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Reidy JA, Brizzi K, Chan SH, Day H, Epstein SK, Fischer M, Garg PS, Gosline A, Jaramillo C, Livne E, Mitchell S, Morgan S, Olmsted MW, Stebbins P, Stumpf I, Vesel T, Yeh IM, Young ME, Goldman RE. Curricular Reform in Serious Illness Communication and Palliative Care: Using Medical Students' Voices to Guide Change. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2024; 99:550-557. [PMID: 38277443 DOI: 10.1097/acm.0000000000005647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
PURPOSE To gather and leverage the voices of students to drive creation of required, integrated palliative care curricula within undergraduate medical education in Massachusetts, which is lacking in a majority of U.S. medical schools. METHOD The study was conducted by the Massachusetts Medical Schools' Collaborative, a working group committed to ensuring all medical students in Massachusetts receive foundational training in serious illness communication (SIC) and palliative care. Eight focus groups (2 per participating medical school) were conducted during January-May 2021 and included a total of 50 students from Boston University Chobanian & Avedisian School of Medicine, Harvard Medical School, Tufts University School of Medicine, and the UMass Chan Medical School. Data collected from focus groups were discussed and coded. Themes were identified using the immersion/crystallization qualitative data analysis approach. RESULTS Six key themes emerged. Students viewed SIC as essential to high-quality medical practice regardless of specialty, and believed training in SIC skills and palliative care should be required in medical school curricula. Students preferred to learn and practice these skills using frameworks, particularly in real-world situations. Students recognized the expertise of palliative care specialists and described them as a scarce, often misunderstood resource in health care. Students reported it was mostly "luck" if they were included in family meetings and observed good role models. Finally, students desired practice in debriefing after difficult and emotional situations. CONCLUSIONS This study confirms long-standing themes on students' experiences with SIC and palliative care topics, including feeling inadequately prepared to care for seriously ill patients as future physicians. Our study collected students' perspectives as actionable data to develop recommendations for curricular change. Collaborative faculty also created recommendations based on the focus group data for immediate and ongoing SIC and palliative care curricular change in Massachusetts, which can apply to medical schools nationwide.
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Larson S, Laures E, Seo M, Cox M, Wagner M. Evidence-Based Pain Assessment in Nonverbal Palliative Care Patients. Pain Manag Nurs 2024; 25:152-159. [PMID: 38246815 DOI: 10.1016/j.pmn.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 11/09/2023] [Accepted: 12/19/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Central to palliative care is the early assessment and treatment of pain, whether physical, psychosocial, or spiritual. Nonverbal palliative care patients are at risk for inadequate pain assessment leading to prolonged suffering. AIMS The purpose of this project was to implement and evaluate an evidence-based pain assessment tool for nonverbal palliative care patients. DESIGN The Iowa Model Revised: Evidence-Based Practice to Promote Excellence in Healthcare and the Implementation Strategies for Evidence-Based Practice Guide provided the guiding frameworks. SETTINGS On a six-bed adult inpatient Palliative Care Unit (PCU). PARTICIPANTS/SUBJECTS Nonverbal palliative care patients. METHODS Evidence supported use of the Multidimensional Objective Pain Assessment Tool (MOPAT) for nonverbal patients receiving palliative care. During an eight-week pilot, nurses recorded pain assessments on a paper form and trended pain scores over a 24-hour period. Evaluation included knowledge, attitudes, and behaviors pre- and post-pilot and was subsequently used in a Precision Implementation Approach to promote adoption. RESULTS Nurses' attitudes toward palliative care pain assessment improved in all items on the evaluation tools. Pain was assessed using MOPAT for 74% of nonverbal palliative care patients and 88% of patients had linked pain interventions to MOPAT scores. CONCLUSIONS MOPAT is the only valid evidence-based pain assessment tool for nonverbal patients receiving palliative care. This project led to successful adoption of the MOPAT within the PCU.
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Affiliation(s)
- Sara Larson
- University of Iowa Hospitals and Clinics, Iowa City, Iowa; St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
| | - Elyse Laures
- University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Minjeong Seo
- University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Margo Cox
- University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Michele Wagner
- University of Iowa Hospitals and Clinics, Iowa City, Iowa
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Li Y, Zhu H, Xu J, Yang J. A questionnaire survey on the implementation of palliative care in the emergency department in China. BMC Palliat Care 2024; 23:68. [PMID: 38459473 PMCID: PMC10924310 DOI: 10.1186/s12904-024-01407-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 03/05/2024] [Indexed: 03/10/2024] Open
Abstract
OBJECTIVES This study was conducted to characterize the need for palliative care and its effect on patients with end-stage disease in the emergency department (ED). DESIGN This was a prospective cohort study. A questionnaire survey was administered to patients with end-stage disease who were admitted to the resuscitation room of the ED and expected to live less than 6 months. RESULTS A total of 82 of 2095 patients admitted to the resuscitation room were included. Only 1 (1.22%) patient had ever received palliative care before admission. Nine patients received palliative care consultation after admission, and they were more likely to select medical places of death accompanied by their families and do not resuscitate orders at the end of life after consultation (P < 0.05). Whether the disease had previously been actively treated and the number of children impacted the choice of treatment at the end of life (P < 0.05). CONCLUSIONS Among patients with end-stage disease admitted to the ED, knowledge of palliative care was lacking. Palliative care could help them avoid the damage caused by pointless resuscitation.
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Affiliation(s)
- Yan Li
- Department of Emergency Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, China
| | - Huadong Zhu
- Department of Emergency Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, China
| | - Jun Xu
- Department of Emergency Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, China.
| | - Jing Yang
- Department of Emergency Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, China.
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Fassas S, King D, Shay M, Schockett E, Yamane D, Hawkins K. Palliative Medicine and End of Life Care Between Races in an Academic Intensive Care Unit. J Intensive Care Med 2024; 39:250-256. [PMID: 37674378 DOI: 10.1177/08850666231200383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Background: Although palliative medicine (PM) is more commonly being integrated into the intensive care unit (ICU), research on racial disparities in this area is lacking. Our objectives were to (a) identify racial disparities in utilization of PM consultation for patients who received ICU care and (b) determine if there were differences in the use of code status or PM consultation over time based on race. Materials and Methods: Retrospective analysis of 571 patients, 18 years and above, at a tertiary care institution who received ICU care and died during their hospital stay. We analyzed two timeframes, 2008-2009 and 2018-2019. Univariate analysis was utilized to evaluate baseline characteristics. A multivariate logistic regression model and interaction P values were employed to assess for differential use of PM consultation, do not resuscitate (DNR) orders, and comfort care (CC) orders between races in aggregate and for changes over time. Results: There was a notable increase in Black/African-American (AA) (54% to 61%) and Hispanic/Latino (2% to 3%) patients over time in our population. Compared to White patients, we found no differences between PM consultation and CC orders. There was a lower probability of DNR orders for Black/AA (adjusted odds ratio [aOR] 0.569; P = .049; confidence interval [CI]: 0.324-0.997) and other/unknown/multiracial patients (aOR: 0.389; P = .273; CI: 0.169-0.900). Comparing our earlier time period to the later time period, we found an increased usage of PM for all patients. Interaction P values suggest there were no differences between races regarding PM, DNR, and CC orders. Conclusions: PM use has increased over time at our institution. Contrary to the previous literature, there were no differences in the frequency of utilization of PM consultation between races. Further analysis to evaluate the usage of PM in the ICU setting in varying populations and geographic locations is warranted.
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Affiliation(s)
- Scott Fassas
- George Washington University Hospital, Washington, DC, USA
| | - Daniel King
- George Washington University Hospital, Washington, DC, USA
| | - Molly Shay
- George Washington University Hospital, Washington, DC, USA
| | | | - David Yamane
- George Washington University Hospital, Washington, DC, USA
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Villarosa AR, Agar M, Kong A, Sousa MS, Harlum J, Parker D, Srinivas R, Wiltshire J, George A. The perceptions of palliative care medical practitioners towards oral health: A descriptive qualitative study. Palliat Med 2024; 38:310-319. [PMID: 38506274 PMCID: PMC10958743 DOI: 10.1177/02692163241233974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
BACKGROUND Oral health problems are common, but often overlooked, among people receiving palliative care. AIM To better understand how oral health can be addressed in this population, this study aimed to explore the perceptions of oral health care among medical practitioners who provide palliative care to inform the development of a palliative oral health care program. DESIGN A descriptive qualitative design was adopted. SETTING/PARTICIPANTS A single focus group was conducted with 18 medical practitioners at a palliative care facility in Sydney, Australia. All participants had experience providing palliative care services to clients. The focus group was audio recorded, transcribed and thematically analysed. RESULTS The results from the inductive thematic analysis identified four themes. The themes highlighted that participants were aware of the oral health needs of people receiving palliative care; however, they also reflected on the complexity in delivering oral health care across the healthcare settings, as well as the challenges around cost, lack of appropriate dental referral pathways, time constraints and limited awareness. Participants also provided recommendations to improve the delivery of oral health care to individuals receiving palliative care. CONCLUSIONS To improve the provision of oral health care in this population, this study highlighted the need for oral health training across the multidisciplinary team, standardised screening assessments and referrals, a collective responsibility across the board and exploring the potential for teledentistry to support oral health care provision.
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Affiliation(s)
- Amy R. Villarosa
- Australian Centre for Integration of Oral Health (ACIOH), School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
- National Centre of Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - Meera Agar
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
- Department of Palliative Care, South Western Sydney Local Health District, Liverpool, NSW, Australia
| | - Ariana Kong
- Australian Centre for Integration of Oral Health (ACIOH), School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Mariana S Sousa
- Australian Centre for Integration of Oral Health (ACIOH), School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Janeane Harlum
- Department of Palliative Care, South Western Sydney Local Health District, Liverpool, NSW, Australia
- District Palliative Care Service, South Western Sydney Local Health District, Liverpool, NSW, Australia
| | - Deborah Parker
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Ravi Srinivas
- Australian Centre for Integration of Oral Health (ACIOH), School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia
- Oral Health Services, South Western Sydney Local Health District, Liverpool, NSW, Australia
- School of Dentistry, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Jennifer Wiltshire
- Department of Palliative Care, South Western Sydney Local Health District, Liverpool, NSW, Australia
| | - Ajesh George
- Australian Centre for Integration of Oral Health (ACIOH), School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
- School of Dentistry, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
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Chen L, Pan Q, Li X, Luo S, Pan X, Huang H. Factors Influencing the Knowledge and Attitudes of Hospice Care Practitioners in Guangxi, China: A Cross-Sectional Study. Risk Manag Healthc Policy 2024; 17:387-397. [PMID: 38476198 PMCID: PMC10928918 DOI: 10.2147/rmhp.s451588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/13/2024] [Indexed: 03/14/2024] Open
Abstract
Purpose Practitioners in China who implement hospice care services include doctors, nurses, and care workers. These individuals play an important role in the holistic care of patients at the end of life and their families. This study aimed to provide baseline data to develop hospice care services and improve relevant policies by investigating the knowledge and attitudes of hospice care practitioners (HCPs) and analyzing influencing factors. Methods This cross-sectional descriptive study used stratified sampling and quota sampling. The HCPs were from nursing homes, medical institutions, integrated medical and nursing institutions, and community health service centers in Guangxi Zhuang Autonomous Region. We examined HCPs' demographic characteristics and scores on a self-designed Chinese scale to measure their knowledge and attitudes(K&A scale). A total of 1821 HCPs completed surveys from May 2022 to July 2022. The data were analyzed using descriptive statistics, univariate analysis and multiple linear regression. Results The standard score of the K&A scale of 1821 HCPs was 61.62 (SD=9.78), and the individual mean scores of knowledge and attitudes were 76.42 (SD=28.13) and 58.69 (SD=11.31), respectively. The final multiple linear regression analysis indicated that the main factors that influenced the K&A score were monthly income, job satisfaction, and the hospice care-related system (HCS). Conclusion The HCPs in this study displayed moderate mean scores for knowledge and a less favorable attitude toward hospice care. Monthly income, job satisfaction and the HCS were the common factors that influenced HCPs' K&A. The results suggest the need to strengthen targeted and professional training for HCPs, increase their welfare and benefits, and improve indigenous policies of hospice care.
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Affiliation(s)
- Lin Chen
- Department of Cardiology, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Qini Pan
- Department of nursing, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China
| | - Xiaohong Li
- College of Life Sciences, Chongqing Normal University, Chongqing, People’s Republic of China
| | - Shuangli Luo
- Department of nursing, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guxngxi, People’s Republic of China
| | - Xiao Pan
- Department of nursing, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China
| | - Huiqiao Huang
- Department of nursing, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China
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Pointon S, Collins A, Philip J. Introducing palliative care in advanced cancer: a systematic review. BMJ Support Palliat Care 2024:spcare-2023-004442. [PMID: 38307704 DOI: 10.1136/spcare-2023-004442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 01/08/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND Negative perceptions about palliative care (PC), held by patients with cancer and their families, are a barrier to early referral and the associated benefits. This review examines the approaches that support the task of introducing PC to patients and families and describes any evaluations of these approaches. METHODS A systematic review with a systematic search informed by the Preferred Reporting Items for Systemic Reviews and Meta-Analyses guidelines was performed on the online databases MEDLINE, PsychInfo and CINAHL from May 2022 to July 2022. Identified studies were screened by title and abstract, and included if they were empirical studies and described an approach that supported the introduction of PC services for adult patients. A narrative-synthesis approach was used to extract and present the findings. RESULTS Searches yielded 1193 unique manuscripts, which, following title and abstract screening, were reduced to 31 papers subject to full-text review, with a final 12 studies meeting eligibility criteria. A diverse range of included studies described approaches used to introduce palliative care, which may be broadly summarised by four categories: education, clinical communication, building trust and rapport and integrative system approaches. CONCLUSION While educational approaches were helpful, they were less likely to change behaviours, with focused communication tasks also necessary to facilitate PC introduction. An established relationship and trust between patient and clinician were foundational to effective PC discussions. A framework to assist clinicians in this task is likely to be multidimensional in nature, although more quantitative research is necessary to establish the most effective methods and how they may be incorporated into clinical practice.
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Affiliation(s)
- Samuel Pointon
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, Fitzroy, Victoria, Australia
| | - Anna Collins
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, Fitzroy, Victoria, Australia
| | - Jennifer Philip
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, Fitzroy, Victoria, Australia
- Department of Palliative Care, Peter MacCallum Cancer Centre, and Royal Melbourne Hospital, Parkville, Victoria, Australia
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Patarroyo - Aponte G, Shoar S, Ashley DM, Noorbaksh A, Patel D, Young AY, Akkanti BH, Warner MT, Patarroyo - Aponte MM, Kar B, Gregoric ID, Ha C, Patel B. The Role of Palliative Care Consultation in Withdrawal of Life-Sustaining Treatment among ICU Patients Receiving Veno-Venous Extracorporeal Membrane Oxygenation (VV-ECMO): A Retrospective Case-Control Study. Am J Hosp Palliat Care 2024; 41:150-157. [PMID: 37117039 PMCID: PMC10751975 DOI: 10.1177/10499091231173092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
Abstract
Background: Extracorporeal membrane oxygenation (ECMO) has extended the survivability of critically ill patients beyond their unsupported prognosis and has widened the timeframe for making an informed decision about the goal of care. However, an extended time window for survival does not necessarily translate into a better outcome and the sustaining treatment is ultimately withdrawn in many patients. Emerging evidence has implicated the determining role of palliative care consult (PCC) in direction of the care that critically ill patients receive. Objective: To evaluate the impact of PCC in withdrawal of life-sustaining treatment (WOLST) among critically ill patients, who were placed on venovenous ECMO (VV-ECMO) at the intensive care unit (ICU) of a tertiary care hospital. Methods: In a retrospective observational study, electronic medical records of 750 patients admitted to the ICU of our hospital between January 1, 2015, and October 31, 2021, were reviewed. Data was collected for patients on VV-ECMO, for whom WOLST was withdrawn during the ICU stay. Clinical characteristics and the underlying reasons for WOLST were compared between those who received PCC (PCC group) and those who did not (non-PCC group). Results: A total of 95 patients were included in our analysis, 63 in the PCC group and 32 in the non-PCC group. The average age of the study population was 48.8 ± 12.6 years, and 64.2% were male. There was no statistically significant difference between the two groups in terms of demographics or clinical characteristics at the time of ICU admission. The average duration of ICU stay and VV-ECMO were 14.1 ± 19.9 days and 9.4 ± 16.6 days, respectively. The number of PCC visits was correlated with the length of ICU stay. The average duration of ICU stay (40.3 ± 33.2 days vs 27.8 ± 19.3 days, P = .05) and ECMO treatment (31.9 ± 27 days vs 18.6 ± 16.1 days, P = .01) were significantly longer in patients receiving PCC than those not receiving PCC. However, the frequency of life sustaining measures or the underlying reasons for WOLST did not significantly differ between the two groups (P > .05). Conclusion: Among ICU patients requiring ECMO support, longer duration of ICU stay and treatment with a higher number of life-sustaining measures seemed to be correlated with the number of PCC visits. The underlying reasons for WOLST seem not to be affected by PCC.
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Affiliation(s)
- Gabriel Patarroyo - Aponte
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
- Memorial Hermann, Texas Medical Center, Houston, TX, USA
| | - Saeed Shoar
- Department of Clinical Research, Scientific Collaborative Initiative, Houston/Largo, TX/MD, USA
| | - Deptmer M. Ashley
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
- Memorial Hermann, Texas Medical Center, Houston, TX, USA
| | - Ali Noorbaksh
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Dev Patel
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Alisha Y. Young
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
- Memorial Hermann, Texas Medical Center, Houston, TX, USA
| | - Bindu H. Akkanti
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
- Memorial Hermann, Texas Medical Center, Houston, TX, USA
| | - Mark T. Warner
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
- Memorial Hermann, Texas Medical Center, Houston, TX, USA
| | - Maria M. Patarroyo - Aponte
- Memorial Hermann, Texas Medical Center, Houston, TX, USA
- Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Biswajit Kar
- Memorial Hermann, Texas Medical Center, Houston, TX, USA
- Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Igor D. Gregoric
- Memorial Hermann, Texas Medical Center, Houston, TX, USA
- Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Caroline Ha
- Department of Palliative Care and Rehabilitation Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Bela Patel
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
- Memorial Hermann, Texas Medical Center, Houston, TX, USA
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Nadolny S, Schildmann E, Gaßmann ES, Schildmann J. What is an "early palliative care" intervention? A scoping review of controlled studies in oncology. Cancer Med 2023; 12:21335-21353. [PMID: 37902232 PMCID: PMC10726823 DOI: 10.1002/cam4.6490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 07/21/2023] [Accepted: 08/21/2023] [Indexed: 10/31/2023] Open
Abstract
INTRODUCTION Early palliative care (EPC) has been advocated to improve cancer patients' health. However, EPC differs with regard to its elements and target groups. It is not known which parts of EPC contribute to effectiveness for which patient group. This scoping review provides a structured analysis of EPC interventions and outcome measures. DESIGN We searched EMBASE, MEDLINE, CINAHL, and CENTRAL up to February 2022. We included randomized controlled trials (RCT), nonrandomized trials, cohort studies (CS), and controlled before-after studies of EPC in adult patients in English, Dutch, and German language. Interventions had to be self-labeled as EPC. Screening and data extraction were performed by two raters. A structured analysis incorporating the TIDieR checklist was performed to describe the elements of the interventions. RESULTS We screened 2651 articles, resulting in 40 articles being included: 34 studies were RCT and six studies were CS with a mean sample size of 208 patients. Patients with pancreatic (n = 10) and lung cancer (n = 9) were most often included. Studies reported different reference points for the onset of EPC such as time after diagnosis of incurable cancer (n = 18) or prognosis (n = 9). Thirteen studies provided information about elements of EPC and eight studies about the control intervention. Most frequent elements of EPC were symptom management (n = 28), case management (n = 16), and advance care planning (ACP; n = 15). Most frequently reported outcome measures were health-related quality of life (n = 26), symptom intensity (n = 6), resource use, and the patient's mood (n = 4 each). CONCLUSION The elicited heterogeneity of ECP in combination with deficits of reporting are considerable barriers that should be addressed to further develop effective EPC interventions for different groups of cancer patients.
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Affiliation(s)
- Stephan Nadolny
- Institute for History and Ethics of Medicine, Interdisciplinary Center for Health SciencesMartin Luther University Halle‐WittenbergHalleGermany
- Institute for Educational and Health‐Care Research in the Health SectorHochschule Bielefeld—University of Applied Sciences and ArtsBielefeldGermany
| | - Eva Schildmann
- Department of Palliative MedicineMedical Faculty, University of AugsburgAugsburgGermany
- Department of Palliative MedicineLMU University Hospital, LMU MunichMunichGermany
| | - Elena S. Gaßmann
- Institute for History and Ethics of Medicine, Interdisciplinary Center for Health SciencesMartin Luther University Halle‐WittenbergHalleGermany
| | - Jan Schildmann
- Institute for History and Ethics of Medicine, Interdisciplinary Center for Health SciencesMartin Luther University Halle‐WittenbergHalleGermany
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Corr CA. Some Reflections on the 50th Anniversary of Hospice Care in America. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231218217. [PMID: 38039094 DOI: 10.1177/00302228231218217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
Abstract
This article celebrates the 50th anniversary of hospice care in America. It also offers a brief recounting of one person's reflections on some aspects of the history, achievements, and current status of American hospice care.
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Affiliation(s)
- Charles A Corr
- School of Humanities, Southern Illinois University at Edwardsville, Edwardsville, IL, USA
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Brooke Tucker C. Do We Really Listen, Improving End-of-Life Conversations. Crit Care Nurs Clin North Am 2023; 35:357-365. [PMID: 37838411 DOI: 10.1016/j.cnc.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
Having end-of-life (EOL) conversations is often difficult for even seasoned clinicians. There are many well-developed conversation guidelines used in the specialty of palliative medicine. There is no one ultimate guide that makes having an emotion-filled conversation easy. However, using the tenets of medical ethics, cloaked with experience, compassion, empathy, and respect makes EOL conversations less traumatic for the patient-family system and for the provider. Palliative specialists have the training and experience in effectively having EOL conversations, especially when death is unavoidable. Utilizing shared decision making, palliative specialists ensure there is mutual respect and communication between providers and the family system.
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Affiliation(s)
- Cinnamon Brooke Tucker
- Palliative Medicine and Supportive Care, LCMC Health-University Medical Center New Orleans, 2000 Canal Street, New Orleans, LA 70112, USA.
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Satheeshkumar PS, Pili R, Epstein JB, Thazhe SBK, Sukumar R, Mohan MP. Characteristics and predictors associated with cancer-related fatigue among solid and liquid tumors. J Cancer Res Clin Oncol 2023; 149:13875-13888. [PMID: 37540252 DOI: 10.1007/s00432-023-05197-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 07/18/2023] [Indexed: 08/05/2023]
Abstract
PURPOSE Cancer-related fatigue (CRF) is a devastating complication with limited recognized clinical risk factors. We examined characteristics among solid and liquid cancers utilizing Machine learning (ML) approaches for predicting CRF. METHODS We utilized 2017 National Inpatient Sample database and employed generalized linear models to assess the association between CRF and the outcome of burden of illness among hospitalized solid and non-solid tumors patients. And further applied lasso, ridge and Random Forest (RF) for building our linear and non-linear ML models. RESULTS The 2017 database included 196,330 prostate (PCa), 66,385 leukemia (Leuk), 107,245 multiple myeloma (MM), and 41,185 cancers of lip, oral cavity and pharynx (CLOP) patients, and among them, there were 225, 140, 125 and 115 CRF patients, respectively. CRF was associated with a higher burden of illness among Leuk and MM, and higher mortality among PCa. For the PCa patients, both the test and the training data had best areas under the ROC curve [AUC = 0.91 (test) vs. 0.90 (train)] for both lasso and ridge ML. For the CLOP, this was 0.86 and 0.79 for ridge; 0.87 and 0.84 for lasso; 0.82 for both test and train for RF and for the Leuk cohort, 0.81 (test) and 0.76 (train) for both ridge and lasso. CONCLUSION This study provided an effective platform to assess potential risks and outcomes of CRF in patients hospitalized for the management of solid and non-solid tumors. Our study showed ML methods performed well in predicting the CRF among solid and liquid tumors.
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Affiliation(s)
- Poolakkad S Satheeshkumar
- Division of Hematology and Oncology, Department of Medicine, University at Buffalo, Buffalo, NY, 14203, USA.
| | - Roberto Pili
- Division of Hematology and Oncology, Department of Medicine, University at Buffalo, Buffalo, NY, 14203, USA
| | - Joel B Epstein
- City of Hope Comprehensive Cancer Center, Duarte CA and Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical System, Los Angeles, CA, USA
| | | | - Rhine Sukumar
- Naseem Al Rabeeh Medical Center, C Ring Road, Doha, Qatar
| | - Minu Ponnamma Mohan
- Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
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Bergman T, Lize N, Beijer S, Raijmakers N, Metselaar S. A care ethics approach to a reduced ability to eat. Nurs Ethics 2023:9697330231197708. [PMID: 37767623 DOI: 10.1177/09697330231197708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
Patients with advanced cancer often experience a reduced ability to eat, which may result in tensions between patients and family members. Often with advanced cancer diagnoses, patients' appetites decline markedly, while family members focus on nutritional intake with the hope that this will postpone death. This hope might cause tensions between the patient and family; the family may expect healthcare professionals to encourage the patient to eat more, whereas the patient needs to be supported in their reduced ability to eat. When these tensions arise, healthcare professionals can experience challenges in providing good palliative care. To address these challenges in the provision of palliative care, healthcare professionals may adopt a care ethics approach. Similar to palliative care's focus on patient and family members' relationships, a care ethics approach emphasizes interdependency and social relationships. Using Joan Tronto's care ethics approach, we conducted a normative analysis of what caring for patients with reduced ability to eat and their family members should look like. Tronto's approach includes five phases of care: caring about, taking care of, care giving, care-receiving, and caring with. Based on our analysis and empirical studies on patients with advanced cancer and family members, concerns with their lack of appetite, we assert that healthcare professionals must be mindful of the potential of tensions related to appetite and be adept in dealing with these tensions. We urge that education is needed for healthcare professionals regarding the psychosocial impact of reduced ability to eat on both patients and family members and interprofessional collaboration is of the essence.
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Affiliation(s)
- Tessa Bergman
- Department of Public and Occupational Health, Amsterdam UMC Location VUmc, Netherlands
| | - Nora Lize
- Netherlands Comprehensive Cancer Organisation, Netherlands
| | - Sandra Beijer
- Netherlands Comprehensive Cancer Organisation, Netherlands
| | - Natasja Raijmakers
- Netherlands Comprehensive Cancer Organisation, Netherlands
- Netherlands Association for Palliative Care
| | - Suzanne Metselaar
- Department of Ethics Law & Humanities, Amsterdam UMC Location VUMC, Netherlands
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14
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Michel C, Seipp H, Kuss K, Hach M, Kussin A, Riera-Knorrenschild J, Bösner S. Key aspects of psychosocial needs in palliative care - a qualitative analysis within the setting of a palliative care unit in comparison with specialised palliative home care. BMC Palliat Care 2023; 22:100. [PMID: 37480117 PMCID: PMC10360287 DOI: 10.1186/s12904-023-01227-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 07/13/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND The number of palliative care patients with complex needs is increasing in developed countries. In addition to physical aspects and symptom control, psychosocial aspects are of great importance for palliative care patients. The aim of this study was to understand which psychosocial aspects are important to patients, relatives and health professionals within the setting of a palliative care unit in comparison with specialised palliative home-care (SPHC). METHODS We used a qualitative design based on semistructured interviews, which were coded via qualitative content analysis. The study took place in the state of Hesse, Germany, and data collection was conducted in 2017 (interviews from the ELSAH study, which was conducted in a SPHC) and 2018 (supplementary interviews conducted in a palliative care unit). The results from both settings were compared. RESULTS In the palliative care unit, 10 health professionals, 11 patients and 8 relatives were interviewed. In the outpatient setting, we interviewed 30 health professionals, 14 patients and 14 relatives. We identified four key psychosocial issues related to palliative care that were relevant in both the inpatient and outpatient settings: care planning, patient-centred care, a protected environment with feelings of safety, and psychological well-being. In addition, immediate availability of medical staff, greater relief of the relatives and better accessibility of psychological care were more important in the inpatient setting than in the specialised palliative home care setting. CONCLUSIONS Knowledge and application of the identified key issues may improve patient-centred palliative care. Accessibility of psychological care and immediate availability of medical staff may be important factors for enhancing psychological well-being in the inpatient palliative care setting. Consideration of the identified key issues may help to develop more collaborative transitions between the palliative care unit and the SPHC and may help to provide palliative care patients and their families with care that is appropriate and feasible for them. TRIAL REGISTRATION The underlying comparative study of the outpatient setting of specialised palliative home-care (ELSAH) was registered within the German Clinical Trials Register DRKS-ID: DRKS00012421, ( https://drks.de/search/de/trial/DRKS00012421 ) on 19th May 2017.
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Affiliation(s)
- Cathrin Michel
- Department of General Practice and Family Medicine, Philipps- University Marburg, Karl-von-Frisch-Straße 4, 35032, Marburg, Germany.
| | - Hannah Seipp
- Department of General Practice and Family Medicine, Philipps- University Marburg, Karl-von-Frisch-Straße 4, 35032, Marburg, Germany
| | - Katrin Kuss
- Department of General Practice and Family Medicine, Philipps- University Marburg, Karl-von-Frisch-Straße 4, 35032, Marburg, Germany
| | - Michaela Hach
- Professional Association of Specialised Palliative Homecare in Hesse, Wiesbaden, Germany
| | - Andrea Kussin
- Department of Anaesthesia and Intensive Care Therapy, Philipps-University of Marburg, Marburg, Germany
| | | | - Stefan Bösner
- Department of General Practice and Family Medicine, Philipps- University Marburg, Karl-von-Frisch-Straße 4, 35032, Marburg, Germany
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15
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Sadowska K, Fong T, Horning DR, McAteer S, Ekwebelem MI, Demetres M, Reid MC, Shalev D. Psychiatric Comorbidities and Outcomes in Palliative and End-of-Life Care: A Systematic Review. J Pain Symptom Manage 2023; 66:e129-e151. [PMID: 37003308 PMCID: PMC10330030 DOI: 10.1016/j.jpainsymman.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 03/14/2023] [Accepted: 03/16/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Although psychiatric comorbidities are common among individuals at end of life, their impact on outcomes is poorly understood. METHODS We conducted a systematic literature review of six databases following preferred reporting items for systematic reviews and meta-analyses guidelines and aimed at assessing the relationship between psychiatric comorbidities and outcomes in palliative and end-of-life care. Six databases were included in our search. This review is registered on PROSPERO (CRD42022335922). RESULTS Our search generated 7472 unique records. Eighty-eight full texts were reviewed for eligibility and 43 studies were included in the review. Clinically, psychiatric comorbidity was associated with poor quality of life, increased physical symptom burden, and low function. The impact of psychiatric comorbidity on health utilization varied, though many studies suggested that psychiatric comorbidity increased utilization of palliative care services. Quality of evidence was limited by lack of consistent approach to confounding variables as well as heterogeneity of the included studies. CONCLUSION Psychiatric comorbidity is associated with significant differences in care utilization and clinical outcome among patients at end of life. In particular, patients with psychiatric comorbidity and serious illness are at high risk of poor quality of life and high symptom burden. Our finding that psychiatric comorbidity is associated with increased utilization of palliative care likely reflects the complexity and clinical needs of patients with serious illness and mental health needs. These data suggest that greater integration of mental health and palliative care services may enhance quality-of-life among patients at end of life.
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Affiliation(s)
| | - Tina Fong
- Case Western Reserve University (T.F.), Cleveland, Ohio, USA
| | - Daniel R Horning
- Teacher's College (D.R.H.), Columbia University, New York, New York, USA
| | - Sandra McAteer
- School of Public Health (S.M.), University of Washington, Seattle, Washington, USA
| | - Maureen I Ekwebelem
- Division of Geriatrics and Palliative Medicine (M.I.E., M.C.R., D.S.), Weill Cornell Medicine, New York, New York, USA
| | - Michelle Demetres
- Samuel J. Wood Library & C.V. Starr Biomedical Information Center (M.D.), Weill Cornell Medicine, New York, USA
| | - M Carrington Reid
- Division of Geriatrics and Palliative Medicine (M.I.E., M.C.R., D.S.), Weill Cornell Medicine, New York, New York, USA
| | - Daniel Shalev
- Division of Geriatrics and Palliative Medicine (M.I.E., M.C.R., D.S.), Weill Cornell Medicine, New York, New York, USA; Department of Psychiatry (D.S.), Weill Cornell Medicine, New York, New York, USA.
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16
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Wu Q, Zhu P, Ji Q, Shi G, Qian M, Xu H, Gu X, Wang W, Zhang Q. The effect of death education course utilizing constructivist learning theory on first grade undergraduate nursing student attitudes and coping abilities towards death: A mixed study design. NURSE EDUCATION TODAY 2023; 126:105809. [PMID: 37058871 DOI: 10.1016/j.nedt.2023.105809] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 02/26/2023] [Accepted: 03/28/2023] [Indexed: 05/25/2023]
Abstract
Inadequate clinical preparation for palliative care is often reflected in inadequate education about death. Nursing students as nurses of the future, it is necessary to make them aware of death and overcome fear of it so that they can cope with their future careers and provide qualified and warmly care service. OBJECTIVES To determine the effect of death education course using constructivist learning theory on first grade undergraduate nursing student attitudes and coping abilities towards death. DESIGN This study was designed using a mixed-methods design. SETTING Two campuses of a university school of nursing in China. PARTICIPANTS First grade Bachelor of Nursing Science students (n = 191). METHODS Data collection includes questionnaires and reflective writing as after class task. Quantitative data were analyzed using descriptive statistics, the Wilcoxon Signed Rank test, and the Mann-Whitney U test. As for reflective writing, content analysis was hired to analysis. RESULTS The intervention group's attitude towards death tended to be neutral acceptance. The intervention group's ability to deal with death (Z = -5.354, p < 0.001) and expression of thoughts about death (Z = -3.89 b, p < 0.001) greater than that of the control group. Four themes (Awareness of death before class, Knowledge, The meaning of palliative care, New cognition) were identified from reflecting writing. CONCLUSION Compared with the conventional teaching, death education course utilizing constructivist learning theory was found to be a more effective method for developing students' death coping skills and reducing fear of death.
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Affiliation(s)
- Qiwei Wu
- School of Nursing, Yangzhou University, 136 Jiangyang Middle Road, Hanjing County, Yangzhou City 225009, Jiangsu Province, China
| | - Pingting Zhu
- School of Nursing, Yangzhou University, 136 Jiangyang Middle Road, Hanjing County, Yangzhou City 225009, Jiangsu Province, China; Jiangsu Key Laboratory of Zoonosis, 136 Jiangyang Middle Road, Hanjing County, Yangzhou City 225009, Jiangsu Province, China.
| | - Qiaoying Ji
- School of Nursing, Yangzhou University, 136 Jiangyang Middle Road, Hanjing County, Yangzhou City 225009, Jiangsu Province, China
| | - Guanghui Shi
- School of Nursing, Yangzhou University, 136 Jiangyang Middle Road, Hanjing County, Yangzhou City 225009, Jiangsu Province, China
| | - Meiyan Qian
- School of Nursing, Yangzhou University, 136 Jiangyang Middle Road, Hanjing County, Yangzhou City 225009, Jiangsu Province, China
| | - HuiWen Xu
- School of Nursing, Yangzhou University, 136 Jiangyang Middle Road, Hanjing County, Yangzhou City 225009, Jiangsu Province, China
| | - Xinyue Gu
- School of Nursing, Yangzhou University, 136 Jiangyang Middle Road, Hanjing County, Yangzhou City 225009, Jiangsu Province, China
| | - Wen Wang
- School of Nursing, Yangzhou University, 136 Jiangyang Middle Road, Hanjing County, Yangzhou City 225009, Jiangsu Province, China
| | - Qianqian Zhang
- School of Nursing, Yangzhou University, 136 Jiangyang Middle Road, Hanjing County, Yangzhou City 225009, Jiangsu Province, China
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17
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Shaulov A, Finkelstein A, Vashdi I, DeKeyser Ganz F, Kienski Woloski-Wruble A, Rubinstein E, Marcus EL, Lesser L, Shaham D. Interprofessional palliative and end-of-life education: short-term and long-term outcomes - mixed-methods analysis. BMJ Support Palliat Care 2023:spcare-2023-004290. [PMID: 37258087 DOI: 10.1136/spcare-2023-004290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/17/2023] [Indexed: 06/02/2023]
Abstract
ObjectiveInterprofessional care is integral to end-of-life (EOL) and palliative care (PC) and may be suited for EOL and PC education.We evaluate the impact of an interprofessional EOL care curriculum on participants, during the course, on completion and 4 years laterusing quantitative (questionnaires) and qualitative (open-ended questions and interviews) methods.The course included 14 fifth and sixth-year medical students, 9 social work students and 7 nursing students enrolled in master's degree programmes. Seventeen participants completed questionnaires 4 years later and eight participated in interviews.On postcourse questionnaires, participants attributed high value to interprofessional education (IPE) (4.77/5±0.50 on a Likert scale). Four years later, participants reported that IPE impacted their professional (3.65/5±1.11) and personal lives (3.94/5±1.09) and found PC IPE important (4.88/5±0.33).Conventional content analysis showed that the course enabled discussion of death and dying and provided an opportunity for a personal-emotional journey. It offered an approach to EOL care and an opportunity to experience interprofessional teamwork at the EOL resulting in behavioural change.Interprofessional EOL education resulted in meaningful and lasting self-reported personal and professional behavioural outcomes.
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Affiliation(s)
- Adir Shaulov
- Department of Hematology, Hadassah Medical Center and Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Adi Finkelstein
- Department of Nursing, Jerusalem College of Technology, Jerusalem, Israel
| | - Inon Vashdi
- School of Medicine, Hadassah and Hebrew University, Jerusalem, Israel
| | - Freda DeKeyser Ganz
- Department of Nursing, Jerusalem College of Technology, Jerusalem, Israel
- Henrietta Szold-Hadassah-Hebrew University School of Nursing in the Faculty of Medicine, Jerusalem, Israel
| | | | | | - Esther-Lee Marcus
- Department of Geriatrics, Herzog Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Lior Lesser
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Dorith Shaham
- Department of Radiology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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18
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Lee S, Kim B. A Photovoice Study on the Position and Role of Hospice Volunteers in Korea. Risk Manag Healthc Policy 2023; 16:931-943. [PMID: 37228846 PMCID: PMC10204757 DOI: 10.2147/rmhp.s403746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 05/13/2023] [Indexed: 05/27/2023] Open
Abstract
Purpose As the quality of life increases, so does the demand for a dignified life. Although there is an increasing interest in hospice care, which helps people experience a comfortable death, the level of change in perception and in its role remain insignificant. Methods This study investigated the position and role of hospice care using photovoice, a technique used in Participatory Action Research, to analyze the data collected from hospice volunteers who participated in a training program in Korea. Results The participants viewed hospice volunteering from the two perspectives: facing unexpected farewells and supporting like bicycle training wheels, highlighting the role of the "connection between death, life, and rest" as a mediator in conflicts between the patients and medical staff. Although the participants dreaded hospice volunteering, it prepared them to share their lives and provided an opportunity for inner growth by expanding knowledge through learning and establishing a "meaningful connection with the community" because they volunteered out of love, not obligation. Conclusion Because the demand for hospice and palliative care is increasing, this study is meaningful as it investigates the perception of hospice care and determines its influencing factors based on the perspective of hospice volunteers and the changes in their perception over time.
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Affiliation(s)
- Sowon Lee
- College of Nursing, Chonnam National University, Gwangju, South Korea
| | - Boyoung Kim
- College of Nursing, Chonnam National University, Gwangju, South Korea
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19
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Abate Y, Solomon K, Azmera YM, de Fouw M, Kaba M. Barrier analysis for continuity of palliative care from health facility to household among adult cancer patients in Addis Ababa, Ethiopia. BMC Palliat Care 2023; 22:57. [PMID: 37173667 PMCID: PMC10175902 DOI: 10.1186/s12904-023-01181-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 05/03/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Annually 57 million people across the globe require palliative care, 76% are from low- and-middle income countries. Continuity of palliative care contributes to a decline in emergency room visits., decreased hospital deaths, improved patient satisfaction, better utilization of services, and cost savings. Despite efforts made to develop the palliative care guideline in Ethiopia, the service is not yet organized and linked to primary health care. This study aimed to explore barriers to the continuum of palliative care from facility to household for cancer patients in Addis Ababa. METHODS Qualitative exploratory study was conducted with face-to-face interviews with a total of 25 participants. The study population was adult cancer patients, primary caregivers, healthcare providers, volunteers, and nationwide advocates. Data were audio recorded, transcribed verbatim and finally imported to Open code version 4.02 software for coding and analysis. Thematic analysis was guided by Tanahashi's framework. RESULTS The key barriers to continuity of palliative care included opioid scarcity and turnover and shortage of healthcare workers. A shortfall of diagnostic materials, cost of medications, lack of government backing, and home-based center's enrollment capacity hampered accessibility. Care providers were instruments of cultural barriers in delivering appropriate end-of-life care, on the other hand, patients' preference for conventional medicine hindered acceptability. Lack of community volunteers, failure of health extension workers to link patients, and spatial limits fraught utilization. The lack of defined roles and services at several levels and the workload on healthcare professionals affected the effectiveness of the nexus. CONCLUSION The continuum of palliative care service from health facility to household in Ethiopia is yet in its infancy compromised by factors related to availability, accessibility, acceptability, utilization, and effectiveness. Further research is required to delineate the roles of various actors; the health sector should smudge out the continuum of palliation to cope with the growing need for palliative care.
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Affiliation(s)
- Yonas Abate
- School of Public Health, Department of Preventive Medicine, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Kalkidan Solomon
- School of Public Health, Department of Preventive Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Marlieke de Fouw
- Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - Mirgissa Kaba
- School of Public Health, Department of Preventive Medicine, Addis Ababa University, Addis Ababa, Ethiopia
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20
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Crooms RC, Taylor JW, Jette N, Morgenstern R, Agarwal P, Goldstein NE, Vickrey BG. Palliative care referral across the disease trajectory in high-grade glioma. J Neurooncol 2023; 163:249-259. [PMID: 37209290 PMCID: PMC10546385 DOI: 10.1007/s11060-023-04338-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 05/06/2023] [Indexed: 05/22/2023]
Abstract
PURPOSE Adults with high-grade glioma (HGG), WHO grade III or IV, have substantial palliative care needs. Our aim was to determine occurrence, timing, and factors associated with palliative care consultation (PCC) in HGG at one large academic institution. METHODS HGG patients receiving care between 08/1/2011 and 01/23/2020 were identified retrospectively from a multi-center healthcare system cancer registry. Patients were stratified by any PCC (yes/no), and timing of initial PCC by disease phase: diagnosis (before radiation), during initial treatment (first-line chemotherapy/radiation), second-line treatment(s), or end-of-life (after last chemotherapy). RESULTS Of 621 HGG patients, 134 (21.58%) received PCC with the vast majority occurring during hospital admission [111 (82.84%)]. Of the 134, 14 (10.45%) were referred during the diagnostic phase; 35 (26.12%) during initial treatment; 20 (14.93%) during second-line treatment; and 65 (48.51%) during end of life. In multivariable logistic regression, only higher Charlson Comorbidity Index was associated with greater odds of PCC [OR 1.3 (95% CI 1.2-1.4), p < 0.01]; but not age or histopathology. Patients who received PCC prior to end of life had longer survival from diagnosis than those referred during end of life [16.5 (8, 24) months vs. 11 (4, 17); p < 0.01]. CONCLUSION A minority of HGG patients ever received PCC, which primarily occurred in the inpatient setting, and nearly half during the end-of-life phase. Thus, only about one in ten patients in the entire cohort potentially received the benefits of earlier PCC despite earlier referral having an association with longer survival. Further studies should elucidate barriers and facilitators to early PCC in HGG.
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Affiliation(s)
- Rita C Crooms
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Jennie W Taylor
- Departments of Neurology and Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Nathalie Jette
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rachelle Morgenstern
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Parul Agarwal
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nathan E Goldstein
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Barbara G Vickrey
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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21
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Safabakhsh N, Lippe MP, Govahi S, Gonzales MJ, Byock I. Unmet palliative care service needs: a patient-centred metric. BMJ Support Palliat Care 2023:spcare-2023-004190. [PMID: 36813534 DOI: 10.1136/spcare-2023-004190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 02/01/2023] [Indexed: 02/24/2023]
Abstract
OBJECTIVES Financial pressures and competing demands for limited resources highlight the importance of defining the unmet need for specialty inpatient palliative care (PC), demonstrating the value of the service line and making decisions about staffing. One measure of access to specialty PC is penetration, the percentage of hospitalised adults receiving PC consultations. Although useful, additional means of quantifying programme performance are required for evaluating access by patients who would benefit. The study sought to define a simplified method of calculating unmet need for inpatient PC. METHODS This retrospective observational study analysed electronic health records from six hospitals in one health system in Los Angeles County.Unmet need for PC was defined by the number of hospitalised patients with four or more chronic serious comorbidities without a PC consultation divided by a denominator of all patients with one or more chronic serious conditions (CSCs) without a PC during the hospitalisation. RESULTS This calculation identified a subset of patients with four or more CSCs that accounts for 10.3% of the population of adults with one or more CSCs who did not receive PC services during a hospitalisation (unmet need). Monthly internal reporting of this metric led to significant PC programme expansion with an increase in average penetration for the six hospitals from 5.9% in 2017 to 11.2% in 2021. CONCLUSIONS Health system leadership can benefit from quantifying the need for specialty PC among seriously ill inpatients. This anticipated measure of unmet need is a quality indicator that complements existing metrics.
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Affiliation(s)
- Nusha Safabakhsh
- Institute for Human Caring, Providence St Joseph Health, Renton, Washington, USA
| | - Megan P Lippe
- School of Nursing, UT Health San Antonio, San Antonio, Texas, USA
| | - Shahrooz Govahi
- Institute for Human Caring, Providence St Joseph Health, Renton, Washington, USA
| | - Matthew J Gonzales
- Institute for Human Caring, Providence St Joseph Health, Renton, Washington, USA
| | - Ira Byock
- Institute for Human Caring, Providence St Joseph Health, Renton, Washington, USA
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22
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Feldman DB, Corn BW. Hope and cancer. Curr Opin Psychol 2023; 49:101506. [PMID: 36493525 DOI: 10.1016/j.copsyc.2022.101506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 10/24/2022] [Accepted: 10/26/2022] [Indexed: 12/12/2022]
Abstract
Two models of hope have predominated in the literature pertaining to cancer-Snyder's "Hope Theory" and Herth's hope model-both of which have produced brief self-report measures. Growing evidence demonstrates that hope, as operationalized in these models, is associated with a number of psychological variables in individuals with cancer, including depression, distress, coping, symptom burden, and posttraumatic growth. Emerging evidence also suggests that hope may predict probability of survival in advanced cancer. Surveys show that patients and families generally prefer healthcare communication that authentically conveys prognosis; such communication is not associated with decreased hope, but may actually foster hope. Finally, several interventions have been developed to enhance hope in people with cancer, which generally demonstrate medium effects.
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23
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Snijders R, Raijmakers N, Firouzian A, Kodde A, Kazimier H, Bols F, Zerstegen C, Brom L. Trends in Palliative Care Telephone Consultation Support for Health Care Professionals: A Dutch Nationwide Registry between 2004 and 2019. J Palliat Med 2023; 26:87-93. [PMID: 35994009 DOI: 10.1089/jpm.2022.0097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background: Regional palliative care consultation (PCC) teams aim to support health care professionals by telephone in providing quality palliative care (PC) in the Netherlands. Objectives: The study aims to assess trends in the number and characteristics of PC telephone consultations in the Netherlands between 2004 and 2019. Design: A retrospective observational study reviewed data from the Dutch national register for PC consultations by telephone (PRADO). To assess trends in the number of consultations, three time periods were defined: 2004-2008, 2009-2013, and 2014-2019. All analyses were conducted using STATA. Results: A total of 83,554 PC telephone consultations were analyzed. There was a slight decrease in the number of consultations since 2014, from 5811 (2014) to 4914 (2019). The Dutch PCC telephone helpdesk was mainly consulted by general practitioners, with pharmacological issues (65%) and pain (44%) being the main concerns. The data included 73,833 patients, of whom 63% were 65 years or older (18-109) and 51% were male. The proportion of noncancer patients increased during the selected time periods, 2004-2008 (11%), 2009-2013 (16%), and 2014-2019 (22%). The proportion of consultations requested for hospitalized patients was higher in 2014-2019 (7.9%) than in 2009-2013 (4.5%). Conclusion: Dutch PC telephone consultations have changed over time. More PC telephone consultations were held for hospitalized patients and noncancer diseases over the past years. These trends are in line with the shift toward more integrated PC in which different services collaborate.
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Affiliation(s)
- Rolf Snijders
- Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,Netherlands Association for Palliative Care, Utrecht, the Netherlands
| | - Natasja Raijmakers
- Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,Netherlands Association for Palliative Care, Utrecht, the Netherlands
| | - Azadeh Firouzian
- Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Astrid Kodde
- Netherlands Association for Palliative Care, Utrecht, the Netherlands.,Stichting PaTz, Utrecht, the Netherlands
| | - Hetty Kazimier
- Netherlands Association for Palliative Care, Utrecht, the Netherlands
| | - Floor Bols
- Department of Palliative Care, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | | | - Linda Brom
- Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,Netherlands Association for Palliative Care, Utrecht, the Netherlands
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Nunciaroni AT, Neves IF, Marques CSG, Santos ND, Corrêa VFA, Silva RFA. Palliative Care in Heart Failure: An Integrative Review of Nurse Practice. Am J Hosp Palliat Care 2023; 40:96-105. [PMID: 35414263 DOI: 10.1177/10499091221085276] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Introduction: Because it is a chronic disease of progressive evolution, heart failure requires nursing attitudes and practices that are articulated with palliative care, implemented in an interdisciplinary team along with patients and their families. Objective: Identifying nurses' attitudes and practices in palliative care in cardiology. Method: Integrative literature review. The searches were carried out in the following bases: Google Scholar, Virtual Health Library, LILACS, SciELO, Embase, MEDLINE, CINAHL, and Scopus; through the terms Palliative Care AND Cardiology AND Nursing. Results: We identified 1298 studies published in the last five years, 14 of which have been selected for the scope of this review. Nurse attitudes and practices were characterized as: approach to symptom control; promotion of comfort and well-being; integrality of care and family orientation; effective communication among patients, family members and nursing team; timely evaluation for palliative care. Most of the studies included in this review have evidence level 2C (n = 7) and 2B (n = 4). Therefore, the results can be interpreted as reliable. Conclusions: This study makes important contributions to the practice of nurses in palliative care for heart failure. Based on the evidence collected, nurses can develop actions with the nursing team and with the interdisciplinary team related to direct patient and family care, as well as professional training. However, the field lacks studies showing the practices and actions implemented by the nursing team.
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Affiliation(s)
- Andressa T Nunciaroni
- Alfredo Pinto Nursing School, 89111Federal University of the State of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Izabella F Neves
- Registered Nurse, Federal University of the State of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Caroline S G Marques
- Cardiology Nursing specialist, Federal University of the State of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Noemi D Santos
- Registered Nurse at 219784National Institute of Cardiology, Rio de Janeiro, RJ, Brazil
| | - Vanessa F A Corrêa
- Alfredo Pinto Nursing School, 89111Federal University of the State of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Renata Flavia A Silva
- Alfredo Pinto Nursing School, 89111Federal University of the State of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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25
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Cuviello A, Pasli M, Bhatia S, Johnson LM, Anghelescu DL, Baker JN. Dexmedetomidine and Propofol at End of Life in Pediatric Oncology: Trends in Palliative Sedation Therapy. J Palliat Med 2023; 26:79-86. [PMID: 35944277 PMCID: PMC9810498 DOI: 10.1089/jpm.2021.0650] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2022] [Indexed: 01/13/2023] Open
Abstract
Context: Palliative sedation therapy (PST) can address suffering at the end of life (EOL) in children with cancer; yet, little is known about PST in this population. Objectives: We sought to describe the characteristics of pediatric oncology patients requiring PST at the EOL. Methods: A retrospective review was completed for pediatric oncology patients who required PST at a United States academic institution over 10 years, including demographics, disease characteristics, EOL characteristics, and medications for PST and symptom management. Results: PST was utilized in 3% of patients at the EOL. Of 24 study participants receiving PST, 83% (n = 20), 12.5% (n = 3), and 4.2% (n = 1) received dexmedetomidine, propofol, or both, respectively. The most frequent diagnosis for patients receiving PST was acute myelogenous leukemia (20.8%, n = 5). All patients were followed up by the palliative care team, and two-thirds (66.6%, n = 16) were also followed up by the pain management service; 79% (n = 19) were enrolled in hospice, and 98.5% (n = 23) had a Physician Orders for Scope of Treatment in place. Pain was the most common refractory symptom leading to PST initiation (33.3%, n = 8), followed by neuroagitation and dyspnea. PST was initiated a median of 2.5 days before death. A third of deaths occurred in the intensive care unit (33.3%, n = 8). Conclusions: PST was rare in this study; dexmedetomidine was used as first-line treatment for PST in patients at the EOL with refractory symptoms. Its place in PST protocols in pediatric oncology should be validated with prospective studies. Our study suggests the potential value of collaboration between palliative care and pain specialists in the context of PST.
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Affiliation(s)
- Andrea Cuviello
- Division of Oncology and Anesthesiology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Melisa Pasli
- Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
| | - Shalini Bhatia
- Division of Oncology and Anesthesiology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Liza-Marie Johnson
- Division of Oncology and Anesthesiology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Doralina L. Anghelescu
- Division of Oncology and Anesthesiology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Justin N. Baker
- Division of Oncology and Anesthesiology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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26
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Mavragani A, Banegas MP, Henrikson NB. Conceptions of Legacy Among People Making Treatment Choices for Serious Illness: Protocol for a Scoping Review. JMIR Res Protoc 2022; 11:e40791. [PMID: 36485023 PMCID: PMC9789496 DOI: 10.2196/40791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 11/04/2022] [Accepted: 11/05/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Legacy-what one leaves behind and how one hopes to be remembered after death-is an unexplored and important dimension of decision-making for people facing serious illnesses. A preliminary literature review suggests that patients facing serious illness consider legacy when making medical decisions, for example, forgoing expensive treatment with limited or unknown clinical benefit to preserve one's inheritance for their children. To date, very little is known about the conceptual foundations of legacy. No conceptual frameworks exist that provide a comprehensive understanding of how legacy considerations relate to patient choices about their medical care. OBJECTIVE The objective of this scoping review is to understand the extent and type of research addressing the concept of legacy by people facing serious illness to inform a conceptual framework of legacy and patient treatment choices. METHODS This protocol follows the guidelines put forth by Levac et al, which expands the framework introduced by Arksey and O'Malley, as well as the Joanna Briggs Institute Reviewer's manual. This scoping review will explore several electronic databases including PubMed, Medline, CINAHL, Cochrane Library, PsycINFO, and others and will include legacy-specific gray literature, including dissertation research available via ProQuest. An initial search will be conducted in English-language literature from 1990 to the present with selected keywords to identify relevant articles and refine the search strategy. After the search strategy has been finalized, 2 independent reviewers will undertake a 2-part study selection process. In the first step, reviewers will screen article titles and abstracts to identify the eligibility of each article based on predetermined exclusion or inclusion criteria. A third senior reviewer will arbitrate discrepancies regarding inclusions or exclusions. During the second step, the full texts will be screened by 2 reviewers, and only relevant articles will be kept. Relevant study data will be extracted, collated, and charted to summarize the key findings related to the construct of legacy. RESULTS This study will identify how people facing serious illness define legacy, and how their thinking about legacy impacts the choices they make about their medical treatments. We will note gaps in the literature base. The findings of this study will inform a conceptual model that outlines how ideas about legacy impact the patient's treatment choices. The results of this study will be submitted to an indexed journal. CONCLUSIONS Very little is known about the role of legacy in the treatment decisions of patients across the continuum of serious illness. In particular, no comprehensive conceptual model exists that would provide an understanding of how legacy is considered by people making decisions about their care during serious illness. This study will be among the first to construct a conceptual model detailing how considerations of legacy impact medical decision-making for people facing or living with serious illnesses. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/40791.
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Affiliation(s)
| | - Matthew P Banegas
- Kaiser Permanente Center for Health Research, Portland, OR, United States.,Radiation Medicine and Applied Science School, University of California San Diego, La Jolla, CA, United States
| | - Nora B Henrikson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States.,Department of Health Systems Science, Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, CA, United States.,Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, United States
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27
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Billiot AA, Danos DM, Stevens J, Vance KM, Raven MC, Lyons JM. Palliative care reduces emergency room visits and total hospital days among patients with metastatic HPB and GI cancers. Sci Rep 2022; 12:21068. [PMID: 36473913 PMCID: PMC9727158 DOI: 10.1038/s41598-022-23928-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 11/07/2022] [Indexed: 12/12/2022] Open
Abstract
Palliative care services (PCS) have improved quality of life for patients across various cancer subtypes. Minimal data exists regarding PCSfor metastatic hepatopancreaticobiliary (HPB) and gastrointestinal (GI) cancers. We assessed the impact of PCS on emergency department visits, hospital admissions, and survival among these patients. Patients with metastatic HPB and GI cancer referred to outpatient PCS between 2014 and 2018 at a single institution were included. We compared the demographics, outcomes, and end-of-life indicators between those who did and did not receive PCS. The study included 183 patients, with 118 (64.5%) having received PCS. There were no significant differences in age, gender, race, marital status, or insurance. Those receiving PCS were more likely to have colorectal cancer (p = 0.0082) and receive chemotherapy (p = 0.0098). On multivariate analysis, PCS was associated with fewer ED visits (p = 0.0319), hospital admissions (p = 0.0002), and total inpatient hospital days (p < 0.0001) per 30 days of life. Overall survival was greater among patients receiving PCS (HR: 0.65 (0.46-0.92)). Outpatient PCS for patients with metastatic HPB and GI cancer is associated with fewer emergency department visits, hospital admissions, and inpatient hospital days, and improved overall survival.
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Affiliation(s)
- Angelle A. Billiot
- grid.279863.10000 0000 8954 1233LSUHSC Department of Surgery, New Orleans, LA USA
| | - Denise M. Danos
- grid.279863.10000 0000 8954 1233LSUHSC School of Public Health, New Orleans, LA USA
| | - Jenny Stevens
- grid.279863.10000 0000 8954 1233LSUHSC Department of Surgery, New Orleans, LA USA
| | - Katie M. Vance
- Our Lady of the Lake-Division of Academic Affairs, Baton Rouge, LA USA
| | - Mary C. Raven
- Our Lady of the Lake Cancer Institute, 7777 Hennessy Blvd, Baton Rouge, LA 70808 USA
| | - John M. Lyons
- grid.279863.10000 0000 8954 1233LSUHSC Department of Surgery, New Orleans, LA USA ,Our Lady of the Lake Cancer Institute, 7777 Hennessy Blvd, Baton Rouge, LA 70808 USA
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28
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Kameyama N, Sato T, Arai D, Fujisawa D, Takeuchi M, Nakachi I, Kawada I, Yasuda H, Ikemura S, Terai H, Nukaga S, Nakano Y, Hirano T, Minematsu N, Asakura T, Kamatani T, Tanaka K, Suzuki S, Miyawaki M, Naoki K, Fukunaga K, Soejima K. Most Important Things and Associated Factors With Prioritizing Daily Life in Patients With Advanced Lung Cancer. JCO Oncol Pract 2022; 18:e1977-e1986. [PMID: 36346964 DOI: 10.1200/op.22.00124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Patients' values and priorities in their lives should be appreciated from an early phase of incurable diseases such as advanced cancer. However, studies examining these characteristics have been lacking. This study attempted to determine what patients with advanced lung cancer valued most, once they had been diagnosed, and any associated factors. METHODS Patients with newly diagnosed advanced lung cancer (N = 248) were enrolled in a questionnaire survey conducted at 16 hospitals in Japan. Their priorities were assessed using a free-text response to the question what is the most important thing to you now? at the time of diagnosis and 3 months after diagnosis. The free-text responses were classified into 10 categories for quantification. The clinical characteristics associated with the category describing daily life were further examined. RESULTS Free-text comments were obtained from 103 (44.0%) and 66 (42.6%) patients at the time of diagnosis and at 3 months, respectively. The most frequent categories were family (at diagnosis: 50.5%; at 3 months: 50.0%) and daily life (at diagnosis: 33.0%; at 3 months: 36.4%), followed by health (at diagnosis: 32.0%; at 3 months: 27.3%) at both time points. The patients mentioning daily life, the issues related to how to spend daily life, showed significantly higher total scores and functional well-being subscale scores on the Functional Assessment of Cancer Therapy-Lung scale at both time points and lower depression scores at diagnosis and lower anxiety scores at 3 months on the Hospital Anxiety and Depression Scale. CONCLUSION Family and daily life were highly valued by patients with advanced lung cancer at diagnosis. A better quality of life and better mood were associated with mentioning daily life, which should be taken into account in care planning to maintain patients' involvement in daily life even with incurable diseases.
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Affiliation(s)
- Naofumi Kameyama
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.,Division of Pulmonary Medicine, Kawasaki Municipal Ida Hospital, Kawasaki, Japan
| | - Takashi Sato
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.,Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Daisuke Arai
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.,Pulmonary Division, Internal Medicine, Saiseikai Utsunomiya Hospital, Utsunomiya, Japan
| | - Daisuke Fujisawa
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.,Division of Patient Safety, Keio University School of Medicine, Tokyo, Japan
| | - Mari Takeuchi
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.,Palliative Care Center, Keio University Hospital, Tokyo, Japan
| | - Ichiro Nakachi
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.,Pulmonary Division, Internal Medicine, Saiseikai Utsunomiya Hospital, Utsunomiya, Japan
| | - Ichiro Kawada
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hiroyuki Yasuda
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Shinnosuke Ikemura
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hideki Terai
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Shigenari Nukaga
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.,Division of Genome Biology, National Cancer Center Research Institute, Tokyo, Japan
| | - Yasushi Nakano
- Division of Pulmonary Medicine, Kawasaki Municipal Ida Hospital, Kawasaki, Japan
| | - Toshiyuki Hirano
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.,Department of Internal Medicine, Sano-Kosei General Hospital, Sano, Japan
| | - Naoto Minematsu
- Department of Internal Medicine, Hino Municipal Hospital, Tokyo, Japan
| | - Takanori Asakura
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.,Department of Pulmonary Medicine, Saitama City Hospital, Saitama, Japan
| | - Takashi Kamatani
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.,Department of Biological Sciences, Graduate School of Science, The University of Tokyo, Tokyo, Japan.,Department of Medical Science Mathematics, Medical Research Institute, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kyuto Tanaka
- Division of Pulmonary Medicine, Kawasaki Municipal Kawasaki Hospital, Kawasaki, Japan.,Department of Respiratory Medicine, Nippon Kokan Hospital, Kawasaki, Japan
| | - Shoji Suzuki
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.,Department of Pulmonary Medicine, Saitama City Hospital, Saitama, Japan
| | - Masayoshi Miyawaki
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.,Department of Pulmonary Medicine, Eiju General Hospital, Tokyo, Japan
| | - Katsuhiko Naoki
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Koichi Fukunaga
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kenzo Soejima
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.,Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan
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Enguidanos S, Rahman A, Lomeli S. A Tale of Two Trials: A Comparative Case Study of Successful versus Terminated Home-Based Palliative Care Trials. J Palliat Med 2022; 25:1767-1773. [PMID: 35675655 DOI: 10.1089/jpm.2022.0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background: In 2007 we published a trial of home-based palliative care (HBPC) conducted in a managed care organization (MCO) that found significant improvements in patient satisfaction with health care, rates of home deaths, and reductions in health care use and costs. A decade later, we undertook a similar trial of HBPC within accountable care organizations (ACOs) funded by the Patient-Centered Outcomes Research Institute. This trial tested the same model using similar eligibility criteria and recruitment strategies as the earlier trial, yet it failed to achieve its enrollment targets. Objectives: To understand key differences in the trials that contributed to the success of one and failure of the other. Methods: We conducted a comparative case study of the original MCO HBPC trial and the subsequent ACO HBPC trial. Two researchers familiar with both trials reviewed both quantitative and qualitative data obtained from previous analyses and publications to develop a rich, in-depth understanding of each study. Results: We identified four differences that explain in large part why the ACO trial failed while the MCO trial succeeded. These differences center on the trials' setting, target populations, outreach strategies, and providers' understanding of palliative care. Discussion: Our findings demonstrate the challenges in conducting research in complex health care systems and how physician and setting structures along with target population and lack of general palliative care knowledge can influence the success of research. Conclusion: Future HBPC trials must consider the strengths and weaknesses of trial design factors when partnering with multiple health care organizations. ClinicalTrials.gov Identifier: NCT03128060.
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Affiliation(s)
- Susan Enguidanos
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
| | - Anna Rahman
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
| | - Sindy Lomeli
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
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30
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Johnson AW, Byriel B, Rubeck J, Ghabril M, Orman ES. Standardized Criteria Increases Palliative Care Consultation Utilization in Patients With End-Stage Liver Disease: A Pilot Study. Am J Hosp Palliat Care 2022:10499091221127984. [PMID: 36167488 DOI: 10.1177/10499091221127984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Context: Patients with end-stage liver disease have high symptom burden and high healthcare utilization, which may be improved by palliative care consultation. Objectives: We sought to determine if implementing standardized palliative care consultation criteria in hospitalized patients with end-stage liver disease would increase palliative care utilization and improve patient outcomes. Methods: We conducted a retrospective cohort study of hospitalized patients with end-stage liver disease. Patients under the age of 18, received a previous liver transplant, or admitted for liver transplantation were not included. Patients with end-stage liver disease meeting two or more of the following criteria were included: (i)Child Pugh C cirrhosis, (ii)2 or more liver related hospitalizations within 6 months, (iii) current alcohol use with alcoholic cirrhosis, and (iv) unsuitable for transplantation work up. We compared consults before and after implementation of the criteria, and we compared outcomes in patients who did and did not see palliative care. Results: With implementation, consults increased (2/25 (8%) vs 11/33 (33%), p = .020). Palliative care was associated with higher completion of health care representative documentation (66.7% vs 35.7%, P = .20) and physician orders for scope of treatment forms (16.7% vs 0%, P = 0.13). Patients seen by palliative care had a higher rate of discharges with hospice (30.8% vs 0, P = .002). Conclusions: Implementation of standardized palliative care consultation criteria for patients with end-stage liver disease increased palliative care utilization. Patients seen by palliative care had increased discharges with hospice services and a trend towards higher completion rates of advanced directives.
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Affiliation(s)
- Amy W Johnson
- Division of General Internal Medicine & Geriatrics, 12250Indiana University School of Medicine, Indianapolis. IN, USA
| | - Benjamin Byriel
- Gastroenterology Fellowship, Department of Medicine, 12250Indiana University School of Medicine, Indianapolis. IN, USA
| | | | - Marwan Ghabril
- Division of Gastroenterology & Hepatology, 12250Indiana University School of Medicine, Indianapolis. IN, USA
| | - Eric S Orman
- Division of Gastroenterology & Hepatology, 12250Indiana University School of Medicine, Indianapolis. IN, USA
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31
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Kornfeld-Matte R, Rosell J, Leeson GW. A Rights-Based Approach to Ageing in the Americas. JOURNAL OF POPULATION AGEING 2022. [DOI: 10.1007/s12062-022-09390-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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32
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Chang J, Han KT, Medina M, Kim SJ. Palliative care and healthcare utilization among deceased metastatic lung cancer patients in U.S. hospitals. BMC Palliat Care 2022; 21:136. [PMID: 35897031 PMCID: PMC9327255 DOI: 10.1186/s12904-022-01026-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 07/19/2022] [Indexed: 11/24/2022] Open
Abstract
Objective The benefits of palliative care for cancer patients were well developed; however, the characteristics of receiving palliative care and the utilization patterns among lung cancer patients have not been explored using a large-scale representative population-based sample. Methods The National Inpatient Sample of the United States was used to identify deceased metastatic lung cancer patients (n = 5,068, weighted n = 25,121) from 2010 to 2014. We examined the characteristics of receiving palliative care use and the association between palliative care and healthcare utilization, measured by discounted hospital charges and LOS (length of stay). The multivariate survey logistic regression model (to identify predictors for receipts of palliative care) and the survey linear regression model (to measure how palliative care is associated with healthcare utilization) were used. Results Among 25,121 patients, 50.1% had palliative care during the study period. Survey logistic results showed that patients with higher household income were more likely to receive palliative care than those in lower-income groups. In addition, during hospitalization, receiving palliative care was associated with11.2% lower LOS and 28.4% lower discounted total charges than the non-receiving group. Conclusion Clinical evidence demonstrates the benefits of palliative care as it is associated with efficient end-of-life healthcare utilization. Health policymakers must become aware of the characteristics of receiving the care and the importance of limited healthcare resource allocation as palliative care continues to grow in cancer treatment.
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Affiliation(s)
- Jongwha Chang
- Department of Healthcare Administration, College of Business, Texas Woman's University, Denton, TX, USA
| | - Kyu-Tae Han
- Division of Cancer Control and Policy, National Cancer Center, Goyang, Republic of Korea.,National Hospice Center, National Cancer Center, Goyang, Republic of Korea
| | - Mar Medina
- School of Pharmacy, University of Texas at El Paso, El Paso, TX, USA
| | - Sun Jung Kim
- Department of Healthcare Administration, College of Business, Texas Woman's University, Denton, TX, USA. .,Department of Health Administration and Management, College of Medical Science, Soonchunhyang University, Asan, Republic of Korea. .,Center for Healthcare Management Science, Soonchunhyang University, Asan, Republic of Korea. .,Department of Software Convergence, Soonchunhyang University, Asan, Republic of Korea.
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33
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Marx G, Mallon T, Pohontsch NJ, Schade F, Dams J, Zimansky M, Asendorf T, Böttcher S, Mueller CA, Freitag M, Hummers E, van den Bussche H, Schäfer I, König HH, Stiel S, Schneider N, Nauck F, Friede T, Scherer M. Effectiveness of a specialist palliative home care nurse-patient consultation followed by an interprofessional telephone case conference compared with usual care among patients with non-oncological palliative care needs: protocol for the multicentre KOPAL cluster-randomised controlled trial. BMJ Open 2022; 12:e059440. [PMID: 35879008 PMCID: PMC9330329 DOI: 10.1136/bmjopen-2021-059440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Progressive chronic, non-malignant diseases (CNMD) like congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD) and dementia are of growing relevance in primary care. Most of these patients suffer from severe symptoms, reduced quality of life and increased numbers of hospitalisations. Outpatient palliative care can help to reduce hospitalisation rate by up to 50%. Due to the complex medical conditions and prognostic uncertainty of the course of CNMD, early interprofessional care planning among general practitioners who provide general palliative care and specialist palliative home care (SPHC) teams seems mandatory. The KOPAL study (a concept for strenghtening interprofessional collaboration for patients with palliative care needs) will test the effectiveness of a SPHC nurse-patient consultation followed by an interprofessional telephone case conference. METHODS AND ANALYSIS Multicentre two-arm cluster randomised controlled trial KOPAL with usual care as control arm. The study is located in Northern Germany and aims to recruit 616 patients in 56 GP practices (because of pandemic reasons reduced to 191 participants). Randomisation will take place on GP practice level immediately after inclusion (intervention group/control group). Allocation concealment is carried out on confirmation of participation. Patients diagnosed with CHF (New York Heart Association (NYHA) classification 3-4), COPD (Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage classification 3-4, group D) or dementia GDS stage 4 or above). Primary outcome is a reduced hospital admission within 48 weeks after baseline, secondary outcomes include symptom burden, quality of life and health costs. The primary analysis will follow the intention-to-treat principle. Intervention will be evaluated after the observation period using qualitative methods. ETHICS AND DISSEMINATION The responsible ethics committees of the cooperating centres approved the study. All steps of data collection, quality assurance and data analysis will continuously be monitored. The concept of KOPAL could serve as a blueprint for other regions and meet the challenges of geographical equity in end-of-life care. TRIAL REGISTRATION NUMBER DRKS00017795; German Clinical Trials Register.
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Affiliation(s)
- Gabriella Marx
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tina Mallon
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nadine Janis Pohontsch
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Franziska Schade
- Department of Palliative Medicine, University Medical Center Göttingen, Gottingen, Germany
| | - Judith Dams
- Department of Health Economics and Health Care Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Manuel Zimansky
- Institute for General Practice and Palliative Care, Hannover Medical School, Hannover, Germany
| | - Thomas Asendorf
- Department of Medical Statistics, University Medical Center Goettingen, Goettingen, Germany
| | - Silke Böttcher
- Division of General Practice, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Christiane A Mueller
- Department of General Practice, University Medical Center Goettingen, Goettingen, Germany
| | - Michael Freitag
- Division of General Practice, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Eva Hummers
- Department of General Practice, University Medical Center Goettingen, Goettingen, Germany
| | - Hendrik van den Bussche
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ingmar Schäfer
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Care Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stephanie Stiel
- Institute for General Practice and Palliative Care, Hannover Medical School, Hannover, Germany
| | - Nils Schneider
- Institute for General Practice and Palliative Care, Hannover Medical School, Hannover, Germany
| | - Friedemann Nauck
- Department of Palliative Medicine, University Medical Center Göttingen, Gottingen, Germany
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Goettingen, Goettingen, Germany
| | - Martin Scherer
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Review of Religious Variables in Advance Care Planning for End-of-Life Care: Consideration of Faith as a New Construct. Am J Geriatr Psychiatry 2022; 30:747-758. [PMID: 34972634 DOI: 10.1016/j.jagp.2021.11.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/30/2021] [Accepted: 11/30/2021] [Indexed: 12/28/2022]
Abstract
Religion and spirituality have long been considered important social determinants of human health, and there exists an extensive body of research to support such. End-of-life (EOL) may raise complex questions for individuals about religious and spiritual (R/S) values guiding advance care planning (ACP) and EOL care decisions, including the provision of spiritual care. This commentary will review the history and current national trends of ACP activities for EOL, principally within the United States. It will describe the relationship of religious variables and the attributes of selected research instruments used to study religious variables on ACP and EOL preferences. The review also summarizes unique ACP challenges for patients with neurocognitive disorders and severe mental illness. Findings disclose that higher levels of religiosity, reliance on religious coping, conservative faith traditions, and "belief in God's control over life's length and divine intervention have lower levels of ACP and more intensive EOL care preferences, although the provision of spiritual spiritual care at EOL mitigates intensive EOL care. Based upon the curated evidence, we propose an epistemological justification to consider "faith" as a separately defined religious variable in future ACP and EOL research. This review is relevant to geriatric psychiatrists and gerontological health care professionals, as they may be part of multidisciplinary palliative care teams; provide longitudinal care to patients with neurocognitive disorders and severe mental illness; and may provide diagnostic, emotional, and therapeutic services for patients and families who may struggle with EOL care decisions.
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Yilmaz S, Grudzen CR, Durham DD, McNaughton C, Marcelin I, Abar B, Adler D, Bastani A, Baugh CW, Bernstein SL, Bischof JJ, Coyne CJ, Henning DJ, Hudson MF, Klotz A, Lyman GH, Madsen TE, Pallin DJ, Reyes-Gibby C, Rico JF, Ryan RJ, Shapiro NI, Swor R, Thomas CR, Venkat A, Wilson J, Yeung SCJ, Caterino JM. Palliative Care Needs and Clinical Outcomes of Patients with Advanced Cancer in the Emergency Department. J Palliat Med 2022; 25:1115-1121. [PMID: 35559758 PMCID: PMC9467631 DOI: 10.1089/jpm.2021.0567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Older adults with cancer use the emergency department (ED) for acute concerns. Objectives: Characterize the palliative care needs and clinical outcomes of advanced cancer patients in the ED. Design: A planned secondary data analysis of the Comprehensive Oncologic Emergencies Research Network (CONCERN) data. Settings/Subjects: Cancer patients who presented to the 18 CONCERN affiliated EDs in the United States. Measurements: Survey included demographics, cancer type, functional status, symptom burden, palliative and hospice care enrollment, and advance directive code status. Results: Of the total (674/1075, 62.3%) patients had advanced cancer and most were White (78.6%) and female (50.3%); median age was 64 (interquartile range 54-71) years. A small proportion of them were receiving palliative (6.5% [95% confidence interval; CI 3.0-7.6]; p = 0.005) and hospice (1.3% [95% CI 1.0-3.2]; p = 0.52) care and had a higher 30-day mortality rate (8.3%, [95% CI 6.2-10.4]). Conclusions: Patients with advanced cancer continue to present to the ED despite recommendations for early delivery of palliative care.
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Affiliation(s)
- Sule Yilmaz
- Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center, Rochester, New York, USA
- Address correspondence to: Sule Yilmaz, PhD, Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center, 265 Crittenden Boulevard, Rochester, NY 14642, USA
| | - Corita R. Grudzen
- Ronald O. Perelman Department of Emergency Medicine and Population Health, New York University School of Medicine, New York, New York, USA
| | - Danielle D. Durham
- Department of Radiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | | | - Isabelle Marcelin
- Ronald O. Perelman Department of Emergency Medicine and Population Health, New York University School of Medicine, New York, New York, USA
| | - Beau Abar
- Department of Emergency Medicine, University of Rochester, Rochester, New York, USA
| | - David Adler
- Department of Emergency Medicine, University of Rochester, Rochester, New York, USA
| | - Aveh Bastani
- Department of Emergency Medicine, William Beaumont Hospital—Troy Campus, Troy, Michigan, USA
| | - Christopher W. Baugh
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Steven L. Bernstein
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jason J. Bischof
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Christopher J. Coyne
- Department of Emergency Medicine, University of California San Diego, San Diego, California, USA
| | - Daniel J. Henning
- Department of Emergency Medicine, University of Washington, Seattle, Washington, USA
| | | | - Adam Klotz
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Gary H. Lyman
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center and the Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Troy E. Madsen
- Division of Emergency Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Daniel J. Pallin
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Cielito Reyes-Gibby
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Juan Felipe Rico
- Department of Pediatrics, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Richard J. Ryan
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Nathan I. Shapiro
- Department of Emergency Medicine, Beth Israel Deaconness Medical Center, Boston, Massachusetts, USA
| | - Robert Swor
- Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, Michigan, USA
| | - Charles R. Thomas
- Department of Radiation Medicine, Knight Cancer Institute, Oregon Health and Sciences University, Portland, Oregon, USA
| | - Arvind Venkat
- Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Jason Wilson
- Department of Emergency Medicine, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Sai-Ching Jim Yeung
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jeffrey M. Caterino
- Department of Emergency Medicine and Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Enguidanos S, Lomeli S, Kogan AC, Rahman A, Lewis N. Home-Based Palliative Care Team Perspectives on Challenges in Patient Referral and Enrollment. J Pain Symptom Manage 2022; 63:665-672. [PMID: 35081443 DOI: 10.1016/j.jpainsymman.2022.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/03/2022] [Accepted: 01/13/2022] [Indexed: 12/12/2022]
Abstract
CONTEXT As funding for home-based palliative care continues to expand, there is an increasing need to understand barriers to patient referral to and acceptance of home-based palliative care. OBJECTIVES The aim of this study was to elicit perspectives of home-based palliative care administrators and providers on barriers encountered in identification, referral, and enrollment of patients eligible for home-based palliative care. METHODS We conducted a qualitative study employing focus groups of nine home-based palliative care agencies across California. Focus groups were audio-recorded and transcribed. Using thematic analysis, researchers independently coded the transcripts and identified themes from the codes. RESULTS A total of 25 HBPC staff participated in the nine focus groups. Participants included both clinicians (n = 17) and administrators (n = 8). Our analysis revealed 13 themes that fit under four major thematic categories: 1) lack of formal payment structures (few HBPC payors and variation in payment and services among payors), 2) agency structure barriers (limitations of electronic medical records and multiple lines of business), 3) patient- and family-level barriers (misconceptions and/or lack of palliative care knowledge, uninformed of the referral and/or no warm hand-off, reluctance to have strangers in the home, overwhelmed with health issues and related services, HBPC service refusal/unresponsive to outreach), and 4) physician-level barriers (misconceptions and/or lack of palliative care knowledge, variability in HBPC payment and services, lack of time, patient ownership). CONCLUSION HBPC providers identified a myriad of barriers that preclude patient access to HBPC. With growing provision of HBPC services, greater efforts to overcome these barriers are needed.
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Affiliation(s)
- Susan Enguidanos
- University of Southern California (S.E., S.L., A.R., N.L.), Los Angeles, California, USA.
| | - Sindy Lomeli
- University of Southern California (S.E., S.L., A.R., N.L.), Los Angeles, California, USA
| | | | - Anna Rahman
- University of Southern California (S.E., S.L., A.R., N.L.), Los Angeles, California, USA
| | - Nicole Lewis
- University of Southern California (S.E., S.L., A.R., N.L.), Los Angeles, California, USA
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Chirikov VV, Corman S, Qiao Y, Huang X. Clinical and Economic Burden of Out-of-Hospital Cardiac Arrest in US Commercial Insurance Population (2014 to 2019). Am J Cardiol 2022; 169:42-50. [PMID: 35063266 DOI: 10.1016/j.amjcard.2021.12.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/16/2021] [Accepted: 12/20/2021] [Indexed: 11/29/2022]
Abstract
Little is known about the economic burden incurred by out-of-hospital cardiac arrest (OHCA) in the US commercial insurance setting. We used IBM MarketScan Commercial Claims and Encounters Database (January 2014 to March 2019) to identify patients hospitalized with OHCA based on the International Classification of Diseases codes. Patients who survived the initial OHCA episode were stratified by prognosis based on discharge setting and classified into mild (discharged home), moderate (skilled nursing facility), severe (inpatient rehabilitation or long-term hospital), and very severe (hospice) prognosis groups, respectively. Patients were followed up for 12 months after discharge for health care resource utilization and medical costs, which were inflated to year 2020. Overall, 23,512 patients with OHCA hospitalization were identified, of whom 14,667 were <65 years and 60.5% were men. The incidence of OHCA per 100,000 was steady in patients <65 years over the years (17.9 in 2014; 17.5 in 2018) but among those ≥65 years, decreased from 139.7 in 2014 to 111.1 in 2018. Total medical costs 12 months after discharge generally increased with severity of prognosis, with an average for the mild, moderate, and severe prognosis group, respectively, estimated to be $52,746, $100,394, and $130,530 among patients <65 years, and $63,194, $65,794, and $70,973 among those ≥65 years. Costs were lower for those with very severe prognosis ($7,102 for <65 years; $2,553 for ≥65 years), possibly due to high mortality. In conclusion, OHCA continues to pose a substantial clinical and economic burden on patients and the US health care system, which increases with the severity of disease prognosis.
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Affiliation(s)
| | | | - Yao Qiao
- OPEN Health Evidence & Access, Bethesda, Maryland
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Lei L, Lu Y, Gan Q, Hu Z, Luo Y. Awareness and Perceptions of Palliative Care Among the Elderly: A Qualitative Study. J Palliat Care 2022; 37:204-212. [PMID: 35195464 DOI: 10.1177/08258597221082393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objectives: With the rapidly aging population worldwide, the demand for palliative care is increasing. Palliative care publicity and education must be further developed globally, especially for the elderly. It is essential to perform targeted promotion by understanding the awareness and needs of palliative care of the elderly. This study aimed to investigate elderly people's awareness of palliative care and their own views on and needs for palliative care, which could provide a basis for the popularization of palliative care among them. Methods: A total of 20 elderly people were recruited to participate in the semi-structured, and in-depth interviews. Participants were from communities and nursing homes in Chongqing, China. The interview transcripts were coded using the method of thematic analysis. Results: Finally, 4 themes and 10 subthemes were identified, that is: unawareness of the concept of palliative care (never heard of palliative care, confusion between euthanasia and palliative care), motivations for accepting palliative care (personal perspective: less suffering; family perspective: relieving the burden), factors influencing palliative care decision (cost of palliative care, knowledge of palliative care, opinion of decision-making agents), and necessity and preferences for publicizing palliative care (eagerness to know more about palliative care, focusing on policy and charges, preference for Electronic Media Advertising). Conclusions: Palliative care publicity among the elderly is important and necessary. Findings in this study could provide some insights into how to popularize palliative care among the elderly. Considering the preference of the elderly for access to palliative care information, simultaneous publicity through TV and online channels is suggested. Since the elderly would like to choose their doctors and adult children as decision-making agents, more communication between community, health professionals and family is advocated.
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Affiliation(s)
- Lei Lei
- School of Nursing, Army Medical University (Third Military Medical University), Chongqing, P.R. China
| | - Ya Lu
- School of Nursing, Army Medical University (Third Military Medical University), Chongqing, P.R. China
| | - Quanxi Gan
- Southwest University Hospital, Chongqing, P.R. China
| | - Zongping Hu
- The Thirteenth Hospital of Chongqing, Chongqing, P.R. China
| | - Yu Luo
- School of Nursing, Army Medical University (Third Military Medical University), Chongqing, P.R. China
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Rollison J, Bandini JI, Gilbert M, Phillips J, Ahluwalia SC. Incorporating the Patient and Caregiver Voice in Palliative Care Quality Measure Development. J Pain Symptom Manage 2022; 63:293-300. [PMID: 34389415 DOI: 10.1016/j.jpainsymman.2021.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/03/2021] [Indexed: 11/22/2022]
Abstract
CONTEXT Despite rapid growth in outpatient palliative care, we lack an understanding of patient and caregiver experiences of care received in this context. OBJECTIVES As part of a national effort to develop palliative care quality metrics for use in accountability programs, we sought to develop survey items assessing patients' experiences of outpatient palliative care, incorporating the patient's voice. METHODS We conducted 25 one-hour telephone cognitive interviews using a convenience sample of outpatient palliative care patients and caregivers to cognitively test survey items. Guided by a semi-structured protocol, we assessed the comprehensibility, ambiguity, and adaptability of survey instructions and specific items/response options. RESULTS Participants generally understood the intended meaning of the question content. Some participants struggled with the stated time period of three months as a reference period for reporting their experiences. While some expressed preferences for question wording, no clear patterns emerged across participants. CONCLUSION In general, question wording and response options did not present challenges to understanding content. Respondents ascribed a variety of meanings to the concepts, validating that the measures capture a range of experiences. However, the referenced timeframe of three months was more difficult to answer for some questions than others. Implications for research, policy or practice: Based on the findings from the cognitive testing, the survey items are being tested as part of a national study to understand the quality of care for patients. These measures may be used in the future by Medicare to help outpatient palliative care programs improve their care.
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Affiliation(s)
| | | | | | | | - Sangeeta C Ahluwalia
- RAND Corporation, Santa Monica, California, USA; UCLA Fielding School of Public Health, Los Angeles, California, USA.
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40
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Cardenas V, Rahman A, Zhu Y, Enguidanos S. Reluctance to Accept Palliative Care and Recommendations for Improvement: Findings From Semi-Structured Interviews With Patients and Caregivers. Am J Hosp Palliat Care 2022; 39:189-195. [PMID: 33896233 PMCID: PMC8684814 DOI: 10.1177/10499091211012605] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Despite some insurance plans now paying for home-based palliative care, recent reports have suggested that insurance coverage for palliative care may be insufficient in expanding patient access to home-based palliative care. AIM To identify patients' and caregivers' perceived barriers to home-based palliative care and their recommendations for overcoming these barriers. DESIGN We conducted a qualitative study using semi-structured individual interviews. Our interview protocol elicited participants' perspectives on home-based palliative care services; positive and negative aspects of the palliative program explanation; and suggestions for improving messaging around home-based palliative care. SETTING/PARTICIPANTS Twenty-five participants (patients, proxies, and their caregivers) who were eligible for a randomized controlled trial of home-based palliative care were interviewed by telephone. RESULTS Themes related to home-based palliative care referral barriers included reluctance to have home visits, enrollment timing, lack of palliative care knowledge, misconceptions about palliative care, and patients' self-perceived health condition. Themes related to recommendations for overcoming these obstacles included ensuring that palliative care referrals come from healthcare providers or insurance companies and presenting palliative care services more clearly. CONCLUSION Findings reinforce the need for additional palliative care education among patients with serious illness (and their caregivers) and the importance of delivering palliative care information and referrals from trusted sources.
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Affiliation(s)
- Valeria Cardenas
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Anna Rahman
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Yujun Zhu
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Susan Enguidanos
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
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Kluger BM, Miyasaki JM. Key concepts and opportunities. HANDBOOK OF CLINICAL NEUROLOGY 2022; 190:3-15. [PMID: 36055718 DOI: 10.1016/b978-0-323-85029-2.00014-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Neuropalliative care is an emerging field dedicated to applying palliative care approaches to meet the needs of persons living with neurologic illness and their families. The development of this field acknowledges the unique needs of this population, including in terms of neuropsychiatric symptoms, the impact of neurologic illness on personhood, and the logistics of managing neurologic disability. In defining the goals of this field, it is important to distinguish between neuropalliative care as an approach to care, as a skillset, as a medical subspecialty, and as a public health goal as each of these constructs offers their own contributions and opportunities. As a newly emerging field, there are nearly unlimited opportunities to improve care through research, clinical care, education, and advocacy.
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Affiliation(s)
- Benzi M Kluger
- Department of Neurology, University of Rochester, Rochester, NY, United States
| | - Janis M Miyasaki
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada.
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Golla V, Kaye DR. The Impact of Health Delivery Integration on Cancer Outcomes. Surg Oncol Clin N Am 2021; 31:91-108. [PMID: 34776068 DOI: 10.1016/j.soc.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although integrated health care has largely been associated with increases in prices and static or decreased quality across many disease states, it has shown some successes in improving cancer care. However, its impact is largely equivocal, making consensus statements difficult. Critically, integration does not necessarily translate to clinical coordination, which might be the true driver behind the success of integrated health care delivery. Moving forward, it is important to establish payment models that support clinical care coordination. Shifting from a fragmented health system to a coordinated one may improve evidence-based cancer care, outcomes, and value for patients.
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Affiliation(s)
- Vishnukamal Golla
- Duke National Clinician Scholars Program, 200 Morris St, Suite 3400, DUMC Box 104427, Durham, NC 27701, USA; Department of Surgery, Division of Urology, Duke University Medical Center, Durham, NC, USA; Duke Cancer Institute, Durham, NC, USA; Duke-Margolis Policy Center; Durham Veterans Affairs Health Care System, Durham, NC, USA.
| | - Deborah R Kaye
- Department of Surgery, Division of Urology, Duke University Medical Center, Durham, NC, USA; Duke Cancer Institute, Durham, NC, USA; Duke-Margolis Policy Center
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43
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Zhang H, Li Y, McConnell W. Predicting potential palliative care beneficiaries for health plans: A generalized machine learning pipeline. J Biomed Inform 2021; 123:103922. [PMID: 34607012 DOI: 10.1016/j.jbi.2021.103922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/25/2021] [Accepted: 09/29/2021] [Indexed: 11/28/2022]
Abstract
Recognizing that palliative care improves the care quality and reduces the healthcare costs for individuals in their end of life, health plan providers strive to better enroll the appropriate target population for palliative care. Current research has not adequately addressed challenges related to proactively select potential palliative care beneficiaries from a population health perspective. This study presents a Generalized Machine Learning Pipeline (GMLP) to predict palliative needs in patients using administrative claims data. The GMLP has five steps: data cohort creation, feature engineering, predictive modeling, scoring beneficiaries, and model maintenance. It encapsulates principles of population health management, business domain knowledge, and machine learning (ML) process knowledge with an innovative data pull strategy. The GMLP was applied in a regional health plan using a data cohort of 17,197 patients. Multiple ML models were turned and evaluated against a custom performance metric based on the business requirement. The best model was an AdaBoost model with a precision of 71.43% and a recall of 67.98%. The post-implementation evaluation of the GMLP showed that it increased the recall of high mortality risk patients, improved their quality of life, and reduced the overall cost. The GMLP is a novel approach that can be applied agnostically to the data and specific ML algorithms. To the best of our knowledge, it is the first attempt to continuously score palliative care beneficiaries using administrative data. The GMLP and its use case example presented in the paper can serve as a methodological guide for different health plans and healthcare policymakers to apply ML in solving real-world clinical challenges, such as palliative care management and other similar risk-stratified care management workflows.
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Affiliation(s)
- Hengwei Zhang
- University of Tampa, Sykes College of Business, 401 W Kennedy Blvd, Tampa, FL 33606 USA.
| | - Yan Li
- Claremont Graduate University , Center for Information Systems and Technology, 130 E. 9th Street - ABC 217, Claremont, CA 91711, USA.
| | - William McConnell
- Claremont Graduate University , School of Community and Global Health, 130 E. 9th Street, Claremont, CA 91711, USA.
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Piamjariyakul U, Smothers A, Young S, Morrissey E, Petitte T, Wen S, Zulfikar R, Sangani R, Shafique S, Smith CE, Bosak K. Verifying intervention fidelity procedures for a palliative home care intervention with pilot study results. Res Nurs Health 2021; 44:854-863. [PMID: 34196013 PMCID: PMC8440457 DOI: 10.1002/nur.22166] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 06/05/2021] [Accepted: 06/10/2021] [Indexed: 11/06/2022]
Abstract
Fidelity (consistency of intervention implementation) is essential to rigorous research. Intervention fidelity maintains study internal validity, intervention reproducibility, and transparency in the research conduct. The purpose of this manuscript is to describe intervention fidelity strategies/procedures developed for a pilot study testing a new palliative care nursing intervention (FamPALcare) for families managing advanced lung disease. The procedures described herein are based on the fidelity best practices recommendations from the NIH Consortium. An evidence-based checklist guided observational ratings of the fidelity procedures used and the intervention content implemented in each intervention session. Descriptive data on how participants understood (received), enacted, or used the intervention information were summarized. The fidelity checklist observational scores found ≥93% of the planned intervention content was implemented, and the fidelity strategies were adhered to consistently during each intervention session. The small variation (7%) in implementation was expected and related to participants' varying experiences, input, and/or questions. The helpfulness scale items include participants' ability to use home care resources, to anticipate and manage end-of-life symptoms, and to use Advance Directive forms. The high ratings (M = 4.4) on the 1-5 (very helpful) Likert Helpfulness Scale verified participants utilized the information from the intervention. Furthermore, there was an improvement in patients' breathlessness scores and completion of Advance Directive forms at 3 months after baseline. It is essential to plan intervention fidelity strategies to use throughout a study and to report fidelity results.
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Affiliation(s)
| | | | | | - Elizabeth Morrissey
- West Virginia University, School of Nursing
- West Virginia University Hospital
| | | | - Sijin Wen
- West Virginia University, Department of Biostatistics School of Public Health
| | - Rafia Zulfikar
- West Virginia University, Section of Pulmonary, Critical Care, and Sleep Medicine, School of Medicine
| | - Rahul Sangani
- West Virginia University, Section of Pulmonary, Critical Care, and Sleep Medicine, School of Medicine
| | - Saima Shafique
- West Virginia University, Department of Epidemiology School of Public Health
| | - Carol E Smith
- University of Kansas Medical Center, School of Nursing
- University of Kansas Medical Center, School of Preventive Medicine
| | - Kelly Bosak
- University of Kansas Medical Center, School of Nursing
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Gievers L, Khaki S, Dotson A, Chen Z, Macauley RC, Tolle S. Social Determinants of Health May Predict End of Life Portable Orders for Life Sustaining Treatment Form Completion and Treatment Selections. Am J Hosp Palliat Care 2021; 39:678-686. [PMID: 34569256 DOI: 10.1177/10499091211041566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND End of life (EOL) care planning is important for aging adults given the growing prevalence of chronic medical conditions in the US. The Portable Orders for Life Sustaining Treatment (POLST) program promotes communication between clinicians and patients with advanced illness about EOL treatment preferences. Despite growing resources for EOL care, utilization remains unequal based on social determinants of health (SDOH), including race, language, urbanization, and education. We evaluated the relationship between POLST form selections and completion rates and SDOH. METHODS Oregon POLST Registry and American Community Survey data from 2013 to 2017 were analyzed retrospectively. POLST form completion rates and selections, and various SDOH, including age, income, insurance status, urbanization, etc. were recorded. Data were merged based on ZIP codes and analyzed using χ2 or Wilcoxon-Mann-Whitney tests. Logistic regression was performed. RESULTS 127,588 POLST forms from 319 ZIP codes were included. POLST form completion rates were highest among urban ZIP codes, and urban registrants more often selected CPR and full treatment. ZIP codes with higher incomes tended to select CPR. ZIP codes with higher rates of private insurance completed POLST forms, and selected CPR and full treatment more frequently. ZIP codes with higher rates of Bachelor's degrees (or higher) completed POLST forms and selected full treatment more frequently. CONCLUSIONS Various SDOH-specifically, urbanization, insurance status, income level and educational level achieved-may influence POLST form completion rates and selections. The expanding socioeconomic diversity and growth of urban communities, highlight the need for broader access to EOL planning and POLST.
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Affiliation(s)
- Ladawna Gievers
- Department of Pediatrics, Oregon Health and Science University, Portland, OR, USA
| | - Sheevaun Khaki
- Department of Pediatrics, Oregon Health and Science University, Portland, OR, USA
| | - Abby Dotson
- Oregon POLST Registry, Department of Emergency Medicine, Portland, OR, USA
| | - Zunqiu Chen
- Department of General Internal Medicine, External Consultant, Portland, OR, USA
| | - Robert C Macauley
- Department of Pediatrics, Oregon Health and Science University, Portland, OR, USA
| | - Susan Tolle
- Division of General Internal Medicine and Geriatrics, Center for Ethics in Health Care, Oregon Health and Science University, Portland, OR, USA
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Abu-Odah H, Molassiotis A, Liu JYW. Global palliative care research (2002-2020): bibliometric review and mapping analysis. BMJ Support Palliat Care 2021; 12:376-387. [PMID: 34373283 PMCID: PMC9691821 DOI: 10.1136/bmjspcare-2021-002982] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 07/11/2021] [Indexed: 12/25/2022]
Abstract
Background and objective Despite the important benefits of a bibliometric approach on mapping a research field, relatively little efforts have previously been conducted to map and analyse the global trends of palliative care (PC)-related research. This bibliometric review aimed to provide an overall picture and systematic mapping of the state of research trends within the field of PC internationally. Methods Scopus and Web of Science databases were searched to retrieve original articles focusing on PC between 2002 and 2020. Searching was conducted on 5 May 2020, and was updated on 6 May 2021. All retrieved articles were assessed by title and abstract, and the bibliometric metadata of those that met the inclusion criteria were downloaded for analysis. The results were analysed by VOSviewer and Gephi software. Results A total of 19,199 articles met the inclusion criteria. Significant growth of the number of published articles was reported by around five-fold from 2002 to 2020. The USA and UK were the most productive countries in terms of the number of papers published and citations. Weak collaborations were observed between low-income or middle-income countries and high-income countries. Cancer-related PC research was the most common focus. Seven clusters of research were identified and included heart failure and cancer prognosis, nursing home, pain and symptoms management, PC knowledge and attitudes, quality improvement of services, PC ethics, and the ongoing assessment of PC services. Conclusions There is a need to expand PC-related research to non-cancer diseases. More international research and cross-institutional cooperation is required to address more global PC issues and benefit from wider sharing of expertees, potentially leading to higher quality or more impactful studies. Setting up research agendas and priorities from funding bodies and institutions may also enhance cooperation among researchers.
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Affiliation(s)
- Hammoda Abu-Odah
- School of Nursing,The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Alex Molassiotis
- School of Nursing,The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Justina Yat Wa Liu
- School of Nursing,The Hong Kong Polytechnic University, Kowloon, Hong Kong
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Effect of instrumental support on distress among family caregivers: Findings from a nationally representative study. Palliat Support Care 2021; 18:519-527. [PMID: 32090725 DOI: 10.1017/s1478951520000036] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVE A priority focus on palliative and supportive care is helping the 43.5 million caregivers who care for individuals with serious illness. Lacking support may lead to caregiver distress and poorer care delivery to patients with serious illness. We examined the potential of instrumental support (assistance with material and task performance) to mitigate distress among caregivers. METHOD We analyzed data from the nationally representative Health Information National Trends Survey (HINTS V2, 2018). Informal/family caregivers were identified in HINTS V2 if they indicated they were caring for or making healthcare decisions for another adult with a health problem. We used the PROMIS® instrumental support four-item short-form T-scores and the Patient Health Questionnaire (PHQ-4) for distress. We examined multivariable linear regression models for associations between distress and instrumental support, adjusted for sampling weights, socio-demographics, and caregiving variables (care recipient health condition(s), years caregiving (≥2), relationship to care recipient, and caregiver burden). We examined interactions between burden and instrumental support on caregiver distress level. RESULTS Our analyses included 311 caregivers (64.8% female, 64.9% non-Hispanic White). The unweighted mean instrumental support T-score was 50.4 (SD = 10.6, range = 29.3-63.3); weighted mean was 51.2 (SE = 1.00). Lower instrumental support (p < 0.01), younger caregiver age (p < 0.04), higher caregiving duration (p = 0.008), and caregiver unemployment (p = 0.006) were significantly associated with higher caregiver distress. Mean instrumental support scores by distress levels were 52.3 (within normal limits), 49.4 (mild), 48.9 (moderate), and 39.7 (severe). The association between instrumental support and distress did not differ by caregiver burden level. CONCLUSIONS Poor instrumental support is associated with high distress among caregivers, suggesting the need for palliative and supportive care interventions to help caregivers leverage instrumental support.
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Ogunsanya ME, Goetzinger EA, Owopetu OF, Chandler PD, O'Connor LE. Predictors of Palliative Care Knowledge: Findings from the Health Information National Trends Survey. Cancer Epidemiol Biomarkers Prev 2021; 30:1433-1439. [PMID: 34088752 DOI: 10.1158/1055-9965.epi-20-1790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/10/2021] [Accepted: 04/09/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Palliative care plays an important role in improving the quality of life for patients with cancer and their caregivers and has been associated with increased patient satisfaction. However, palliative care knowledge in the general population is limited, and often physician referral occurs late in prognosis. The objective of this analysis was to examine factors associated with palliative care knowledge. METHOD Using data from the 2018 NCI's Health Information National Trends Survey (HINTS) 5 Cycle 2, descriptive statistics, bivariate analyses, and multivariable logistic regressions were used to assess factors associated with respondents' palliative care knowledge using ORs and 95% confidence intervals as measures of association. The outcome of interest was measured with the item "How would you describe your level of knowledge about palliative care?" Possible response selections were "I've never heard of it," "I know a little bit about palliative care," and "I know what palliative care is and could explain it to someone else." To reduce the risk of type 1 error, jackknife variance estimations with repeated replications were used. All analyses were conducted with the SURVEYLOGISTIC command using SAS 9.4 (SAS Institute Inc.), and the statistical significance level was set at P < 0.05. RESULTS A total of 3,450 respondents (weighted sample size: 249,489,772) met the inclusion criteria. About 89% (n = 3,000) of all respondents had inadequate knowledge of palliative care. Multivariable analyses indicated that frequent health care utilization as defined as ≥ 2 times per year [OR, 3.01; 95% confidence interval (CI), 2.65-3.58], female gender (OR, 2.15; 95% CI, 1.31-3.59), being married (OR, 2.02; 95% CI, 1.14-3.59), having a college degree or higher (OR, 13.83; 95% CI, 1.71-12.04), and having a regular source of care (OR, 2.67; 95% CI, 1.37-1.90) had greater odds of adequate palliative care knowledge. Those without a cancer diagnosis were less likely to have adequate knowledge of palliative care (OR, 0.49; 95% CI, 0.41-0.89). CONCLUSIONS Knowledge of palliative care in the United States is low, particularly for those not already actively using their available healthcare system. Public health education efforts are needed to target subgroups of the U.S. population identified by this analysis to increase palliative care knowledge. IMPACT Healthcare providers have a major role to play in improving palliative care knowledge.
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Affiliation(s)
- Motolani E Ogunsanya
- Department of Pharmacy, Clinical & Administrative Sciences, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
| | - Elizabeth A Goetzinger
- Department of Pharmacy, Clinical & Administrative Sciences, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Oluwatomi F Owopetu
- Department of Community Medicine, University College Hospital, Ibadan, Nigeria
| | - Paulette D Chandler
- Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Lauren E O'Connor
- Risk Factor Assessment Branch, Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, NCI, NIH, Rockville, Maryland
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Quelal K, Olagoke O, Shahi A, Torres A, Ezegwu O, Golzar Y. Trends and Predictors of Palliative Care Consultation Among Patients Admitted for LVAD: A Retrospective Analysis From the Nationwide Inpatient Sample Database From 2006-2014. Am J Hosp Palliat Care 2021; 39:353-360. [PMID: 34080439 DOI: 10.1177/10499091211021837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Left ventricular assist devices (LVADs) are an essential part of advanced heart failure (HF) management, either as a bridge to transplantation or destination therapy. Patients with advanced HF have a poor prognosis and may benefit from palliative care consultation (PCC). However, there is scarce data regarding the trends and predictors of PCC among patients undergoing LVAD implantation. AIM This study aims to assess the incidence, trends, and predictors of PCC in LVAD recipients using the United States Nationwide Inpatient Sample (NIS) database from 2006 until 2014. METHODS We conducted a weighted analysis on LVAD recipients during their index hospitalization. We compared those who had PCC with those who did not. We examined the trend in palliative care utilization and calculated adjusted odds ratios (aOR) to identify demographic, social, and hospital characteristics associated with PCC using multivariable logistic regression analysis. RESULTS We identified 20,675 admissions who had LVAD implantation, and of them 4% had PCC. PCC yearly rate increased from 0.6% to 7.2% (P < 0.001). DNR status (aOR 28.30), female sex (aOR 1.41), metastatic cancer (aOR: 3.53), Midwest location (aOR 1.33), and small-sized hospitals (aOR 2.52) were positive predictors for PCC along with in-hospital complications. Differently, Black (aOR 0.43) and Hispanic patients (aOR 0.25) were less likely to receive PCC. CONCLUSION There was an increasing trend for in-hospital PCC referral in LVAD admissions while the overall rate remained low. These findings suggest that integrative models to involve PCC early in advanced HF patients are needed to increase its generalized utilization.
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Affiliation(s)
- Karol Quelal
- Department of Internal Medicine, Cook County Health, Chicago, IL, USA
| | - Olankami Olagoke
- Division of Cardiovascular Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Anoj Shahi
- Department of Internal Medicine, Cook County Health, Chicago, IL, USA
| | - Andrea Torres
- Department of Internal Medicine, Cook County Health, Chicago, IL, USA
| | - Olisa Ezegwu
- Department of Internal Medicine, Cook County Health, Chicago, IL, USA
| | - Yasmeen Golzar
- Division of Cardiology, Cook County Health, Chicago, IL, USA
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Langan E, Kamal AH, Miller KEM, Kaufman BG. Comparing Palliative Care Knowledge in Metropolitan and Nonmetropolitan Areas of the United States: Results from a National Survey. J Palliat Med 2021; 24:1833-1839. [PMID: 34061644 DOI: 10.1089/jpm.2021.0114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background: Despite recent growth in access to specialty palliative care (PC) services, awareness of PC by patients and caregivers is limited and misconceptions about PC persist. Identifying gaps in PC knowledge may help inform initiatives that seek to reduce inequities in access to PC in rural areas. Objective: We compared knowledge of PC in metropolitan and nonmetropolitan areas of the United States using a nationally representative sample of U.S. adults. Design: We used data from the 2018 Health Information National Trends Survey (HINTS) 5 Cycle 2 to compare prevalence and predictors of PC knowledge and misconceptions in nonmetropolitan and metropolitan areas as defined by the 2013 Urban-Rural Classification (URC) Scheme for Counties. We estimated the association between nonmetro status and knowledge of PC, adjusted for respondent characteristics, using multivariable logistic regression. Results: More respondents reported that they had never heard of PC in nonmetro (78.8%) than metro (70.1%) areas (p < 0.05). Controlling for other factors, nonmetro residence was associated with a 41% lower odds of PC knowledge (odds ratio [OR] = 0.59; 95% confidence interval [CI] = 0.37-0.94), and Hispanic respondents also demonstrated significantly lower odds of PC knowledge conditional on rural status (OR = 0.47; CI = 0.27-0.83). Misconceptions about PC were high in both metro and nonmetro areas. Conclusion: Awareness of PC was lower in rural and micropolitan areas compared with metropolitan areas, suggesting the need for tailored educational strategies. The reduced awareness of PC among Hispanic respondents regardless of rural status raises concerns about equitable access to PC services for this population.
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Affiliation(s)
- Erica Langan
- Trinity College of Arts and Sciences, Duke University, Durham, North Carolina, USA
| | - Arif H Kamal
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Katherine E M Miller
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA.,Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, North Carolina, USA
| | - Brystana G Kaufman
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA.,Margolis Center for Health Policy, Duke University, Durham, North Carolina, USA.,Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, North Carolina, USA
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