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Hospice, Palliative

Sarosh Khan, Maria Ribeiro, Diogo Fernandes, Colin Reid
72 year old man with known systolic & diastolic heart failure presented with congestive cardiac failure symptoms over a period of 6 weeks. Successful resection of left upper lobe lung adenocarcinoma 4 years prior. Poor response to optimal medical therapy and IV diuresis. Repeat echocardiogram elicited rare images (Videos 1, 2 and 3) of a significant invasive pericardial tumour involving myocardium and endocardium (Figure 1). Comparative CT thorax images are also provided (Figure 2a & Figure 2b). The importance of cardiac silhouette evaluation on CXR's for interval change is highlighted with 6 month retrospective review in this case (Figure 3)...
March 14, 2018: Echo Research and Practice
Shane Sinclair, Thomas F Hack, Shelley Raffin-Bouchal, Susan McClement, Kelli Stajduhar, Pavneet Singh, Neil A Hagen, Aynharan Sinnarajah, Harvey Max Chochinov
BACKGROUND: Healthcare providers are considered the primary conduit of compassion in healthcare. Although most healthcare providers desire to provide compassion, and patients and families expect to receive it, an evidence-based understanding of the construct and its associated dimensions from the perspective of healthcare providers is needed. OBJECTIVES: The aim of this study was to investigate healthcare providers' perspectives and experiences of compassion in order to generate an empirically derived, clinically informed model...
March 14, 2018: BMJ Open
Stephanie Stiel, Mareike Nurnus, Christoph Ostgathe, Carsten Klein
BACKGROUND: Clinical practice of Palliative Sedation (PS) varies between institutions worldwide and sometimes includes problematic practices. Little available research points at different definitions and frameworks which may contribute to uncertainty of healthcare professionals in the application of PS. This analysis investigates what demographic factors and characteristics of treatment practices differ between institutions with high versus low sedation rates estimates in Palliative and Hospice Care in Germany...
March 13, 2018: BMC Palliative Care
Kristi Soileau, Nanette Elster
The hospice philosophy embraces palliative care for the terminally ill, for whom quality of life is the central focus of comfort care management. Often, caregivers hesitate or simply do not elect to extend oral care for patients nearing the end of life, due to difficulties encountered in patient compliance, a sense of futility in doing so, staff time constraints in prioritizing care, underfunding, or a lack of education as to how and why such care should be delivered to the hospice patient. This article aims to show physiological and psychosocial reasons why the hospice patient has a need for properly and regularly implemented oral care and why dental professionals have an ethical responsibility to address the current void that exists in hospice-centered oral care...
January 1, 2018: Journal of Palliative Care
Ewa Zabrocka, Marek Z Wojtukiewicz, Ewa Sierko
Advanced cancer patients in hospice are at notably increased risk of venous thromboembolism (VTE) due to age, local and distal advancement of the malignancy and bed confinement, among other factors. Asymptomatic VTE prevalence among palliative care patients has been found to reach 50%, whereas the clinically overt form occurs in 10%. Hospice patients are frequently given medications increasing VTE risk, for instance megestrol which is a drug commonly used in cancer cachexia. Many of the available guidelines encourage the implementation of thromboprophylaxis (TPX) in cancer patients, e...
February 2018: Advances in Clinical and Experimental Medicine: Official Organ Wroclaw Medical University
Youngin Lee, Seung Hun Lee, Yun Jin Kim, Sang Yeoup Lee, Jeong Gyu Lee, Dong Wook Jeong, Yu Hyeon Yi, Young Jin Tak, Hye Rim Hwang, Mieun Gwon
BACKGROUND: This study investigates the effects of a new medical insurance payment system for hospice patients in palliative care programs and analyzes length of survival (LoS) determinants. METHOD: At the Pusan National University Hospital hospice center, between January 2015 and April 2016, 276 patients were hospitalized with several diagnosed types of terminal stage cancer. This study separated patients into two groups, "old" and "new," by admission date, considering the new system has been applied from July 15, 2015...
March 7, 2018: BMC Palliative Care
Winnie Y Zou, Hashem B El-Serag, Yvonne H Sada, Sarah L Temple, Shubhada Sansgiry, Fasiha Kanwal, Jessica A Davila
BACKGROUND: Hospice provides integrative palliative care for advance-staged hepatocellular carcinoma (HCC) patients, but hospice utilization in HCC patients in the USA is not clearly understood. AIMS: We examined hospice use and subsequent clinical course in advance-staged HCC patients. METHODS: We conducted a retrospective study on a national, Veterans Affairs cohort with stage C or D HCC. We evaluated demographics, clinical factors, treatment, and clinical course in relation to hospice use...
March 5, 2018: Digestive Diseases and Sciences
Sivakumar Subramaniam, Pauline Dand, Martin Ridout, Declan Cawley, Sophie Miller, Paola Valli, Rebecca Bright, Brendan O'Neill, Tricia Wilcocks, Georgina Parker, Dee Harris
OBJECTIVES: In palliative care settings, predicting prognosis is important for patients and clinicians. The Palliative Prognostic Index (PPI), a prognostic tool calculated using clinical indices alone has been validated within cancer population. This study was to further test the discriminatory ability of the PPI (ie, its ability to determine whether a subject will live more or less than a certain amount of time) in a larger sample but with a palliative care context and to compare predictions at two different points in time...
March 5, 2018: BMJ Supportive & Palliative Care
R Xia, D H Wang
With the improvement of diagnosis and treatment, tumor has become a chronic disease, and an increasing number of older patients will live with tumors. This change has led to an increase in demand for intensive care unit (ICU) and a challenge to the traditional ICU treatment concept. The option of ICU consists of two parts. The first is the option for admission. Since classic predictors of mortality are no longer relevant, we suggest broadening the criteria for ICU admission. Patients during the first course of cancer therapies should be treated with a full-code status similar to that of other patients without malignancy...
February 23, 2018: Zhonghua Zhong Liu za Zhi [Chinese Journal of Oncology]
Cory Taylor, Jamie C Fertal, Solomon Liao
BACKGROUND: Withdrawal of life-support for an individual with refractory schizophrenia following attempted suicide remains controversial. Discussion regarding prognosis of mental illness and the distinction between somatic and mental illness brings out many ethical issues. This paper will examine the role and weight of severe persistent mental illness in the withdrawal of life support following attempted suicide. CASE DESCRIPTION: A 30-year-old gentleman with deafness and schizophrenia was admitted with multiple self-inflicted visceral stab wounds...
February 26, 2018: Journal of Pain and Symptom Management
N Rose Gaston, Jill M Randall, Lisa R Kiesel
Physician-assisted suicide (PAS) is explicitly legal in five states and by court decision in one. Legislative bills have been introduced in other states including Minnesota, Iowa, and Wisconsin. This quantitative study was designed to understand Midwest, hospice and palliative care at end-of-life social workers' attitudes toward PAS, preferred terminology, perception of preparedness for the implementation, and awareness of PAS legislation in their state. Sixty-two social workers from Minnesota, Iowa, and Wisconsin completed an anonymous online survey...
March 1, 2018: Journal of Social Work in End-of-life & Palliative Care
Laura P Gelfman, Marie Bakitas, Lynne Warner Stevenson, James N Kirkpatrick, Nathan E Goldstein
BACKGROUND: Heart failure (HF) is a chronic progressive illness associated with physical and psychological burdens, high morbidity, mortality, and healthcare utilization. Palliative care is interdisciplinary care that aims to relieve suffering and improve quality of life for persons with serious illness and their families. It is offered simultaneously with disease-oriented care, unlike hospice or end-of-life care. Despite the demonstrated benefits of palliative care in other populations, evidence for palliative care in the HF population is limited...
June 2017: Journal of Palliative Medicine
Shlomit Strulov Shachar, Trevor A Jolly, Ellen Jones, Hyman B Muss
Triple-negative breast cancer, which affects about 10% of older women with breast cancer, represents a major treatment challenge in this population. Treatment decisions for these patients can best be made based on geriatric assessment, estimated life expectancy, whether the treatment goal is prolonged survival or palliation, the potential benefits and toxicities of a specific treatment, and the patient's personal goals for treatment. Treatment outcomes for healthy older and younger women are similar, but great challenges exist in managing the vulnerable and frail patient...
February 15, 2018: Oncology (Williston Park, NY)
Susanny J Beltran
End-stage restlessness, or terminal agitation, is experienced by some patients during their final days and is characterized by physical, emotional, or spiritual distress, agitation or anxiety. End-stage restlessness negatively affects the patient's death experience and can be distressing to the family and care team. Using the 2007 National Home and Hospice Care survey, this study examined factors associated with experiencing end-stage restlessness among non-Hispanic white and Hispanic hospice patients deceased at time of discharge...
February 26, 2018: Journal of Social Work in End-of-life & Palliative Care
Michael Hoerger, Joseph A Greer, Vicki A Jackson, Elyse R Park, William F Pirl, Areej El-Jawahri, Emily R Gallagher, Teresa Hagan, Juliet Jacobsen, Laura M Perry, Jennifer S Temel
Purpose We describe the key elements of early palliative care (PC) across the illness trajectory and examine whether visit content was associated with patient-reported outcomes and end-of-life care. Methods We performed a secondary analysis of patients with newly diagnosed advanced lung or noncolorectal GI cancer (N = 171) who were randomly assigned to receive early PC. Participants attended at least monthly visits with board-certified PC physicians and advanced practice nurses at Massachusetts General Hospital...
February 23, 2018: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
Dorothy McCaughan, Eve Roman, Alexandra G Smith, Anne C Garry, Miriam J Johnson, Russell D Patmore, Martin R Howard, Debra A Howell
BACKGROUND: Haematological malignancies (leukaemias, lymphomas and myeloma) are complex cancers that are relatively common, affect all ages and have divergent outcomes. Although the symptom burden of these diseases is comparable to other cancers, patients do not access specialist palliative care (SPC) services as often as those with other cancers. To determine the reasons for this, we asked SPC practitioners about their perspectives regarding the barriers and facilitators influencing haematology patient referrals...
February 21, 2018: BMC Palliative Care
Marin Golčić, Renata Dobrila-Dintinjana, Goran Golčić, Ira Pavlović-Ružić, Aleksandra Stevanović, Lidija Gović-Golčić
PURPOSE: Quality of life is the cornerstone of palliative care, and assessing it requires validated and standardized questionnaires. However, the majority of questionnaires are not tested in a hospice setting. The purpose of this study is to evaluate the quality of life in a hospice using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 for Palliative Care (PAL) (EORTC QLQ-C15-PAL) questionnaire and validating it in Croatian language...
January 1, 2018: American Journal of Hospice & Palliative Care
Christina L Vaughan, Benzi M Kluger
PURPOSE OF REVIEW: While care for patients with movement disorders has traditionally focused on motor symptoms, there is increasing evidence that optimal care for these disorders is more complex both in terms of the spectrum of symptoms experienced by patients (e.g., pain, depression) and the multidimensional needs of patients and their families. Palliative care is an approach to the care of patients and families affected by serious illnesses that seeks to relieve suffering by addressing complex medical symptoms, psychosocial issues, spiritual well-being, and goals of care...
February 21, 2018: Current Treatment Options in Neurology
Casey M Hay, Joseph L Kelley, Robert P Edwards, Kathleen M Pombier, John T Comerci
Super-utilizers account for many emergency department visits (EDV) and hospitalizations. Among Medicare/Medicaid patients, 5% to 10% account for >50% of spending. Little is known about super-utilization in gynecologic oncology. Charts of 64 gynecologic oncology patients with ≥3 EDV and/or admissions over 12 months were reviewed retrospectively. Cancer type distribution was 47% ovarian, 23% cervical, 23% endometrial, and 6% vulvar. Treatment at index visit was 61% chemotherapy, 16% no treatment, 8% recent surgery, and 6% radiation...
February 1, 2018: American Journal of Medical Quality: the Official Journal of the American College of Medical Quality
David B Bekelman, Rachel Johnson-Koenke, Daniel W Bowles, Stacy M Fischer
BACKGROUND: Patients with cancer could benefit from early primary (i.e., basic) palliative care. Scalable models of care delivery are needed. OBJECTIVE: Examine the feasibility of a stepped peer navigator and social work intervention developed to improve palliative care outcomes. DESIGN: Single-arm prospective clinical trial. The peer navigator educated patients to advocate for pain and symptom management with their healthcare providers, motivated patients to pursue advance care planning, and discussed the role of hospice...
February 20, 2018: Journal of Palliative Medicine
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