Talking with families and children about the death of a parent

Death Of A Parent ◽

Care Consultation ◽

Provider Outcomes ◽

Structured Communication

Patient and provider outcomes are significantly related to the effectiveness of interprofessional communication Good interprofessional communication includes adopting an attitude of curiosity, recognizing that communication happens at several levels simultaneously, and acknowledging the importance of skilful conflict management. Barriers to good communication among interdisciplinary team members include team organization, provider hierarchy, and professional identity. Optimal communication among palliative consultants and other clinicians requires expert consultation etiquette, and overcoming particular challenges faced by palliative care consultants including the high emotion often accompanying palliative care consultations and the often contrasting assessment of the patient’s needs by the consulting and referring clinicians. The chapter describes how to use structured communication tools, designated forums for discussion, flattened hierarchy, and an open, no-fault culture, along with five core principles for good communication in palliative care consultation: curiosity, humility, transparency, clarity, and judiciousness. Palliative care plays a key role in optimizing interprofessional communication.

Communication between professionals

10.1093/med/9780199656097.003.0063 ◽

2015 ◽

Author(s):

Jane deLima Thomas ◽

Amanda Moment ◽

Janet Abrahm ◽

Katie Fitzgerald

Keyword(s):

Palliative Care ◽

Conflict Management ◽

Interdisciplinary Team ◽

Evidence Base ◽

Future Directions ◽

Interprofessional Communication ◽

Good Communication ◽

Care Consultation ◽

Provider Outcomes

This chapter discusses the importance of communication between professionals in palliative care. It begins by describing the evidence base that shows that patient and provider outcomes are significantly related to the effectiveness of interprofessional communication. Next it outlines the principles of good interprofessional communication including the importance of adopting an attitude of curiosity, recognizing that communication happens at several levels simultaneously, and acknowledging the importance of skilful conflict management. The following section on communication among members of an interdisciplinary team (IDT) reviews the barriers to good IDT communication, including team organization, provider hierarchy, and professional identity. The next section on communication between palliative consultants and other clinicians discusses consultation etiquette and its evidence base; highlights some of the particular challenges faced by palliative care consultants; and describes strategies for good communication in palliative care consultation. The chapter concludes with a description of future directions in the study and promulgation of interprofessional communication and the role that the field of palliative care can play.

Perceptions of Specialty Palliative Care and Its Role in Pediatric Stem Cell Transplant: A Multi-Disciplinary Qualitative Study

10.22541/au.162284190.02520988/v1 ◽

2021 ◽

Author(s):

Griffin Collins ◽

Hannah Beaman ◽

Alvin Ho ◽

Michelle Hermiston ◽

Harvey Cohen ◽

...

Keyword(s):

Palliative Care ◽

Stem Cell ◽

Stem Cell Transplant ◽

Palliative Care Team ◽

Care Team ◽

Cell Transplant ◽

Team Members ◽

Care Integration ◽

Background Consultation of specialty palliative care remains uncommon in pediatric stem cell transplant (SCT) despite growing evidence that early integration of palliative care improves outcomes in patients with advanced cancers or undergoing SCT. Little is known about how multidisciplinary pediatric SCT teams perceive palliative care and its role in SCT. Procedure We conducted semi-structured interviews of members of a multi-disciplinary SCT team to understand their perceptions of palliative care, how specialty palliative care is integrated into SCT, and to identify barriers to increased integration. Eligible participants included physicians, nurses, nurse practitioners, social workers, and child life specialists. Data was analyzed using thematic analysis. Results Four major themes were identified. First, SCT team members held a favorable perception of the palliative care team. Second, participants desired increased palliative care integration in SCT. Third, participants believed that the palliative care team had insufficient resources to care for the large number of SCT patients which led to the SCT team limiting palliative care consultation. And, finally, the lack of a standardized palliative care consultation process prevented greater integration of palliative care in SCT. Conclusions SCT team members held a favorable perception of palliative care and saw a role for greater palliative care integration throughout the SCT course. We identified modifiable barriers to greater palliative care integration. SCT teams who desire greater palliative care integration may adapt and implement an existing model of palliative care integration in order to improve standardization and increase integration of specialty palliative care in SCT.

The Palliative Care Illusion on Acute Wards An Ethnographic Study of the Introduction of a Palliative Care Consultation Team

10.21203/rs.3.rs-556119/v1 ◽

2021 ◽

Author(s):

Maria Friedrichsen ◽

Yvonne Hajradinovic ◽

Maria Jakobsson ◽

Kerstin Brachfeld ◽

Anna Milberg

Keyword(s):

Palliative Care ◽

Health Care Team ◽

Ethnographic Study ◽

Care Team ◽

Team Members ◽

Dying Patients ◽

Consultation Team ◽

Care Consultation ◽

Acute Wards

Abstract Acute care and palliative care are described as different incompatible organisational care cultures, with contrasts and contradictions. Few studies have observed the actual meeting between these two cultures. Purpose: To study the meeting and interaction of two different organisational care cultures, palliative care and curative acute wards, when a palliative care consultation team introduces consulting services to acute wards regarding end-of-life palliative care. Methods: An ethnographic study design was used, including observations, interviews and diary entries. A palliative care consultation team visited surgical and internal medicine wards during one year. An integrative bedside education approach was used, where physicians and nurses experienced in PC tried to embed PC principles and interventions into daily practice. The analysis was inspired by Spradley’s ethnography.Results: Three themes were found in the study: 1) Values, illusions, and wording in the acute care culture; 2) Didactic challenges and strategies, and 3) The palliative illusion becomes a fusion. On the acute wards, fast “turn over” was the goal of care: to treat patients quickly and send them home. Primary health care team members believed that they gave dying patients good care, a conclusion not supported by the palliative care team, who identified values problems and a knowledge shortage among all primary team members. Because the primary team did not have time for reflection regarding patients’ whole situation, and wanted to do as much as possible before “giving up”, their patients could be one hour from death before the primary team provided palliative care. After one year, primary team members wanted the palliative care consultation team to continue, since they felt they could not handle dying patients on their own.Conclusion: Palliative care consultation team make changes about end- of- life care when working with primary health care team members on acute wards. The didactic challenges are many and require efforts.

Trends and Predictors of Palliative Care Consultation Among Patients Admitted for LVAD: A Retrospective Analysis From the Nationwide Inpatient Sample Database From 2006-2014

American Journal of Hospice and Palliative Medicine® ◽

10.1177/10499091211021837 ◽

2021 ◽

pp. 104990912110218

Author(s):

Karol Quelal ◽

Olankami Olagoke ◽

Anoj Shahi ◽

Andrea Torres ◽

Olisa Ezegwu ◽

...

Keyword(s):

Palliative Care ◽

Nationwide Inpatient Sample ◽

Metastatic Cancer ◽

The United States ◽

Left Ventricular ◽

Ventricular Assist Devices ◽

Left Ventricular Assist Devices ◽

Incidence Trends ◽

Background: Left ventricular assist devices (LVADs) are an essential part of advanced heart failure (HF) management, either as a bridge to transplantation or destination therapy. Patients with advanced HF have a poor prognosis and may benefit from palliative care consultation (PCC). However, there is scarce data regarding the trends and predictors of PCC among patients undergoing LVAD implantation. Aim: This study aims to assess the incidence, trends, and predictors of PCC in LVAD recipients using the United States Nationwide Inpatient Sample (NIS) database from 2006 until 2014. Methods: We conducted a weighted analysis on LVAD recipients during their index hospitalization. We compared those who had PCC with those who did not. We examined the trend in palliative care utilization and calculated adjusted odds ratios (aOR) to identify demographic, social, and hospital characteristics associated with PCC using multivariable logistic regression analysis. Results: We identified 20,675 admissions who had LVAD implantation, and of them 4% had PCC. PCC yearly rate increased from 0.6% to 7.2% (P < 0.001). DNR status (aOR 28.30), female sex (aOR 1.41), metastatic cancer (aOR: 3.53), Midwest location (aOR 1.33), and small-sized hospitals (aOR 2.52) were positive predictors for PCC along with in-hospital complications. Differently, Black (aOR 0.43) and Hispanic patients (aOR 0.25) were less likely to receive PCC. Conclusion: There was an increasing trend for in-hospital PCC referral in LVAD admissions while the overall rate remained low. These findings suggest that integrative models to involve PCC early in advanced HF patients are needed to increase its generalized utilization.

Palliative Care in Patients With High-Grade Gliomas in the Neurological Intensive Care Unit

The Neurohospitalist ◽

10.1177/1941874419869714 ◽

2019 ◽

Vol 10 (3) ◽

pp. 163-167

Author(s):

Jon Rosenberg ◽

Allie Massaro ◽

James Siegler ◽

Stacey Sloate ◽

Matthew Mendlik ◽

...

Keyword(s):

Quality Of Life ◽

Intensive Care Unit ◽

Palliative Care ◽

High Grade ◽

Neurological Intensive Care Unit ◽

Code Status ◽

Neurological Intensive Care ◽

Background: Palliative care improves quality of life in patients with malignancy; however, it may be underutilized in patients with high-grade gliomas (HGGs). We examined the practices regarding palliative care consultation (PCC) in treating patients with HGGs in the neurological intensive care unit (NICU) of an academic medical center. Methods: We conducted a retrospective cohort study of patients admitted to the NICU from 2011 to 2016 with a previously confirmed histopathological diagnosis of HGG. The primary outcome was the incidence of an inpatient PCC. We also evaluated the impact of PCC on patient care by examining its association with prespecified secondary outcomes of code status amendment to do not resuscitate (DNR), discharge disposition, 30-day mortality, and 30-day readmission rate, length of stay, and place of death. Results: Ninety (36% female) patients with HGGs were identified. Palliative care consultation was obtained in 16 (18%) patients. Palliative care consultation was associated with a greater odds of code status amendment to DNR (odds ratio [OR]: 18.15, 95% confidence interval [CI]: 5.01-65.73), which remained significant after adjustment for confounders (OR: 27.20, 95% CI: 5.49-134.84), a greater odds of discharge to hospice (OR: 24.93, 95% CI: 6.48-95.88), and 30-day mortality (OR: 6.40, 95% CI: 1.96-20.94). Conclusion: In this retrospective study of patients with HGGs admitted to a university-based NICU, PCC was seen in a minority of the sample. Palliative care consultation was associated with code status change to DNR and hospice utilization. Further study is required to determine whether these findings are generalizable and whether interventions that increase PCC utilization are associated with improved quality of life and resource allocation for patients with HGGs.

“I Don't Have Time to Sit and Talk with Them”: Hospitalists’ Perspectives on Palliative Care Consultation for Patients with Dementia

Journal of the American Geriatrics Society ◽

10.1111/jgs.16712 ◽

2020 ◽

Vol 68 (10) ◽

pp. 2365-2372

Author(s):

Katherine R. Courtright ◽

Trishya L. Srinivasan ◽

Vanessa L. Madden ◽

Jason Karlawish ◽

Stephanie Szymanski ◽

...

Keyword(s):

Palliative Care ◽

Palliative care consultation and aggressive care at end of life in unresectable pancreatic cancer

Current Oncology ◽

10.3747/co.26.4389 ◽

2019 ◽

Vol 26 (1) ◽

Cited By ~ 1

Author(s):

C. Lees ◽

S. Weerasinghe ◽

N. Lamond ◽

T. Younis ◽

Ravi Ramjeesingh

Keyword(s):

Pancreatic Cancer ◽

Palliative Care ◽

End Of Life ◽

Potential Effect ◽

Unresectable Pancreatic Cancer ◽

Integral Role ◽

Care Consultation ◽

Aggressive Care ◽

Key Indicators

Background Palliative care (pc) consultation has been associated with less aggressive care at end of life in a number of malignancies, but the effect of the consultation timing has not yet been fully characterized. For patients with unresectable pancreatic cancer (upcc), aggressive and resource-intensive treatment at the end of life can be costly, but not necessarily of better quality. In the present study, we investigated the association, if any, between the timing of specialist pc consultation and indicators of aggressive care at end of life in patients with upcc.Methods This retrospective cohort study examined the potential effect of the timing of specialist pc consultation on key indicators of aggressive care at end of life in all patients diagnosed with upcc in Nova Scotia between 1 January 2010 and 31 December 2015. Statistical analysis included univariable and multivariable logistic regression.Results In the 365 patients identified for inclusion in the study, specialist pc consultation was found to be associated with decreased odds of experiencing an indicator of aggressive care at end of life; however, the timing of the consultation was not significant. Residency in an urban area was associated with decreased odds of experiencing an indicator of aggressive care at end of life. We observed no association between experiencing an indicator of aggressive care at end of life and consultation with medical oncology or radiation oncology.Conclusions Regardless of timing, specialist pc consultation was associated with decreased odds of experiencing an indicator of aggressive care at end of life. That finding provides further evidence to support the integral role of pc in managing patients with a life-limiting malignancy.