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American Journal of Hospice & Palliative Care

Meredith A MacKenzie, Alexandra Hanlon
This study aimed to examine the role of diagnosis in health-care utilization patterns after hospice enrollment. Using 2007 National Home and Hospice Care Survey data from hospice patients with heart failure (n = 311) and cancer (n = 946), we analyzed emergency service use and discharge to hospital via logistic regression pre- and postpropensity score matching. Prematching, patients with heart failure had twice the odds of emergency services use than patients with cancer ( P < .001) and twice the odds of discharge to hospital ( P = ...
January 1, 2017: American Journal of Hospice & Palliative Care
Say Salomon, Elizabeth Chuang, Deepa Bhupali, Daniel Labovitz
BACKGROUND: Site of death is an important quality indicator for patients with terminal illness. Racial and ethnic disparities exist in the quality of end-of-life care. This study explores the site of death of patients admitted for and dying of complications of acute neurovascular events in a hospital network in an urban, low-income, predominantly minority community. METHODS: This is a retrospective cohort study of patients admitted to 1 of 3 general hospitals that are part of an academic medical center in Bronx, New York, with the diagnosis of acute ischemic stroke, intracerebral hemorrhage, or subarachnoid hemorrhage who died during the index admission or were discharged with hospice services...
January 1, 2017: American Journal of Hospice & Palliative Care
Brooke Worster, Declan Kennedy Bell, Vibin Roy, Amy Cunningham, Marianna LaNoue, Susan Parks
BACKGROUND: Palliative care is associated with significant benefits, including reduced pain and suffering, an increased likelihood of patients dying in their preferred location, and decreased health-care expenditures. Racial and ethnic disparities are well-documented in hospice use and referral patterns; however, it is unclear whether these disparities apply to inpatient palliative care services. OBJECTIVE: To determine if race is a significant predictor of time to inpatient palliative care consult, patient enrollment in hospice, and patients' overall hospital length of stay among patients of an inpatient palliative care service...
January 1, 2017: American Journal of Hospice & Palliative Care
Asher Edwards, Samuel Nam
As the baby boomer generation ages, the need for palliative care services will be paramount and yet training for palliative care physicians is currently inadequate to meet the current palliative care needs. Nonspecialty-trained physicians will need to supplement the gap between supply and demand. Yet, no uniform guidelines exist for the training of internal medicine residents in palliative care. To our knowledge, no systematic study has been performed to evaluate how internal medicine residencies currently integrate palliative care into their training...
January 1, 2017: American Journal of Hospice & Palliative Care
Tsovinar Arutyunyan, Folafoluwa Odetola, Ryan Swieringa, Matthew Niedner
OBJECTIVE: Parents of seriously ill children require attention to their spiritual needs, especially during end-of-life care. The objective of this study was to characterize parental attitudes regarding physician inquiry into their belief system. MATERIALS AND MAIN RESULTS: A total of 162 surveys from parents of children hospitalized for >48 hours in pediatric intensive care unit in a tertiary academic medical center were analyzed. Forty-nine percent of all respondents and 62% of those who identified themselves as moderate to very spiritual or religious stated that their beliefs influenced the decisions they made about their child's medical care...
December 9, 2016: American Journal of Hospice & Palliative Care
Emilie Green, Sarah Ward, Will Brierley, Ben Riley, Henna Sattar, Tim Harris
BACKGROUND: Patients with palliative care needs frequently attend the emergency department (ED). There is no international agreement on which patients are best cared for in the ED, compared to the primary care setting or direct admission to the hospital. This article presents the quantitative phase of a mixed-methods service evaluation, exploring the reasons why patients with palliative care needs present to the ED. METHODS: This is a single-center, observational study including all patients under the care of a specialist palliative care team who presented to the ED over a 10-week period...
November 30, 2016: American Journal of Hospice & Palliative Care
Cheryl A Krause-Parello, Cari Levy, Elizabeth Holman, John E Kolassa
The United States is home to 23 million veterans. In many instances, veterans with serious illness who seek healthcare at the VA receive care from a palliative care service. Animal-assisted intervention (AAI) is gaining attention as a therapeutic stress reducing modality; however, its effects have not been well studied in veterans receiving palliative care in an acute care setting. A crossover repeated-measures study was conducted to examine the effects of an animal-assisted intervention (AAI) in the form of a therapy dog on stress indicators in 25 veterans on the palliative care service at the VA Eastern Colorado Healthcare System in Denver, CO...
November 28, 2016: American Journal of Hospice & Palliative Care
Jennifer L Tripken, Cathy Elrod, Susan Bills
BACKGROUND/OBJECTIVES: Advance care planning (ACP) is an iterative, complex, and dynamic process of discussion, decision-making, and documentation about end-of-life care. The extent to which this process takes place in older adults in diverse socioeconomic settings is not well documented. The aim of this study was to assess the knowledge, attitudes, and beliefs about ACP among older adults in two socioeconomically diverse settings to identify the individual and contextual factors that influence behaviors regarding end-of-life care...
November 15, 2016: American Journal of Hospice & Palliative Care
Dorothy Brooten, JoAnne M Youngblut, Carmen Caicedo, Teresa Del Moral, G Patricia Cantwell, Balagangadhar Totapally
BACKGROUND AND OBJECTIVES: Infant/child death is described as a most stressful life event; however, there are few reports of effects on parent physical health during the first year after the death. The study's purpose is to examine the patterns of parent acute illnesses, hospitalizations, and medication changes over 1 to 13 months after neonatal intensive care unit (NICU) or pediatric intensive care unit (PICU) infant/child death in 3 racial/ethnic groups. METHODS: Secondary analyses were conducted with longitudinal data on parent health and functioning 1 to 13 months after infant/child NICU/PICU death...
November 15, 2016: American Journal of Hospice & Palliative Care
Lisa C Lindley, Sheri L Edwards
OBJECTIVE: To map and describe the geographic distribution of pediatric hospice care need versus supply in California over a 4-year time period (2007-2010). METHODS: Multiple databases were used for this descriptive longitudinal study. The sample consisted of 2036 children and adolescent decedents and 136 pediatric hospice providers. Geocoded data were used to create the primary variables of interest for this study-need and supply of pediatric hospice care. Geographic information systems were used to create heat maps for analysis...
November 11, 2016: American Journal of Hospice & Palliative Care
Jennifer Healy, Phylliss Chappell, Shuko Lee, Jeanette Ross, Sandra Sanchez-Reilly
CONTEXT: Dying is a natural process, yet physicians are often uncomfortable caring for dying patients. Learners have limited exposure to curriculum on caring for dying patients and often navigate these encounters without appropriate skills and confidence. We developed and implemented the Double Parallel Curriculum in Palliative Care (DP-PC): End-of-Life (EOL) module. The DP-PC focuses on teaching third-year medical students (MS3) to not only take care of patients in their last hours of life but give learners the confidence to teach patient's families what to expect as they hold vigil at their loved one's bedside...
November 7, 2016: American Journal of Hospice & Palliative Care
Hyunjin Noh, Junghyun Kim, Omar T Sims, Shaonin Ji, Patricia Sawyer
Associations of perceived health and social and physical activities with end-of-life (EOL) issues have been rarely studied, not to mention racial disparities in such associations. To address this gap, this study examined racial differences in the associations of perceived health and levels of social and physical activities with advance care planning, EOL concerns, and knowledge of hospice care among community-dwelling older adults in Alabama. Data from a statewide survey of 1044 community-dwelling older adults on their long-term care needs were analyzed using descriptive statistics and logistic and linear regressions...
November 4, 2016: American Journal of Hospice & Palliative Care
Laurence Tan, Lai Kiow Sim, Lynnette Ng, Hui Jin Toh, James Alvin Low
There has been a growing trend in addressing spiritual needs in caring for the person, especially nearing the end of one's life. Advance care planning (ACP) facilitates understanding of preferences and explores the spiritual and existential aspects of care. This study explores the views and preferences of a group of Catholic nuns in Singapore, specifically looking at what was meaningful and valuable to them when determining treatment options at the end of life. Twenty-three nuns were purposively recruited in July 2012...
February 2017: American Journal of Hospice & Palliative Care
Julia Bandini, Christine Mitchell, Zachary D Epstein-Peterson, Ada Amobi, Jonathan Cahill, John Peteet, Tracy Balboni, Michael J Balboni
The hidden curriculum, or the socialization process of medical training, plays a crucial role in the development of physicians, as they navigate the clinical learning environment. The purpose of this qualitative study was to examine medical faculty and students' perceptions of psychological, moral, and spiritual challenges during medical training in caring for critically ill patients. Focus groups were conducted with 25 Harvard Medical School (HMS) students, and interviews were conducted with 8 HMS faculty members...
February 2017: American Journal of Hospice & Palliative Care
On Ying Liu, Theodore Malmstrom, Patricia Burhanna, Miriam B Rodin
BACKGROUND: Research on inpatient palliative medicine reports quality-of-life outcomes and selected "hard" outcomes including pain scores, survival, and readmissions. OBJECTIVE: This case study reports the evolution of an inpatient palliative consultation (IPC) team to show how IPC induces culture change in a hospital that previously had no palliative care. DESIGN: Retrospective chart review. SETTING: A Catholic university-affiliated, inner-city hospital...
February 2017: American Journal of Hospice & Palliative Care
Sio Leng Wong, Sok Man Leong, Cheng Man Chan, Sut Peng Kan, Hon Wai Benjamin Cheng
BACKGROUND: Fan therapy is often suggested for relieving the symptom of dyspnea in patients with advanced cancer, but relevant literature among Asians is limited. OBJECTIVE: Phase 2 clinical trial to assess the clinical feasibility and outcome of using an electric fan to alleviate the symptom of dyspnea in Chinese patients with advanced cancer. METHODS: Thirty patients with advanced cancer having unresolved breathlessness were recruited from Hospice and Palliative Care Centre of Kiang Wu Hospital in Macau...
February 2017: American Journal of Hospice & Palliative Care
Carrie M Henderson, Michael FitzGerald, K Sarah Hoehn, Norbert Weidner
CONTEXT: Palliative sedation is a means of relieving intractable symptoms at the end of life, however, guidelines about its use lack consistency. In addition, ethical concerns persist around the practice. There are reports of palliative sedation in the pediatric literature, which highlight various institutional perspectives. OBJECTIVES: This survey of 4786 pediatric providers sought to describe their knowledge of and current practices around pediatric palliative sedation...
February 2017: American Journal of Hospice & Palliative Care
Tetsusuke Yoshimoto, Shiro Tomiyasu, Toshinari Saeki, Tomohiro Tamaki, Takahiro Hashizume, Masahiko Murakami, Motohiro Matoba
It has been reported that pain relief for patients with cancer is suboptimal in Japan. This has been mainly attributed to inadequate dissemination of the World Health Organization (WHO) guidelines for cancer pain management. To better understand this problem, we reviewed how 6 hospital palliative care teams (HPCTs) used the WHO guidelines for unrelieved pain in a 1-year audit that included 534 patients. The HPCT interventions were classified according to the contents of the WHO guidelines. In our study, HPCT interventions involved opioid prescriptions in >80% of referred patients, and "For the Individual" and "Attention to Detail" were the 2 most important principles...
February 2017: American Journal of Hospice & Palliative Care
Larry D Cripe, David G Hedrick, Kevin L Rand, Debra Burns, Daniella Banno, Ann Cottingham, Debra Litzelman, Mary L Hoffmann, Nora Martenyi, Richard M Frankel PhD
PURPOSE: More physicians need to acquire the skills of primary palliative care. Medical students' clerkship experiences with death, dying, and palliative care (DDPC), however, may create barriers to learning such skills during residency. Whether professional development is differentially affected by DDPC is unknown. This knowledge gap potentially hinders the development of educational strategies to optimize students' preparedness for primary palliative care. METHOD: Third-year students submitted professionalism narratives (N = 4062) during their internal medicine clerkship between 2004 and 2011...
February 2017: American Journal of Hospice & Palliative Care
Dona J Reese, Sarah Buila, Sarah Cox, Jessica Davis, Meaghan Olsen, Elaine Jurkowski
Research documents a lack of access to, utilization of, and satisfaction with hospice care for African Americans. Models for culturally competent hospice services have been developed but are not in general use. Major organizational barriers include (1) lack of funding/budgeting for additional staff for community outreach, (2) lack of applications from culturally diverse professionals, (3) lack of funding/budgeting for additional staff for development of culturally competent services, (4) lack of knowledge about diverse cultures, and (5) lack of awareness of which cultural groups are not being served...
February 2017: American Journal of Hospice & Palliative Care
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