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Knisley C, Baumrucker SJ. Eleology- A Modest Proposal. Am J Hosp Palliat Care 2024; 41:581-582. [PMID: 37703334 DOI: 10.1177/10499091231198215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023] Open
Abstract
A proposal to create a new name for our specialty: Eleology.
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Affiliation(s)
- Caleb Knisley
- Department of Family Medicine, ETSU Quillen College of Medicine, Bristol, TN, USA
| | - Steven J Baumrucker
- Palliative Medicine Service Line, Ballad Health System, Johnson City, TN, USA
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Starr LT, Washington KT, Jabbari J, Benson JJ, Oliver DP, Demiris G, Cagle JG. Pain Management Education for Rural Hospice Family Caregivers: A Pilot Study With Embedded Implementation Evaluation. Am J Hosp Palliat Care 2024; 41:619-633. [PMID: 37491002 PMCID: PMC11032627 DOI: 10.1177/10499091231191114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Assessing and managing hospice patients' pain is a common source of anxiety among hospice family caregivers (HFCGs), especially caregivers in rural communities who face special challenges including distance, limited access, and concerns about opioid misuse. OBJECTIVE To pilot test Ready2Care, a pain management education intervention for rural HFCGs. We sought to determine whether there was a signal of benefit for clinically-relevant outcomes and to identify contextual factors pertinent to conducting a future randomized clinical trial of Ready2Care. METHODS We conducted a multi-method, single-arm study, enabling completion of paired t-tests comparing pre- and post-intervention measures of caregiver anxiety, pain management self-efficacy, barriers to pain management, and reports of patient pain intensity and corresponding patient and caregiver distress. We concurrently conducted an embedded implementation evaluation via calculation of descriptive statistics (recruitment and retention data) and directed content analysis of brief caregiver interviews. RESULTS Twenty-seven (n = 27) HFCGs participated; 15 completed the study. Among completers, significant improvement was observed in patient pain intensity (average 1.4 points decrease on 0-10 scale) and in overall pain experience. No statistically significant changes were detected in caregiver anxiety, barriers to pain management, or pain management self-efficacy. Facilitators to successful conduct of a future clinical trial included high acceptability of Ready2Care, driven by its perceived clarity and relevance to caregivers' concerns. Barriers included lower-than-anticipated accrual and an attrition rate of nearly 44%. CONCLUSION A multisite clinical trial of Ready2Care is warranted; however, its success may require more effective recruitment and retention strategies for rural caregiver participants.
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Affiliation(s)
- Lauren T. Starr
- Department of Biobehavioral Health Sciences, NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | | | - JoAnn Jabbari
- Washington University in St Louis School of Medicine, St Louis, MO, USA
- Barnes-Jewish College, Goldfarb School of Nursing, St Louis, MO, USA
| | | | - Debra Parker Oliver
- Washington University in St Louis School of Medicine, St Louis, MO, USA
- Barnes-Jewish College, Goldfarb School of Nursing, St Louis, MO, USA
| | - George Demiris
- Department of Biobehavioral Health Sciences, NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - John G. Cagle
- Center to Advance Chronic Pain Research, University of Maryland, School of Social Work, Baltimore, MD, USA
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Gaines AG, Cagle JG. Associations Between Certificate of Need Policies and Hospice Quality Outcomes. Am J Hosp Palliat Care 2024; 41:471-478. [PMID: 37256687 DOI: 10.1177/10499091231180613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Certificate of need (CON) laws are state-based regulations requiring approval of new healthcare entities and capital expenditures. Varying by state, these regulations impact hospices in 14 states and DC, with several states re-examining provisions. AIM This cross-sectional study examined the association of CON status on hospice quality outcomes using the hospice item set metric (HIS). DESIGN Data from the February 2022 Medicare Hospice Provider and General Information reports of 4870 US hospices were used to compare group means of the 8 HIS measures across CON status. Multiple regression analysis was used to predict HIS outcomes by CON status while controlling for ownership and size. RESULTS Approximately 86% of hospices are in states without a hospice CON provision. The unadjusted mean HIS scores for all measures were higher in CON states (M range 94.40-99.59) than Non-CON (M range 90.50-99.53) with significant differences in all except treatment preferences. In the adjusted model, linear regression analyses showed hospice CON states had significantly higher HIS ratings than those from Non-CON states for beliefs and values addressed (β = .05, P = .009), pain assessment (β = .05, P = .009), dyspnea treatment (β = .08, P < .001) and the composite measure (β = .09, P < .001). Treatment preferences, pain screening, dyspnea screening, and opioid bowel treatment were not statistically significant (P > .05). CONCLUSION The study suggests that CON regulations may have a modest, but beneficial impact on hospice-reported quality outcomes, particularly for small and medium-sized hospices. Further research is needed to explore other factors that contribute to HIS outcomes.
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Affiliation(s)
- Arlen G Gaines
- Doctoral Program in Palliative Care, Department of Pharmacy Practice and Science, University of Maryland, Baltimore, MD, USA
| | - John G Cagle
- Department of Social Work, University of Maryland, Baltimore, MD, USA
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Serna MK, Yoon C, Fiskio J, Lakin JR, Schnipper JL, Dalal AK. The Association of Standardized Documentation of Serious Illness Conversations With Healthcare Utilization in Hospitalized Patients: A Propensity Score Matched Cohort Analysis. Am J Hosp Palliat Care 2024; 41:479-485. [PMID: 37385609 PMCID: PMC10983774 DOI: 10.1177/10499091231186818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023] Open
Abstract
Background: Serious Illness Conversations (SICs) conducted during hospitalization can lead to meaningful patient participation in the decision-making process affecting medical management. The aim of this study is to determine if standardized documentation of a SIC within an institutionally approved EHR module during hospitalization is associated with palliative care consultation, change in code status, hospice enrollment prior to discharge, and 90-day readmissions. Methods: We conducted retrospective analyses of hospital encounters of general medicine patients at a community teaching hospital affiliated with an academic medical center from October 2018 to August 2019. Encounters with standardized documentation of a SIC were identified and matched by propensity score to control encounters without a SIC in a ratio of 1:3. We used multivariable, paired logistic regression and Cox proportional-hazards modeling to assess key outcomes. Results: Of 6853 encounters (5143 patients), 59 (.86%) encounters (59 patients) had standardized documentation of a SIC, and 58 (.85%) were matched to 167 control encounters (167 patients). Encounters with standardized documentation of a SIC had greater odds of palliative care consultation (odds ratio [OR] 60.10, 95% confidence interval [CI] 12.45-290.08, P < .01), a documented code status change (OR 8.04, 95% CI 1.54-42.05, P = .01), and discharge with hospice services (OR 35.07, 95% CI 5.80-212.08, P < .01) compared to matched controls. There was no significant association with 90-day readmissions (adjusted hazard ratio [HR] .88, standard error [SE] .37, P = .73). Conclusions: Standardized documentation of a SIC during hospitalization is associated with palliative care consultation, change in code status, and hospice enrollment.
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Affiliation(s)
- Myrna K. Serna
- Division of General Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Catherine Yoon
- Hospital Medicine Unit, Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, MA, USA
| | - Julie Fiskio
- Hospital Medicine Unit, Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, MA, USA
| | - Joshua R. Lakin
- Harvard Medical School, Boston, MA, USA
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA, USA
| | - Jeffrey L. Schnipper
- Hospital Medicine Unit, Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Anuj K. Dalal
- Hospital Medicine Unit, Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Gallo Marin B, Oliva R, Anandarajah G. Exploring the Beliefs, Values, and Understanding of Quality End-of-Life Care in the Latino Community: A Spanish-Language Qualitative Study. Am J Hosp Palliat Care 2024; 41:508-515. [PMID: 37408485 DOI: 10.1177/10499091231188693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
Context: Hospice services are underutilized by the Latino community in the United States. Previous research has identified that language is a key barrier contributing to disparities. However, very few studies have been conducted in Spanish to specifically explore other barriers to hospice enrollment or values related to end-of-life (EOL) care in this community. Here, we remove the language barrier in order to gain an in-depth understanding of what members of the diverse Latino community in one state in the USA considers high quality EOL and barriers to hospice. Methods: This exploratory semi-structured individual interview study of Latino community members was conducted in Spanish. Interviews were audio-recorded, transcribed verbatim and translated to English. Transcripts were analyzed by three researchers, using a grounded-theory approach to identify themes and sub-themes. Main Findings: Six major themes emerged: (1) concept of "a good death"-spiritual peace, family/community connection, no burdens left behind; (2) centrality of family; (3) lack of knowledge about hospice/palliative care; (4) Spanish language as critical; (5) communication style differences; and (6) necessity for cultural understanding. The central theme of "a good death" was closely linked to having the entire family physically and emotionally present. The four other themes represent interrelated, compounding barriers to achieving this "good death." Principal Conclusions: Healthcare providers and the Latino community can work together to decrease hospice utilization disparities by: actively involving family at every step; addressing misconceptions regarding hospice; conducting important conversations in Spanish; and improving provider skills in culturally sensitive care, including communication style.
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Affiliation(s)
| | - Rocío Oliva
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Gowri Anandarajah
- Warren Alpert Medical School of Brown University, Providence, RI, USA
- Hope Hospice and Palliative Care Rhode Island, Providence, RI, USA
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Reckrey JM, McKendrick K, Morrison RS, Osakwe ZT, Ornstein KA, Aldridge M. Variation in Hospice Aide Care by Residential Setting. J Palliat Med 2024. [PMID: 38647702 DOI: 10.1089/jpm.2023.0585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
Background: Hospice care frequently includes hands-on care from hospice aides, but the need for hospice aide care may vary in residential settings (e.g., assisted livings and nursing homes). Objectives: The objective of this study is to compare hospice aide use and factors associated with use across residential settings. Design: This longitudinal cohort study used data from Medicare beneficiaries in the United States enrolled in the Medicare Current Beneficiary Survey (MCBS) who died between 2010 and 2019 and had hospice claims and available residential setting data in MCBS (n = 1,915). Analysis: Decedent hospice aide use was compared by residential settings; multivariable models controlling for sociodemographic, clinical/functional, and hospice characteristics examined factors associated with hospice aide care in different residential settings. Results: Hospice aide visits were least common in the community setting (64.4% vs. 76.6% vs. 72.6% with any hospice aide visits in community, assisted living, and nursing home, respectively, p = 0.001). In adjusted models, factors associated with hospice aide visits did not significantly differ by residential settings. Conclusions: Despite staff providing hands-on support in assisted livings and nursing homes, hospice aide visits were more common in residential as opposed to community settings, and factors associated with hospice aide visits were similar among settings. To maximize the potentially positive impact of hospice aides on overall care, additional work is needed to understand when hospice aides are used and how hospice aides collaborate with families and care teams. This will help to ensure that hospice care is appropriately tailored to individual care needs in all residential settings.
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Affiliation(s)
| | - Karen McKendrick
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - R Sean Morrison
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Zainab Toteh Osakwe
- Adelphi University College of Nursing and Public Health, New York, New York, USA
| | | | - Melissa Aldridge
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Gilbert E, Viggiani ND, de Sousa Martins J, Palit T, Sears J, Knights D, Roulston A, Turner M, Selman LE. How do people in prison access palliative care? A scoping review of models of palliative care delivery for people in prison in high-income countries. Palliat Med 2024:2692163241242647. [PMID: 38623718 DOI: 10.1177/02692163241242647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
BACKGROUND An ageing prison population with complex health needs combined with punitive sentencing practices means palliative care for incarcerated individuals is increasingly important. However, there is limited evidence regarding the models of care delivery in high-income countries, and their associated challenges and benefits. AIM To develop a typology of models of palliative care provision for incarcerated individuals, synthesise evidence of their outcomes and describe facilitators of and challenges in delivering different models of palliative and end-of-life care in prisons. DESIGN Scoping review following Arksey and O'Malley, with narrative synthesis. The protocol was registered prospectively (reviewregistry1260). DATA SOURCES MEDLINE, EMBASE, CINAHL, PsycINFO, the Social Sciences Citation Index and grey literature were searched on 15th March 2023. The Mixed Methods Appraisal Tool (MMAT) was used for quality appraisal. RESULTS A total of 16,865 records were screened; 22 peer-reviewed articles and 18 grey literature sources met the inclusion criteria. Three models were identified: Embedded Hospice, Outsourcing Care and Community Collaboration. The Embedded Hospice model shows potential benefits for patients and prisons. Outsourcing Care may miss opportunities for comprehensive care. Collaborative Care relies on proactive prison-community relationships that could be formalised for improvement. Psychosocial and bereavement needs of those dying in prison and their caregivers lack sufficient documentation. CONCLUSION Further research is needed to evaluate prison hospice costs and examine how prison hospices impact compassionate release usage. Beyond the USA, policies might formalise care pathways and recognise best practices. Further investigation to address psychosocial needs of people in prison with life-limiting illnesses and post-death bereavement support is required.
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Affiliation(s)
- Emma Gilbert
- Palliative and End of Life Care Research Group, Bristol Medical School, University of Bristol, Bristol UK
| | - Nick De Viggiani
- School of Health and Social Wellbeing, Unversity of the West of England, UK
| | - Joana de Sousa Martins
- Palliative and End of Life Care Research Group, Bristol Medical School, University of Bristol, Bristol UK
| | - Tanuka Palit
- Academic Clinical Fellow Centre of Academic Primary Care, Bristol Medical School, University of Bristol, UK
| | | | | | - Audrey Roulston
- Professor of Social Work in Palliative Care, School of Social Sciences, Education and Social Work Queen's University, Belfast, UK
| | - Mary Turner
- Reader in Health Services Research, University of Huddersfield, Huddersfield, UK
| | - Lucy E Selman
- Palliative and End of Life Care Research Group, Bristol Medical School, University of Bristol, Bristol UK
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Beltran SJ, Molina O, Chapple R. Enhancing End-of-Life Care Knowledge Among Older Spanish-Speaking Adults: Results From a Pilot Educational Intervention on Advance Care Planning and Care Options. Am J Hosp Palliat Care 2024:10499091241246057. [PMID: 38621826 DOI: 10.1177/10499091241246057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Disparities in advance care planning (ACP) among older Latinos necessitate targeted interventions to enhance engagement and knowledge in end-of-life care. This study aimed to evaluate the effectiveness of a resource-efficient, culturally tailored educational intervention in improving ACP readiness and knowledge among older Latino adults in the community. METHODS A quasi-experimental pretest-posttest design was used to assess the impact of the intervention. The study involved community-dwelling older Latinos (aged 61-94) in the U.S. attending community wellness centers. Measures included participants' knowledge of ACP, care options, familiarity with hospice and palliative care, and attitudes toward hospice, assessed using pre- and post-intervention surveys. RESULTS Statistically significant improvements were observed in ACP knowledge, understanding of care options, and attitudes towards hospice and palliative care post-intervention. Demographic factors influenced knowledge scores, with no significant gender differences in the intervention's efficacy. CONCLUSIONS The educational intervention effectively enhanced end-of-life care planning readiness and knowledge among older Latinos. The study highlights the potential for sustainable, accessible, and culturally sensitive educational strategies to reduce disparities in ACP knowledge and possibly engagement.
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Affiliation(s)
- Susanny J Beltran
- School of Social Work, University of Central Florida, Orlando, FL, USA
| | - Olga Molina
- School of Social Work, University of Central Florida, Orlando, FL, USA
| | - Reshawna Chapple
- School of Social Work, University of Central Florida, Orlando, FL, USA
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Cagle JG, Carrion I, Becker TD, Zhang P. Spanish Translation and Dissemination of EMPOWER Materials to Address Barriers to Pain Management at the End of Life. Palliat Med Rep 2024; 5:162-170. [PMID: 38665226 PMCID: PMC11043617 DOI: 10.1089/pmr.2023.0090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2024] [Indexed: 04/28/2024] Open
Abstract
Introduction The Effective Management of Pain by Overcoming Worries to Enable Relief (EMPOWER) intervention is an evidence-supported approach for addressing barriers to pain management (e.g., patient/family concerns about addiction) at the end of life. Such barriers appear more pronounced among Spanish-speaking individuals. This study aimed to (1) translate EMPOWER materials into Spanish, (2) disseminate materials to hospices with ≥25% Hispanic patients, and (3) survey hospices about the use and usefulness of materials. Methods We back translated EMPOWER materials with harmonization, then disseminated materials to 242 hospices. Thereafter, we used a semistructured survey to assess use and usefulness of EMPOWER materials using univariate statistics and content analysis. Results Thirty-eight hospice representatives responded (participation rate = 15.7%). Respondents were primarily non-White (55.3%) and Hispanic (60.5%). Nealy half (47.4%) were nurses. A majority (81.6%) indicated they currently employ ≥1 full-time English-Spanish bilingual team member. Among those who reported receiving the EMPOWER materials (n = 29), 58.6% indicated they-or another staff member-used them with patients or families. Using a single-item rating (0 = not useful to 10 = very useful), respondents evaluated the English EMPOWER materials' usefulness as 7.6 (standard deviation [SD] = 1.4) and Spanish materials as 8.4 (SD = 1.4). Most (62.1%) indicated they would likely use EMPOWER materials in the future. Conclusion Thematic findings suggest EMPOWER reinforces clinical education, promotes discussion about pain management, and helps address culturally specific barriers to care. EMPOWER appears to be a useful, easy to use, and promising intervention that can be implemented among both English- and Spanish-speaking populations.
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Affiliation(s)
- John G. Cagle
- University of Maryland School of Social Work, Baltimore, Maryland, USA
| | - Iraida Carrion
- University of South Florida School of Social Work, Tampa, Florida, USA
| | - Todd D. Becker
- University of Maryland School of Social Work, Baltimore, Maryland, USA
| | - Peiyuan Zhang
- University of Maryland School of Social Work, Baltimore, Maryland, USA
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Ben-Arye E, Samuels N, Keshet Y, Golan M, Baruch E, Dagash J. Exploring unmet concerns in home hospice cancer care: Perspectives of patients, informal caregivers, palliative care providers, and family physicians. Palliat Support Care 2024:1-9. [PMID: 38587040 DOI: 10.1017/s1478951524000567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
OBJECTIVES The study examines perspectives of patients in home hospice care; their informal caregivers; palliative health-care providers (HCPs); and family physicians, all regarding patients' unmet needs and quality of life (QoL)-related concerns. METHODS Participants from all 4 groups were approached within 2 months after the patient's admission to the home hospice care unit. Participants completed Edmonton Symptom Assessment Scale (ESAS) and Measure Yourself Concerns and Wellbeing (MYCAW) questionnaires, for patient's QoL-related concerns. Qualitative analysis of short narratives was conducted using ATLAS.ti software for systematic coding. RESULTS In total, 78 participants completed the study questionnaires: 24 patients, 22 informal caregivers, 22 palliative HCPs, and 11 family physicians. Informal caregivers gave higher scores (i.e., greater severity) than patients for fatigue on ESAS (p = 0.009); and family physicians lower scores than patients for ESAS drowsiness (p = 0.046). Compared with patients, palliative HCPs gave higher scores for patient emotional-spiritual concerns (77.2% vs. 41.7%, p = 0.02); lower scores for gastrointestinal concerns (p = 0.048); and higher scores for overall function (p = 0.049). Qualitative assessment identified a gap between how patients/informal caregivers vs. palliative HCPs/family physicians regard emotional-spiritual themes, including discussing issues related to death and dying. SIGNIFICANCE OF RESULTS The findings of the present study suggest that exploring a multifaceted cohort of home hospice patients, informal caregivers, palliative HCPs, and family physicians may provide insight on how to reduce communication gaps and address unmet needs of patients, particularly regarding emotional and spiritual concerns. CONCLUSIONS While the 4 groups were similar in their scoring of patient QoL-related concerns, there were discrepancies for some concerns (e.g., patient fatigue) and expectations regarding the need to discuss emotional and spiritual concerns, including on death and dying. Educational initiatives with programs providing training to all 4 groups may help bridge this gap, creating a more open and collaborative hospice care environment.
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Affiliation(s)
- Eran Ben-Arye
- Integrative Oncology Program, The Oncology Service and Lin Medical Center, Clalit Health Services, Haifa, Israel
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Noah Samuels
- Center for Integrative Complementary Medicine, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yael Keshet
- Department of Sociology, Western Galilee College, Akko, Israel
| | - Miri Golan
- Integrative Oncology Program, The Oncology Service and Lin Medical Center, Clalit Health Services, Haifa, Israel
| | - Erez Baruch
- Integrative Oncology Program, The Oncology Service and Lin Medical Center, Clalit Health Services, Haifa, Israel
| | - Jamal Dagash
- Integrative Oncology Program, The Oncology Service and Lin Medical Center, Clalit Health Services, Haifa, Israel
- Palliative Care - Home Care Hospice, Clalit Health Services, Haifa, Israel
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Baker Rogers JE. Hospices and Emergency Preparedness Planning: A Scoping Review of the Literature. J Palliat Care 2024; 39:161-172. [PMID: 37198908 DOI: 10.1177/08258597231176410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Objective. Palliative and end-of-life care, as provided by hospices, are important elements of a healthcare response to disasters. A scoping review of the literature was conducted to examine and synthesize what is currently known about emergency preparedness planning by hospices. Methods. A literature search of academic and trade publications was conducted through 6 publication databases, following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines when applicable. Publications were selected and findings were organized into themes. Results. A total of 26 articles were included in the literature review. Six themes of Policies and Procedures; Testing/Training/Education; Integration and Coordination; Mitigation; Risk Assessment/Hazard and Vulnerability Analysis; and Regulations were identified. Conclusions. This review demonstrates that hospices have begun to individualize emergency preparedness features that support their unique role. The review supports all-hazards planning for hospices, and emerging from this review is a developing vision for expanded roles of hospices to help communities in times of disaster. Continued research in this specialized area is needed to improve hospices' emergency preparedness efforts.
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Affiliation(s)
- Janna E Baker Rogers
- West Virginia University, Morgantown, WV, USA
- Palliative Care Graduate Program, School of Pharmacy, University of Maryland, Baltimore, MD, USA
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Khosla N. "It Seems Like a Bad Thing": US South Asian Youths' Perspectives About the Use of Hospice Care. Am J Hosp Palliat Care 2024; 41:383-390. [PMID: 37265240 DOI: 10.1177/10499091231180819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND South Asians are one of the fastest growing populations in the US. Family based decision making is common among this population. Little is known about their knowledge and attitudes towards hospice use. OBJECTIVE This study explored US South Asian youths' knowledge of, and attitudes towards hospice care. DESIGN Qualitative study, using focus group discussions. METHODS Thirty-six university students of South Asian heritage participated in ten focus group discussions. Data were coded inductively and deductively. Thematic analysis was performed. Disagreements were resolved through discussion. RESULTS Participants were in consensus that if patients had an incurable, fatal condition, keeping them comfortable was important. Several participants were unaware of the terms 'hospice' and 'palliative care'. After these terms were explained, most opposed hospice care for reasons of 'desire for a normal life', 'cultural incompatibility', 'concerns about the hospice environment' and 'preference for home as the place of death'. Some were opposed to even home hospice fearing that it would continuously remind the family and patient about impending death. Concerns were also expressed about having a 'stranger' in the home to provide hospice care. One participant said she would support hospice use if it aligned with the patient's values. Others cited financial reasons and quality of life as considerations in choosing hospice care. CONCLUSIONS Research is needed on culturally-appropriate modes of palliative care education and advocacy for South Asian populations in the US, especially youth, that are often the decision makers for the care of older family members.
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Affiliation(s)
- Nidhi Khosla
- Department of Public Health, California State University East Bay, Hayward, CA, USA
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Cummings J, Sano M, Auer S, Bergh S, Fischer CE, Gerritsen D, Grossberg G, Ismail Z, Lanctôt K, Lapid MI, Mintzer J, Palm R, Rosenberg PB, Splaine M, Zhong K, Zhu CW. Reduction and prevention of agitation in persons with neurocognitive disorders: an international psychogeriatric association consensus algorithm. Int Psychogeriatr 2024; 36:251-262. [PMID: 36876335 PMCID: PMC10480345 DOI: 10.1017/s104161022200103x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
OBJECTIVES To develop an agitation reduction and prevention algorithm is intended to guide implementation of the definition of agitation developed by the International Psychogeriatric Association (IPA). DESIGN Review of literature on treatment guidelines and recommended algorithms; algorithm development through reiterative integration of research information and expert opinion. SETTING IPA Agitation Workgroup. PARTICIPANTS IPA panel of international experts on agitation. INTERVENTION Integration of available information into a comprehensive algorithm. MEASUREMENTS None. RESULTS The IPA Agitation Work Group recommends the Investigate, Plan, and Act (IPA) approach to agitation reduction and prevention. A thorough investigation of the behavior is followed by planning and acting with an emphasis on shared decision-making; the success of the plan is evaluated and adjusted as needed. The process is repeated until agitation is reduced to an acceptable level and prevention of recurrence is optimized. Psychosocial interventions are part of every plan and are continued throughout the process. Pharmacologic interventions are organized into panels of choices for nocturnal/circadian agitation; mild-moderate agitation or agitation with prominent mood features; moderate-severe agitation; and severe agitation with threatened harm to the patient or others. Therapeutic alternatives are presented for each panel. The occurrence of agitation in a variety of venues-home, nursing home, emergency department, hospice-and adjustments to the therapeutic approach are presented. CONCLUSIONS The IPA definition of agitation is operationalized into an agitation management algorithm that emphasizes the integration of psychosocial and pharmacologic interventions, reiterative assessment of response to treatment, adjustment of therapeutic approaches to reflect the clinical situation, and shared decision-making.
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Affiliation(s)
- Jeffrey Cummings
- Joy Chambers-Grundy Professor of Brain Science, Director, Chambers-Grundy Center for Transformative Neuroscience, Co-Director, Pam Quirk Brain Health and Biomarker Laboratory, Department of Brain Health, School of Integrated Health Sciences. University of Nevada Las Vegas (UNLV)
| | - Mary Sano
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, NYC NY and James J. Peters VAMC, Bronx NY
| | - Stefanie Auer
- Centre for Dementia Studies, University for Continuing Education Krems, Austria
| | - Sverre Bergh
- The research centre for age-related functional decline and disease, Innlandet hospital trust, Ottestad, Norway
| | - Corinne E. Fischer
- Faculty of Medicine, Department of Psychiatry, University of Toronto, Canada
| | - Debby Gerritsen
- Department of Primary and Community Care, Radboud university medical center, Radboud Institute for Health Sciences, Radboud Alzheimer Center, Nijmegen, the Netherlands
| | - George Grossberg
- Department of Psychiatry & Behavioral Neuroscience, Division of Geriatric Psychiatry St Louis University School of Medicine
| | - Zahinoor Ismail
- Departments Psychiatry, Neurology, Epidemiology, and Pathology, Hotchkiss Brain Institute & O’Brien Institute for Public Health University of Calgary
| | - Krista Lanctôt
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute; and Departments of Psychiatry and Pharmacology/Toxicology, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Maria I Lapid
- Mayo Clinic Department of Psychiatry and Psychology, Rochester, MN, USA
| | - Jacobo Mintzer
- Psychiatrist, Ralph. H. Johnson VA Medical Center, Charleston, SC and Professor, College of Health Professions, Medical University of South Carolina, Charleston, SC
| | - Rebecca Palm
- Department of Nursing Science, Faculty of Health, Witten/Herdecke University, 58455 Witten, Germany
| | - Paul B. Rosenberg
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - Michael Splaine
- Owner Splaine Consulting, Managing Partner, Recruitment Partners LLC
| | - Kate Zhong
- Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas
| | - Carolyn W. Zhu
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine, NYC, NY and James J. Peters VAMC, Bronx NY
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Tate CE, Mami G, McNulty M, Rinehart DJ, Yasui R, Rondinelli N, Treem J, Fairclough D, Matlock DD. Evaluation of a Novel Hospice-Specific Patient Decision Aid. Am J Hosp Palliat Care 2024; 41:414-423. [PMID: 37477279 DOI: 10.1177/10499091231190776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023] Open
Abstract
Background: We tested a novel hospice-specific patient decision aid to determine whether the decision aid could improve hospice knowledge, opinions of hospice, and decision self-efficacy in making decisions about hospice. Methods: Two patient-level randomized studies were conducted using two different cohorts. Recruitment was completed from March 2019 through May 2020. Cohort #1 was recruited from an academic hospital and a safety-net hospital and Cohort #2 was recruited from community members. Participants were randomized to review a hospice-specific patient decision aid. The primary outcomes were change in hospice knowledge, hospice beliefs and attitudes, and decision self-efficacy Wilcoxon signed rank tests were used to evaluate differences on the primary outcomes between baseline and 1-month. Participants: Participants were at least 65 years of age. A total of 266 participants enrolled (131 in Cohort #1 and 135 in Cohort #2). Participants were randomized to the intervention group (n = 156) or control group (n = 109). The sample was 74% (n = 197) female, 58% (n = 156) African American and mean age was 74.9. Results: Improvements in hospice knowledge between baseline and 1-month were observed in both the intervention and the control groups with no differences between groups (.43 vs .275 points, P = .823). There were no observed differences between groups on Hospice Beliefs and Attitudes scale (3.29 vs 3.08, P = .076). In contrast, Decision Self-Efficacy improved in both groups and the effect of the intervention was significant (8.04 vs 2.90, P = -.027). Conclusions: The intervention demonstrated significant improvements in decision self-efficacy but not in hospice knowledge or hospice beliefs and attitudes.
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Affiliation(s)
- Channing E Tate
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), School of Medicine, University of Colorado, Aurora, CO, USA
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Gwendolyn Mami
- President and CEO, Global Collaborations, LLC, Denver, CO, USA
- Advisory Team Chair, Zion Senior Center, Denver, CO, USA
| | - Monica McNulty
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), School of Medicine, University of Colorado, Aurora, CO, USA
| | - Deborah J Rinehart
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
- Center for Health Systems Research, Office of Research, Denver Health and Hospital Authority, Denver, CO, USA
| | - Robin Yasui
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Nicole Rondinelli
- Division of Palliative Care, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jonathan Treem
- Division of Palliative Care, University of Colorado School of Medicine, Aurora, CO, USA
| | - Diane Fairclough
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), School of Medicine, University of Colorado, Aurora, CO, USA
| | - Daniel D Matlock
- Division of Geriatrics, University of Colorado School of Medicine, Aurora, CO, USA
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, CO, USA
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15
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Mooney KH, Coombs LA, Whisenant MS, Wilson CM, Moraitis AM, Steinbach MN, Sloss EA, Lloyd JLE, Alekhina N, Berry PH, Kang Y, Iacob E, Donaldson GW. Impact of an automated, remote monitoring and coaching intervention in reducing hospice cancer family caregiving burden: A multisite randomized controlled trial. Cancer 2024; 130:1171-1182. [PMID: 38009953 DOI: 10.1002/cncr.35131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/29/2023] [Accepted: 11/01/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Care for those with life-limiting cancer heavily involves family caregivers who may experience significant physical and emotional burden. The purpose of this study was to test the impact of Symptom Care at Home (SCH), an automated digital family caregiver coaching intervention, during home hospice, when compared to usual hospice care (UC) on the primary outcome of overall caregiver burden. Secondary outcomes included Caregiver Burden at weeks 1 and 8, Mood and Vitality subscales, overall moderate-to-severe caregiving symptoms, and sixth month spouse/partner bereavement outcomes. METHODS Using a randomized, multisite, nonblinded controlled trial, 332 cancer family caregivers were enrolled and analyzed (159 SCH vs. 173 UC). Caregivers were primarily White (92%), female (69%), and spouse caregivers (53%). Caregivers provided daily reports on severity levels (0-10 scale) for their anxiety, depressed mood, fatigue, disturbed sleep, and caregiving interference with normal activities. These scores combined constituted the Caregiver Burden primary outcome. Based on reported symptoms, SCH caregivers received automated, tailored coaching about improving their well-being. Reports of moderate-to-severe caregiving symptoms also triggered hospice nurse notification. Secondary outcomes of Mood and Vitality were subcomponents of the Caregiver Burden score. A combined bereavement adjustment tool captured sixth month bereavement. RESULTS The SCH intervention reduced overall Caregiver Burden compared to UC (p < .001), with a 38% reduction at 8 weeks and a medium-to-large effect size (d = .61). SCH caregivers experienced less (p < .001) disruption in both Mood and Vitality. There were higher levels of moderate-to-severe caregiving symptoms overtime in UC (OR, 2.722). All SCH caregivers benefited regardless of caregiver: sex, caregiver relationship, age, patient diagnosis and family income. SCH spouse/partner caregivers achieved better sixth month bereavement adjustment than UC (p < .007). CONCLUSIONS The SCH intervention significantly decreased caregiving burden over UC and supports the maintenance of family caregiver mood and vitality throughout caregiving with extended benefit into bereavement.
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Affiliation(s)
- Kathi H Mooney
- Huntsman Cancer Institute, Salt Lake City, Utah, USA
- University of Utah, Salt Lake City, Utah, USA
| | - Lorinda A Coombs
- University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
| | | | | | | | - Mary N Steinbach
- Huntsman Cancer Institute, Salt Lake City, Utah, USA
- University of Utah, Salt Lake City, Utah, USA
| | | | - Jennifer L E Lloyd
- Huntsman Cancer Institute, Salt Lake City, Utah, USA
- University of Utah, Salt Lake City, Utah, USA
| | | | | | | | - Eli Iacob
- University of Utah, Salt Lake City, Utah, USA
| | - Gary W Donaldson
- Huntsman Cancer Institute, Salt Lake City, Utah, USA
- University of Utah, Salt Lake City, Utah, USA
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16
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DeGroote NP, Harris E, Lange A, Wasilewski-Masker K, Klosky JL, Wolfe J, Kavalieratos D, Brock KE. A Pilot of a Telehealth- Hospice Transition Intervention for Children and Young Adults with Cancer. J Pain Symptom Manage 2024:S0885-3924(24)00678-X. [PMID: 38561131 DOI: 10.1016/j.jpainsymman.2024.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 03/20/2024] [Accepted: 03/24/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND AND AIMS Telehealth can improve care for patients with progressive cancer enrolling in hospice. Coordinated telehealth visits (patient/family-hospital-hospice) may improve communication, satisfaction with and interdisciplinary hospice collaboration. This pilot examines the impact of three coordinated telehealth visits on these outcomes. METHODS This is a prospective pilot study of 0-29-year-old patients with cancer initiating hospice care between 2021-2023. Adult patients, caregivers, oncology and palliative care clinicians, hospice nurses and administrators were surveyed about feasibility and acceptability with telehealth (Technology Acceptance Model 2) after first and third telehealth visits. Hospice satisfaction (Consumer Assessment of Healthcare Providers and Systems) was completed by caregivers after visit 3 and during bereavement. Healthcare professionals completed the Assessment of Interprofessional Team Collaboration Scale II (AITCS-II). Survey responses were summarized and differences in scores were analyzed. RESULTS Of 40 eligible patients, 24 enrolled, 19 completed visit 1, and 13 completed visit 3. Fourteen caregivers and two adult patients completed visit 1 surveys; nine caregivers and two adult patients completed visit 3 surveys. Participants highly rated telehealth acceptability after visit 1 (Median: 4.5, IQR: 4.0-4.7) and 3 (Median: 4.4, IQR: 4.0-4.7). Hospice services were rated as highly satisfactory at visit 3 (Median: 4.0, IQR: 3.7-4.0) and during bereavement (Median: 3.7, IQR: 3.5-4.0). Healthcare professionals (n = 85 surveys) reported excellent interprofessional collaboration (Hospital clinicians median: 99/115 and hospice teams 111/115). CONCLUSIONS Participants found coordinated telehealth visits to be feasible, acceptable, and satisfactory. Telehealth may be utilized as an acceptable alternative to clinic visits and fosters hospital-hospice collaboration.
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Affiliation(s)
- Nicholas P DeGroote
- Aflac Cancer & Blood Disorders Center (N.P.D., E.H., A.L., K.W.M., J.L.K., K.E.B.), Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Ebonee Harris
- Aflac Cancer & Blood Disorders Center (N.P.D., E.H., A.L., K.W.M., J.L.K., K.E.B.), Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Anna Lange
- Aflac Cancer & Blood Disorders Center (N.P.D., E.H., A.L., K.W.M., J.L.K., K.E.B.), Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Karen Wasilewski-Masker
- Aflac Cancer & Blood Disorders Center (N.P.D., E.H., A.L., K.W.M., J.L.K., K.E.B.), Children's Healthcare of Atlanta, Atlanta, Georgia, USA; Emory University School of Medicine (K.W.M., J.L.K., K.E.B.), Department of Pediatrics, Emory University, Atlanta, Georgia, USA
| | - James L Klosky
- Aflac Cancer & Blood Disorders Center (N.P.D., E.H., A.L., K.W.M., J.L.K., K.E.B.), Children's Healthcare of Atlanta, Atlanta, Georgia, USA; Emory University School of Medicine (K.W.M., J.L.K., K.E.B.), Department of Pediatrics, Emory University, Atlanta, Georgia, USA
| | - Joanne Wolfe
- Massachusetts General Hospital (J.W.), Department of Pediatrics, Boston, Massachusetts, USA; Brigham and Women's Hospital (J.W.), Department of Pediatrics, Boston, Massachusetts, USA; Harvard Medical School (J.W.), Boston, Massachusetts, USA
| | - Dio Kavalieratos
- Department of Family and Preventive Medicine (D.K.), Division of Palliative Medicine, Emory University, Atlanta, Georgia, USA
| | - Katharine E Brock
- Aflac Cancer & Blood Disorders Center (N.P.D., E.H., A.L., K.W.M., J.L.K., K.E.B.), Children's Healthcare of Atlanta, Atlanta, Georgia, USA; Emory University School of Medicine (K.W.M., J.L.K., K.E.B.), Department of Pediatrics, Emory University, Atlanta, Georgia, USA.
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17
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Karlin D, Pham C, Furukawa D, Kaur I, Martin E, Kates O, Vijayan T. State-of-the-Art Review: Use of Antimicrobials at the End of Life. Clin Infect Dis 2024; 78:e27-e36. [PMID: 38301076 DOI: 10.1093/cid/ciad735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Indexed: 02/03/2024] Open
Abstract
Navigating antibiotics at the end of life is a challenge for infectious disease (ID) physicians who remain deeply committed to providing patient-centered care and engaging in shared decision making. ID physicians, who often see patients in both inpatient and outpatient settings and maintain continuity of care for patients with refractory or recurrent infections, are ideally situated to provide guidance that aligns with patients' goals and values. Complex communication skills, including navigating difficult emotions around end-of-life care, can be used to better direct shared decision making and assist with antibiotic stewardship.
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Affiliation(s)
- Daniel Karlin
- Division of General Internal Medicine, Department of Medicine, University of California, Los Angeles, California, USA
| | - Christine Pham
- Division of Infectious Diseases, Department of Medicine, University of California, Los Angeles, California, USA
- Department of Pharmaceutical Services, University of California, Los Angeles, California, USA
| | - Daisuke Furukawa
- Division of Infectious Diseases, Department of Medicine, Stanford University, Palo Alto, California, USA
| | - Ishminder Kaur
- Division of Infectious Diseases, Department of Pediatrics, University of California, Los Angeles, California, USA
| | - Emily Martin
- Division of General Internal Medicine, Department of Medicine, University of California, Los Angeles, California, USA
| | - Olivia Kates
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Tara Vijayan
- Division of Infectious Diseases, Department of Medicine, University of California, Los Angeles, California, USA
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18
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Estell MH, Whitford KJ, Ulrich AM, Larsen BE, Wood C, Bigelow ML, Dockter TJ, Schoonover KL, Stelpflug AJ, Strand JJ, Walton MP, Lapid MI. Music Therapy Intervention to Reduce Symptom Burden in Hospice Patients: A Descriptive Study. Am J Hosp Palliat Care 2024:10499091241237991. [PMID: 38501668 DOI: 10.1177/10499091241237991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024] Open
Abstract
Background: Music therapy (MT) offers benefits of improved symptom relief and quality of life at the end of life, but its impact on hospice patients and caregivers needs more research. Objective: To assess the impact of MT intervention on symptom burden and well-being of hospice patients and caregivers. Methods: A total of 18 hospice patients, selected based on scores ≥4 on the revised Edmonton Symptom Assessment System (ESAS-r) items on pain, depression, anxiety, or well-being, participated in MT sessions provided by a board-certified music therapist. Over a period of 2-3 weeks, 3-4 MT sessions were conducted for each. Patient Quality of life (QOL) was assessed using the Linear Analogue Self-Assessment (LASA). Depression and anxiety were measured with the Patient Health Questionnaire-4 (PHQ-4). For the 7 caregivers enrolled, stress levels were measured using the Pearlin role overload measure and LASA. Results: Patients reported a reduction in symptom severity and emotional distress and an increase in QOL. All patients endorsed satisfaction with music therapy, describing it as particularly beneficial for stress relief, relaxation, spiritual support, emotional support, and well-being. Scores on overall QOL and stress were worse for caregivers. Conclusion: This study provides evidence that MT reduces symptom burden and enhances the quality of life for hospice patients. Hospice patients and their caregivers endorsed satisfaction with MT. Given the benefits observed, integrating MT into hospice care regimens could potentially improve patient and caregiver outcomes. Larger studies should be conducted to better assess the impact of MT in this population.
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Affiliation(s)
- Madison H Estell
- Medical School, Mayo Clinic Alix School of Medicine, Rochester, MN, USA
| | - Kevin J Whitford
- Medical School, Mayo Clinic Alix School of Medicine, Rochester, MN, USA
- Mayo Clinic Hospice, Mayo Clinic, Rochester, MN, USA
- Department of Medicine, Mayo Clinic Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Angela M Ulrich
- Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Travis J Dockter
- Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Kimberly L Schoonover
- Medical School, Mayo Clinic Alix School of Medicine, Rochester, MN, USA
- Division of Community Internal Medicine, Geriatrics and Palliative Care, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Jacob J Strand
- Medical School, Mayo Clinic Alix School of Medicine, Rochester, MN, USA
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Monica P Walton
- Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Maria I Lapid
- Medical School, Mayo Clinic Alix School of Medicine, Rochester, MN, USA
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
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19
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Ginggeaw S, LeBlanc R. The determinants of actual place of death among noncancer patients with end-stage chronic health conditions: a scoping review. Palliat Care Soc Pract 2024; 18:26323524241236964. [PMID: 38510469 PMCID: PMC10953110 DOI: 10.1177/26323524241236964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 02/15/2024] [Indexed: 03/22/2024] Open
Abstract
A home is a preferred place of death by most people. Nurses play a key role in supporting end-of-life home care, yet less is known about the factors that determine home as a place of death. This scoping review describes the percentage of actual places of death and determines social factors related to home as the place of death among noncancer patients with end-stage chronic health conditions. Inclusion criteria included (1) noncancer chronic illness conditions, (2) outcomes of place of death, and (3) factors that determine home as a place of death. Sources of evidence included PubMed, CINAHL, and Web of Science databases, which were searched in May 2022, and additional searches from May 2022 to November 2023.The JBI scoping review guide (2020) and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Review extension were used. Twenty-eight studies were included in this analysis. The range of percentages is varied within the same place of death among the sample. Two major constructs that determine a home as a place of death were identified: preceding factors and social capital. The results suggest that the place of death among noncancer patients with end-stage chronic health conditions should be continued to be understood. Two constructs determined home as a place of death and are considered as a fundamental to increasing equal accessibility in the initiation of palliative care services to promote home death and meet end-of-life care goals.
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Affiliation(s)
- Sangduan Ginggeaw
- Elaine Marieb College of Nursing, University of Massachusetts Amherst, 651 North Pleasant Street, Amherst, MA 01003, USA
| | - Raeann LeBlanc
- Elaine Marieb College of Nursing, University of Massachusetts Amherst, Amherst, MA, USA
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20
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Bigger SE, Foreman RA, Keinath C, Towsley GL. Transitions between skilled home health and hospice for persons living with dementia: a systematic review of literature. Ann Palliat Med 2024; 0:apm-23-524. [PMID: 38509644 DOI: 10.21037/apm-23-524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
BACKGROUND In the United States (US), nearly one third of skilled home health (HH) patients and nearly one half of hospice patients have diagnoses of Alzheimer's disease and related dementias (ADRD), conditions often characterized by a slow decline in cognition and function. Many persons living with dementia (PLWDs) are cared for at home yet may transition between care settings such as skilled HH or hospice, potentially leading to fragmented and poorer care. The purpose of this systematic review was to examine literature pertaining to (I) care transitions for PLWD who are enrolled in skilled HH and hospice in the US, and (II) specifically, care transitions between skilled HH and hospice for PLWD. METHODS We conducted a systematic review. From March to November 16, 2023, we searched CINAHL, PsychInfo (EBSCO version), and PubMed databases inputting keywords and index terms related to HH, care transition, hospice, and dementia. Articles were included if they were peer-reviewed, primary research studies that were published between 2017-2023 and addressed care transitions for PLWD enrolled in US skilled HH and hospice or transitions between the two settings. We evaluated the quality of each article and extracted relevant data. We described studies by setting while analyzing for similarities and differences between them. RESULTS Of 230 studies, 14 met our inclusion criteria. We found that PLWD are at higher risk for early, unsuccessful discharge from-and readmission to-skilled HH; and PLWD are at higher risk for being discharged alive from hospice. Only one study pertained to care transitions for PLWD between skilled HH and hospice. CONCLUSIONS We included only studies set in the US, as skilled HH and hospice may differ in policy and practice in other countries, which limits our findings. Future work should explore assessment approaches specific to PLWD that lead to higher quality of coordination of care to, from, and between skilled HH and hospice.
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Affiliation(s)
- Sharon E Bigger
- College of Nursing, East Tennessee State University, Johnson City, TN, USA
| | - Robin Ann Foreman
- College of Nursing, East Tennessee State University, Johnson City, TN, USA
| | - Christiana Keinath
- University Libraries, East Tennessee State University, Johnson City, TN, USA
| | - Gail L Towsley
- College of Nursing, University of Utah, Salt Lake City, UT, USA
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21
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Morley NE, Ramirez-Urquiola CM, Nakagawa S. Withdrawal of Left Ventricular Assist Device in Dementia: A Case Report. J Palliat Med 2024. [PMID: 38451550 DOI: 10.1089/jpm.2023.0064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024] Open
Abstract
Left ventricular assistance devices (LVADs) are one type of life support with the unique quality of allowing recipients to live outside the hospital. This case report explores the decision by a patient and their family to withdraw LVAD therapy in the setting of dementia and consultant team recommendations at odds with one another due to the patient's simultaneous alertness and lack of decisional capacity. It then discusses the guiding principles that led to the withdrawal of LVAD therapy and lessons drawn from the experience by the care team.
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Affiliation(s)
- Nicholas E Morley
- Emergency Medicine/Internal Medicine PGY-2, SUNY Downstate Medical Center and Kings County Hospital Center, Brooklyn, New York, New York, USA
| | - Cristina M Ramirez-Urquiola
- Adult Palliative Care Services, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Shunichi Nakagawa
- Adult Palliative Care Services, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
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Abstract
Hospice care involves focusing on our patients' goals of care and good symptom management. This coincides with a focus on their comfort, dignity, and respect. Working with lesbian, gay, bisexual, transgender, queer and/or questioning (LGBTQ+) patients on a hospice service can be challenging for medical staff. Many of these potential challenges relate to lack of training of medical professionals. These patients often receive discriminatory care compared to those who do not identify as LGBTQ+. This case study describes an assigned-male-at-birth Veteran admitted to a Veterans Affairs Community Living Center (CLC) hospice service who, after admission, informed staff of the strong desire to go forward with gender reassignment. Despite a prognosis of 6 months, working with the Veteran to help achieve these goals, supporting the medical plans for providing gender-transition information, and focusing on addressing the Veteran with appropriate pronouns were critical to our medical team's support for our Veteran at this difficult time.
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Affiliation(s)
- David B Brecher
- Hospice and Palliative Care, Geriatrics and Extended Care, Department of Veterans Affairs Puget Sound Health Care System, Tacoma, WA, USA
| | - Melissa S Romero
- Hospice and Palliative Care, Geriatrics and Extended Care, Department of Veterans Affairs Puget Sound Health Care System, Tacoma, WA, USA
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23
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Osakwe ZT, Calixte R, Peterson ML, Young SG, Ikhapoh I, Pierre K, McIntosh JT, Senteio C, Girardin JL. Association of Hospice Agency Location and Neighborhood Socioeconomic Disadvantage in the U.S. Am J Hosp Palliat Care 2024; 41:309-317. [PMID: 37644697 DOI: 10.1177/10499091231195319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Despite the growing increase in the utilization of hospice in the U.S, disparities exist in the utilization of hospice. Accumulating evidence has shown that neighborhood characteristics have an impact on availability of hospice agencies. OBJECTIVE To assess the association between neighborhood social vulnerability and hospice agency availability. METHODS Using the Medicare Post-Acute Care and Hospice Provider Utilization and Payment Public Use Files (PAC PUF) for 2019. Hospice agency addresses were geocoded to the census tract level. Multivariable Poisson regression models were used to assess the association between socioeconomic status SVI theme and hospice agency availability adjusting for number of home health agencies, primary care health profession shortage, per cent Black, and Percent Hispanic at the census tract level and rurality. RESULTS The socioeconomic status SVI subtheme was associated with decreased likelihood of hospice agency availability (adjusted IRR (aIRR), .56; 95% CI, .50- .63; P < .001). Predominantly Black, and predominantly Hispanic neighborhoods had lower rates of hospice agency availability (aIRR, .48; 95% CI, .39-.59; P < .001 and aIRR, .29; 95% CI, .24-.36; P < .001), respectively. CONCLUSION Neighborhood socioeconomic disadvantage was associated with lower availability of hospice agencies. Policies aimed at increasing access to hospice should be cognizant of neighborhood socioeconomic disadvantage.
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Affiliation(s)
- Zainab Toteh Osakwe
- College of Nursing and Public Health, Adelphi University, Garden City, NY, USA
| | - Rose Calixte
- Department of Epidemiology and Biostatistics, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Mandi-Leigh Peterson
- North Dakota Healthcare Workforce Group, University of North Dakota, Grand Forks, ND, USA
| | - Sean G Young
- Peter O'Donnell Jr. School of Public Health, UT Southwestern Medical Center, Dallas, TX, USA
| | - Izuagie Ikhapoh
- School of Engineering and Applies Sciences, University of Buffalo, Buffalo, NY, USA
| | - Kaydeen Pierre
- College of Nursing and Public Health, Adelphi University, Garden City, NY, USA
| | - Jennifer T McIntosh
- College of Nursing and Public Health, Adelphi University, Garden City, NY, USA
- Yale University School of Nursing, Orange, CT, USA
| | - Charles Senteio
- Department of Library and Information Science, School of Communication and Information, Rutgers University, New Brunswick, NJ, USA
| | - Jean-Louis Girardin
- Department of Psychiatry and Neurology at the Miller School of Medicine, University of Miami, Miami, FL, USA
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Stevens E. My Hayley Story: A Thank You to Those Who Teach. J Pain Symptom Manage 2024; 67:e255-e258. [PMID: 37088115 DOI: 10.1016/j.jpainsymman.2023.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/07/2023] [Accepted: 04/13/2023] [Indexed: 04/25/2023]
Affiliation(s)
- Erin Stevens
- Department of Internal Medicine, Division of Palliative Medicine (E.S.), The Ohio State University, Columbus, Ohio, USA; The James Comprehensive Cancer Center (E.S.), The Ohio State University, Columbus, Ohio, USA.
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Niedzwiecki MJ, Forrow LV, Gellar J, Pohl RV, Chen A, Miescier L, Kranker K. The Medicare Care Choices Model was associated with reductions in disparities in the use of hospice care for Medicare beneficiaries with terminal illness. Health Serv Res 2024. [PMID: 38419507 DOI: 10.1111/1475-6773.14289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVE To assess the effects of the Medicare Care Choices Model (MCCM) on disparities in hospice use and quality of end-of-life care for Medicare beneficiaries from underserved groups-those from racial and ethnic minority groups, dually eligible for Medicare and Medicaid, or living in rural areas. DATA SOURCES AND STUDY SETTING Medicare enrollment and claims data from 2013 to 2021 for terminally ill Medicare fee-for-service beneficiaries nationwide. STUDY DESIGN Through MCCM, terminally ill enrolled Medicare beneficiaries received supportive and palliative care services from hospice providers concurrently with curative treatments. Using a matched comparison group, we estimated subgroup-specific effects on hospice use, days at home, and aggressive treatment and multiple emergency department visits in the last 30 days of life. DATA COLLECTION/EXTRACTION METHODS The sample included decedent Medicare beneficiaries enrolled in MCCM and a matched comparison group from the same geographic areas who met model eligibility criteria at time of enrollment: having a diagnosis of cancer, congestive heart failure, chronic obstructive pulmonary disease, or HIV/AIDS; living in the community; not enrolled in the Medicare hospice benefit in the previous 30 days; and having at least one hospital stay and three office visits in the previous 12 months. PRINCIPAL FINDINGS Eligible beneficiaries from underserved groups were underrepresented in MCCM. MCCM increased enrollees' hospice use and the number of days at home and reduced aggressive treatment among all subgroups analyzed. MCCM also reduced disparities in hospice use by race and ethnicity and dual eligibility by 4.1 (90% credible interval [CI]: 1.3-6.1) and 2.4 (90% CI: 0.6-4.4) percentage points, respectively. It also reduced disparities in having multiple emergency department visits for rural enrollees by 1.3 (90% CI: 0.1-2.7) percentage points. CONCLUSIONS MCCM increased hospice use and quality of end-of-life care for model enrollees from underserved groups and reduced disparities in hospice use and having multiple emergency department visits.
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Affiliation(s)
| | | | | | | | | | - Lynn Miescier
- Center for Medicare & Medicaid Innovation, Centers for Medicare & Medicaid Services, Baltimore, Maryland, USA
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Hughes NM, Noyes J, Stringer C, Pritchard T. "Before I came to the hospice, I had nobody". A qualitative exploration of what patients, family-caregivers, clinicians and volunteers valued most about home, day therapy or inpatient hospice services. Palliat Care Soc Pract 2024; 18:26323524241231820. [PMID: 38426037 PMCID: PMC10903190 DOI: 10.1177/26323524241231820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 01/25/2024] [Indexed: 03/02/2024] Open
Abstract
Background Globally, the demand for hospice care continues to grow resulting in substantial resource burden. Whilst some countries are able to rely on fixed government contributions, statutory funding for palliative care in the United Kingdom is unequally distributed. These unstable funding streams and increased demand means that hospices need to evidence their value. Objective This study explored the experiences of patients and family-caregivers to determine what they valued most from accessing hospice services in Wales. Methods In this large multi-site qualitative study, 94 semi-structured interviews and 2 focus groups were conducted with hospice patients (n = 45), family-caregivers (n = 18), hospice staff (n = 31) and volunteers (n = 10). The audio recordings were transcribed verbatim and analysed using Framework analysis. Results Seven themes described patient and family-caregiver experiences and what they valued most: relationships with staff and volunteers, greater support networks which reduced social isolation and loneliness, provision of information and advice which improved patient autonomy, symptom management and subsequent reduction in psychological distress, improvements in patient functionality, mobility and overall physical health and respite relief which promoted improved relationships. Conclusion This is the largest study to explore what patients and family-caregivers value from hospice care. Findings indicate that hospice care provides a truly needs-led and strengths-based service to those who are nearing and at the end-of-life, which is highly valued by patients and family members.
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Affiliation(s)
| | - Jane Noyes
- School of Medical and Health Sciences, Bangor University, Bangor LL57 2DG, UK
| | - Carys Stringer
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
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27
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Lowenthal C, Ekwebelem M, Callahan ME, Pike K, Weisblatt S, Silva M, Novas AL, Tucci AS, Reid MC, Shalev D. Mental Health Service Integration in Hospice Organizations: A National Survey of Hospice Clinicians and Medical Leadership. Am J Hosp Palliat Care 2024:10499091241233677. [PMID: 38378452 DOI: 10.1177/10499091241233677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024] Open
Abstract
Background: Unmet mental health needs are associated with a range of negative consequences for individuals at the end of life. Despite the high prevalence of mental health needs among individuals enrolled in hospice, there is a paucity of data describing mental health service integration in hospices in the United States. Objectives: 1. To identify patterns of mental health service integration in hospice organizations nationally; 2. To characterize gaps in mental health service delivery in hospice settings as perceived by hospice clinicians and medical leadership. Methods: A cross-sectional survey querying hospice clinicians and hospice medical leadership nationally. Results: A total of 279 surveys were included. Clinically significant mental health symptoms were common among hospice patients; the most frequently encountered symptom groups were depression, anxiety, dementia, and delirium. A minority of hospices maintained relationships with psychiatrists (23%, n = 60), psychiatric nurse practitioners (22%, n = 56), or psychologists (19%, n = 49). Only 38% (n = 99) of respondents were satisfied with their patients' access to services and only 45% (n = 118) were satisfied with the quality of these services. Common limitations to providing adequate mental health services included lack of specialist services, short length of stay for patients, and reluctance of patients to engage in these services. Conclusions: Significant mental health symptoms are common among hospice patients, and hospice organizations perceive these needs are not being met. Further research is needed to better understand the current treatment landscape and design interventions to address these needs.
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Affiliation(s)
| | - Maureen Ekwebelem
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Mary E Callahan
- Department of Medicine, Columbia University, New York, NY, USA
| | | | | | - Milagros Silva
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, NY, USA
| | | | - Amy S Tucci
- Hospice Foundation of America, Washington, DC, USA
| | - M Carrington Reid
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Daniel Shalev
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, NY, USA
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
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Kim HD, Duberstein PR, Lin H, Wu B, Zafar A, Jarrín OF. Home Health Care and Hospice Use Among Medicare Beneficiaries With and Without a Diagnosis of Dementia. J Palliat Med 2024. [PMID: 38359388 DOI: 10.1089/jpm.2023.0583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
Background: Home health care is a core benefit of Medicare and Medicaid insurance programs and includes services to improve health, maintain health, or slow health decline. Objective: To examine the relationship between home health care use during the last three years of life and hospice use in the last six months of life among Medicare beneficiaries with and without dementia. Design: Nationally representative retrospective cohort study. Setting/Subjects: Medicare beneficiaries with at least three years of continuous enrollment who died in 2019 in the United States (n = 2,169,422). Measurements: The primary outcome was hospice use, and the secondary outcome was hospice duration. The independent variable was a composite of the presence and timing of home health care initiation during the last three years of life. Results: Home health care was used by 46.4% of Medicare beneficiaries and hospice care was used by 53.1% of beneficiaries, with 28.3% using both. Compared with beneficiaries who did not use home health care, those who started home health care before the last year of life (odds ratio [OR] = 1.57, 95% confidence interval [CI] = 1.56-1.58) or during the last year of life (OR = 1.75, 95% CI = 1.74-1.77) were more likely to use hospice. The effects were stronger in those without a diagnosis of dementia (OR = 1.92, 95% CI = 1.90-1.94) compared with those without a dementia diagnosis (OR = 1.34, 95% CI = 1.32-1.35) who started home health in the final year of life. Conclusions: Receiving home health care in the final years of life is associated with increased hospice use at the end-of-life in Medicare beneficiaries with and without a dementia diagnosis.
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Affiliation(s)
- Hyosin Dawn Kim
- College of Health, Oregon State University, Corvallis, Oregon, USA
| | - Paul R Duberstein
- School of Public Health, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
| | - Haiqun Lin
- School of Nursing, Rutgers, The State University of New Jersey, Newark, New Jersey, USA
| | - Bei Wu
- Rory Meyers College of Nursing, New York, New York, USA
- NYU Aging Incubator, New York University, New York, New York, USA
| | - Anum Zafar
- Institute for Health, Health Care Policy, and Aging Research, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Olga F Jarrín
- School of Nursing, Rutgers, The State University of New Jersey, Newark, New Jersey, USA
- Institute for Health, Health Care Policy, and Aging Research, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
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Serna MK, Yoon C, Fiskio J, Lakin JR, Schnipper JL, Dalal AK. A Mixed Methods Analysis of Standardized Documentation of Serious Illness Conversations Within an Electronic Health Record Module During Hospitalization. Am J Hosp Palliat Care 2024:10499091241228269. [PMID: 38334010 DOI: 10.1177/10499091241228269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Analysis of documented Serious Illness Conversations (SICs) in the inpatient setting can help clinicians align management to address patient and caregiver needs. METHODS We conducted a mixed methods analysis of the first instance of standardized documentation of a SIC within a structured module among hospitalized general medicine patients from 2018 to 2019. Percentage of documentations that included a description of patient or family understanding of the patient's medical condition and use of radio buttons to answer the "prognostic information shared," "hopes," and "worries" modules are reported. Using grounded theory approach, physicians analyzed free text entries to: "What is important to the patient/family?" and "Recommendations or next steps planned." RESULTS Out of 5142 patients, 59 patients had a documented SIC. Patient or family understanding of the medical condition(s) was reported in 56 (95%). For "prognostic information shared," the most frequently selected radio buttons were: 49 (83%) incurable disease and 28 (48%) prognosis of weeks to months while those for "hopes" were: 52 (88%) be comfortable and 27 (46%) be at home and for "worries" were: 49 (83%) other physical suffering and 36 (61%) pain. Themes generated from entries to "What's important to patient/family?" included being with loved ones; comfort; mentally and physically present; and reliable care while those for "Recommendations" were coordinating support services; symptom management; and support and communication. CONCLUSIONS SIC content indicated concern about pain and reliable care suggesting the complex, intensive nature of caring for seriously ill patients and the need to consider SICs earlier in the life course of patients.
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Affiliation(s)
- Myrna Katalina Serna
- Division of General Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Catherine Yoon
- Hospital Medicine Unit, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA
| | - Julie Fiskio
- Hospital Medicine Unit, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA
| | - Joshua R Lakin
- Harvard Medical School, Boston, MA, USA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jeffrey L Schnipper
- Hospital Medicine Unit, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Anuj K Dalal
- Hospital Medicine Unit, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Giwangkancana GW, Anina HN, Sukandar H. Predicting End-of-Life in a Hospital Setting. J Multidiscip Healthc 2024; 17:619-627. [PMID: 38352861 PMCID: PMC10863460 DOI: 10.2147/jmdh.s443425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/14/2023] [Indexed: 02/16/2024] Open
Abstract
Background The ability to predict the prognosis of a disease and anticipate death is valuable for patients and families especially in an acute care setting for chronically ill patient. Multiple scoring systems are used to measure disease progression and predict hospital mortality in patients with life-threatening illnesses, taking into account acute conditions, catastrophic events, and slow decline. Aim Our primary aim is to assess palliative performance score (PPS), early warning score (EWS) and local rumah sakit Dr Hasan Sadikin (RSHS) score to predict 14 days in-hospital mortality. Methods This was a single-center prospective cohort study from November 2022 to April 2023. Patients with World Health Organization category of terminal illnesses were scored using PPS, EWS and RSHS score and were followed up for 14 days in hospital. Multivariate analysis were conducted and The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines were used. Results A multivariable model was calculated using Cox regression. The final model results indicate that EWS (HR: 2.9, 95% CI: 1.1-7.7) and a decrease in consciousness (HR: 3.6, 95% CI: 1.2-10.22) were statistically significant in predicting mortality. Discussions Most patient in the cohort that died had cancer and were admitted in the previous 6 months. Relying solely on single prediction may not provide enough accuracy, within a 14-day timeframe. Therefore, the results of multivariate analysis were not statistically significant due to Several factors contribute to the complexity of this prediction challenge. As a multifaceted disease with varying stages, treatments, and outcomes, cancer presents a diverse landscape of patient experiences. Conclusion EWS and decreased consciousness are significant predictors of in-hospital mortality. It is crucial in clinical setting to use multiple indicators to predict death and improve patient care.
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Affiliation(s)
- Gezy Weita Giwangkancana
- Department of Anesthesia and Intensive Care, Faculty of Medicine Universitas Padjadjaran /Dr. Hasan Sadikin National Referral and Teaching Hospital, Bandung, Indonesia
| | - Heni Nur Anina
- Department of Nursing Dr. Hasan Sadikin National Referral and Teaching Hospital, Bandung, Indonesia
| | - Hadyana Sukandar
- Department of Public Health Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia
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Cruz-Oliver DM, Milner GE, Mensh K, Bugayong M, Blinka MD, Durkin N, Abshire Saylor M, Budhathoki C, Oliver DP. Promising Impact of Telenovela Intervention for Caregivers of Hospice Patients: A Pilot Study. Am J Hosp Palliat Care 2024:10499091241228835. [PMID: 38321708 DOI: 10.1177/10499091241228835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Hospice family caregivers (HFCGs) support the needs of their loved ones but are at risk of developing distress and anxiety. NOVELA is a four-chapter telenovela-style educational video to support topics related to hospice caregiving. Telehealth visits are scheduled in 4 weekly sessions consisting of a chapter and subsequent discussion with an interventionist. This feasibility pilot study tested NOVELA's effect to change HFCGs' outcomes, session and outcome measure completion (defined a priori as >70%). METHODS This is a single-group pretest-posttest study of HFCGs of care recipients with PPS score >20% from 3 hospices in the U.S. Mid-Atlantic region. At baseline and at final posttest, participants completed a web-based survey assessing 3 outcomes: anxiety, self-efficacy, and satisfaction with intervention. Descriptive, t-test, and chi-square statistics were computed. RESULTS Participants in our study (N = 59) were mainly collage educated, White, female, adult children of home-bound people with a non-cancer diagnosis. Outcomes changed in the expected direction (P > .05) with higher self-efficacy (Cohen's d = -.08 [95% CI -.4 to .2) and lower anxiety (Cohen's d = .2 [95% CI -.1 to .5]) scores from final to baseline, 86% of HFCGs were satisfied or very satisfied with NOVELA, session (33/59) and outcome measure (43/59) completion averaged 68%. CONCLUSION Encouraging trends in NOVELA's estimation of effect suggests that NOVELA may buffer stressful aspects of hospice caregiving. However, further refinement of NOVELA is needed. Supporting HFCGs through supportive educational interventions may reduce distress and anxiety with broad implications for quality improvement.
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Affiliation(s)
- Dulce M Cruz-Oliver
- Section of Palliative Medicine, Division of General Internal Medicine Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | | | - Kelsea Mensh
- Med-Surg Oncology 5A, Sibley Memorial Hospital, Washington, DC, USA
| | - Marielle Bugayong
- Division of General Internal Medicine Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Marcela D Blinka
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Center on Aging and Health, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nowella Durkin
- Division of General Internal Medicine Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | | | - Debra Parker Oliver
- Division of Palliative Medicine, Goldfarb School of Nursing, Barnes Jewish Hospital, Washington University, St. Louis, MO, USA
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Uno A. How Views on Death and Time Perspectives Relate to Palliative Care Nurses' Attitudes Toward Terminal Care? Omega (Westport) 2024; 88:1031-1050. [PMID: 34872421 DOI: 10.1177/00302228211055269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study's purpose was to explore how palliative care nurses' views on death and time perspectives are related to their terminal care attitudes. A questionnaire survey-consisting of the Death Attitude Inventory, Experiential Time Perspective Scale, and the Japanese version of the Frommelt Attitudes Toward Care of the Dying Scale-was administered to 300 individuals. Cluster analysis was conducted to categorize the way nurses perceive death, which revealed four types: Avoidant, middle, accepting, and indifferent. As a result of the analysis of variance on the terminal care attitudes, based on the types of views on death and time attitudes, it was found that the middle and accepting types, as well as the adaptive formation of time attitudes, were related to positive terminal care attitudes. In conclusion, more effective improvements in attitudes toward terminal care can be expected by incorporating time perspective, in addition to the conventional approaches focusing on death.
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Affiliation(s)
- Akari Uno
- Graduate School of Education, Tohoku University, Sendai, Japan
- Japan Society for the Promotion of Science Research Fellow, Japan
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Langmann GA, Childers J, Merlin JS. Caring for Patients With Opioid Misuse or Substance Use Disorders in Hospice: A National Survey. J Palliat Med 2024; 27:209-215. [PMID: 37824806 DOI: 10.1089/jpm.2023.0082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023] Open
Abstract
Background: Opioid misuse and substance use disorders (SUDs) including opioid use disorder (OUD) are common and negatively impact quality of life. Hospice clinicians' experiences with these conditions have not been well described. Objectives: We sought to explore hospice clinicians' knowledge, practices, and comfort caring for patients with opioid misuse (e.g., a pattern of unsanctioned opioid use escalation, or concurrent illicit substance use) and SUDs. Design: We recruited hospice clinicians in the United States via national hospice and palliative care organizations to complete an online survey designed by the study authors and pilot tested with an interdisciplinary group of current/former hospice clinicians. Results: One hundred seventy-five clinicians (40% nurses, 40% physicians, 16% nurse practitioners) responded to the survey; most had cared for two or more hospice patients with opioid misuse or SUD in the past month. The majority felt confident identifying opioid misuse (94%) and taking SUD histories (79%). Most (62%) felt it is their role to treat hospice patients for SUD, though 56% lacked comfort in using buprenorphine for OUD treatment. While the majority felt it is their role to treat pain in hospice patients with SUDs (94%) and that hospice can help patients with SUDs (94%), many were not comfortable managing pain in patients taking buprenorphine (45%) or naltrexone (49%) for SUDs. Most felt comfortable managing pain in patients taking methadone for SUD (73%). Conclusions: Opioid misuse and SUD are common in hospice. Though clinicians are comfortable taking relevant histories, they feel less comfortable managing patients' opioid misuse or SUD, or these patients' pain.
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Affiliation(s)
- Gabrielle A Langmann
- Supportive and Palliative Care Program, Division of General Internal Medicine, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, Utah, USA
| | - Julie Childers
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Jessica S Merlin
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Wladkowski SP, Wallace CL, Coccia K, Hyde RC, Hinyard L, Washington KT. Live Discharge of Hospice Patients with Alzheimer's Disease and Related Dementias: A Systematic Review. Am J Hosp Palliat Care 2024; 41:228-239. [PMID: 36977504 PMCID: PMC10763573 DOI: 10.1177/10499091231168401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
Background: Hospice is intended to promote the comfort and quality of life of dying patients and their families. When patients are discharged from hospice prior to death (ie, experience a "live discharge"), care continuity is disrupted. This systematic review summarizes the growing body of evidence on live discharge among hospice patients with Alzheimer's Disease and related dementias (ADRD), a clinical subpopulation that disproportionately experiences this often burdensome care transition. Methods: Researchers conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Reviewers searched AgeLine, APA PsycINFO (Ovid), CINAHL Plus with Full Text, ProQuest Dissertations & Theses Global, PubMed, Scopus, and Web of Science (Core Collection). Reviewers extracted data and synthesized findings from 9 records, which reported findings from 10 individual studies. Results: The reviewed studies, which were generally of high quality, consistently identified diagnosis of ADRD as a risk factor for live discharge from hospice. The relationship between race and live hospice discharge was less clear and likely dependent upon the type of discharge under investigation and other (eg, systemic-level) factors. Research on patient and family experiences underscored the extent to which live hospice discharge can be distressing, confusing, and associated with numerous losses. Conclusion: Research specific to live discharge among ADRD patients and their families is limited. Synthesis across included studies points to the importance for future research to differentiate between types of live discharge-revocation vsversus decertification-as these are vastly different experiences in choice and circumstances.
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Affiliation(s)
- Stephanie P Wladkowski
- College of Health and Human Services, Bowling Green State University Department of Human Services, Bowling Green, OH, USA
| | - Cara L Wallace
- School of Social Work, Saint Louis University, St. Louis, MO, USA
| | - Kathryn Coccia
- School of Social Work, Saint Louis University, St. Louis, MO, USA
| | - Rebecca C Hyde
- Pius XII Memorial Library, Saint Louis University, St. Louis, MO, USA
| | - Leslie Hinyard
- Department of Health and Clinical Outcomes Research, School of Medicine, Saint Louis University, St. Louis, MO, USA
| | - Karla T Washington
- Division of Palliative Medicine, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
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Caplan H, Santos J, Bershad M, Spritzer K, Liantonio J. Assessment of Feelings Towards Advanced Care Planning in the Latino Community. Am J Hosp Palliat Care 2024; 41:187-192. [PMID: 37159467 DOI: 10.1177/10499091231173413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Previous studies have noted that participation in advanced care planning (ACP) and end-of-life (EOL) discussions remain low among Latino communities. Various studies have found that interventions within Latino communities can positively improve engagement in ACP, however, minimal research exists regarding patient satisfaction of ACP discussions with healthcare providers outside of preorganized educational interventions. Our study aims to understand how conversations about ACP are perceived by Latino patients in a primary care setting. METHODS Subjects were identified from the institution's family medicine clinic from October 2021 to October 2022. Participants were those over the age of 50 who identified as Latino and were available at the clinic on the day of survey administration. An 8-question, 5-point, Likert scale survey assessed perceptions about ACP planning and gauged satisfaction of conversations with health care providers. The survey concluded with a multiple-choice question inquiring about individuals whom patients have spoken to regarding ACP/EOL wishes. Survey data was gathered through Qualtrics. RESULTS Of the 33 patients, the majority have at least somewhat thought about their EOL wishes (avg = 3.48/5). Most usually felt they were given enough time with their doctor (avg = 4.12/5) and comfortable speaking about ACP and EOL decisions (avg = 4.55/5). Generally, participants felt somewhat happy with how their doctor has spoken about ACP/EOL care (avg = 3.24/5). However, patients only felt a little to somewhat satisfied with the explanation of ACP/EOL from providers (avg = 2.82/5) and a little to somewhat confident in having the proper forms in place (avg = 2.76/5). Religious officials were a little to somewhat important to these conversations (avg = 2.55/5). Overall, patients have discussed ACP more frequently with family members and friends than health care providers, lawyers, or religious leaders. CONCLUSIONS The initial data demonstrates that many Latino patients are engaging in ACP conversations, both with healthcare providers and loved ones. Patients largely feel comfortable discussing EOL wishes with their doctor suggesting a trustful relationship. However, patients are only somewhat happy with these ACP conversations. Our study highlights a need for enhanced ACP education to improve satisfaction and confidence in formal documentation. Physicians should continue to engage and individualize ACP discussions to increase EOL preparedness among Latino patients.
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Sualp K, Beltran S, Chen G. The Impact of Neighborhood-Level Factors on Perceived Quality of Hospice Service Satisfaction: A Geographic Information System Study. Health Soc Work 2024; 49:7-15. [PMID: 38066681 DOI: 10.1093/hsw/hlad032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 03/14/2023] [Accepted: 06/15/2023] [Indexed: 01/31/2024]
Abstract
Racial/ethnic minorities are underrepresented in hospice care in the United States, despite this being the standard of care for terminally ill individuals. Research indicates that location of services (e.g., rural vs. urban) plays a role in the differences in quality and quantity of services observed. However, the influences of neighborhood structural characteristics on quality of hospice services have not been explored. The purpose of this study was to explore the relationship between hospice neighborhood characteristics and caregiver-rated satisfaction with services in Florida. Data were derived from the Consumer Assessment of Healthcare Providers and Systems Hospice Survey and American Community Survey; ArcGIS was used to generate heat maps to provide visual representations. Findings showed that higher neighborhood immigrant density predicted lower family satisfaction with timely care, communication, spiritual support, and likelihood to recommend the agency services. The U.S. population is projected to continue to grow in its diversity, and thus understanding neighborhood characteristics associated with racial/ethnic minorities' perception of care quality are important for shaping care improvements.
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Affiliation(s)
- Kenan Sualp
- PhD, MSW, is assistant professor, School of Social Work, College of Health Professions and Sciences, University of Central Florida, 12805 Pegasus Drive, HS 1 Building Room 214, Orlando, FL 32816, USA
| | - Susanny Beltran
- PhD, is assistant professor, Center Behavioral Health Research and Training, School of Social Work, College of Health Professions and Sciences, University of Central Florida, Orlando, FL, USA
| | - Guochao Chen
- MSW, is case manager, U.S. Department of Housing and Urban Development-U.S. Department of Veterans Affairs Supportive Housing, University of Central Florida, Orlando, FL, USA
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O'Conner-Von S, Shlafer R, Galchutt P, Kettering S, Bouterse A, Freese R, Berry P. A Survey of State Correctional Health Care Providers on Advance Care Planning: Opportunity for Collaboration With Corrections. Am J Hosp Palliat Care 2024:10499091241226638. [PMID: 38279955 DOI: 10.1177/10499091241226638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2024] Open
Abstract
Prison populations are rapidly aging. Persons in prison age quicker and suffer more chronic illness and disability than their nonincarcerated peers, posing challenges to caring for prisoners who are chronically ill and dying. The goal of our study was to describe state prisons' practices and policies addressing persons in prison with advanced chronic and life limiting illness through a national web-based survey of state-level prison health care professionals. In particular, we focused on advanced care planning, use of health care directives, decision-making about goals of care, including life sustaining treatments, The response rate was 22% for a sample size 152 completed surveys. The average age of respondent was 52 years; majority were female and Caucasian, and had worked in corrections more than 8 years. Nearly half were registered nurses. Most reported their prison did not have a dedicated end-of-life care program and only 11% offered a peer-care program. However, two-thirds indicated their facility provided the opportunity to designate a health care agent with physicians most likely responsible for facilitating completion of a health care directive. It is evident the care of persons aging and dying in prison is complex and requires further investigation addressing staff and prison population education, ethics guidelines for care, compassionate release, and advance care planning. This study suggests that hospice and palliative care professionals could collaborate with corrections professionals and national organizations to provide innovative education and support to enhance the humane care of this vulnerable population.
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Affiliation(s)
| | - Rebecca Shlafer
- University of Minnesota Medical School, Minneapolis, MN, USA
| | | | | | - Ali Bouterse
- University of Minnesota, Social Sciences, Minneapolis, MN, USA
| | - Rebecca Freese
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, USA
| | - Patricia Berry
- University of Utah College of Nursing, Salt Lake, UT, USA
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Bharadwaj A, Oliver DP, Washington KT, Benson J, Pitzer K, White P, Demiris G. Family Caregiver Communication and Perceptions of Involvement in Hospice Care. J Palliat Med 2024. [PMID: 38271546 DOI: 10.1089/jpm.2023.0576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024] Open
Abstract
Background: The burden of caregiving for family members is significant and becomes particularly challenging at end of life, with negative effects on mental health, including anxiety and depression. Research has shown caregivers need better communication with their health care team. Objectives: To evaluate the relationship between hospice team communication with caregivers and caregiver involvement in care. Methods: The purpose of this secondary analysis of data collected from a U.S.-based cluster crossover randomized trial was to evaluate whether caregiver-centered communication (Caregiver-Centered Communication Questionnaire) is associated with a caregiver's perceptions of involvement in care (Perceived Involved in Care Scale). A block-wise approach was used to estimate linear models, which were created using total scores and subscale scores. Results: Caregiver-centered communication was positively associated with perceptions of involvement in care. Conclusion: Skilled communication between hospice clinicians and family caregivers is critical in helping family members perception they are involved in the care of their loved one. There could be similar benefit in caregiver-centered communication during cancer treatment as well.
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Affiliation(s)
- Archana Bharadwaj
- Department of Anesthesiology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Debra Parker Oliver
- Division of Palliative Medicine, Department of Medicine, Goldfarb School of Nursing, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Karla T Washington
- Division of Palliative Medicine, Department of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Jacquelyn Benson
- Division of Palliative Medicine, Department of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Kyle Pitzer
- Division of Palliative Medicine, Department of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Patrick White
- Division of Palliative Medicine, Department of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - George Demiris
- Department of Biobehavioral and Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Ishak Tayoob M, Rayala S, Doherty M, Singh HB, Alimelu M, Lingaldinna S, Palat G. Palliative Care for Newborns in India: Patterns of Care in a Neonatal Palliative Care Program at a Tertiary Government Children's Hospital. Health Serv Insights 2024; 17:11786329231222858. [PMID: 38269395 PMCID: PMC10807304 DOI: 10.1177/11786329231222858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 12/08/2023] [Indexed: 01/26/2024] Open
Abstract
Neonatal palliative care is a specialized area within children's palliative care, which focusses on the needs of infants with life-limiting or life-threatening conditions. Nearly one quarter of global neonatal deaths occur in India, where neonatal palliative care evidence is limited. This study describes the development and implementation of a neonatal palliative care program within a neonatal intensive care unit (NICU) at a government hospital, describing the implementing an 8-month pilot palliative care program for neonates, including the patterns of care, and barriers and enablers of success. The hospital-based palliative care team included trained pediatric palliative care physicians, a nurse, and a counselor. There was a steady increase in monthly referrals. There were 110 referrals in total, including 89 (81%) deaths and 18 (16%) babies were alive at the time of final follow-up, 10 months after the pilot program was completed. The program addressed physical symptoms, including providing morphine, as well as psychosocial and spiritual concerns of families. A model of hospital-based palliative care for neonates can be implemented within NICUs in tertiary government hospitals in India. Neonatal palliative care programs should include partnerships with charitable organizations to support implementation costs and provide palliative care training, mentorship, and capacity-building support.
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Affiliation(s)
| | | | - Megan Doherty
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Two Worlds Cancer Collaboration Foundation, Kelowna, Canada
- Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada
| | | | | | | | - Gayatri Palat
- Pain Relief and Palliative Care Society, Hyderabad, India
- Mehdi Nawaj Jung Institute of Oncology and Regional Cancer Centre, Hyderabad, India
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de Graaf E, Grant M, van der Baan F, Ausems M, Leget C, Teunissen S. The Impact of Hospice Care Structures on Care Processes: A Retrospective Cohort Study. Am J Hosp Palliat Care 2024:10499091241228254. [PMID: 38234063 DOI: 10.1177/10499091241228254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024] Open
Abstract
Background: Palliative care is subject to substantial variations in care, which may be shaped through adapting the organisational structures through which care is provided. Whilst the goal of these structures is to improve patient care, there is a lack of evidence regarding their effect on care processes and patient outcomes. Aims: This study aims to describe the relationship between care structures and the quantity and domains of care processes in hospice care. Design: Retrospective cohort study. Settings/Participants: Data were collected from Dutch hospice patient's clinical records and hospice surveys, detailing hospice structures, patient clinical characteristics and care processes. Results: 662 patients were included from 42 hospices, mean age 76.1 years. Hospices were categorised according to their care structures - structured clinical documentation and multidisciplinary meetings. Patients receiving care in hospices with structured multidisciplinary meetings had an increased quantity of documented care processes per patient on admission through identification (median 4 vs 3, P < .001), medication (2 vs 1, P = .004) and non-medication (1 vs 0, P < .001) interventions, monitoring (2 vs 1, P < .001) and evaluation (0 vs 0, P = .014), and prior to death. Similar increases were identified for patients who received care in hospices with structured documentation upon admission, but these changes were not consistent prior to death. Conclusions: This study details that the care structures of documentation and multidisciplinary meetings are associated with increased quantity and breadth of documentation of care processes in hospice care. Employing these existing structures may result in improvements in the documentation of patient care processes, and thus better communication around patient care.
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Affiliation(s)
- Everlien de Graaf
- Centre of Expertise in Palliative Care Utrecht, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Matthew Grant
- Centre of Expertise in Palliative Care Utrecht, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Frederieke van der Baan
- Centre of Expertise in Palliative Care Utrecht, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Marieke Ausems
- Palliative Care Physician, The Dutch College of General Practitioners, the Netherlands
| | - Carlo Leget
- University of Humanistic Studies, Utrecht, the Netherlands
| | - Saskia Teunissen
- Centre of Expertise in Palliative Care Utrecht, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands
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Tafazoli A, Cronin-Wood K. Pediatric Oncology Hospice: A Comprehensive Review. Am J Hosp Palliat Care 2024:10499091241227609. [PMID: 38225192 DOI: 10.1177/10499091241227609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2024] Open
Abstract
Pediatric hospice is a new terminology in current medical literature. Implementation of pediatric hospice care in oncology setting is a vast but subspecialized field of research and practice. However, it is accompanied by substantial uncertainties, shortages and unexplored sections. The lack of globally established definitions, principles, and guidelines in this field has adversely impacted the quality of end-of-life experiences for children with hospice needs worldwide. To address this gap, we conducted a comprehensive review of scientific literature, extracting and compiling the available but sparse data on pediatric oncology hospice from the PubMed database. Our systematic approach led to development of a well-organized structure introducing the foundational elements, highlighting complications, and uncovering hidden gaps in this critical area. This structured framework comprises nine major categories including general ideology, population specifications, role of parents and family, psychosocial issues, financial complications, service locations, involved specialties, regulations, and quality improvement. This platform can serve as a valuable resource in establishing a scientifically reliable foundation for future experiments and practices in pediatric oncology hospice.
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Affiliation(s)
- Ali Tafazoli
- Healthcare administration program, St Lawrence College, Kingston Campus, ON, Canada
- Hospice Kingston, Queen's University, Kingston, ON, Canada
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
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Geriya D, Dave V. Assessment of Quality of Life among Terminally Ill Cancer Patients Receiving Palliative Care at Hospice Centre, Ahmedabad City, India. Indian J Community Med 2024; 49:115-119. [PMID: 38425962 PMCID: PMC10900469 DOI: 10.4103/ijcm.ijcm_88_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 11/06/2023] [Indexed: 03/02/2024] Open
Abstract
Background Cancer has been the leading cause of death worldwide, and palliative care is an approach that improves the quality of life (QoL) of patients and their families facing the problem associated with life-threatening illness. Hospice care helps patients and their family to cope with the change from treating the cancer to living life as fully as possible through their final days. This study aimed to (1) assess the sociodemographic and clinical profile of terminally ill cancer patients, (2) assess the QoL among terminally ill cancer patients receiving palliative care, and (3) study various determinants affecting their QoL. Material and Methods A cross-sectional study was conducted among terminally ill cancer patients receiving palliative care at the Hospice Centre, Community Oncology Centre, Ahmedabad. Based on previous years' admission data, a sample size of 360 was taken. Patients who are seriously ill up to the extent that they were unable to respond and had a previous positive history of psychiatric illness before the diagnosis of cancer were excluded. Institutional ethical committee (IEC) permission was obtained before the study. Statistical analysis was performed using the Chi-square test in Statistical Package for the Social Sciences (SPSS) software. Results The mean age of participants was 48.1 ± 13.0 years. The gender distribution of participants was males and females (226 (62.8%) and 134 (37.2%)), respectively. On studying, the involvement of various anatomical sites as "primary site of cancer" revealed that head and neck carcinoma had the highest (63.3%) involvement and hematological cancer had the lowest (0.6%) involvement. Of total, 62% of participants had "below-average QoL," followed by 34.9% of participants having "significantly poor QoL." There was a significant association between different age groups, time lag in cancer diagnosis, and treatment initiation and QoL. Conclusion Spearman's rank correlations between the majority of factors fell in "low partially positive" category except for the physical well-being (factor 2) and psychosocial well-being (factor 3) with optimism and belief (factor 7), where they were in "low partially negative" category.
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Affiliation(s)
- Disha Geriya
- Department of Community Medicine, Dr. M. K. Shah Medical College and Research Centre, Ahmedabad, Gujarat, India
| | - Viral Dave
- Department of Community Medicine, GCS Medical College, Hospital and Research Centre, Ahmedabad, Gujarat, India
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Rabitti E, Cavuto S, Díaz Crescitelli ME, Bassi MC, Ghirotto L. Hospice Patients' End-of-Life Dreams and Visions: A Systematic Review of Qualitative Studies. Am J Hosp Palliat Care 2024; 41:99-112. [PMID: 36947427 PMCID: PMC10710003 DOI: 10.1177/10499091231163571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
When conscious, about 50% to 60% of hospice patients report a "visitation" by someone who is not there while they dream or are awake: a phenomenon known as End-of-Life Dreams and Visions (ELDVs). Since the dying process is frequently complicated by delirium, ELDVs risk being misidentified as such by professionals and caregivers. To observe these phenomena from patients' perspectives, we conducted a systematic review to aggregate and synthesize the findings from the qualitative studies about ELDVs of patients assisted in hospices to indicate future directions for research and care. MEDLINE/PubMed, Embase, CINAHL, PsycINFO, Scopus, and Web of Science databases were searched, yielding 293 documents after duplicates were removed. Six qualitative articles reporting on five unique studies conducted in hospice settings were included in the meta-synthesis. We generated three main categories: i) typologies of ELDVs reported, ii) emotional consequences, and iii) intersubjective meaning-making. The ELDVs reported were experiences that remained intimate and unsocialized and thus preventing participants from defining a shared sense in their relationships. Training healthcare professionals to recognize ELDVs and take advantage of them in the care relationship is desirable. We also encourage the patient's family members to listen and understand ELDVs when they occur actively. For caregivers to know how to interpret these phenomena may provide them with additional strategies for supporting, reassuring, and strengthening their relationships with their loved ones. The review allowed us to inform healthcare professionals and caregivers about how to help patients share their emotional and identity-related experiences and meaning-making in end-of-life.
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Affiliation(s)
- Elisa Rabitti
- Psycho-Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Silvio Cavuto
- Clinical Trials and Statistics Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Maria Chiara Bassi
- Medical Library, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Luca Ghirotto
- Qualitative Research Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Abstract
Cultural narratives shape how we think about the world, including how we decide when the end of life begins. Hospice care has become an integral part of the end-of-life care in the United States, but as it has grown, its policies and practices have also imposed cultural narratives, like those associated with the "six-month rule" that the majority of the end of life takes place in the final six months of life. This idea is embedded in policies for a range of care practices and reimbursement processes, even though six months is not always a meaningful marker. In the case of people living with advanced dementia, six months is both too early in the trajectory to facilitate conversations and too late in the trajectory to ensure decision-making capacity. This essay encourages scholars and policy-makers to consider how cultural narratives may limit what they think is possible in care for people living with dementia.
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Untaru EN, Han H, David A, Chi X. Biophilic Design and Its Effectiveness in Creating Emotional Well-Being, Green Satisfaction, and Workplace Attachment Among Healthcare Professionals: The Hospice Context. HERD 2024; 17:190-208. [PMID: 37606216 DOI: 10.1177/19375867231192087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
OBJECTIVE The present study aimed to explore the biophilic design attributes within a hospice care center from the healthcare professionals' perspective by utilizing a qualitative research and investigated the effect of hospice professionals' attitudes toward the uncovered green features on the prediction of their workplace attachment through a quantitative research. BACKGROUND In hospice establishments, studies showed that applying biophilic design principles significantly reduces stress and improves emotional well-being. Yet, despite its importance, attitude toward biophilic design, and its significant influence on well-being, satisfaction and attachment to the workplace of hospice healthcare professionals have not yet been researched. METHODS The qualitative research used semi-structured in-depth interviews among hospice professionals to reveal biophilic design features that exert an influence on their activity, while the quantitative research employed a confirmatory factor analysis and the structural equation modeling to analyze the data. RESULTS AND CONCLUSIONS The qualitative research generated five biophilic design features, such as open spaces with natural light, natural decorative elements, landscape provided by nature through windows, wooden furniture, and colors that create a warm atmosphere within the hospice care center. The quantitative approach indicated that attitude toward the uncovered biophilic design features in the context of the COVID-19 pandemic significantly improved the healthcare providers' emotional well-being. This dimension, in turn, contributed to their satisfaction with green features/natural decor and attachment to the workplace. Results of this study provide practitioners and researchers valuable strategies to incorporate biophilic design features in the working environments of hospice settings.
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Affiliation(s)
- Elena-Nicoleta Untaru
- Faculty of Economic Sciences and Business Administration, Transilvania University of Braşov, Braşov, Romania
| | - Heesup Han
- College of Hospitality and Tourism Management, Sejong University, Gwanjin-Gu, Seoul, South Korea
| | - Andreea David
- Faculty of Economic Sciences and Business Administration, Transilvania University of Braşov, Braşov, Romania
| | - Xiaoting Chi
- School of Tourism and Geography Science, Qingdao University, Qingdao, Shandong Province, P.R. China
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Wachterman MW, Smith D, Carpenter JG, Griffin HL, Thorpe J, Feder SL, Hoelter J, Ersek M, Shreve S, Kutney-Lee A. A comparison of end-of-life care quality for Veterans receiving hospice in VA nursing homes and community nursing homes. J Am Geriatr Soc 2024; 72:59-68. [PMID: 37947240 PMCID: PMC10842969 DOI: 10.1111/jgs.18606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 08/23/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND While the Veterans Health Administration (VA) has long provided hospice care within VA community living centers (CLCs, i.e., VA nursing homes), an increasing number of Veterans are receiving hospice in VA-contracted community nursing homes (CNHs). However, little data exist about the quality of end-of-life (EOL) care provided in CNHs. The aim of this study was to compare family ratings of the quality of EOL care provided to Veterans receiving hospice in VA CLCs and VA-contracted CNHs. METHODS We conducted a retrospective analysis of national data from VA's electronic medical record and Bereaved Family Survey (BFS) for Veterans who received hospice in VA CLCs or VA-contracted CNHs between October 2021 and March 2022. The final sample included 1238 Veterans who died in either a CLC (n = 1012) or a CNH (n = 226) and whose next-of-kin completed the BFS. Our primary outcome was the BFS global rating of care received in the last 30 days of life. Secondary outcomes included BFS items related to symptom management, communication, emotional and spiritual support, and information about burial and survivor benefits. We compared unadjusted and adjusted proportions for all BFS outcomes between those who received hospice in CLCs and CNHs. RESULTS The adjusted proportion of family members who gave the best possible rating (a score of 9 or 10 out of a possible 10) for the overall care received near EOL was more than 13 percentage points higher for Veterans who received hospice in VA CLCs compared to VA-contracted CNHs. Our findings also revealed quality gaps of even greater magnitude in specific EOL care-focused domains. CONCLUSIONS Our findings document inadequacies in the quality of multiple aspects of EOL care provided to Veterans in CNH-based hospice and illuminate the urgent need for policy and practice interventions to improve this care.
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Affiliation(s)
- Melissa W Wachterman
- Section of General Internal Medicine, Veterans Affairs Boston Health Care System, Boston, Massachusetts, USA
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Dawn Smith
- Veteran Experience Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Joan G Carpenter
- Veteran Experience Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
- University of Maryland School of Nursing, Baltimore, Maryland, USA
| | - Hillary L Griffin
- Veteran Experience Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Joshua Thorpe
- Center for Health Equity Research and Promotion, Pittsburgh VA Medical Center, Pittsburgh, Pennsylvania, USA
- University of North Carolina School of Pharmacy, Chapel Hill, North Carolina, USA
| | - Shelli L Feder
- Yale University School of Nursing, Orange, Connecticut, USA
- Pain Research, Informatics, Multi-Morbidities, and Education Center, VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Jillian Hoelter
- University of Maryland School of Nursing, Baltimore, Maryland, USA
| | - Mary Ersek
- Veteran Experience Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Scott Shreve
- US Department of Veteran Affairs, Hospice and Palliative Care Program, Washington, DC, USA
- Lebanon VA Medical Center, Lebanon, Pennsylvania, USA
| | - Ann Kutney-Lee
- Veteran Experience Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
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Largent EA, Lowers J, Pope TM, Quill TE, Wynia MK. When People Facing Dementia Choose to Hasten Death: The Landscape of Current Ethical, Legal, Medical, and Social Considerations in the United States. Hastings Cent Rep 2024; 54 Suppl 1:S11-S21. [PMID: 38382034 DOI: 10.1002/hast.1550] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
Some individuals facing dementia contemplate hastening their own death: weighing the possibility of living longer with dementia against the alternative of dying sooner but avoiding the later stages of cognitive and functional impairment. This weighing resonates with an ethical and legal consensus in the United States that individuals can voluntarily choose to forgo life-sustaining interventions and also that medical professionals can support these choices even when they will result in an earlier death. For these reasons, whether and how a terminally ill individual can choose to control the timing of their death is a topic that cannot be avoided when considering the dementia trajectory. With a focus on the U.S. context, this landscape review considers the status of provisions that would legally permit people facing dementia to hasten death with appropriate support from medical professionals. This review can be used to plan and guide clinical and legal practitioner discussion and policy development concerning evolving questions not fully covered by existing medical decision-making provisions.
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Felice MD, Koehne EL, Patel HD, Elliott N, Hekman L, Lewer O, Rahman F, Petix S, Ellis J, Santos GD. The Current Status of Palliative Care, Hospice, and End-of-Life Health Care Utilization in Patients With Malignant Ureteral Obstruction. Urol Pract 2024; 11:187-196. [PMID: 38117967 PMCID: PMC11001302 DOI: 10.1097/upj.0000000000000472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 09/26/2023] [Indexed: 12/22/2023]
Abstract
INTRODUCTION Malignant ureteral obstruction is associated with a poor prognosis, with a median survival of 3 to 7 months. These patients are ideal candidates for concurrent palliative care services, consistent with American Society of Clinical Oncology guidelines. We aimed to characterize palliative care, hospice, and end-of-life health care utilization in patients with malignant ureteral obstruction. METHODS Patients ≥ 18 years old at our institution and diagnosed with malignant ureteral obstruction between May 2014 and August 2020 were retrospectively identified and pertinent data extracted. Palliative care, hospice, and end-of-life health care utilization was described, and factors associated with each were assessed with logistic regression models. Overall survival was assessed with Cox proportional hazard regression models. RESULTS One hundred fifteen patients qualified for analysis; 39.1% (45/115) utilized palliative care and spent a median of 12.5 days (IQR 3-52 days) on nonhospice palliative care. On adjusted analysis Black ethnicity (aOR 3.44, 95% CI: 1.08-10.94) was associated with palliative care utilization. Of the patients, 53.9% (62/115) utilized hospice. The median time from hospice initiation to death was 12 days (IQR 5-23 days). On adjusted analysis, prior extirpative surgery (aOR 3.63, 95% CI 1.01-13.05) and palliative care utilization (aOR 4.38, 95% CI 1.70-11.31) were associated with hospice utilization. Median survival following diagnosis was 141 days (IQR 37.5-442.5). Of the patients, 43.0% (37/86) had high end-of-life health care utilization. On multivariable analysis, only hospice (aOR 0.03, 95% CI 0.01-0.14) was associated with less end-of-life health care utilization. CONCLUSIONS Palliative care is underutilized in malignant ureteral obstruction. Hospice, but not palliative care utilization, was associated with decreased end-of-life health care utilization.
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Affiliation(s)
- Michael D. Felice
- Department of Urology, Loyola University Medical Center, Maywood, Illinois
| | - Elizabeth L. Koehne
- Department of Urology, Loyola University Medical Center, Maywood, Illinois
- Department of Urology, University of Washington, Seattle, Washington
| | - Hiten D. Patel
- Department of Urology, Loyola University Medical Center, Maywood, Illinois
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Nicholas Elliott
- Department of Urology, Loyola University Medical Center, Maywood, Illinois
| | - Lauren Hekman
- Stritch School of Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Owen Lewer
- Stritch School of Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Farah Rahman
- Stritch School of Medicine, Loyola University Medical Center, Maywood, Illinois
| | | | - Jeffrey Ellis
- Department of Urology, Loyola University Medical Center, Maywood, Illinois
| | - Grace Delos Santos
- Department of Urology, Loyola University Medical Center, Maywood, Illinois
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Cloyes KG, Reynaga M, Vega M, Thomas Hebdon MC, Thompson C, Rosenkranz SJ, Tay D, Reblin M, Ellington L. The Burden of having to Wonder: Hospice Caregiving Experiences of LGBTQ+ Cancer Family Caregivers. Am J Hosp Palliat Care 2024; 41:56-62. [PMID: 36822189 DOI: 10.1177/10499091231159089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND AND OBJECTIVES LGBTQ+ people are more likely to be caregivers for family and friends with life-limiting illnesses than non-LGBTQ+ people. LGBTQ+ caregivers may also experience stigma, bias, and discrimination, in addition to caregiving stress. Yet few studies have elicited LGBTQ+ family caregivers' perspectives on their end-of-life (EOL) experiences of home hospice. RESEARCH DESIGN AND METHODS We conducted semi-structured interviews with LGBTQ+ family caregivers of home hospice patients (N = 20). Following an interpretive descriptive approach, interview data were audio recorded, transcribed, and iteratively coded, and themes were developed and synthesized. RESULTS The burden of having to wonder expressed caregivers' uncertainty and concern about whether their negative experiences were common to all EOL caregivers or stemmed from cultural stigma and provider bias. Participants described how invisibility vs. risks of disclosure, anticipatory anxiety, perceived microaggressions, and protective vigilance increased stress and complicated caregiver-provider communication. Navigating EOL universalities vs. minority realities depicted underlying tensions between commonly assumed universalities of EOL caregiving and LGBTQ+-specific experiences. Providers' discomfort, awkward communication, lack of access to culturally competent EOL support resources, and broader structural and cultural discrimination eroded their sense of connectedness and safety. Together, these themes characterized the impact of minority stress at EOL. DISCUSSION AND IMPLICATIONS Our findings suggest that LGBTQ+ hospice caregivers are at risk for minority stress in addition to more common sources of EOL caregiving pressures and thus have specific support and communication needs. Providers must understand this to deliver effective EOL care for all families.
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Affiliation(s)
- Kristin G Cloyes
- School of Nursing, Oregon Health and Science University, Portland, OR, USA
| | - Miranda Reynaga
- Psychology, University of Michigan College of Literature Science and the Arts, Ann Arbor, MI, USA
| | | | | | | | - Susan J Rosenkranz
- School of Nursing, Oregon Health and Science University, Portland, OR, USA
| | - Djin Tay
- University of Utah Health, Salt Lake City, UT, USA
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Knight HP, Brennan C, Hurley SL, Tidswell AJ, Aldridge MD, Johnson KS, Banach E, Tulsky JA, Abel GA, Odejide OO. Perspectives on Transfusions for Hospice Patients With Blood Cancers: A Survey of Hospice Providers. J Pain Symptom Manage 2024; 67:1-9. [PMID: 37777022 PMCID: PMC10873003 DOI: 10.1016/j.jpainsymman.2023.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/07/2023] [Accepted: 09/16/2023] [Indexed: 10/02/2023]
Abstract
CONTEXT Patients with blood cancers have low rates of hospice use. While lack of transfusion access in hospice is posited to substantially contribute to these low rates, little is known about the perspectives of hospice providers regarding transfusion access in hospice. OBJECTIVES To characterize hospice providers' perspectives regarding care for patients with blood cancers and transfusions in the hospice setting. METHODS In 2022, we conducted a cross-sectional survey of a sample of hospices in the United States regarding their experience caring for patients with blood cancers, perceived barriers to hospice use, and interventions to increase enrollment. RESULTS We received 113 completed surveys (response rate = 23.5%). Of the cohort, 2.7% reported that their agency always offers transfusions, 40.7% reported sometimes offering transfusions, and 54.9% reported never offering transfusions. In multivariable analyses, factors associated with offering transfusions included nonprofit ownership (OR 5.93, 95% CI, 2.2-15.2) and daily census >50 patients (OR 3.06, 95% CI, 1.19-7.87). Most respondents (76.6%) identified lack of transfusion access in hospice as a barrier to hospice enrollment for blood cancer patients. The top intervention considered as "very helpful" for increasing enrollment was additional reimbursement for transfusions (72.1%). CONCLUSION In this national sample of hospices, access to palliative transfusions was severely limited and was considered a significant barrier to hospice use for blood cancer patients. Moreover, hospices felt increased reimbursement for transfusions would be an important intervention. These data suggest that hospice providers are supportive of increasing transfusion access and highlight the critical need for innovative hospice payment models to improve end-of-life care for patients with blood cancers.
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Affiliation(s)
- Helen P Knight
- Department of Psychosocial Oncology and Palliative Care (H.P.K., J,A,T.), Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Caitlin Brennan
- Care Dimensions Inc. (C.B., S.L.H.), Boston, Massachusetts; Boston College Connell School of Nursing (C.B.), Chestnut Hill, Massachusetts
| | | | - Anna J Tidswell
- Division of Population Sciences (A.J.T., G.A.A., O.O.O.), Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Melissa D Aldridge
- Brookdale Department of Geriatrics and Palliative Medicine (M.D.A.), Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kimberly S Johnson
- Division of Geriatrics (K.S.J.), Duke University Medical Center, Durham, North Carolina
| | - Edo Banach
- Manatt Health (E.B.), Washington, District of Columbia
| | - James A Tulsky
- Department of Psychosocial Oncology and Palliative Care (H.P.K., J,A,T.), Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Gregory A Abel
- Division of Population Sciences (A.J.T., G.A.A., O.O.O.), Dana-Farber Cancer Institute, Boston, Massachusetts; Division of Hematologic Malignancies (G.A.A., O.O.O.), Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Oreofe O Odejide
- Division of Population Sciences (A.J.T., G.A.A., O.O.O.), Dana-Farber Cancer Institute, Boston, Massachusetts; Division of Hematologic Malignancies (G.A.A., O.O.O.), Dana-Farber Cancer Institute, Boston, Massachusetts.
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