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End-of-life care in emergency department

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https://www.readbyqxmd.com/read/28401622/predicting-mortality-in-the-emergency-department-external-validation-and-derivation-of-a-clinical-prediction-tool
#1
Rajat N Moman, Caitlin Loprinzi Brauer, Katherine M Kelsey, Rachel D Havyer, Christine M Lohse, M Fernanda Bellolio
BACKGROUND: he Choosing Wisely campaign has called for better engagement of palliative and hospice care services for patients in the emergency department (ED). PREDICT is a clinical prediction tool that was derived in an Australian ED cohort. It assesses a patient's risk of mortality at one year to select those who would benefit from advanced care planning. Such goals of care discussion can improve patients' ability to communicate what they want out of their healthcare and, in cases of end-of-life, potentially reduce the number of futile interventions...
April 12, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28385298/understanding-advance-care-documents-what-the-nurse-advocate-needs-to-know
#2
Erika Kellogg
The emergency department is a critical care area for those with immediate health care needs, and death is not an uncommon outcome. The discussion regarding end-of-life care is often a subject nurses feel uncomfortable or unprepared to address. Additionally, nurses often encounter obstacles when providing end-of-life care in the emergency department environment. It is vital that emergency nurses are educated about the many aspects of end-of-life care to feel better prepared to address the topic which will ultimately improve patient care...
April 3, 2017: Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association
https://www.readbyqxmd.com/read/28353509/innovative-urgent-care-for-the-palliative-patient-at-home
#3
Carmel L Montgomery, Charlotte Pooler, Julia E Arsenault, Colleen Berean, Robert Sharman, Cheryl L Cameron, Ingrid de Kock
Palliative and end-of-life patients in their homes are at risk of developing symptom crises requiring urgent care. The usual care for these patients involves transport to an Emergency Department (ED) despite the preference of most palliative patients to stay home. The objective of this initiative was to develop an innovative strategy to provide collaborative care in the home to alleviate symptoms and avoid transport. A partnership was created among Emergency Medical Services and Community Care staff, physicians, and leaders to enable patients to stay at home with existing resources during symptom crisis...
April 2017: Home Healthcare Now
https://www.readbyqxmd.com/read/28333569/are-preferences-for-aggressive-medical-treatment-associated-with-healthcare-utilization-in-the-very-old
#4
Steven M Albert, June R Lunney, Lei Ye, Robert Boudreau, Diane Ives, Suzanne Satterfield, Cameron M Kaplan, Teresa Waters, Hilsa N Ayonayon, Susan M Rubin, Anne B Newman, Tamara Harris
OBJECTIVES: To examine the relationship between end-of-life (EOL) treatment preferences and recent hospitalization or emergency department (ED) care in the very old. DESIGN: Quarterly telephone follow-up of participants in the EOL in the Very Old cohort. SETTING: The EOL in the Very Old Age cohort drew from 1403 participants in the Health, Aging, and Body Composition (Health ABC) study who were alive in year 15 of follow-up. 87.5% (n = 1227) were successfully recontacted and enrolled...
March 23, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28264944/innovative-oncology-care-models-improve-end-of-life-quality-reduce-utilization-and-spending
#5
Erin Murphy Colligan, Erin Ewald, Sarah Ruiz, Michelle Spafford, Caitlin Cross-Barnet, Shriram Parashuram
Three models that received Health Care Innovation Awards from the Centers for Medicare and Medicaid Services (CMS) aimed to reduce the cost and use of health care services and improve the quality of care for Medicare beneficiaries with cancer. Each emphasized a different principle: the oncology medical home, patient navigation, or palliative care. Comparing participants in each model who died during the study period to matched comparators, we found that the oncology medical home and patient navigation models were associated with decreased costs in the last ninety days of life ($3,346 and $5,824 per person, respectively) and fewer hospitalizations in the last thirty days of life (fifty-seven and forty per 1,000 people, respectively)...
March 1, 2017: Health Affairs
https://www.readbyqxmd.com/read/28225375/impact-of-a-child-life-and-music-therapy-procedural-support-intervention-on-parental-perception-of-their-child-s-distress-during-intravenous-placement
#6
Gabriela S Ortiz, Todd OʼConnor, Jessa Carey, Adam Vella, Audrey Paul, Diane Rode, Alan Weinberg
OBJECTIVES: Child life specialists and music therapists have a unique and integral role in providing psychosocial care to pediatric patients and families. These professionals are trained to provide clinical interventions that support coping and adjustment and reduce the risk of psychological trauma related to hospital visits and health care encounters. The researchers devised a multimodal approach using a combined child life and music therapy intervention to address procedure-related distress in patients receiving intravenous (IV) placement in the pediatric emergency department...
February 21, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28214236/are-hospital-ed-transfers-less-likely-among-nursing-home-residents-with-do-not-hospitalize-orders
#7
Taeko Nakashima, Yuchi Young, Wan-Hsiang Hsu
OBJECTIVES: This study aims to examine whether an advance directive "Do Not Hospitalize" (DNH) would be effective in reducing hospital/emergency department (ED) transfers. Similar effects in residents with dementia were also examined. DESIGN: Cross-sectional study. SETTING/SUBJECTS: New York State (NYS) nursing home residents (n = 43,024). MEASUREMENTS AND ANALYSIS: The Minimum Data Set 2.0 was used to address the study aims...
February 14, 2017: Journal of the American Medical Directors Association
https://www.readbyqxmd.com/read/28169049/the-association-of-community-based-palliative-care-with-reduced-emergency-department-visits-in-the-last-year-of-life-varies-by-patient-factors
#8
Katrina Spilsbury, Lorna Rosenwax, Glenn Arendts, James B Semmens
STUDY OBJECTIVE: Palliative care has been shown to reduce end-of-life emergency department (ED) use. Our objective was to determine how the association of community-based palliative care with reduced ED visits in the last year of life varied by patient factors. METHODS: This was a retrospective cohort study of 11,875 decedents who died with neoplasms, heart failure, renal failure, chronic obstructive pulmonary disease, or liver failure in Western Australia in 2009 to 2010...
April 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/28152860/using-information-technology-to-power-an-integrated-community-based-oncology-palliative-care-model
#9
Andrew Allan Hertler, Lianne Matthews, RaeLynn Carr
166 Background: There is a need to improve palliative care program access for patients with cancer. The identification of candidates for palliative care at the point of diagnose can improve care and reduce costs. This pilot program was launched in July 2015 by four stakeholders: Health plan; Regional palliative care provider; Community oncology practice; and Oncology quality management provider. METHODS: Objectives are to increase patient satisfaction, reduce unnecessary utilization and costs...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28125760/resource-use-and-medicare-costs-during-lay-navigation-for-geriatric-patients-with-cancer
#10
Gabrielle B Rocque, Maria Pisu, Bradford E Jackson, Elizabeth A Kvale, Wendy Demark-Wahnefried, Michelle Y Martin, Karen Meneses, Yufeng Li, Richard A Taylor, Aras Acemgil, Courtney P Williams, Nedra Lisovicz, Mona Fouad, Kelly M Kenzik, Edward E Partridge
Importance: Lay navigators in the Patient Care Connect Program support patients with cancer from diagnosis through survivorship to end of life. They empower patients to engage in their health care and navigate them through the increasingly complex health care system. Navigation programs can improve access to care, enhance coordination of care, and overcome barriers to timely, high-quality health care. However, few data exist regarding the financial implications of implementing a lay navigation program...
January 26, 2017: JAMA Oncology
https://www.readbyqxmd.com/read/28100061/outpatient-palliative-care-and-aggressiveness-of-end-of-life-care-in-patients-with-metastatic-colorectal-cancer
#11
Si Won Lee, Hyun Jung Jho, Ji Yeon Baek, Eun Kyung Shim, Hyun Mi Kim, Ji Yeon Ku, Eun Jung Nam, Yoon-Jung Chang, Hye Jin Choi, Sun Young Kim
BACKGROUND: Palliative care in outpatient setting has been shown to promote better symptom management and transition to hospice care among patients with advanced cancer. Nevertheless, specialized palliative care is rarely provided at cancer centers in Korea. Herein, we aimed to assess aggressiveness of end-of-life care for patients with metastatic colorectal cancer according to the use of outpatient palliative care (OPC) at a single cancer center in Korea. METHODS: We performed a retrospective medical record review for 132 patients with metastatic colorectal cancer who died between 2011 and 2014...
January 1, 2017: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/28063864/the-end-of-life-experience-of-pediatric-heart-transplant-recipients
#12
Seth A Hollander, John Dykes, Sharon Chen, Lynsey Barkoff, Barbara Sourkes, Harvey Cohen, David N Rosenthal, Daniel Bernstein, Beth D Kaufman
CONTEXT: Despite advances in therapies, many pediatric heart transplant (Htx) recipients will die prematurely. We characterized the circumstances surrounding death in this cohort, including location of death and interventions performed in the final 24 hours. METHODS: We reviewed all patients who underwent Htx at Lucile Packard Children's Hospital, Stanford, survived hospital discharge, and subsequently died between 7/19/2007-9/13/2015. The primary outcome studied was location of death, characterized as inpatient, outpatient, or emergency department (ED)...
January 4, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28056201/predictors-of-and-trends-in-high-intensity-end-of-life-care-among-children-with-cancer-a-population-based-study-using-health-services-data
#13
Alisha Kassam, Rinku Sutradhar, Kimberley Widger, Adam Rapoport, Jason D Pole, Katherine Nelson, Joanne Wolfe, Craig C Earle, Sumit Gupta
Purpose Children with cancer often receive high-intensity (HI) medical care at the end-of-life (EOL). Previous studies have been limited to single centers or lacked detailed clinical data. We determined predictors of and trends in HI-EOL care by linking population-based clinical and health-services databases. Methods A retrospective decedent cohort of patients with childhood cancer who died between 2000 and 2012 in Ontario, Canada, was assembled using a provincial cancer registry and linked to population-based health-care data...
January 10, 2017: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28032432/perception-of-prognosis-of-cancer-patients-by-non-oncologists
#14
Hadar Goldvaser, Yonatan Milman, Tal Dujovni, Anat Stern, Muhamad Mahamid, Ekaterina Hanovich, Amir Zivony, Tzippy Shochat, Rinat Yerushalmi, Anat Gafter-Gvili, Baruch Brenner, Daniel Shepshelovich
BACKGROUND: Data are lacking regarding the perception of cancer patients' prognosis by physicians who are not oncologists. METHODS: This was a multicenter survey of seven university-affiliated hospitals, assessing physicians' perception of the median survival of patients with seven advanced malignancies. The study cohort included physicians from all 73 internal medicine, surgery, emergency medicine and critical care departments in the participating hospitals. Family practitioners were contacted through email...
December 2016: International Journal of Clinical Practice
https://www.readbyqxmd.com/read/28029586/social-determinants-multimorbidity-and-patterns-of-end-of-life-care-in-older-adults-dying-from-cancer
#15
Siran M Koroukian, Nicholas K Schiltz, David F Warner, Charles W Given, Mark Schluchter, Cynthia Owusu, Nathan A Berger
OBJECTIVE: Most prior studies on aggressive end-of-life care in older patients with cancer have accounted for social determinants of health (e.g., race, income, and education), but rarely for multimoribidity (MM). In this study, we examine the association between end-of-life care and each of the social determinants of health and MM, hypothesizing that higher MM is associated with less aggressive care. METHODS: From the linked 1991-2008 Health and Retirement Study, Medicare data, and the National Death Index, we identified fee-for-service patients age ≥66years who died from cancer (n=835)...
March 2017: Journal of Geriatric Oncology
https://www.readbyqxmd.com/read/27997005/-urgent-hospitalization-of-the-cancer-patient-problems-and-opportunity
#16
Gianmauro Numico, Maura Rossi
Cancer patients are frequently subject to non programmed access to the emergency department or to the oncological services. The main underlying needs are disease-related symptoms, treatment-related toxicity and end-of-life issues. Sudden events frequently change the trajectory of the disease and ask for rapid changes of cancer care. Hospital admission is frequently an unavoidable step in clinical history, especially in the last months of life. While an improvement in symptoms management and a tighter patients' control could prevent from the unexpected worsening of clinical conditions, oncologists and emergency physicians are called to a strict cooperation...
December 2016: Recenti Progressi in Medicina
https://www.readbyqxmd.com/read/27979041/acute-cardioversion-vs-a-wait-and-see-approach-for-recent-onset-symptomatic-atrial-fibrillation-in-the-emergency-department-rationale-and-design-of-the-randomized-acwas-trial
#17
Elton Dudink, Brigitte Essers, Wouter Holvoet, Bob Weijs, Justin Luermans, Hemanth Ramanna, Anho Liem, Jurren van Opstal, Lukas Dekker, Vincent van Dijk, Timo Lenderink, Otto Kamp, Lennert Kulker, Michiel Rienstra, Bas Kietselaer, Marco Alings, Jos Widdershoven, Joan Meeder, Martin Prins, Isabelle van Gelder, Harry Crijns
BACKGROUND: Current standard of care for patients with recent-onset atrial fibrillation (AF) in the emergency department aims at urgent restoration of sinus rhythm, although paroxysmal AF is a condition that resolves spontaneously within 24 hours in more than 70% of the cases. A wait-and-see approach with rate-control medication only and when needed cardioversion within 48 hours of onset of symptoms is hypothesized to be noninferior, safe, and cost-effective as compared with current standard of care and to lead to a higher quality of life...
January 2017: American Heart Journal
https://www.readbyqxmd.com/read/27917433/death-among-elderly-patients-in-the-emergency-department-a-needs-assessment-for-end-of-life-care
#18
Rakhee Yash Pal, Win Sen Kuan, Yiwen Koh, Kuhan Venugopal, Irwani Ibrahim
INTRODUCTION: Elderly patients with serious chronic diseases often present to the emergency department (ED) in the last moments of their life, many with identifiable trajectories of dying: organ failure, advanced cancer and chronic frailty. These patients and their families may benefit more from good end-of-life (EOL) care provision than the standard resuscitative approach. This study aimed to determine the incidence and nature of death among patients aged ≥ 65 years in an ED, and characterise their trajectories of dying...
March 2017: Singapore Medical Journal
https://www.readbyqxmd.com/read/27846111/experiences-of-healthcare-professionals-in-providing-palliative-end-of-life-care-to-patients-in-emergency-departments-a-systematic-review-protocol
#19
Kai Yeung Cheung, Kai Chiu Chan
The objective of this review is to identify and synthesize the best available evidence on the experiences of healthcare professionals in providing palliative care to patients at the end of life in emergency departments.
October 2016: JBI Database of Systematic Reviews and Implementation Reports
https://www.readbyqxmd.com/read/27807085/-i-ll-be-in-a-safe-place-a-qualitative-study-of-the-decisions-taken-by-people-with-advanced-cancer-to-seek-emergency-department-care
#20
Lesley A Henson, Irene J Higginson, Barbara A Daveson, Clare Ellis-Smith, Jonathan Koffman, Myfanwy Morgan, Wei Gao
OBJECTIVE: To explore the decisions of people with advanced cancer and their caregivers to seek emergency department (ED) care, and understand the issues that influence the decision-making process. DESIGN: Cross-sectional qualitative study incorporating semistructured patient and caregiver interviews. METHODS: Between December 2014 and July 2015, semistructured interviews were conducted with 18 people with advanced cancer, all of whom had recently attended the ED of a large university teaching hospital located in south-east London; and six of their caregivers...
November 2, 2016: BMJ Open
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