaborate PHC provision for GPs. Participants stressed the importance of PC in GPs’ work. But also PC is a small field in general practice. GPs’ PHC benefits from the deep trust resulting from the often close and long-term GP–patient relationship. Complexity and bureaucracy of PHC structures as well as the lack of resources and multidisciplinary cooperation are named as barriers for providing PHC. The highest level of care is reached in specialized PHC, which only very few, severely impaired patients need.Conclusions:Participating GPs see themselves as important PHC providers as well as referrers and coordinators. Complexity and discontinuity in PC arrangements create challenges for their provision. Therefore, they long for reduced bureaucratic burdens.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-04-28T09:28:44Z
      DOI: 10.1177/1049909120920541
       
  • Perceptions of Facilitators and Barriers to Measuring and Improving
           Quality in Palliative Care Programs
    • Authors: Kamini Kuchinad, Ritu Sharma, Sarina R. Isenberg, Nebras Abu Al Hamayel, Sallie J. Weaver, Junya Zhu, Susan M. Hannum, Arif H. Kamal, Anne M. Walling, Karl A. Lorenz, Jonathan Ailon, Sydney M. Dy
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Objective:To examine perceptions of facilitators and barriers to quality measurement and improvement in palliative care programs and differences by professional and leadership roles.Methods:We surveyed team members in diverse US and Canadian palliative care programs using a validated survey addressing teamwork and communication and constructs for educational support and training, leadership, infrastructure, and prioritization for quality measurement and improvement. We defined key facilitators as constructs rated ≥4 (agree) and key barriers as those ≤3 (disagree) on 1 to 5 scales. We conducted multivariable linear regressions for associations between key facilitators and barriers and (1) professional and (2) leadership roles, controlling for key program and respondent factors and clustering by program.Results:We surveyed 103 respondents in 11 programs; 45.6% were physicians and 50% had leadership roles. Key facilitators across sites included teamwork, communication, the implementation climate (or environment), and program focus on quality improvement. Key barriers included educational support and incentives, particularly for quality measurement, and quality improvement infrastructure such as strategies, systems, and skilled staff. In multivariable analyses, perceptions did not differ by leadership role, but physicians and nurse practitioners/nurses/physician assistants rated most constructs statistically significantly more negatively than other team members, especially for quality improvement (6 of the 7 key constructs).Conclusions:Although participants rated quality improvement focus and environment highly, key barriers included lack of infrastructure, especially for quality measurement. Building on these facilitators and measuring and addressing these barriers might help programs enhance palliative care quality initiatives’ acceptability, particularly for physicians and nurses.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-04-27T07:25:36Z
      DOI: 10.1177/1049909120916702
       
  • Palliative Care in a Death-Denying Culture: Exploring Barriers to Timely
           
    • Authors: Rebecca M. Crimmins, Lydia Elliott, Darren T. Absher
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Context:Heart failure (HF) is a complex, life-limiting disease that is prevalent and burdensome. All major cardiology societies and international clinical practice guidelines recommend the integration of palliative care (PC) interventions alongside usual HF management.Objectives:The purpose of this review of the literature was to evaluate the various barriers to the early initiation of PC for HF patients in the primary care setting.Methods:An integrative literature review was conducted in order to assess and incorporate the diverse sources of literature available. An EBSCO search identified relevant articles in the following databases: Medline complete, Academic Search Premier, CINAHL, PsycINFO, Cochrane Library, and SocINDEX. The search was limited to full text, peer reviewed, English only, and published between 2010 and 2019.Results:Barriers to the integration of PC for HF patients include poor communication between provider/patient and interdisciplinary providers, the misperception and miseducation of what PC is and how it can be incorporated into patient care, the unpredictable disease trajectory of HF, and the limited time allowed for patient care in the primary care setting.Conclusion:The results of this review highlight a lack of communication, time, and knowledge as barriers to delivering PC. Primary care providers caring for patients with HF need to establish an Annual Heart Failure Review to meticulously evaluate symptoms and allow the time for communication involving prognosis, utilize a PC referral screening tool such as the Needs Assessment Tool: Progressive Disease-Heart Failure, and thoroughly understand the benefits and appropriate integration of PC.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-04-22T09:24:49Z
      DOI: 10.1177/1049909120920545
       
  • Palliative Care Consultations in Trauma Patients and Role of
           Do-Not-Resuscitate Orders: Propensity-Matched Study
    • Authors: Alexander A. Fokin, Joanna Wycech, Jeffrey K. Katz, Alexander Tymchak, Richard L. Teitzman, Susan Koff, Ivan Puente
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Objective:To delineate characteristics of trauma patients associated with a palliative care consultation (PCC) and to analyze the role of do-not-resuscitate (DNR) orders and related outcomes.Methods:Retrospective study included 864 patients from 2 level one trauma centers admitted between 2012 and 2019.  Level 1 trauma centers are designated for admission of the most severe injured patients. Palliative care consultation group of 432 patients who received PCC and were compared to matched control (MC) group of 432 patients without PCC. Propensity matching covariates included Injury Severity Score, mechanism of injury, gender, and hospital length of stay (HLOS). Analysis included patient demographics, injury parameters, intensive care unit (ICU) admissions, ICU length of stay (ICULOS), duration of mechanical ventilation, timing of PCC and DNR, and mortality. Palliative care consultation patients were further analyzed based on DNR status: prehospital DNR, in-hospital DNR, and no DNR (NODNR).Results:Palliative care consultation compared to MC patients were older, predominantly Caucasian, with more frequent traumatic brain injury (TBI), ICU admissions, and mechanical ventilation. The average time to PCC was 5.3 days. Do-not-resuscitate orders were significantly more common in PCC compared to MC group (71.5% vs 11.1%, P < .001). Overall mortality was 90.7% in PCC and 6.0% in MC (P < .001). In patients with DNR, mortality was 94.2% in PCC and 18.8% in MC. In-hospital DNR-PCC compared to NODNR-PCC patients had shorter ICULOS (5.0 vs 7.3 days, P = .04), HLOS (6.2 vs 13.2 days, P = .006), and time to discharge (1.0 vs 6.3 days, P = .04).Conclusions:Advanced age, DNR order, and TBI were associated with a PCC in trauma patients and resulted in significantly higher mortality in PCC than in MC patients. Combination of DNR and PCC was associated with shorter ICULOS, HLOS, and time from PCC to discharge.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-04-22T09:22:49Z
      DOI: 10.1177/1049909120919672
       
  • Access to Home and Community Health Services for Older Adults With
           Serious, Life-Limiting Illness: A Study Protocol
    • Authors: Jacob D. Hill, Allison M. Cuthel, Corita R. Grudzen
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Objectives:The objective of this study is to identify contextual access factors to home and community health services for end-of-life support for older adults with serious life-limiting illness, as well as determine if access to home and community services is associated with health-care utilization.Design:This study includes an environmental scan, grey literature review, qualitative interviews, and health-care utilization analysis. This study is a subproject of the Grudzen et al. Primary Palliative Care for Emergency Medicine (PRIM-ER) study.Settings/Location:Analysis will include data collection from 17 health systems implementing the PRIM-ER intervention.Participants:For the qualitative interviews, one emergency medicine (EM) physician and one EM nurse will be interviewed from each of the 17 participating health systems. For the health-care utilization analysis, we will use the Senior Care Services Scale (SCSS), American Hospital Association Annual Survey of Hospitals (AHA-ASH), and Medicare claims for all emergency department (ED) visits for serious illness who present at each participating health system.Outcome Measures:The contextual analysis will obtain data on home and community services, such as hospice, home health services, assisted living, integrative medicine services, etc., available around each health system’s highest volume ED, federal and state regulations influencing access to services, as well as EM provider perspectives on access to services. The health-care utilization analysis will determine if SCSS scores, which measure service availability, are associated with health-care usage. High or low SCSS scores are determined by comparing health system service availability on the AHA-ASH to the national median SCSS value.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-04-20T09:47:07Z
      DOI: 10.1177/1049909120920230
       
  • Advance Care Planning for African American Caregivers of Relatives With
           Dementias: Cluster Randomized Controlled Trial
    • Authors: Gloria J. Bonner, Sally Freels, Carol Ferrans, Alana Steffen, Marie L. Suarez, Barbara L. Dancy, Yashika J. Watkins, William Collinge, Alysha S. Hart, Neelum T. Aggarwal, Diana J. Wilkie
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background and Objectives:African-American family caregivers may have insufficient knowledge to make informed end-of-life (EOL) decisions for relatives with dementias. Advance Care Treatment Plan (ACT-Plan) is a community-based education intervention to enhance knowledge of dementia and associated EOL medical treatments, self-efficacy, intentions, and behavior (written EOL care plan). This study evaluated efficacy of the intervention compared to attention control.Research Design and Methods:In a theoretically based, 2-group, cluster randomized controlled trial, 4 similar Midwestern urban megachurches were randomized to experimental or control conditions. Each church recruited African-American caregivers, enrolling concurrent waves of 5 to 9 participants in 4 weekly 1-hour sessions (358 total: ACT-Plan n = 173, control n = 185). Dementia, cardiopulmonary resuscitation (CPR), mechanical ventilation (MV), and tube feeding (TF) treatments were discussed in ACT-Plan classes. Participants completed assessments before the initial class, after the final class (week 4), and at week 20. Repeated measures models were used to test the intervention effect on changes in outcomes across time, adjusting for covariates as needed.Results:Knowledge of CPR, MV, TF, and self-efficacy to make EOL treatment decisions increased significantly more in the ACT-Plan group at weeks 4 and 20. Knowledge of dementia also increased more in the ACT-Plan group at both points, reaching statistical significance only at week 20. Intentions to make EOL treatment decisions and actually an advance care plan were similar between treatment arms.Discussion and Implications:Findings demonstrate promise for ACT-Plan to increase informed EOL treatment decisions for African American caregivers of individuals with dementias.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-04-20T09:43:40Z
      DOI: 10.1177/1049909120916127
       
  • The Impact of Varying Levels of Advance Care Planning Engagement on
           Perceptions of the End-of-Life Experience Among Caregivers of Deceased
           Patients With Cancer
    • Authors: Kristin Levoy, Harleah Buck, Victoria Behar-Zusman
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Context:Advance care planning (ACP) is used to prepare patients and caregivers for future “in the moment” decisions at the end-of-life. Patients with cancer generally do not engage in all 3 components of ACP (documented living will, health-care surrogate, end-of-life discussions); however, little is known about the impact of these varying levels of ACP engagement on caregivers postdeath.Objective:To examine the relationship between varying levels of ACP engagement and caregivers’ perceptions of cancer decedents’ end-of-life experiences.Methods:A secondary analysis of the 2002 to 2014 waves of the Health and Retirement Study data using structural equation modeling was conducted. Five levels of ACP engagement were defined: full (discussions/documents), augmented discussions, documents only, discussions only, and no engagement.Results:Among the 2172 cancer death cases, the analyzed sample included 983 cases where end-of-life decisions occurred. Compared to no ACP, all levels of ACP were significantly associated with caregivers’ positive perceptions of cancer decedents’ end-of-life experiences (P ≤ .001), controlling for sex, race, and Hispanic ethnicity (R 2 = .21). However, the relative impact of each level of ACP engagement was not equal; full engagement (β = .61) was associated with a greater impact compared to each of the partial levels of engagement (augmented discussions [β = .33], documents only [β = .17], discussions only [β = .17]).Conclusion:Partial ACP engagement, not just nonengagement, serves as an important clinically modifiable target to improve the end-of-life care experience among patients with cancer and the perceptions of those experiences among bereaved caregivers.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-04-13T10:51:26Z
      DOI: 10.1177/1049909120917899
       
  • Generalist Palliative Care in the California Safety Net: A Structured
           Assessment to Design Interventions for a Range of Care Settings
    • Authors: Wendy G. Anderson, Monique Parrish, Kathleen Kerr, Anne Kinderman, Michael Rabow, Melissa Schoen, Kate Meyers
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background:To provide high quality care to all patients who have serious illness, health-care systems must develop effective generalist palliative care strategies.Objective:To identify palliative care quality gaps within a range of settings in the California safety net and to develop theory-based interventions to address them.Design:Structured assessment using the National Consensus Project for Quality Palliative Care Clinical Practice Guidelines and a Predisposing, Reinforcing, and Enabling Constructs in Educational/Environmental Diagnosis and Evaluation intervention planning model-based worksheet, which integrates behavior theories to identify factors that predispose, enable, and reinforce clinicians to perform recommended behaviors.Setting and Participants:Adviser pairs—one from palliative care and one from a partner service line—from 10 California public health-care systems conducted assessments at their sites. A steering committee provided educational webinars, best practices, and assessment tools.Measurements:Adviser pairs interviewed at least 6 partner service line stakeholders to identify palliative care quality gaps, behaviors clinicians should perform to close gaps, and factors that predispose, enable, and reinforce those behaviors.Results:Partner service lines were primary care (n = 4), surgery (n = 3), emergency department (n = 2), and radiation oncology (n = 1). Selected gaps were advance care planning and goals of care communication (n = 6), identifying patients with serious illness (n = 3), and pain management (n = 1). All sites designed multiple interventions to address gaps, based on factors that predispose, enable, and reinforce a target audience to perform a target behavior. Advisers reported that the program strengthened relationships between palliative care and the partner service lineConclusion:This structured assessment helped busy clinicians develop theory-based generalist palliative care interventions.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-04-13T09:43:55Z
      DOI: 10.1177/1049909120915461
       
  • Impact of a Palliative Care Education Module in Patients With Heart
           Failure
    • Authors: Shelley L. Thompson, Cary Ward, Anthony Galanos, Margaret Bowers
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background:Heart failure (HF) impacts 6.2 million American adults. With no cure, therapies aim to prevent progression and manage symptoms. Inclusion of palliative care (PC) helps improve symptoms and quality of life. Heart failure guidelines recommend the inclusion of PC in HF therapy, but referrals are often delayed.Objective:Introduce PC to patients with HF and examine the impact on PC consults, readmission, mortality, and intensive care unit (ICU) transfers.Methods:Patients (n = 60) admitted with HF to an academic hospital were asked to view a PC educational module. A number of PC consults, re-admissions, mortality, and transfers to the ICU were compared among participants and those who declined.Results:Nine patients in the intervention group (n = 30) requested a PC consult (P = .042) versus 2 in the usual care group (n = 30; P = .302). There was no statistically significant difference in readmissions, mortality, or ICU transfers between groups.Conclusions:Palliative care education increases the likelihood of PC utilization but in this short-term project was not found to statistically impact mortality, re-admissions, or transfers to higher levels of care.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-04-09T09:17:32Z
      DOI: 10.1177/1049909120918524
       
  • Students Practicing Interprofessional Collaboration in the Context of
           Hospice and Palliative Care
    • Authors: Michelle Gierach, David Brechtelsbauer, Jody Serfling, Katie Bloom, Gary Strickland, Jodi Heins
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Interprofessional education allows students to collaborate with students and professionals of multiple disciplines. An Interdisciplinary Palliative Care (IPC) Seminar, held in the Midwest, involves students from disciplines of medicine, nursing, pharmacy, social work, and chaplaincy. The curriculum of the seminar incorporates asynchronous and synchronous didactic presentations, experiential learning through group exercises and discussion, along with home visits by students in interdisciplinary dyads. The purpose of this study was to determine whether students’ participation in a 3-week IPC seminar would positively influence their socialization and value of interprofessional collaboration with the ultimate goal of developing skilled professionals who engage in interprofessional practice in hospice and palliative care settings. This descriptive study invited participants to take a pre- and postseminar online survey using the Interprofessional Socialization and Valuing Scale-21 (ISVS-21) to assess shifts in students’ perceptions of interprofessional socialization and the value of collaborative health-care practice. In their pre-and postseminar scores, 71 participants reported they more strongly agreed with all items on the ISVS-21 after completing the seminar. The results from this study suggest the IPC Seminar is an effective educational model for advancing the value of interprofessional socialization and collaborative practice in hospice and palliative health-care.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-04-09T09:16:02Z
      DOI: 10.1177/1049909120917365
       
  • Identifying End-of-Life Preferences Among Chinese Patients With Cancer
           Using the Heart to Heart Card Game
    • Authors: Tong Li, Xianbo Pei, Xiaoli Chen, Shuqin Zhang
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background:Understanding the preferences for end-of-life (EOL) care is imperative in providing quality care to patients with life-threatening illness. However, it is difficult for patients, families, and health-care providers to initiate EOL conversations in China. An easy-to-use tool that could help health-care providers initiate EOL discussions is the Heart to Heart Card Game (HHCG), originally designed for Chinese Americans.Objective:To evaluate the EOL preferences among Chinese patients with cancer using the HHCG.Methods:We conducted a descriptive study to assess EOL preferences using HHCG among patients at the oncology chemoradiotherapy department of a Chinese tertiary hospital.Results:We recruited 58 patients in total of which 40 (69%) patients completed HHCG. The most frequently selected card was “I want my family to get along,” followed by “I don’t want to be a burden to my family,” and “I want to maintain my dignity.” Among the 3 cards selected, social needs were rated as the most important (36.7%), followed by spiritual needs (35.8%), physical needs (20.0%), and financial needs (7.5%). The evaluation of the HHCG revealed that more than 70% of the participants highly valued HHCG.Conclusion:The HHCG can be used as a communication tool to encourage EOL discussions between cancer patients and health-care providers in China. Moreover, Chinese patients with cancer attach significant importance to their family and maintaining dignity at the EOL.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-04-09T09:13:23Z
      DOI: 10.1177/1049909120917361
       
  • A Novel Interprofessional Palliative Care and Geriatrics Curriculum for
           Nephrology Teams
    • Authors: Ana Tuya Fulton, Katherine Richman, Maroun Azar, Kelley Sanzen, Jessica Devine, Christine Ferrone, Joshua Ray Tanzer, Kate Lally
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background:The population of older adults with chronic kidney disease (CKD) is increasing and nephrologists need education on the principles of geriatrics and palliative care to effectively care for this population.Objectives:Our objective was to develop and deliver a curriculum to interprofessional clinicians caring for older adults with CKD. The aim of this curriculum would be to improve knowledge of the principles of geriatrics and palliative care.Design:We have previously developed a curriculum on geriatrics and palliative care targeted toward primary care teams. In this project, we used an interdisciplinary steering committee to modify the curriculum for nephrology teams.Setting:This curriculum was delivered in a live grand rounds setting and was recorded and made available via online platform for virtual learning.Participants:The 6-session curriculum was delivered to 611 live and online learners between January 2018 and April 2019, with more than half of the participants (n = 317) completing more than 1 session. Participants came from a variety of disciplines including medicine, nursing, pharmacy, and social work.Results:Participants had a high rate of agreement with the statement that the curriculum met learning objectives, with live participants having stronger agreement. Participants reported that the activity would change their practice behavior by calling palliative care earlier, as well as improving their communication skills.Conclusion:Interprofessional collaboration can result in improved learning around the management of patients with CKD or end-stage kidney disease.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-04-01T09:35:39Z
      DOI: 10.1177/1049909120915462
       
  • Survival, Outcomes, and Use of Acuity Scoring Systems Following
           Tracheotomy in Veteran Patients
    • Authors: Carol M. Bier-Laning, Jeffrey Hotaling, W. Jeffrey Canar, Aziz A. Ansari
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Objectives:To determine whether established prognosis tools used in the general population of critically ill patients will accurately predict tracheotomy-related outcomes and survival outcomes in critically ill patients undergoing tracheotomy.Methods:Retrospective chart review of 94 consecutive critically ill patients undergoing isolated tracheotomy.Results:Logistic Organ Dysfunction System (LODS) and sepsis-related organ failure assessment (SOFA) scores, 2 validated measures of acuity in critically ill patients, were calculated for all patients. The only tracheotomy-related outcome of significance was the finding that patients with an LODS score ≤6 were more likely to become ventilator independent (P < .015). Higher LODS or SOFA scores were associated with in-house death (LODS, P = .001, SOFA, P = .008) and death within 90 days (LODS, P = .009, SOFA, P = .031), while death within 180 days was associated only with a higher LODS score (LODS, P = .018). When controlling for age, there was an association between both LODS (P = .015) and SOFA (P = .019) scores and death within 90 days of tracheotomy.Conclusions:The survival outcome for critically ill patients undergoing tracheotomy seems accurately predicted based on scoring systems designed for use in the general population of critically ill patients. Logistic Organ Dysfunction System may also be useful to predict the likelihood of the tracheotomy-related outcome of ventilator independence. This suggests that LODS scores may be helpful to palliative care clinicians as part of a shared decision-making aid in critically ill, ventilated patients for whom tracheotomy is being considered.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-03-30T09:27:44Z
      DOI: 10.1177/1049909120914518
       
  • Patients’ Perspectives and Advice on How to Discuss Sexual Orientation,
           Gender Identity, and Sexual Health in Oncology Clinics
    • Authors: Elizabeth Cathcart-Rake, Jennifer O’Connor, Jennifer L. Ridgeway, Carmen Radecki Breitkopf, Judith S. Kaur, Jessica Mitchell, Konstantinos Leventakos, Aminah Jatoi
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Objective:This study sought to understand the patients’ perspective of what contributes to an absence of discussions of sexual orientation (SO), gender identity (GI), and sexual health in cancer care.Methods:Patients were recruited from oncology, gynecology, and a gender transition clinic to participate in semistructured interviews, which were analyzed with qualitative methods.Results:A total of 25 patients were interviewed, shedding light on 2 themes. The first was that these conversations are important but infrequent. One patient explained, “…. we know people who have had sex changes…[they] would have appreciated that question.” In response to whether sexual health was ever brought up, one patient responded, “No doctor ever has.” Patients described unaddressed issues: “There have been times, you know, we’ve wondered if it was okay to make love.” The second theme consisted of 4 pragmatic, patient-provided points to facilitate discussions: (1) implementation of a scale of 1 to 10 (with 10 being comfortable) to first gauge patients’ comfort in talking about SO, GI, and sexual health; (2) having the health-care provider explore the topic again over-time; (3) making sure the health-care provider is comfortable, as such comfort appears to enhance the patient’s comfort (“I have a doctor here, a female doctor, who just matter of fact will ask if I get erections and so on because of the medication she’s giving me);” and (4) eliminating euphemisms (one patient stated, “I don’t know what you mean by ‘sexual health’.”).Conclusion:Oncology health-care providers have a unique opportunity and responsibility to address SO, GI, and sexual health.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-03-26T09:51:14Z
      DOI: 10.1177/1049909120910084
       
  • Pediatric Resident Perception and Participation in End-of-Life Care
    • Authors: Jason Z. Niehaus, Megan Palmer, Michelle LaPradd, Amy Haskamp, Amy Hatton, Caitlin Scanlon, Adam B. Hill
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background:Despite advances in medical care, pediatric deaths are still an unfortunate reality. Most of these deaths occur within a hospital setting. End-of-life care is an important part of medical care for children with serious illnesses. Despite the importance, pediatric providers report a lack of comfort surrounding end-of-life care.Objective:To assess categorical pediatric residents’ perceptions and participation in providing end-of-life care to dying children and their families.Study Design:This is a survey-based, descriptive, mixed-methods study. Survey was sent to categorical pediatric residents at Indiana University School of Medicine in June 2018 to obtain both quantitative and qualitative information on resident perception and participation in end-of-life care. Surveys were sent to 100 residents with a response rate of 68%.Setting/Participants:Pediatric residents at Indiana University School of Medicine.Results:The comfort and participation in end-of-life care are limited in all levels of pediatric training. Residents do not feel comfortable with 19 of 22 questions related to end-of-life care. Only 32% of residents felt their education prepared them to participate in end-of-life care. Almost one-fifth (19.5%) of residents report participating in zero aspect of end-of-life care. Themes discussed by residents include education, experience, communication, social norms, emotions, self-care, comfort, and family.Conclusion:More formalized education and training is needed to increase resident comfort with and participation in end-of-life care. Such future interventions should focus on communication surrounding difficult conversations and providing guidance for families.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-03-20T10:34:05Z
      DOI: 10.1177/1049909120913041
       
  • Chaplaincy Care in the MICU: Describing the Spiritual Care Provided to
           MICU Patients and Families at the End of Life
    • Authors: Dirk Labuschagne, Alexia Torke, Daniel Grossoehme, Katie Rimer, Martha Rucker, Kristen Schenk, James Slaven, George Fitchett
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background:Gravely ill patients admitted to the intensive care unit (ICU), and their families experience acute spiritual and existential needs and often require complex decisions about their care. Little is known about what constitutes chaplaincy care for patients or families in ICUs. Chaplains report that participation in medical decision-making is part of their role.Objective:To describe the spiritual care provided to patients and their families in the ICU.Methods:This was a retrospective observational study of spiritual care for patients and families in the medical ICUs (MICUs) at 4 medical centers over a 3-month period. Inclusion criteria were death in the MICU or discharge to palliative care or hospice. Measures included medical, treatment, and spiritual care information (number of visits, length of visit, chaplain categories, and type of spiritual care provided).Results:Of the 254 patients, 197 (78%) received a total of 485 spiritual care visits. Seventy-seven percent of visits included provision of emotional/spiritual support; only 15% included decision-making support such as family meetings or goals-of-care conversations. The proportion receiving spiritual care increased as patients neared death or discharge. Staff chaplains were involved in goals-of-care conversations to a greater extent than student or part-time chaplains (P < .05).Conclusion:Spiritual care was provided to most patients and/or families at the end of life. Low chaplain involvement in decision-making in the MICU suggests opportunities to improve chaplains’ contributions to ICU care.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-03-20T10:31:13Z
      DOI: 10.1177/1049909120912933
       
  • Opioid-Related Sleep-Disordered Breathing: An Update for Clinicians
    • Authors: Waqas Jehangir, Alexander D. Karabachev, Zankhana Mehta, Mellar Davis
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Opioids are an effective treatment for patients with intractable pain. Long-term administration of opioids for pain relief is being delivered by an increasing number of medical providers in the United States including primary care physicians and nonspecialists. One common complication of chronic opioid use is sleep-disordered breathing which can result in various morbidities as well as an increase in all-cause mortality. It is important for providers to understand the relationship between opioids and sleep-disordered breathing as well as methods to improve diagnosis and strategies for treatment. This review aims to update clinicians on the mechanism, diagnosis, and treatment of opioid-related sleep-disordered breathing in order to improve the quality of care for patients with chronic pain.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-03-19T01:21:25Z
      DOI: 10.1177/1049909120913232
       
  • Pharmacy-Led Quality Improvement Project on Pain Control Using Continuous
           Subcutaneous Infusion of Opioids in an Inpatient Hospice Unit
    • Authors: Nayma Moya Romero, Sandra DiScala, Jennifer Quellhorst, Michael A. Silverman
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Objectives:The purpose of this quality improvement (QI) project was to improve the overall process of implementing continuous subcutaneous infusion of opioids (CSCIOs) at the West Palm Beach Veterans Affairs Medical Center and characterize their use in the hospice unit.Methods:A retrospective chart review from July 2014 to August 2017 was conducted to identify patients who had received CSCIO. Results were analyzed with descriptive statistics.The business philosphy, LEAN methodology “The 5 Whys” was utilized to identify the root causes for delayed infusion timeliness and corrections were implemented by August 2018. Follow-up retrospective time study completed from September 2018 to February 2019.Results:Of the 107 patients identified, 7 were excluded and 100 were reviewed. The mean age was 73 years, 94% male, and 86% Caucasian. A total of 55 veterans received morphine with an average final infusion rate of 2.5 mg/h. A total of 45 Veterans received hydromorphone with a final infusion rate of 1.3 mg/h. The average infusion duration until death was 5 days. Pharmacy verified 94 (94%) orders and nursing verified 55 (55%) orders within 1 hour (gold standard). Sixteen (16%) patients received CSCIO within 1 hour. The 5 Whys identified nursing order verification and pharmacy lack of visual STAT order notification for priority as the potential sources for infusion timeliness improvement. The follow-up time study confirmed improvement in pharmacy delivery time from 29% to 75% on time.Conclusion:Pharmacist-led intervention directed to improve CSCIO processes in an inpatient hospice unit utilizing LEAN QI methodology increased timeliness of pharmacy CSCIO delivery.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-03-19T01:15:05Z
      DOI: 10.1177/1049909120912954
       
  • Advance Directive as Ulysses Contract: The Application of Stopping of
           Eating and Drinking by Advance Directive
    • Authors: Adam D. Marks, Judith C. Ahronheim
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Increased attention is being paid to “dementia directives,” advance directives tailored to persons with dementia that outline what treatments an individual with dementia might wish to receive or forgo should they lose capacity. Particular focus has been placed on the request to have assisted oral feedings withheld, the so-called Stopping of Eating and Drinking by Advance Directive (SED by AD), the purpose of which is to hasten death. This article reviews the available literature regarding the practice of SED by AD and explores the clinical and ethical aspects as they present at the bedside. Our review aims to show that practical, clinically applicable ways to approach such requests must be developed in order to balance the fundamental principles at play.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-03-13T09:48:12Z
      DOI: 10.1177/1049909120912951
       
  • Advance Care Planning in Chronically Ill Persons Diagnosed With Heart
           Failure or Chronic Obstructive Pulmonary Disease: An Integrative Review
    • Authors: Molly T. Williams, Sharon L. Kozachik, Mohana Karlekar, Rebecca Wright
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Introduction:Advance care planning (ACP) discussions help guide future medical care consistent with patient wishes. These discussions should be a part of routine care and should be readdressed frequently as a patient’s medical condition changes. Limited literature exists supporting structured processes for identifying persons who may benefit from these conversations. The purpose of this integrative review was to understand whether targeting patients with episodic disease trajectories in the acute care setting will increase their willingness to participate in ACP discussions.Methods:Using the Johns Hopkins Nursing Evidence-Based Practice Model as a guideline, this integrative review focused on the research query “In the acute care setting, does targeting patients with heart failure or chronic obstructive pulmonary disease for ACP lead to increased willingness to participate in these discussions.” Articles from 2009 to September 2019 were considered for review.Results:Six articles met inclusion criteria for final analysis. Articles outside of the United States were excluded. Four themes emerged from the literature: (1) improved patient attitudes toward ACP, (2) effective communication surrounding care preferences, (3) strengthened connection between preferred and delivered care, and (4) increased patient involvement in ACP.Conclusion:Chronic diseases such as heart failure and COPD have a high symptom burden punctuated by exacerbations, making it difficult to know when introduction of ACP discussions would be most beneficial. Future research should focus on a deeper evaluation of when to introduce ACP conversations in this population and which ACP interventions are effective to facilitate these discussions.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-03-13T09:35:49Z
      DOI: 10.1177/1049909120909518
       
  • Impact of Length of Hospice on Spending and Utilization Among Medicare
           Beneficiaries With Lung Cancer
    • Authors: Yamini Kalidindi, Jeah Jung, Joel Segel, Douglas Leslie
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Objectives:To estimate differences in spending and utilization between hospice users and non-users with lung cancer by length of hospice enrollment.Study Design:Retrospective analysis using 2009-2013 Medicare claims.Methods:The study sample was a 10% random sample of Medicare fee-for-service beneficiaries with lung cancer who died between 2010 and 2013. We identified different categories of hospice users (hospice enrollment for 1-7 days, 8-14 days, 15-30 days, 31-60 days, 61 days – 6 months) and non-users. We used propensity score matching to match users in each enrollment category with non-users. The outcomes were: a) total Medicare spending, b) number of hospitalizations, c) number of emergency department (ED) visits, d) number of physician-administered chemotherapy claims, and e) number of radiation therapy sessions. Regression analysis was used to compare outcomes between users and non-users by enrollment period.Results:Hospice users had significantly lower spending, fewer hospitalizations, and fewer ED visits than non-users across all categories of hospice enrollment.  Large savings occurred when patients stayed in hospice for at least one month (US$16,566 for those enrolled 61 days – 6 months; US$16,409 for those enrolled 31-60 days). Significant reduction in use of outpatient services including chemotherapy and radiation therapy was observed among patients using hospice for at least 1 month.Conclusions:Hospice led to cost savings by reducing utilization of aggressive care towards end-of-life among lung cancer patients. While cost savings were realized even when hospice is utilized for a short duration, large savings occurred when hospice is used for at least 1 month.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-03-03T10:18:33Z
      DOI: 10.1177/1049909120909304
       
  • Considerations for Integrating Advance Care Planning Into the Electronic
           Health Record: A Primer for Clinicians
    • Authors: Adam Moses, Ajay Dharod, Jeff Williamson, Nicholas M. Pajewski, Daniel Tuerff, Jia Guo, Jennifer Gabbard
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Opportunities for expanding advance care planning (ACP) throughout the health-care system make it critical that primary care (PC) providers have a basic understanding of how the electronic health record (EHR) can aid promoting ACP discussions and documentation. This article will offer PC providers 5 useful tips for implementing ACP in outpatient settings utilizing the EHR.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-03-02T03:07:51Z
      DOI: 10.1177/1049909120909303
       
  • Aggressive End-of-Life Care and Symptom Relief Treatments in Terminally
           Ill Patients Who Had Discussed Withdrawal of Mechanical Ventilation: A
           Hospital-Based Observational Study
    • Authors: Hsiao-Ting Chang, Ming-Hwai Lin, Chun-Ku Chen, Tzeng-Ji Chen, Shinn-Jang Hwang
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Objective:The aim of this study was to explore the status of aggressive end-of-life care and symptom relief treatments in terminally ill patients who had discussed the withdrawal of mechanical ventilation.Methods:This research is a retrospective observational study based on a chart review. Terminal patients aged ≥20 years, who were intubated with mechanical ventilation support, who underwent hospice-shared care, and who personally, or whose close relatives, had discussed the withdrawal of mechanical ventilation with hospice-shared care team members in a tertiary hospital in Taiwan during 2012 to 2015 were included. Demographics, medical conditions, and aggressive end-of-life care, including hospitalization, use of vasopressors, artificial nutrition, tube feeding, antibiotics, and symptom relief treatments including the use of opioids, steroids, and sedatives, were identified. The modes of care and treatments of patients by the status of withdrawal of mechanical ventilation were compared.Results:A total of 141 patients had discussed the withdrawal of mechanical ventilation, and 111 (78.7%) had been withdrawn. Aggressive end-of-life care was noted in all patients regardless of mechanical ventilation status. There were no significant differences in the number and pattern of aggressive end-of-life care measures between patients who had or had not been withdrawn. There were significantly higher rates of symptom relief treatments used in patients who had been withdrawn.Conclusions:Aggressive end-of-life care is common for patients who have discussed the withdrawal of mechanical ventilation. There are significantly higher rates of symptom relief medications administered in patients who have been withdrawn from mechanical ventilation.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-03-02T02:44:11Z
      DOI: 10.1177/1049909120906612
       
  • End-of-Life Admission to the Emergency Department: Experience of
           Mexico’s National Cancer Institute of a Developing Country
    • Authors: Silvia Allende-Pérez, Pamela González, Adriana Peña-Nieves, Ángel Herrera-Gómez, Emma Verástegui
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background:Admission to the emergency department (ED) of patients with advanced or end-of-life (EoL) cancer saturates the services that provide active medical attention to the complications of anticancer therapy, and the lack of specific protocol limits proper handling.Objective:The aim of this study was to describe the characteristics of patients with advanced cancer admitted to the ED at the EoL in a comprehensive cancer center in Mexico.Patients and Methods:We conducted a retrospective analysis of patients admitted to ED of the National Cancer Institute of Mexico City, with 3 or less days before they died, between January 2011 and December 2018. The data collected included clinical and demographic characteristics, reason for admission to the ED, number of admissions to ED in the last month of life, and cancer treatment received.Results:A total of 426 patients were included; 60.8% were female with a median age of 60 years; 71.6% patients were receiving some kind of disease-modifying treatment, although the oncologist had considered they could die within 6 months, and 16 of them were receiving concomitant PC. 8.9% of these patients had been admitted 3 or more times to the ED in the last month. The principal reasons for admission to ED were dyspnea, uncontrolled pain, 12 patients were admitted in active death and 94 died within hours of admission to ED.Conclusions:Palliative care approach in oncological patients admitted to ED is important to avoid unnecesary suffering at the EoL.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-02-26T02:50:41Z
      DOI: 10.1177/1049909120908793
       
  • Systematic Review of the Prevalence, Predictors, and Treatment of Insomnia
           in Palliative Care
    • Authors: Isa Nzwalo, Maria Ana Aboim, Natércia Joaquim, Ana Marreiros, Hipólito Nzwalo
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Introduction:The primary function of palliative care is to improve quality of life. The recognition and treatment of symptoms causing suffering is central to the achievement of this goal. Insomnia reduces quality of life of patients under palliative care. Knowledge about prevalence, associated factors, and treatment of insomnia in palliative care is scarce.Methodology:Literature review about the prevalence, predictors, and treatment options of insomnia in palliative care patients. Primary sources of investigation were identified and selected through Pubmed and Scopus databases. The research was complemented by reference search in identified articles and selected reviews. OpenGrey and Google Scholar were used for searching grey literature. Study quality analysis was based on the Newcastle-Ottawa Scale.Results:A total of 65 studies were included in the review. Most studies had acceptable /good quality. The prevalence of insomnia in the included studies ranged from 2.1% to 100%, with a median overall prevalence of 49.5%. Sociodemographic factors such as age; clinical characteristics such as functional status, disease stage, pain, and use of specific drugs, including opioids; psychological factors such as anxiety/depression; and spiritual factors such as feelings of well-being were identified as predictors. The treatment options identified were biological (pharmacological and nonpharmacological), psychological (visualization, relaxation), and spiritual (prayer).Conclusions:The systematic review showed that the prevalence of insomnia is high, with at least one in 3 patients affected in most studies. Insomnia’s risk factors and treatment in palliative care are both associated to physical, psychological, social, and spiritual factors, reflecting its true holistic nature.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-02-26T02:46:03Z
      DOI: 10.1177/1049909120907021
       
  • The Impacts of Prognostic Awareness on Mood and Quality of Life Among
           Patients With Advanced Cancer
    • Authors: EunKyo Kang, Jung Hun Kang, Su-Jin Koh, Eun-Kee Song, Hyun-Jeong Shim, Bhumsuk Keam, Chi-Hoon Maeng, Yu Jung Kim, Hwan Jung Yun, Kyung Hae Jung, Jung Hye Kwon, Soon Nam Lee, Jung Lim Lee, Young Rok Do, JeongHee Min, Jihye Lee, Jiyeon Choo, Young Ho Yun
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background:Accurate awareness of the prognosis is an important factor in the treatment decision of patients with advanced cancer; however, prognostic disclosure is still subject to debate because it can reduce patient’s satisfaction and increase depression.Aim:The purpose of this study is to assess whether patients’ prognostic awareness is associated with decreased quality of life (QoL) or increased depressive mood in patients with advanced cancerDesign and Participants:In this cohort study, 386 patients with advanced cancer were recruited across 3 periods from December 2016 to August 2018. The outcome of this study was a change in QoL and depression according to the patients’ prognostic awareness at baseline, 3 months, and 6 months.Results:This study found significant differences in changes of QoL based on patients’ prognostic awareness. From baseline to 3 months, emotional functioning (P = .039), pain (P = .042), existential well-being (P = .025), and social support (P = .038) subscale scores improved significantly more in those with lack of prognostic awareness. Over 6 months, the group without prognostic awareness improved significantly in terms of physical functioning (P = .037), emotional functioning (P = .002), nausea/vomiting (P = .048), and constipation (P = .039) subscale scores and existential well-being scores (P = .025). No significant difference between the groups was found in terms of depression.Conclusion:Accurate prognostic awareness may pose harm and may provide no additional benefits in terms of QoL and mood among patients with advanced cancer for a short period of time.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-02-13T11:14:42Z
      DOI: 10.1177/1049909120905789
       
  • Characteristics, Mortality Rates, and Treatments Received in Last Few Days
           of Life for Patients Dying in Intensive Care Units: A Multicenter Study
    • Authors: Issa Mohammad Almansour, Muayyad Mustafa Ahmad, Mohammad Minwer Alnaeem
      First page: 761
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background:Information is presently lacking about the end-of-life care in intensive care unit (ICU). We explored the characteristics, mortality rates, and treatments received in the last few days of life for patients who died in ICU.Methods:This was a retrospective multicenter cohort study. We included patients who died from different medical illnesses between January 2014 and January 2017 in 8 medical ICUs across 3 major health-care systems in Jordan. Of 11 029 patients who were admitted for the study in ICUs, data from 3885 health records were retrieved and analyzed. Pediatric patients aged younger than 18 years and patients admitted to an ICU for less than 4 hours were excluded.Results:The mean ICU mortality rate was 34.6% (29%-38%), with a slight decline from 2014 through 2016. Most of the patients who died were male (56.6%), transferred from the emergency department (46.8%), and had multiple comorbidities (74%). Cardiopulmonary resuscitation, invasive mechanical ventilation, pharmacological hemodynamic support, and artificial hydration were pursued until death for most patients (91.5%, 80.1%, 78.8%, and 94.1%, respectively).Conclusions:Aggressive treatment modalities were usually pursued for critically ill patients at the end of their lives. There is a need to explore further the current end-of-life care needs and practices in ICUs in Jordan and to tailor end-of-life care and management suitably to meet the needs of Islamic and Arabic cultures.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-01-29T02:13:38Z
      DOI: 10.1177/1049909120902976
       
  • Patient Risk Factor Profiles Associated With the Timing of Goals-of-Care
           Consultation Before Death: A Classification and Regression Tree Analysis
    • Authors: Lauren T. Starr, Connie M. Ulrich, Paul Junker, Liming Huang, Nina R. O’Connor, Salimah H. Meghani
      First page: 767
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background:Early palliative care consultation (“PCC”) to discuss goals-of-care benefits seriously ill patients. Risk factor profiles associated with the timing of conversations in hospitals, where late conversations most likely occur, are needed.Objective:To identify risk factor patient profiles associated with PCC timing before death.Methods:Secondary analysis of an observational study was conducted at an urban, academic medical center. Patients aged 18 years and older admitted to the medical center, who had PCC, and died July 1, 2014 to October 31, 2016, were included. Patients admitted for childbirth or rehabilitationand patients whose date of death was unknown were excluded. Classification and Regression Tree modeling was employed using demographic and clinical variables.Results:Of 1141 patients, 54% had PCC “close to death” (0-14 days before death); 26% had PCC 15 to 60 days before death; 21% had PCC>60 days before death (median 13 days before death). Variables associated with receiving PCC close to death included being Hispanic or “Other” race/ethnicity intensive care patients with extreme illness severity (85%), with age 75 increasing this probability (98%). Intensive care patients with extreme illness severity were also likely to receive PCC close to death (64%) as were 50% of intensive care patients with less than extreme illness severity.Conclusions:A majority of patients received PCC close to death. A complex set of variable interactions were associated with PCC timing. A systematic process for engaging patients with PCC earlier in the care continuum, and in intensive care regardless of illness severity, is needed.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-06-30T09:15:56Z
      DOI: 10.1177/1049909120934292
       
  • Knowledge and Perceptions Regarding Palliative Care Among Religious
           Leaders in Uasin Gishu County, Kenya: Survey and Focus Group Analysis
    • Authors: Faith Rialem, Jessie P. Gu, Violet Naanyu, Zipporah Ali, Patrick Chege, Dinah Chelagat, Millicent Korir, Wangari Waweru-Siika, Peter S. Kussin
      First page: 779
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Spirituality and religion are at the core of Kenyan life. Pastoral leaders play a key role in shaping the individual and community’s response to living with chronic and life-threatening illnesses. Involvement of religious leaders would therefore be critical in advocacy and education efforts in palliative care (PC) to address the needs of this population. The goal of this study was to evaluate the knowledge and perceptions of religious leaders in Western Kenya regarding PC. This was a mixed-methods study with 86 religious leaders utilizing a 25-question survey followed by 5-person focus group discussions. Eighty-one percent of participants agreed that pastors should encourage members with life-threatening illnesses to talk about death and dying. However, almost a third of participants (29%) also agreed with the statement that full use of PC can hasten death. The pastors underscored challenges in end-of-life spiritual preparation as well as the importance of traditional beliefs in shaping cultural norms. Pastors supported the need for community-based PC education and additional training in PC for religious leaders. The results of this study confirm the dominant role of religion and spirituality in PC in Kenya. This dominant role in shaping PC is tied closely to Kenyan attitudes and norms surrounding death and dying.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-01-24T10:11:26Z
      DOI: 10.1177/1049909119899657
       
  • Hospice Care: Hope and Meaning in Life Mediate Subjective Well-Being of
           Staff
    • Authors: Shimon Shiri, Isaiah Wexler, Anat Marmor, Zeev Meiner, Isabella Schwartz, Osnat Levzion Korach, Daniel Azoulay
      First page: 785
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Objectives:Subjective well-being has been associated with decreased work burnout and elevated work engagement. We investigated the impact of hope and meaning in life on subjective well-being among workers in a hospice care setting. Comparison was made to health-care workers in a rehabilitation unit.Methods:Thirty-five hospice care workers were surveyed and their responses compared with those of 36 rehabilitation workers. Survey instruments measuring hope, meaning in life, work engagement, and satisfaction with life were utilized.Results:Individuals working in a hospice care center have significantly higher levels of work engagement than their counterparts in rehabilitation. For both groups, hope was significantly related to subjective well-being. For hospice care but not rehabilitation workers, meaning in life was also related to subjective well-being. Multivariate analysis showed that hope and meaning in life were independent factors predicting subjective well-being in hospice care workers.Significance of Results:Hospice care workers are highly engaged in their work despite the challenging nature of their work. What characterizes these workers is a level of subjective well-being that is related to both meaning in life and hope. Maintaining a high level of subjective well-being may be an important factor in preventing burnout among those working in hospice care settings.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-02-13T11:04:39Z
      DOI: 10.1177/1049909120905261
       
  • Accelerated Resolution Therapy: Randomized Controlled Trial of a
           Complicated Grief Intervention
    • Authors: Harleah G. Buck, Paula Cairns, Nnadozie Emechebe BPharm, Diego F. Hernandez, Tina M. Mason, Jesse Bell, Kevin E. Kip, Philip Barrison, Cindy Tofthagen
      First page: 791
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background and Objectives:Complicated grief (CG) is severe, prolonged (>12 months) grieving. Complicated grief disproportionately affects older adults and is associated with negative physical/psychological effects. Although treatment options exist, those which do are time-intensive. We report on a randomized clinical trial (RCT) which examined whether accelerated resolution therapy (ART), a novel mind-body therapy, is effective in treating CG, post-traumatic stress disorder (PTSD), and depression among hospice informal caregivers.Research Design and Methods:Prospective 2 group, wait-listed RCT. All participants were scheduled to receive 4 ART sessions.Inclusion:≥60 years, inventory of CG>25, and PTSD checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition>33 or Psychiatric Diagnostic Screen Questionnaire PTSD subscale>5.Exclusion:Major psychiatric disorder, other current psychotherapy treatment. Depression was measured by the Center for Epidemiologic Studies Depression.Results:Mean (standard deviation [SD]) age of 54 participants was 68.7 (7.2) years, 85% female, and 93% white. Participants assigned to ART reported significantly greater mean (SD) CG reduction (−22.8 [10.3]) versus Wait-list participants (−4.3 [6.0]). Within-participant effect sizes (ESs) for change from baseline to 8-week post-treatment were CG (ES = 1.96 (95% confidence interval [CI]: 1.45-2.47; P < .0001), PTSD (ES = 2.40 [95% CI: 1.79-3.00]; P < .0001), depression (ES = 1.63 [95% CI: 1.18-2.08; P < .0001). Treatment effects did not substantially differ by baseline symptom levels.Discussion and Implications:Results suggests that ART presents an effective and less time-intensive intervention for CG in older adults. However, it should undergo further effectiveness testing in a larger, more diverse clinical trial with a focus on determining physiological or behavioral mechanisms of action.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-01-21T11:06:01Z
      DOI: 10.1177/1049909119900641
       
  • “Online Training Is Great but Human Interaction Is Better”: Training
           Preferences of VA Interdisciplinary Palliative Care Consult Teams
    • Authors: Beverly Rosa Williams, F. Amos Bailey, Patricia S. Goode, Elizabeth A. Kvale, Laurie A. Slay, Marie A. Bakitas, Kathryn L. Burgio
      First page: 800
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      A growing body of research has examined modalities for delivering palliative care education; however, we know little about education and training preferences of VA interdisciplinary Palliative Care Consult Teams (PCCT). In the BEACON II study, we explored training preferences of PCCTs from 46 Veterans Affairs Medical Centers (VAMCs) participating in either a multisite webinar or a small group, in-person workshop. We interviewed participants by telephone seven to eight month post-training. In all, 75.9% preferred in-person education and training, including 78.9% of workshop participants and 73.1% of webinar participants. Respondents described in-person training as fostering learning through the following processes: (1) active engagement and focus, (2) interaction and networking, (3) meaning-making and relevance, and (4) reciprocity and commitment. Although it is not possible for Web-based palliative care education programs to replicate all aspects of the in-person learning experience, building experiential, interactive, meaningful, and reciprocal components into Web-based education may help shift preferences and make interdisciplinary team-based palliative care education accessible to a larger audience.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-03-03T09:57:20Z
      DOI: 10.1177/1049909120907599
       
  • Virtual Reality for Therapeutic Recreation in Dementia Hospice Care: A
           Feasibility Study
    • Authors: Claire Ferguson, Marcia Y. Shade, Julie Blaskewicz Boron, Elizabeth Lyden, Natalie A. Manley
      First page: 809
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Objectives:To explore acceptability, tolerability, and subjective experience of virtual reality (VR) as therapeutic recreation for hospice patients living with dementia (hPLWD).Design:Descriptive study setting.Community Hospice Agency Participants:A convenience sample of n = 25 hPLWD cared for by a local hospice agency.Intervention:Participants viewed a beach scene using VR headset for ≤30 minutes.Measurements:Tolerability was measured with Pain Assessment IN Advanced Dementia (PAINAD)scores at baseline, every 5 minutes during VR use, and 5 minutes after headset removal. Additionally, follow-up phone calls to caregivers several hours after the intervention were performed to inquire regarding any noted adverse effect after the intervention. The subjective experience was measured with qualitative semistructured interviews with the hPLWD regarding enjoyment for the VR. Descriptive statistics were performed on all collected data.Results:The VR was stopped early in 2 of the participants due to a ≥2-point increase in PAINAD score. Baseline behavioral and psychological symptoms of dementia (BPSD) were reported to have worsened in 2 (8%) of the participants at follow-up. There was no significant difference between dementia type and usage time or dementia severity and usage time. Of the 25 participants, 14 (56%) reported enjoying VR and 12 (48%) would do it again.Conclusion:Virtual reality use was generally safe and enjoyable in hPLWD. Virtual reality can provide meaningful activity and enhance quality of life for hPLWD at the end of life. In the future, VR may be a useful intervention for BPSD in hPLWD.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-01-24T10:18:46Z
      DOI: 10.1177/1049909120901525
       
  • The Life Experiences Among Primary Family Caregivers of Home-Based
           Palliative Care
    • Authors: Meng-Ping Wu, Sheng-Jean Huang, Lee-Ing Tsao
      First page: 816
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background:An increasing number of patients with terminal illnesses prefer to die in their own homes due to aging, high medical payments, a limited number of hospitalization days, and the ability to receive care from family members. However, few studies have been conducted on the subjective perception and value of caregivers for home-based palliative care (HBPC).Objective:To identify common themes and topics of primary family caregivers’ lived experiences with HBPC when taking care of terminally ill family members.Methods:We conducted audio-recorded transcripts of one-on-one in-depth interviews of primary family caregivers of HBPC. Through a purposive sampling method, the participants were all interviewed; these interviews were transcribed verbatim and analyzed using a grounded theory approach.Results:A total of 22 primary family caregivers participated in the study. “Wholeheartedly accompanying one’s family to the end of life at home” was the core category. Six main themes describing caregivers’ experiences emerged from the interviews: (1) learning the basic skills of end-of-life home care, (2) arranging the sharing and rotation of care, (3) preparing for upcoming deaths and funerals, (4) negotiating the cultural and ethical issues of end-of-life home care, (5) ensuring a comfortable life with basic life support, and (6) maintaining care characterized by concern, perseverance, and patience.Conclusions: Primary family caregivers of HBPC need support and must learn home care skills by means of the holistic approach. It is crucial to establish assessment tools for caregivers’ preparedness for HBPC, including biopsychosocial and cultural considerations.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-03-02T03:03:31Z
      DOI: 10.1177/1049909120907601
       
  • Race and Ethnicity and Satisfaction With Communication in the Intensive
           Care Unit
    • Authors: Elizabeth Chuang, Ryan J. Fiter, Omar C. Sanon, Ann Wang, Aluko A. Hope, Clyde B. Schechter, Michelle N. Gong
      First page: 823
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Purpose:Racial and ethnic minority patients receive poorer quality end-of-life (EoL) care compared with white patients. Differences in quality of communication (QOC) with clinicians may contribute to these disparities. We measured differences in satisfaction with communication in the intensive care unit (ICU) by race and ethnicity.Materials and Methods:This is a cross-sectional survey of family members of patients in ICUs of an academic medical center serving a diverse urban population using The Family Satisfaction with the ICU (FS-ICU) and QOC scales.Results:One hundred surveys were completed (18.8% white, non-Hispanic; 34.4% black, non-Hispanic; 31.3% Hispanic; 15.6% other race/ethnicity). Mean FS-ICU score was 84.2 (standard deviation [SD] 20.5) for white patients, 83.3 (SD 16.2) for black patients, 82.7 (SD 17.8) for Hispanic or Latino patients, and 80.9 (SD 18.8) for patients with other race/ethnicity (Kruskal-Wallis, P = .92). Differences remained insignificant when controlling for patient and respondent characteristics. The QOC scale was not scored due to nonresponse levels on questions about EoL communication.Conclusions:Uniformly high ratings may have been influenced by avoidance of EoL discussion. This study is inconclusive regarding whether QOC influences disparities in EoL care since quality of EoL communication was not captured.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-04-02T10:09:53Z
      DOI: 10.1177/1049909120916126
       
  • Understanding Distress Among Patients With Cancer Receiving Specialized,
           Supportive Care Services
    • Authors: Rachel Funk-Lawler, Katie Rider Mundey
      First page: 830
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background:Cancer and its treatment can cause persistent psychosocial consequences for patients. Although distress among the general cancer population has been well studied, many patients who report high distress do not receive specialty, follow-up care. We know little about the distress needs of those who attend appointments with support services. Improved knowledge of this subpopulation of patients with cancer may improve supportive care service delivery.Methods:This is a descriptive chart review that examines results from a cancer distress tool in an outpatient supportive care clinic and explores factors associated with distress among patients who attend an appointment for support beyond usual oncologic care. All adult patients with a cancer diagnosis presenting to the supportive care clinic during a 120-day period for an initial intake completed a self-report needs assessment tool. A review of medical records was then conducted. Primarily descriptive statistics, mean comparison, and correlational analysis summarized the data.Results:Nearly 48% of individuals rated very severe distress in at least one area of functioning. Areas with the highest average distress ratings included pain, fatigue, sleep, and anxiety. No significant associations were found between total distress scores and demographic or illness-related variables. Anxiety and depression were higher among those scheduled to see a behavioral health specialist than a palliative provider.Conclusions:Patient and illness factors were not associated with needs among those who attended appointments with support providers. Study results suggest that a biopsychosocial approach from interdisciplinary providers is warranted to manage the needs of patients referred for additional supportive care.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-02-18T09:35:16Z
      DOI: 10.1177/1049909120905780
       
  • Inter-Rater Reliability of the Phase of Illness Tool in Pediatric
           Palliative Care
    • Authors: Kimberley Burke, Lucy H. Coombes, Ann Petruckevitch, Anna-Karenia Anderson
      First page: 837
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background:Phase of Illness is used to describe the stages of a patient’s illness in the palliative care setting. Categorization is based on individual needs, family circumstances, and the adequacy of a care plan. Substantial (κ = .67) and moderate (κ = .52) inter-rater reliability is demonstrated when categorizing adults; however, there is a lack of similar studies in pediatrics.Objective:To test the inter-rater reliability of health-care professionals when assigning pediatric palliative care patients to a Phase of Illness. Furthermore, to obtain user views on phase definitions, ease of assignment, feasibility and acceptability of use.Method:A prospective cohort study in which up to 9 health-care professionals’ independently allocated 80 pediatric patients to a Phase of Illness and reported on their experiences. This study took place between June and November 2017.Results:Professionals achieved a moderate level of agreement (κ = 0.50). Kappa values per phase were as follows: stable = 0.63 (substantial), unstable = 0.26 (fair), deteriorating = 0.45 (moderate), and dying = 0.43 (moderate). For the majority of allocations, professionals report that the phase definitions described patients very well (76.1%), and they found it easy to assign patients (73.5%). However, the unstable phase caused the most uncertainty.Conclusion:The results of this study suggest Phase of Illness is a moderately reliable, acceptable, and feasible tool for use in pediatric palliative care. Current results are similar to those found in some adult studies. However, in a quarter of cases, users report some uncertainty in the application of the tool, and further study is warranted to explore whether suggested refinements improve its psychometric properties.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-03-19T09:54:14Z
      DOI: 10.1177/1049909120912674
       
  • Does Time for (in)Direct Nursing Care Activities at the End of Life for
           Patients With or Without Specialized Palliative Care in a University
           Hospital Differ' A Retrospective Analysis
    • Authors: Monica C. Fliedner, Monika Hagemann, Steffen Eychmüller, Cynthia King, Christa Lohrmann, Ruud J. G. Halfens, Jos M. G. A. Schols
      First page: 844
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background:Nurses’ end of life (EoL) care focuses on direct (eg, physical) and indirect (e,g, coordination) care. Little is known about how much time nurses actually devote to these activities and if activities change due to support by specialized palliative care (SPC) in hospitalized patients.Aims:(1) Comparing care time for EoL patients receiving SPC to usual palliative care (UPC);(2) Comparing time spent for direct/indirect care in the SPC group before and after SPC.Methods:Retrospective observational study; nursing care time for EoL patients based on tacs® data using nonparametric and parametric tests. The Swiss data method tacs measures (in)direct nursing care time for monitoring and cost analyses.Results:Analysis of tacs® data (UPC, n = 642; SPC, n = 104) during hospitalization before death in 2015. Overall, SPC patients had higher tacs® than UPC patients by 40 direct (95% confidence interval [CI]: 5.7-75, P = .023) and 14 indirect tacs® (95% CI: 6.0-23, P < .001). No difference for tacs® by day, as SPC patients were treated for a longer time (mean number of days 7.2 vs 16, P < .001).Subanalysis for SPC patients showed increased direct care time on the day of and after SPC (P < .001), whereas indirect care time increased only on the day of SPC.Conclusions:This study gives insight into nurses’ time for (in)direct care activities with/without SPC before death. The higher (in)direct nursing care time in SPC patients compared to UPC may reflect higher complexity. Consensus-based measurements to monitor nurses’ care activities may be helpful for benchmarking or reimbursement analysis.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-03-17T10:31:30Z
      DOI: 10.1177/1049909120905779
       
  • Factors Affecting Decisions Regarding Terminal Care Locations of Patients
           With Metastatic Breast Cancer
    • Authors: Noriko Nogami, Katsuya Nakai, Yoshiya Horimoto, Akio Mizushima, Mitsue Saito
      First page: 853
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background:Metastatic breast cancer (MBC) is generally incurable, but patients can survive longer than those with other cancer types. Treatment strategies for MBC are complex, and it is difficult to establish evidence of efficacy since symptoms and patient backgrounds vary markedly. Some patients struggle to decide where to receive end-of-life care, despite palliative care intervention, and some die in unexpected places. With the aim of ascertaining the best way to intervene on behalf of patients with end-stage breast cancer, we retrospectively examined interventions provided by our palliative care team. We investigated factors influencing the decision-making processes of patients with MBC regarding end-of-life care locations and where patients actually died.Methods:Clinical records of 44 patients with MBC, all Japanese women, who received palliative care interventions at our hospital, were retrospectively investigated. We examined factors, such as age, possibly impacting decision-making processes regarding the final location and actual place of death.Results:Thirty-five (80%) patients were able to decide where to receive end-of-life care, while the others were not. For these 35 patients, desired locations were the palliative care unit (77%), home palliative care (14%), and the hospital (9%). Age and recurrence-free survival (RFS) were factors influencing patients’ decision-making processes (P = .030 and .044, respectively). Of the 35 patients, 25 (71%) were able to receive end-of-life care at their desired locations.Conclusions:Young patients and those with short RFS struggled with making decisions regarding where to receive end-of-life care. Such patients might benefit from prompt introduction of advanced care planning.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-01-23T10:09:38Z
      DOI: 10.1177/1049909119901154
       
  • Advanced Stage of Disease and Systemic Inflammation as Factors Associated
           With Referral of Patients With Colorectal Cancer to a Palliative Care Unit
           
    • Authors: Thiago Huaytalla Silva, Wilza Arantes Ferreira Peres, Karla Santos da Costa Rosa, Arthur Orlando Correa Schilithz, Livia Costa de Oliveira, Leonardo Borges Murad
      First page: 859
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Objective:To identify factors associated with referral to an exclusive palliative care unit (PCU) in patients with colorectal cancer (CRC).Methods:Retrospective cohort study with patients having CRC of both sexes treated at a hospital unit, aged ≥20 years. Data were extracted from the medical records of pretreatment patients between January 2008 and August 2014. The outcome was referral to the PCU within 5 years. Logistic regression analyses were performed to assess whether sociodemographic, clinical, nutritional, and biochemistry data were associated to referral, generating odds ratios (OR), and 95% confidence intervals (CI).Results:Four hundred fifteen patients were evaluated. The Patient-Generated Subjective Global Assessment demonstrated a prevalence of malnutrition of 57.3%. One hundred one (24.3%) patients were referred to the PCU after 16.3 months (interquartile range: 7.2-33.5). These patients were more likely to be at an advanced stage of the disease and have malnutrition and exacerbated systemic inflammation. Tumor stage III and IV (OR: 2.05; 95% CI: 1.12-3.76) and neutrophil-to-lymphocyte ratio (NLR) ≥3 (OR: 1.89; 95% CI: 1.12-3.17) were predictors of an increased chance of referral to the PCU.Conclusion:Advanced disease stage and NLR were associated with referral of patients with CCR to a PCU.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-02-07T11:52:11Z
      DOI: 10.1177/1049909120902789
       
  • The Role of Palliative Care in Caring for the Families of Patients With
           COVID-19
    • Authors: Melissa Bakar, Elizabeth Capano, Melissa Patterson, Brooke McIntyre, Chaplain Jean Walsh
      First page: 866
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      In palliative care, we strive to provide care to the whole patient. When we think about the whole patient, we include the people who are important in our patients' lives. Our New York City-based palliative care team has found that caring for patients' loved ones has proven to be an even more important aspect of the care we have provided during the COVID epidemic. In this article, we describe the multicomponenet interdisciplinary interventions we have implemented to enhance our ability to create a therapeutic alliance with family members and facilitate the provision of goal concordant care to patients with COVID during this extremely difficult time.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-06-08T10:08:04Z
      DOI: 10.1177/1049909120931506
       
  • Palliative Care Team Involvement in Patients With COVID-19 in New York
           City
    • Authors: Reiichiro Obata, Tetsuro Maeda, Dahlia Rizk, Toshiki Kuno
      First page: 869
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      Background:With the highest number of cases in the world as of April 13, 2020, New York City (NYC) became the epicenter of the global coronavirus disease 2019 (COVID-19) pandemic. The data regarding palliative team involvement in patients with COVID-19, however, remains scarce. We aimed to investigate outcomes of palliative team involvement for the patients with COVID-19 in NYC.Methods:Consecutive 225 patients with confirmed COVID-19 requiring hospitalization in our urban academic medical center in NYC were analyzed. Patients were divided into 2 groups, those with a palliative care consult (palliative group: 14.2% [n = 32]) versus those with no palliative care consult (no palliative group: 85.8% [n = 193]).Results:The palliative group was older and had more comorbidities. During the hospital course, the palliative group had more intensive care unit stays, rapid response team activations, and more use of vasopressors (P < .05). Patients with palliative care had higher rates of invasive mechanical ventilation than those without (46.9% vs 10.4%, P < .001). Cardiopulmonary resuscitation was performed in 12 patients (6.5% vs 5.2%, P = .77) and death rate was 100% in both subsets. Notably, initial code status was not different between the 2 groups, however, code status at discharge was significantly different between them (P < .001). The rate of full code decreased by 70% in the palliative group and by 47.5% in the no palliative care group from admission to the time of death.Conclusions:Critically ill patients hospitalized for COVID-19 benefit from palliative team consults by helping to clarify advanced directives and minimize futile resuscitative efforts.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-07-08T10:20:14Z
      DOI: 10.1177/1049909120940986
       
  • Discussing Goals of Care in a Pandemic: Precedent for an Unprecedented
           Situation
    • Authors: Ariane Lewis
      First page: 873
      Abstract: American Journal of Hospice and Palliative Medicine®, Ahead of Print.
      The COVID-19 pandemic has precipitated the need for frequent end-of-life discussions. The circumstances surrounding these conversations are quite atypical. Here, I describe one such goals-of-care discussion during the pandemic and how I relied on the precedent of prior goals-of-care discussions to guide me through an unprecedented situation.
      Citation: American Journal of Hospice and Palliative Medicine®
      PubDate: 2020-07-14T10:18:43Z
      DOI: 10.1177/1049909120941881
       
 
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