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Palliative care, end of life care, hospice

Dawon Baik, Hwayoung Cho, Ruth M Masterson Creber
BACKGROUND: Shared decision making (SDM) is a key attribute of patient-centered care, which empowers palliative care patients to be able to make optimal medical decisions about end-of-life treatments based on their own values and preferences. AIM: The aim of this systematic literature review is to detail and compare interventions supporting SDM over the last 10 years (January 2008 to December 2017) and to analyze patient/caregiver outcomes at the end of life. METHODS: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines...
January 1, 2018: American Journal of Hospice & Palliative Care
Ilaria Massa, Oriana Nanni, Flavia Foca, Marco Maltoni, Stefania Derni, Nicola Gentili, Giovanni Luca Frassineti, Andrea Casadei Gardini, Martina Valgiusti, Dino Amadori, Elena Prati, Mattia Altini, Davide Gallegati, Elisabetta Sansoni
BACKGROUND: Appropriate cessation of chemotherapy and timely referral of patients to hospice services are crucial for the quality of care near death. We investigated the quality of care in our Cancer Institute in very advanced metastatic colorectal cancer patients treated in real life. PATIENTS AND METHODS: We performed a retrospective analysis of electronic medical data of patients with metastatic colorectal cancer who were candidates for chemotherapy during the study period (1 January 2007-30 June 2014) and died before 31 December 2014...
June 19, 2018: BMC Palliative Care
Katsiaryna Laryionava, Katja Mehlis, Elena Bierwirth, Friederike Mumm, Wolfgang Hiddemann, Pia Heußner, Eva C Winkler
BACKGROUND: Many patients with advanced cancer receive chemotherapy close to death and are referred too late to palliative or hospice care, and therefore die under therapy or in intensive care units. Oncologists still have difficulties in involving patients appropriately in decisions about limiting tumor-specific or life-prolonging treatment. OBJECTIVE: The aim of this Ethics Policy for Advanced Care Planning and Limiting Treatment Study is to develop an ethical guideline for end-of-life decisions and to evaluate the impact of this guideline on clinical practice regarding the following target goals: reduction of decisional conflicts, improvement of documentation transparency and traceability, reduction of distress of the caregiver team, and better knowledge and consideration of patients' preferences...
June 15, 2018: JMIR Research Protocols
Rossana De Palma, Daniela Fortuna, Sarah E Hegarty, Daniel Z Louis, Rita Maria Melotti, Maria Luisa Moro
BACKGROUND: Multiple studies demonstrate substantial utilization of acute hospital care and, potentially excessive, intensive medical and surgical treatments at the end-of-life. AIM: To evaluate the relationship between the use of home and facility-based hospice palliative care for patients dying with cancer and service utilization at the end of life. DESIGN: Retrospective, population-level study using administrative databases. The effect of palliative care was analyzed between coarsened exact matched cohorts and evaluated through a conditional logistic regression model...
June 1, 2018: Palliative Medicine
Jane Seymour, David Clark
Background : The Liverpool Care Pathway for the Dying Patient ('the LCP') was an integrated care pathway (ICP) recommended by successive governments in England and Wales to improve end-of-life care, using insights from hospice and palliative care. It was discontinued in 2014 following mounting criticism and a national review.  The ensuing debate among clinicians polarised between 'blaming' of the LCP and regret at its removal. Employing the concept of 'boundary objects', we aimed to address three questions: 1) why and how did the LCP come to prominence as a vehicle of policy and practice 2) what factors contributed to its demise? 3) what immediate implications and lessons resulted from its withdrawal? Methods : We use primary and secondary sources in the public domain to assemble a critical and historical review...
2018: Wellcome Open Research
Shunichi Nakagawa, Arthur R Garan, Hiroo Takayama, Koji Takeda, Veli K Topkara, Melana Yuzefpolskaya, Susan X Lin, Paolo C Colombo, Yoshifumi Naka, Craig D Blinderman
BACKGROUND: The difference of end-of-life care for left ventricular assist device (LVAD) patients, between destination therapy (DT) and bridge to transplant (BTT), and the effect of palliative care in this population remain unknown. OBJECTIVE: The primary outcomes of this retrospective cohort study were the place of death, do-not-resuscitate (DNR) order, palliative care consultation in the last month, and hospice enrollment. Secondary outcomes were time on the LVAD, life-sustaining treatment in the last week of life, LVAD deactivation, and clinical trajectory...
June 6, 2018: Journal of Palliative Medicine
Amy Beasley, Marie A Bakitas, Rebecca Edwards, Dio Kavalieratos
Palliative care offers patients with a serious illness and their families access to services that can improve quality of life, mood, and symptoms. However, the term palliative care is often confused with end of life or hospice services limiting its application to persons with chronic illnesses who might benefit. Non-hospice palliative care is a term that is emerging to more accurately reflect the broader care model that palliative care represents. The aim of this review was to identify the characteristics of published nonhospice palliative care interventions...
April 25, 2018: Annals of Palliative Medicine
Elizabeth J Lilley, Katherine C Lee, John W Scott, Nicole J Krumrei, Adil H Haider, Ali Salim, Rajan Gupta, Zara Cooper
BACKGROUND: Palliative care is associated with lower intensity treatment and better outcomes at the end of life. Trauma surgeons play a critical role in end-of-life (EOL) care, however the impact of PC on healthcare utilization at the end of life has yet to be characterized in older trauma patients. METHODS: This retrospective cohort study using 2006-2011 national Medicare claims included trauma patients ≥65 years who died within 180 days after discharge. The exposure of interest was inpatient palliative care during the trauma admission...
May 30, 2018: Journal of Trauma and Acute Care Surgery
David Hausner, Nanor Kevork, Ashley Pope, Breffni Hannon, John Bryson, Jenny Lau, Gary Rodin, Lisa W Le, Camilla Zimmermann
PURPOSE: Acute palliative care units (APCUs) admit patients with cancer for symptom control, transition to community palliative care units or hospice (CPCU/H), or end-of-life care. Prognostication early in the course of admission is crucial for decision-making. We retrospectively evaluated factors associated with patients' discharge disposition on an APCU in a cancer center. METHODS: We evaluated demographic, administrative, and clinical data for all patients admitted to the APCU in 2015...
May 30, 2018: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
Thomas W LeBlanc, Pamela C Egan, Adam J Olszewski
Hospice provides high-quality end-of-life care, but patients with leukemias use hospice services less frequently than those with solid tumors. Transfusion dependence (TD) may hinder or delay enrollment, as hospice organizations typically disallow transfusions. We examined the association between TD and end-of-life outcomes among Medicare beneficiaries with leukemia. From the Surveillance, Epidemiology, and End Results-Medicare database, we selected beneficiaries with acute and chronic leukemias, who died in 2001-2011...
May 30, 2018: Blood
C Klein, C Wittmann, K N Wendt, C Ostgathe, S Stiel
BACKGROUND: Palliative sedation (PS) serves as a therapeutic option in cases of otherwise intractable suffering. As the use of sedative and hypnotic medication in many diverse situations is a core competency of anesthesiology, anesthesiologists are confronted with questions of sedative therapy at the end of life in institutions for specialized palliative care, in intensive care units and intermediate care wards. In recent years a number of guidelines have been published internationally but so far no official guidelines exist in Germany...
May 16, 2018: Der Anaesthesist
Piotr Krakowiak, Renata Deka, Anna Janowicz
Democracy in Eastern Europe arrived after a long fight with a communist regime, and the activities of medical volunteers have been developing in opposition to the existing then in Poland mentality called Homo Sovieticus. From 1981 onwards the Polish Hospice Movement there was inspired by practitioners and international experiences brought by visits of Dr. Cicely Saunders. The history of modern end-of-life care in Poland was connected to caring communities, which could be called compassionate, because of the volunteering of all hospice team members...
April 2018: Annals of Palliative Medicine
Chloé Prod'homme, Dominique Jacquemin, Licia Touzet, Regis Aubry, Serge Daneault, Laurent Knoops
BACKGROUND: Integrated palliative care is correlated with earlier end-of-life discussion and improved quality of life. Patients with haematological malignancies are far less likely to receive care from specialist palliative or hospice services compared to other cancers. AIM: The main goal of this study was to determine hematologists' barriers to end-of-life discussions when potentially fatal hematological malignancies recur. DESIGN: Qualitative grounded theory study using individual interviews...
May 2018: Palliative Medicine
Lee Ai Chong, Poh Heng Chong, Joyce Chee
BACKGROUND: The provision of pediatric palliative care in Asia Pacific varies between countries and availability of essential medications for symptoms at the end of life in this region is unclear. OBJECTIVE: To determine medications available and used in the management of six symptoms at the end of life among pediatric palliative care practitioners in Asia Pacific. To identify alternative pharmacological strategies for these six symptoms if the oral route was no longer possible and injections are refused...
May 7, 2018: Journal of Palliative Medicine
Katherine Knighting, Lucy Bray, Julia Downing, Andrew J Kirkcaldy, Tracy K Mitchell, Mary R O'Brien, Melissa Pilkington, Barbara A Jack
AIM: To seek views of UK children's and adult hospices on the availability and challenges of providing services for young adults with life-limiting conditions. BACKGROUND: Internationally there are a growing number of young adults with life-limiting conditions and/or complex needs which are degenerative, progressive and diverse and involve complex life-long symptom, medication management as well as palliative care. There are 55,721 young adults, aged 18-40 in England, which continues to increase...
May 6, 2018: Journal of Advanced Nursing
Erica C Kaye, Samantha DeMarsh, Courtney A Gushue, Jonathan Jerkins, April Sykes, Zhaohua Lu, Jennifer M Snaman, Lindsay J Blazin, Liza-Marie Johnson, Deena R Levine, R Ray Morrison, Justin N Baker
BACKGROUND: In the U.S., more children die from cancer than from any other disease, and more than one third die in the hospital setting. These data have been replicated even in subpopulations of children with cancer enrolled on a palliative care service. Children with cancer who die in high-acuity inpatient settings often experience suffering at the end of life, with increased psychosocial morbidities seen in their bereaved parents. Strategies to preemptively identify children with cancer who are more likely to die in high-acuity inpatient settings have not been explored...
May 4, 2018: Oncologist
Tabitha Thomas, Gemma Clarke, Stephen Barclay
BACKGROUND: Discharge from inpatient palliative care units to long-term care can be challenging. In the United Kingdom, hospice inpatients move to a care home if they no longer require specialist palliative care and cannot be discharged home. There is evidence to suggest that patients and families find the prospect of such a move distressing. AIM: To investigate the issues that arise when patients are transferred from hospice to care home at the end of life, from the perspective of the hospice multidisciplinary team...
April 1, 2018: Palliative Medicine
Jessica I Hoell, Hannah L Weber, Stefan Balzer, Mareike Danneberg, Gabriele Gagnon, Laura Trocan, Arndt Borkhardt, Gisela Janßen, Michaela Kuhlen
Pediatric advance care planning seeks to ensure end-of-life care conforming to the patients/their families' preferences. To expand our knowledge of advance care planning and "medical orders for life-sustaining treatment" (MOLST) in pediatric palliative home care, we determined the number of patients with MOLST, compared MOLST between the four "Together for Short Lives" (TfSL) groups and analyzed, whether there was a relationship between the content of the MOLST and the patients' places of death...
April 3, 2018: Oncotarget
Mary J Isaacson
BACKGROUND: Life-limiting illness plagues Native Americans, yet access to palliative and end-of-life care, including hospice care, is severely limited. AIM: This study aimed to explore palliative and hospice care with Native American elders and tribal health educators on a Northern Plains reservation in the US. METHODS: Using a community-based participatory approach, participants discussed the cultural acceptability of palliative and hospice care in their tribal community...
April 2, 2018: International Journal of Palliative Nursing
Sandhya K Mudumbi, Claire E Bourgeois, Nicholas A Hoppman, Catherine H Smith, Manisha Verma, Marie A Bakitas, Cynthia J Brown, Alayne D Markland
BACKGROUND: Patients with decompensated cirrhosis (DC) and/or hepatocellular carcinoma (HCC) have a high symptom burden and mortality and may benefit from palliative care (PC) and hospice interventions. OBJECTIVE: Our aim was to search published literature to determine the impact of PC and hospice interventions for patients with DC/HCC. METHODS: We searched electronic databases for adults with DC/HCC who received PC, using a rapid review methodology...
April 26, 2018: Journal of Palliative Medicine
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