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Palliative Care AND (Services OR Models)

Sue E Morris, John P Kearns, Amanda Moment, Kathleen A Lee, Jane deLima Thomas
Despite increasing attention in the medical and nursing literature about the importance of self-care for clinicians and the prevention of burnout, coping with the deaths of patients is an often-neglected component of clinical training. In this article, we describe the development of "Remembrance," an interdisciplinary approach to acknowledge and process the deaths of patients on our inpatient palliative care service, paying particular attention to how patients and their families affect us as clinicians...
December 15, 2018: Journal of Palliative Medicine
S Mulcahy, J Prendergast, G Foley, A O Hare, E Murphy, E M Guinan, J Hussey
Aims This study aimed to identify the physiotherapy exercise rehabilitation services available to patients with cancer in Ireland and to identify barriers to the provision of services. Methods Physiotherapy department managers in specialised cancer centres, public and private hospitals and palliative care settings were surveyed to establish the availability of exercise rehabilitation services for patients with cancer. Results Of 40 managers contacted, 24 responded providing information about 26 services. Ten services employed a dedicated oncology physiotherapist...
October 11, 2018: Irish Medical Journal
Ewa Delmaczynska, Roger Newham
AIMS AND OBJECTIVES: To explore of the prevalence and outcomes of advance care planning for patients with left ventricular assist devices: a review. BACKGROUND: End-stage heart failure is associated with significant symptom burden at rest. Left ventricular assist devices are not curative nevertheless they alleviate symptoms and prolong survival. Evidence suggests that most patients with left ventricular assist devices and their families do not have open discussions regarding end of life wishes until catastrophic complications arise...
December 15, 2018: Journal of Clinical Nursing
S Ryan, D Hayes, B Creedon
Introduction Delirium is common in palliative care. It effects up to 88% of patients with advanced cancer at end of life and has a point prevalence of 20% in the acute hospital setting across all diagnoses. It is under diagnosed and not optimally treated. “Months of the Year Backwards” (MOTYB) is an ideal screening tool for delirium with a sensitivity of 83.8%. It is brief to perform and carries low burden for patients. The aim of this study is to investigate the use of MOTYB as a screening tool for delirium in palliative care patients in the acute hospital setting...
September 10, 2018: Irish Medical Journal
Christopher J Plymire, Elissa G Miller, Meg Frizzola
Limited studies exist regarding the timing, location, or physicians involved in do-not-resuscitate (DNR) order placement in pediatrics. Prior pediatric studies have noted great variations in practice during end-of-life (EOL) care. This study aims to analyze the timing, location, physician specialties, and demographic factors influencing EOL care in pediatrics. We examined the time preceding and following the implementation of a pediatric palliative care team (PCT) via a 5-year, retrospective chart review of all deceased patients previously admitted to inpatient services...
December 10, 2018: Children
Malin Knutsen Glette, Olav Røise, Tone Kringeland, Kate Churruca, Jeffrey Braithwaite, Siri Wiig
BACKGROUND: Thirty-day hospital readmissions represent an international challenge leading to increased prevalence of adverse events, reduced quality of care and pressure on healthcare service's resources and finances. There is a need for a broader understanding of hospital readmissions, how they manifest, and how resources in the primary healthcare service may affect hospital readmissions. The aim of the study was to examine how nurses and nursing home leaders experienced the resource situation, staffing and competence level in municipal healthcare services, and if and how they experienced these factors to influence hospital readmissions...
December 12, 2018: BMC Health Services Research
Heather R Britt, Meghan M JaKa, Karl M Fernstrom, Paige E Bingham, Anne E Betzner, Jessica R Taghon, Nathan D Shippee, Tetyana P Shippee, Sandra E Schellinger, Eric W Anderson
Whole-person care is a new paradigm for serious illness, but few programs have been robustly studied. We sought to test the effect of LifeCourse (LC), a person-centered program for patients living with serious illness, on health-care utilization, care experience, and quality of life, employing a quasi-experimental design with a Usual Care (UC) comparison group. The study was conducted 2012 to 2017 at an upper-Midwest not-for-profit health-care system with outcomes measured every 3 months until the end of life...
December 13, 2018: American Journal of Hospice & Palliative Care
Anand Avati, Kenneth Jung, Stephanie Harman, Lance Downing, Andrew Ng, Nigam H Shah
BACKGROUND: Access to palliative care is a key quality metric which most healthcare organizations strive to improve. The primary challenges to increasing palliative care access are a combination of physicians over-estimating patient prognoses, and a shortage of palliative staff in general. This, in combination with treatment inertia can result in a mismatch between patient wishes, and their actual care towards the end of life. METHODS: In this work, we address this problem, with Institutional Review Board approval, using machine learning and Electronic Health Record (EHR) data of patients...
December 12, 2018: BMC Medical Informatics and Decision Making
Huw Williams, Sir Liam Donaldson, Simon Noble, Peter Hibbert, Rhiannon Watson, Joyce Kenkre, Adrian Edwards, Andrew Carson-Stevens
BACKGROUND: Patients receiving palliative care are often at increased risk of unsafe care with the out-of-hours setting presenting particular challenges. The identification of improved ways of delivering palliative care outside working hours is a priority area for policymakers. AIM: To explore the nature and causes of unsafe care delivered to patients receiving palliative care from primary-care services outside normal working hours. DESIGN: A mixed-methods cross-sectional analysis of patient safety incident reports from the National Reporting and Learning System...
December 12, 2018: Palliative Medicine
Boris Zernikow, Katharina Szybalski, Bettina Hübner-Möhler, Julia Wager, Michael Paulussen, Lisa Lassay, Norbert Jorch, Carola Weber, Dominik T Schneider, Gisela Janßen, Prasad T Oommen, Michaela Kuhlen, Thomas Brune, Regina Wieland, Michael Schündeln, Bernhard Kremens, Alfred Längler, Aram Prokop, Rita Kiener, Tim Niehues, Martina Rose, Margit Baumann-Köhler, Monika Pöppelmann, Heike Thorer, Martin Irnich, Kumar Sinha, Joanne Wolfe, Pia Schmidt
BACKGROUND: About one quarter of children affected with cancer die. For children and their families, the end-of-life period is highly distressing. AIM: This study focused on how end-of-life care in pediatric cancer patients changed over a period of 10 years and if changes in pediatric palliative care structures were associated with quality of care. DESIGN: Over a 10-year period, all pediatric oncology departments in one German federal state were invited to participate in a repeated cross-sectional cohort study at three time-points (2005, 2010, 2015)...
December 12, 2018: Palliative Medicine
Karin Oechsle
Patients with hematologic malignancies (HM) nowadays rarely receive palliative or hospice care, and studies on potential effects of integrated palliative care are rare. This narrative review provides a comprehensive overview on their current end-of-life care, first data on integrated specialist palliative care (SPC) and potential barriers. Symptom burden and distress in patients with HM seem to be comparable to other cancer patients, but their performance status and specific symptoms are even worse. Prolongation of life usually remains the main focus until the last days or weeks of life...
December 12, 2018: Oncology Research and Treatment
Julia Thumfart, Dirk Bethe, Sarah Wagner, Wolfgang Pommer, Cornelia Rheinländer, Dominik Müller
AIM: Children and adolescents with end stage renal disease face a high morbidity and mortality. Palliative care provides a multidisciplinary approach to reduce disease burden and improve quality of life. This study evaluated concepts and current structures of palliative care from the perspective of a multidisciplinary paediatric nephrology team including physicians, nurses and psychosocial health professionals. METHODS: Evaluation was done by an online survey sent to the members of the German Society of Nephrology and to the nurse managers of German paediatric dialysis centres between April 9th 2018 and May 31th 2018...
December 11, 2018: Acta Paediatrica
Penelope J Slater, Rachel M Edwards, Ashraf A Badat
Purpose: Challenges experienced by staff in the Oncology Services Group at Queensland Children's Hospital led to issues with staff retention, well-being, and stress on team culture. Therefore, a customized program was developed through a needs analysis to improve the well-being and resilience of oncology staff, enabling them to cope with stressors and critical incidents inherent in their everyday work and to flourish. The program included education, on-site counselors, mindfulness sessions, debriefing, well-being resources, and improved engagement, support, and communication...
2018: Journal of Healthcare Leadership
Penelope J Slater, Rachel M Edwards
Purpose: Around 170 multidisciplinary staff of the Oncology Services Group at Queensland Children's Hospital, Brisbane, care for children with oncology, hematology, and palliative care needs from throughout Queensland and northern New South Wales. A series of challenges impacted staff resilience and retention, and strategies were needed to improve staff well-being and enable them to flourish despite the inherent work stressors. Methods: A needs analysis was conducted using themes from Discovery Interviews with 51 staff, surveys related to "The Work Stressors Scale - Pediatric Oncology" and "The Work Rewards Scale - Pediatric Oncology" completed by 59 staff, and an organizational staff survey responded to by 51 staff...
2018: Journal of Healthcare Leadership
Steven Vanderstichelen, Joachim Cohen, Yanna Van Wesemael, Luc Deliens, Kenneth Chambaere
OBJECTIVES: Volunteers have an important place in palliative care (PC), positively influencing quality of care for seriously ill people and those close to them and providing a link to the community. However, it is not well understood where volunteers fit into PC provision or how to support them adequately. We therefore chose to describe volunteer roles across care settings through the perspective of those closely involved in the care of terminally ill people. METHODS: A qualitative study was conducted using both focus groups with volunteers, nurses, psychologists and family physicians and individual semistructured interviews with patients and family caregivers...
December 7, 2018: BMJ Supportive & Palliative Care
Jaqueline Rodrigues da Silva, Emanuelly Varea Maria Wiegert, Livia Oliveira, Larissa Calixto-Lima
OBJECTIVES: The aim of the present study was to evaluate the association between sarcopenia, diagnosed by different muscle mass measurement techniques, with nutritional status and overall survival in patients with advanced cancer under palliative care. AIM: To investigate the association of sarcopenia, according to distinct muscle mass measurement methods, with nutritional status and overall survival (OS). METHODS: This observational and prospective study, including 334 patients, defined sarcopenia as reduced muscle mass and strength...
September 15, 2018: Nutrition
Simon Noah Etkind, Natasha Lovell, Caroline Jane Nicholson, Irene J Higginson, Fliss Em Murtagh
BACKGROUND: The frail older population is growing, and many frail older people have episodes of acute illness. Patient preferences are increasingly considered important in the delivery of person-centred care and may change following acute illness. AIM: To explore influences on the care preferences of frail older people with recent acute illness. DESIGN: Qualitative in-depth individual interviews, with thematic analysis. SETTING/PARTICIPANTS: Maximum variation sample of 18 patients and 7 nominated family carers from a prospective cohort study of people aged over 65, scoring ⩾5 on the Clinical Frailty Scale, and with recent acute illness, who were not receiving specialist palliative care...
December 7, 2018: Palliative Medicine
Anastasia Vishnevetsky, Carla Zapata Del Mar, Juan Luis Cam, Mario Cornejo-Olivas, Claire J Creutzfeldt
BACKGROUND: The development of palliative care in Peru remains limited, particularly for nononcological services, such as neurology. The goal of this study was to explore attitudes toward and knowledge about palliative and end-of-life care among patients, families, nurses, and doctors in a specialized neurological institute in Lima, Peru. MATERIALS AND METHODS: We used a mixed methods approach consisting of 78 surveys and 21 qualitative, semistructured interviews that were recorded, transcribed, and analyzed using thematic analysis...
December 8, 2018: Journal of Palliative Medicine
Charlotte Wool, Anita Catlin
The aims of this article are twofold: (I) provide a general overview of perinatal bereavement services throughout the healthcare system and (II) identify future opportunities to improve bereavement services, including providing resources for the creation of standardized care guidelines, policies and educational opportunities across the healthcare system. Commentary is provided related to maternal child services, the neonatal intensive care unit (NICU), prenatal clinics, operating room (OR) and perioperative services, emergency department (ED), ethics, chaplaincy and palliative care services...
November 22, 2018: Annals of Palliative Medicine
Andrew T Olagunju, Babatunde Fadipe, Rotimi W Buraimoh, Olagoke K Ale, Theophilus I Umeizudike, Raphael E Ogbolu, Nasur Buyinza, Jonathan Bayuo, Barbara Mutedzi, Kennedy Nkhoma, Eve Namisango, Katherine Bristowe, Deokhee Yi, Julia Downing, Olatunji F Aina, Joseph D Adeyemi, Fliss E M Murtagh, Richard Harding
BACKGROUND: The burden of symptoms and other concerns in chronic kidney disease (CKD) is known to be high, adversely affecting the quality of life of the growing number of those with this condition in developing countries. In this paper, we describe the protocol of a longitudinal observational study among people living with CKD. The study is developed to assess the bio-psychosocial factors associated with palliative care symptoms and concerns, and pattern of health services usage among Nigerians with stages 3-5 CKD...
October 17, 2018: Annals of Palliative Medicine
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