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American Journal of Hospice & Palliative Care

Raya Elfadel Kheirbek, Yara Alemi, Janusz Wojtusiak, Lena Kheirbek, Sorina Madison, Ali Fokar, Rami Doukky, Hans J Moore
BACKGROUND: Acute decompensated heart failure (HF) is the leading cause for hospital readmission. Large-scale sustainable interventions to reduce readmission rate have not been fully explored or proven effective. OBJECTIVE: We studied the impact of hospice and palliative care service utilization on 30-day all-cause hospital readmissions for patients with HF. METHODS AND RESULTS: Data were retrieved from the Department of Veterans Affairs Corporate Data Warehouse...
February 17, 2019: American Journal of Hospice & Palliative Care
Min Jung Geum, Ji Hyune Ahn, Jae Song Kim, Soo Hyun Kim, Eun Sun Son, Youn Jung Hu, Hye Jin Choi, Sandy Jeong Rhie
PURPOSE: The purpose of the study was to evaluate the impact on pain management by multidisciplinary palliative care team (mPCT) and the team pharmacist. METHODS: Patients who were admitted to palliative care unit (PCU) for at least 7 days between April 2014 and December 2015 were included. The mPCT consisted of a physician, a pharmacist, nurses, and non-clinical support staff. The team was on charge of pain management of patients who were admitted to PCU. Pain intensity was assessed at 3 time points in each patient; 1 week before PCU admission (day -7), on the day of admission (day 0), and 1 week after admission (day 7) using 0 to 10 numerical rating scale (NRS)...
February 12, 2019: American Journal of Hospice & Palliative Care
Caterina Magnani, Chiara Mastroianni, Diana Giannarelli, Maria Consiglia Stefanelli, Valeria Di Cienzo, Teresa Valerioti, Giuseppe Casale
BACKGROUND: Oral problems are frequent in palliative care and can cause disabling symptoms such as orofacial pain, dysgeusia, and xerostomia. Even if oral care is an essential aspect of nursing, it is often not considered as a priority, especially when various complex patients' needs have to be managed. OBJECTIVE: The aim of this study was to describe oral conditions and evaluate the impact of standard oral care on symptom control and patient's perceived comfort in a sample of terminally ill patients...
February 12, 2019: American Journal of Hospice & Palliative Care
Luiz Guilherme L Soares, Renato Vieira Gomes, André M Japiassu
Patients with hematologic malignancies (HMs) often receive poor-quality end-of-life care. This study aimed to identify trends in end-of-life care among patients with HM in Brazil. We conducted a retrospective cohort study (2015-2018) of patients who died with HM, using electronic medical records linked to health insurance databank, to evaluate outcomes consistent with health-care resource utilization at the end of life. Among 111 patients with HM, in the last 30 days of life, we found high rates of emergency department visits (67%, n = 75), intensive care unit admissions (56%, n = 62), acute renal replacement therapy (10%, n = 11), blood transfusions (45%, n = 50), and medical imaging utilization (59%, n = 66)...
February 11, 2019: American Journal of Hospice & Palliative Care
Hon-Wai Benjamin Cheng, Pui-Shan Karen Shek, Ching-Wah Man, Oi-Man Chan, Chun-Hung Chan, Kit-Man Lai, Suk-Ching Cheng, Koon-Sim Fung, W K Lui, Carman Lam, Yuen-Kwan Ng, Wan-To Wong, Cherry Wong
BACKGROUND: Noncancer patients with life-limiting diseases often receive more intensive level of care in their final days of life, with more cardiopulmonary resuscitation performed and less do-not-resuscitate (DNR) orders in place. Nevertheless, death is still often a taboo across Chinese culture, and ethnic disparities could negatively affect DNR directives completion rates. OBJECTIVES: We aim to explore whether Chinese noncancer patients are willing to sign their own DNR directives in a palliative specialist clinic, under a multidisciplinary team approach...
February 11, 2019: American Journal of Hospice & Palliative Care
Sara G McCleskey, Cindy L Cain
BACKGROUND: While disparities in end-of-life care have been well-documented, explanations for the persistence of disparities are less clear. This study sought to examine diverse perceptions of end-of-life care, especially regarding how medical professionals can better serve all populations. OBJECTIVE: To investigate similarities and differences in end-of-life care preferences, across racial and ethnic groups. DESIGN: This work consists of a qualitative study utilizing in-depth focus group discussions...
February 6, 2019: American Journal of Hospice & Palliative Care
Shannon M Nugent, Christopher G Slatore, Linda Ganzini, Sara E Golden, Dana Zive, Kelly C Vranas, Donald R Sullivan
INTRODUCTION: The Oregon Physicians Orders for Life-Sustaining Treatment (POLST) Program allows patients with advanced illness to document end-of-life (EOL) care preferences. We examined the characteristics and associated EOL care among Veterans with and without a registered POLST. METHODS: Retrospective, cohort study of advanced-stage (IIIB and IV) patients with lung cancer who were diagnosed between 2008 and 2013 as recorded in the VA Central Cancer Registry. We examined a subgroup of 346 Oregon residents...
January 30, 2019: American Journal of Hospice & Palliative Care
Joshua A Rolnick, Judy A Shea, Joanna L Hart, Scott D Halpern
BACKGROUND: Little is understood about the different ways patients complete advance directives (ADs), which is most commonly through lawyers and increasingly using websites. OBJECTIVE: To understand patients' perspectives on different approaches to facilitating AD completion, the value of legal regulation of ADs, and the use of a web-based platform to create an AD. DESIGN: Semi-structured interviews with patients. SETTING/PARTICIPANTS: We purposively sampled 25 patients at least 70 years of age or with a chronic disease from 2 internal medicine clinics...
January 29, 2019: American Journal of Hospice & Palliative Care
Meredith MacKenzie Greenle, Karen B Hirschman, Ken Coburn, Sherry Marcantonio, Alexandra L Hanlon, Mary Naylor, Elizabeth Mauer, Connie Ulrich
Patients with chronic illness are associated with high health-care utilization and this is exacerbated in the end of life, when health-care utilization and costs are highest. Complex Care Management (CCM) is a model of care developed to reduce health-care utilization, while improving patient outcomes. We aimed to examine the relationship between health-care utilization patterns and patient characteristics over time in a sample of older adults enrolled in CCM over the last 2 years of life. Generalized estimating equation models were used...
January 29, 2019: American Journal of Hospice & Palliative Care
Eon Sook Lee, Sang-Yeon Suh, Thomas W LeBlanc, Sang Hwa Himchack, Sanghee Shiny Lee, Yoonjoo Kim, Hong-Yup Ahn
BACKGROUND: Prognostication is an essential component of palliative care for patients with advanced cancer but also poses challenges. Little is known about physicians' perspectives on prognostication and prognostic tools used in palliative care practice in Eastern countries. OBJECTIVES: To explore Korean physicians' perspectives and experiences with prognostication in their palliative care practices. METHODS: Semi-structured interviews were conducted in Korea in 11 palliative care physicians...
January 27, 2019: American Journal of Hospice & Palliative Care
Mellar P Davis, Bertrand Behm
Ginseng has been used for centuries to treat various diseases and has been commercially developed and cultivated in the past 300 years. Ginseng products may be fresh, dried (white), or dried and steamed (red). Extracts may be made using water or alcohol. There are over 50 different ginsenosides identified by chromatography. We did an informal systematic qualitative review that centered on fatigue, cancer, dementia, respiratory diseases, and heart failure, and we review 113 studies in 6 tables. There are multiple potential benefits to ginseng in cancer...
January 27, 2019: American Journal of Hospice & Palliative Care
Mervyn Y H Koh, Jia F Lee, Socrates Montalban, Chik L Foo, Allyn Y M Hum
BACKGROUND: The American College of Emergency Physicians has identified early palliative care referral for patients with advanced cancer as a key competent of the Choosing Wisely campaign. OBJECTIVES: To study the feasibility of a new 3-way model of care between emergency department (ED), hospital palliative care department, and inpatient/home hospice. METHODS: This was a prospective, descriptive study that included oncology patients who attended the hospital ED over a 3-year period from January 2015 to December 2017...
January 23, 2019: American Journal of Hospice & Palliative Care
Kathryn Levy, Pei C Grant, Rachel M Depner, Kelly E Tenzek, Megan E Pailler, Lynda K Beaupin, Jennifer M Breier, David J Byrwa
BACKGROUND: Research indicates that informal caregiving can have intense physical and mental impact on the individual. Relative to caregivers of adults, pediatric palliative caregivers appear less in literature despite experiencing greater mental, physical, financial, and social strain. There is limited research on the creation and evaluation of interventions specifically for this population despite clear need. OBJECTIVE: This study aims to evaluate the feasibility and engagement of the Photographs of Meaning Program, a modified meaning-making intervention for pediatric palliative caregivers...
January 21, 2019: American Journal of Hospice & Palliative Care
Amber Zimmer Deptola, Jessica Riggs
Despite an aging population and an increase in the prevalence of chronic severe illness, many patients will not have end-of-life care discussions with their outpatient physicians. This very likely contributes to considerable hospital utilization toward the end of life, without any clear benefit. At our medical center, we noticed a very high rate of floor-to-intensive care unit (ICU) transfers for patients with life-limiting illness and poor prognosis. We initiated a quality assessment and improvement project aimed at increasing goals-of-care conversations for high-risk patients early in their hospital stays...
January 17, 2019: American Journal of Hospice & Palliative Care
Lee Ann Johnson, Amy Blew, Ann M Schreier
BACKGROUND: Lung cancer is the leading cause of cancer deaths globally. Individuals are diagnosed at an advanced stage with limited life expectancy. OBJECTIVES: To explore potential health disparities in hospice utilization and length of stay (LOS) in a diverse sample of patients with lung cancer. METHODS: Demographic and clinical information as well as data for hospice utilization and LOS was extracted from electronic health records. Data were analyzed using descriptive statistics, χ2 tests, and an analysis of variance test...
January 16, 2019: American Journal of Hospice & Palliative Care
Steven J Baumrucker, Matt Stolick, Laura Hutchinson, Angela Eastridge, Lawrence Devereux, Russell W Adkins, Gregory T Carter
MC is a 42-year-old female who was in a motor vehicle accident and suffered multiple contusions as well as a fracture of the left femur, pelvic ramus, and left orbit. Due to contusion of the brain, MC has been comatose for over a week and is on mechanical ventilation to protect her airway. There is no written declaration of surrogacy. During the admission, surgery to repair the left femoral fracture was performed and was complicated by severe blood loss. Currently, MC's hematocrit is 24% with a hemoglobin of 7...
January 16, 2019: American Journal of Hospice & Palliative Care
Krishna Patel, Andre D'Souza, Hunter Groninger
BACKGROUND: Continuous cardiac inotropes are increasingly utilized for symptom management in advanced heart failure (AHF). Among patients who are not eligible for cardiac transplant or mechanical circulatory support, many are hospice eligible at the time of inotrope initiation. Nevertheless, given relative infrequent use as well as cost issues, acceptability and management of inotropes in the hospice setting are likely widely variable between hospice agencies. OBJECTIVE: To describe hospice care experiences for patients with AHF receiving continuous inotrope therapies and weaning inotropes at the end of life...
January 10, 2019: American Journal of Hospice & Palliative Care
Kayoko Morio, Isseki Maeda, Isao Yokota, Kazuyuki Niki, Taizo Murata, Yasushi Matsumura, Etsuko Uejima
OBJECTIVE: Polypharmacy (PP) is a burden in elderly patients with cancer pain; however, risk factors for PP remain unclear. The purpose of this study was to investigate the risk factors for PP in this patient population. METHODS: We retrospectively reviewed the medical charts of patients aged ≥65 years with cancer pain who were treated at Osaka University Hospital between February 2014 and June 2016 according to the World Health Organization 3-step ladder for cancer pain relief...
January 10, 2019: American Journal of Hospice & Palliative Care
Sven Niklas Burmann, Martin Neukirchen, Christoph Ostgathe, Mingo Beckmann, Jacqueline Schwartz, Karin Scheer, Stephanie Klco-Brosius, Joerg Hense, Martin Teufel, Mitra Tewes
BACKGROUND: In Germany, some units of specialized palliative care (SPC) offer a 6- to 12-month rotation for resident physicians (RPs) and fellows from different specialties. OBJECTIVE: This pilot study aimed to evaluate feasibility of assessing palliative care knowledge (PCK) and palliative care self-efficacy (PCSE) using a paper-based questionnaire. METHODS: Palliative care knowledge and PCSE were assessed by introducing a score, followed by a descriptive analysis (determination of frequency, mean, median, and range) using nonparametric tests (χ2 test, Mann-Whitney U test)...
January 8, 2019: American Journal of Hospice & Palliative Care
Holly B Cunningham, Shannon A Scielzo, Paul A Nakonezny, Brandon R Bruns, Karen J Brasel, Kenji Inaba, Scott C Brakenridge, Jeffrey D Kerby, Bellal A Joseph, M J Mohler, Joseph Cuschieri, Mary E Paulk, Akpofure P Ekeh, Tarik D Madni, Luis R Taveras, Jonathan B Imran, Steven E Wolf, Herb A Phelan
BACKGROUND: The value of defining goals of care (GoC) for geriatric patients is well known to the palliative care community but is a newer concept for many trauma surgeons. Palliative care specialists and trauma surgeons were surveyed to elicit the specialties' attitudes regarding (1) importance of GoC conversations for injured seniors; (2) confidence in their own specialty's ability to conduct these conversations; and (3) confidence in the ability of the other specialty to do so. METHODS: A 13-item survey was developed by the steering committee of a multicenter, palliative care-focused consortium and beta-tested by trauma surgeons and palliative care specialists unaffiliated with the consortium...
January 6, 2019: American Journal of Hospice & Palliative Care
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