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Hospice care

J Russell Hoverman, Marcus A Neubauer, Melissa Jameson, Jad E Hayes, Kathryn J Eagye, Mitra Abdullahpour, Wendy J Haydon, Maria Sipala, Amy Supraner, Michael A Kolodziej, Diana K Verrilli
PURPOSE: Reform of cancer care delivery seeks to control costs while improving quality. Texas Oncology collaborated with Aetna to conduct a payer-sponsored program that used evidence-based treatment pathways, a disease management call center, and an introduction to advance care planning to improve patient care and reduce total costs. METHODS: From June 1, 2013, to May 31, 2016, 746 Medicare Advantage patients with nine common cancer diagnoses were enrolled. Patients electing for patient support services were telephoned by oncology nurses who assessed symptoms and quality of life and introduced advance care planning...
March 16, 2018: Journal of Oncology 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
Samuel Enumah, Elizabeth J Lilley, Stephanie Nitzschke, Adil H Haider, Ali Salim, Zara Cooper
BACKGROUND: Hospice improves quality and value of end of life care (EOLC), and enrollment has increased for older patients dying from chronic medical conditions. It remains unknown if the same is true for older patients who die after moderate to severe traumatic brain injury (msTBI). METHODS: Subjects included Medicare beneficiaries (≥65 years) who were hospitalized for msTBI from 2005 to 2011. Outcomes included intensity and quality of EOLC for decedents within 30 days of admission, and 30-day mortality for the entire cohort...
March 1, 2018: American Journal of Surgery
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
Kathrin Boerner, Jason Rodriquez, Emma Quach, Meghan Hendricksen
This study examined how the Medical Order for Life-sustaining Treatment (MOLST) is implemented in two nursing homes in Massachusetts; one had primarily long-term care residents and high hospice utilization, the other had low hospice utilization and a high proportion of post-acute care residents. Qualitative in-person interviews with 21 staff members who had a role implementing the MOLST explored their experiences using the form in their daily work routines. Staff at both nursing homes described benefits of the MOLST such as providing guidance for staff and family...
March 6, 2018: Geriatric Nursing
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
Lilit Karapetyan, Om Dawani, Heather S Laird-Fick
The immigrant population in the United States has grown over the past years. Undocumented immigrants account for 14.6% of the uninsured population in the United States. Decisions about end-of-life treatment are often difficult to reach in the best of situations. We present a 43-year-old undocumented Mexican female immigrant with metastatic sarcomatoid squamous cell cervical cancer and discuss the barriers that she faced during her treatment. Limited English proficiency, living below the poverty line, low level of education, and lack access to Medicare, Medicaid, or other insurance coverage under the Affordable Care Act are major causes of decreased health-care access and service utilization by the immigrant population...
January 1, 2018: Journal of Palliative Care
Patrick M Zueger, Holly M Holmes, Gregory S Calip, Dima M Qato, A Simon Pickard, Todd A Lee
OBJECTIVES: To describe medications that older hospice beneficiaries receive through Medicare Part D and assess patterns in Part D use for individuals admitted to hospice for cancer and noncancer causes. DESIGN: Descriptive cohort analysis using the Surveillance, Epidemiology and End Results (SEER)-Medicare linked database. SETTING: U.S. hospice programs PARTICIPANTS: Part D-enrolled Medicare beneficiaries aged 66 and older who were admitted to hospice and died while under hospice care between January 1, 2008, and December 31, 2013 (N = 88,957)...
March 6, 2018: Journal of the American Geriatrics Society
Bridgette Kram, Kylie M Weigel, Michelle Kuhrt, Daniel L Gilstrap
OBJECTIVE: To evaluate the proportion of patients receiving a hospital discharge prescription for a scheduled enteral opioid following initiation as a weaning strategy from a continuous opioid infusion in the Intensive Care Unit (ICU). DESIGN: Retrospective, observational study. SETTING: Five adult ICUs at a large, quaternary care academic medical center. PATIENTS: Endotracheally intubated, opioid-naive adults receiving a continuous opioid infusion with a concomitant scheduled enteral opioid initiated...
January 2018: Journal of Opioid Management
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
Aman Chauhan, Millicent Horn, Gray Magee, Kurt Hodges, Mark Evers, Susanne Arnold, Lowell Anthony
This unique case series and review of literature suggests that immune checkpoint inhibitors may have clinical activity in neuroendocrine tumors. Objective: Summarize advances of immuno-oncology in neuroendocrine tumors with the help of a case series. Design: Case series and review of literature. Intervention or Exposure: The patients were treated with immune checkpoint inhibitors (pembrolizumab or nivolumab). Main Outcomes and Measuress: Life expectancy, quality of life, disease progression...
February 6, 2018: Oncotarget
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
Sally A Hageman, Anita J Tarzian, John Cagle
The costs of serious medical illness and end of life care are often a heavy burden for patients and families (Collins, Stepanczuk, Williams, & Rich, 2016 ; Kim, 2007 ; May et al., 2014 ; Zarit, 2004 ). Twenty-six practitioners, including social workers, managers/administrators, supervisors, and case managers from five health care settings, participated in qualitative semistructured interviews about financial challenges patients encountered. Seven practitioners took part in a focus group. Practitioners were recruited from hospice (n = 5), long-term care (n = 5), intensive care (n = 5), dialysis (n = 6), and oncology (n = 5)...
March 5, 2018: Journal of Social Work in End-of-life & 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]
Christie Hancock, Phillip Knouse, Imad Almanaseer, Jacob Bitran
BACKGROUND: Double-hit lymphomas (DHLs) are high-grade diffuse large B-cell lymphomas with concurrent translocations involving myc and bcl-2 and/or bcl-6. A patient with DHL often has advanced disease at presentation and typically responds poorly to standard therapy with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone). More intensive treatment regimens have been studied; however, few data are available on the outcomes in elderly patients (aged > 70 years) treated with these therapies...
February 15, 2018: Clinical Lymphoma, Myeloma & Leukemia
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
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