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Poor end-of-life care

Megan Quinn, Sheila Gephart
BACKGROUND: Palliative care is a holistic framework that is designed to improve quality of life by identifying and treating distressing symptoms of life-threatening or complex conditions. Neonatal palliative care (NPC) has potential benefits for parents, staff, and patients, yet evidence suggests that implementation and utilization of organized NPC services are low. PURPOSE: The purpose of this study is to answer the clinical question: In neonatal intensive care, what evidence can be used to guide implementation of palliative care protocols? SEARCH STRATEGY: A literature search was conducted using CINAHL (Cumulative Index of Nursing and Allied Health Literature), PubMed, and the Cochrane Library databases...
October 22, 2016: Advances in Neonatal Care: Official Journal of the National Association of Neonatal Nurses
Abby R Rosenberg, Joanne Wolfe, Lori Wiener, Maureen Lyon, Chris Feudtner
Importance: For clinicians caring for adolescent patients living with progressive, life-threatening illness, discussions regarding prognosis, goals of care, and treatment options can be extremely challenging. While clinicians should respect and help to facilitate adolescents' emerging autonomy, they often must also work with parents' wishes to protect patients from the emotional distress of hearing bad news. Observations: We reviewed the ethical justifications for and against truth-telling, and we considered the published ethical and practice guidance, as well as the perspectives of patients, parents, and clinicians involved in these cases...
October 17, 2016: JAMA Pediatrics
Joseph Em van Agteren, Kristin V Carson, Leong Ung Tiong, Brian J Smith
BACKGROUND: Lung volume reduction surgery (LVRS) performed to treat patients with severe diffuse emphysema was reintroduced in the nineties. Lung volume reduction surgery aims to resect damaged emphysematous lung tissue, thereby increasing elastic properties of the lung. This treatment is hypothesised to improve long-term daily functioning and quality of life, although it may be costly and may be associated with risks of morbidity and mortality. Ten years have passed since the last version of this review was prepared, prompting us to perform an update...
October 14, 2016: Cochrane Database of Systematic Reviews
Jaclyn Yoong, Aleece MacPhail, Gael Trytel, Prashanti Yalini Rajendram, Margaret Winbolt, Joseph E Ibrahim
Objective Limitation of Medical Treatment (LMT) forms are an essential element of end-of-life care. Decision making around LMT is complex and often involves patients with dementia. Despite the complexity, junior doctors frequently play a central role in completing LMT forms. The present study sought perspectives from a range of stakeholders (hospital clinicians, medical education personnel, legal and advocacy staff) about junior doctors' roles in completing LMT forms in general and for patients with dementia...
October 14, 2016: Australian Health Review: a Publication of the Australian Hospital Association
David Li, Holly G Prigerson, Josephine Kang, Paul K Maciejewski
CONTEXT: Radiation therapy (RT) is used with palliative intent in patients with advanced stage cancer. Prior studies, primarily in patients with poor performance status (PS), suggest that RT is associated with aggressive medical care, which may impact patients' quality of life near death (QoD) adversely. OBJECTIVE: This study examines associations between RT use and patients' receipt of aggressive care and QoD based on patients' PS. METHODS: Multi-institutional, prospective cohort study of patients with end-stage cancers (N=312) and identified as terminally ill at study enrollment...
October 5, 2016: Journal of Pain and Symptom Management
Myles Nickolich, Areej El-Jawahri, Thomas W LeBlanc
A growing literature demonstrates that MDS is associated with significant impairments in overall quality of life. Given the poor prognosis for many patients with MDS, and the considerable morbidities associated with this disease, there is a critical need to address palliative and end-of-life care needs in this population. However, palliative and end-of-life care issues are under-represented in the MDS literature. In this article, we highlight a growing body of literature that demonstrates unmet palliative and end-of-life care needs in hematologic malignancies, including MDS, and highlight opportunities for further research and quality improvement initiatives to address unmet needs in MDS care...
October 4, 2016: Current Hematologic Malignancy Reports
Yi-Hsin Liang, Chih-Hsin Wei, Wen-Hui Hsu, Yu-Yun Shao, Ya-Chin Lin, Pei-Chun Chou, Ann-Lii Cheng, Kun-Huei Yeh
PURPOSE: Do-not-resuscitate (DNR) consent is crucial in end-of-life (EOL) care for patients with advanced cancer. However, DNR consents signed by patients (DNR-P) and surrogates (DNR-S) reflect differently on patient autonomy and awareness. METHODS: This retrospective study enrolled advanced cancer patients treated at National Taiwan University Hospital, Hsin-Chu Branch between 2012 and 2014. Patients who signed DNR consent at other hospitals were excluded; the remaining patients were subsequently classified into DNR-S and DNR-P groups...
October 4, 2016: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
Eliana Ferroni, Francesco Avossa, Franco Figoli, Maurizio Cancian, Cosimo De Chirico, Elisabetta Pinato, Michele Pellizzari, Ugo Fedeli, Mario Saugo, Domenico Mantoan
BACKGROUND: Hospital admissions at the end of life (EOL) represent an established indicator of poor quality of care. OBJECTIVE: To examine the impact of intensity of integrated primary and specialist home-based palliative care for chronic diseases (HPCCD) plans of care on EOL hospital access. METHODS: Retrospective population-based study using linked mortality, hospitalization, and home care data. Intensity of HPCCD was measured 90-31 days before death; outcomes were hospital death and prolonged hospital stay for medical reasons in the last month of life...
October 3, 2016: Journal of Palliative Medicine
(no author information available yet)
Given recent media reports of poor nursing practices, the subject of compassion has become more important than ever.
September 30, 2016: Nursing Management (Harrow)
Anne E Holland, Ajay Mahal, Catherine J Hill, Annemarie L Lee, Angela T Burge, Narelle S Cox, Rosemary Moore, Caroline Nicolson, Paul O'Halloran, Aroub Lahham, Rebecca Gillies, Christine F McDonald
BACKGROUND: Pulmonary rehabilitation is a cornerstone of care for COPD but uptake of traditional centre-based programmes is poor. We assessed whether home-based pulmonary rehabilitation, delivered using minimal resources, had equivalent outcomes to centre-based pulmonary rehabilitation. METHODS: A randomised controlled equivalence trial with 12 months follow-up. Participants with stable COPD were randomly assigned to receive 8 weeks of pulmonary rehabilitation by either the standard outpatient centre-based model, or a new home-based model including one home visit and seven once-weekly telephone calls from a physiotherapist...
September 26, 2016: Thorax
Jon T Powell, José C Pons, Marian Chertow
Waste generation is expected to increase in most countries for many decades with landfill disposal still the dominant solid waste management method(1-3). Yet, operational characteristics of landfills are often poorly understood with comparative statistics substantially lacking. Here, we call for a more formal waste informatics to organize and standardize waste management knowledge at multiple spatial scales through analysis of recently reported data from 1232 U.S. landfills and other high resolution data sets...
October 6, 2016: Environmental Science & Technology
M Gysels, C C Reilly, C J Jolley, C Pannell, Femke Spoorendonk, J Moxham, C Bausewein, I J Higginson
CONTEXT: Dignity is poorly conceptualized and little empirically explored in end of life care. A qualitative evaluation of a service offering integrated palliative and respiratory care for patients with advanced disease and refractory breathlessness uncovered an unexpected outcome, it enhanced patients' dignity. OBJECTIVES: To analyse what constitutes dignity for people suffering from refractory breathlessness with advanced disease, and its implications for the concept of dignity...
September 17, 2016: Journal of Pain and Symptom Management
Zubair Umer Mohamed, Fazil Muhammed, Charu Singh, Abish Sudhakar
BACKGROUND AND AIMS: The practice of intensive care includes withholding and withdrawal of care, when appropriate, and the goals of care change around this time to comfort and palliation. We decided to survey the attitudes, training, and skills of intensive care residents in relation to end-of-life (EoL) care. All residents at our institute who has worked for at least a month in an adult Intensive Care Unit were invited to participate. MATERIALS AND METHODS: After Institutional Ethics Committee approval, a Likert-scale questionnaire, divided into five composite measures of EoL skills including training and attitude, was handed over to individual residents and completed data were anonymized...
August 2016: Indian Journal of Critical Care Medicine
Gabriel A Brooks, Sherri O Stuver, Yichen Zhang, Stephanie Gottsch, Belen Fraile, Kristen McNiff, Anton Dodek, Joseph O Jacobson
BACKGROUND: A majority of patients with poor-prognosis cancer express a preference for in-home death; however, in-hospital deaths are common. OBJECTIVE: We sought to identify characteristics associated with in-hospital death. DESIGN: Case series. SETTING/SUBJECTS: Commercially insured patients with cancer who died between July 2010 and December 2013 and who had at least two outpatient visits at a tertiary cancer center during the last six months of life...
September 14, 2016: Journal of Palliative Medicine
Jessica R Bauman, Zofia Piotrowska, Alona Muzikansky, Emily Gallagher, Emily Scribner, Brandon Temel, Lecia V Sequist, Rebecca S Heist, Jennifer S Temel
BACKGROUND/OBJECTIVE: Patients with metastatic nonsmall cell lung cancer (NSCLC) harboring epidermal growth factor receptor (EGFR) mutations benefit from improved survival and quality of life with EGFR-directed therapy. We sought to explore if these improvements in cancer care impacted the delivery of end-of-life (EOL) care in this population. DESIGN: We retrospectively reviewed medical records of patients cared for at our institution with the diagnosis of metastatic EGFR-mutant NSCLC who died by January 2015...
September 14, 2016: Journal of Palliative Medicine
Jennifer M Snaman, Erica C Kaye, Melody J Cunningham, April Sykes, Deena R Levine, Daniel Mahoney, Justin N Baker
BACKGROUND: Medical trainees consistently report suboptimal instruction and poor self-confidence in communication skills. Despite this deficit, few established training programs provide comprehensive, pediatric-specific communication education, particularly in the provision of "bad news." To our knowledge, no programs currently use bereaved parent educators to facilitate communication training for pediatric subspecialty trainees. PROCEDURE: The authors designed and implemented a pilot communication training seminar in which bereaved parent educators and faculty facilitators led small groups in interactive, role-play scenarios...
September 8, 2016: Pediatric Blood & Cancer
Bobby Daly, Andrew Hantel, Kristen Wroblewski, Jay S Balachandran, Selina Chow, Rebecca DeBoer, Gini F Fleming, Olwen M Hahn, Justin Kline, Hongtao Liu, Bhakti K Patel, Anshu Verma, Leah J Witt, Mayumi Fukui, Aditi Kumar, Michael D Howell, Blase N Polite
PURPOSE: Terminal oncology intensive care unit (ICU) hospitalizations are associated with high costs and inferior quality of care. This study identifies and characterizes potentially avoidable terminal admissions of oncology patients to ICUs. METHODS: This was a retrospective case series of patients cared for in an academic medical center's ambulatory oncology practice who died in an ICU during July 1, 2012 to June 30, 2013. An oncologist, intensivist, and hospitalist reviewed each patient's electronic health record from 3 months preceding terminal hospitalization until death...
September 6, 2016: Journal of Oncology Practice
L L Ganca, L Gwyther, R Harding, M Meiring
BACKGROUND: Thousands of South Africans are diagnosed with life-threatening illness every year. Research shows that, globally, of the 20 million people who need palliative care at the end of life every year, <10% receive it. OBJECTIVES: To explore communication skills and practices of medical practitioners when conveying a poor prognosis to patients and families, and to identify their communication skills, needs and understanding of palliative care. METHODS: This was an exploratory qualitative study of practising doctors, using a grounded theory approach...
September 2016: South African Medical Journal, Suid-Afrikaanse Tydskrif Vir Geneeskunde
John J Oosterink, Mariska G Oosterveld-Vlug, Jolien J Glaudemans, H Roeline W Pasman, Dick L Willems, Bregje D Onwuteaka-Philipsen
BACKGROUND: Timely end-of-life (EOL) discussions between patients and physicians are considered essential for high-quality EOL care, but research shows that these discussions frequently do not occur or occur late. In oncology, one barrier for timely EOL discussions is poor collaboration between oncologic specialists and GPs. OBJECTIVE: To explore interprofessional communication and coordination between oncologic specialists and GPs on EOL discussions. METHODS: We conducted in-depth interviews with 16 GPs and 14 oncologic specialists...
September 1, 2016: Family Practice
Sigrid N W Vorrink, Helianthe S M Kort, Thierry Troosters, Pieter Zanen, Jan-Willem J Lammers
Physical inactivity in patients with chronic obstructive pulmonary disease (COPD) is associated with poor health status and increased disease burden. The present study aims to test the efficacy of a previously developed mobile (m)Health intervention to improve or maintain physical activity in patients with COPD after pulmonary rehabilitation.A randomised controlled trial was performed in 32 physiotherapy practices in the Netherlands. COPD patients were randomised into intervention or usual care groups. The intervention consisted of a smartphone application for the patients and a monitoring website for the physiotherapists...
October 2016: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
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