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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
Andrew W Schram, Gavin W Hougham, David O Meltzer, Gregory W Ruhnke
BACKGROUND: There is an emerging literature on the physician competencies most meaningful to patients and their families. However, there has been no systematic review on physician competency domains outside direct clinical care most important for patient- and family-centered outcomes in critical care settings at the end of life (EOL). Physician competencies are an essential component of palliative care (PC) provided at the EOL, but the literature on those competencies relevant for patient and family satisfaction is limited...
August 31, 2016: American Journal of Hospice & Palliative Care
Gloria Bonner, Sharon Williams, Diana Wilkie, Alysha Hart, Glenda Burnett, Geraldine Peacock
BACKGROUND: An initial and vital important step in recruiting participants for church-based hospice and palliative care research is the establishment of trust and credibility within the church community. Mistrust of medical research is an extremely important barrier hindering recruitment in African American (AA) communities. A church-based EOL dementia education project is currently being conducted at four large urban AA churches. Church leaders voiced mistrust concerns of previous researchers who conducted investigations in their faith-based institutions...
August 30, 2016: American Journal of Hospice & Palliative Care
William W Palmer, Francis K Yuen
This investigation explored the relationship between hospice patient disease type, length of stay (LOS) in hospice, and caregiver utilization of grief counseling in bereavement. A 10-year retrospective study was conducted utilizing data from caregivers associated with hospice patients who died between 2004 and 2014. A threshold of inclusion for disease type (≥1.00% of hospice admissions) resulted in a sample size of 3704 patients, comprising 19 different disease types and 348 associated caregivers who received counseling...
August 16, 2016: American Journal of Hospice & Palliative Care
Laura E Miller, Scott A Eldredge, Elizabeth D Dalton
Nurse-patient conversations about pain management are complex. Given recent increases in prescription pain pill abuse, such interactions merit scholarly attention. In-depth interviews with 21 nurses were conducted to explicitly explore nurses' information seeking about pain. The participants in this study gathered pain information from patients through a variety of means and reported facing challenges and dilemmas when communicating with patients about pain management and medicinal preferences. These results have important implications for nurses, patient outcomes, and the broader health-care system and imply that continued educational and intervention efforts are essential in this complicated communicative context...
August 4, 2016: American Journal of Hospice & Palliative Care
Luis O Chavez, Sharon Einav, Joseph Varon
PURPOSE: To investigate how a terminal illness may affect the health-care providers' resuscitation preferences. METHODS: We conducted a cross-sectional survey in 9 health-care institutions located in 4 geographical regions in North and Central America, investigating attitudes toward end-of-life practices in health-care providers. Statistical analysis included descriptive statistics and χ(2) test for the presence of associations (P < 0.05 being significant) and Cramer V for the strength of the association...
August 3, 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
Nan Sook Park, Yuri Jang, Jung Eun Ko, David A Chiriboga
Racial/ethnic minorities tend to underutilize hospice services. Guided by Andersen behavioral health model, the purpose of this study was to explore the predictors of the willingness to use hospice services in racially/ethnically diverse older men and women. Data were drawn from the Survey of Older Floridians: 504 non-Hispanic whites, 360 African Americans, 328 Cuban Americans, and 241 non-Cuban Hispanics. In each group, logistic regression models of the willingness to use hospice were estimated. A greater likelihood of willingness was observed among younger non-Hispanic whites and among African Americans with fewer functional disabilities...
September 2016: American Journal of Hospice & Palliative Care
Shanshan Wei, Fanglin Chen, Hongyan Chen, Ying Guo, David Hui, Sriram Yennurajalingam, Gary Chisholm, En Liu, Zhongli Liao, Li Yang, Heng Cheng, Yuanyuan Zhou, Hong Guo, Eduardo Bruera
BACKGROUND: Understanding the medical decision-making and information disclosure preferences is important for care quality. OBJECTIVES: To examine the feasibility of using the questionnaires and to identify modifications needed in the following study. DESIGN: Thirty-three pairs of patients with advanced cancers and their caregivers were asked to complete the questionnaires. RESULTS: More than 60% of patients and caregivers had an educational level of middle school and below...
September 2016: American Journal of Hospice & Palliative Care
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