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Palliative care, end of life care, hospice

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
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
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
(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
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
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
Lisa C Lindley, Laura V Trujillo
INTRODUCTION: More than 8,000 Hispanic children die annually in the United States; yet little is known about the end-of-life care utilized. The purpose of this study was to examine the children and family characteristics associated with end-of-life care for Hispanic children. METHOD: A sample of 370 Hispanic children was created, using the 2009-2010 California Medicaid data. The relationship between child and family characteristics and end-of-life care utilization (i...
September 20, 2016: Hispanic Health Care International: the Official Journal of the National Association of Hispanic Nurses
Carol Tishelman, Olav Lindqvist, Senada Hajdarevic, Birgit H Rasmussen, Ida Goliath
The web of relationships between wellbeing and the environments in which people live has long been recognized. However, relatively little research has been conducted about end-of-life surroundings from the perspective of the dying person. In this study, we investigate which aspects of their surroundings are particularly meaningful for the people inhabiting them in the last phases of life, based on participant-produced photographs with follow-up interviews. Twenty-three people were purposefully recruited via specialized in-patient palliative care/hospice units, specialized palliative care home care teams, and residential care facilities for the elderly...
November 2016: Social Science & Medicine
Susan C Miller, Julie C Lima, Orna Intrator, Edward Martin, Janet Bull, Laura C Hanson
OBJECTIVES: To evaluate how receipt and timing of nursing home (NH) palliative care consultations (primarily by nurse practitioners with palliative care expertise) are associated with end-of-life care transitions and acute care use DESIGN: Propensity score-matched retrospective cohort study. SETTING: Forty-six NHs in two states. PARTICIPANTS: Nursing home residents who died from 2006 to 2010 stratified according to days between initial consultation and death (≤7, 8-30, 31-60, 61-180)...
September 19, 2016: Journal of the American Geriatrics Society
Phoebe G Prioleau, Tacara N Soones, Katherine Ornstein, Meng Zhang, Cardinale B Smith, Ania Wajnberg
OBJECTIVES: To investigate factors associated with place of death of individuals in the Mount Sinai Visiting Doctors Program (MSVD). DESIGN: A retrospective chart review was performed of all MSVD participants who died in 2012 to assess predictors of place of death in the last month of life. SETTING: MSVD, a home-based primary and palliative care program in New York. PARTICIPANTS: MSVD participants who were discharged from the program because of death between January 2012 and December 2012 and died at home, in inpatient hospice, or in the hospital (N = 183)...
September 19, 2016: Journal of the American Geriatrics Society
Kershena Liao, Jennifer Blumenthal-Barby, Andrew G Sikora
OBJECTIVE: The factors influencing head and neck surgical oncologists' goals of care and decisions to initiate conversations about transitioning to palliative-intent treatment for patients with limited curative treatment options are incompletely understood. Lack of guidance for physicians on this topic can lead to inconsistent utilization of palliative services, as well as confusing, upsetting experiences for patients and families. We review the literature investigating the clinical factors, inter- and intrapersonal factors, and financial and health care system considerations that head and neck cancer physicians weigh during this decision-making process...
September 13, 2016: Otolaryngology—Head and Neck Surgery
Nisha Sutherland, Catherine Ward-Griffin, Carol McWilliam, Kelli Stajduhar
Evidence of gender differences in the amount and type of care provided by family caregivers in hospice palliative home care suggests potential inequities in health and health care experiences. As part of a larger critical ethnographic study examining gender relations among clients with cancer, their family caregivers and primary nurses, this article describes gendered expectations and exemptions for family caregivers within the sociopolitical context of end-of-life at home. Data were collected from in-depth interviews (n = 25), observations of agency home care visits (n = 9) and analyses of policy and home care agency documents (n = 12)...
September 7, 2016: Nursing Inquiry
Ann Kutney-Lee, Dawn Smith, Joshua Thorpe, Cindy Del Rosario, Said Ibrahim, Mary Ersek
BACKGROUND: Few studies have examined comprehensively racial/ethnic variations in quality of end-of-life care. OBJECTIVE: Examine end-of-life care quality received by Veterans and their families, comparing racial/ethnic minorities to nonminorities. RESEARCH DESIGN: This is a retrospective, cross-sectional analysis of chart review and survey data. SUBJECTS: Nearly all deaths in 145 Veterans Affairs Medical Centers nationally (n=94,697) in addition to Bereaved Family Survey (BFS) data (n=51,859) from October 2009 to September 2014...
August 30, 2016: Medical Care
Naveen Salins, Raghavendra Ramanjulu, Lipika Patra, Jayita Deodhar, Mary Ann Muckaden
INTRODUCTION: World Health Organization and American Society of Clinical Oncology recommend early integration of specialist palliative care in patients with cancer. This paper focuses on critical review of evidence on integration of early specialist palliative care in cancer care and patient-related outcomes. METHODS: The question for the literature search was - Does integration of early specialist palliative care in cancer care influences patient-related outcomes? 31 articles related to literature search review question were included in this paper...
July 2016: Indian Journal of Palliative Care
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