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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
Kip Waite, Jane Rhule, David Bush, Barry Meisenberg
We undertook a retrospective review of a subset of expired patients at our community hospital to evaluate end-of-life care patterns and the use of advanced care planning tools among patients who died in the hospital. These 162 expired patients fell into 1 of the 3 diagnosis-related groups of cardiac, respiratory, or infectious disease. Seventy-nine percent of patients arrived to the hospital with no requested limitations in the extent of resuscitative efforts, even though 98% of all patients had major or extreme severity of illness and risk of mortality scores...
October 11, 2016: American Journal of Hospice & Palliative Care
Joseph Sacco, Rebecca Virata
The discontinuation of life sustaining medical treatment (LSMT) in severely and permanently impaired neonates, especially artificial nutrition and hydration (ANH) is subject to uncertainty and controversy. Definitive clinical guidelines are lacking, clinical research is limited, ethical disagreement is commonplace, and while case and statutory law provide legal underpinning for the practice in defined circumstances, uncertainty in this realm likely influences clinical practice. We use the case of a neurologically devastated neonate to highlight and review these arenas, and show how, using available legal, ethical, and clinical standards and practice, the case of Baby O was resolved, and to underline the need for further research in neonatal palliative care...
October 11, 2016: American Journal of Hospice & Palliative Care
Yuya Hagiwara, Jeanette Ross, Shuko Lee, Sandra Sanchez-Reilly
BACKGROUND: Few educational interventions have been developed to teach Family Meeting (FM) communication skills at the undergraduate level. We developed an innovative curriculum to address this gap. METHODS: Fourth year medical students during 2011-2013 (n = 674) completed training for conducting a FM. To assess the effectiveness of this training, students completed a FM Objective Structured Clinical Exam (OSCE) that included 15 domains rated on a 1-5 point Likert scale...
September 20, 2016: American Journal of Hospice & Palliative Care
Aileen Chen, Erwin J Loquias, Ramesh Roshan, Richard Levene, Raymond Zelhof, Terry Hickey, Gail Austin Cooney, Faustino Gonzalez
BACKGROUND: Diphenhydramine (DPH) is most commonly used via oral, topical, intramuscular (IM) and intravenous (IV) routes for the palliation of pruritus, treatment of extrapyramidal symptoms, management of parkinsonism and for allergic reactions. However, many hospice patients are unable to take oral medications and/or do not have IV access. Moreover, topical administration has a relatively slow rate of absorption. For this reason, in the hospice setting it is not uncommon for diphenhydramine to be administered via the subcutaneous (SC) route secondary to its ease of access, low infection rates and its low levels of discomfort...
September 13, 2016: American Journal of Hospice & Palliative Care
Yuri Jang, Nan Sook Park, David A Chiriboga, Kavita Radhakrishnan, Miyong T Kim
OBJECTIVES: The purposes of the present study were (1) to explore the completion rate of advance directives (ADs) in a sample of Asian Americans and (2) to examine the direct and moderating effects of knowledge of AD, education, and acculturation in predicting AD completion. Education and acculturation were conceptualized as moderators in the link between knowledge and completion of ADs. METHODS: Using data from 2609 participants in the 2015 Asian American Quality of Life survey (aged 18-98), logistic regression analyses on AD completion were conducted, testing both direct and moderating effects...
September 13, 2016: American Journal of Hospice & Palliative Care
Kelly Arnett, Rebecca L Sudore, David Nowels, Cindy X Feng, Cari R Levy, Hillary D Lum
BACKGROUND: Interprofessional health care team members consider advance care planning (ACP) to be important, yet gaps remain in systematic clinical routines to support ACP. A clearer understanding of the interprofessional team members' perspectives on ACP clinical routines in diverse settings is needed. METHODS: One hundred eighteen health care team members from community-based clinics, long-term care facilities, academic clinics, federally qualified health centers, and hospitals participated in a 35-question, cross-sectional online survey to assess clinical routines, workflow processes, and policies relating to ACP...
September 6, 2016: American Journal of Hospice & Palliative Care
Fukiko Mikan, Makoto Wada, Michiko Yamada, Ayaka Takahashi, Hideki Onishi, Mayumi Ishida, Kazuki Sato, Sachiko Shimizu, Motohiro Matoba, Mitsunori Miyashita
PURPOSE: This study was designed to clarify the association between pain and quality of life (QOL) of Japanese patients with cancer using a cancer-specific QOL scale (European Organization for Research and Treatment of Cancer [EORTC] QLQ-C15-PAL) in 3 care settings (outpatient, inpatient, and palliative care units [PCUs]). METHODS: We examined the above-mentioned purpose for the total of 404 patients. RESULTS: In outpatients, physical, emotional functioning (EF), and global health status/QOL (QL item) were significantly correlated with average pain, and their correlation coefficients were -0...
September 2016: American Journal of Hospice & Palliative Care
Maria Heckel, Sonja Bussmann, Stephanie Stiel, Christoph Ostgathe, Martin Weber
PURPOSE: To validate the Quality of Dying and Death (QoDD) instrument for health professionals (QoDD-D-MA) and to test its feasibility in 2 German palliative care units (PCUs). METHODS: The QoDD was translated from English to German and then retranslated following European Organisation for Research and Treatment of Cancer (EORTC) guidelines. Data were collected in 2 German PCUs to calculate aspects of validity and reliability. RESULTS: Mean total score was 83...
September 2016: American Journal of Hospice & Palliative Care
Briana J Jegier, Sean O'Mahony, Julie Johnson, Rita Flaska, Anthony Perry, Mary Runge, Teri Sommerfeld
OBJECTIVE: Rush University Medical Center (RUMC) and Horizon Hospice opened the first centralized inpatient hospice unit (CIPU) in a Chicago academic medical center in 2012. This study examined if there was a difference in cost or length of stay (LOS) in a CIPU compared to hospice care in scattered beds throughout RUMC. STUDY DESIGN AND METHODS: This retrospective, cross-sectional study compared cost and LOS for patients admitted to the CIPU (n = 141) and those admitted to hospice scattered beds (SBM) throughout RUMC (n = 56)...
September 2016: American Journal of Hospice & Palliative Care
Rachel L Novak, Brie N Noble, Erik K Fromme, Michael O Tice, Jessina C McGregor, Jon P Furuno
Antibiotics are frequently used in hospice care, despite limited data on safety and effectiveness in this patient population. We surveyed Oregon hospice programs on antibiotic policies and prescribing practices. Among 39 responding hospice programs, the median reported proportion of current census using antibiotics was 10% (interquartile range = 3.5%-20.0%). Approximately 31% of responding hospice programs had policies for antibiotic initiation, 17% of hospice programs had policies for antibiotic discontinuation, and 95% of hospice programs had policies for managing drug interactions...
September 2016: American Journal of Hospice & Palliative Care
Jonathan Bergman, Eric Ballon-Landa, Steven E Lerman, Lorna Kwan, Carol J Bennett, Mark S Litwin
BACKGROUND: Web-based modules provide a convenient and low-cost education platform, yet should be carefully designed to ensure that learners are actively engaged. In order to improve attitudes and knowledge in end-of-life (EOL) care, we developed a web-based educational module that employed hyperlinks to allow users access to auxiliary resources: clinical guidelines and seminal research papers. METHODS: Participants took pre-test evaluations of attitudes and knowledge regarding EOL care prior to accessing the educational module, and a post-test evaluation following the module intervention...
September 2016: American Journal of Hospice & Palliative Care
Adam E Singer, Tayla Ash, Claudia Ochotorena, Karl A Lorenz, Kelly Chong, Scott T Shreve, Sangeeta C Ahluwalia
PURPOSE: Family meetings can be challenging, requiring a range of skills and participation. We sought to identify tools available to aid the conduct of family meetings in palliative, hospice, and intensive care unit settings. METHODS: We systematically reviewed PubMed for articles describing family meeting tools and abstracted information on tool type, usage, and content. RESULTS: We identified 16 articles containing 23 tools in 7 categories: meeting guide (n = 8), meeting planner (n = 5), documentation template (n = 4), meeting strategies (n = 2), decision aid/screener (n = 2), family checklist (n = 1), and training module (n = 1)...
September 2016: American Journal of Hospice & Palliative Care
Manali I Patel, Jay Bhattacharya, Steven M Asch, James Kahn
OBJECTIVES: To evaluate the documentation of advance directive (ADs) and physician orders for life-sustaining treatment (POLST) with acceptance of palliative care (PC) services referral among patients with cancer. METHODS: We retrospectively reviewed veterans with advanced cancers at the Veterans Administration Palo Alto Health Care System. Chi-square tests estimated AD and POLST documentation and referral to PC. Logistic regression models estimated the odds of AD and POLST documentation and PC referral...
September 2016: American Journal of Hospice & Palliative Care
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