Snapshot of an acute palliative care unit in a tertiary cancer hospital

2013 ◽  
Vol 12 (4) ◽  
pp. 331-337 ◽  
Author(s):  
Akhila Reddy ◽  
Marieberta Vidal ◽  
Maxine de la Cruz ◽  
Sriram Yennurajalingam ◽  
Eduardo Bruera
Keyword(s):  
Palliative Care ◽  
The United States ◽  
Palliative Care Unit ◽  
Psychosocial Issues ◽  
Special Report ◽  
Working Together ◽  
Consultation Services ◽  
Specialized Unit

AbstractMost palliative care (PC) programs in the United States provide consultation services that assist the primary medical team with issues ranging from controlling patients' symptoms to initiating end-of-life discussions. This approach may be sufficient to address many patients' needs. However, for certain patients with complex medical and psychosocial issues, a better alternative is a more streamlined approach that can be provided in an acute palliative care unit (APCU), where the PC staff assumes the role of the primary team. An APCU is a specialized unit that delivers highly sophisticated care with professionals from various disciplines working together to improve the quality of life of patients and their families. However, descriptions of the process of delivering PC in the APCU are limited. In this special report, we portray a single day with a series of patients whose care was managed at our APCU to illustrate the unique components of an APCU that allow holistic care for patients with multiple complex medical and psychosocial issues.

Disparities among GU cancer patients referred to palliative care.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 114-114
Author(s):  
Saad Omar Atiq ◽  
James Helzberg ◽  
Nathan Hirshman ◽  
Zainab Atiq ◽  
Daniel J. George ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Prostate Cancer ◽  
Palliative Care ◽  
Cancer Patients ◽  
The United States ◽  
Quality Data ◽  
Black Patients ◽  
Quality Of Life Scale

114 Background: The role of palliative care in genitourinary (GU) malignancies has been understudied. Despite representing nearly 25% of new cancer diagnoses, with over 350,000 new cases diagnosed each year, few GU patients have been included in palliative care trials under the theory that symptoms are less severe for GU patients than other solid tumors. Early involvement of palliative care services improves the patient care experience, decreases healthcare utilization, is associated with survival benefit, and results in improved quality of life and mood. To further elucidate the role of palliative care in oncology, we must study its utility in subsets of malignancy like GU cancers, as needs for patients may differ by malignancy type. Methods: A retrospective cross-sectional analysis of initial outpatient palliative care visits was performed using data from the Quality Data Collection Tool for Palliative Care (QDACT-PC) database from 2014-2020. QDACT-PC is a web-based, point-of-care registry used by physicians across the United States to track quality metrics associated with patient consultations. Data was collected and analyzed from patients' initial visits including pain scale, dyspnea scale, feeling of well-being (Quality of Life scale), fatigue scale, constipation scale, palliative performance status (PPS), and preference for resuscitation status. Scales for these variables were 0-10, with the exception of a scale of 0-100% for PPS. Patients less than 18 and greater than 90 years old were excluded. Chi-squared and Student’s t-tests were used to compare categorical and continuous variables, respectively. Results: 824 GU oncology patients (358 prostate cancer patients, 251 bladder cancer patients, 215 renal cancer patients) were compared against all patients with non-GU cancers (7807 patients). Notably, non-GU patients reported higher rates of fatigue (4.50 vs. 4.13, p = 0.0013) and dyspnea (1.63 vs. 1.11, p < 0.0001) than GU patients. GU malignancies had non-significant higher reported pain (3.73 vs. 3.60, p = 0.3109) and constipation (1.96 vs. 1.83, p = 0.2319) and lower PPS (4.95 vs. 4.96, p = 0.8555) and QOL (4.55 vs. 4.73, p = 0.0962). Preference for resuscitation at the time of referral was similar between the two groups (p = 0.6339). Only 16.5% of prostate cancer patients referred to palliative care in this database were black, while black patients are often estimated to represent 30% of new prostate cancer diagnoses each year. Conclusions: GU patients represent 9.54% of cancer patients seen by palliative care while the incidence is nearly 25%. Traditionally, GU patients were underrepresented in palliative care trials under the notion of less severe symptoms; however, this study demonstrates that GU patients have as severe symptoms as non-GU patients, highlighting a disparity in referral to palliative care. Furthermore, the lack of representation of black patients suggests potential inequity and warrants further investigation.

scholarly journals Enhancing Informed Consent for Physician Aid in Dying: Potential Role of Handout on Possible Benefits of Palliative Care

2017 ◽  
Vol 13 (10) ◽  
pp. e838-e843 ◽  
Author(s):  
Harry Peled ◽  
Kathleen E. Bickel ◽  
Christina Puchalski
Keyword(s):  
Palliative Care ◽  
Informed Consent ◽  
The United States ◽  
Patient Comprehension ◽  
Aid In Dying ◽  
Procedural Safeguard ◽  
Potential Benefits ◽  
Improve Patient

In the United States, physician aid in dying (PAD) is now legal in several states. However, neither a requirement for a palliative care (PC) consultation nor a defined education in PC exists for physicians participating in PAD or patients requesting assistance. Patients with advanced chronic and serious illness often experience complex physical, psychosocial, and spiritual distress. PC focuses on relieving this distress and improving patient quality of life through early identification and intervention in all domains of suffering, including physical, psychological, social, and spiritual. Ideally, we would recommend a PC consult, but unfortunately, PC is not readily available or offered at this time to all those who might benefit from it. We present a case for providing an educational handout to patients who inquire about PAD. This handout explains the potential benefits of PC as an additional procedural safeguard to existing regulations. Such information would help to ensure the integrity of the informed consent process, enhance shared decision making, and improve patient comprehension of the options.

Dialysis withdrawal and palliative care

2015 ◽  
Author(s):  
Arkadiy Pinkhasov ◽  
Michael J. Germain ◽  
Lewis M. Cohen
Keyword(s):  
Palliative Care ◽  
The United States ◽  
Medical Decisions ◽  
Dialysis Treatment ◽  
Quality Of Dying ◽  
Prediction Of Survival ◽  
Renal Patient ◽  
Dialysis Withdrawal

This chapter discusses why dialysis withdrawal is so common in the United States, when dialysis withdrawal and withholding is appropriate, and the role of palliative care in the renal patient. It discusses guidelines that were created to aid in dialysis withdrawal, dialysis initiation, and prognostic calculation. Factors contributing to the phenomenon of dialysis discontinuation include variability in the criteria for initiation of renal replacement therapy, increasing numbers of incident and prevalent geriatric patients, new emphasis on autonomy and quality of life, the development of improved prognostic instruments for prediction of survival, growing acceptance of medical decisions that accelerate dying, and a clearer appreciation of the quality of dying that ensues following the cessation of dialysis. There continues to be a need for further integration of palliative medicine in the clinical management of patients with chronic kidney disease, especially since hospice services are often unavailable unless a decision is made to stop dialysis treatment. The importance of communication between staff and patients and the documentation of the plan of care is critical.

Biopsychosocial Patterning of Multimorbidity and Its Consequences

2018 ◽  
pp. 220-236
Author(s):  
Elliot Friedman ◽  
Beth LeBreton ◽  
Lindsay Fuzzell ◽  
Elizabeth Wehrpsann
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
Functional Outcomes ◽  
The United States ◽  
Chronic Medical Conditions ◽  
Quality Of Life Research ◽  
Increased Risk ◽  
Over Time

By many estimates the majority of adults over age 65 have two or more chronic medical conditions (multimorbidity) and are consequently at increased risk of adverse functional outcomes. Nonetheless, many older adults with multimorbidity are able to maintain high levels of function and retain good quality of life. Research presented here is designed to understand the influences that help ensure better functional outcomes in these older adults. This chapter presents findings that draw on data from the Midlife in the United States study. The independent and interactive contributions of diverse factors to multimorbidity and changes in multimorbidity over time are reviewed. The degree that multimorbidity increases risk of cognitive impairment and disability is examined. The role of inflammation as a mediator is considered. Multimorbidity is increasingly the norm for older adults, so better understanding of factors contributing to variability in multimorbidity-related outcomes can lead to improved quality of life.

scholarly journals The Value of Citizen Science in Increasing Our Knowledge of Under-Sampled Biodiversity: An Overview of Public Documentation of Auchenorrhyncha and the Hoppers of North Carolina

2021 ◽  
Vol 9 ◽  
Author(s):  
Kyle D. Kittelberger ◽  
Solomon V. Hendrix ◽  
Çağan Hakkı Şekercioğlu
Keyword(s):  
North Carolina ◽  
Citizen Science ◽  
Spatial Scales ◽  
The United States ◽  
Undescribed Species ◽  
The Past ◽  
Global Biodiversity ◽  
Temporal And Spatial

Due to the increasing popularity of websites specializing in nature documentation, there has been a surge in the number of people enthusiastic about observing and documenting nature over the past 2 decades. These citizen scientists are recording biodiversity on unprecedented temporal and spatial scales, rendering data of tremendous value to the scientific community. In this study, we investigate the role of citizen science in increasing knowledge of global biodiversity through the examination of notable contributions to the understanding of the insect suborder Auchenorrhyncha, also known as true hoppers, in North America. We have compiled a comprehensive summary of citizen science contributions—published and unpublished—to the understanding of hopper diversity, finding over fifty previously unpublished country and state records as well as dozens of undescribed and potentially undescribed species. We compare citizen science contributions to those published in the literature as well as specimen records in collections in the United States and Canada, illuminating the fact that the copious data afforded by citizen science contributions are underutilized. We also introduce the website Hoppers of North Carolina, a revolutionary new benchmark for tracking hopper diversity, disseminating knowledge from the literature, and incorporating citizen science. Finally, we provide a series of recommendations for both the entomological community and citizen science platforms on how best to approach, utilize, and increase the quality of sightings from the general public.

Palliative Care

2015 ◽  
pp. 105-123
Author(s):  
May Hua
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Intensive Care ◽  
Critical Illness ◽  
Serious Illness ◽  
Surgical Units ◽  
Potential Benefits

Palliative care is a specialty of medicine that focuses on improving quality of life for patients with serious illness and their families. As the limitations of intensive care and the long-term sequelae of critical illness continue to be delimited, the role of palliative care for patients that are unable to achieve their original goals of care, as well as for survivors of critical illness, is changing and expanding. The purpose of this chapter is to introduce readers to the specialty of palliative care and its potential benefits for critically ill patients, and to present some of the issues related to the delivery of palliative care in surgical units.

Palliative Care in End-Stage Neurological Disease

2018 ◽  
Author(s):  
Tobias Walbert ◽  
Joel Phillips
Keyword(s):  
Parkinson’S Disease ◽  
Palliative Care ◽  
Parkinson's Disease ◽  
Symptom Management ◽  
Neurological Diseases ◽  
The United States ◽  
Pain Syndromes ◽  
End Stage ◽  
Chronic Course

Neurological disorders are among the leading causes of morbidity and death worldwide. Although stroke is the third leading cause of death, after heart disease and cancer, in the United States, other neurological diseases have a more chronic course that leads to protracted disability, morbidity, and death. Unfortunately, for many of these disorders, such as Parkinson’s disease, amyotrophic lateral sclerosis (ALS), and multiple sclerosis (MS), no cure is currently available. Patients suffer from dysarthria, dysphagia, muscle spasm, bladder and bowel difficulties, pain syndromes, and fatigue. Adequate symptom management and palliative care have the potential to maintain good quality of life for patients for as long as possible and ease the burden on both caregivers and patients. This chapter outlines the principles of clinical symptom management for some of the most important neurological diseases, specifically ALS, stroke, MS, and Parkinson’s disease.

Improving the Quality of Care across All Settings

2019 ◽  
pp. 573-605
Author(s):  
Marilyn Bookbinder ◽  
Romina Arceo ◽  
James T. McDaniel
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
The United States ◽  
Healthcare Settings ◽  
National Priority ◽  
Hospice And Palliative Care ◽  
Eol Care ◽  
Clinician Assessment ◽  
Care Path

This chapter provides perspectives on quality-based initiatives in the United States across healthcare settings and populations and describes their impact on patient, professional, and system outcomes. The authors discuss the need for quality improvement (QI) at end of life, QI principles, and the models, methods, and tools most frequently used. Also described are areas of national priority for improving end-of-life (EOL) care. A care-path for the end of life is used to illustrate a QI effort and the FOCUS_PDSA method and to encourage use of specific tools for improving EOL care, including respiratory distress, and a clinician assessment of EOL care using The Joint Commission (TJC) tracer methodology. The authors review the linkages between QI and practice changes in hospitals and hospices that ultimately lead to improved EOL care and close with examples of how nurses are providing leadership in the field of quality hospice and palliative care.

scholarly journals Deregulation and the Assault on Science and the Environment

2020 ◽  
Vol 41 (1) ◽  
pp. 347-361 ◽  
Author(s):  
Jonathan M. Samet ◽  
Thomas A. Burke
Keyword(s):  
Public Health ◽  
Environmental Pollution ◽  
Reasoned Action ◽  
Scientific Evidence ◽  
Well Being ◽  
The United States ◽  
Research To Policy ◽  
Health And Well Being

The quality of the environment is a major determinant of the health and well-being of a population. The role of scientific evidence is central in the network of laws addressing environmental pollution in the United States and has been critical in addressing the myriad sources of environmental pollution and the burden of disease attributable to environmental factors. We address the shift away from reasoned action and science to a reliance on belief and document the efforts to separate regulation from science and to remove science-based regulations and policies intended to protect public health. We outline the general steps for moving from research to policy, show how each has been undermined, offer specific examples, and point to resources that document the enormity of the current efforts to set aside scientific evidence.

High–Tech, Aggressive Palliative Care: In the Service of Quality of Life

1993 ◽  
Vol 9 (1) ◽  
pp. 37-41 ◽  
Author(s):  
David M. Dush
Keyword(s):  
Quality Of Life ◽  
United States ◽  
Health Care ◽  
Palliative Care ◽  
Hospice Care ◽  
High Technology ◽  
The United States ◽  
High Tech ◽  
Hospice Movement

The hospice movement grew in part as a reaction to the perception that modern medical care had become too technological at the expense of being impersonal and insensitive to human psychological and spiritual concerns. In the United States, the institutionalization of hospice care under Medicare and other reimbursement systems has further established hospice as an alternative to high-technology, high-cost care. The present paper examines the question: What if hospice care becomes itself high-technology, aggressive, costly health care in order to remain true to its goal of maximizing quality of life? Implications for the goals and philosophical underpinnings of palliative care are discussed.

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