More than Means to an End: Assessing Surgical Provider Familiarity with Palliative Care

2021 ◽  
pp. 000313482110488
Author(s):  
Candace L. Ward ◽  
Austin B. Goetz ◽  
Samantha N. Olafson ◽  
Ryan B. Cohen ◽  
Mark J Kaplan ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Nurse Practitioners ◽  
Palliative Medicine ◽  
Physician Assistants ◽  
Training And Development ◽  
Medicine Service ◽  
Poor Outcomes ◽  
Attending Physicians ◽  
Question Survey

Background As palliative medicine concepts emerge as essential surgical education, there has been a resulting spike in surgical palliative care research. Historic surgical dogma viewed mortality and comfort-focused care as a failure of the providers’ endurance, knowledge base, or technical skill. Therefore, many providers avoided consultation to a palliative medicine service until it became evident a patient could not survive or was actively dying. As the need for surgical palliative care grows, the identification of deficits in surgical providers’ understanding of the scope of palliative medicine is necessary to direct further training and development efforts. Method A ten-question survey was emailed to all residents, physician assistants, nurse practitioners, and attending physicians in the general surgery and subspecialty surgical departments within the Einstein Healthcare Network. Results 30 non-trainees (attending surgeons, nurse practitioners, and physician assistants) and 26 trainees (PGY-1 to PGY-5) completed the survey. Less than half of participants reported training in conversations regarding withdrawal of life-prolonging treatments in the setting of expected poor outcomes, 55% reported receiving training in pain management, and 64% reported receiving training in delivery of bad news. 54% report being involved in five or more end-of-life discussions in the last year with trainees reporting fewer end-of-life discussions than non-trainees; 67% of trainees reported zero to four discussions while 23% of non-trainees reported over twenty discussions ( P = .009). Conclusions Despite many participants training in intensive care settings, providers lack the training to carry out major discussions regarding life-limiting illness, goals of care, and end-of-life independently.

Mapping end-of-life and anticipatory medications in palliative care patients using a longitudinal general practice database

2021 ◽  
pp. 1-7
Author(s):  
H. Khalil ◽  
M. Garett ◽  
A. Byrne ◽  
P. Poon ◽  
K. Gardner ◽  
...  
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
General Practice ◽  
End Of Life ◽  
Nurse Practitioners ◽  
Hospital Admissions ◽  
Population Level ◽  
Screening Tools ◽  
Care Needs ◽  
Stakeholder Consultation

Abstract Objective End-of-life and anticipatory medications (AMs) have been widely used in various health care settings for people approaching end-of-life. Lack of access to medications at times of need may result in unnecessary hospital admissions and increased patient and family distress in managing palliative care at home. The study aimed to map the use of end-of-life and AM in a cohort of palliative care patients through the use of the Population Level Analysis and Reporting Data Space and to discuss the results through stakeholder consultation of the relevant organizations. Methods A retrospective observational cohort study of 799 palliative care patients in 25 Australian general practice health records with a palliative care referral was undertaken over a period of 10 years. This was followed by stakeholders’ consultation with palliative care nurse practitioners and general practitioners who have palliative care patients. Results End-of-life and AM prescribing have been increasing over the recent years. Only a small percentage (13.5%) of palliative care patients received medications through general practice. Stakeholders’ consultation on AM prescribing showed that there is confusion about identifying patients needing medications for end-of-life and mixed knowledge about palliative care referral pathways. Significance of results Improved knowledge and information around referral pathways enabling access to palliative care services for general practice patients and their caregivers are needed. Similarly, the increased utility of screening tools to identify patients with palliative care needs may be useful for health care practitioners to ensure timely care is provided.

Palliative and Supportive Care: Introducing a new international journal; The “Care” Journal of Palliative Medicine

2003 ◽  
Vol 1 (1) ◽  
pp. 1-2 ◽  
Author(s):  
William Breitbart
Keyword(s):  
Palliative Care ◽  
Supportive Care ◽  
End Of Life ◽  
Palliative Medicine ◽  
Continuum Of Care ◽  
Educational Resource ◽  
Delivery Of Care ◽  
Life Threatening

We are extremely proud and gratified to present the inaugural issue of our new international palliative care journal, Palliative & Supportive Care (P&SC). P&SC is the first international journal of palliative medicine that focuses on the psychiatric, psychosocial, spiritual, existential, ethical, philosophical, and humanities aspects of palliative care. The journal's aim is to serve as an educational resource for practitioners from a wide array of disciplines engaged in the delivery of care to those with life-threatening illnesses along the entire continuum of care, from diagnosis to the end of life. The journal also seeks to both stimulate and provide a forum for research in the psychiatric, psychosocial, and spiritual components of palliative care.

Integrative Palliative Care

2018 ◽  
Author(s):  
Angela Lee ◽  
Stephanie Cheng ◽  
Dale Lupu
Keyword(s):  
Primary Care ◽  
Palliative Care ◽  
End Of Life ◽  
Integrative Medicine ◽  
Advance Care Planning ◽  
Palliative Medicine ◽  
Geriatric Patients ◽  
Care Planning ◽  
Patient Goals ◽  
Advance Care

Integrative medicine and palliative medicine share many tenets. This chapter reviews integrative approaches to the most common symptoms needing palliation among geriatric patients at the end of life, including pain, nausea and vomiting, constipation, dyspnea, and fatigue. Several palliative care approaches to communication about patient goals and advance care planning for a time when the patient is unable to make decisions are described. Resources to support advance care planning are provided. Finally, issues that need to be addressed by either primary care geriatrics or in consultation with palliative care in the last weeks, days, and hours of life are described.

Self-Determination, End-of-Life Decisions, and the Role of Nurse Practitioners

2015 ◽  
Vol 21 (1) ◽  
pp. 11-14 ◽  
Author(s):  
Heather Bradley
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Terminally Ill ◽  
Self Determination ◽  
End Of Life Decisions ◽  
Supportive Role ◽  
Societal Changes

Nurse practitioners should be aware that societal changes could lead to their being asked to actively assist terminally ill patients who wish to end their lives, as opposed to their current supportive role in palliative care. With physician staff shortages and the need for nurse practitioners to fill the gaps, end-of-life responsibilities could be placed in the hands of nurse practitioners, rather than being reserved for physicians alone (Sagon, 2013). End-of-life matters raise uncertainties about the nurse practitioner role because it differs state by state, relates to ethics, reflects the religious beliefs of those involved, and concerns the conflict of nurses simultaneously caring for their patients while advocating for their right to self-determination in choosing to end their lives.

Palliative Care in Nephrology

2020 ◽  
Keyword(s):  
Palliative Care ◽  
Kidney Disease ◽  
Supportive Care ◽  
Nurse Practitioners ◽  
Quality Care ◽  
Physician Assistants ◽  
Care Needs ◽  
Patient Centered ◽  
Medical Practitioners ◽  
Seriously Ill Patients

Palliative care has become increasingly important across the spectrum of healthcare, and with it, the need for education and training of a broad range of medical practitioners not previously associated with this field of care. As part of the Integrating Palliative Care series, this volume on palliative care in nephrology guides readers through the core palliative knowledge and skills needed to deliver high value, high quality care for seriously ill patients with chronic and end-stage kidney disease. Chapters are written by a team of international leaders in kidney palliative care and are organized into sections exploring unmet supportive care needs, palliative care capacity, patient-centered care, enhanced support at the end of life, and more. Chapter topics are based on the Coalition for Supportive Care of Kidney Patients Pathways Project change package of 14 evidence-based best practices to improve the delivery of palliative care to patients with kidney disease. An overview of the future of palliative care nephrology with attention to needed policy changes rounds out the text. Palliative Care in Nephrology is an ideal resource for nephrologists, nurses, nurse practitioners, physician assistants, social workers, primary care clinicians, and other practitioners who wish to learn more about integrating individualized, patient-centered palliative care into treatment of their patients with kidney disease.

scholarly journals 23 Current Trends in Canada in Neonatal Palliative Care

2020 ◽  
Vol 25 (Supplement_2) ◽  
pp. e8-e9
Author(s):  
Gillian MacLean ◽  
Alessia Gallipoli ◽  
Ayla Raabis
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Nurse Practitioners ◽  
Policy Development ◽  
Neonatal Intensive Care ◽  
Vital Role ◽  
Primary Objective ◽  
Provider Education ◽  
Palliative Care Teams ◽  
Neonatal Nurse Practitioners

Abstract Background The area of palliative care in pediatrics has been expanding, as evidence emphasizes the benefits of providing pediatric patients and their families with optimized care in cases of chronic illness and end-of-life. The majority of pediatric deaths occur in infants under one year, with significant portions of these deaths taking place in Neonatal Intensive Care Units (NICU). The expansion of palliative care into neonatal medicine is of significant importance, as symptom management and end-of-life care plays a vital role in providing complete care to these infants. Guidelines that have been put into place can vary significantly between centers. Published studies in neonatal palliative care (PC) describe these challenges, however little data currently exists specific to Canadian NICUs. Objectives The primary objective was to gather information about current practice trends and themes around barriers in neonatal PC. Design/Methods An anonymous survey was distributed to Canadian Level 3 NICU staff, including neonatologists, neonatal nurse practitioners (NP), and neonatal fellows through the Qualtrics platform. Surveys were distributed through email and responses tracked in the Qualtrics system. Results The survey response rate was 57. The majority of respondents were neonatologists (50%), with many having more than 5 years of experience. Provision of palliative care was common with 20/57 respondents being involved in 5 or more cases in the past year. Only 40% of respondents reported that neonatologists and neonatal NPs received palliative care training at their center. When education did exist, lectures (31%) and workshops (26%) were most common. 97% said their centre would benefit from more education. 53% of respondents said their center had an established guideline around neonatal PC, 20% did not know and 27% answered no. Only 8% of respondents who work at centres with a guideline found that it was consistently followed. Respondents were asked to identify barriers to implementation at their place of practice. Common responses noted challenges in NICU collaborations with maternal-fetal medicine and palliative care teams, as well as lack of education and providers’ personal beliefs. Lastly, respondents provided details of their guidelines or common practices in PC which has been collated and summarized. Conclusion The results provide a snapshot of the current palliative care practices in academic NICUs across Canada. Overall the results were positive with many centers having a guideline and some provider education. The perceived barriers highlight focus areas for future education and policy development, and emphasize the importance of improved collaboration moving forward.

Older Adult Population

2021 ◽  
pp. 320-343
Author(s):  
Harry S. Strothers ◽  
Dipenkumar Patel
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Older Adult ◽  
Symptom Management ◽  
Older Patients ◽  
Adult Population ◽  
Geriatric Medicine ◽  
Physician Assistants ◽  
Syndrome Symptom ◽  
Older Adult Population

Geriatric medicine is a specialty of medicine concerned with physical, mental, functional, and social conditions in acute, chronic, rehabilitative, preventive, and end-of-life care in older patients. Geriatric palliative care integrates the complementary specialties of geriatrics and palliative care to provide comprehensive care for older patients entering the later stage of their lives and their families. This chapter provides physician assistants with an overview of palliative care in older adults, the differences between palliative care and hospice, the understanding and managing of geriatrics syndrome, symptom management in older patients and the complexities of end of life, discussion of goals of care, and communicating with geriatric patients and families.

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