scholarly journals RACIAL DISPARITIES IN HOSPICE USE AT THE END OF LIFE: FINDINGS FROM THE REGARDS STUDY

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S436-S436
Author(s):  
Katherine Ornstein ◽  
Orla C Sheehan ◽  
Jin Huang ◽  
J David Rhodes ◽  
David L Roth
Keyword(s):  
Racial Disparities ◽  
End Of Life ◽  
Racial Differences ◽  
Cause Of Death ◽  
End Of Life Care ◽  
Hospice Care ◽  
Life Care ◽  
Stroke Incidence ◽  
Regards Study ◽  
Hospice Use

Abstract Hospice supports patients and families through interdisciplinary care focused on symptom management and maximization of quality of life. Although hospice care confers well-documented benefits, it remains underutilized: many patients do not use it at all or enter care too late to receive any benefit. While racial disparities in hospice use have been documented, hospice utilization among non-white decedents remains understudied, particularly among those with non-cancer diagnoses. Therefore, we used the REasons for Geographic and Racial Differences in Stroke (REGARDS) study, a population-based investigation of stroke incidence with oversampling of Blacks and cause of death adjudication by expert panel review, linked to Medicare claims data to examine racial disparities in end-of-life care. We identified 1221 participants who died between 2013-2015 due to natural causes excluding sudden death. More than half (52.8%) used hospice during the last 6 months of life (median =15 days), with use among cancer decedents over 70%. Overall, Blacks were significantly less likely to use hospice (OR=0.570) compared to Whites in adjusted analyses. Among hospice users, Blacks did not significantly differ from Whites in length of stay. In analyses stratified by cause of death (dementia, cancer, CVD and other), Blacks were significantly less likely than Whites to use hospice for all causes of death other than dementia. Despite tremendous growth of hospice in recent decades, our findings suggest that this effective service remains highly underutilized among Blacks dying from cancer, CVD and other serious illnesses, suggesting a need for targeted intervention to eliminate disparities in quality end-of-life care.

Hospice Use Among Patients With Cancer: Trends, Barriers, and Future Directions

2020 ◽  
Vol 16 (12) ◽  
pp. 803-809
Author(s):  
Mihir N. Patel ◽  
Jonathan M. Nicolla ◽  
Fred A.P. Friedman ◽  
Michala R. Ritz ◽  
Arif H. Kamal
Keyword(s):  
End Of Life ◽  
Advanced Cancer ◽  
End Of Life Care ◽  
Hospice Care ◽  
Rapid Development ◽  
Spiritual Needs ◽  
Life Care ◽  
General Acceptance ◽  
Patients With Cancer ◽  
Hospice Use

Patients with advanced cancer and their families frequently encounter clinical and logistical challenges related to end-of-life care. Hospice provides interdisciplinary and holistic care to meet patients’ biomedical, psychosocial, and spiritual needs in the last phases of life. Despite increasing general acceptance and use among patients with cancer, hospice remains underused. Underuse stems from ongoing misconceptions regarding hospice and its purpose, coupled with the rapid development of novel anticancer treatments, such as immunotherapies and targeted therapies, that have changed the landscape of possibilities. Furthermore, rapid evolutions in how end-of-life care is structured and reimbursed for will affect how oncology patients will intersect with hospice care. In this review, we explore the current and future challenges to greater integration of hospice care in the care of patients with advanced cancer and propose five recommendations as part of the path forward.

Measuring Attitudes About End-of-Life Care: Evaluation of a Modified Version of the Hospice Philosophy Scale

2018 ◽  
Vol 39 (8) ◽  
pp. 828-833
Author(s):  
Daniel J. Van Dussen ◽  
John Cagle ◽  
Amy J. Plant ◽  
Seokho Hong ◽  
Krystal L. Culler ◽  
...  
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Convergent Validity ◽  
Hospice Care ◽  
Adult Population ◽  
Life Care ◽  
Cross Sectional ◽  
Validation Data ◽  
End Of Life Issues ◽  
Hospice Use

The Hospice Philosophy Scale (HPS) is the only scaled instrument that measures health professionals’ attitudes about end-of-life care consistent with the hospice philosophy. This study tested the properties of a modified version of the HPS to provide preliminary validation data on internal consistency, convergent validity, and factorability in a broad population of adults. A cross-sectional telephone survey designed to assess the general population’s attitudes regarding hospice use was administered. exploratory factor analysis elicited an eight-item instrument (HPS-8). The HPS-8 produced a Cronbach’s alpha of .73 and demonstrated sufficient convergent validity, including positive associations with a scale measuring the importance of relevant end-of-life issues ( r = .41, p < .001), a personal preference for hospice (ρ = .36, p < .001), and, among those who had experienced hospice care, satisfaction with hospice care (ρ = .28, p < .01). Our evidence suggests the HPS-8 is a reliable and valid instrument for use with a general adult population.

Dysphagia in Hospice Care: The Roles of Social Work and Speech-Language Pathologists

2014 ◽  
Vol 23 (4) ◽  
pp. 173-186 ◽  
Author(s):  
Deborah Hinson ◽  
Aaron J. Goldsmith ◽  
Joseph Murray
Keyword(s):  
Social Work ◽  
End Of Life ◽  
Case Studies ◽  
End Of Life Care ◽  
Hospice Care ◽  
Patient Communication ◽  
Life Care ◽  
Speech Language Pathologists ◽  
Four Levels

This article addresses the unique roles of social work and speech-language pathologists (SLPs) in end-of-life and hospice care settings. The four levels of hospice care are explained. Suggested social work and SLP interventions for end-of-life nutrition and approaches to patient communication are offered. Case studies are used to illustrate the specialized roles that social work and SLP have in end-of-life care settings.

Serious Mental Illness and Hospice Care

2021 ◽  
pp. 082585972110220
Author(s):  
Gwen Levitt
Keyword(s):  
Mental Health ◽  
End Of Life ◽  
End Of Life Care ◽  
Psychiatric Illness ◽  
Hospice Care ◽  
Treatment Options ◽  
Life Care ◽  
Case Review ◽  
Health Community ◽  
End Stage

There are a small number of articles in the literature discussing palliative and end-of-life care in the SMI population. Most tackle the questions relating to competency to refuse care in end-stage anorexia or terminal medical conditions. This is a case review of a 55 year old patient with a complex psychiatric and medical history, who despite extensive treatment and long hospitalizations has failed to regain any ability to care for her basic needs. She has exhausted all available treatment options and her prognosis is extremely poor. The mental health community is resistant to discussing and/ or confronting the fact that such a patient faces with the need for end-of-life care directly related to chronic psychiatric illness.

scholarly journals Aging and Advanced Dementia Matters: End-of-Life Care in Nursing Homes

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 520-521
Author(s):  
Ruth Lopez ◽  
Ellen McCarthy ◽  
Meghan Hendricksen ◽  
Susan McLennon ◽  
Anita Rogers ◽  
...  
Keyword(s):  
Nursing Home ◽  
End Of Life ◽  
Racial Differences ◽  
End Of Life Care ◽  
Feeding Tube ◽  
Nursing Home Care ◽  
Life Care ◽  
Advanced Dementia ◽  
Southeastern Us ◽  
Intensity Of Care

Abstract Over 5 million Americans have dementia, and the majority will die in nursing home (NHs). While comfort is the main goal of care for most NH residents with advanced dementia, they commonly receive burdensome and costly interventions such as hospital transfers and feeding tubes that are of little clinical benefit. Despite 20 years of research and numerous experts and associations advocating a palliative approach to care, quantitative studies continue to demonstrate striking and persistent regional, facility, and racial differences, including: greater intensity care among African American versus White residents; greater intensity of care in the Southeastern US; and wide variation in care among NHs in the same region of the country. The reasons for these differences are poorly understood. Assessment of Disparities and Variation for Alzheimer’s disease in Nursing home Care at End of life (ADVANCE) is a 3-year, NIA funded qualitative study of 16 NHs in 4 regions of the country which aims to explain regional and racial factors influencing feeding tube and hospital transfer rates. The purpose of this presentation is to present the methodology established in this study and to highlight factors challenging and enabling implementation of the study protocol. To date, data have been collected in 11 NHs, and include 135 staff interviews, 40 proxy interviews, and nearly 800 hours of observation. These findings demonstrate that although challenging, large qualitative research is possible and holds promise as an effective method to illuminate complex processes influencing end-of-life care for NH residents with advanced dementia.

Opposing Vitalism and Embracing Hospice: How a Theology of the Sabbath Can Inform End-of-Life Care

2021 ◽  
Author(s):  
Sarah K Sawicki
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Hospice Care ◽  
Modern Medicine ◽  
The Body ◽  
Care Plan ◽  
Life Care ◽  
Negative Effects ◽  
Whole Person

Abstract Medicine often views hospice care as “giving up,” which results in a reduced quality of end-of-life care for many patients. By integrating a theology of the Sabbath with modern medicine, hospice becomes a sacred and valuable way to honor the dying patient in a comprehensive and holistic way. A theology of Sabbath as “Sacredness in Time” can provide the foundation for a shift in understanding hospice as a legitimate care plan, which shifts the focus from controlling and manipulating space for the body, to rest and enjoyment of time for the whole person. First, I explore vitalism and its negative effects on the institution of hospice. Second, I address the main misconceptions and biases surrounding hospice in order to establish hospice as an appropriate option for the terminally ill. Finally, I argue for a shift away from sacredness in space (as seen in vitalism) to sacredness in time.

scholarly journals CAREGIVER BURDEN, BENEFIT, AND PERCEPTIONS OF END-OF-LIFE CARE QUALITY

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S668-S668
Author(s):  
Elizabeth A Luth ◽  
Teja Pristavec
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Hospice Care ◽  
Quality Care ◽  
Care Quality ◽  
National Study ◽  
Life Care ◽  
Care Needs ◽  
Caregiving Burden ◽  
High Burden

Abstract End-of-life care quality (EOLCQ) gauges our success in providing quality care to dying individuals. EOLQC measures rely on reports from bereaved family members who provide care for dying loved ones, but analyses seldom account for how caregivers’ experiences influence their EOLCQ perceptions. Caregivers frequently experience burden, which is linked to poor health outcomes and may negatively bias EOLCQ reports. Individuals may also perceive caregiving benefits that can offset deleterious burden effects, but potentially encourage overly positive EOLCQ perceptions. This paper links National Study of Caregivers (2011) and National Health and Aging Trends Study (2011-2016) data, using regression analysis and a sample of 380 EOL caregivers to examine how caregiving burden and benefits perceptions shape and moderate EOLCQ reports. Caregiving burden is unrelated to EOLCQ in adjusted models. Benefits are associated with marginally greater odds of being informed about the dying person’s condition and reporting their personal care needs were met. Burden and benefits moderate these two measures. Despite benefits, low burden caregivers report they were informed about the dying person’s condition with 90% probability. Regardless of burden, high benefits caregivers report the same with 90% probability. Low burden and benefits caregivers report met care needs with 90% probability. High burden and benefits caregivers have 90% probability of such reports. Given these reports are used in formal hospice care evaluations by CMS, additional research should explore why caregiving burden and benefit are associated with some EOLCQ measures and why individuals reporting high burden and benefits provide more positive EOLCQ appraisals.

Hospice Use and End-of-Life Care for Patients With End-stage Renal Disease

2018 ◽  
Vol 178 (6) ◽  
pp. 799 ◽  
Author(s):  
Margaret L. Schwarze ◽  
Kate Schueller ◽  
R. Allan Jhagroo
Keyword(s):  
Renal Disease ◽  
End Of Life ◽  
End Stage Renal Disease ◽  
End Of Life Care ◽  
Life Care ◽  
Hospice Use ◽  
Stage Renal Disease ◽  
End Stage

Defining end-of-life care from perspectives of nursing ethics

2012 ◽  
Vol 19 (5) ◽  
pp. 608-618 ◽  
Author(s):  
Shigeko (Seiko) Izumi ◽  
Hiroko Nagae ◽  
Chihoko Sakurai ◽  
Emiko Imamura
Keyword(s):  
End Of Life ◽  
Health Care Providers ◽  
End Of Life Care ◽  
Hospice Care ◽  
Medical Model ◽  
Codes Of Ethics ◽  
Nursing Ethics ◽  
Life Care ◽  
Care Providers ◽  
Definition Of

Despite increasing interests and urgent needs for quality end-of-life care, there is no exact definition of what is the interval referred to as end of life or what end-of-life care is. The purpose of this article is to report our examination of terms related to end-of-life care and define end-of-life care from nursing ethics perspectives. Current terms related to end-of-life care, such as terminal care, hospice care, and palliative care, are based on a medical model and are restrictive in terms of diagnosis and prognosis. Using codes of ethics for nurses as a framework, we attempt to identify people to whom nurses are responsible to provide end-of-life care and develop a definition of end-of-life care that is more inclusive and applicable to a broader range of people who would benefit from end-of-life care by nurses and other health-care providers.

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