1
|
Hoff T, Trovato K, Kitsakos A. Hospice Satisfaction Among Patients, Family, and Caregivers: A Systematic Review of the Literature. Am J Hosp Palliat Care 2024; 41:691-705. [PMID: 37467032 DOI: 10.1177/10499091231190778] [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: 07/20/2023] Open
Abstract
Background: Hospice care is an underused form of intervention at the end of life. The experiences of patients, families, and other caregivers are important to consider in thinking about how to encourage greater use of hospice care, through policies and advocacy that promote its benefits. Specifically, patient, family, and other caregiver satisfaction with hospice care is important to understand better. Methods: A PRISMA-guided review of the research on hospice care satisfaction and its correlates among patients, families, and other caregivers. Included in the review is research published over the time period 2000-2023 identifying a hospice care satisfaction finding. Results: Thirty-eight studies were included in the review. Key findings were: (a) higher levels of hospice care satisfaction among patients, families, and other caregivers; and (b) correlates of hospice care satisfaction falling into the categories of communication, comfort, and support. The published literature had fewer findings related to demographic correlates of satisfaction such as age or race/ethnicity and was lacking in comparative research examining satisfaction across different types of hospice care settings. Discussion: Extant research demonstrates a consistently higher level of hospice care satisfaction among patients, families, and other caregivers. This satisfaction appears related to specific aspects of care delivery that involve effective care coordination and communication; pain and symptom management; and emotional support. Strengthening future research involves testing additional interventions aimed at enhancing satisfaction; including more comparative research across hospice care settings; and more studies that include patients as the key respondents.
Collapse
Affiliation(s)
- Timothy Hoff
- D'Amore-McKim School of Business and School of Public Policy and Urban Affairs, Northeastern University, Boston, MA, USA
- Green-Templeton College, University of Oxford, Oxford, UK
| | - Kathryn Trovato
- Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Aliya Kitsakos
- School of Public Policy and Urban Affairs, Northeastern University, Boston, MA, USA
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Hua M, Guo L, Ing C, Lackraj D, Wang S, Morrison RS. Specialist Palliative Care Use and End-of-Life Care in Patients With Metastatic Cancer. J Pain Symptom Manage 2024; 67:357-365.e15. [PMID: 38278187 PMCID: PMC11032225 DOI: 10.1016/j.jpainsymman.2024.01.029] [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: 11/16/2023] [Revised: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 01/28/2024]
Abstract
CONTEXT For patients with advanced cancer, high intensity treatment at the end of life is measured as a reflection of the quality of care. Use of specialist palliative care has been promoted to improve care quality, but whether its use is associated with decreased treatment intensity on a population-level is unknown. OBJECTIVES To determine whether receipt of specialist palliative care use is associated with differences in end-of-life quality metrics in patients with metastatic cancer. METHODS Retrospective propensity-matched cohort of patients age ≥ 65 who died with metastatic cancer in U.S. hospitals with palliative care programs that participated in the National Palliative Care Registry in 2018-2019. Cox proportional hazards regression was used to assess the impact of specialist palliative care on use of chemotherapy in the last 14 days of life, use of intensive care unit (ICU) in the last 30 days of life, use of hospice, and hospice enrollment ≥ three days. RESULTS After 1:2 matching, our cohort consisted of 15,878 exposed and 31,756 unexposed patients. Receipt of specialist palliative care was associated with a decrease in use of chemotherapy (adjusted hazard ratio (aHR) 0.59 [0.50-0.70]) and ICU at the end of life (aHR 0.86 [0.80-0.92]), and an increase in hospice use (aHR 1.92 [1.85-1.99]) and hospice enrollment for ≥three days (aHR 2.00 [1.93-2.07]). CONCLUSION On a population-level, use of specialist palliative care was associated with improved metrics for quality end-of-life care for patients dying with metastatic cancer, underscoring the importance of its integration into cancer care.
Collapse
Affiliation(s)
- May Hua
- Department of Anesthesiology (M.H., C.I.), College of Physicians and Surgeons, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA.
| | - Ling Guo
- Department of Anesthesiology (L.G.), College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Caleb Ing
- Department of Anesthesiology (M.H., C.I.), College of Physicians and Surgeons, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Deven Lackraj
- Department of Anesthesiology (D.L.), Columbia University College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Shuang Wang
- Department of Biostatistics (S.W.), Mailman School of Public Health, Columbia University, New York, New York, USA
| | - R Sean Morrison
- Icahn School of Medicine at Mount Sinai and James J Peters VA (R.S.M.), Bronx, New York, USA
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Hotchkiss J, Ridderman E, Buftin W. Overall US Hospice Quality According to Decedent Caregivers-Natural Language Processing and Sentiment Analysis of 3389 Online Caregiver Reviews. Am J Hosp Palliat Care 2024; 41:527-544. [PMID: 37338245 DOI: 10.1177/10499091231185593] [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: 06/21/2023] Open
Abstract
Objectives: With an untapped quality resource in online hospice reviews, study aims were exploring hospice caregiver experiences and assessing their expectations of the hospice Medicare benefit. Methods: Topical and sentiment analysis was conducted using natural language processing (NLP) of Google and Yelp caregiver reviews (n = 3393) between 2013-2023 using Google NLP. Stratified sampling weighted by hospice size to approximate the daily census of US hospice enrollees. Results: Overall caregiver sentiment of hospice care was neutral (S = .14). Therapeutic, achievable expectations and misperceptions, unachievable expectations were, respectively, the most and least prevalent domains. Four topics with the highest prevalence, all had moderately positive sentiments: caring staff, staff professionalism and knowledge; emotional, spiritual, bereavement support; and responsive, timely or helpful. Lowest sentiments scores were lack of staffing; promises made, but not kept, pain, symptoms and medications; sped-up death, hasted, or sedated; and money, staff motivations. Significance of Results: Caregivers overall rating of hospice was neutral, largely due to moderate sentiment on achievable expectations in two-thirds of reviews mixed with unachievable expectations in one-sixth of reviews. Hospice caregivers were most likely to recommend hospices with caring staff, providing quality care, responsive to requests, and offering family support. Lack of staff, inadequate pain-symptom management were the two biggest barriers to hospice quality. All eight CAHPS measures were found in the discovered review topics. Close-ended CAHPS scores and open-ended online reviews have complementary insights. Future research should explore associations between CAHPS and review insights.
Collapse
|
6
|
Newcomer K, Godfrey S, Kumar S, Lorusso N, Patel N, Garrett B, Chen C, Sulistio MS. Increasing Knowledge about Implantable Cardioverter Defibrillators at the End of Life, an Effective Approach for Hospice Workers to Improve Patient Care. J Pain Symptom Manage 2024; 67:e409-e415. [PMID: 38331233 DOI: 10.1016/j.jpainsymman.2024.01.040] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 01/21/2024] [Accepted: 01/25/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Implantable cardioverter defibrillators (ICDs) decrease mortality in high-risk patients but can also cause distressing shocks near death. Patients who lack knowledge about their ICDs are more likely to have an active device at the end of life. Many hospice workers lack sufficient knowledge to educate patients about ICDs. MEASURES An ICD educational video created for use in a diverse, underserved patient population was shown to hospice workers from two large community hospices and attendees of a regional conference. A validated 10 question survey was given to participants before and after the video. OUTCOMES Significant improvement in ICD knowledge scores was seen in all participants (W = 3119.5, P < 0.0001). While doctors and nurses showed higher pretest knowledge, post-test knowledge scores equalized across all participants. CONCLUSIONS/LESSONS LEARNED An ICD patient educational video designed for a diverse, underserved patient population effectively improved ICD knowledge to a uniform excellent level for a broad range of hospice workers.
Collapse
Affiliation(s)
- Kelley Newcomer
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Sarah Godfrey
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Sharika Kumar
- University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Nakul Patel
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Brenden Garrett
- University of Texas Southwestern Medical Center, Dallas, Texas
| | | | | |
Collapse
|
7
|
Zhang Y, Zheng L, He Y, Han M, Wang Y, Xv J, Qiu H, Yang L. Development and validation of the hospice professional coping scale among Chinese nurses. BMC Health Serv Res 2024; 24:491. [PMID: 38643136 PMCID: PMC11031935 DOI: 10.1186/s12913-024-10970-9] [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: 07/25/2023] [Accepted: 04/09/2024] [Indexed: 04/22/2024] Open
Abstract
BACKGROUND Hospice care professionals often experience trauma patient deaths and multiple patient deaths in a short period of time (more so than other nurses). This repeated exposure to the death process and the death of patients leads to greater psychological pressure on hospice care professionals. But at present, people pay more attention to the feelings and care burden of the family members of dying patients but pay less attention to medical staff. Thus, this study aimed to develop a scale on the burden of care for hospice care providers and assess the coping capacity of hospice professionals. Raising awareness of the psychological burden of hospice professionals. METHODS Through a literature review, research group discussion, Delphi method and a pre-survey of professional coping skills among nurses, 200 hospice professionals who had received training in hospice care from pilot institutions engaged in or providing hospice care were selected for investigation. Cronbach's α coefficient and split-half reliability were used to test the internal consistency of the scale, and content validity and explore factor analysis (EFA) were used to test the construct validity of the scale. RESULTS Two rounds of Delphi methods were carried out, and the effective recovery rate was 100%. The expert authority coefficients of the two rounds were 0.838 and 0.833, respectively. The Kendall's W coefficient of experts in the first round was 0.121 ~ 0.200 (P < 0.05), and the Kendall's W coefficient of the second round was 0.115-0.136 (P < 0.05), indicating a good level of expert coordination. The final survey scale for the care burden of hospice professionals included four dimensions-working environment (9 items), professional roles (8 items), clinical nursing (9 items) and psychological burden (7 items)-with a total of 33 items. The total Cronbach's α coefficient of the scale was 0.963, and the Cronbach's α coefficients of the working environment, professional roles, clinical nursing and psychological burden dimensions were 0.920, 0.889, 0.936 and 0.910, respectively. The total split-half reliability of the scale was 0.927, and the split-half reliability of each dimension was 0.846, 0.817, 0.891, and 0.832. The content validity of the scale items ranged from 0.90 to 1.00. Exploratory factor analysis revealed 5 common factors, with a total cumulative contribution rate of 68.878%. The common degree of each item in the scale was > 0.4, and the factor loading of each item was also > 0.4. CONCLUSION The scale is an open-access, short, easy-to-administer scale. And which for assessing hospice care burden among hospice professionals developed in this study demonstrated strong reliability and validity. This tool can serve as a dependable instrument for evaluating the burden of hospice care for terminally ill patients by professionals in the hospice setting.
Collapse
Affiliation(s)
- Yanting Zhang
- Department of Critical Care Medicine, Hubei Clinical Research Center for Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China
| | - Li Zheng
- Department of Lung Cancer Radiotherapy and Chemotherapy, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China
| | - Yanling He
- Department of Gynecological Tumor Radiotherapy and Chemotherapy, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China
| | - Min Han
- Department of Gynecological Tumor Radiotherapy and Chemotherapy, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China
| | - Yu Wang
- Department of Gynecological Tumor Radiotherapy and Chemotherapy, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China
| | - Jinyu Xv
- Department of Gynecological Tumor Radiotherapy and Chemotherapy, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China
| | - Hui Qiu
- Department of Gynecological Tumor Radiotherapy and Chemotherapy, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China.
| | - Liu Yang
- Department of Gynecological Tumor Radiotherapy and Chemotherapy, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China.
| |
Collapse
|
8
|
van Baal K, Hemmerling M, Stahmeyer JT, Stiel S, Afshar K. End-of-life care in Germany between 2016 and 2020 - A repeated cross-sectional analysis of statutory health insurance data. BMC Palliat Care 2024; 23:105. [PMID: 38643167 PMCID: PMC11031961 DOI: 10.1186/s12904-024-01387-6] [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: 03/21/2023] [Accepted: 02/15/2024] [Indexed: 04/22/2024] Open
Abstract
BACKGROUND The Hospice and Palliative Care Act of 2015 aimed at developing and regulating the provision of palliative care (PC) services in Germany. As a result of the legal changes, people with incurable diseases should be enabled to experience their final stage of life including death according to their own wishes. However, it remains unknown whether the act has impacted end-of-life care (EoLC) in Germany. OBJECTIVE The present study examined trends in EoLC indicators for patients who died between 2016 and 2020, in the context of Lower Saxony, Germany. METHODS Repeated cross-sectional analysis was conducted on data from the statutory health insurance fund AOK Lower Saxony (AOK-LS), referring to the years 2016-2020. EoLC indicators were: (1) the number of patients receiving any form of outpatient PC, (2) the number of patients receiving generalist outpatient PC and (3) specialist outpatient PC in the last year of life, (4) the onset of generalist outpatient PC and (5) the onset of specialist outpatient PC before death, (6) the number of hospitalisations in the 6 months prior to death and (7) the number of days spent in hospital in the 6 months prior to death. Data for each year were analysed descriptively and a comparison between 2016 and 2020 was carried out using t-tests and chi-square tests. RESULTS Data from 160,927 deceased AOK-LS members were analysed. The number of patients receiving outpatient PC remained almost consistent over time (2016 vs. 2020 p = .077). The number of patients receiving generalist outpatient PC decreased from 28.4% (2016) to 24.5% (2020; p < .001), whereas the number of patients receiving specialist outpatient PC increased from 8.5% (2016) to 11.2% (2020; p < .001). The onset of generalist outpatient PC moved from 106 (2016) to 93 days (2020; p < .001) before death, on average. The onset of specialist outpatient PC showed the reverse pattern (2016: 55 days before death; 2020: 59 days before death; p = .041). CONCLUSION Despite growing needs for PC at the end of life, the number of patients receiving outpatient PC did not increase between 2016 and 2020. Furthermore, specialist outpatient PC is being increasingly prescribed over generalist outpatient PC. Although the early initiation of outpatient PC has been proven valuable for the majority of people at the end of life, generalist outpatient PC was not initiated earlier in the disease trajectory over the study period, as was found to be true for specialist outpatient PC. Future studies should seek to determine how existing PC needs can be optimally met within the outpatient sector and identify factors that can support the earlier initiation of especially generalist outpatient PC. TRIAL REGISTRATION The study "Optimal Care at the End of Life" was registered in the German Clinical Trials Register (DRKS00015108; 22 January 2019).
Collapse
Affiliation(s)
- Katharina van Baal
- Institute for General Practice and Palliative Care, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
| | - Melissa Hemmerling
- AOK Lower Saxony, Department for Health Services Research, Hildesheimer Str. 273, 30519, Hannover, Germany
| | - Jona Theodor Stahmeyer
- AOK Lower Saxony, Department for Health Services Research, Hildesheimer Str. 273, 30519, Hannover, Germany
| | - Stephanie Stiel
- Institute for General Practice and Palliative Care, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Kambiz Afshar
- Institute for General Practice and Palliative Care, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| |
Collapse
|
9
|
Chambergo-Michilot D, Becerra-Gonzales VG, Kittipibul V, Colombo R, Bravo-Jaimes K. Racial Differences in Hospice Care Outcomes in Patients With Advanced Heart Failure: Systematic Review and Meta-analysis. Am J Cardiol 2024; 217:5-9. [PMID: 38382703 DOI: 10.1016/j.amjcard.2024.01.025] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 01/08/2024] [Accepted: 01/28/2024] [Indexed: 02/23/2024]
Abstract
There remains a paucity of investigational data about disparities in hospice services in people with non-cancer diagnoses, specifically in heart failure (HF). Black patients with advanced HF have been disproportionally affected by health care services inequities but their outcomes after hospice enrollment are not well studied. We aimed to describe race-specific outcomes in patients with advanced HF who were enrolled in hospice services. We obtained the data from PubMed, Scopus, and Embase for all investigations published until January 11, 2023. All studies that reported race-specific outcomes after hospice enrollment in patients with advanced HF were included. Of the 1,151 articles identified, 5 studies (n = 24,899) were considered for analysis involving a sample size ranging from 179 to 11,754 patients. Black patients had an increased risk of readmission (odds ratio 1.55, 95% confidence interval [CI] 1.34 to 1.79, I2 0%) and discharge (odds ratio 1.75, 95% CI 1.53 to 1.99, I2 0%) compared with White patients. Moreover, Black patients have a nonsignificant lower risk of mortality compared with White patients (relative risk 0.67, 95% CI 0.43 to 1.05, I2 90%). In conclusion, this study showed that Black patients with advanced HF receiving hospice care have a higher risk of readmission and discharge compared with White patients.
Collapse
Affiliation(s)
| | - Victor G Becerra-Gonzales
- Division of Cardiology, Department of Medicine, University of Miami/Jackson Memorial Hospital, Miami, Florida
| | | | - Rosario Colombo
- Division of Cardiology, Department of Medicine, University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - Katia Bravo-Jaimes
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida.
| |
Collapse
|
10
|
Yang L, Zhou Q, Hong T, Zhang L, Che H. Analysis on the willingness and influencing factors of choosing hospice care service institutions among among older people in Wuhu, China: a cross-sectional study. BMJ Open 2024; 14:e083400. [PMID: 38569717 DOI: 10.1136/bmjopen-2023-083400] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate the inclination and determinants influencing the selection of hospice care service institutions among elderly individuals in China. DESIGN The study conducted has a cross-sectional design. SETTING The study was conducted at four urban community centres in Wuhu, Anhui Province, China. PARTICIPANTS The sample consisted of 642 older adults, with ages ranging from 60 to over (mean age=71.03 years, SD=7.18). METHOD This study, based on the Anderson model, developed a questionnaire after conducting a preliminary survey and engaging in several group discussions. The final questionnaire encompassed the basic information, health status, attitude towards hospice care, choice of hospice care institutions and reasons of the older people. A regional population study was conducted using the Logistic regression model to estimate the ORs (OR) of influencing factors selected by hospice services. RESULTS 38.5% of respondents expressed their willingness to receive hospice care, while 22.3% were unwilling and 39.3% felt ambivalent towards it. The acceptance rate of older people in hospice care increases with higher levels of education and monthly income. 47.0% of older people opted for hospice care in a general hospital ward, indicating that demand for hospice services among older people in Wuhu City is primarily focused on such wards. The univariate analysis revealed significant differences in the willingness of older individuals to accept hospice care services based on gender, age, educational attainment and income levels. Regardless of the location of hospice care, older men had a lower likelihood of being willing to use hospice services compared with older women. The proportion of older women choosing a hospice ward or general hospital was 53.8%, which was higher than that of older men at 42.0%. The proportion of older men choosing a community health service institution was 31.6%, higher than 23.3% of women. The educational level differences significantly influence the older people's inclination towards receiving hospice care. CONCLUSION With the ageing population of Wuhu City on the rise, there is an increasing demand for hospice services. In their final journey, older individuals require multilevel hospice care services, which necessitates equipping general hospitals with hospice wards and using community health service centres to meet their specific needs.
Collapse
Affiliation(s)
- Liu Yang
- School of Nursing, Wannan Medical College, Wuhu, Anhui, China
| | - Quan Zhou
- Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, China
| | - Ting Hong
- Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, China
| | - Lin Zhang
- School of Nursing, Wannan Medical College, Wuhu, Anhui, China
| | - Hengying Che
- Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, China
| |
Collapse
|
11
|
Brimble MJ, Anstey S, Davies J, Dunn C. An exploration of managing emotional labour and maintaining professional integrity in children's hospice nursing. Int J Palliat Nurs 2024; 30:180-188. [PMID: 38630645 DOI: 10.12968/ijpn.2024.30.4.180] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 04/19/2024]
Abstract
BACKGROUND Research exploring nurse-parent relationships in children's hospices is rare. AIM To investigate how children's hospice nurses manage emotional labour and professional integrity in their long-term relationships with parents. METHODS A purposive sample of six children's nurses, from hospices across England, recorded audio diaries and participated in telephone interviews. Narratives were thematically analysed. FINDINGS Three overarching, cross-cutting themes were identified-purposeful positioning; balancing personability and professionalism; coping with and counterbalancing emotional labour. All themes were indicative of and/or built upon emotional intelligence constructs, such as self-awareness, self-regulation, appropriate (managed) empathy, social skills and intrinsic motivation. Innate features of children's hospice work were important for perpetuating intrinsic motivation and satisfaction. CONCLUSION This study provided an insight into the management of emotional labour and professional integrity by experienced children's hospice nurses. The identification of emotional intelligence skills merits further exploration in this environment, as well as other children's palliative care settings.
Collapse
Affiliation(s)
- Mandy J Brimble
- Senior Lecturer, Cardiff University School of Healthcare Sciences
| | - Sally Anstey
- Emeritus Reader, Cardiff University School of Healthcare Sciences
| | - Jane Davies
- Honorary Senior Research Fellow, Cardiff University School of Healthcare Sciences
| | - Catherine Dunn
- Lecturer, Cardiff University School of Healthcare Sciences
| |
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
Dasch B. [The Trend in Places of Death Over Two Decades in the City of Muenster - an Observational Study Based on evaluated Death Certificates]. Gesundheitswesen 2024; 86:322-329. [PMID: 37816382 PMCID: PMC11003251 DOI: 10.1055/a-2125-5177] [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: 10/12/2023]
Abstract
Aim of the study The study examined the distribution of places of death in the Westphalian city of Muenster over an observation period of 20 years.Methods All death certificates issued in the city of Muenster from 2001, 2011, 2017, 2021 were evaluated by places of death (home (HO), hospital (HT), hospice (HP), nursing home (NH), other place (OP)). For hospital patients, deaths on intensive care units (ICU) and palliative care units (PAL) were also considered separately. Any medical information on cause of death was used to identify decedents with malignant tumor or dementia disease.Results A total of 14,240 death certificates were evaluated. A malignant tumor disease was documented in 34.0%, dementia in 11.1%. For the general population, the distribution of places of death was as follows (2001/2021; %): HO (24.0/14.6); HT (63.2/60.2) [ICU (13.3/24.6), PAL (0.0/10.9)], HP (3.8/4.9), NH (7.8/19.5), OP (1.1/0.7). Most tumor patients died in hospital (2021: 60.6%), fewer patients at home (2021: 15.4%). From 2001 to 2021, the proportion of cancer patients who died in a PAL increased significantly (+24.4%); hospices showed a moderate increase (+5.0%). A majority of dementia patients died in nursing homes (2021: 66.6%) and fewer patients at home (2021: 12.2%).Conclusion For the general population and for tumor patients, the hospital is the most common place of death and the nursing home for patients with dementia. Overall, deaths at home decreased continuously over time. For tumor patients, palliative care units and hospices are becoming increasingly important as places of death, and for dementia patients, nursing homes in particular.
Collapse
Affiliation(s)
- Burkhard Dasch
- Zentrale Einrichtung Palliativmedizin, Universitätsklinikum
Münster, Münster, Germany
| |
Collapse
|
14
|
Jackson GP, Jackson CE, Boland JW, Featherstone I, Huang C, Ogden M, Sartain K, Siddiqi N, Twiddy M, Pearson M, Johnson MJ. Improving the Detection, Assessment, Management and Prevention of Delirium in Hospices (the DAMPen-D study): Feasibility study of a flexible and scalable implementation strategy to deliver guideline-adherent delirium care. Palliat Med 2024; 38:447-456. [PMID: 38634231 PMCID: PMC11025298 DOI: 10.1177/02692163241236325] [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] [Indexed: 04/19/2024]
Abstract
BACKGROUND Delirium is a complex condition, stressful for all involved. Although highly prevalent in palliative care settings, it remains underdiagnosed and associated with poor outcomes. Guideline-adherent delirium care may improve its detection, assessment and management. AIM To inform a future definitive study that tests whether an implementation strategy designed to improve guideline-adherent delirium care in palliative care settings improves patient outcomes (reduced proportion of in-patient days with delirium). DESIGN With Patient Involvement members, we conducted a feasibility study to assess the acceptability of and engagement with the implementation strategy by hospice staff (intervention), and whether clinical record data collection of process (e.g. guideline-adherent delirium care) and clinical outcomes (evidence of delirium using a validated chart-based instrument;) pre- and 12-weeks post-implementation of the intervention would be possible. SETTING/PARTICIPANTS In-patient admissions in three English hospices. RESULTS Between June 2021 and December 2022, clinical record data were extracted from 300 consecutive admissions. Despite data collection during COVID-19, target clinical record data collection (n = 300) was achieved. Approximately two-thirds of patients had a delirium episode during in-patient stay at both timepoints. A 6% absolute reduction in proportion of delirium days in those with a delirium episode was observed. Post-implementation improvements in guideline-adherent metrics include: clinical delirium diagnosis 15%-28%; delirium risk assessment 0%-16%; screening on admission 7%-35%. CONCLUSIONS Collection of data on delirium outcomes and guideline-adherence from clinical records is feasible. The signal of patient benefit supports formal evaluation in a large-scale study.
Collapse
Affiliation(s)
- Gillian P Jackson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Catriona E Jackson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
- Leeds Teaching Hospitals NHS Trust, St James’s University Hospital, Leeds, UK
| | - Jason W Boland
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | | | - Chao Huang
- Institute of Clinical & Applied Health Research, Hull York Medical School, University of Hull, Hull, UK
| | | | - Kathryn Sartain
- York and Scarborough Teaching Hospitals NHS Foundation Trust, York Hospital, York, UK
| | - Najma Siddiqi
- Department of Health Sciences, University of York, York, UK
| | - Maureen Twiddy
- Institute of Clinical & Applied Health Research, Hull York Medical School, University of Hull, Hull, UK
| | - Mark Pearson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| |
Collapse
|
15
|
Bell SG, Althouse AD, Belin SC, Arnold RM, Smith KJ, White DB, Chu E, Schenker Y, Thomas TH. Associations of Health Care Utilization and Therapeutic Alliance in Patients with Advanced Cancer. J Palliat Med 2024; 27:515-520. [PMID: 38574330 DOI: 10.1089/jpm.2023.0559] [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: 04/06/2024] Open
Abstract
Introduction: Therapeutic alliance (TA), or the extent to which patients feel a sense of caring and trust with their physician, may have an impact on health care utilization. We sought to determine if TA is associated with: (1) emergency department (ED) visits within 30 days of death and (2) hospice enrollment. Methods and Materials: This is a secondary analysis of data from a randomized clinical trial. We used restricted cubic splines to assess the relationship between TA scores and health care utilization. Results: Six hundred seventy-two patients were enrolled in the study, with 331 (49.3%) dying within 12 months. Patients with higher TA were less likely to have an ED visit in the last 30 days of life, but there was no evidence of a relationship between TA and enrollment in hospice. Conclusions: Higher TA was associated with decreased ED visits within 30 days of death. There was no association between TA and rates of hospice enrollment. Clinical Registration Number: NCT02712229.
Collapse
Affiliation(s)
- Sarah G Bell
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Andrew D Althouse
- Palliative Research Center (PaRC), University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Shane C Belin
- Palliative Research Center (PaRC), University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Robert M Arnold
- Palliative Research Center (PaRC), University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kenneth J Smith
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Douglas B White
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Edward Chu
- Department of Oncology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Yael Schenker
- Palliative Research Center (PaRC), University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Teresa H Thomas
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
16
|
Davies C, Basire K, Jones V, Gillmore D, Hosie A, Gourley A, Collier A. "Beyond Feasibility": A Qualitative Study of Patients, Their Whānau (Family) and Staff Perspectives and Experiences of a Non- Pharmacological Delirium-Prevention Intervention in Two Aotearoa/New Zealand Hospices. J Pain Symptom Manage 2024; 67:327-336.e2. [PMID: 38253215 DOI: 10.1016/j.jpainsymman.2024.01.012] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/07/2024] [Indexed: 01/24/2024]
Abstract
CONTEXT Delirium is prevalent in the hospice population. Despite causing significant distress to patients and families, delirium is under-recognised. There is a need to better understand delirium prevention and outcomes in this population including people's experiences of delirium-prevention strategies in different cultural contexts. OBJECTIVES To determine whether the "PRESERVE Aotearoa" delirium prevention intervention was feasible and acceptable for Māori (indigenous peoples of Aotearoa/ New Zealand) and non-Māori patients with advanced cancer, their families (called whānau in this paper), and clinical staff. METHODS A qualitative semistructured interview substudy of a cohort PRESERVE Aotearoa feasibility study codesigned with a Māori partner to ensure inclusion of Māori-centred values. The study was underpinned conceptually by He Awa Whiria (braided rivers)-combining Western and Māori knowledges. Data were analysed using Hopwood and Srivasta's framework. RESULTS Twenty-six patients and their whānau, 21 clinical staff and five researchers from two stand-alone hospices in the North Island, Aotearoa/New Zealand. Finding showed that, for the most part, participants considered the study interventions feasible and acceptable. Inductive analysis resulted in four themes highlighting the importance to whānau of their participation in the study: benefits of learning about delirium; the affirmation of the caregiver role and whānau-centred care; valuing fundamentals of care; and research as legacy. CONCLUSION This qualitative study found that it is feasible and acceptable to study multicomponent nonpharmacological delirium-prevention interventions in Aotearoa/New Zealand hospice inpatient units. The study also highlights the value of Māori-centred approaches and whānau involvement in these settings.
Collapse
Affiliation(s)
- Cheryl Davies
- Tu Kotahi Māori Asthma Trust (C.D.), Kokiri Marae, Lower Hutt, New Zealand
| | - Kaye Basire
- Te Omanga Hospice (K.B., D.G.), Lower Hutt, New Zealand
| | - Vicki Jones
- Faculty of Health and Medical Sciences (V.J., A.C.), The University of Auckland, Auckland, New Zealand; Waipuna Hospice (V.J.), Tauranga, New Zealand
| | | | - Annmarie Hosie
- School of Nursing and Midwifery (A.H.), University of Notre Dame Australia, Darlinghurst, New South Wales, Australia; St Vincent's Health Network Sydney (A.H.), Darlinghurst, New South Wales, Australia; Improving Palliative, Aged and Chronic Care through Research and Translation (IMPACCT) (A.H.), University of Technology Sydney, Ultimo, New South Wales, Australia
| | | | - Aileen Collier
- Faculty of Health and Medical Sciences (V.J., A.C.), The University of Auckland, Auckland, New Zealand; Research Centre for Palliative Care Death and Dying (RePaDD) (A.C.), Flinders University of South Australia, Adelaide, South Australia, Australia; Northern Adelaide Palliative Care Service (A.C.), Northern Adelaide Local Health Network, Adelaide, South Australia, Australia
| |
Collapse
|
17
|
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.
Collapse
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
| |
Collapse
|
18
|
Jensen FB, Thorpe D. Social Model Hospice: Providing Hospice and Palliative Care for a Homeless Population in Salt Lake City, Utah. J Hosp Palliat Nurs 2024; 26:91-97. [PMID: 37976394 DOI: 10.1097/njh.0000000000001000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Health care for the homeless population is a complex challenge and represents a significant gap in care, particularly for those at the end of life. Hospice care may be desired but is rarely an option for people without residences, social support, and payment sources. Social model hospice is a unique paradigm of care delivery that offers a viable solution to make hospice and palliative care possible for this population. In this historical report from interviews with early organizers, prior and current leadership (n = 6), the evolution of The INN Between in Salt Lake City, Utah, is described. In 2010, The INN Between was conceptualized as a nonprofit community effort addressing this need to provide an alternative to people dying unsheltered. After 5 years of planning, it opened in 2015 and has grown to become a comprehensive community resource for homeless medically frail and terminally ill individuals. Recommendations for establishing social model hospices are made: key strategies include identifying stakeholders dedicated to alleviating end-of-life homelessness needs, doing a formal needs assessment to identify community resource deficits, and forming mentoring relationships with established programs. Social model hospice is a viable way of meeting the end-of-life needs of many communities' most vulnerable residents.
Collapse
|
19
|
Stiel S, Ernst A, Röwer HAA, de Jong L, Burger B, Schneider N, Damm K, Stahmeyer JT, Apolinarski B, Herbst FA. [Empirically derived recommendations for the development and expansion of day hospices in Germany - Results of a Delphi expert panel]. Z Evid Fortbild Qual Gesundhwes 2024; 185:72-82. [PMID: 38431457 DOI: 10.1016/j.zefq.2024.01.002] [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: 08/04/2023] [Revised: 01/11/2024] [Accepted: 01/15/2024] [Indexed: 03/05/2024]
Abstract
INTRODUCTION A needs-based and patient-oriented hospice and palliative care also includes day hospices as a specialised semi-inpatient care offer. The establishment and development of these facilities in Germany has been rather unsystematic. In order to ensure quality and adequacy of these structures, research is needed. METHODS A Delphi consensus study was conducted online from November 2022 to February 2023 aiming at generating recommendations for the development and expansion of day hospices in Germany. For each recommendation, the participants indicated on a four-point verbal rating scale how much they agreed upon a) the relevance and b) the feasibility of the recommendation. Items were considered consented when 80% of the participants (strongly) agreed with the recommendation regarding both criteria. If no consensus was reached, the recommendations were revised according to the participants' free text comments and presented in the next Delphi round. Descriptive analyses were applied. RESULTS A total of 64 experts participated in the first Delphi round and 44 in the second. In round 1, 34 recommendations and in round 2 six recommendations were consented. The final set contains a total of 40 recommendations: 18 on the tasks of day hospices, 13 on cooperation, 7 on funding, and 2 on public relations. DISCUSSION Recommendations for the development and expansion of day hospices in Germany were developed. Due to their highly rated feasibility, the recommendations should be directly transferable into care practice. It remains to be seen to what extent they will be taken into account in the renegotiation of the framework agreement for day hospices. CONCLUSION The Delphi-consented recommendations provide a basis to guide action in the currently very dynamic development of hospice work and palliative care in Germany.
Collapse
Affiliation(s)
- Stephanie Stiel
- Institut für Allgemeinmedizin und Palliativmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland.
| | - Alexandra Ernst
- Institut für Allgemeinmedizin und Palliativmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Hanna A A Röwer
- Institut für Allgemeinmedizin und Palliativmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Lea de Jong
- Institut für Versicherungsbetriebslehre, Leibniz Universität Hannover, Hannover, Deutschland
| | - Birte Burger
- Stabsbereich Versorgungsforschung, AOK - Die Gesundheitskasse für Niedersachsen, Hannover, Deutschland
| | - Nils Schneider
- Institut für Allgemeinmedizin und Palliativmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Kathrin Damm
- Institut für Versicherungsbetriebslehre, Leibniz Universität Hannover, Hannover, Deutschland
| | - Jona T Stahmeyer
- Stabsbereich Versorgungsforschung, AOK - Die Gesundheitskasse für Niedersachsen, Hannover, Deutschland
| | - Beate Apolinarski
- Institut für Allgemeinmedizin und Palliativmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Franziska A Herbst
- Institut für Allgemeinmedizin und Palliativmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| |
Collapse
|
20
|
Tafazoli Moghadam E, Tafazoli A. Providing care for siblings of children on hospice. Palliat Support Care 2024; 22:417-418. [PMID: 37818646 DOI: 10.1017/s1478951523001359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Affiliation(s)
| | - Ali Tafazoli
- Hospice Kingston, Queen's University, Kingston, ON, Canada
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
- Department of Health Care Administration, Kingston Campus, St Lawrence College, Kingston, ON, Canada
| |
Collapse
|
21
|
McLouth LE, Stapleton JL, Bursac V, Zelaya CM, Shelton BJ, Thakur K, Hands I, Blu C, Chih MY, McFarlin JM. Piloting a Patient Tool to Aid Palliative Care Referrals during Advanced Lung Cancer Treatment. J Pain Symptom Manage 2024; 67:337-345.e2. [PMID: 38219963 PMCID: PMC10939763 DOI: 10.1016/j.jpainsymman.2024.01.013] [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: 09/26/2023] [Revised: 01/02/2024] [Accepted: 01/06/2024] [Indexed: 01/16/2024]
Abstract
CONTEXT Patient misperceptions are a strong barrier to early palliative care discussions and referrals during advanced lung cancer treatment. OBJECTIVES We developed and tested the acceptability of a web-based patient-facing palliative care education and screening tool intended for use in a planned multilevel intervention (i.e., patient, clinician, system-level targets). METHODS We elicited feedback from advanced lung cancer patients (n = 6), oncology and palliative care clinicians (n = 4), and a clinic administrator (n = 1) on the perceived relevance of the intervention. We then tested the prototype of a patient-facing tool for patient acceptability and preliminary effects on patient palliative care knowledge and motivation. RESULTS Partners agreed that the intervention-clinician palliative care education and an electronic health record-integrated patient tool-is relevant and their feedback informed development of the patient prototype. Advanced stage lung cancer patients (n = 20; age 60 ± 9.8; 40% male; 70% with a technical degree or less) reviewed and rated the prototype on a five-point scale for acceptability (4.48 ± 0.55), appropriateness (4.37 ± 0.62), and feasibility (4.43 ± 0.59). After using the prototype, 75% were interested in using palliative care and 80% were more motivated to talk to their oncologist about it. Of patients who had or were at risk of having misperceptions about palliative care (e.g., conflating it with hospice), 100% no longer held the misperceptions after using the prototype. CONCLUSION The palliative care education and screening tool is acceptable to patients and may address misperceptions and motivate palliative care discussions during treatment.
Collapse
Affiliation(s)
- Laurie E McLouth
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, Kentucky, USA; Center for Health Equity Transformation, University of Kentucky, Lexington, Kentucky, USA; Markey Cancer Center, University of Kentucky, Lexington, Kentucky, USA.
| | - Jerod L Stapleton
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky, USA; Department of Health, Behavior, and Society, College of Public Health, University of Kentucky, Lexington, Kentucky, USA
| | - Vilma Bursac
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, Kentucky, USA; Center for Health Equity Transformation, University of Kentucky, Lexington, Kentucky, USA
| | - Carina M Zelaya
- Department of Communication, University of Maryland, Baltimore, Maryland, USA
| | - Brent J Shelton
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky, USA; Department of Internal Medicine, Division of Cancer Biostatistics, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Kshitij Thakur
- Department of Internal Medicine, Gastroenterology, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Isaac Hands
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky, USA
| | - Chaney Blu
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky, USA
| | - Ming-Yuan Chih
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky, USA; Department of Health and Clinical Sciences, College of Health Sciences, University of Kentucky, Lexington, Kentucky, USA
| | - Jessica M McFarlin
- Department of Neurology, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| |
Collapse
|
22
|
Huang HW, Liu CY, Tung TH, Liu LN. Effects of hospice-shared care on terminal cancer patients in Taiwan: A hospital-based observational study. Eur J Oncol Nurs 2024; 69:102525. [PMID: 38340644 DOI: 10.1016/j.ejon.2024.102525] [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: 04/18/2023] [Revised: 01/29/2024] [Accepted: 02/04/2024] [Indexed: 02/12/2024]
Abstract
PURPOSE To assess how hospice-shared care (HSC) affected the likelihood of aggressive medical treatments and the life quality among terminal cancer patients. METHODS In the first part, a cohort of 160 late-stage cancer patients who died in non-hospice wards were identified to review their charts in their last 22 days before death. In the second part, a total of 19 late-stage cancer patients with clear consciousness admitted to non-hospice wards were identified to investigate their quality of life for the final 2 weeks before death. RESULTS The utilization rate of HSC was 55.6%. Among these, the rate for late referral to HSC (≤7 days before death) was 43.8% and early referral (>3 months before death) was 5.6%. Compared to the non-HSC group, in the last few weeks of life, the HSC group underwent lower incidence of chemotherapy use (10.1% vs. 39.4%, p < .001), signed do-not-resuscitate orders (0% vs. 21.1%, p < .001), emergency room visits (13.5% vs. 40.8%, p < .001), intensive care unit admission or ventilator use (2.2% vs. 11.3%, p = .019), and endotracheal intubation (2.2% vs. 9.9%, p = .038). However, the quality of life did not appear to have obvious differences between the two groups (p > .05). CONCLUSION In Taiwan, late HSC referral in terminal cancer patients is common. HSC is associated with a reduced likelihood of aggressive medical utilization. However, the effect of HSC in improving patients' quality of life in the last few weeks needs to be further evaluated.
Collapse
Affiliation(s)
- Hui-Wen Huang
- Nursing Department, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Nursing, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Chun-Yu Liu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan; Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan
| | - Tao-Hsin Tung
- Evidence-based Medicine Center, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang, China
| | - Li-Ni Liu
- Department of Nursing, Fu Jen Catholic University, New Taipei City, Taiwan.
| |
Collapse
|
23
|
Osakwe ZT, Bollens-Lund E, Wang Y, Ritchie CS, Reckrey JM, Ornstein KA. Clinician Perception of Likelihood of Death in the Next Year Is Associated With 1-Year Mortality and Hospice Use Among Older Adults Receiving Home Health Care. J Palliat Med 2024; 27:481-486. [PMID: 38346312 PMCID: PMC10998701 DOI: 10.1089/jpm.2023.0043] [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] [Accepted: 11/01/2023] [Indexed: 04/06/2024] Open
Abstract
Background: Given the complex care needs of older adults receiving home health care (HHC), it is important for HHC clinicians to identify those with limited prognosis who may benefit from a transition to hospice care. Objectives: To assess the association between HHC clinician-identified likelihood of death and (1) 1-year mortality, and (2) hospice use. Methods: Prospective cohort study from the National Health and Aging Trends Study (NHATS) waves 2011-2018, linked to the Outcomes and Assessment Information Set (OASIS) HHC assessment and Medicare data among 915 community-dwelling NHATS respondents. HHC clinician-identified likelihood of death/decline was determined using OASIS item M1034. Multivariable logistic regression was used to assess the association between clinician-identified likelihood of death/decline and 1-year mortality and hospice use. Results: HHC clinicians identified 42% of the sample as at increased risk of decline or death. One year mortality was 22.3% (n = 548), and 15.88% (n = 303) used hospice within 12 months of HHC. HHC clinician-perceived likelihood of death/decline was associated with greater odds of 1-year mortality (odds ratio [OR], 6.57; confidence interval (95% CI), 2.56-16.90) and was associated with greater likelihood of hospice use (OR, 1.61; 95% CI, 1.00-2.62). Conclusion: HHC clinician perception of patients' risk of death or decline is associated with 1-year mortality. A better understanding of HHC patients at high risk for mortality can facilitate improved care planning and identification of homebound older adults who may benefit from hospice.
Collapse
Affiliation(s)
- Zainab Toteh Osakwe
- College of Nursing and Public Health, Adelphi University, Garden City, New York, USA
| | - Evan Bollens-Lund
- Icahn School of Medicine at Mount Sinai, Brookdale Department of Geriatrics and Palliative Medicine, New York, New York, USA
| | - Yihan Wang
- Icahn School of Medicine at Mount Sinai, Brookdale Department of Geriatrics and Palliative Medicine, New York, New York, USA
| | - Christine S. Ritchie
- Division of Palliative Care and Geriatric Medicine, Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer M. Reckrey
- Icahn School of Medicine at Mount Sinai, Brookdale Department of Geriatrics and Palliative Medicine, New York, New York, USA
| | - Katherine A. Ornstein
- Center for Equity in Aging, Johns Hopkins University, School of Nursing, Baltimore, Maryland, USA
| |
Collapse
|
24
|
Olsman E, Versteeg A. Happiness in Hospice Care in The Netherlands: A Case Study Design. J Relig Health 2024; 63:1538-1553. [PMID: 38421565 DOI: 10.1007/s10943-024-02011-w] [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] [Accepted: 02/01/2024] [Indexed: 03/02/2024]
Abstract
Happiness is central in spirituality but has hardly been explored in palliative care. The objective of this study is to explore happiness in hospice care in the Netherlands. A case study design consisting of participatory observations and semi-structured interviews was used. Happiness was associated with all dimensions of health. Patients spoke about a growing receptivity and a deepening of connections with themselves and others. Hospice staff related their happiness to feeling a true connection and their work supported them in appreciating their own lives in new ways. This study suggests that happiness can be found in settings that are frequently associated with suffering.
Collapse
Affiliation(s)
- Erik Olsman
- Section of Chaplaincy Studies, Department of Community & Care, Protestant Theological University, Janskerkhof 12, 3512 BL, Utrecht, The Netherlands.
| | | |
Collapse
|
25
|
Bower KA, Hallock J, Li X, Kent T, Wardlow L. Cost and Utilization Implications of a Health Plan's Home-Based Palliative Care Program. J Palliat Med 2024; 27:464-470. [PMID: 38271576 PMCID: PMC10998702 DOI: 10.1089/jpm.2023.0401] [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] [Accepted: 10/30/2023] [Indexed: 01/27/2024] Open
Abstract
Background: A California-based health plan offered home-based palliative care (HBPC) to members who needed support at home but did not yet qualify for hospice. Objectives: This study compares hospital and emergency department (ED) utilization and costs and mortality for individuals receiving HBPC to a cohort not receiving palliative care services (Usual Care). Design: This is an observational retrospective study using claims data covering a prestudy period and a study period during which time half of the study population received HBPC services. Setting/Subjects: Seriously ill individuals who received HBPC were matched with those receiving Usual Care using a propensity-based matching algorithm. Intervention: Interdisciplinary teams from home health and hospice agencies provided HBPC services. Measurements: Outcome measures included hospital and ED utilization and cost before and during the study period and mortality during the study period. Results: For both groups, hospital and ED utilization and associated costs were higher during the prestudy period than during the study period. No differences were found in outcome measures between groups during the study period. Average time in the study period was longer for the HBPC group than that in the Usual Care group, indicating that they lived longer or transitioned to hospice later. Conclusion: Although individuals in both groups were living with serious illnesses for which worsening health and increased acute care utilization are expected over time, both groups had reduced acute care utilization and costs during the study period compared with the prestudy period. Reduced utilization and costs were equivalent for both groups.
Collapse
Affiliation(s)
- Kimberly A. Bower
- Pediatric Palliative Care, Rady Children's Hospital San Diego, San Diego, California, USA
- Blue Shield of California, Oakland, California, USA
| | | | - Xiaoli Li
- Blue Shield of California, Oakland, California, USA
| | - Tyler Kent
- West Health Institute, La Jolla, California, USA
| | | |
Collapse
|
26
|
Dancis A. Do-Not-Hospitalize Orders in Assisted Living Facilities: Direct Care Workers' Perspectives. J Gerontol Nurs 2024; 50:11-15. [PMID: 38569104 DOI: 10.3928/00989134-20240311-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
PURPOSE To gather sufficient qualitative data to create an intervention that would prevent direct care workers (DCWs) from sending residents with do-not-hospitalize (DNH) orders to the hospital. METHOD This was a qualitative study with eight participants that included a descriptive survey followed by semi-structured interviews. RESULTS DCWs were unfamiliar with DNH orders and their thinking on end-of-life care was binary (hospice or hospital) and protocol driven. However, supportive leaders were able to help DCWs problem-solve these complicated scenarios. Results were mixed on whether having a RN on site was helpful. CONCLUSION DCWs may benefit from having access to a nurse with palliative care experience when making decisions about residents with DNH orders. [Journal of Gerontological Nursing, 50(4), 11-15.].
Collapse
|
27
|
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.
Collapse
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
| |
Collapse
|
28
|
Breitsameter C. When dying does not go well: a qualitative study. BMC Palliat Care 2024; 23:69. [PMID: 38461270 PMCID: PMC10924395 DOI: 10.1186/s12904-024-01379-6] [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: 01/11/2023] [Accepted: 02/06/2024] [Indexed: 03/11/2024] Open
Abstract
BACKGROUND Several studies deal with the question of what constitutes a "satisfactory death". A smaller number of studies deal with unsatisfactory dying processes. And only a few shed light on unsatisfactory deaths that take place in hospices and palliative care units, which see themselves as places conducive to a "good" death. What also remains largely undiscussed are the ethical aspects that accompany the observation of an unsatisfactory course of death. METHOD The research was carried out as an exploratory and qualitative study. The data collection and analysis were based on the methods of the "grounded theory". RESULTS Notions of a bad death are articulated here, though hardly by the affected persons and their relatives themselves, but rather by the professionals. Principally, descriptions of unsatisfactory dying processes refer to deficient success in symptom control, whereby the principle of autonomy is of particular importance. The focus here is not only on the needs of patients, but also on the needs of staff. The manifestation of such notions is related to the requirements arising from a practice that apparently evokes a need for accountability in the form of communicative reassurance. CONCLUSION An idealised definition of "dying well" is in danger of losing sight of the contextual specifics of the practice involved, which can lead to ethically problematic situations.
Collapse
Affiliation(s)
- Christof Breitsameter
- Lehrstuhl für Moraltheologie, Katholisch-Theologische Fakultät, Ludwig-Maximilians-Universität München, Geschwister-Scholl-Platz 1, 80539, Munich, Germany.
| |
Collapse
|
29
|
Richardson S, Price J, Sheedy G, Chadwick A. Simulated learning for staff at a children's hospice: a quality improvement project. Nurs Child Young People 2024; 36:21-26. [PMID: 37718550 DOI: 10.7748/ncyp.2023.e1489] [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] [Accepted: 05/15/2023] [Indexed: 09/19/2023]
Abstract
Simulated learning has well known positive effects but its use in palliative care education is limited. A quality improvement project was undertaken at a children's hospice to develop and evaluate simulation workshops. The aim was to increase the knowledge, skills and confidence of nurses and healthcare assistants in managing challenging situations commonly experienced when caring for children with life-limiting conditions and their families. The Plan, Do, Study, Act (PDSA) model for improvement was used to test simulation workshops on a small scale using a post-workshop questionnaire and reflective diaries. Despite some initial anxiety, participants felt that the workshop had enhanced their confidence, knowledge and skills, particularly in relation to conducting challenging conversations. The project has provided insight and evidence to develop simulated learning at the children's hospice and further afield.
Collapse
Affiliation(s)
| | - Jayne Price
- Kingston University, London, England; Rebecca Whiting, practice education facilitator, Shooting Star Children's Hospices, Guildford, England
| | | | - Anna Chadwick
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, England
| |
Collapse
|
30
|
Irvin K, Kitsantas P, Wojtusiak J, Avramovic S, Xue H. Assessing the Impact of the Center for Medicare and Medicaid Services Policy Guidance on Part D Prescriptions Among Hospice Patients. Am J Hosp Palliat Care 2024; 41:302-308. [PMID: 37194055 DOI: 10.1177/10499091231176048] [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: 05/18/2023] Open
Abstract
Hospice care facilities are required to provide prescription drugs related to a hospice patient's terminal illness. From October 2010 to present, the Center for Medicare and Medicaid Services (CMS) has issued a series of communications regarding Medicare paying for hospice patients' prescription drugs under Part D that should be covered under the hospice Medicare Part A benefit. On April 4, 2011, CMS issued specific policy guidance to providers aimed at preventing inappropriate billing. While CMS has documented Part D prescription decreases in hospice patients, no research exists that connects these decreases and the policy guidance. This study aims to evaluate the effect of the April 4, 2011, policy guidance on hospice patients' Part D prescriptions. This study employed generalized estimating equations to assess (1) total monthly average prescriptions of all medications and (2) four categories of commonly prescribed hospice medications in pre-and-post policy guidance. This research used the Medicare claims of 113,260 Part D-enrolled Medicare male patients aged 66 and older between April 2009 and March 2013, including 110,547 non-hospice patients and 2713 hospice patients. Hospice patients' monthly average total Part D prescriptions decreased from 7.3 pre-policy guidance to 6.5 medications following the issuing of the guidance, while the four categories of hospice-specific medications decreased from .57 to .49. The findings of this study show that CMS's guidance issued to providers to prevent the inappropriate billing of hospice patients' prescriptions to the Part D benefit may lead to Part D prescription decreases as observed in this sample.
Collapse
Affiliation(s)
- Katherine Irvin
- Department of Health Administration and Policy, George Mason University College of Health and Human Services, Fairfax, VA, USA
| | - Panagiota Kitsantas
- Department of Health Administration and Policy, George Mason University College of Health and Human Services, Fairfax, VA, USA
| | - Janusz Wojtusiak
- Department of Health Administration and Policy, George Mason University College of Health and Human Services, Fairfax, VA, USA
| | - Sanja Avramovic
- Department of Health Administration and Policy, George Mason University College of Health and Human Services, Fairfax, VA, USA
| | - Hong Xue
- Department of Health Administration and Policy, George Mason University College of Health and Human Services, Fairfax, VA, USA
| |
Collapse
|
31
|
Morrison KT, Bailey FA, Nowels D, Scott MC. A Report on the Innovative University of Colorado Community Hospice and Palliative Medicine Fellowship. J Palliat Med 2024; 27:400-404. [PMID: 38133545 DOI: 10.1089/jpm.2023.0286] [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: 12/23/2023] Open
Abstract
Background: Predictive health services modeling signals a shortage of board-certified Hospice and Palliative Medicine (HPM) physicians. Methods: This article introduces the Community Hospice and Palliative Medicine (CHPM) Fellowship, an Accreditation Council for Graduate Medical Education (ACGME) Advancing Innovation in Residency Education (AIRE) project designed to enable mid-career physicians (at least five years out from residency or fellowship) to achieve eligibility for board certification in HPM. Results: From 2020 to 2023, 24 fellows have completed or are currently participating in the CHPM fellowship which is evaluated using the Kirkpatrick model. Conclusion: This program shows promise in addressing the impending HPM workforce shortage by allowing physicians to complete a fellowship in their local communities.
Collapse
Affiliation(s)
- Katherine T Morrison
- Division of General Internal Medicine, Department of Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - F Amos Bailey
- Division of General Internal Medicine, Department of Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - David Nowels
- Department of Family Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Maurice C Scott
- Division of General Internal Medicine, Department of Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| |
Collapse
|
32
|
He X, Li B, Liu X, Jiao P, Zhao Y. Correlation between hospice competence and death coping ability among nursing students in China: A cross-sectional survey. Nurse Educ Today 2024; 134:106080. [PMID: 38163389 DOI: 10.1016/j.nedt.2023.106080] [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: 02/21/2023] [Revised: 12/13/2023] [Accepted: 12/18/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Palliative care involves providing comprehensive physical, psychological, and social care to improve clinical symptoms and quality of life, as well as to ensure patients' dignity at the end of life. Nurses are important members of hospice care teams, and undergraduate nursing students are the hospice care providers of the future. The ability of undergraduate nursing students to provide hospice care will, thus, directly affect service quality. OBJECTIVE To understand the relationship between hospice competence and the death-coping abilities of nursing students and provide a theoretical basis for promoting the development of hospice education for nursing students. METHODS A convenience sample of 204 nursing students from a university in China completed the general conditions questionnaire, Hospice Competency Assessment Questionnaire, and a simplified version of the Coping with Death Scale. RESULTS The participants' overall average hospice competency score was 46 (35-52), with an average score of 3.0 (2.3-3.3) for effective caregiving skills, 2.6 (2.0-3.0) for cultural and ethical values, and 3.0 (2.2-3.4) for interprofessional teamwork. The average death-coping competency score was 92 (72-107). Multivariate logistic regression and Spearman's correlation analysis showed a positive correlation between death-coping and hospice competencies (P < 0.05). CONCLUSION Nursing students' overall hospice competency is low to moderate. Consequently, nurse educators should effectively modify the hospice education curriculum using the Dedicated Education Unit model.
Collapse
Affiliation(s)
- Xiaona He
- Nursing Department of Xinjiang Medical University, China
| | - Boya Li
- Nursing Department of Xinjiang Medical University, China
| | - Xinxin Liu
- Nursing Department of Xinjiang Medical University, China
| | - Peijuan Jiao
- Nursing Department of Xinjiang Medical University, China
| | - Yue Zhao
- Nursing Department of Xinjiang Medical University, China.
| |
Collapse
|
33
|
Mayahara M, Tay DL, Kates J, Rosa WE. Palliating Serious Illness During Disasters and Public Health Emergencies. Am J Nurs 2024; 124:56-60. [PMID: 38386836 DOI: 10.1097/01.naj.0001008424.70710.ca] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
ABSTRACT The increase in disasters and public health emergencies in recent years is a serious public health concern. The needs of suffering victims can be multifaceted, particularly the needs of those who are from systematically marginalized populations. Palliative care nurses play a vital role in mitigating the suffering of those affected by these events. Despite the acute need, there is a lack of nurses who specialize in hospice and palliative care and generalist nurses are not sufficiently prepared to provide palliative care during disasters and public health emergencies. Nurses and nursing students should use national and global resources and training opportunities to hone their palliative care skills as well as learn self-care skills to increase their resiliency. Outcomes from research and collaborative efforts should be used to educate the future nursing workforce and advocate for equitable delivery of quality palliative care for all people who are affected by disasters and public health emergencies.
Collapse
Affiliation(s)
- Masako Mayahara
- Masako Mayahara is professor of nursing in the Goldfarb School of Nursing, Barnes-Jewish College, and associate professor in the Division of Palliative Medicine, Washington University School of Medicine, St. Louis. Djin L. Tay is assistant professor at the University of Utah College of Nursing, Salt Lake City. Jeannette Kates is associate professor and director, Adult-Gerontology Primary Care Nurse Practitioner Program, Thomas Jefferson University, Philadelphia. William E. Rosa is assistant attending behavioral scientist, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York City. Contact author: Masako Mayahara, . The authors have disclosed no potential conflicts of interest, financial or otherwise
| | | | | | | |
Collapse
|
34
|
Guo M, Guo L, Li Y. Nonprofit behavior altered by monetary donations: evidence from the U.S. hospice industry. Eur J Health Econ 2024; 25:207-220. [PMID: 36913132 DOI: 10.1007/s10198-023-01571-0] [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: 08/14/2022] [Accepted: 01/30/2023] [Indexed: 06/18/2023]
Abstract
This study investigates whether reliance on monetary donations alters nonprofit firms' behaviors. Specifically, in the hospice industry, a shorter patients' length of stay (LOS) speeds up overall patient turnover, allowing a hospice to serve more patients and expand its donation network. We measure hospices' donation reliance using the donation-revenue ratio, which indicates the importance of donations for revenue structure. By exploiting the supply shifter of donation, we adopt the number of donors as an instrument to control for the potential endogeneity issue. Our result suggests that a one-percentage-point increase in the donation-revenue ratio decreases patient LOS by 8%. Hospices that are more reliant on donations serve patients diagnosed with diseases that have shorter life expectancies to achieve a lower average LOS of all patients' stay. Overall, we find that monetary donations alter the behavior of nonprofit organizations.
Collapse
Affiliation(s)
- Miao Guo
- College of Finance and Statistics, Hunan University, Changsha, China
| | - Lei Guo
- School of Government, University of Chinese Academy of Social Science, Beijing, China
| | - Yang Li
- School of Economics, Faculty of Humanities and Social Sciences, The University of Nottingham Ningbo China, Room 310-2 IEB, 199 Taikang East Road, Ningbo, 315100, China.
| |
Collapse
|
35
|
Dias N, White M, Harmuth S, Horvick S. A Structured Home Health and Hospice Clinical Rotation and Onboarding Model to Address the Nursing Shortage. Home Healthc Now 2024; 42:78-83. [PMID: 38437040 DOI: 10.1097/nhh.0000000000001237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
North Carolina home health and hospice agencies are experiencing serious shortages of registered nurses (RNs), particularly in rural areas. These shortages can negatively impact patients and families by delaying access to care and possibly resulting in avoidable hospitalizations/rehospitalizations. Many home health and hospice agencies do not hire newly graduated RNs due to limited patient care experience, limited or no opportunity for home health/hospice clinical rotations, and the autonomous nature of providing care in the home. The Hospice and Home Health Foundation of North Carolina was awarded a $468,196 3-year grant, and, in collaboration with key stakeholders, developed a model for clinical rotation experiences in home health and hospice settings for RN students as well as an onboarding model for newly graduated RNs. Seven home health and hospice project partner agencies were selected to pilot the models. This article describes program implementation and evaluation. We used a survey method and site visit interviews to assess program effectiveness. Students provided positive feedback about the clinical rotation and more than 80% indicated their clinical rotation met "most" or "almost all" of their learning needs. The focus group interviews provided substantive anecdotal examples to validate the survey results.
Collapse
|
36
|
Starr LT, Washington K, Pitzer K, Oliver DP, Demiris G. Close but Not Close Enough: How Distance Caregiving is Associated with Hospice Family Caregiver Hospice Communication Experiences. Health Commun 2024; 39:482-492. [PMID: 36683376 PMCID: PMC10362092 DOI: 10.1080/10410236.2023.2170199] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Half of hospice family caregivers report having unmet information needs, which can contribute to poor pain and symptom management, emergency department use, and hospice disenrollment for care-recipients and to caregiver strain and stress. Effective communication between hospice teams and family caregivers is critical yet communication inadequacies persist. Despite the growing prevalence of distance caregiving, including in hospice care, and the relationship between caregiver proximity and communication effectiveness, little is known about how caregiver proximity is associated with caregiver perceptions of hospice communication. In this secondary analysis of quantitative data from two multisite randomized clinical trials (NCT03712410 and NCT02929108) for hospice family caregivers (N = 525), multivariate linear models with demographic and contextual controls were used to analyze caregivers' perceptions of caregiver-centered communication with hospice providers based on caregiver proximity to the hospice care-recipient. In multivariate models, "local" hospice family caregivers who lived within 1 hour of the hospice care-recipient reported less effective communication with the hospice team than co-residing caregivers; and older caregivers rated communication more favorably than younger caregivers. To improve communication and collaboration between hospice teams and caregivers, regardless of proximity, distance communication training for hospice teams and interventions such as telehealth communication and virtual tools that enable triadic collaboration are recommended. Research is needed to understand why local caregivers, specifically, perceive communication quality less favorably and how hospice teams can better meet local and distance caregiver communication needs.
Collapse
Affiliation(s)
- Lauren T. Starr
- NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Department of Biobehavioral Health Sciences, Philadelphia, Pennsylvania
| | - Karla Washington
- Washington University in St. Louis School of Medicine, Division of Palliative Medicine, St. Louis, Missouri
| | - Kyle Pitzer
- Washington University in St. Louis School of Medicine, Division of Palliative Medicine, St. Louis, Missouri
| | - Debra Parker Oliver
- Washington University in St. Louis School of Medicine, Division of Palliative Medicine, St. Louis, Missouri
- Barnes Jewish College, Goldfarb School of Nursing, St. Louis, Missouri
| | - George Demiris
- NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Department of Biobehavioral Health Sciences, Philadelphia, Pennsylvania
- University of Pennsylvania Perelman School of Medicine, Department of Biostatistics and Epidemiology, Philadelphia, Pennsylvania
| |
Collapse
|
37
|
Stolzberg N, Paramanandam G, Myers SR, Abreu S, Volk-Craft BE. A Tunneled Catheter Placement Program for Community Hospices. J Pain Symptom Manage 2024; 67:e163-e168. [PMID: 37992847 DOI: 10.1016/j.jpainsymman.2023.11.008] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 11/24/2023]
Abstract
CONTEXT The symptoms associated with the excessive fluid accumulation of ascites or pleural effusions can be intractable to medical management and can have a significant negative impact on quality of life of hospice patients. Hospice of the Valley, a community-based, nonprofit hospice agency has historically referred patients to outpatient providers for paracentesis, thoracentesis, and placement of tunneled drainage catheters. OBJECTIVES To describe an in-house pilot program of tunneled catheter placement to provide immediate and longer-term symptom relief for selected hospice patients. METHODS The logistics and cost of the pilot program are described. Key data elements, including select demographics, patient eligibility screening, and incidence of procedure-related or late complications are reported. RESULTS A total of 135 drainage procedures completed on 127 unique hospice patients over 27 months (2020-2023) were reviewed. The rate of procedure-related complications (<4%) and late complications (<3%) are low. The average cost per procedure ($1030) compares favorably with outpatient providers' fees. The program was well-accepted by the interdisciplinary hospice team, patients, and families. CONCLUSIONS An in-house program of tunneled catheter placement is a feasible option for hospice providers with low-cost exposure and high potential for improved quality of life and symptom relief for selected patients.
Collapse
Affiliation(s)
- Ned Stolzberg
- Hospice of the Valley (N.S., S.M., S.A.), Phoenix, Arizona, USA.
| | | | - Shelly R Myers
- Hospice of the Valley (N.S., S.M., S.A.), Phoenix, Arizona, USA.
| | - Shawn Abreu
- Hospice of the Valley (N.S., S.M., S.A.), Phoenix, Arizona, USA.
| | | |
Collapse
|
38
|
Sonal S, Jain B, Bajaj SS, Dee EC, Boudreau C, Cusack JC, Kunitake H, Goldstone R, Bordeianou LG, Cauley Md CE, Francone TD, Ricciardi R, Qadan M, Berger DL. Trends and Determinants of Location of Death Due to Colorectal Cancer in the United States : A Nationwide Study. Ann Surg Oncol 2024; 31:1447-1454. [PMID: 37907701 DOI: 10.1245/s10434-023-14337-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 08/09/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND Colorectal cancer (CRC) is the second leading cause of cancer-related mortality in the United States (US); however, there are limited data on location of death in patients who die from CRC. We examined the trends in location of death and determinants in patients dying from CRC in the US. METHODS We utilized the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database to extract nationwide data on underlying cause of death as CRC. A multinomial logistic regression was performed to assess associations between clinico-sociodemographic characteristics and location of death. RESULTS There were 850,750 deaths due to CRC from 2003 to 2019. There was a gradual decrease in deaths in hospital, nursing home, or outpatient facility/emergency department over time and an increase in deaths at home and in hospice. Relative to White decedents, Black, Asian, and American Indian/Alaska Native decedents were less likely to die at home and in hospice compared with hospitals. Individuals with lower educational status also had a lower risk of dying at home or in hospice compared with in hospitals. CONCLUSIONS The gradual shift in location of death of patients who die of CRC from institutionalized settings to home and hospice is a promising trend and reflects the prioritization of patient goals for end-of-life care by healthcare providers. However, there are existing sociodemographic disparities in access to deaths at home and in hospice, which emphasizes the need for policy interventions to reduce health inequity in end-of-life care for CRC.
Collapse
Affiliation(s)
- Swati Sonal
- Wang Ambulatory Care Center (WACC) 460, Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
- Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - Bhav Jain
- Massachusetts Institute of Technology, Cambridge, MA, USA
| | | | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Chloe Boudreau
- Wang Ambulatory Care Center (WACC) 460, Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
- University of Oxford, Oxford, UK
| | - James C Cusack
- Wang Ambulatory Care Center (WACC) 460, Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
- Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - Hiroko Kunitake
- Wang Ambulatory Care Center (WACC) 460, Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
- Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - Robert Goldstone
- Wang Ambulatory Care Center (WACC) 460, Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
- Department of Surgery, Harvard Medical School, Boston, MA, USA
- Department of Surgery, Newton-Wellesley Hospital, Newton, MA, USA
| | - Liliana G Bordeianou
- Wang Ambulatory Care Center (WACC) 460, Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
- Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - Christy E Cauley Md
- Wang Ambulatory Care Center (WACC) 460, Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
- Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - Todd D Francone
- Department of Surgery, Newton-Wellesley Hospital, Newton, MA, USA
- Department of Surgery, Tufts University School of Medicine, Boston, MA, USA
| | - Rocco Ricciardi
- Wang Ambulatory Care Center (WACC) 460, Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
- Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - Motaz Qadan
- Wang Ambulatory Care Center (WACC) 460, Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
- Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - David L Berger
- Wang Ambulatory Care Center (WACC) 460, Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.
- Department of Surgery, Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
39
|
Svynarenko R, Huang G, Keim-Malpass J, Cozad MJ, Qualls KA, Stone Sharp W, Kirkland DA, Lindley LC. A Comparison of Hospice Care Utilization Between Rural and Urban Children in Appalachia: A Geographic Information Systems Analysis. Am J Hosp Palliat Care 2024; 41:288-294. [PMID: 37115718 PMCID: PMC10826679 DOI: 10.1177/10499091231173415] [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: 04/29/2023] Open
Abstract
Long driving times from hospice providers to patients lead to poor quality of care, which may exacerbate in rural and highly isolated areas of Appalachia. This study aimed to investigate geographic patterns of pediatric hospice care across Appalachia. Using person-level Medicaid claims of 1,788 pediatric hospice enrollees who resided in the Appalachian Region between 2011 and 2013. A database of boundaries of Appalachian counties, postal addresses of hospices, and population-weighted county centroids of residences of hospice enrollees driving times from the nearest hospices were calculated. A choropleth map was created to visualize rural/urban differences in receiving hospice care. The average driving time from hospice to child residence was 28 minutes (SD = 26). The longest driving time was in Eastern Kentucky-126 minutes (SD = 32), and the shortest was in South Carolina-11 min (SD = 9.1). The most significant differences in driving times between rural and urban counties were found in Virginia 28 (SD = 7.5) and 5 minutes (SD = 0), respectively, Tennessee-43 (SD = 28) and 8 minutes (SD = 7), respectively; and West Virginia-49 (SD = 30) and 12 minutes (SD = 4), respectively. Many pediatric hospice patients reside in isolated counties with long driving times from the nearest hospices. State-level policies should be developed to reduce driving times from hospice providers.
Collapse
Affiliation(s)
| | - Guoping Huang
- Spatial Sciences Institute, University of Southern California, Los Angeles, CA, USA
| | | | - Melanie J Cozad
- Department of Health Services Research and Administration, University of Nebraska Medical Center, Omaha, NE, USA
| | - Kerri A Qualls
- College of Nursing, University of Tennessee, Knoxville, TN, USA
| | | | - Deb A Kirkland
- College of Nursing, University of Tennessee, Knoxville, TN, USA
| | - Lisa C Lindley
- College of Nursing, University of Tennessee, Knoxville, TN, USA
| |
Collapse
|
40
|
McDarby M, Russell D, King L, Kozlov E, Luth EA. Knowledge Gaps in End-Of-Life Family Caregiving for Persons Living With Dementia: A Study of Hospice Clinician Perspectives. Am J Hosp Palliat Care 2024; 41:270-280. [PMID: 37173809 PMCID: PMC10640658 DOI: 10.1177/10499091231176298] [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: 05/15/2023] Open
Abstract
INTRODUCTION More than 35% of hospice care recipients 65 and older have a dementia diagnosis. Yet family care partners of persons living with dementia report feeling unprepared to address their hospice recipient's changing needs nearing end of life. Hospice clinicians may have unique insight into the knowledge needs of family care partners and strategies for end-of-life dementia caregiving. METHODS Semi-structured interviews were conducted with 18 hospice physicians, nurse practitioners, nurses, and social workers. Interview transcripts were deductively analyzed using thematic analysis to examine clinicians' perspectives on gaps and strategies related to family care partner knowledge about end-of-life dementia caregiving. RESULTS We identified 3 themes related to gaps in family care partners' knowledge: dementia is a progressive, fatal disease; end-of-life symptoms and symptom management in persons living with advanced dementia; and understanding hospice goals and guidelines. Three themes related to clinicians' strategies to increase knowledge included: providing education; teaching strategies to facilitate coping and preparedness for end-of-life care; and communicating with empathy. DISCUSSION Clinicians perceive gaps in knowledge specific to dementia and end of life among family care partners. These gaps include a lack of understanding of Alzheimer's symptom progression and strategies to manage common symptoms. Recommendations for approaches to reduce knowledge gaps include providing education and strategies delivered with empathy toward the family care partner experience. CONCLUSION Clinicians who work with persons living with dementia receiving hospice care have valuable insights regarding family care partners' gaps in knowledge. Implications on the training and preparation of hospice clinicians working with this care partner population are discussed.
Collapse
Affiliation(s)
- Meghan McDarby
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David Russell
- Department of Sociology, Appalachian State University, Boone, NC, USA
- VNS Health, Center for Home Care Policy & Research, New York, NY, USA
| | - Lori King
- VNS Health, Center for Home Care Policy & Research, New York, NY, USA
| | - Elissa Kozlov
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Elizabeth A. Luth
- Institute for Health, Health Care Policy, and Aging Research and Department of Family Medicine and Community Health, Rutgers University, New Brunswick, NJ, USA
| |
Collapse
|
41
|
Tilley CP. Evolution of the Specialist-Level Palliative Wound, Ostomy, and Continence Nurse in Hospice and Palliative Settings: A View From Here. J Wound Ostomy Continence Nurs 2024; 51:99-100. [PMID: 38527316 DOI: 10.1097/won.0000000000001066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Affiliation(s)
- Charles P Tilley
- Charles P. Tilley, PhD, ANP-BC, ACHPN, CWOCN, Albany Medical Center, Albany, New York; and Rutgers School of Nursing-Camden, Camden, New Jersey
| |
Collapse
|
42
|
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.
Collapse
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
| |
Collapse
|
43
|
Scanlon H, Latchford G, Allsop M. 'So being here is. . . I feel like I'm being a social worker again, at the hospice': Using interpretative phenomenological analysis to explore social workers' experiences of hospice work. Palliat Med 2024; 38:320-330. [PMID: 38372027 PMCID: PMC10955780 DOI: 10.1177/02692163231220163] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
BACKGROUND Social workers have a significant role in hospices working with clients who are facing death but there is limited detailed understanding of the emotional impact of this work on social workers. Research has highlighted that those involved in hospice work find the work both a struggle (e.g. because of heightened emotions) and rewarding (noting that end-of-life care can feel like a privilege). AIM To explore UK hospice social workers' emotional experiences of work and how this influences their practice. DESIGN Semi-structured interviews were conducted with hospice social workers. Interviews were transcribed and transcripts were analysed using Interpretative Phenomenological Analysis. SETTING/PARTICIPANTS Eight social workers from different hospices in the UK. RESULTS Five overlapping superordinate themes emerged: making a difference to clients and families ('the difference made'), the emotional impact of working in hospices ('dealing with people's emotions, and death, and dying, it's serious stuff'), the relational context of this type of work ('awareness of affinity to connect'), the ways in which coping is facilitated in hospices ('seen it coming') and a foundation theme, connection and disconnection to values ('(dis)connection to values'). CONCLUSIONS The results offer an exploration of social workers' experiences of their work in hospices; how adept they were at coping and how they prepared for and made sense of the often emotionally-laden experiences encountered. Their experience of the rewards and meaning derived from their work offers important findings for clinical practice. Further research is suggested to explore a multitude of healthcare professionals' perspectives across country settings using Interpretative Phenomenological Analysis.
Collapse
Affiliation(s)
- Hayley Scanlon
- Leeds Teaching Hospitals NHS Trust, St James’ University Hospital, Leeds, UK
| | | | | |
Collapse
|
44
|
Goett R, Lyou J, Willoughby LR, Markwalter DW, Gorgas DL, Southerland LT. Integrating Hospice and Palliative Medicine Education Within the American Board of Emergency Medicine Model. West J Emerg Med 2024; 25:213-220. [PMID: 38596921 PMCID: PMC11000566 DOI: 10.5811/westjem.18448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/20/2023] [Accepted: 01/12/2023] [Indexed: 04/11/2024] Open
Abstract
Background Hospice and palliative medicine (HPM) is a board-certified subspecialty within emergency medicine (EM), but prior studies have shown that EM residents do not receive sufficient training in HPM. Experts in HPM-EM created a consensus list of competencies for HPM training in EM residency. We evaluated how the HPM competencies integrate within the American Board of Emergency Medicine Milestones, which include the Model of the Clinical Practice of Emergency Medicine (EM Model) and the knowledge, skills, and abilities (KSA) list. Methods Three emergency physicians independently mapped the HPM-EM competencies onto the 2019 EM Model items and the 2021 KSAs. Discrepancies were resolved by a fourth independent reviewer, and the final mapping was reviewed by all team members. Results The EM Model included 78% (18/23) of the HPM competencies as a direct match, and we identified recommended areas for incorporating the other five. The KSAs included 43% (10/23). Most HPM competencies included in the KSAs mapped onto at least one level B (minimal necessary for competency) KSA. Three HPM competencies were not clearly included in the EM Model or in the KSAs (treating end-of-life symptoms, caring for the imminently dying, and caring for patients under hospice care). Conclusion The majority of HPM-EM competencies are included in the current EM Model and KSAs and correspond to knowledge needed to be competent in EM. Programs relying on the EM Milestones to plan their curriculums may miss training in symptom management and care for patients at the end of life or who are on hospice.
Collapse
Affiliation(s)
- Rebecca Goett
- Rutgers New Jersey Medical School, Department of Emergency Medicine, Newark, New Jersey
| | - Jason Lyou
- The Ohio State University Wexner Medical Center, Department of Emergency Medicine, Columbus, Ohio
| | - Lauren R. Willoughby
- The Ohio State University Wexner Medical Center, Department of Emergency Medicine, Columbus, Ohio
| | - Daniel W. Markwalter
- University of North Carolina School of Medicine, Department of Emergency Medicine, Chapel Hill, North Carolina
- University of North Carolina School of Medicine, UNC Palliative Care Program, Chapel Hill, North Carolina
| | - Diane L. Gorgas
- The Ohio State University Wexner Medical Center, Department of Emergency Medicine, Columbus, Ohio
| | - Lauren T. Southerland
- The Ohio State University Wexner Medical Center, Department of Emergency Medicine, Columbus, Ohio
| |
Collapse
|
45
|
Wang YJ, Hsu CY, Yen AMF, Chen HH, Lai CC. Advancing screening tool for hospice needs and end-of-life decision-making process in the emergency department. BMC Palliat Care 2024; 23:51. [PMID: 38389106 PMCID: PMC10885365 DOI: 10.1186/s12904-024-01391-w] [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: 12/12/2023] [Accepted: 02/19/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Predicting mortality in the emergency department (ED) is imperative to guide palliative care and end-of-life decisions. However, the clinical usefulness of utilizing the existing screening tools still leaves something to be desired. METHODS We advanced the screening tool with the A-qCPR (Age, qSOFA (quick sepsis-related organ failure assessment), cancer, Performance Status Scale, and DNR (Do-Not-Resuscitate) risk score model for predicting one-year mortality in the emergency department of Taipei City Hospital of Taiwan with the potential of hospice need and evaluated its performance compared with the existing screening model. We adopted a large retrospective cohort in conjunction with in-time (the trained and the holdout validation cohort) for the development of the A-qCPR model and out-of-time validation sample for external validation and model robustness to variation with the calendar year. RESULTS A total of 10,474 patients were enrolled in the training cohort and 33,182 patients for external validation. Significant risk scores included age (0.05 per year), qSOFA ≥ 2 (4), Cancer (5), Eastern Cooperative Oncology Group (ECOG) Performance Status score ≥ 2 (2), and DNR status (2). One-year mortality rates were 13.6% for low (score ≦ 3 points), 29.9% for medium (3 < Score ≦ 9 points), and 47.1% for high categories (Score > 9 points). The AUROC curve for the in-time validation sample was 0.76 (0.74-0.78). However, the corresponding figure was slightly shrunk to 0.69 (0.69-0.70) based on out-of-time validation. The accuracy with our newly developed A-qCPR model was better than those existing tools including 0.57 (0.56-0.57) by using SQ (surprise question), 0.54 (0.54-0.54) by using qSOFA, and 0.59 (0.59-0.59) by using ECOG performance status score. Applying the A-qCPR model to emergency departments since 2017 has led to a year-on-year increase in the proportion of patients or their families signing DNR documents, which had not been affected by the COVID-19 pandemic. CONCLUSIONS The A-qCPR model is not only effective in predicting one-year mortality but also in identifying hospice needs. Advancing the screening tool that has been widely used for hospice in various scenarios is particularly helpful for facilitating the end-of-life decision-making process in the ED.
Collapse
Affiliation(s)
- Yu-Jing Wang
- Department of Emergency Medicine, Taipei City Hospital, Taiwan. No. 10, Sec. 4, Ren-Ai Road, Ren-Ai Branch, Taipei, Taiwan
- Master of Public Health Program, National Taiwan University, Taipei, Taiwan
| | - Chen-Yang Hsu
- Master of Public Health Program, National Taiwan University, Taipei, Taiwan
- Medical Department, Daichung Hospital, Miaoli, Taiwan
- Taiwan Association of Medical Screening, Taipei, Taiwan
| | - Amy Ming-Fang Yen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hsiu-Hsi Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chao-Chih Lai
- Department of Emergency Medicine, Taipei City Hospital, Taiwan. No. 10, Sec. 4, Ren-Ai Road, Ren-Ai Branch, Taipei, Taiwan.
- Master of Public Health Program, National Taiwan University, Taipei, Taiwan.
| |
Collapse
|
46
|
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.
Collapse
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
| |
Collapse
|
47
|
O'Malley KA, Baird L, Kaiser AP, Bashian HM, Etchin AG, Sager ZS, Heintz H, Korsun L, Kemp K, Moye J. Maximizing Veterans Health Affairs Community Hospice Collaborations: Review of Perceived Resource Needs to Support Veterans at End of Life. J Hosp Palliat Nurs 2024; 26:21-28. [PMID: 37962223 DOI: 10.1097/njh.0000000000000980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Within the United States, approximately 330 000 military veterans die annually, but only 5% of deaths occur in Veterans Health Administration (VHA) facilities. To help provide end-of-life care for veterans, the VHA built community partnerships with community hospice and palliative care (HPC) organizations. Veterans experience unique psychosocial factors making it vital to ensure HPC organizations have access to veteran-specific knowledge and resources to reduce suffering. To better understand the strengths and limitations of these partnerships, community HPC staff (N = 483) responded to quantitative and qualitative survey questions developed using an access to care theory for veterans. Survey responses demonstrated variable perceptions of access to VHA care and resources. Respondents reported excellent experiences (44%) and relationships with their local facility (50%) and had a reliable contact who provided needed assistance (92%). Thematic analysis identified a need for VHA care and barriers to access, which were associated with technical characteristics, and geographical and cultural issues. These findings can help inform future research and policy regarding access to VHA resources for end-of-life care for veterans in the community and guide resource development for community HPC providers.
Collapse
|
48
|
Wendel SK, Whitcomb M, Solomon A, Swafford A, Youngwerth J, Wiler JL, Bookman K. Emergency department hospice care pathway associated with decreased ED and hospital length of stay. Am J Emerg Med 2024; 76:99-104. [PMID: 38039564 DOI: 10.1016/j.ajem.2023.11.017] [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: 07/02/2023] [Revised: 11/03/2023] [Accepted: 11/10/2023] [Indexed: 12/03/2023] Open
Abstract
INTRODUCTION While increasing evidence shows that hospice and palliative care interventions in the ED can benefit patients and systems, little exists on the feasibility and effectiveness of identifying patients in the ED who might benefit from hospice care. Our aim was to evaluate the effect of a clinical care pathway on the identification of patients who would benefit from hospice in an academic medical center ED setting. METHODS We instituted a clinical pathway for ED patients with potential need for or already enrolled in hospice. This pathway was digitally embedded in the electronic health record and made available to ED physicians, APPs and staff in a non-interruptive fashion. Patient and visit characteristics were evaluated for the six months before (05/04/2021-10/4/2021) and after (10/5/2021-05/04/2022) implementation. RESULTS After pathway implementation, more patients were identified as appropriate for hospice and ED length of stay (LOS) for qualifying patients decreased by a median of 2.9 h. Social work consultation for hospice evaluation increased, and more patients were discharged from the ED with hospice. As more patients were identified with end-of-life care needs, the number of patients admitted to the hospital increased. However, more patients were admitted under observation status, and admission LOS decreased by a median of 18.4 h. CONCLUSION This non-interruptive, digitally embedded clinical care pathway provided guidance for ED physicians and APPs to initiate hospice referrals. More patients received social work consultation and were identified as hospice eligible. Those patients admitted to the hospital had a decrease in both ED and hospital admission LOS.
Collapse
Affiliation(s)
- Sarah K Wendel
- Department of Emergency Medicine, University of Colorado, Aurora, CO 80045, United States of America.
| | - Mackenzie Whitcomb
- School of Medicine, Oregon Health & Science University, Portland, OR, United States of America
| | - Ariel Solomon
- Care Management, University of Colorado Hospital, Aurora, CO, United States of America
| | - Angela Swafford
- Care Management, University of Colorado Hospital, Aurora, CO, United States of America; Behavioral Health, UCHealth, Aurora, CO, United States of America
| | - Jeanie Youngwerth
- Department of Medicine, University of Colorado, Aurora, CO, United States of America
| | - Jennifer L Wiler
- Department of Emergency Medicine, University of Colorado, Aurora, CO 80045, United States of America
| | - Kelly Bookman
- Department of Emergency Medicine, University of Colorado, Aurora, CO 80045, United States of America
| |
Collapse
|
49
|
Haas A, Price RA, Elliott MN, Teno JM, DeYoreo M. Hospice Care Experiences Among Medicare Decedents With and Without COVID-19, 2020-2021. J Pain Symptom Manage 2024; 67:e153-e156. [PMID: 37918456 DOI: 10.1016/j.jpainsymman.2023.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 10/25/2023] [Indexed: 11/04/2023]
Affiliation(s)
- Ann Haas
- RAND Corporation (A.H.), Pittsburgh, Pennsylvania 15213, USA; RAND Corporation (R.A.P., J.M.T.), Arlington, Virginia 22202, USA; RAND Corporation (M.N.E., M.D.), Santa Monica, California 90401, USA; Brown University School of Public Health (J.M.T.), Providence, Rhode Island 02903, USA.
| | - Rebecca Anhang Price
- RAND Corporation (A.H.), Pittsburgh, Pennsylvania 15213, USA; RAND Corporation (R.A.P., J.M.T.), Arlington, Virginia 22202, USA; RAND Corporation (M.N.E., M.D.), Santa Monica, California 90401, USA; Brown University School of Public Health (J.M.T.), Providence, Rhode Island 02903, USA
| | - Marc N Elliott
- RAND Corporation (A.H.), Pittsburgh, Pennsylvania 15213, USA; RAND Corporation (R.A.P., J.M.T.), Arlington, Virginia 22202, USA; RAND Corporation (M.N.E., M.D.), Santa Monica, California 90401, USA; Brown University School of Public Health (J.M.T.), Providence, Rhode Island 02903, USA
| | - Joan M Teno
- RAND Corporation (A.H.), Pittsburgh, Pennsylvania 15213, USA; RAND Corporation (R.A.P., J.M.T.), Arlington, Virginia 22202, USA; RAND Corporation (M.N.E., M.D.), Santa Monica, California 90401, USA; Brown University School of Public Health (J.M.T.), Providence, Rhode Island 02903, USA
| | - Maria DeYoreo
- RAND Corporation (A.H.), Pittsburgh, Pennsylvania 15213, USA; RAND Corporation (R.A.P., J.M.T.), Arlington, Virginia 22202, USA; RAND Corporation (M.N.E., M.D.), Santa Monica, California 90401, USA; Brown University School of Public Health (J.M.T.), Providence, Rhode Island 02903, USA
| |
Collapse
|
50
|
Fu F, Ng YH, Wang J, Chui EWT. Journey to inpatient hospice care: A qualitative study on the decision-making process of Chinese family caregivers of persons with terminal cancer. Patient Educ Couns 2024; 119:108072. [PMID: 38048729 DOI: 10.1016/j.pec.2023.108072] [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: 07/20/2023] [Revised: 10/29/2023] [Accepted: 11/11/2023] [Indexed: 12/06/2023]
Abstract
OBJECTIVE To understand family caregivers' decision-making process to place their family members with terminal cancer in inpatient hospice care, especially in the social-cultural contexts whereby the caregivers have a dominant say about the care of their seriously ill family members. METHODS A qualitative study with a phenomenological approach was undertaken to understand the lived experience of caregivers of persons with terminal cancer in the decision-making process. Semi-structured qualitative interviews were conducted with a purposive sample of 17 caregivers in Shanghai, China. Thematic analysis was used to analyze the data. RESULTS The caregivers underwent a winding and socioculturally mediated four-stage process. The stages are (i) trigger for alternatives: lost hope for a cure, (ii) meandering the see-saw process, (iii) the last straws: physical limitations and witnessing unbearable suffering, and (iv) the aftermath: acceptance versus lingering hope. Caregivers' attitudes towards death and their family members with advanced cancer expressed care wishes influence the state of the aftermath. CONCLUSIONS Chinese sociocultural values and beliefs about caregiving and death provide insightful explanations for the observed process. PRACTICAL IMPLICATIONS Training healthcare professionals in cultural competence, developing an effective hospice referral system, and delivering socioculturally acceptable death education are critical interventions to facilitate better decision-making experiences.
Collapse
Affiliation(s)
- Fang Fu
- Social Work Department, School of Social Development and Public Policy, Fudan University, Shanghai, China
| | - Yong Hao Ng
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
| | - Juan Wang
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong.
| | - Ernest Wing-Tak Chui
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
| |
Collapse
|