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Hospice and palliative care

Tracey Bleakley, Heather Richardson, Shaun O'Leary, Caroline Scates, Karen Harrison Dening, Kerry Harrison
Foreword Hospice UK's annual conference is the national hospice and palliative care charity's flagship event, bringing together everyone involved in leading hospice, palliative and end-of-life care for adults, children and young people. In 2018, the conference spanned two days and was held at the International Centre in Telford, Shropshire. Its theme was Transforming Palliative Care and it provided a unique forum for delegates to discuss current and forthcoming issues facing the hospice and palliative care community, and to discover new ways of thinking from outside of the sector...
February 2, 2019: International Journal of Palliative Nursing
Catherine R Butler, Margaret L Schwarze, Ronit Katz, Susan M Hailpern, William Kreuter, Yoshio N Hall, Maria E Montez Rath, Ann M O'Hare
BACKGROUND: Lower extremity amputation is common among patients with ESRD, and often portends a poor prognosis. However, little is known about end-of-life care among patients with ESRD who undergo amputation. METHODS: We conducted a mortality follow-back study of Medicare beneficiaries with ESRD who died in 2002 through 2014 to analyze patterns of lower extremity amputation in the last year of life compared with a parallel cohort of beneficiaries without ESRD. We also examined the relationship between amputation and end-of-life care among the patients with ESRD...
February 19, 2019: Journal of the American Society of Nephrology: JASN
Laura S Porter, Gregory Samsa, Jennifer L Steel, Laura C Hanson, Thomas W LeBlanc, Janet Bull, Stacy Fischer, Francis J Keefe
BACKGROUND/AIMS: Pain is a major concern of patients with advanced cancer and their caregivers. There is strong evidence that pain coping skills training interventions based on cognitive-behavioral principles can reduce pain severity and pain interference. However, few such interventions have been tested for patients with advanced cancer and their family caregivers. This study aims to test the efficacy of a caregiver-guided pain coping skills training protocol on patient and caregiver outcomes...
February 19, 2019: Clinical Trials: Journal of the Society for Clinical Trials
Luca Miceli, Rym Bednarova, Lucia Slaviero, Luigi Vetrugno, Tiziana Bove
OBJECTIVES: Objectives. To explore the perceived self-competence level of palliative care nurses in the province of Belluno (Italy), compared to Core Curriculum in Palliative Care Nursing (CCICP) competencies and to identify own strengths and weaknesses. METHODS: The authors performed a descriptive study using an anonymous questionnaire. The study population included 25 Palliative Care and Hospice nurses and ward managers of a local health unit in the city of Belluno and one in Feltre (Italy), of whom 24 agreed to participate in the study and compiled the questionnaire correctly...
September 2018: Igiene e Sanità Pubblica
Francesca Ingravallo, Kim de Nooijer, Valentina Pucci, Cinzia Casini, Guido Miccinesi, Judith A C Rietjens, Piero Morino
OBJECTIVE: To investigate whether and when palliative sedation was discussed with hospice patients with cancer and/or with their families and factors associated with patient involvement in such discussions. METHODS: Medical records of all patients with cancer who died in an Italian hospice in 2014-2015 (N = 326) were retrospectively reviewed. Multiple logistic regression was used to assess the association between patients' characteristics and palliative sedation discussion with the patient versus palliative sedation discussion only with the family...
February 17, 2019: European Journal of Cancer 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
Barret Rush, Clark Fruhstofer, Keith R Walley, Leo Anthony Celi, Mayur Brahmania
BACKGROUND: Patients with end-stage liver disease (ESLD) have a reduced life expectancy and a significant symptom burden. Our aim is to determine if inpatient palliative care (PC) referral for patients with ESLD is associated with decreased hospital readmission rates. METHODS: The 2013 US Nationwide Readmission Database (NRD) was used for the current analysis. The NRD allows for longitudinal analysis of all patient hospital admissions across 22 states. Patients ≥18 years of age with a diagnosis of ESLD with at least two decompensating events were included in the analysis...
February 13, 2019: BMJ Supportive & Palliative Care
Lee A Hugar, Samia H Lopa, Jonathan G Yabes, Justin A Yu, Robert M Turner, Mina M Fam, Liam C MacLeod, Benjamin J Davies, Angela B Smith, Bruce L Jacobs
OBJECTIVES: To describe the rate and determinants of palliative care use among Medicare beneficiaries with bladder cancer and encourage a national dialogue on improving coordinated urologic, oncologic, and palliative care in patients with genitourinary malignancies. MATERIALS AND METHODS: Using Surveillance, Epidemiology, and End Results-Medicare data, we identified patients diagnosed with muscle-invasive bladder cancer between 2008-2013. Our primary outcome was receipt of palliative care, defined as the presence of a claim submitted by a Hospice and Palliative Medicine subspecialist...
February 13, 2019: BJU International
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
Stephanie M Munz, Joseph I Helman, Margaret K Tiner, Anita L Hart
This reflection describes a life-limiting case of oral squamous cell carcinoma (SCC) that required thoughtful management facilitated by an advance care plan (ACP). A 70-year-old female was diagnosed with a T4aN2bM0 biopsy-proven invasive, well-differentiated keratinizing SCC. Surgical wide-local excision included teeth #11-16 with left unilateral neck dissection, levels I-V. She was rehabilitated with maxillary obturator prosthesis and underwent chemoradiation therapy. Her course was complicated by dysphagia and trismus...
February 12, 2019: Special Care in Dentistry
Bella Vivat, Lucy Bemand-Qureshi, Jane Harrington, Sarah Davis, Patrick Stone
BACKGROUND: Little research has explored the detail of practice when using sedative medications at the end of life. One work package of the I-CAN-CARE research programme investigates this in UK palliative care. AIMS: To investigate current practices when using sedative medication at the end of life in London, UK, by (1) qualitatively exploring the understandings of palliative care clinicians, (2) examining documented sedative use in patient records and (3) comparing findings from both investigations...
February 12, 2019: Palliative Medicine
Cindy Del Rosario, Ann Kutney-Lee, Julie Sochalski, Mary Ersek
PURPOSE: Several studies have identified differences in end-of-life (EOL) care between urban and rural areas, yet little is known about potential differences in care processes or family evaluations of care. The purpose of this study was to examine the relationship between rurality of residence and quality of EOL care within the Veterans Affairs health care system. METHODS: This study was a retrospective, cross-sectional analysis of 126,475 veterans who died from October 2009 through September 2016 in inpatient settings across 151 facilities...
February 11, 2019: Journal of Rural Health
Priyal P Fadadu, Joy C Liu, Brenda M Schiltz, Tran Dang Xoay, Phan Huu Phuc, Ashok Kumbamu, Yves Ouellette
BACKGROUND: Although the need for palliative care is gaining recognition in Southeast Asia, knowledge about how decisions are made for children near the end of life remains sparse. OBJECTIVE: To explore pediatric intensivists' attitudes and practices surrounding end-of-life care in Vietnam. METHODS: This is a mixed-methods study conducted at a tertiary pediatric and neonatal intensive care unit in Hanoi. Physicians and nurses completed a quantitative survey about their views on end-of-life care...
February 6, 2019: Journal of Palliative Medicine
Laura Finn, Sonia Malhotra
Palliative Care and its medical subspecialty, known as Palliative Medicine, is the care of anyone with a serious illness. This emerging field includes Hospice and comfort care, however, it is not limited to end-of-life care. Examples of the types of serious illness that Palliative Medicine clinicians care for include and are not limited to hematologic and oncologic diseases, such as cancer, advanced heart and lung diseases (e.g., congestive heart failure and chronic obstructive pulmonary disorder), advanced liver and kidney diseases, and advanced neurologic illnesses (e...
February 1, 2019: Healthcare (Basel, Switzerland)
Aoife Gleeson, Faye Johnson
OBJECTIVES: An increasing number of patients with motor neuron disease (MND) in the UK and Ireland use assisted ventilation, and a small proportion of these use long-term tracheostomy ventilation (TV).1 2 NICE guidelines recommend that patients with MND should routinely receive specialist palliative care input.3 The aim was to establish the extent to which hospices and specialist palliative care units (SPCUs) in the UK and Ireland currently manage patients with MND using assisted ventilation especially TV and to identify any associated barriers...
February 2, 2019: BMJ Supportive & Palliative Care
Clare White, Simon I R Noble, Max Watson, Flavia Swan, Victoria L Allgar, Eoin Napier, Annmarie Nelson, Jayne McAuley, Jennifer Doherty, Bernadette Lee, Miriam J Johnson
BACKGROUND: The prevalence of deep venous thrombosis in patients with advanced cancer is unconfirmed and it is unknown whether current international thromboprophylaxis guidance is applicable to this population. We aimed to determine prevalence and predictors of femoral deep vein thrombosis in patients admitted to specialist palliative care units (SPCUs). METHODS: We did this prospective longitudinal observational study in five SPCUs in England, Wales, and Northern Ireland (four hospices and one palliative care unit)...
February 2019: Lancet Haematology
Cecilia W M Kwan, Carmen W H Chan, Kai Chow Choi
BACKGROUND: A life review is a promising intervention to enhance spiritual well-being in older people. Conventional life review interventions are lengthy and often led by psychologists. OBJECTIVES: This is the first randomised controlled trial study to examine the effectiveness and applicability of a nurse-led short term life-review intervention in people with life limiting diseases, the purpose being to enhance their spiritual well-being and lower their anxiety and depression...
January 3, 2019: International Journal of Nursing Studies
Jason W Boland, Stephen Barclay, Jane Gibbins
Palliative care is the holistic care of patients with advanced, progressive incurable illness. Palliative care is well recognized as an essential component of medical student curricula. However, teaching is variable within medical schools. Using current literature, these tips aim to highlight key points necessary to facilitate the development and delivery of palliative care teaching to medical students. The key practice points include: clinical exposure to patients with palliative care needs and those that are dying, being compulsory (and integrated) across the course, summative and formative assessments to encourage learning, support from within the university for curricular time and development, visits to a hospice/inpatient palliative care facility, emphasis on clinically based learning later in the course, teaching by specialists in palliative care as well as specialists in other areas including Family Doctors/General Practitioners, innovative teaching methods and inter-professional learning to develop teaching...
January 28, 2019: Medical Teacher
Janice Marie Haley
Research conducted using the Haley Transcultural Strengths Assessment Interview Guide used in several studies has identified 11 sources of strength routinely utilized by parents caring for their child with intensive needs and child in hospice/palliative care. Results of past studies demonstrated this Strengths Guide (SG) interview to be an intervention bringing a heightened realization of the importance and utilization of one's inner strengths. The purpose of this study was to assess the long-term impact of this SG with a population of parents who participated in a previous study using the SG...
January 24, 2019: Journal of Hospice and Palliative Nursing: JHPN
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
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