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barriers to end of life discussions

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https://www.readbyqxmd.com/read/29775556/let-s-talk-about-it-supporting-family-communication-during-end-of-life-care-of-pediatric-patients
#1
Meghan L Marsac, Christine Kindler, Danielle Weiss, Lindsay Ragsdale
BACKGROUND: Communication is key in optimizing medical care when a child is approaching end of life (EOL). Research is yet to establish best practices for how medical teams can guide intrafamily communication (including surviving siblings) when EOL care is underway or anticipated for a pediatric patient. While recommendations regarding how medical teams can facilitate communication between the medical team and the family exist, various barriers may prevent the implementation of these recommendations...
May 18, 2018: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/29767578/-death-is-difficult-in-any-language-a-qualitative-study-of-palliative-care-professionals-experiences-when-providing-end-of-life-care-to-patients-from-culturally-and-linguistically-diverse-backgrounds
#2
Anna Green, Natalia Jerzmanowska, Marguerite Green, Elizabeth A Lobb
BACKGROUND: Ethnic minority patients have unique challenges in accessing health services. These include language difficulties, unfamiliarity with the health system, lower rates of cancer screening and survival, higher rates of reported side effects from cancer treatment and poorer quality of life. Little is known about this patient group when transitioning to palliative care. AIM: To elicit the experiences of palliative care health professionals when providing care for patients from culturally and linguistically diverse backgrounds which differ from mainstream Australian language and culture...
May 1, 2018: Palliative Medicine
https://www.readbyqxmd.com/read/29756557/barriers-to-end-of-life-discussions-among-hematologists-a-qualitative-study
#3
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
https://www.readbyqxmd.com/read/29743759/knowledge-and-attitude-of-er-and-intensive-care-unit-physicians-toward-do-not-resuscitate-in-a-tertiary-care-center-in-saudi-arabia-a-survey-study
#4
Alaa Gouda, Norah Alrasheed, Alaa Ali, Ahmad Allaf, Najd Almudaiheem, Youssuf Ali, Ahmad Alghabban, Sami Alsalolami
Introduction: Only a few studies from Arab Muslim countries address do-not-resuscitate (DNR) practice. The knowledge of physicians about the existing policy and the attitude towards DNR were surveyed. Objective: The objective of this study is to identify the knowledge of the participants of the local DNR policy and barriers of addressing DNR including religious background. Methods: A questionnaire has been distributed to Emergency Room (ER) and Intensive Care Unit (ICU) physicians...
April 2018: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/29675459/bioengineered-systems-and-designer-matrices-that-recapitulate-the-intestinal-stem-cell-niche
#5
REVIEW
Yuli Wang, Raehyun Kim, Samuel S Hinman, Bailey Zwarycz, Scott T Magness, Nancy L Allbritton
The relationship between intestinal stem cells (ISCs) and the surrounding niche environment is complex and dynamic. Key factors localized at the base of the crypt are necessary to promote ISC self-renewal and proliferation, to ultimately provide a constant stream of differentiated cells to maintain the epithelial barrier. These factors diminish as epithelial cells divide, migrate away from the crypt base, differentiate into the postmitotic lineages, and end their life span in approximately 7 days when they are sloughed into the intestinal lumen...
March 2018: Cellular and Molecular Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/29649396/surgeons-perceived-barriers-to-palliative-and-end-of-life-care-a-mixed-methods-study-of-a-surgical-society
#6
Pasithorn A Suwanabol, Ari C Reichstein, Z Tuba Suzer-Gurtekin, Jane Forman, Maria J Silveira, Lona Mody, Arden M Morris
BACKGROUND: Nearly 20% of colorectal cancer (CRC) patients present with potentially incurable (Stage IV) disease, yet their physicians do not integrate cancer treatment with palliative care. Compared with patients treated by primary providers, surgical patients with terminal diseases are significantly less likely to receive palliative or end-of-life care. OBJECTIVE: To describe surgeon perspectives on palliative and end-of-life care for patients with Stage IV CRCs...
March 13, 2018: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/29607704/perceived-barriers-to-goals-of-care-discussions-with-patients-with-advanced-cancer-and-their-families-in-the-ambulatory-setting-a-multicenter-survey-of-oncologists
#7
Josee-Lyne Ethier, Thivaher Paramsothy, John J You, Robert Fowler, Sonal Gandhi
BACKGROUND: Earlier goals of care (GOC) discussions in patients with advanced cancer are associated with less aggressive end-of-life care including decreased use of medical technologies. Unfortunately, conversations often occur late in the disease trajectory when patients are acutely unwell. Here, we evaluate practitioner perspectives of patient, family, physician, and external barriers to early GOC discussions in the ambulatory oncology setting. METHODS: A previously published survey to assess barriers to GOC discussions among clinicians on inpatient medical wards was modified for the ambulatory oncology setting and distributed to oncologists from 12 centers in Ontario, Canada...
January 1, 2018: Journal of Palliative Care
https://www.readbyqxmd.com/read/29600591/veteran-centred-content-in-medical-education
#8
Paula T Ross, Monica L Lypson
BACKGROUND: Veterans have unique experiences that warrant special consideration in health care. Unfortunately, training in veteran-centred care has not been a clear focus of medical education, and only a very small proportion of medical schools include military cultural competency in their curricula. METHODS: We conducted an 80-minute focus group with six US veterans. Open-ended questions were used to elicit their perceptions of the health care that they receive, and how it can be improved...
March 30, 2018: Clinical Teacher
https://www.readbyqxmd.com/read/29580230/palliative-care-for-people-with-schizophrenia-a-qualitative-study-of-an-under-serviced-group-in-need
#9
Beverley McNamara, Anne Same, Lorna Rosenwax, Brian Kelly
BACKGROUND: People with schizophrenia are at risk of receiving poorer end of life care than other patients. They are often undertreated, avoid treatment and are about half as likely to access palliative care. There are limited options for end of life care for this under-serviced group in need. This study aims to address the paucity of research by documenting possible need, experiences of health care service use and factors affecting palliative care use for people with schizophrenia who have advanced life limiting illness...
March 27, 2018: BMC Palliative Care
https://www.readbyqxmd.com/read/29549489/perspectives-on-multidrug-resistant-organisms-at-the-end-of-life-a-focus-group-study-of-staff-members-and-institutional-stakeholders
#10
Franziska A Herbst, Maria Heckel, Johanna M Tiedtke, Thomas Adelhardt, Alexander Sturm, Stephanie Stiel, Christoph Ostgathe
BACKGROUND: There is a lack of research into how hospital staff and institutional stakeholders (i. e. institutional representatives from public health authorities, hospital hygiene, and the departments of microbiology, palliative care, and geriatrics) engage with patients who are carriers of multidrug-resistant organisms and receiving end-of-life care. Knowledge of their experiences, workload, and needs should be considered in dealing with hospitalized carriers of multidrug-resistant organisms as well as staff education...
March 16, 2018: Zeitschrift Für Gerontologie und Geriatrie
https://www.readbyqxmd.com/read/29512426/end-of-life-care-for-an-undocumented-mexican-immigrant-resident-perspective
#11
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...
April 2018: Journal of Palliative Care
https://www.readbyqxmd.com/read/29498611/community-perspectives-of-end-of-life-preparedness
#12
Davina Banner, Shannon Freeman, Damanpreet K Kandola, Madeline Meikle, Bridget K M Russell, E Anne Sommerfeld, Donna Flood, Catharine J Schiller
While death is a universal human experience, the process of planning for death can be difficult and may be avoided altogether. To understand community perspectives of end-of-life preparedness, we undertook a multimethod study exploring the experiences of 25 community members and 10 stakeholders engaged in end-of-life planning. In addition, card sorting activities and focused discussions with 97 older adults were undertaken to highlight perspectives and needs. Data were analyzed using descriptive statistics and qualitative description...
March 2, 2018: Death Studies
https://www.readbyqxmd.com/read/29490198/who-cares-for-the-carers-at-hospital-discharge-at-the-end-of-life-a-qualitative-study-of-current-practice-in-discharge-planning-and-the-potential-value-of-using-the-carer-support-needs-assessment-tool-csnat-approach
#13
Gail Ewing, Lynn Austin, Debra Jones, Gunn Grande
BACKGROUND: Carer factors prevent patients achieving timely and appropriate hospital discharge. There is a lack of research into interventions to support carers at hospital discharge. AIM: To explore whether and how family carers are currently supported during patient discharge at end of life; to assess perceived benefits, acceptability and feasibility of using The Carer Support Needs Assessment Tool (CSNAT) Approach in the hospital setting to support carers. DESIGN: Qualitative...
May 2018: Palliative Medicine
https://www.readbyqxmd.com/read/29488729/nursing-management-of-people-experiencing-homelessness-at-the-end-of-life
#14
Wendy Ann Webb, Theresa Mitchell, Brian Nyatanga, Paul Snelling
Homelessness is a complex and multidimensional issue often involving a combination of personal vulnerability, the limitations of social housing, and inadequacies in welfare support. Providing palliative and end-of-life care to people experiencing homelessness is challenging, both to individuals receiving care and nurses aiming to meet their complex needs. This article discusses what is understood by the concept of 'homelessness' and examines the barriers to accessing effective healthcare for people who are homeless and have life-limiting conditions...
February 28, 2018: Nursing Standard
https://www.readbyqxmd.com/read/29479017/japan-s-healthcare-policy-for-the-elderly-through-the-concepts-of-self-help-ji-jo-mutual-aid-go-jo-social-solidarity-care-kyo-jo-and-governmental-care-ko-jo
#15
Kyoko Sudo, Jun Kobayashi, Shinichiro Noda, Yoshiharu Fukuda, Kenzo Takahashi
Elderly care is an emerging global issue threatening both developed and developing countries. The elderly in Japan increased to 26.7% of the population in 2015, and Japan is classified as a super-aged society. In this article, we introduce the financial aspects of the medical care and welfare services policy for the elderly in Japan. Japan's universal health insurance coverage system has been in place since 1961. Long-term care includes welfare services, which were separated from the medical care insurance scheme in 2000 when Japan was already recognized as an aging society...
March 18, 2018: Bioscience Trends
https://www.readbyqxmd.com/read/29466968/palliative-care-specialists-perceptions-concerning-referral-of-haematology-patients-to-their-services-findings-from-a-qualitative-study
#16
Dorothy McCaughan, Eve Roman, Alexandra G Smith, Anne C Garry, Miriam J Johnson, Russell D Patmore, Martin R Howard, Debra A Howell
BACKGROUND: Haematological malignancies (leukaemias, lymphomas and myeloma) are complex cancers that are relatively common, affect all ages and have divergent outcomes. Although the symptom burden of these diseases is comparable to other cancers, patients do not access specialist palliative care (SPC) services as often as those with other cancers. To determine the reasons for this, we asked SPC practitioners about their perspectives regarding the barriers and facilitators influencing haematology patient referrals...
February 21, 2018: BMC Palliative Care
https://www.readbyqxmd.com/read/29432705/lay-patient-navigators-perspectives-of-barriers-facilitators-and-training-needs-in-initiating-advance-care-planning-conversations-with-older-patients-with-cancer
#17
Soumya J Niranjan, Chao-Hui S Huang, J Nicholas Dionne-Odom, Karina I Halilova, Maria Pisu, Patricia Drentea, Elizabeth A Kvale, Kerri S Bevis, Thomas W Butler, Edward E Partridge, Gabrielle B Rocque
CONTEXT: Respecting Choices is an evidence-based model of facilitating advance care planning (ACP) conversations between health-care professionals and patients. However, the effectiveness of whether lay patient navigators can successfully initiate Respecting Choices ACP conversations is unknown. As part of a large demonstration project (Patient Care Connect [PCC]), a cohort of lay patient navigators underwent Respecting Choices training and were tasked to initiate ACP conversations with Medicare beneficiaries diagnosed with cancer...
April 2018: Journal of Palliative Care
https://www.readbyqxmd.com/read/29396240/discussing-conservative-management-with-older-patients-with-ckd-an-interview-study-of-nephrologists
#18
Keren Ladin, Renuka Pandya, Allison Kannam, Rohini Loke, Tira Oskoui, Ronald D Perrone, Klemens B Meyer, Daniel E Weiner, John B Wong
BACKGROUND: Although dialysis may not provide a large survival benefit for older patients with kidney failure, few are informed about conservative management. Barriers and facilitators to discussions about conservative management and nephrologists' decisions to present the option of conservative management may vary within the nephrology provider community. STUDY DESIGN: Interview study of nephrologists. SETTING & PARTICIPANTS: National sample of US nephrologists sampled based on sex, years in practice, practice type, and region...
May 2018: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/29380222/cross-cultural-medical-care-training-and-education-a-national-survey-of-pediatric-hematology-oncology-fellows-in-training-and-fellowship-program-directors
#19
Amulya A Nageswara Rao, Deepti M Warad, Amy L Weaver, Cathy D Schleck, Vilmarie Rodriguez
Pediatric hematologists/oncologists face complex situations such as breaking bad news, treatment/clinical trials discussions, and end-of-life/hospice care. With increasing diversity in patient and physician populations, cultural competency and sensitivity training covering different aspects of pediatric hematology/oncology (PDHO) care can help improve health care delivery and reduce disparities. Though it is considered a required component of fellowship training, there is no clearly defined curriculum meant specifically for PDHO fellows-in-training (PDHO-F)...
January 27, 2018: Journal of Cancer Education: the Official Journal of the American Association for Cancer Education
https://www.readbyqxmd.com/read/29335033/should-capacity-assessments-be-performed-routinely-prior-to-discussing-advance-care-planning-with-older-people
#20
Oleg Kiriaev, Emme Chacko, J D Jurgens, Meagan Ramages, Phillipa Malpas, Gary Cheung
BACKGROUND: People with dementia receive worse end of life care compared to those with cancer. Barriers to undertaking advanced care planning (ACP) in people with dementia include the uncertainty about their capacity to engage in such discussions. The primary aim of this study was to compare the Advance Care Planning-Capacity Assessment Vignette tool (ACP-CAV) with a semi-structured interview adapted from the MacArthur Competence Assessment Tool-Treatment (MacCAT-T). The secondary aim was to identify demographic and cognitive functioning variables that may predict whether a person has capacity to discuss ACP...
January 16, 2018: International Psychogeriatrics
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