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1
Connor, Stephen R., Chris Cody, and Stephen G. Arter. "Pharmaceutical Care Standards for Hospice Providers." Journal of Pharmaceutical Care in Pain & Symptom Control 2, no. 4 (January 1994): 5–14. http://dx.doi.org/10.1300/j088v02n04_02.
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Olson, Sharon L. "Hospice day care standards development in Michigan." American Journal of Hospice Care 6, no. 2 (March 1989): 35–39. http://dx.doi.org/10.1177/104990918900600217.
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Lum, Hillary D., Carolyn Horney, David Koets, Jean S. Kutner, and Daniel D. Matlock. "Availability of Heart Failure Medications in Hospice Care." American Journal of Hospice and Palliative Medicine® 33, no. 10 (July 10, 2016): 924–28. http://dx.doi.org/10.1177/1049909115603689.
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Background: Availability of cardiac medications in hospice for acute symptom management of heart failure is unknown. This study explored hospice approaches to cardiac medications for patients with heart failure. Methods: Descriptive study using a quantitative survey of 46 US hospice agencies and clinician interviews. Results: Of 31 hospices that provided standard home medication kits for acute symptom management, only 1 provided medication with cardiac indications (oral furosemide). Only 22% of the hospice agencies had a specific cardiac medication kit. Just over half (57%) of the agencies could provide intravenous inotropic therapy, often in multiple hospice settings. Clinicians described an individualized approach to cardiac medications for patients with heart failure. Conclusion: This study highlights opportunities for practice guidelines that inform medical therapy for hospice patients with heart failure.
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EISENBERGER, ANDREW, and JOMARIE ZELEZNIK. "Care planning for pressure ulcers in hospice: The team effect." Palliative and Supportive Care 2, no. 3 (September 2004): 283–89. http://dx.doi.org/10.1017/s1478951504040374.
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Objective: The standards of care for patients at risk for or with a pressure ulcer in hospitals and nursing homes focus on prevention and ulcer healing using an interdisciplinary approach. Although not a primary hospice condition, pressure ulcers are not uncommon in dying patients. Their management in hospices, particularly the involvement of family caregivers, has not been studied. The objective of this study is to identify the factors that influence care planning for the prevention and treatment of pressure ulcers in hospice patients and develop a taxonomy to use for further study.Methods: A telephone survey was conducted with 18 hospice directors of clinical services and 10 direct-care nurses. Descriptive qualitative data analysis using grounded theory was utilized.Results: The following three themes were identified: (1) the primary role of the hospice nurse is an educator rather than a wound care provider; (2) hospice providers perceive the barriers and burdens of family caregiver involvement in pressure ulcer care to be bodily location of the pressure ulcer, unpleasant wound characteristics, fear of causing pain, guilt, and having to acknowledge the dying process when a new pressure ulcer develops; and (3) the “team effect” describes the collaboration between family caregivers and the health care providers to establish individualized achievable goals of care ranging from pressure ulcer prevention to acceptance of a pressure ulcer and symptom palliation.Significance of results: Pressure ulcer care planning is a model of collaborative decision making between family caregivers and hospice providers for a condition that occurs as a secondary condition in hospice. A pressure ulcer places significant burdens on family caregivers distinct from common end-of-life symptoms whose treatment is directed at the patient. Because the goals of pressure ulcer care appear to be individualized for a dying patient and their caregivers, the basis of quality-of-care evaluations should be the process of care rather than the outcome of an incident pressure ulcer.
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Walker, Andreas, and Christof Breitsameter. "Ethical decision-making in hospice care." Nursing Ethics 22, no. 3 (June 29, 2014): 321–30. http://dx.doi.org/10.1177/0969733014534873.
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Background: Hospices are based on a holistic approach which places the physical, psychological, social and spiritual welfare of their patients at the forefront of their work. Furthermore, they draw up their own mission statements which they are at pains to follow and seek to conduct their work in accordance with codes of ethics and standards of care. Research question and design: Our study researched what form the processes and degrees of latitude in decision-making take in practice when questions of an ethical and ethically relevant nature arise. We used a qualitative approach. Data collection and evaluation was based on the methods of grounded theory. Ethical considerations: The study was reported to the relevant Ethics Commission who had raised no objections following the submission of the study protocol. The study at the hospices was approved by the directors of the hospices and the nursing teams. The rights of the participants were protected by obtaining informed consent. Results: Medication in the prefinal phase and questions affecting the provision of solids and liquids in the end-of-life phase have an ethical dimension. In the context of these two fields, decisions are taken collectively. A nurse’s individual (and ethically relevant) leeway in decision-making processes is restricted to the nurse’s own style of administering care. The nurse’s decision-making often depends to a far greater degree on her ability to adapt her concept of ideal care to fit the practical realities of her work than to any conceptual framework. Discussion: An adaptive process is necessary for the nurse because she is required to incorporate the four pillars of hospice care – namely, physical, psychological, social and spiritual care – into the practice of her daily work. Conclusion: Ethically relevant decisions are often characterised by nurses adjusting their aspiration levels to the practical conditions with which they are confronted.
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TANG, SIEW TZUH, RUTH MCCORKLE, and ELIZABETH H. BRADLEY ph.d. "Determinants of death in an inpatient hospice for terminally ill cancer patients." Palliative and Supportive Care 2, no. 4 (December 2004): 361–70. http://dx.doi.org/10.1017/s1478951504040489.
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Objective:Despite the strong emphasis on home-based end-of-life care in the United States and the recognition of dying at home as a gold standard of quality of care, hospice home care is not a panacea and death at home may not be feasible for every terminally ill cancer patient. Admission to an inpatient hospice and dying there may become a necessary and appropriate solution to distressing patients or exhausted families. However, the factors associated with death in an inpatient hospice have not been examined in previous studies.Methods:A prospective cohort study was conducted to investigate the determinants of death in an inpatient hospice for terminally ill cancer patients. Approximately two-fifths (40.8%) of the 180 terminally ill cancer patients in this study died in inpatient hospices over the 3-year study period.Results:Results from Cox proportional hazards model with adjustment for covariates revealed several factors that were significantly associated with dying in inpatient hospice, as opposed to home, in a nursing home, or in the hospital. Patients were more likely to die in an inpatient hospice if they received hospice care before death (hazard ratio [HR] = 7.32, 95% confidence interval [CI]: 3.21–16.67), if they had a prestated preference to die in an inpatient hospice (HR = 4.86, 95% CI: 2.24–10.51), if they resided in New Haven County (HR = 1.70, 95% CI: 1.00–2.93), or if they experienced higher levels of functional dependency (HR = 1.05, 95% CI: 1.02–1.08).Significance of results:The high prevalence of inpatient hospice deaths for terminally ill cancer patients in this study was related to the local health care system characteristics, health care needs at the end of life, and personal preference of place of death. Findings from this study may shed light on future directions for developing end-of-life care tailored to the needs of cancer patients who are admitted to hospices and eventually die there.
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Bainbridge, Daryl, Mohanna Giruparajah, Hanyan Zou, and Hsien Seow. "The care experiences of patients who die in residential hospice: A qualitative analysis of the last three months of life from the views of bereaved caregivers." Palliative and Supportive Care 16, no. 4 (June 29, 2017): 421–31. http://dx.doi.org/10.1017/s147895151700058x.
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AbstractObjective:Despite the increasing prominence of residential hospices as a place of death and that, in many regards, this specialized care represents a gold standard, little is known about the care experience in this setting. Using qualitative survey data, we examined the positive and negative perceptions of care in hospices and in other prior settings.Method:Qualitative comments were extracted from the CaregiverVoice survey completed by bereaved caregivers of decedents who had died in 16 residential hospices in Ontario, Canada. On this survey, caregivers reported what was good and bad about the services provided during the last three months of life as separate open-text questions. A constant-comparison method was employed to derive themes from the responses.Results:A total of 550 caregivers completed the survey, 94% (517) of whom commented on either something good (84%) and/or bad (49%) about the care experience. In addition to residential hospice, the majority of patients represented also received palliative care in the home (69%) or hospital (59%). Overall, most positive statements were about care in hospice (71%), whereas the negative statements tended to refer to other settings (81%). The hospice experience was found to exemplify care that was compassionate and holistic, in a comforting environment, offered by providers who were personable, dedicated, and informative. These humanistic qualities of care and the extent of support were generally seen to be lacking from the other settings.Significance of results:Our examination of the good and bad aspects of palliative care received is unique in qualitatively exploring palliative care experiences across multiple settings, and specifically that in hospices. Investigation of these perspectives affirmed the elements of care that dying patients and their family caregivers most value and that the hospices were largely effective at addressing. These findings highlight the need for reinforcing these qualities in other end-of-life settings to create comforting and supportive environments.
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McMAHON, ROBIN L. "An ethical dilemma in a hospice setting." Palliative and Supportive Care 1, no. 1 (March 2003): 79–87. http://dx.doi.org/10.1017/s1478951503030013.
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The codes of ethics of the National Hospice and Palliative Care Organization and the National Association of Social Workers support ethical standards of client self-determination and confidentiality. Lack of societal consensus on the parameters of a terminally ill person's right to die continues to confound at times the health care field, including hospice programs. This article explores an actual case where a hospice social worker faced an ethical dilemma related to the sanctity of life versus patient autonomy. While a more seasoned social worker might have chosen a different alternative to the dilemma, this case illustrates the importance of creating an interdisciplinary rather than multidisciplinary hospice team and the need for ongoing dialogue on how to support patient choice.
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Naysmith, A. "Quality, Standards, Organisational and Clinical Audit for Hospice and Palliative Care Services." Quality and Safety in Health Care 2, no. 1 (March 1, 1993): 70. http://dx.doi.org/10.1136/qshc.2.1.70-a.
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HEAD, BARBARA. "Who Sets the Standard for Hospice Care?" Home Healthcare Nurse 19, no. 3 (March 2001): 175. http://dx.doi.org/10.1097/00004045-200103000-00016.
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King, Jonathan Douglas, Janet Retseck, Jens C. Eickhoff, Tien Hoang, Anne M. Traynor, and Toby Christopher Campbell. "Integrated oncopalliative care versus standard care for patients with metastatic lung cancer: A single institution retrospective review." Journal of Clinical Oncology 31, no. 15_suppl (May 20, 2013): 9566. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.9566.
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9566 Background: Patients with metastatic non-small cell lung cancer (NSCLC) receiving early palliative care (PC) demonstrated improved anxiety, quality of life, and survival compared to standard oncology care (SOC). ASCO clinical practice guidelines recommend concurrent PC and SC be offered to patients with metastatic NSCLC. Our lung cancer clinic is partially integrated with PC. We performed retrospective chart review comparing patients seen in our integrated clinic with SOC patients for survival, trial participation, chemotherapy and hospice utilization. Methods: Charts of all patients with advanced lung cancer from July 2007-June 2011 were reviewed. Eligible patients were those who received any care at our center. Demographic, treatment details, survival, and hospice utilization data were obtained. Overall survival and length of hospice enrollment were calculated for patients treated with PC compared to SOC. Results: Of 207 patients, 82 received PC. Overall survival favored PC (11.9 months vs. 10.1 months, p=0.032). Hospice length of stay (LOS) favored PC (38.5 days vs. 24 days in SOC, p=0.047). There was not a significant difference in lines of chemotherapy, chemotherapy in the last 30 days of life, or trial participation. Conclusions: Our chart review provides confirmatory evidence that early integrated PC in lung cancer patients increases survival and hospice LOS without affecting chemotherapy utilization or trial participation. [Table: see text]
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Gingerich, Barbara Stover. "Accreditation Commission for Health Care’s New Hospice Standards Manual." Home Health Care Management & Practice 17, no. 6 (October 2005): 489–91. http://dx.doi.org/10.1177/1084822305278123.
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Von Gunten, Charles F. "A quality improvement approach to oncologist referrals for hospice care." Journal of Clinical Oncology 34, no. 26_suppl (October 9, 2016): 45. http://dx.doi.org/10.1200/jco.2016.34.26_suppl.45.
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45 Background: Cancer patients frequently experience short lengths of service in home hospice care. Methods: The Oncology Clinical Guidance Council, composed of medical, surgical, gynecological and radiation oncologists sets standards of care for the OhioHealth system serving central Ohio. The Council was polled for consensus on how long a cancer patient should be enrolled in hospice care. Then, median length of stay of patients referred by 18 medical oncologists from their offices to OhioHealth hospice for calendar year 2014 were obtained. A letter from the Chairs of the Oncology Clinical Guidancee Council was sent to each medical oncologist noting the council's opinion about optimal length of stay, the length of stay reported by the National Hospice and Palliative Care Organization (NHPCO), and the median length of stay of all patients referred by OhioHealth oncologists. A chart graphing the median length of stay by oncologist, indicating the name of the oncologist to which the letter was directed, was mailed to each oncologist. One year later, for calendar year 2015, the measurement of median length of stay by oncologist was repeated. Results: 64% of the Oncology Clinical Guidance Council members polled think the median length-of-service for hospice care for cancer patients should be 90 days (3 months) and 20% think it should be 45 days (6 weeks). The NHPCO national median is 43 days. At baseline, the median length of stay for 176 cancer patients referred in calendar 2014 was 19.7 days. The median length of stay for 133 patients referred in the first 10 months of 2015 was 39.6 days. Conclusions: A simple quality improvement approach to improving hospice length of service by oncologists yielded a doubling to reach the national median in one year.
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GUIRGUIS-YOUNGER, MANAL, MARY-LOU KELLEY, and MARGARET MCKEE. "Professionalization of hospice volunteer practices: What are the implications?" Palliative and Supportive Care 3, no. 2 (June 2005): 143–44. http://dx.doi.org/10.1017/s1478951505050224.
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Volunteers are increasingly considered as core members of interdisciplinary palliative care teams, and thus no longer “informal providers.” The definitive trend towards formalizing the role of hospice volunteers is indicated not only by national work to develop best practices (Ferris et al., 2002), but also by efforts of the Canadian Council on Health Services Accreditation to develop quality indicators for accrediting volunteer agencies. This movement emerged from a need to coordinate, define and standardize the role of volunteers in palliative care settings, as well as to manage organizational resources and maintain standards of excellence. The purpose of this forum is to highlight the possible impact of this development on the nature of volunteer contribution to end-of-life care.
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Heidemann, Elma G. "Book Review: Quality, Standards, Organisational and Clinical Audit for Hospice and Palliative Care Services." Journal of Palliative Care 11, no. 1 (March 1995): 57. http://dx.doi.org/10.1177/082585979501100112.
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FRIEDMAN, MARY McGOLDRICK. "What’s New in the 2004 Joint Commission Home Care and Hospice Standards? PART 1." Home Healthcare Nurse: The Journal for the Home Care and Hospice Professional 22, no. 1 (January 2004): 56–59. http://dx.doi.org/10.1097/00004045-200401000-00015.
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FRIEDMAN, MARY McGOLDRICK. "What’s New in the 2004 Joint Commission Home Care and Hospice Standards? Part 2." Home Healthcare Nurse: The Journal for the Home Care and Hospice Professional 22, no. 2 (February 2004): 124–28. http://dx.doi.org/10.1097/00004045-200402000-00014.
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Phongtankuel, Veerawat, Ronald D. Adelman, Kelly Trevino, Erika Abramson, Phyllis Johnson, Clara Oromendia, Charles R. Henderson, and M. C. Reid. "Association Between Nursing Visits and Hospital-Related Disenrollment in the Home Hospice Population." American Journal of Hospice and Palliative Medicine® 35, no. 2 (March 13, 2017): 316–23. http://dx.doi.org/10.1177/1049909117697933.
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Background: Over 10% of hospice patients experience a transition out of hospice care during the last months of life. Hospice transitions from home to hospital (ie, hospital-related hospice disenrollment) result in fragmented care, which can be burdensome for patients and caregivers. Nurses play a major role in delivering home hospice care, yet little is known about the association between nursing visits and disenrollment. Objectives: The study’s purpose is to examine the association between the average number of nursing visits per week and hospital-related disenrollment in the home hospice population. We hypothesize that more nursing visits per week will be associated with reduced odds for disenrollment. Design: A retrospective cohort study using Medicare data. Participants: Medicare hospice beneficiaries who were ≥18 years old in 2012. Outcome measured: Hospitalization within 2 days of hospice disenrollment. Results: The sample included 115 103 home hospice patients, 6450 (5.6%) of whom experienced a hospital-related disenrollment. The median number of nursing visits per week was 2 (interquartile range 1.3-3.2), with a mean of 2.5 (standard deviation ±1.6). There was a decreased likelihood of a hospital-related disenrollment when comparing enrollments that had <3 nursing visits per week on average to 3 to <4 visits (odds ratio [OR] 0.39; P value <.001), 4 to <5 visits (OR 0.29; P value <.001), and 5+ visits (OR 0.21; P value <.001). Conclusions: More nursing visits per week was associated with a decreased likelihood of a hospital-related hospice disenrollment. Further research is needed to understand what components of nursing care influence care transitions in the home hospice setting.
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Shalev, Ariel, Veerawat Phongtankuel, M. Carrington Reid, Sara J. Czaja, Ritchell Dignam, Rosemary Baughn, Matthew Newmark, Holly G. Prigerson, Jeanne Teresi, and Ronald D. Adelman. "Home Hospice Caregivers’ Perceived Information Needs." American Journal of Hospice and Palliative Medicine® 36, no. 4 (October 9, 2018): 302–7. http://dx.doi.org/10.1177/1049909118805413.
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Background: Although home hospice organizations provide essential care for and support to terminally ill patients, many day-to-day caregiving responsibilities fall to informal (ie, unpaid) caregivers. Studies have shown that caregivers value receiving clear information about end-of-life (EoL) care. Meeting the information needs of this group is critical in improving their experience in hospice. Objectives: To identify the information needs of informal home hospice caregivers. Design: One hundred five semi-structured phone interviews with informal caregivers were conducted. Study data were analyzed using a standard qualitative method (ie, content analysis). Participants: Informal home hospice caregivers whose loved ones have been discharged (death or live discharge) from an urban, nonprofit hospice organization. Measured: Participants’ information needs were ascertained by assessing whether information regarding hospice was or was not fully explained or whether there was information they wished they knew prior to the hospice transition. Results: Among study participants, 48.6% had unmet information needs related to (1) general information about hospice (n = 17, 16.2%), (2) what to expect at the EoL (n = 19, 18.1%), and (3) support provided by hospice (n = 30, 28.6%). Specifically, caregivers expressed the need for more information on what hospice is, caring for a dying patient, and the day-to-day care hospice provides. Conclusion: Our study indicates that approximately half of the informal caregivers had unmet information needs. Further research is needed to identify efficacious strategies to best meet the information needs of this group. Specific topics that need emphasis include what hospice care is, what to expect at the EoL, and what level of support hospice offers.
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Soileau, Kristi, and Nanette Elster. "The Hospice Patient’s Right to Oral Care." Journal of Palliative Care 33, no. 2 (March 13, 2018): 65–69. http://dx.doi.org/10.1177/0825859718763283.
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The hospice philosophy embraces palliative care for the terminally ill, for whom quality of life is the central focus of comfort care management. Often, caregivers hesitate or simply do not elect to extend oral care for patients nearing the end of life, due to difficulties encountered in patient compliance, a sense of futility in doing so, staff time constraints in prioritizing care, underfunding, or a lack of education as to how and why such care should be delivered to the hospice patient. This article aims to show physiological and psychosocial reasons why the hospice patient has a need for properly and regularly implemented oral care and why dental professionals have an ethical responsibility to address the current void that exists in hospice-centered oral care. Varying viewpoints are discussed regarding the need for oral health monitoring and maintenance in both the capable patient with capacity and in the patient who lacks capacity and is totally dependent, yet who exhibits no particular signs of oral distress nor desire for hygiene measures. Consideration is given to family dynamics in such care. Oral care of the elderly patients and terminally ill is sorely lacking, and dental educators are challenged to cultivate in students a sense of professional duty toward caring for the vulnerable elderly patients. Dental professionals should create initiatives in developing, promoting, and implementing an appropriate standard of oral care for the hospice patient.
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Karikari-Martin, Pauline, Lirong Zhao, and Lynn Miescier. "HOSPICE SERVICES IN THE HOME SETTING AND CHARACTERISTICS OF MEDICARE DECEDENTS." Innovation in Aging 3, Supplement_1 (November 2019): S500. http://dx.doi.org/10.1093/geroni/igz038.1850.
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Abstract There is little empirical work documenting the characteristics of Medicare beneficiaries receiving hospice services in the home setting using the Medicare place of service codes. The objective of this study is to examine differences in Medicare decedents who received hospice services in traditional and non-traditional homes (assisted living, and nursing home settings) defined by these codes. We conducted a secondary analysis of 675,782 Medicare decedents who received hospice services in 2015. Chi-squared and ANOVA tests were used to describe the socio-demographics, health conditions, utilization, and hospice payments of the decedents. Most of the decedents received hospice care in a traditional home (64.9%), but beneficiaries, aged 85 years and over, received hospice services in assisted living (72.1%) or nursing homes (59.8%). Overall, decedents who received Medicare hospice benefits in assisted living had the highest number of hospice days (mean=149.7 lifetime days; median = 30; standard deviation (S.D.) =245), and decedents in traditional homes had the fewest number of hospice days (mean=86.7 lifetime days; median = 24; S.D. =179). Among Medicare–Medicaid (duals) decedents who used hospice care, 49% received hospice care in nursing homes, and infrequently, 7% at assisted living. Medicare hospice payments were highest ($20,439 per beneficiary) for decedents in assisted living, but least for those in traditional homes ($11,830). Hospice services offered to Medicare beneficiaries who are 85 years and older, duals, or have a diagnosis of dementia may require more oversight and coordination of resources to ensure that they receive appropriate hospice services in non-traditional homes.
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Glicken, Anita, and Gerald Merenstein. "A Neonatal End-of-Life Palliative Protocol— An Evolving New Standard of Care?" Neonatal Network 21, no. 4 (June 2002): 35–36. http://dx.doi.org/10.1891/0730-0832.21.4.35.
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IN 1979 THE CHILDREN’ S Hospital, Denver began to address the needs of the unfortunate group of infants who exhibit evidence of poor prognosis and for whom the question is raised whether any more should be done to prolong their lives.1 This program for the NICU was based on concepts first introduced and popularized by the hospice movement.2,3 It was recognized that generally NICU staff are concerned with neonatal survival—a rescue mode of care. Staff are often ill-equipped to provide adequate care to the family of the dying infant. This program proposed a new approach to the very difficult issues involved in the care of these very sick and dying infants. The Neonatal Hospice Program was a comprehensive plan focusing on four main areas: decisionmaking process and shift to palliative care, creation of a home-like, family room setting for the infant and family, involvement of family in the dying process and hospice training for NICU staff. Over the past 20 years, elements of this program have been implemented in many NICUs. However, the adaptation of a comprehensive program for palliative neonatal care has not been universally implemented. NICU staff and families of dying infants continue to seek change in hospital practice. Catlin and Carter have undertaken important research in exploring current trends in the care for the infant from whom life support is withdrawn or withheld.
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Clifford, Kathleen, Colleen Tallen, Mary Helen Davis, Tamara Griess, Dan Sayam Zuckerman, and Lynne Padgett. "Implementing patient-centered care: Challenges in community oncology." Journal of Clinical Oncology 30, no. 34_suppl (December 1, 2012): 192. http://dx.doi.org/10.1200/jco.2012.30.34_suppl.192.
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192 Background: The newest Commission on Cancer (CoC) standards focus on patient-centered care across the cancer continuum and include palliative care (PC) and psychosocial care (PS). Little is published regarding the challenges of implementing these standards in community oncology settings. To help examine the integration of PC and PS and to identify barriers and best practices, an assessment was conducted by sites selected to take part in the National Cancer Institutes’ Community Cancer Centers Project (NCCCP). Methods: The NCCCP’s goals to improve quality of care and reduce healthcare disparities included goals for expansion of PC and PS services. Volunteers formed workgroups using monthly teleconferences to share best practices and resources. A questionnaire based on the National Quality Forum (NQF) preferred practices was completed (January-April 2012) by 22 of 29 sites. Results: All respondents have inpatient PC available, 65% in the outpatient setting; 39% described PC as an integral part of their cancer program. All have designated outpatient staff providing symptom management and rehabilitation services. Nurse practitioners and physician assistants are used at 78% of the centers. Interdisciplinary staff includes pharmacists and dietitians; integrative/complementary medicine is found in 57% of the centers. All have integrated PS services: social workers are available in 91% of sites, 30% have psychiatrists, and 30% have psychologists. Most perform psychosocial screening using the NCCN Distress Management tool; 74% have standardized processes. Spiritual support is present in 70% of programs, sexual counseling services in 26%. The majority provides bereavement support. 48% have an outpatient advanced directive program. Inpatient hospice beds are available in 52% of the institutions and 22% own a hospice. Conclusions: Challenges remain with implementation of psychosocial screening and care. Programs to address sexual counseling and advanced directives are lacking. Additional efforts are needed to integrate PC services across the cancer continuum. Project funded with federal funds from the NCI, Contract No. HHSN261200800001E.
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Greer, Joseph A., William F. Pirl, Vicki A. Jackson, Alona Muzikansky, Inga T. Lennes, Rebecca S. Heist, Emily R. Gallagher, and Jennifer S. Temel. "Effect of Early Palliative Care on Chemotherapy Use and End-of-Life Care in Patients With Metastatic Non–Small-Cell Lung Cancer." Journal of Clinical Oncology 30, no. 4 (February 1, 2012): 394–400. http://dx.doi.org/10.1200/jco.2011.35.7996.
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Purpose Prior research shows that introducing palliative care soon after diagnosis for patients with metastatic non–small-cell lung cancer (NSCLC) is associated with improvements in quality of life, mood, and survival. We sought to investigate whether early palliative care also affects the frequency and timing of chemotherapy use and hospice care for these patients. Patients and Methods This secondary analysis is based on a randomized controlled trial of 151 patients with newly diagnosed metastatic NSCLC presenting to an outpatient clinic at a tertiary cancer center from June 2006 to July 2009. Participants received either early palliative care integrated with standard oncology care or standard oncology care alone. By 18-month follow-up, 133 participants (88.1%) had died. Outcome measures included: first, number and types of chemotherapy regimens, and second, frequency and timing of chemotherapy administration and hospice referral. Results The overall number of chemotherapy regimens did not differ significantly by study group. However, compared with those in the standard care group, participants receiving early palliative care had half the odds of receiving chemotherapy within 60 days of death (odds ratio, 0.47; 95% CI, 0.23 to 0.99; P = .05), a longer interval between the last dose of intravenous chemotherapy and death (median, 64.00 days [range, 3 to 406 days] v 40.50 days [range, 6 to 287 days]; P = .02), and higher enrollment in hospice care for longer than 1 week (60.0% [36 of 60 patients] v 33.3% [21 of 63 patients]; P = .004). Conclusion Although patients with metastatic NSCLC received similar numbers of chemotherapy regimens in the sample, early palliative care optimized the timing of final chemotherapy administration and transition to hospice services, key measures of quality end-of-life care.
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Gimova, I. A., and Ya V. Senkina. "Saint Petersburg Children’s Hospice: The history of the institution, the standards and methods for palliative care." Russian Journal of Children Hematology and Oncology, no. 3 (April 3, 2015): 78–82. http://dx.doi.org/10.17650/2311-1267-2014-0-3-78-82.
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Greer, Joseph A., Pamela M. McMahon, Angela Tramontano, Emily R. Gallagher, William F. Pirl, Vicki A. Jackson, and Jennifer S. Temel. "Effect of early palliative care on health care costs in patients with metastatic NSCLC." Journal of Clinical Oncology 30, no. 15_suppl (May 20, 2012): 6004. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.6004.
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6004 Background: Introducing palliative care soon after diagnosis for patients with metastatic non-small cell lung cancer (NSCLC) leads to improvements in quality of life, mood, end-of-life care, and possibly survival. We sought to investigate whether early palliative care is also associated with health care cost savings. Methods: This secondary analysis is based on a randomized controlled trial of 151 patients with newly-diagnosed, metastatic NSCLC presenting to an outpatient clinic at a tertiary cancer center between 6/2006 and 7/2009. Participants received either early palliative care integrated with standard oncology care or standard oncology care alone. We queried participants’ electronic health records as well as our institution’s billing database to collect data on frequency and costs of outpatient clinic visits, inpatient hospitalizations, chemotherapy administration, and hospice services. The primary outcome was the difference in average resource use costs during the final month of life between groups. Results: By 18-month follow up, 133 (88.1%) participants had died, and 125 (82.8%) had available data for this analysis. Participants in the early palliative care group had a mean cost savings of $2,282 (median=$2,432) per patient in total health care expenditures during the final month of life compared to the standard care group. The difference was primarily accounted for by lower costs for inpatient visits (mean saving per patient=$3,110) and chemotherapy administration (mean saving per patient=$640). Although expenditures for outpatient clinic visits were similar between groups, the costs for hospice services were greater for the early palliative care group because of the longer lengths of stay in hospice care (mean cost per patient=$1,125). Conclusions: Early palliative care for individuals diagnosed with metastatic NSCLC not only improves multiple patient outcomes but also may be associated with lower hospital resource use costs, primarily through decreased inpatient visits and chemotherapy administration at the end of life.
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Rizk, Sophia, Elizabeth Horn Prsic, William Rafelson, John Leonard Reagan, and Angela Marie Taber. "Outpatient palliative care encounters in stage IV lung cancer care: An institutional review." Journal of Clinical Oncology 33, no. 29_suppl (October 10, 2015): 128. http://dx.doi.org/10.1200/jco.2015.33.29_suppl.128.
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128 Background: Palliative Care (PC) is becoming increasingly integrated into standard oncologic care (SC). Previous research suggests that patients receiving PC report better quality of life, and may have prolonged survival. This study evaluates the effect of PC integration in patients diagnosed with stage IV non-small cell lung cancer (NSCLC) at a single institution. Methods: All patients diagnosed with Stage IV NSCLC between January 2010 and January 2013 were considered for inclusion and retrospective analysis of their care. Charts were reviewed to identify patients who received outpatient PC with a licensed PC physician in addition to SC. There were no guidelines regarding the nature of the PC intervention. Retrospective analyses of multiple factors were assessed, including: receipt of chemotherapy and/or radiotherapy, utilization of emergency and sick visits, frequency and timing of hospice referral, and duration of hospice utilization. Overall survival was also assessed. Results: 136 patients fulfilled study inclusion criteria. 29 patients received PC in addition to SC, and 107 received SC alone. No statistically significant difference was noted between the groups with respect to age, sex, lines of chemotherapy administered, number of emergency department visits, or number of clinic sick visits. Hospice was offered more frequently in the PC group; however, there was no difference in the amount of time spent on hospice, and no difference in overall survival. There was a trend towards longer survival in the PC group (220 days vs. 254 days). Patients seen in a multidisciplinary clinic were significantly more likely to receive a PC evaluation (RR 1.28 CI 1.073-1.52, p < 0.006). Conclusions: This retrospective study examines how PC is integrated in actual clinical models. Multidisciplinary clinic patients were more likely to receive PC after controlling for comorbidities. There was no significant difference between PC and SC group outcomes. Although this study is small, it demonstrates common practice patterns, and identifies the need to identify the components of the PC encounter that are important in order to maximize the potential benefits of PC interventions.
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Vachon, Mary L. S. "The Impact of the Document International Work Group in Death, Dying and Bereavement: Assumptions and Principles Underlying Standards for Terminal Care." OMEGA - Journal of Death and Dying 70, no. 1 (November 2014): 27–41. http://dx.doi.org/10.2190/om.70.1.d.
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This article reflects on the development and impact of the International Workgroup on Death, Dying and Bereavement's (IWG) pivotal document on The Assumptions and Principles Underlying Standards for Terminal Care. It was at the Ars Moriendi meetings in Columbia, Maryland that the author first met Bob and Bunny Kastenbaum. The meeting led to the development of IWG and the first task of this group was the development of the “Standards” document. The initial document reflected the pioneering work already being done by Kastenbaum and others on the committee and then was formative in the development of other documents such as the National Hospice Association Standards. Participants in the original workgroup were asked for their reflections on the significance of the document and the literature was surveyed to assess the impact of the “Standards” document on the field.
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Hui, David, and Eduardo Bruera. "Models of Palliative Care Delivery for Patients With Cancer." Journal of Clinical Oncology 38, no. 9 (March 20, 2020): 852–65. http://dx.doi.org/10.1200/jco.18.02123.
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Palliative care has evolved over the past five decades as an interprofessional specialty to improve quality of life and quality of care for patients with cancer and their families. Existing evidence supports that timely involvement of specialist palliative care teams can enhance the care delivered by oncology teams. This review provides a state-of-the-science synopsis of the literature that supports each of the five clinical models of specialist palliative care delivery, including outpatient clinics, inpatient consultation teams, acute palliative care units, community-based palliative care, and hospice care. The roles of embedded clinics, nurse-led models, telehealth interventions, and primary palliative care also will be discussed. Outpatient clinics represent the key point of entry for timely access to palliative care. In this setting, patient care can be enhanced longitudinally through impeccable symptom management, monitoring, education, and advance care planning. Inpatient consultation teams provide expert symptom management and facilitate discharge planning for acutely symptomatic hospitalized patients. Patients with the highest level of distress and complexity may benefit from an admission to acute palliative care units. In contrast, community-based palliative care and hospice care are more appropriate for patients with a poor performance status and low to moderate symptom burden. Each of these five models of specialist palliative care serve a different patient population along the disease continuum and complement one another to provide comprehensive supportive care. Additional research is needed to define the standards for palliative care interventions and to refine the models to further improve access to quality palliative care.
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Hildebrand, Sara, Kristy Tayapongsak, Richard Stephenson, and Nathan Paul Streer. "The impact of hospice services in the care of patients with advanced stage non-small cell lung cancer." Journal of Clinical Oncology 32, no. 31_suppl (November 1, 2014): 104. http://dx.doi.org/10.1200/jco.2014.32.31_suppl.104.
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104 Background: Prior research has shown that early incorporation of palliative care alongside standard oncological care in metastatic non-small cell lung cancer (NSCLC) patients results in longer survival and less aggressive treatment at the end of life. The purpose of our study was to profile the continuum of care of stage IV NSCLC patients, comparing it to quality indicators for excellence in end-of-life (EOL) cancer care, as defined by the Quality Oncology Practice Initiative and other published studies. Specifically, our aim was to explore the connection between hospice enrollment and end-of-life quality measures. Methods: 197 deceased stage IV NSCLC patients diagnosed between 2008 and 2010 at two separate tertiary care centers within the same county were identified. A retrospective review was conducted, collecting data from electronic medical records regarding antitumor treatment services received, post-diagnosis hospital admissions, palliative care consultations, hospice referrals and enrollments, and circumstances surrounding the patient’s death. The patients were separated into two groups depending on their status of hospice enrollment, and the remainder of the measures compared accordingly. Results: There was no significant difference in number of lines of chemotherapy received and total number of post-diagnosis hospital admissions between the patients who were enrolled in hospice and those who were not. However, the group who received hospice services had a significantly lower number of hospitalizations in the last 30 days of life (p<0.001), emergency department admissions in the last 30 days of life (p<0.01), and intensive care unit admissions in the last 30 days of life (p<0.001). Median survival, measured by the length of time between diagnosis and death, did not differ between the two groups. Conclusions: This study demonstrates that, among patients with metastatic NSCLC, hospice enrollment was associated with optimized end-of-life oncological care, as seen with fewer hospital admissions in the last 30 days of life, without incurring a lower median survival.
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Ezenwa, Miriam O., Marie L. Suarez, Jesus D. Carrasco, Theresa Hipp, Anayza Gill, Jacob Miller, Robert Shea, et al. "Implementing the PAINRelieveIt Randomized Controlled Trial in Hospice Care: Mechanisms for Success and Meeting PCORI Methodology Standards." Western Journal of Nursing Research 39, no. 7 (September 12, 2016): 924–41. http://dx.doi.org/10.1177/0193945916668328.
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Baltz, Alan P., Laura E. Gressler, Ryan C. Costantino, and Mary Lynn McPherson. "Nonprescription Medication Use in Hospice Patients." American Journal of Hospice and Palliative Medicine® 37, no. 5 (September 17, 2019): 336–42. http://dx.doi.org/10.1177/1049909119876259.
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Objective: Patients admitted to hospice are more vulnerable to age-related physiologic changes, polypharmacy, and inappropriate medication use and monitoring. The objective of this study was to characterize the utilization of nonprescription medications in a hospice population. Methods: This was a retrospective study designed to characterize nonprescription or over-the-counter medication use in hospice patients. Data for this study were provided by Seasons Hospice & Palliative Care, a national hospice organization with licenses to operate in 19 states and collected from January 1 to December 31, 2016. The most frequently utilized nonprescription medications, therapeutic classes, and the frequency of patients with at least 1 claim within a therapeutic class were summarized. Results: The final study population included 62 639 orders representing 15 164 patients. The average age was 79.31 years with a standard deviation of 13.31 years. The average length of stay was 26.80 days with a standard deviation of 44.14 days. The top 5 most common medications were as follows: acetaminophen (25.15%), bisacodyl (21.69%), senna (8.35%), omeprazole (4.51%), and docusate (4.46%). Approximately 13 714 (29.67%) of patients were exposed to analgesics, 13 469 (29.14%) to laxatives, and 3535 (7.65%) to antacids or antigas medications. Conclusion: This study highlights numerous opportunities for improvement in the use of nonprescription medications among hospice patients. Reducing the use of nonprescription medications that are ineffective or produce unwanted side effects can contribute to improving the quality of care that patients receive.
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Rivera Mercado, Felix Manuel, Carol Luhrs, Alice Beal, Maura Langdon, Joan Secrest, and Susan M. Talbot. "Integration of palliative care services into standard oncology practice at diagnosis of metastatic lung cancer at VA New York Harbor Healthcare System." Journal of Clinical Oncology 33, no. 29_suppl (October 10, 2015): 165. http://dx.doi.org/10.1200/jco.2015.33.29_suppl.165.
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165 Background: The 2012 ASCO provisional clinical opinion addressed the integration of palliative care into standard oncology practice at the time a person is diagnosed with metastatic or advanced cancer. The inclusion of Palliative Care among the National Quality Forum (NQF) framework represented a major advance in palliative care. NQF metrics include chemotherapy administered in the last 14 days of life, hospice less than 3 days before death, ICU or hospital admission, more than one Emergency Room visit in the last 30 days, and death in hospital. Although the use of hospice and other palliative care services has increased, many are enrolled in hospice less than 3 weeks before death. By improving quality of life, cost, and survival in patients with metastatic cancer, palliative care has increasing relevance for the care of patients with cancer. Methods: Retrospective chart review study of lung cancer patients diagnosed at VA from 2010-2013. Inclusion criteria: > 18 years of age with new diagnosis of metastatic lung cancer. Exclusion criteria: < 18 years of age, Stage I-III lung cancer. Results: Total of 125 patients were diagnosed with Stage IV lung cancer. The mean time from diagnosis to death was only 185 days (6.1 months). The VA NYHHS patients were more likely to visit the ED, be admitted to the hospital and ICU in the last 30 days of life, and subsequently die in the hospital. Conclusions: Several confounders were identified, including climate related closure of facilities (2012 Sandy storm), lack of social support, low ICU admission criteria, burial benefits for patients dying in a VA, and delay in transition to Hospice. Currently 392 patients with stage IV solid tumors diagnosed 2010-2014 are being studied. [Table: see text]
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Pasina, Luca, Angela Recchia, Pasquale Agosti, Alessandro Nobili, and Barbara Rizzi. "Prevalence of Preventive and Symptomatic Drug Treatments in Hospice Care: An Italian Observational Study." American Journal of Hospice and Palliative Medicine® 36, no. 3 (August 16, 2018): 216–21. http://dx.doi.org/10.1177/1049909118794926.
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Background: The aim of pharmacotherapy in people at the end of life should be symptom control, more than prolonging life. Drugs for disease prevention should therefore be discouraged, but this is not the usual practice. The prevalence of unnecessary preventive drugs at the end of life is not well described, although some studies suggest it is common. Methods: This retrospective longitudinal study describes the prevalence of patients receiving preventive and symptomatic drug treatments at admission (T1) and before death (T2) in an Italian hospice. All adults admitted to the VIDAS hospice between March 2015 and February 2017 were included in the analysis. Results: The study sample comprised 589 end-of-life patients with a mean age of 75.3 (12.1) years. The mean number of drugs decreased from admission to the hospice to the time of death (mean [standard deviation]: 9.7 [3.4] and 8.7 [3.0]). All patients were appropriately treated with symptomatic drugs at T1 and T2, while there were significantly fewer patients from T1 to T2 with at least 1 preventive medication that could be considered for deprescription at the end of life (511, 86.8% and 286, 48.6%; P < .0001). Conclusions: Hospice admission can be associated with a definite reduction in the use of commonly prescribed preventive medications. However, about half of end-of-life patients can be prescribed avoidable medications. Drugs for peptic ulcer and gastroesophageal reflux disease and antithrombotics were the potentially avoidable preventive medications most frequently prescribed at admission to the hospice and before death.
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Egan, Pamela C., Thomas W. LeBlanc, and Adam J. Olszewski. "End-of-Life Care Quality Outcomes Among Medicare Beneficiaries with Hematologic Malignancies." Blood 132, Supplement 1 (November 29, 2018): 829. http://dx.doi.org/10.1182/blood-2018-99-112692.
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Abstract Background: Benefits of hospice care for patients with advanced solid cancers have been extensively studied, but they have not been comprehensively documented in hematologic malignancies (HM). Surveys indicate that hematologists harbor concerns about adequacy of hospice services for patients with HM (Odejide et al., Cancer 2017; Hui et al., Ann Oncol 2015). A common perception is that these patients often receive chemotherapy until the very end of life (EOL) and are destined to die in the acute care setting (Sekeres & Gerds, Cancer 2015). They also experience a barrier to hospice use when transfusion dependence develops (LeBlanc et al., Blood 2018). In this context, some authors have questioned whether standard measures of EOL care quality proposed by the National Quality Forum (NQF) should apply to patients with HM, and whether the use of hospice services can improve such measures. Our objective was to describe EOL care quality measures derivable from Medicare administrative claims among patients with HM who did or did not use hospice services. Methods: From the population-based linked SEER-Medicare registry, we selected fee-for-service beneficiaries with leukemias (acute or chronic), myeloma, myeloproliferative neoplasms (MPN), myelodysplastic syndrome (MDS), or lymphoma (any subtype), who died in 2007-2011. We identified beneficiaries who used hospice services, and ascertained claims-based indicators of aggressive EOL care corresponding to select NQF care quality measures: 1) death in acute care hospital, 2) number of days spent in acute care hospital within 30 days of death, 3) intensive care unit (ICU) admission within 30 days of death, 4) use of chemotherapy within 14 days of death, and 5) Medicare spending for care within the last 30 days of life. Binary outcomes were compared in multivariable robust Poisson models (reporting relative risk, RR), count outcomes in negative binomial models, and costs in a log-gamma model. All estimates were reported with 95% confidence intervals (CI). Models were adjusted for age, sex, race, marital status, Medicaid co-insurance (indicator of low socio-economic status), prevalent poverty in the county of residence, comorbidity index, poor performance status indicator, calendar year, and survival from diagnosis. Results: We identified 13,556 decedents with leukemia, 7,910 with myeloma, 9,543 with MPN/MDS, and 22,990 with lymphoma, who had median age at death of 78 years (interquartile range [IQR] 72-84). Overall, 47% of patients used hospice services, enrolling at median 22 months from diagnosis (IQR, 5-59; varying from 13 in leukemia to 28 in lymphoma). Median length of stay on hospice was 9 days (IQR, 3-27), varying from 8 to 10 days between different HM. Overall, 39% of patients died in hospital settings (from 36% in myeloma to 41% in leukemia). Median number of days spent in hospital at EOL was 4 in all types of HM. ICU admissions within the last month of life occurred in 39% of patients, and chemotherapy was administered to 10% in the last 14 days (varying from 7% in MPN/MDS to 13% in leukemia). These measures significantly differed between hospice enrollees and non-enrollees (Table). In multivariable models, use of hospice services was associated with a significant decrease in the aggressiveness of EOL care, as follows: 95% decrease in inpatient deaths (adjusted RR, 0.05; 95%CI, 0.05-0.06), 48% decrease in days spent in hospital (adjusted relative count, 0.62; 95%CI 0.60-0.63), 44% decrease in the risk of ICU stay (adjusted RR, 0.56; 95%CI, 0.54-0.57), 47% decrease in the use of chemotherapy (adjusted RR, 0.53; 95%CI, 0.50-0.57), and 38% decrease in mean Medicare spending at EOL (adjusted relative cost, 0.62; 95%CI, 0.60-0.63). Conclusions: The proportion of Medicare beneficiaries with HM who die in inpatient setting (39%) or are admitted to ICU (39%) in the last month of life is higher than in a contemporary population of Medicare beneficiaries with cancer (22% and 27%, respectively, in 2009 per Teno et al., JAMA 2013). Across the spectrum of HM, which vary in prognosis and clinical course, use of hospice services is associated with markedly improved measures of EOL care quality, as well as lower Medicare spending in the last month of life. However, only 47% of beneficiaries with HM use hospice services (compared with 59% in Teno et al.). Chemotherapy use at EOL was uncommon, challenging the notion that pervasive chemotherapy is a barrier to hospice use in HM. Disclosures Olszewski: Genentech: Research Funding; Spectrum Pharmaceuticals: Consultancy, Research Funding; TG Therapeutics: Research Funding.
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Golčić, Marin, Renata Dobrila-Dintinjana, Goran Golčić, Lidija Gović-Golčić, and Aleksandar Čubranić. "Physical Exercise: An Evaluation of a New Clinical Biomarker of Survival in Hospice Patients." American Journal of Hospice and Palliative Medicine® 35, no. 11 (April 26, 2018): 1377–83. http://dx.doi.org/10.1177/1049909118772566.
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Purpose: Survival analysis is an important issue in palliative care. However, there is a lack of quality clinical biomarkers for assessing survival, especially in bedridden patients. Recent research supports the benefit of physiotherapy in palliative care, as majority of hospice patients are able to perform physical therapy. We propose the hypothesis that the difference in activity during physical exercise can be used as a biomarker of survival in hospice care. Methods: We examined 536 consecutive patients who performed physical exercises in our hospice from March 2013 to July 2017. Univariate, multivariate, and Kaplan-Meier analysis were performed to explore the association between the level of physical exercise activity and survival. Results: Physical exercises were performed by almost 70% of our hospice patients. The patients who initially performed active exercises lived longer, on average, compared to patients who only managed passive exercises (15 days vs 6 days, hazard ratio 0.60, 0.49-0.74). Surprisingly, the difference in survival based on the level of physical activity remained consistent regardless of the patient performance score, emphasizing its usefulness as an independent survival biomarker in a hospice setting. This tool also gave us an option to recognize a significant proportion of bedridden patients performing active exercises (30%), previously unrecognized using standard performance scales, exhibiting longer survival compared to others with the same performance score. Conclusion: Patients’ level of activity during physical exercises has the potential to be a valuable new clinical biomarker in palliative care, whether used individually or combined with commonly used performance scales.
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Ke, Ya-Ting, An-Chi Peng, Yi-Min Shu, Min-Hsien Chung, Kang-Ting Tsai, Ping-Jen Chen, Tzu-Chieh Weng, Chien-Chin Hsu, Hung-Jung Lin, and Chien-Cheng Huang. "Prevalence of Geriatric Syndromes and the Need for Hospice Care in Older Patients of the Emergency Department: A Study in an Asian Medical Center." Emergency Medicine International 2020 (July 17, 2020): 1–9. http://dx.doi.org/10.1155/2020/7174695.
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Background. The prevalence of geriatric syndromes and the need for hospice care in the emergency department (ED) in Asian populations remain unclear. This study was conducted to fill the data gap. Methods. Using a newly developed emergency geriatric assessment (EGA), we investigated the prevalence of geriatric syndromes and the need for hospice care in older ED patients of a tertiary medical center between September 1, 2016, and January 31, 2017. Results. We recruited a total of 693 patients with a mean age of 78.0 years (standard deviation 8.2 years), comprising 46.6% of females. According to age subgroups, 37.4% of patients were aged 65–74 years, 37.4% were aged 75–84 years, and 25.2% were aged ≥85 years. The prevalence rates of geriatric syndromes were as follows: delirium (11.4%), depression (23.4%), dementia (43.1%), deterioration of activities of daily living (ADL) for <1 year (29.4%), vision impairment (22.2%), hearing impairment (23.8%), sleep disturbance (13.1%), any fall in <1 year (21.8%), polypharmacy (28.7%), pain (35.1%), pressure ulcer (5.6%), incontinence or retention (29.6%), indwelling device or physical restrain (21.6%), nutrition problem (35.7%), frequent use of medical resources (50.1%), lack of advance care planning (84.0%), caregiver problem (4.6%), socioeconomic problem (5.5%), and need for family meeting (6.2%). The need for hospice care was 11.9%. Most geriatric syndromes increased with advancing age except depression, sleep disturbance, polypharmacy, pain, nutrition problem, lack of advance care planning, caregiver problem, and socioeconomic problem. Conclusion. Geriatric syndromes and the need for hospice care were common in the older ED patients. Further studies about subsequent intervention for improving geriatric care are needed.
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Lio, Jonathan, Xiaohong Ning, Lianlian Wu, Ling Fu, Renslow Sherer, and Li He. "Exploring Palliative Care Competency Standards for Medical Education in China: A Survey of National Hospice Service Program Providers." Journal of Palliative Medicine 21, no. 1 (January 2018): 6–8. http://dx.doi.org/10.1089/jpm.2017.0381.
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Hashem, Ferhana, Charlotte Brigden, Patricia Wilson, and Claire Butler. "Understanding what works, why and in what circumstances in hospice at home services for end-of-life care: Applying a realist logic of analysis to a systematically searched literature review." Palliative Medicine 34, no. 1 (December 18, 2019): 16–31. http://dx.doi.org/10.1177/0269216319867424.
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Background: We have undertaken a systematically searched literature review using a realist logic of analysis to help synthesise the diverse range of literature available on hospice at home services. Aim: To find out in the existing literature what features of hospice at home models work best, for whom and under what circumstances. Design: A realist logic of analysis was applied to synthesise the evidence focusing on mechanisms by which an intervention worked (or did not work). An initial programme theory was developed using the National Association for Hospice at Home standards, Normalisation Process Theory and through refinement using stakeholder engagement. Data sources: PubMed, Science Direct, AMED, BNI, CINAHL, EMBASE, Health Business Elite, HMIC, Medline, PsychINFO, SCOPUS, Web of Science, DARE, Google Scholar, NHS Evidence, NIHR CRN portfolio database, NIHR journal library of funded studies, including searches on websites of relevant professional bodies (August 2014, June 2017, June 2019). Results: Forty-nine papers were reviewed, of which 34 contributed evidence to at least one of the eight theory areas: marketing and referral, sustainable funding model, service responsiveness and availability, criteria for service admission, knowledge and skills of care providers, integration and coordination, anticipatory care, support directed at carers. Conclusions: Our literature review showed how it was possible to develop a coherent framework and test it against 34 published papers and abstracts. Central to this review was theory building, and as further evidence emerges, our programme theories can be refined and tested against any new empirical evidence.
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Kegye, Adrienne, and Éva Pádi. "Opportunities of team psychotherapy in hospice-palliative care. Results of a model program." Orvosi Hetilap 154, no. 28 (July 2013): 1102–5. http://dx.doi.org/10.1556/oh.2013.29661.
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Introduction: Hospice care has been developing for 20 years. In the framework of the high standard palliative treatment hospice care involves symptom control as well as the psychosocial support of patients and their relatives. Aim: Developed as a model, the aims of the psychoeducational and supporting program were to reduce the psychological symptoms, form the active coping mechanisms, reduce feeling of isolation and help the communication of the patients treated in the Oncological Rehabilitation and Hospice Department of the Vaszary Kolos Hospital in Esztergom, Hungary. Method: The program consisted of the following elements: analiticly orientated team psychoterapy, creative occupation, physiotherapy, dietetics guidance and oncological consulting. Results: During the model supporting program the authors observed significant changes in both the patients and staff members which had a positive impact on the department’s operation and the atmosphere, too. Conclusions: The model program showed that in team work can give beneficial and cost-efficient psychosocial support to patients using the carers’ energy in the most effective way. Orv. Hetil., 2013, 154, 1102–1105.
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Lewis, Charles R., Ana de Vedia, Barbara Reuer, Rodney Schwan, and Christina Tourin. "Integrating complementary and alternative medicine (CAM) into standard hospice and palliative care." American Journal of Hospice and Palliative Medicine® 20, no. 3 (May 2003): 221–28. http://dx.doi.org/10.1177/104990910302000312.
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Zhang, Zetao, Yi Zhu, Zhaoping He, Yuling He, Naning Wang, and Jianping Zhao. "Hospice palliative care program management, setup, and operation with a national pilot study in Haidian, Beijing." Journal of Clinical Oncology 36, no. 34_suppl (December 1, 2018): 121. http://dx.doi.org/10.1200/jco.2018.36.34_suppl.121.
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121 Background: In 2016, an inpatient hospice palliative care ward was initiated in Beijing Haidian Hospital, which was the first pilot study program in Beijing. Challenges of implementing the program and the process to facilitate change in the hospital’s and society culture in China. Methods: This program has been partnered with Ovation Health International and Hospice Palliative Care Alliance of China Foundation at beginning of the program development in order to streamline the program design and establish standard operating procedures. The program was operated by a multi-disciplinary team which is the first of these kinds of team structure in Chinese health system, including the program manager, physicians, nurses, social workers, psychologic counsellors, chaplains, and volunteers. Results: The program has served over 200 patients and their families in the first year. The inpatient hospice unit has 2 specially decorated rooms with 6 in-patient beds, a meeting room, and a farewell room. The program has expanded its palliative care counselling service to the entire hospital and affiliated community nursing homes and will plan to expand the number of beds to 20 in the inpatient hospice unit. The implementation of the program has been full of obstacles, encompassing the lack of trained professionals, limited financial resources, higher staff turnover, and professional misunderstanding and public rejection. Now upgraded to a National Pilot model of China, the trial program team led by the program manager, has overcome core barriers/challenges in team building, team enablement, resource supporting, public education, and society awareness to keep the program growth. Conclusions: The lessons learned from the experience of developing the first hospital-based hospice palliative care program in the capital of China will be presented. Particularly, barriers and challenges, both modifiable and non-modifiable, will be shared as well as facilitating factors. The authors will share the pathway to partner across disciplines, with policy makers, and in research, education, and practice. This helps the team in the creation of new knowledge and in continuing to establish the evidence-based value of palliative care in China.
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&NA;. "HPNA Announces Publication of the Statement on the Scope and Standards of Hospice and Palliative Nursing Practice." Journal of Hospice & Palliative Nursing 1, no. 4 (October 1999): 164. http://dx.doi.org/10.1097/00129191-199910000-00010.
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Paredes, Anghela, Madison Hyer, Elizabeth Palmer, Maryam B. Lustberg, and Timothy M. Pawlik. "Racial/ethnic disparities in hospice utilization among Medicare beneficiaries dying from pancreatic cancer." Journal of Clinical Oncology 37, no. 31_suppl (November 1, 2019): 41. http://dx.doi.org/10.1200/jco.2019.37.31_suppl.41.
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41 Background: While racial/ethnic treatment disparities among patients with pancreatic cancer have been documented, variation in other aspects of care including hospice utilization have not. As such, we sought to define the incidence, as well as characterize the timing, of hospice utilization among racial/ethnic minority patients following pancreatectomy for pancreatic cancer. Methods: The Medicare Standard Analytic Files were used to identify white and racial/ethnic minorities (African Americans and Hispanics) who underwent pancreatectomy for pancreatic cancer. Trends and timing related to overall hospice utilization among racial/ethnic minority and white patients were analyzed. Results: Among the 6,530 individuals (median age: 73, IQR 69-78; 51.5% female; 6.6% % racial/ethnic minority) who underwent a pancreatectomy for pancreatic cancer, 64.6% (n = 4221) had died by the end of the follow-period. Among deceased individuals, three-fourths of patients (n = 3149, 74.6%) had used hospice leading up to the time of death. Among individuals who died, age and comorbidity burden were similar among racial/ethnic minority and white patients; racial/ethnic minority patients were less likely, however, to have used hospice services compared with white patients (racial/ethnic minorities: n = 188, 68.9%, whites: n = 2,961, 75.0%; p = 0.024). On multivariable analysis, after controlling for clinical factors, racial/ethnic minority patients remained 27% less likely than whites to initiate hospice services prior to death (OR 0.73, 95%CI 0.56-0.95, p = 0.021). Despite overall lower use of hospice, racial/ethnic minority patients had comparable odds of late hospice utilization (i.e. within 3 days of death) versus white patients (OR 0.75, 95% CI 0.49-1.14, p = 0.18). Conclusions: While most patients undergoing pancreatectomy for pancreatic cancer utilized hospice services prior to death, ethnic/racial minority were less likely to use hospice services than whites. Further research should seek to better understand possible barriers to hospice initiation among racial/ethnic minority patients with cancer.
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Severson, Jane Alcyne, Jeffrey B. Smerage, Jamie Lindsay, Laura Petersen, Keith Mark Swetz, and Arif Kamal. "Using a collaborative approach for rapid deployment of advance care planning in the outpatient oncology setting." Journal of Clinical Oncology 34, no. 7_suppl (March 1, 2016): 255. http://dx.doi.org/10.1200/jco.2016.34.7_suppl.255.
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255 Background: The Michigan Oncology Quality Consortium (MOQC) is a quality collaborative supported by Blue Cross Blue Shield of Michigan with the goal of improving cancer care in Michigan by using data gathered as part of the national Quality Oncology Practice Initiative (QOPI) program. In spring 2014, MOQC launched a statewide collaborative focused on advance care planning (ACP) with the following aim: to provide training and resources on how to engage patients in a discussion of goals, preferences, and priorities for care. Methods: The collaborative was comprised of three half day learning sessionsthat included an overview of legal and documentation requirements, and facilitator-lead role play with patient actors. Lean resources (templates, workflows) to support standard work in the clinic were disseminated. Eight oncology practices participated ranging in size from 1-25 physicians. ASCO QOPI data were analyzed pre and post collaborative in spring 2014 and spring 2015. Results: Improvement in QOPI performance from spring 2014 to 2015 on “hospice enrollment, palliative care referral/services, or documented discussion” (73.8% to 77.6%) and “for patients not referred, hospice or palliative care discussed within the last 2 months of life” (17.7% to 23.9%) was noted for participating practices (n = 8). Collaborative participants also compared favorably to all other MOQC practices (n = 47) in spring 2015 on “hospice enrollment, palliative care referral or documented discussion” (77.6% vs. 66.2%) (p < 0.001). Conclusions: Use of a collaborative education modelthat includes facilitator-lead role play and dissemination of lean resources to create standard work may be an efficient and effective approach to improve discussion and documentation of advance care planning.
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Gaster, Sam, Francine Arneson, Luis Alexander Rojas-Espaillat, Nathan Hruby, and Mari Perrenoud. "Clinical and financial outcomes in cancer patients with integration of specialty palliative care versus standard oncology care." Journal of Clinical Oncology 37, no. 27_suppl (September 20, 2019): 47. http://dx.doi.org/10.1200/jco.2019.37.27_suppl.47.
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47 Background: Evidence suggests that integrating palliative care into usual oncology care benefits patients with advanced cancer and their caregivers (Ferrell et al., 2017). We evaluated patients with an advanced cancer diagnosis with concurrent palliative care versus standard oncology care to determine how both clinical and financial outcomes differ in our cancer center. Methods: We conducted a retrospective analysis on 340 deceased cancer patients who attended an office visit at a medical/gynecologic oncology clinic between January 2018 and February 2019. Patients who received concurrent palliative care as well as patients that received usual oncologic care were included. Data available in the electronic health record (EHR) were abstracted to quantify patient and practice level data. We compared differences in advance care planning (ACP) documentation, DNR designation, hospice enrollment prior to death, chemotherapy in the last 14 days of life, and health care utilization and cost. Results: Forty-nine patients received a specialty palliative care consultation concurrent with their cancer care. Compared to their counterparts, patients who received a specialty palliative care consultation were more likely to have a completed advanced care plan (57% v 16%, p < .05), have a DNR designation (29% v 4%, p < .05) in the EHR, to enroll in hospice prior to death (78% v 50%, p < .05), and at an earlier time (Mdiff = 14 days, p = .05). Patients who received a specialty palliative care consultation were also less likely to receive chemotherapy in the last 14 days of life (2% v 7%) and end-of-life acute care utilization was lower in patients with a specialty palliative care consultation, including ED visits (50% v 67%) and hospitalizations (20% v 59%), but these results were not statistically significant. Median per patient per month (PPPM) total cost of care was higher pre-consult ($9,307) versus post-consult ($6,088; Diff = -$3,219), but this result was statistically non-significant. Conclusions: These results provide additional support for advantage of concurrent specialty palliative care in patients with advanced cancer versus standard oncologic care.
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Miller, Pringl. "Surgical Palliative Care—Where Are We in 2020?" American Surgeon 86, no. 11 (November 2020): 1436–40. http://dx.doi.org/10.1177/0003134820965951.
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The practice of surgical palliative care is not new. Dr Balfour M. M. Mount, a retired urologic surgeon is considered the father of North American Palliative Care and coined the term Palliative Care in 1975. Dr Geoffrey P. Dunn, a retired general surgeon and hospice and palliative medicine specialist along with other like minded surgical colleagues were instrumental in developing the field of surgical palliative care. Dr Olga Jonasson, championed the American Board of Surgery becoming one of the sponsoring boards of the Hospice and Palliative Medicine certifying exam. Dr Anne Mosenthal advocated for palliative care to be integrated as parallel clinical aims so espoused in the Trauma Quality and Improvement Program Palliative Care Best Practice Guidelines. Dr Mosenthal currently chairs the American College of Surgeons Committee on Surgical Palliative Care. This introductory article is a brief history about the origins of surgical palliative care and sheds light on the current landscape of surgeons integrating primary and specialty palliative care into surgical practice. The aim of this surgical palliative care symposium is to take everyday surgical problems and highlight the application and benefit of palliative care when treating surgical patients with serious illness. Integrating palliative care principles into standard clinical management is evidenced based patient-centered practice.
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Magnani, Caterina, Chiara Mastroianni, Diana Giannarelli, Maria Consiglia Stefanelli, Valeria Di Cienzo, Teresa Valerioti, and Giuseppe Casale. "Oral Hygiene Care in Patients With Advanced Disease: An Essential Measure to Improve Oral Cavity Conditions and Symptom Management." American Journal of Hospice and Palliative Medicine® 36, no. 9 (February 12, 2019): 815–19. http://dx.doi.org/10.1177/1049909119829411.
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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. Method: A prospective cohort study was carried out among 415 patients who were admitted to hospice. Patients were recruited before undergoing standard assisted procedure for oral hygiene care. Oral cavity condition, symptoms, and comfort were assessed at the recruitment (T0) and after 3 days (T2). Results: Seventy-five eligible patients were recruited. The Oral Assessment Guide score was significantly decreased after oral standard care ( P value <.0001). The average time spent by nursing staff for oral hygiene care was 5.3 minutes. Dysgeusia and xerostomia were significantly decreased after oral standard care ( P = .02 and P = .03). Patients reported a high level of comfort (86.6%) after the procedures for oral hygiene care. Conclusion: Patients admitted to hospice had frequent alterations in oral cavity with partial loss of its functions that can compromise their quality of life. Standard procedures for oral hygiene care are simple and fast to perform, and they may improve oral cavity conditions, symptoms control, and patients’ comfort.
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Shaiova, Lauren, Ann Berger, Craig D. Blinderman, Eduardo Bruera, Mellar P. Davis, Susan Derby, Charles Inturrisi, et al. "Consensus guideline on parenteral methadone use in pain and palliative care." Palliative and Supportive Care 6, no. 2 (May 23, 2008): 165–76. http://dx.doi.org/10.1017/s1478951508000254.
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ABSTRACTOnce used only as third-line therapy for chronic pain management, methadone is now being used as first- and second-line therapy in palliative care. The risks and stigma associated with methadone use are known, but difficulties with dosing methadone and lack of an established conversion protocol from other opiates have limited the access for patient populations who could potentially benefit from this medication. For palliative care patients, the benefits of methadone can far outweigh its risks. This article provides an overview and specific recommendations on the use of parenteral methadone in pain and palliative care, with a focus on the transition from hospital to home/hospice care. The goal of this consensus guideline is to assist clinicians who are providing chronic pain management in acute care hospital and nonhospital settings (i.e., hospice, long-term care facilities, and community) for patients with life-limiting illnesses, where the goals of care are focused on comfort (i.e., palliative care). The recommendations in this article intend to promote a standard of care involving the use of intravenous methadone with the aim of reaching a broader population of patients for whom this drug would provide important benefits.
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Srivastava, Piyush. "The benefits of early integration of palliative care as a part of standard outpatient oncology care." Journal of Clinical Oncology 32, no. 31_suppl (November 1, 2014): 18. http://dx.doi.org/10.1200/jco.2014.32.31_suppl.18.
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18 Background: It is well known that palliative care (PC) services are skillful in aligning patients' goals of care with healthcare team’s plan of care and treating symptoms related to an advanced disease. The culture of PC is now focusing efforts upstream since earlier interaction fosters more thoughtful discussion of goals and more effective symptom management. Decreased or late access to PC services has traditionally been due to physician factors, including inaccuracies in prognostication, personal bias and lack of awareness of PC mission. With this understanding, we have consciously constructed a robust, standardized, formalized process in the oncology setting for patient identification and automatic referral to the outpatient PC clinic as a part of usual care to diminish the influence of oncologists. Methods: Due to the wide geographic area of our population, there are five ½ day outpatient PC clinics, two of which are embedded in outpatient oncology centers at two medical centers. These are staffed by an MD and RN, with option of chaplain and social work interventions. The Edmonton Symptom Assessment Scale serves as our tool to monitor patient’s clinical course. We have created a reproducible, patient selection and outreach process to make PC as part of ‘normal’ cancer care. Results: 330 oncology patients were seen over a 20 month period. Of these only 8 PC clinic patients received chemotherapy in the last 30 days prior to death vs 153 patients who were not seen in PC clinic. Within the last 14 days of life no patients who were seen in PC clinic received chemotherapy vs 54 patients who were not seen in clinic. This compares well to the national average of 10%. 55% were referred to hospice compared to the national average of only 11%. The average LOS for hospice was 50.8 days compared to the national average of 40.6 days. ER visits decreased by 15% and hospital admissions decreased by 63% for patients with PC clinic encounters. Subjectively, patient’s symptoms improved by 75%. Conclusions: These upstream encounters facilitate more thoughtful medical decision making for patients with terminal cancer diagnosis, improving quality of care and QOL and positively affecting hospital utilization.