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https://www.readbyqxmd.com/read/28073292/health-care-utilization-after-hospice-enrollment-in-patients-with-heart-failure-and-cancer
#1
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
https://www.readbyqxmd.com/read/28072478/the-difficulties-experienced-by-nurses-and-healthcare-staff-involved-in-the-process-of-breaking-bad-news
#2
Clare Warnock, Jean Buchanan, Angela Mary Tod
AIMS: To explore the difficulties experienced by nurses and healthcare professionals when engaging in the process of breaking bad news BACKGROUND: The challenges faced by staff when breaking bad news have previously been researched in relation to particular settings or subjects. This study involved staff from diverse settings and roles to develop broader insights into the range of difficulties experienced in clinical practice. DESIGN: The study used a descriptive survey design involving self-reported written accounts and framework analysis...
January 10, 2017: Journal of Advanced Nursing
https://www.readbyqxmd.com/read/28057703/advance-directives-and-end-of-life-care-among-nursing-home-residents-receiving-maintenance-dialysis
#3
Manjula Kurella Tamura, Maria E Montez-Rath, Yoshio N Hall, Ronit Katz, Ann M O'Hare
BACKGROUND AND OBJECTIVES: Little is known about the relation between the content of advance directives and downstream treatment decisions among patients receiving maintenance dialysis. In this study, we determined the prevalence of advance directives specifying treatment limitations and/or surrogate decision-makers in the last year of life and their association with end-of-life care among nursing home residents. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Using national data from 2006 to 2007, we compared the content of advance directives among 30,716 nursing home residents receiving dialysis to 30,825 nursing home residents with other serious illnesses during the year before death...
January 5, 2017: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/28042063/hospice-use-and-pain-management-in-elderly-nursing-home-residents-with-cancer
#4
Jacob N Hunnicutt, Jennifer Tjia, Kate L Lapane
CONTEXT: Pain management is suboptimal in nursing homes. OBJECTIVES: To estimate the extent to which receipt of hospice in nursing homes (NH) increases the receipt of pain management for residents with cancer at the end-of-life. METHODS: Study participants included Medicare beneficiaries with cancer who were NH residents in the last 90 days of life in 2011-2012 (n=78,160). Residents in pain on hospice were matched to like residents without hospice by facility, type of pain assessment (self-report/staff assessment), and weeks until death (9,064 matched strata, 16,968 unique residents...
December 29, 2016: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28039504/end-of-life-care-for-head-and-neck-cancer-patients-a-population-based-study
#5
Tzu-Lung Kuo, Ching-Heng Lin, Rong-San Jiang, Ting-Ting Yen, Chen-Chi Wang, Kai-Li Liang
PURPOSE: Head and neck cancers (HNCs) usually present a poor prognosis and cause high morbidity rates. Recent surveys have demonstrated that HNC incidence rates are still on the increase in many countries. Our study objective was to assess the end-of-life care for patients with HNCs in Taiwan. METHODS: Data was retrieved from Taiwan's National Health Insurance Research Database, where we identified patients who had been diagnosed with HNCs from January 1997 to December 2010...
December 30, 2016: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
https://www.readbyqxmd.com/read/28034963/renal-dysfunction-is-associated-with-poststroke-discharge-disposition-and-in-hospital-mortality-findings-from-get-with-the-guidelines-stroke
#6
Nada El Husseini, Gregg C Fonarow, Eric E Smith, Christine Ju, Lee H Schwamm, Adrian F Hernandez, Phillip J Schulte, Ying Xian, Larry B Goldstein
BACKGROUND AND PURPOSE: Kidney disease is a frequent comorbidity in patients presenting with acute ischemic stroke. We evaluated whether the estimated glomerular filtration rate (eGFR) on admission is associated with poststroke in-hospital mortality or discharge disposition. METHODS: In this cohort study, data from ischemic stroke patients in Get With The Guidelines-Stroke linked to fee-for-service Medicare data were analyzed. The Modification of Diet in Renal Disease study equation was used to calculate the eGFR (mL/min/1...
December 29, 2016: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28029712/caregiver-patient-and-nurse-visit-communication-patterns-in-cancer-home-hospice
#7
Maija Reblin, Margaret Clayton, Jiayun Xu, Jennifer Hulett, Seth Latimer, Gary Donaldson, Lee Ellington
OBJECTIVE: Few studies have examined the triadic communication between patients, spouse caregivers, and nurses in the home hospice setting. Thus, little is known about the types of communication patterns that unfold. The goals of the study were to first, identify common patterns of communication in home hospice nurse-patient-caregiver home hospice visits and second, to identify nurse, caregiver-patient dyad, and visit characteristics that predict visit communication patterns. METHOD: Nurses (n = 58) and hospice cancer patient and spouse caregiver dyads (n = 101; 202 individuals) were recruited from 10 hospice agencies...
December 28, 2016: Psycho-oncology
https://www.readbyqxmd.com/read/28001466/the-intensive-palliative-care-unit-changing-outcomes-for-hospitalized-cancer-patients-in-an-academic-medical-center
#8
Haipeng Zhang, Constance Barysauskas, Elizabeth Rickerson, Paul Catalano, Joseph Jacobson, Carol Dalby, Charlotta Lindvall, Kathy Selvaggi
BACKGROUND: Patients with advanced cancer often require complex symptom management. At Dana-Farber/Brigham and Women's Cancer Center, the intensive palliative care unit (IPCU) admits symptomatic oncology patients with uncontrolled symptoms throughout the trajectory of illness. Patients are uniquely managed by an interdisciplinary team of clinicians who focus on symptom management and advance care planning. OBJECTIVE: The purpose of our analysis was to investigate goals-of-care outcomes and healthcare utilization after admission to the IPCU...
December 21, 2016: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/27997281/use-of-compounded-dextromethorphan-quinidine-suspension-for-pseudobulbar-affect-in-hospice-patients
#9
Robert G Wahler, Alfred T Reiman, Joshua V Schrader
BACKGROUND: Pseudobulbar affect (PBA) consists of unprovoked and uncontrollable episodes of laughing and/or crying. In end-of-life situations, PBA symptoms can be especially distressing to family and friends during an already heightened emotional time. Although a commercial product combining dextromethorphan and quinidine (DMQ) is FDA approved for use in PBA, many hospice patients are unable to swallow any solids or semisolids. An alternative formulation for these patients is needed. OBJECTIVE: We present here two cases in which we used a compounded DMQ suspension successfully to treat PBA symptoms in the weeks before the patients' death...
December 20, 2016: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/27995269/-new-legal-regulations-for-palliative-care-with-implications-for-politics-and-practice
#10
Heiner Melching
In December 2015 two different laws were adopted. Both are of importance for palliative care. One of the laws criminalizes commercial, "business-like" assisted suicide (§ 217 German Criminal Code), the other one aims to improve hospice and palliative care in Germany. Through the latter far-reaching changes in Social Code Books V and XI, as well as of the Hospital Finance Act have been made. This new Act to Improve Hospice and Palliative Care (HPG) focuses, amongst others, on: (a) Better funding of hospice services, by raising the minimum grant for patients in inpatient hospices paid per day by the health insurance funds by about 28...
January 2017: Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz
https://www.readbyqxmd.com/read/27984407/organizational-characteristics-associated-with-the-provision-of-cultural-competency-training-in-home-and-hospice-care-agencies
#11
Azza AbuDagga, Robert Weech-Maldonado, Fang Tian
BACKGROUND: Despite the increasing interest in community-based health care, little information exists on cultural competency training (CCT) and its predictors in this setting. PURPOSE: We examined the associations between six organizational characteristics and the provision of CCT in home health care and hospice agencies. METHODOLOGY: We used cross-sectional data from the agency component of the 2007 National Home and Hospice Care Survey. The CCT provision composite was composed of three items: whether the agency provides mandatory cultural training to understand cultural differences/beliefs that may affect delivery of services to (a) all administrators, clerical, and management staff; (b) all direct service providers; and (c) all volunteers...
December 15, 2016: Health Care Management Review
https://www.readbyqxmd.com/read/27964972/why-older-adults-may-decline-offers-of-post-acute-care-services-a-qualitative-descriptive-study
#12
Justine S Sefcik, Ashley Z Ritter, Emilia J Flores, Rebecca H Nock, Jo-Ana D Chase, Christine Bradway, Sheryl Potashnik, Kathryn H Bowles
The most common post-acute care (PAC) services available to patients after hospital discharge include home care, skilled nursing facilities, nursing homes, inpatient rehabilitation, and hospice. Patients who need PAC and receive services have better outcomes, however almost one-third of those offered services decline. Little research exists on PAC decision-making and why patients may decline services. This qualitative descriptive study explored the responses of thirty older adults to the question: "Can you, from the patient point of view, tell me why someone would not want post hospital care?" Three themes emerged...
December 10, 2016: Geriatric Nursing
https://www.readbyqxmd.com/read/27940628/what-determines-duration-of-palliative-care-before-death-for-patients-with-advanced-disease-a-retrospective-cohort-study-of-community-and-hospital-palliative-care-provision-in-a-large-uk-city
#13
Michael I Bennett, Lucy Ziegler, Matthew Allsop, Sunitha Daniel, Adam Hurlow
OBJECTIVE: For patients with advanced cancer, several randomised controlled trials have shown that access to palliative care at least 6 months before death can improve symptoms, reduce unplanned hospital admissions, minimise aggressive cancer treatments and enable patients to make choices about their end-of-life care, including exercising the choice to die at home. This study determines in a UK population the duration of palliative care before death and explores influencing factors...
December 9, 2016: BMJ Open
https://www.readbyqxmd.com/read/27934630/does-place-of-death-vary-by-deprivation-for-patients-known-to-specialist-palliative-care-services
#14
Michael Macfarlane, Emma Carduff
OBJECTIVES: Referral to, and usage of, specialist palliative care (SPC) services are not equitable and social deprivation may be a contributory factor in this. Deprivation may also affect the place of death of patients with cancer. No study, however, has investigated whether inequalities persist following referral to SPC services. This study investigates whether place of death varies by deprivation for patients known to SPC services. METHODS: Place of death and postcode were obtained for 485 consecutive patients known to SPC services within NHS Lothian who died in 2014-2015...
December 1, 2016: BMJ Supportive & Palliative Care
https://www.readbyqxmd.com/read/27912043/palliative-care-interventions-for-patients-with-heart-failure-a-systematic-review-and-meta-analysis
#15
Michelle S Diop, James L Rudolph, Kristin M Zimmerman, Mary A Richter, L Michal Skarf
OBJECTIVE: To systematically characterize interventions and effectiveness of palliative care for advanced heart failure (HF) patients. BACKGROUND: Patients with advanced heart failure experience a high burden of distressing symptoms and diminished quality of life. Palliative care expertise with symptom management and healthcare decision-making benefits HF patients. METHODS: A systematic PubMed search was conducted from inception to June 2016 for studies of palliative care interventions for HF patients...
January 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/27893951/events-leading-to-hospital-related-disenrollment-of-home-hospice-patients-a-study-of-primary-caregivers-perspectives
#16
Veerawat Phongtankuel, Shawn Paustian, Manney Carrington Reid, Amanda Finley, Angela Martin, John Delfs, Rosemary Baughn, Ronald D Adelman
BACKGROUND: Approximately 25% of hospice disenrollments in the United States occur as the result of hospitalization, which can lead to burdensome transitions and undesired care. Informal caregivers (e.g., spouses, children) play a critical role in caring for patients on home hospice. Research examining hospital-related disenrollment among these patients is limited. OBJECTIVE: To understand the events surrounding the hospitalization of patients discharged from home hospice through the perspective of their informal caregivers...
November 28, 2016: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/27885907/the-challenges-of-implementing-a-multi-centre-audit-of-end-of-life-care-in-care-homes
#17
Jean Levy, Julie Kinley, Frances Conway
AIMS: This article aims to share the experience of a hospice in facilitating a multi-centre audit of end-of-life care in care homes, particularly noting the challenges and enablers of carrying out the audit. METHODS: The audit was a retrospective multi-centre survey of bereaved relatives/next of kin of residents who died in the care home, using an anonymous, validated questionnaire: the Family Perception of Care Scale. Questionnaires were sent 3-months after bereavement...
November 2, 2016: International Journal of Palliative Nursing
https://www.readbyqxmd.com/read/27865257/pain-and-social-processes-for-hospice-cancer-patients-an-integrative-review
#18
REVIEW
Olga Ehrlich, Rachel K Walker
PURPOSE: Hospice cancer patients experience poorly-controlled pain in spite of widely-disseminated evidence-based guidelines for use by hospice care practitioners. Pain management occurs in the context of the interdisciplinary team, centered on a caring triad in the home: the person with pain, their caregiver, and their nurse. This review: 1) Summarizes what is known about differing ways that members of the hospice caring triad (patients, caregivers, and nurses) interpret and respond to cancer pain, in order to develop a cancer pain social processes theoretical framework, 2) Identifies gaps in understanding of hospice cancer pain social processes, and 3) Identifies framework concepts for research-based clinical practice with potential to improve pain outcomes...
December 2016: European Journal of Oncology Nursing: the Official Journal of European Oncology Nursing Society
https://www.readbyqxmd.com/read/27834750/baseline-predictors-of-poor-outcome-in-patients-too-good-to-treat-with-intravenous-thrombolysis
#19
Syed F Ali, Khawja Siddiqui, Hakan Ay, Scott Silverman, Aneesh Singhal, Anand Viswanathan, Natalia Rost, Michael Lev, Lee H Schwamm
BACKGROUND AND PURPOSE: Several studies have reported poor outcomes in patients too good to treat with intravenous thrombolysis because of mild or rapidly improving symptoms. We sought to determine baseline clinical and imaging predictors of poor outcome in these patients. METHODS: Among 3950 consecutive stroke admissions (2009-2015) in our local Get With the Guidelines-Stroke database, 632 patients presented ≤4.5 hours and did not receive tissue-type plasminogen activator, with 380 of 632 (60...
December 2016: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/27820595/the-relationship-between-index-hospitalizations-sepsis-and-death-or-transition-to-hospice-care-during-30-day-hospital-readmissions
#20
Brett W Dietz, Tiffanie K Jones, Dylan S Small, David F Gaieski, Mark E Mikkelsen
BACKGROUND: Hospital readmissions are common, expensive, and increasingly used as a metric for assessing quality of care. The relationship between index hospitalizations and specific outcomes among those readmitted remains largely unknown. OBJECTIVES: Identify risk factors present during the index hospitalization associated with death or transition to hospice care during 30-day readmissions and examine the contribution of infection in readmissions resulting in death...
November 4, 2016: Medical Care
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