scholarly journals QOLP-40. END-OF-LIFE CARE FOR GLIOBLASTOMA PATIENTS IN JAPAN

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi206-vi207
Author(s):  
Tomoko Omura ◽  
Yasuji Miyakita ◽  
Makoto Ohno ◽  
Masamichi Takahashi ◽  
Kenji Fujimoto ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Home Care ◽  
End Of Life ◽  
Hospice Care ◽  
Term Care ◽  
Palliative Home Care ◽  
Eol Care ◽  
At Home

Abstract BACKGROUND Despite aggressive treatment with surgery and chemo-radiation therapy, it is difficult to cure patients with glioblastoma (GBM). The end-of-life (EOL) phase of patients with GBM, and related problems, have not yet been adequately studied. Unlike in other countries, most cancer patients died in the hospital (84%) in 2017, but the Japanese government has recommended palliative home care and the number of deaths at home has recently been increasing. This study explores the current situation of EOL care for GBM patients in Japan. METHODS We retrospectively examined the clinical course and EOL phase of 166 consecutive patients who were treated in our hospital between 2010 and 2017. RESULT: In total, 107 patients died; 27 (25.7%) at home, 24 (22.8%) in hospice care, 8 (7.6%) in nursing homes, 46 (43.9%) in hospitals (long-term care hospitals [LTCH; 19.8%], our hospital [13.3%], and other neurosurgical hospitals [10.4%]). According to our previous research, in 2001–2005, 6% of GBM patients died at home, 3% in hospice case, and 91% in the hospital. The KPSof patients who started palliative home care or transferred to another hospital was 50–60. The median survival time and length of EOL phase for patients who died at home were 498 and 76.5 days; 395 and 103 days in hospice care; 533 days and 149 days in LTCH; 374 days and 52 days in our hospital; 338 and 75.5 days in other neurosurgical hospital; and 557 days and 37 days in nursing homes, respectively. CONCLUSION The number of GBM patients who died at home in Japan is increasing, and we must consider the problems of the EOL phase and improve the quality of EOL care.

scholarly journals NQPC-10 END-OF-LIFE PHASE OF GLIOBLASTOMA

2019 ◽  
Vol 1 (Supplement_2) ◽  
pp. ii31-ii31
Author(s):  
Tomoko Omura ◽  
Yasuji Miyakita ◽  
Takaki Omura ◽  
Makoto Ohno ◽  
Masamichi Takahashi ◽  
...  
Keyword(s):  
Nursing Homes ◽  
End Of Life ◽  
Hospice Care ◽  
Deep Coma ◽  
Term Care ◽  
Home Based ◽  
Prognosis Group ◽  
Eol Care ◽  
At Home

Abstract BACKGROUND Despite aggressive treatment with surgery and chemo-radiation therapy, it is difficult to cure patients with glioblastoma (GBM). The end-of-life (EOL) phase of patients with GBM, and related problems, have not yet been adequately studied. Most cancer patients died in the hospital (84%) in 2017, but the Japanese government has recommended palliative home-care and the number of deaths at home has recently been increasing. This study explores the current situation of EOL care for GBM patients in our hospital. METHODS We retrospectively examined the clinical course and EOL phase of 166 consecutive patients who were treated in our hospital between 2010 and 2017. RESULT In total, 107 patients died; 28 (26%) at home, 25 (23%) in hospice care, 9(9%) in nursing homes, 21(20%) in long-term care hospitals (LTCH), 13(12%) in our hospital, and 11(10%) in other neurosurgical hospitals. The median survival time and length of EOL phase for patients who died at home were 596 and 77 days; 469 and 103 days in hospice care; 528 days and 149 days in LTCH; 388 days and 52 days in our hospital; 802 and 91 days in other neurosurgical hospital; and 565 days and 55 days in nursing homes, respectively. The KPS of patients who transferred to LTCH or was started palliative care in other neurological hospital was 60. That of other patients was 50.The patients who died at home entered deep coma in the last 3.5 days (n=24) of life and could not take oral feeds for 7 days (n=26). CONCLUSION According to cancer patient study, the home-based palliative time of longer prognosis group were 59 days. EOL phase of GBM may be longer than other cancer. We must consider the problems of the EOL phase and improve the quality of EOL care.

scholarly journals Dying in America — An Examination of Policies that Deter Adequate End-of-life Care in Nursing Homes

2005 ◽  
Vol 33 (2) ◽  
pp. 294-309 ◽  
Author(s):  
Diane E. Hoffmann ◽  
Anita J. Tarzian
Keyword(s):  
Nursing Homes ◽  
End Of Life ◽  
End Of Life Care ◽  
Care Setting ◽  
Hospice Care ◽  
Life Care ◽  
Public Attention ◽  
Term Care

The quality of end-of-life care in this country is often poor. There is abundant literature indicating that dying individuals do not receive adequate pain medication or palliative care, are tethered to machines and tubes in a way that challenges their dignity and autonomy, and are not helped to deal with the emotional grief and psychological angst that may accompany the dying process. While this is true for individuals in many settings, it seems to be especially true for individuals in nursing homes. This is somewhat puzzling given that (1) considerable resources have been devoted to bringing public attention to this problem, (2) we have the knowledge and expertise to provide such care, and (3) we have a government-financed benefit that covers this type of care - the Medicare hospice benefit (MHB).While utilization of hospice care has increased during the last decade, there is considerable evidence that hospice care remains underutilized particularly in the long term care setting.

Quality End-of-Life CarePatients’ Perspectives (DRAFT)

2018 ◽  
Author(s):  
Jesse A. Soodalter ◽  
Yael Schenker
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Long Term Care ◽  
Sense Of Control ◽  
Life Care ◽  
Patient Centered ◽  
Term Care ◽  
Eol Care

This chapter summarizes Singer and colleagues’ 1999 “Quality End-of-Life Care: Patients’ Perspectives,” which investigates elements of quality end-of-life (EOL) care from patients’ perspectives. The study uses content analysis of previously conducted interviews with 126 dialysis and HIV patients and long-term care residents to identify five domains of quality EOL care: receiving adequate pain and symptom management, avoiding inappropriate prolongation of dying, achieving a sense of control, relieving burden, and strengthening relationships with loved ones. The authors compare these with three other, non-patient-derived taxonomies, finding the study’s domains to be simpler and more specific, less conceptually driven (e.g., “processes of care”), and more outcome-focused. This study pioneered patient-centered research into quality of EOL care, which has since expanded to many other populations

scholarly journals END-OF-LIFE CARE PREFERENCES AND WELL-BEING IN LONG-TERM CARE RESIDENTS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S669-S669
Author(s):  
Kelly Shryock ◽  
Jacinta Dickens ◽  
Anisha Thomas ◽  
Suzanne Meeks
Keyword(s):  
Quality Of Life ◽  
Positive Affect ◽  
End Of Life ◽  
End Of Life Care ◽  
Long Term Care ◽  
Well Being ◽  
Life Care ◽  
Term Care

Abstract Research on end-of-life care in nursing homes comes largely from the viewpoint of staff or family members. We examined patient perspectives on end-of-life care, preferences for care, and quality of life in long-term care settings. We hypothesized that fulfillment of the Self Determination Theory (SDT) needs of autonomy, competence, and relatedness would be related to better well-being and that the degree to which end-of-life care preferences are seen as possible in the setting would be related to SDT need fulfillment and well-being. Preliminary data, collected from older individuals at the end of life (over 55, presence of significant chronic disease, in long term care setting) (n= 72), demonstrated that autonomy, competence, and relatedness measures were moderately and significantly correlated with well-being as measured by life satisfaction, higher positive affect, lower negative affect, and overall quality of life measures The degree to which residents believed that their end-of-life care preferences could be honored in the setting was also significantly correlated with autonomy, competence, relatedness, positive affect, and psychological quality of life. These results are consistent with SDT and suggest that if long term care settings can promote autonomy, connection, and competence in making end of life decisions, possibly by discovering and fulfilling preferences for end of life care, individuals who end their lives on those settings have potential for greater satisfaction and happiness. These results suggest that SDT is a useful framework for ongoing research on how to improve the end of life experiences of older adults in long term care.

Attitudes Toward Intelligent Technologies

2011 ◽  
pp. 231-252
Author(s):  
Lorenza Tiberio ◽  
Massimiliano Scopelliti ◽  
Maria Vittoria Giuliani
Keyword(s):  
Quality Of Life ◽  
Nursing Homes ◽  
Elderly People ◽  
Term Care ◽  
Care Services ◽  
Care Giving ◽  
Human Care

Nursing homes provide long-term care services and can help preserve the quality of life of elderly people subject to physical and cognitive impairments. In this chapter, we explore the role of intelligent technologies as a supplement to human care-giving and the potential to improve quality of life for both older adults and their caregivers in nursing homes. A study was conducted on elderly people’s and caregivers’ attitudes toward the use of intelligent technologies in nursing homes, with the aim of understanding in which domains of everyday activities the application of intelligent technologies can be more suitable. Results showed that attitude toward the application of intelligent technologies in nursing homes is positive, although multifaceted. Elderly people and caregivers considered intelligent technologies as relevant devices for the improvement of quality of life in different domains. Nonetheless, differences related to the role that technologies played in nursing homes clearly emerged.

Direct care staff and parents'/legal guardians' perspectives on end-of-life care in a long-term care facility for medically fragile and intellectually disabled pediatric and young adult residents

2012 ◽  
Vol 11 (4) ◽  
pp. 307-314 ◽  
Author(s):  
Richard I. Grossberg ◽  
Martha Blackford ◽  
Sarah Friebert ◽  
Ethan Benore ◽  
Michael D. Reed
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Response Rate ◽  
Care Facility ◽  
Life Care ◽  
Term Care ◽  
Long Term Care Facility ◽  
Legal Guardians ◽  
Eol Care

AbstractObjective:Children and young adults with severe disabilities and their families are faced with enormous challenges throughout the lifespan, including admitting the child to a long-term care facility (LTCF) and making end-of-life (EOL) care decisions. While children are residents of these specialized LTCF, the majority of their daily care, even up until death, is provided by nursing aides or habilitation aides (HAs) with limited training and educational backgrounds compared with other licensed healthcare providers. The purpose of this study was to determine the impact of a resident's EOL experience on the primary HAs and parents/guardians.Method:Thirty-five resident deaths occurred at Hattie Larlham Center for Children with Disabilities (HLCCD) between January 1, 2006 and February 28, 2009. The HAs and parents/legal guardians were identified for each death and invited to complete three surveys per resident (FAMCARE, Impact of Events Scale (IES)-revised, and Perspective on End-of-Life Care) to assess their experience. There were 112 surveys mailed to 62 HAs and 47 surveys mailed to 47 parents.Results:Forty-two surveys were returned from 18/62 HAs (response rate 29%) and 11/47 parents/legal guardians completed the surveys (response rate 23%). The FAMCARE survey found that parents were more satisfied with the EOL care than were the HAs. The IES-revised found no difference in traumatic responses from either group. Comments from the Perspective on End-of-Life Care survey were analyzed qualitatively for common themes including pain control, respect, decision making, environmental needs, resources, and support.Significance of results:Because of a low response rate, it was difficult to draw significant conclusions; however, several interesting trends were noted regarding the number of deaths HAs experienced, satisfaction with care, and distress. The special needs of this population and their caregivers can provide crucial insights into interventions (e.g. chaplaincy support, debriefings, anticipatory counseling, environmental changes) that might be of benefit for any caregiver or parent of a child with a long-term, chronic condition, particularly involving developmental disability.

Improving the Quality of End-of-Life Care in Long-Term Care Institutions

2013 ◽  
Vol 16 (10) ◽  
pp. 1268-1274 ◽  
Author(s):  
Jenny Lee ◽  
Joanna Cheng ◽  
Kar-ming Au ◽  
Fannie Yeung ◽  
Mei-tak Leung ◽  
...  
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Long Term Care ◽  
Life Care ◽  
Term Care

Assuring the Quality of In-Home Care: The "Other" Challenge for Long-Term Care

1990 ◽  
Vol 30 (4) ◽  
pp. 444-450 ◽  
Author(s):  
R. Applebaum ◽  
P. Phillips
Keyword(s):  
Home Care ◽  
Long Term Care ◽  
The Other ◽  
Term Care

scholarly journals Integrating palliative care and hospice services in long term care: an eightfold path health policy analysis

2019 ◽  
Vol 8 (2) ◽  
pp. 143
Author(s):  
Amil Kusain Tan
Keyword(s):  
End Of Life ◽  
Long Term Care ◽  
Hospice Care ◽  
Advanced Illness ◽  
Term Care ◽  
Study Approach ◽  
Care Services ◽  
Trade Offs ◽  
Health Policy Analysis

It is evident in the literature that as near end of life approaches, health expenditure increases. The rehospitalization and underutilization of palliative and hospice services add to the burgeoning health cost. There is a lack of support for patients with advanced illness in long-term care facilities. This paper aims to provide a comprehensive review of the problem and assess alternatives to reduce readmission among patients with advanced disease and those who are at the end of life.  This paper adapted Bardach’s Eightfold Path analysis as a guide to analyzing the problem using a case study approach. The article discussed the issues, reviewed the literature for evidence, provided the alternatives, identified criteria, evaluated projected outcomes, discussed the trade-offs of adopting the policy, and provided a recommendation. In conclusion, integration of palliative and hospice care services across the continuum of long-term care is a viable alternative policy to address the problem.

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