I Won’t Let You!

2020 ◽  
pp. 53-58
Author(s):  
Elissa G. Miller
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Treatment Plan ◽  
Ethics Committee ◽  
Palliative Care Team ◽  
Care Team ◽  
Medical Providers ◽  
Goals Of Care ◽  
Patient Families ◽  
Hospital Ethics

Conflicts between patient families and medical providers arise frequently. Providers and families may disagree about a patient’s prognosis, the use of life-sustaining medical treatment, the treatment plan, and other issues. Such conflicts may be exacerbated at end of life, especially at end of life for a pediatric patient. Working through such conflicts is a common role for the palliative care team. As with much of the team’s work, it relies on establishing goals of care and partnering with families to resolve conflict as well as engaging the hospital ethics committee when conflict persists. This chapter discusses the multiple ways conflicts may arise in caring for a dying child and makes recommendations for how to resolve them.

scholarly journals Does a Hospital Palliative Care Team Have the Potential to Reduce the Cost of a Terminal Hospitalization? A Retrospective Case-control Study in a Czech Tertiary University Hospital

2021 ◽  
Author(s):  
Zuzana Kremenova ◽  
Jan Svancara ◽  
Petra Kralova ◽  
Martin Moravec ◽  
Katerina Hanouskova ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Case Control Study ◽  
Case Control ◽  
Palliative Care Team ◽  
Care Team ◽  
University Hospital ◽  
Insurance Company ◽  
Retrospective Case ◽  
Control Study

Abstract Background: More than 50% of patients worldwide die in hospitals. It is well known that end-of-life hospital care is costly.Our aims were to test whether the support of the palliative team can reduce end-of-life costs and to study the mechanisms of cost reduction.Methods: This was a one-centre descriptive retrospective case-control study. Big data from registries of routine visits were used for case-control matching. We included the expenses billed to the insurance company and added separately charged drugs and materials. We compared the groups over the duration of the terminal hospitalization, ICU days (ICU=intensive care unit), IV antibiotic use (IV=intravenous), MRI/CT scans (MRI/CR=magnetic resonance imaging/computed tomography), oncologic treatment in the last month of life, and documentation of the dying phase.We searched for all in-hospital cases who died in the university hospital in Prague with the support of the hospital palliative team from January 2019 to April 2020 and matched them with similar controls. The controls were matched according to age, sex, Charlson comorbidity index and diagnosis recorded on the death certificate.Results: We identified 213 dyads. The average daily costs were three times lower in the palliative group (4,392.4 CZK per day=171.3 EUR) than in the non-palliative group (13,992.8 CZK per day=545.8 EUR), and the difference was caused by the shorter time spent in the ICU (16% vs 33% of hospital days). This was probably due to better documentation of the dying phase in the medical records.Conclusions: To date, there are sparse hospital data available on the economic aspects of end-of-life care. We showed that the integration of the palliative care team in the dying phase can be cost saving. The evidence that hospital palliative care can save a substantial amount of money can be used to support the integration of palliative care in hospitals in middle- and low-income countries. A multicentre study with the same design is planned in the future to increase the strength of the results.

Differences in end-of-life communication for children with advanced cancer who were referred to a palliative care team

2015 ◽  
Vol 62 (8) ◽  
pp. 1409-1413 ◽  
Author(s):  
Alisha Kassam ◽  
Julia Skiadaresis ◽  
Sarah Alexander ◽  
Joanne Wolfe
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Advanced Cancer ◽  
Palliative Care Team ◽  
Care Team ◽  
End Of Life Communication

scholarly journals Specialist palliative and end-of-life care for patients with cancer and SARS-CoV-2 infection: a European perspective

2021 ◽  
Vol 13 ◽  
pp. 175883592110422
Author(s):  
Gehan Soosaipillai ◽  
Anjui Wu ◽  
Gino M Dettorre ◽  
Nikolaos Diamantis ◽  
John Chester ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Symptom Control ◽  
Palliative Care Team ◽  
Psychological Support ◽  
Care Team ◽  
Life Care ◽  
Specialist Palliative Care ◽  
Patients With Cancer

Background: Specialist palliative care team (SPCT) involvement has been shown to improve symptom control and end-of-life care for patients with cancer, but little is known as to how these have been impacted by the COVID-19 pandemic. Here, we report SPCT involvement during the first wave of the pandemic and compare outcomes for patients with cancer who received and did not receive SPCT input from multiple European cancer centres. Methods: From the OnCovid repository ( N = 1318), we analysed cancer patients aged ⩾18 diagnosed with COVID-19 between 26 February and 22 June 2020 who had complete specialist palliative care team data (SPCT+ referred; SPCT− not referred). Results: Of 555 eligible patients, 317 were male (57.1%), with a median age of 70 years (IQR 20). At COVID-19 diagnosis, 44.7% were on anti-cancer therapy and 53.3% had ⩾1 co-morbidity. Two hundred and six patients received SPCT input for symptom control (80.1%), psychological support (54.4%) and/or advance care planning (51%). SPCT+ patients had more ‘Do not attempt cardio-pulmonary resuscitation’ orders completed prior to (12.6% versus 3.7%) and during admission (50% versus 22.1%, p < 0.001), with more SPCT+ patients deemed suitable for treatment escalation (50% versus 22.1%, p < 0.001). SPCT involvement was associated with higher discharge rates from hospital for end-of-life care (9.7% versus 0%, p < 0.001). End-of-life anticipatory prescribing was higher in SPCT+ patients, with opioids (96.3% versus 47.1%) and benzodiazepines (82.9% versus 41.2%) being used frequently for symptom control. Conclusion: SPCT referral facilitated symptom control, emergency care and discharge planning, as well as high rates of referral for psychological support than previously reported. Our study highlighted the critical need of SPCTs for patients with cancer during the pandemic and should inform service planning for this population.

Confidence and skills for cystic fibrosis end-of-life care

2020 ◽  
pp. bmjspcare-2020-002274
Author(s):  
Eva Harris-Skillman ◽  
Stephen Chapman ◽  
Aoife Lowney ◽  
Mary Miller ◽  
William Flight
Keyword(s):  
Cystic Fibrosis ◽  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Further Education ◽  
Palliative Care Team ◽  
Care Team ◽  
Life Care ◽  
Team Members ◽  
Palliative Care Teams

ObjectivesOptimal cystic fibrosis (CF) end-of-life care (EOLC) is a challenge. There is little formal guidance about who should deliver this and how CF multi-disciplinary teams should interact with specialist palliative care. We assessed the knowledge, experience and preparedness of both CF and palliative care professionals for CF EOLC.MethodsAn electronic questionnaire was distributed to all members of the Oxford adult CF and palliative care teams.Results35 of a possible 63 members responded (19 CF team; 16 palliative care). Levels of preparedness were low in both groups. Only 11% of CF and 19% of palliative care team members felt fully prepared for EOLC in adult CF. 58% of CF members had no (21%) or minimal (37%) general palliative care training. Similarly, 69% of the palliative care team had no CF-specific training. All respondents desired additional education. CF team members preferred further education in general EOLC while palliative care team members emphasised a need for more CF-specific knowledge.ConclusionsFew members of either the CF or palliative care teams felt fully prepared to deliver CF EOLC and many desired additional educations. They expressed complementary knowledge gaps, which suggests both could benefit from increased collaboration and sharing of specialist knowledge.

Suicidal ideation at end-of-life: The palliative care team's role

2003 ◽  
Vol 1 (3) ◽  
pp. 275-278 ◽  
Author(s):  
ANN GOELITZ
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
Suicidal Ideation ◽  
End Of Life ◽  
Health Care Professionals ◽  
Terminally Ill ◽  
Social Supports ◽  
Palliative Care Team ◽  
Care Team ◽  
Hastened Death

Objective: To report on the case of a terminally ill patient who expresses suicidal ideation.Methods: As this case demonstrates, suicidality at end-of-life poses numerous challenges for the palliative care team. In this case, a 49-year-old man with locally extensive head and neck cancer refused all life-prolonging treatment and expressed a desire to hasten his own death. Other issues, such as chemical dependency and lack of social supports, complicated his care.Results: Suicidality lessened as continuity of care, with ongoing assessments and interventions, addressed sources of suffering and built relationships with health care professionals.Significance of results: This case highlights the observation that desire for hastened death fluctuates for patients at end-of-life and may be influenced by factors under the control of the palliative care team.

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