End-of-life practices in palliative care: a cross sectional survey of physician members of the German Society for Palliative Medicine

2010 ◽  
Vol 24 (8) ◽  
pp. 820-827 ◽  
Author(s):  
Jan Schildmann ◽  
Julia Hoetzel ◽  
Christof Mueller-Busch ◽  
Jochen Vollmann
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Palliative Medicine ◽  
German Society ◽  
Cross Sectional Survey ◽  
Cross Sectional

Cannabis and End-of-Life Care: A Snapshot of Hospice Planning and Experiences Among Illinois Medical Cannabis Patients With A Terminal Diagnosis

2021 ◽  
pp. 104990912110186
Author(s):  
James Alton Croker ◽  
Julie Bobitt ◽  
Sara Sanders ◽  
Kanika Arora ◽  
Keith Mueller ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Fast Track ◽  
Hospice Care ◽  
Cannabis Use ◽  
Care Plan ◽  
Medical Cannabis ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Eol Care

Introduction: Between 2013 and 2019, Illinois limited cannabis access to certified patients enrolled in the Illinois Medical Cannabis Program (IMCP). In 2016, the state instituted a fast-track pathway for terminal patients. The benefits of medicinal cannabis (MC) have clear implications for patients near end-of-life (EOL). However, little is known about how terminal patients engage medical cannabis relative to supportive care. Methods: Anonymous cross-sectional survey data were collected from 342 terminal patients who were already enrolled in ( n = 19) or planning to enroll ( n = 323) in hospice for EOL care. Logistic regression models compare patients in the sample on hospice planning vs. hospice enrollment, use of palliative care vs. hospice care, and use standard care vs non-hospice palliative care. Results: In our sample, cancer patients ( OR = 0.21 (0.11), p < .01), and those who used the fast-track application into the IMCP ( OR = 0.11 (0.06), p < .001) were less likely to be enrolled in hospice. Compared to patients in palliative care, hospice patients were less likely to report cancer as their qualifying condition ( OR = 0.16 (0.11), p < .01), or entered the IMCP via the fast-track ( OR = 0.23 (0.15), p < .05). Discussion: Given low hospice enrollment in a fairly large EOL sample, cannabis use may operate as an alternative to supportive forms of care like hospice and palliation. Clinicians should initiate conversations about cannabis use with their patients while also engaging EOL Care planning discussions as an essential part of the general care plan.

Tetrahydrocannabinol and Cannabidiol Use in an Outpatient Palliative Medicine Population

2020 ◽  
Vol 37 (8) ◽  
pp. 589-593 ◽  
Author(s):  
Bridget H. Highet ◽  
Elizabeth R. Lesser ◽  
Patrick W. Johnson ◽  
Judith S. Kaur
Keyword(s):  
Palliative Care ◽  
Chronic Illness ◽  
Side Effects ◽  
Patient Population ◽  
Palliative Medicine ◽  
Daily Basis ◽  
Care Providers ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Convenience Sample

Background: Palliative medicine physicians are challenged by lack of guidance regarding effectiveness and dosing of cannabis products in the setting of their emerging popularity. Objective: The aim of this study was to describe early patterns of tetrahydrocannabinol (THC) and cannabidiol (CBD) use in Florida following passage of the state’s first medical marijuana law. We describe here the perceived benefits, side effects, and beliefs expressed by patients in a single outpatient academic palliative medicine practice. Methods: A cross-sectional survey was performed of a sequential convenience sample of patients who presented to an outpatient academic palliative medicine clinic over a 3-month period. Results: In all, 24% (14/58) of respondents reported THC use, with half using THC on a daily basis. Patients reported improvements in pain, appetite, and nausea. In all, 71% (10/14) began using THC after the diagnosis of their chronic illness, and the most common form of usage was vaping. In all, 24% (14/58) of patients reported CBD use. Patients reported improvements in pain, and the most common form of usage was topical application. None of the patients had used CBD prior to the onset of their chronic illness. In all, 21% (3/14) of THC users and 21% (3/14) of CBD users thought that their substance was helping to cure their illness. Individual reported side effects in both groups were minimal. Conclusions: Approximately a quarter of outpatient palliative care patients use THC or CBD, often on a daily basis. Palliative care providers should be aware of the frequency, diverse usage, and beliefs behind cannabis product use in this patient population.

scholarly journals Knowledge of palliative care and preference of end of life care: a cross-sectional survey of residents in the Chinese socio-cultural background of Macao

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Kuai In Tam ◽  
Sok Leng Che ◽  
Mingxia Zhu ◽  
Sok Man Leong
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Associated Factors ◽  
Tertiary Education ◽  
Life Care ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Comfort Care ◽  
Study Results

Abstract Background Since the establishment of a hospice in the year 2000 and the development of a palliative care ward in 2019, there is no study examining public’s knowledge of palliative care, nor preference of end of life care in Macao. Aim Targeting Chinese residents of Macao, the current study has 3 goals: i) to understand the level of knowledge of palliative care, ii) to explore the preference of end of life treatments, and iii) to identify the associated factors of the preference of end of life treatments. Methods A cross-sectional questionnaire survey was conducted using a structured questionnaire. The study employed non-probability quota sampling through which Macao residents aged 18 and above were recruited between July and September 2020. Results A total of 737 responses were valid. The average correct rate of palliative care knowledge ranged from 40.4% to 85.5%. Pertaining to end of life treatments, 62.0% of the respondents chose comfort care. However, almost half of the respondents agreed that life-sustaining treatments should not be stopped under any circumstances. Respondents who scored higher in palliative care knowledge and those with secondary and tertiary education were associated factors of choosing comfort care rather than life-sustaining treatments. In addition, respondents who agreed that futile life-sustaining treatments should be stopped were also associated with preference for comfort care. Conclusion The understanding of palliative care amongst Macao residents is inadequate. Despite the public’s inclination towards comfort care, it is generally believed that life-sustaining treatments should not be stopped at the end of life. The study results suggest that not only the knowledge of palliative care should be enhanced amongst the general public in Macao, but information about life-sustaining treatments should also be offered to patients and families by healthcare professionals, in aiding end of life treatment decision making.

scholarly journals End-of-life decision making by Austrian physicians - a cross-sectional study

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
D. Jahn-Kuch ◽  
A. Domke ◽  
S. Bitsche ◽  
H. Stöger ◽  
A. Avian ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Palliative Medicine ◽  
Symptom Relief ◽  
Postal Survey ◽  
Cross Sectional ◽  
End Of Life Decisions ◽  
Legal Situation ◽  
Additional Qualification ◽  
Life Decisions

Abstract Background Austria has recently been embroiled in the complex debate on the legalization of measures to end life prematurely. Empirical data on end-of-life decisions made by Austrian physicians barely exists. This study is the first in Austria aimed at finding out how physicians generally approach and make end-of-life therapy decisions. Methods The European end-of-life decisions (EURELD) questionnaire, translated and adapted by Schildmann et al., was used to conduct this cross-sectional postal survey. Questions on palliative care training, legal issues, and use of and satisfaction with palliative care were added. All Austrian specialists in hematology and oncology, a representative sample of doctors specialized in internal medicine, and a sample of general practitioners, were invited to participate in this anonymous postal survey. Results Five hundred forty-eight questionnaires (response rate: 10.4%) were evaluated. 88.3% of participants had treated a patient who had died in the previous 12 months. 23% of respondents had an additional qualification in palliative medicine. The cause of death in 53.1% of patients was cancer, and 44.8% died at home. In 86.3% of cases, pain relief and / or symptom relief had been intensified. Further treatment had been withheld by 60.0%, and an existing treatment discontinued by 49.1% of respondents. In 5 cases, the respondents had prescribed, provided or administered a drug which had resulted in death. 51.3% of physicians said they would never carry out physician-assisted suicide (PAS), while 30.3% could imagine doing so under certain conditions. 38.5% of respondents supported the current prohibition of PAS, 23.9% opposed it, and 33.2% were undecided. 52.4% of physicians felt the legal situation with respect to measures to end life prematurely was ambiguous. An additional qualification in palliative medicine had no influence on measures taken, or attitudes towards PAS. Conclusions The majority of doctors perform symptom control in terminally ill patients. PAS is frequently requested but rarely carried out. Attending physicians felt the legal situation was ambiguous. Physicians should therefore receive training in current legislation relating to end-of-life choices and medical decisions. The data collected in this survey will help political decision-makers provide the necessary legal framework for end-of-life medical care.

scholarly journals Undergraduate nursing students' knowledge about palliative care and attitudes towards end-of-life care: A three-cohort, cross-sectional survey

2019 ◽  
Vol 74 ◽  
pp. 7-14 ◽  
Author(s):  
Maria Dimoula ◽  
Grigorios Kotronoulas ◽  
Stylianos Katsaragakis ◽  
Maria Christou ◽  
Stavroula Sgourou ◽  
...  
Keyword(s):  
Palliative Care ◽  
Nursing Students ◽  
End Of Life ◽  
End Of Life Care ◽  
Life Care ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Undergraduate Nursing Students ◽  
Undergraduate Nursing

Barriers to Palliative Care Referral and Advance Care Planning (ACP) for Patients With COPD: A Cross-Sectional Survey of Palliative Care Nurses

2021 ◽  
pp. 104990912110181
Author(s):  
Rebecca Disler ◽  
Amy Pascoe ◽  
Tim Luckett ◽  
Doranne Donesky ◽  
Louis Irving ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Advance Care Planning ◽  
Treatment Options ◽  
Chronic Obstructive ◽  
Free Text ◽  
Care Planning ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Advance Care

Background: Chronic obstructive pulmonary disease (COPD) is a progressive, life-limiting illness that requires end-of-life care planning, yet remains under-served. Understanding barriers to advance care planning (ACP) from different specialties’ perspectives will enable a co-ordinated, cross-disciplinary approach to improving ACP access. Methods: Australia and New Zealand palliative care nurses were invited to complete an anonymous online cross-sectional survey. Questions tested knowledge of validated ACP-related practice indicators and canvassed perspectives on barriers to ACP in COPD. Data are described and free-text thematically analyzed. Results: The 90 participants had high knowledge and positive attitudes to ACP in COPD, however, lacked consensus as to whether patients want to know their prognosis or discuss treatment options and end-of-life wishes. 59% discussed ACP in more than half their patients with COPD, and 77% and 73% routinely initiated or followed-up these discussions. Key barriers included: lack of confidence and training in COPD; reluctance to distress patients and families; referral late in the disease course; lack of consensus on referral timing; and lack of patient and clinician understanding of COPD prognoses. Many reported that lack of consensus in the treating team, paired with prognostic uncertainty, precluded timely ACP engagement. Conclusions: Palliative care nurses have substantial knowledge and positive beliefs regarding ACP, however, some beliefs and practices lack alignment with qualitative data on patients’ wishes in COPD. While palliative care nurses are well placed to facilitate early implementation for patients with advanced COPD, ACP training and practice guidelines specific to COPD may increase implementation in this life-limiting disease.

Graduating nurses' knowledge of palliative and end-of-life care

2020 ◽  
Vol 26 (1) ◽  
pp. 5-12
Author(s):  
Ann Selena Cleary
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Baccalaureate Nursing ◽  
Survey Design ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Convenience Sample ◽  
Eol Care ◽  
Care Course ◽  
Nurses Knowledge

Background: Generalist nurses frequently care for people who have advanced chronic diseases in decline, or who are dying. Few studies have measured graduating nurses' knowledge about end-of-life (EoL) care. Aims: To measure and compare knowledge about EoL care using the palliative care quiz for nurses among two cohorts of graduating nurses in a baccalaureate nursing programme. Methods: A quantitative cross-sectional survey design using a convenience sample of two cohorts of students. Findings: Total mean scores were low at 44.5% and 46.5% for the cohorts, respectively; this was not statistically significant. Misconceptions related to presentation and symptom management of the dying patient and integration of palliative with acute care. Palliative care knowledge was higher among the cohort who completed the dedicated EoL care course. Conclusion: Significant misconceptions about EoL care exist among these graduating nurses; this information provides direction for curriculum revision.

scholarly journals Examining public knowledge, attitudes and perceptions towards palliative care: a mixed method sequential study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Sonja McIlfatrick ◽  
Paul Slater ◽  
Esther Beck ◽  
Olufikayo Bamidele ◽  
Sharon McCloskey ◽  
...  
Keyword(s):  
Public Health ◽  
Palliative Care ◽  
End Of Life ◽  
Current Knowledge ◽  
Care Delivery ◽  
Public Awareness ◽  
Public Understanding ◽  
Public Health Issue ◽  
Public Health Approach ◽  
Cross Sectional Survey

Abstract Background Palliative care is recognised as a public health issue with the need for earlier integration in the wider healthcare system. However, research indicates that it continues to be accessed late in the course of an illness, public understanding of palliative care is limited, and common misconceptions prevail. Strategies to address this are needed in order to reduce barriers to palliative care delivery and improve access. Methods An explanatory sequential mixed methods study, comprising a cross-sectional survey and interviews was undertaken. Sociodemographic characteristics, public awareness, knowledge and perceptions of palliative care were examined and strategies to raise awareness and overcome barriers within a public health framework were identified. Survey data were analysed using SPSS v25 with factor analysis and non-parametric statistics and qualitative data were analysed using thematic analysis. Results A total of 1201 participants completed the survey (58.3% female, mean age 61 years) and 25 took part in interviews. A fifth of participants (20.1%) had previously heard about palliative care and had an accurate understanding of the term. Being female, higher educated, married, and older, increased respondents’ levels of awareness. The three most commonly held misconceptions included: Palliative care is exclusively for people who are in the last 6 months of life (55.4% answered incorrectly); A goal of palliative care is to address any psychological issues brought up by serious illness (42.2% answered incorrectly); and a goal of palliative care is to improve a person’s ability to participate in daily activities (39.6% answered incorrectly). Talking about palliative and end of life care was advocated but societal taboos restricted this occurring with exposure limited to personal experience. Conclusions Current knowledge gaps and misconceptions derived from limited ad hoc personal experiences and fear of engaging in taboo conversations may deter people from accessing integrated palliative care services early in a disease trajectory. The results indicate the need for public education programmes that move beyond merely raising awareness but provide key messages within a public health approach, which may change attitudes to palliative care thus ultimately improving end of life outcomes.

scholarly journals Preferences for Advance Directives in Korea

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
So-Sun Kim ◽  
Won-Hee Lee ◽  
JooYoung Cheon ◽  
Jung-Eun Lee ◽  
KiSun Yeo ◽  
...  
Keyword(s):  
End Of Life ◽  
Advance Directives ◽  
End Of Life Care ◽  
Healthcare Providers ◽  
Tube Feeding ◽  
Life Care ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Korean People ◽  
End Stage

Background. The goal of advance directives is to help patients retain their dignity and autonomy by making their own decisions regarding end-stage medical treatment. The purpose of this study was to examine preferences of advance directives among general population in Korea.Method. A descriptive cross-sectional survey was performed from October 2007 to June 2008 in Seoul, Korea. A total of 336 city-dwelling adults self-administered the questionnaire and returned it via mail. Data analyses were conducted using SPSS 17.0.Results. Subjects reported the need for healthcare providers' detailed explanations and recommendations regarding end-of-life care. When there is no hope of recovery and death is imminent, most subjects did not want to receive cardiopulmonary resuscitation nor an IV or tube feeding. However, most of the subjects wanted pain management care.Conclusions. The present study showed that many Korean people have an interest in advance directives. The results show that the autonomy and dignity of patient have increased in importance. To provide better end-of-life care, there is a need to educate patients on the definition and intent of an advance directive. Additional proactive communication between patients and their caregivers should be educated to healthcare providers.

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