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Hospice and palliative care

Mark Corbett
Conceivably, in an ideal world, all patients with a life-limiting illness would receive optimal hospice and palliative care so that no one would ever wish to hasten their own death. The reality, however, is that despite provision of optimal hospice and palliative care, individuals with terminal illness experience suffering, loss of meaning, or deterioration in quality of life to the extent where they express the desire to expedite the dying process. While there has been extensive discussion surrounding physician-assisted death (PAD), there has been less attention paid to the practice of voluntary stopping eating and drinking (VSED) near the end of life...
2016: Narrative Inquiry in Bioethics
Thaddeus Mason Pope
This symposium includes twelve personal narratives from those who have personally participated in voluntarily stopping eating and drinking (VSED). This issue also includes three commentaries on these narratives by experts in philosophy, palliative care, and hospice medicine. The successes, challenges, and observations described by these narrative and commentary authors will not only inform the academic debate about the legitimacy of VSED but will also inform much needed practical guidance for patients, clinicians, and family members on how they can best implement and support VSED...
2016: Narrative Inquiry in Bioethics
Antonio Pangallo, Lara Zibarras, Fiona Patterson
OBJECTIVES: Relatively little research has been directed toward the assessment of resilience in the health care context. Given the stressors associated with the provision of health care, the present study describes the development and evaluation of a situational judgement test (SJT) designed to assess resilience in palliative care health care workers. METHODS: An SJT was developed to measure behaviours associated with resilience in a palliative care context. Next, SJT reliability and validity analyses were assessed in a sample of acute ward, hospice and community palliative care workers (n = 284)...
November 2016: Medical Education
Shannon M Dunlay, Jacob J Strand, Sara E Wordingham, John M Stulak, Angela J Luckhardt, Keith M Swetz
BACKGROUND: Despite the ability of left ventricular assist device as destination therapy (DT-LVAD) to prolong survival for many patients with advanced heart failure, little is known about the eventual end-of-life care that patients with DT-LVAD receive. METHODS AND RESULTS: All patients undergoing DT-LVAD at the Mayo Clinic in Rochester, Minnesota, from January 1, 2007, to September 30, 2014, who subsequently died before July 1, 2015, were included. Information about end-of-life care was obtained from documentation in the electronic medical record...
October 2016: Circulation. Heart Failure
Saud M Alsanad, Rachel L Howard, Elizabeth M Williamson
BACKGROUND: Herb/Dietary Supplements (HDS) are the most popular Complementary and Alternative Medicine (CAM) modality used by cancer patients and the only type which involves the ingestion of substances which may interfere with the efficacy and safety of conventional medicines. This study aimed to assess the level of use of HDS in cancer patients undergoing treatment in the UK, and their perceptions of their effects, using 127 case histories of patients who were taking HDS. Previous studies have evaluated the risks of interactions between HDS and conventional drugs on the basis on numbers of patient using HDSs, so our study aimed to further this exploration by examining the actual drug combinations taken by individual patients and their potential safety...
October 18, 2016: BMC Complementary and Alternative Medicine
Mimi Jenko, Nancy M Short
Bereavement services for families are an established part of hospice and palliative care. However, patients also die in the acute care and long-term care environments. Often, hospice is not involved, creating a potential gap in care. This article recounts a journey to improve care for all families of deceased patients, despite the presence or absence of hospice. A palliative care clinical nurse specialist led a quality improvement team, which used a systems thinking approach to develop and implement a downloadable bereavement booklet for families...
November 2016: Dimensions of Critical Care Nursing: DCCN
Sarah Amador, Claire Goodman, Louise Robinson, Elizabeth L Sampson
BACKGROUND: People living and dying with non-cancer diagnoses, including dementia, have poorer access to generalist and specialist palliative care than people with cancer, and experience worse outcomes in terms of pain and symptom control, and quality and experience of care. In the UK, the National Council for Palliative Care (NCPC) ran a national survey of services for end-of-life care for people with dementia (2008) in which 16 services were identified, and reported on case studies and examples of good practice...
October 14, 2016: BMJ Supportive & Palliative Care
Robert J Zalenski, Spencer S Jones, Cheryl Courage, Denise R Waselewsky, Anna S Kostaroff, David Kaufman, Afzal Beemath, John Bronfman, James W Castillo, Hicham Krayem, Anthony Marinelli, Bradley Milner, Maria Teresa Palleschi, Mona Tareen, Sheri Testani, Ayman Soubani, Julie Walch, Judy Wheeler, Sonali Wilborn, Hanna Granovsky, Robert D Welch
CONTEXT: There are few multi-center studies that examine the impact of systematic screening for palliative care and specialty consultation in the ICU. OBJECTIVE: To determine the outcomes of receiving palliative care consultation (PCC) for patients who screened positive on palliative care referral criteria. METHODS: In a prospective quality assurance intervention with a retrospective analysis, the covariate balancing propensity score method was utilized to estimate the conditional probability of receiving a PCC and to balance important covariates...
October 5, 2016: Journal of Pain and Symptom Management
(no author information available yet)
A good palliative care service is responsive, available to families where they want it, provided round the clock, and co-ordinated by a lead healthcare professional or team. This is the view of one hospice director of care in response to a draft good practice guideline on end of life care from the National Institute for Health and Care Excellence.
October 7, 2016: Nursing Children and Young People
Benjamin Djulbegovic, Athanasios Tsalatsanis, Rahul Mhaskar, Iztok Hozo, Branko Miladinovic, Howard Tuch
INTRODUCTION: Management choices at the end of life are high-stake decisions fraught with emotions, chief among is regret. Our objective in this paper is to test the utility of a regret-based model to facilitate referral to hospice care while helping patients clarify their preferences on how they wish to spend the remaining days of their lives. METHODS: A prospective cohort study that enrolled consecutive adult patients (n = 178) aware of the terminal nature of their disease...
October 3, 2016: European Journal of Cancer
Rachael L Morton, Angela C Webster, Kevin McGeechan, Kirsten Howard, Fliss E M Murtagh, Nicholas A Gray, Peter G Kerr, Michael J Germain, Paul Snelling
BACKGROUND AND OBJECTIVES: We aimed to determine the proportion of patients who switched to dialysis after confirmed plans for conservative care and compare survival and end of life care among patients choosing conservative care with those initiating RRT. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A cohort study of 721 patients on incident dialysis, patients receiving transplants, and conservatively managed patients from 66 Australian renal units entered into the Patient Information about Options for Treatment Study from July 1 to September 30, 2009 were followed for 3 years...
October 3, 2016: Clinical Journal of the American Society of Nephrology: CJASN
Lisa C Lindley
BACKGROUND: California implemented pediatric palliative care legislations that allowed children to receive curative and supportive care from diagnosis of a life-threatening, serious illness in 2010. Palliative care policies may improve access to hospice care as children near end of life. OBJECTIVES: To examine the effect of the palliative care policy on hospice utilization for children and their families was investigated. RESEARCH DESIGN: Using 2007 and 2010 California Medicaid data, a difference-in-difference analysis was conducted to analyze hospice use (i...
September 29, 2016: Journal of Pain and Symptom Management
Amir Shanan, Brenda Stevens, Gail Bishop, Kathleen Cooney, Shea Cox, Robin Downing, Kathy Mitchener, Nancy Soares, Tammy Wynn
End-of-life (EOL) care and decisionmaking embody the critical final stage in a pet's life and are as important and meaningful as the sum of the clinical care provided for all prior life stages. EOL care should focus on maximizing patient comfort and minimizing suffering while providing a collaborative and supportive partnership with the caregiver client. Timely, empathetic, and nonjudgmental communication is the hallmark of effective client support. Veterinarians should not allow an EOL patient to succumb to a natural death without considering the option of euthanasia and ensuring that other measures to alleviate discomfort and distress are in place...
September 29, 2016: Journal of the American Animal Hospital Association
Rebecca Collins, Marianne Matzo
This article is the second in a series on palliative care developed in collaboration with the Hospice and Palliative Nurses Association (HPNA; The HPNA aims to guide nurses in preventing and relieving suffering and in giving the best possible care to patients and families, regardless of the stage of disease or the need for other therapies. The HPNA offers education, certification, advocacy, leadership, and research.
October 2016: American Journal of Nursing
Melanie J Cozad, Lisa C Lindley, Sandy J Mixer
The use of agency nurses offers flexibility in filling registered nurse (RN) openings during times of shortage, yet little is known about their use in specialized palliative care. In an effort to fill this knowledge gap, this study determined whether significant relationships existed between full-time and part-time RN vacancies and the use of agency RNs within specialized hospices that deliver perinatal end-of-life care to women and their families in the event of miscarriage, ectopic pregnancy, or other neonatal complications resulting in death...
September 27, 2016: Policy, Politics & Nursing Practice
Zahra Rahemi, Christine Lisa Williams
This integrative review was conducted to examine the evidence for understanding diversity in end-of-life preferences among older adults of underrepresented groups. Findings from 21 studies were critically examined, grouped, and compared across studies, populations, and settings. Five major themes emerged: advance directives, hospice and palliative care, communication, knowledge and information, and home and family. Despite multidisciplinary attention, content and methodological limitations narrowed understanding of what matters most to these groups when making decisions at end of life...
September 26, 2016: ANS. Advances in Nursing Science
Clare Gardiner, Christine Ingleton, Tony Ryan, Sue Ward, Merryn Gott
BACKGROUND: It is important to understand the costs of palliative and end-of-life care in order to inform decisions regarding cost allocation. However, economic research in palliative care is very limited and little is known about the range and extent of the costs that are involved in palliative care provision. AIM: To undertake a systematic review of the health and social care literature to determine the range of financial costs related to a palliative care approach and explore approaches used to measure these costs...
September 26, 2016: Palliative Medicine
Anna Porteous, Felicity Dewhurst, William Keith Gray, Paul Coulter, Ulka Karandikar, Rachel Kiltie, Lucy Lowery, Fiona MacCormick, Ann Paxton, Jonathan Pickard, Grace Rowley, Jennifer Vidrine, Rowan Walmsley, Kerry Waterfield, Donna Weiand, Eleanor Grogan
OBJECTIVES: The UK National Institute for Health and Care Excellence (NICE) indicate that palliative care patients are at high risk of delirium and should be screened for it using the short confusion assessment method (short CAM). This study aimed to assess the perceptions of the short CAM for delirium screening amongst health-care workers in specialist palliative care inpatient units (SPCUs) and to investigate its use as a screening instrument. METHODS: Patients in 5 SPCUs in the North East of England were screened for delirium using the short CAM and a staff survey assessed the acceptability of the short-CAM in this setting...
September 2, 2016: International Journal of Palliative Nursing
Tali Samson, Esther Iecovich, Pesach Shvartzman
CONTEXT: Exposure to human suffering may have ramifications for the professional quality of life (ProQol) of palliative care teams. The ProQol scale was designed to assess both negative and positive work-related outcomes, and has been used recently for the evaluation of work-related outcomes among palliative care workers. However, the assessment of ProQol among Israeli hospice workers is scant. OBJECTIVES: Assessment of the psychometric properties and the factor structure of the Hebrew version of the 30-item ProQol questionnaire...
September 19, 2016: Journal of Pain and Symptom Management
Minnie Bluhm, Cathleen M Connell, Raymond G De Vries, Nancy K Janz, Kathleen E Bickel, Maria J Silveira
PURPOSE: The value of chemotherapy for patients with cancer in the last weeks of life warrants examination. Late chemotherapy may not improve survival or quality of life but typically precludes hospice enrollment and may result in additional symptoms, increased use of other aggressive treatments, and worsening quality of life. Few studies have explored oncologists' rationales for administering chemotherapy near death. This study examines the self-reported factors that influence oncologists' decisions about late chemotherapy...
September 20, 2016: Journal of Oncology Practice
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