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Palliative Care AND (Services OR Models)

Jo Ellen Wilson, Leanne Boehm, Lauren R Samuels, Deborah Unger, Martha Leonard, Christianne Roumie, E Wesley Ely, Robert S Dittus, Sumi Misra, Jin H Han
OBJECTIVE: Many patients with advanced serious illness or at the end of life experience delirium, a potentially reversible form of acute brain dysfunction, which may impair ability to participate in medical decision-making and to engage with their loved ones. Screening for delirium provides an opportunity to address modifiable causes. Unfortunately, delirium remains underrecognized. The main objective of this pilot was to validate the brief Confusion Assessment Method (bCAM), a two-minute delirium-screening tool, in a veteran palliative care sample...
March 19, 2019: Palliative & Supportive Care
Amy S Kelley, Katelyn B Ferreira, Evan Bollens-Lund, Harriet Mather, Laura C Hanson, Christine S Ritchie
CONTEXT: Identifying the seriously ill population is integral to improving the value of health care. Efforts to identify this population using existing data are anchored to a list of severe medical conditions (SMCs) using diagnostic codes. Published approaches have utilized International Classification of Diseases, Ninth Revision (ICD-9) codes, which has since been replaced by ICD-10. OBJECTIVES: We translated SMCs from ICD-9 to ICD-10 using a refined code list...
March 12, 2019: Journal of Pain and Symptom Management
Gregory M Gressel, Shayan M Dioun, Michael Richley, David W Lounsbury, Bruce D Rapkin, Sara Isani, Nicole S Nevadunsky, D Y S Kuo, Akiva P Novetsky
OBJECTIVE: The Patient-Reported Outcomes Measurement Information System (PROMIS®) Network has developed a comprehensive repository of electronic patient reported outcomes measures (ePROs) of major symptom domains that have been validated in cancer patients. Their use for patients with gynecologic cancer has been understudied. Our objective was to establish feasibility and acceptability of PROMIS ePRO integration in a gynecologic oncology outpatient clinic and assess if it can help identify severely symptomatic patients and increase referral to supportive services...
March 2019: Gynecologic Oncology
Matthew Schefft, Alan R Schroeder, Diane Liu, Daniel Nicklas, Justin Moher, Ricardo Quinonez
Underuse and overuse of medical interventions, failure to use interventions known to be effective, and provision of tests or interventions in which benefits do not exceed harms are types of low-value care. The Lown Institute's Right Care Alliance Children's Health Council identified five "do" recommendations that highlight underuse and five "don't" recommendations that highlight overuse in children's health care. The five "do" recommendations include: do provide access to long-acting reversible contraception for adolescents, do use nonpharmacologic interventions first for treatment of attention-deficit/hyperactivity disorder, do discuss quality of life for children with complex medical conditions using a shared decision-making model and access resources such as palliative care subspecialists, do promote childhood literacy development by providing free, age-appropriate books in clinical settings, and do screen for socioeconomic status of the patient and family and provide access to community health and wellness resources...
March 15, 2019: American Family Physician
Farina Hodiamont, Saskia Jünger, Reiner Leidl, Bernd Oliver Maier, Eva Schildmann, Claudia Bausewein
BACKGROUND: The concept of complexity is used in palliative care (PC) to describe the nature of patients' situations and the extent of resulting needs and care demands. However, the term or concept is not clearly defined and operationalised with respect to its particular application in PC. As a complex problem, a care situation in PC is characterized by reciprocal, nonlinear relations and uncertainties. Dealing with complex problems necessitates problem-solving methods tailored to specific situations...
March 12, 2019: BMC Health Services Research
Erica C Kaye, Courtney A Gushue, Samantha DeMarsh, Jonathan Jerkins, Chen Li, Zhaohua Lu, Jennifer M Snaman, Lindsay Blazin, Liza-Marie Johnson, Deena R Levine, R Ray Morrison, Justin N Baker
BACKGROUND: Racial and ethnic disparities in the provision of end-of-life care are well described in the adult oncology literature. However, the impact of racial and ethnic disparities at end of life in the context of pediatric oncology remains poorly understood. OBJECTIVE: To investigate associations between end-of-life experiences and race/ethnicity for pediatric patients with cancer. METHODS: A retrospective cohort study was conducted on 321 children with cancer enrolled on a palliative care service at an urban pediatric cancer who died between 2011 and 2015...
March 13, 2019: American Journal of Hospice & Palliative Care
Charlotte Castor, Inger Kristensson Hallström, Kajsa Landgren, Helena Hansson
BACKGROUND: Home care service (HCS) for sick children is a complex healthcare service, which can be organised in various models. Despite the possibility to support family everyday life, the accessibility and utilisation may still be limited. The aim of this study was to (i) determine characteristics in referrals to county-based HCS, (ii) determine characteristics of referred children and (iii) assess acceptability of parents and children in county-based HCS. METHODS: Data on characteristics of referrals and referred children were collected from medical records of children 0-17 years of age, referred to eight HCS units during 2015-2018...
March 13, 2019: Scandinavian Journal of Caring Sciences
David Hui, Carlos Eduardo Paiva, Egidio G Del Fabbro, Christopher Steer, Jane Naberhuis, Marianne van de Wetering, Paz Fernández-Ortega, Tatsuya Morita, Sang-Yeon Suh, Eduardo Bruera, Masanori Mori
The objective of this review is to provide an update on prognostication in patients with advanced cancer and to discuss future directions for research in this field. Accurate prognostication of survival for patients with advanced cancer is vital, as patient life expectancy informs many important personal and clinical decisions. The most common prognostic approach is clinician prediction of survival (CPS) using temporal, surprise, or probabilistic questions. The surprise and probabilistic questions may be more accurate than the temporal approach, partly by limiting the time frame of prediction...
March 13, 2019: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
Jenny Hunt, Katherine Bristowe, Sybille Chidyamatare, Richard Harding
BACKGROUND: Ensuring palliative care for all under a new global health policy must include key populations, that is, lesbian, gay, bisexual, transgender and intersex (LGBTI) people, and sex workers. Accessibility and quality of care have not been investigated in lower and middle-income countries where civil rights are the weakest. AIM: To examine the accessibility to, and experiences of, palliative care for key populations in Zimbabwe. DESIGN: Qualitative study using thematic analysis of in-depth interviews and focus groups...
March 12, 2019: Palliative Medicine
Sarah Amador, Elizabeth L Sampson, Claire Goodman, Louise Robinson
BACKGROUND: A challenge for commissioners and providers of end-of-life care in dementia is to translate recommendations for good or effective care into quality indicators that inform service development and evaluation. AIM: To identify and critically evaluate quality indicators for end-of-life care in dementia. RESULTS: We found 8657 references, after de-duplication. In all, 19 publications describing 10 new and 3 updated sets of indicators were included in this review...
March 11, 2019: Palliative Medicine
Deborah Friedman, Rachel W Linnemann, Lily L Altstein, Anna M Georgiopoulos, Suhayla Islam, Kieu-Tram Bach, Anita St John, M Shannon Fracchia, Isabel Neuringer, Allen Lapey, Leonard Sicilian, Samuel M Moskowitz, Lael M Yonker
BACKGROUND: Despite the significant impact of chronic symptoms on quality of life with cystic fibrosis (CF), the role of palliative care in management of this disease is not well defined. The coping, goal assessment, and relief from evolving CF symptoms (CF-CARES) model is a primary palliative care intervention designed to provide chronic symptom management at all stages of the disease. The goal of this pilot study was to estimate the effectiveness of the CF-CARES intervention on improving chronic symptoms and quality of life for people living with CF...
March 10, 2019: Pediatric Pulmonology
J Tung, J Chadder, D Dudgeon, C Louzado, J Niu, R Rahal, A Sinnarajah
Hospitals play an important role in the care of patients with advanced cancer: nearly half of all cancer deaths occur in acute-care settings. The need for increasing access to palliative care and related support services for patients with cancer in acute-care hospitals is therefore growing. Here, we examine how often and how early in their illness patients with cancer might be receiving palliative care services in the 2 years before their death in an acute-care hospital in Canada. The palliative care code from inpatient administrative databases was used as a proxy for receiving, or being referred for, palliative care...
February 2019: Current Oncology
Page E Yaxley
In 2011, Michigan State University College of Veterinary Medicine founded the second veterinary hospice in academic practice. This program was designed to meet the growing demand for veterinary end-of-life care in the community. Veterinary Hospice Care provided patients and their families palliative care services, through utilization of an interdisciplinary team, from the time of terminal diagnosis to the time of death. Families also received dedicated emotional support. As a direct result of the hospice care service, Michigan State University veterinary students as well as in-state technical college students received an increase in end-of-life care in the curriculum...
March 6, 2019: Veterinary Clinics of North America. Small Animal Practice
Dorothy McCaughan, Eve Roman, Alexandra G Smith, Anne C Garry, Miriam J Johnson, Russell D Patmore, Martin R Howard, Debra A Howell
PURPOSE: Patients with haematological malignancies are more likely to die in hospital, and less likely to access palliative care than people with other cancers, though the reasons for this are not well understood. The purpose of our study was to explore haematology nurses' perspectives of their patients' places of care and death. METHOD: Qualitative description, based on thematic content analysis. Eight haematology nurses working in secondary and tertiary hospital settings were purposively selected and interviewed...
April 2019: European Journal of Oncology Nursing: the Official Journal of European Oncology Nursing Society
Yanli Hu, Fan Li, Jeng-Fong Chiou
BACKGROUND: Spiritual care competencies are among the primary professional skills that enable best practices in nursing. Assessing these competencies and identifying those that are insufficient are important tasks. The traditional Chinese version of the Palliative Care Spiritual Care Competency Scale (PCSCCS) used in Taiwan is a well-validated tool to measure palliative caregivers' competencies in providing spiritual care. However, whether this scale is valid and reliable for use with nurses in other health-care contexts is unknown...
March 8, 2019: BMC Palliative Care
Andrew Wilcock, Asmah Hussain, Matthew Maddocks
BACKGROUND: A holistic needs assessment is recommended in people with cancer at key stages, including soon after diagnosis. For people with thoracic cancer, there is a lack of data obtained routinely at this time point. OBJECTIVE: To identify the most common and/or distressing supportive and palliative needs present soon after diagnosis using a specifically developed questionnaire. METHODS: As part of a local rehabilitation service, patients within three to six weeks of a diagnosis of thoracic cancer were invited to complete the Sheffield Profile for Assessment and Referral to Care (SPARC© ) questionnaire...
March 8, 2019: Journal of Palliative Medicine
Courtney E French, Isabelle Delon, Helen Dolling, Alba Sanchis-Juan, Olga Shamardina, Karyn Mégy, Stephen Abbs, Topun Austin, Sarah Bowdin, Ricardo G Branco, Helen Firth, David H Rowitch, F Lucy Raymond
PURPOSE: With growing evidence that rare single gene disorders present in the neonatal period, there is a need for rapid, systematic, and comprehensive genomic diagnoses in ICUs to assist acute and long-term clinical decisions. This study aimed to identify genetic conditions in neonatal (NICU) and paediatric (PICU) intensive care populations. METHODS: We performed trio whole genome sequence (WGS) analysis on a prospective cohort of families recruited in NICU and PICU at a single site in the UK...
March 7, 2019: Intensive Care Medicine
Lisa Moses
A veterinary palliative care service was developed as a specialty service in 2006 at a large, nonprofit teaching veterinary hospital. The service originally was conceived as a pain medicine service, but quickly refocused on palliative care because a need was evident. The Pain and Palliative Care Service at Angell Animal Medical Center is structured primarily as an outpatient service, but does provide consultation services for hospitalized patients. The goals of the service, appointment structure, referral relationships, client communication issues, and practitioner sustainability are described in detail in this article as an aid to development of similar services...
March 4, 2019: Veterinary Clinics of North America. Small Animal Practice
Courtney Bennett, Nathaniel Cook
A growing, multidoctor, mobile hospice and palliative care practice in Louisville, Kentucky, is described. Services are exclusively dedicated to palliative medicine, hospice, and end-of-life care. The characteristics of, and unique considerations associated with, this practice's patient population are discussed. Demand for hospice and palliative care services is increasing even though these fields are in the early stages of growth and development, and availability of services is limited. Research is an essential step toward improving care provision and evaluating the value of hospice and palliative care services in terms of patient comfort, quality of life, and survival time...
March 4, 2019: Veterinary Clinics of North America. Small Animal Practice
Maie El-Sourady, Heidi Chen, Sara F Martin, Joseph Ritchie, Katreece Ellis, Ashley Richeson, Don Moore, Mohana Karlekar, Sumi Misra
Interest and appreciation for palliative care (PC) has resulted in increased demand for both PC services and education. The PC rotation has been shown to improve PC knowledge in medical students (MS) and internal medicine (IM) residents, and PC specialists stand poised to direct the primary PC education of learners at different levels of training. To concurrently teach learners of different levels of training on a busy PC service, we created an educational system that emphasizes management of learner schedules, organization of teaching activities, faculty development to improve teaching skills, and learner self-evaluation...
March 7, 2019: American Journal of Hospice & Palliative Care
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