Resident Perspectives on Palliative Care at an Urban Teaching Hospital

2021 ◽  
pp. 082585972110597
Author(s):  
Uma Raman ◽  
Cris G. Ebby ◽  
Seherisch Ahmad ◽  
Thayer Mukherjee ◽  
Ellen Yang ◽  
...  
Keyword(s):  
Palliative Care ◽  
Teaching Hospital ◽  
Medical Training ◽  
Physician Education ◽  
Care Providers ◽  
Urban Teaching ◽  
Physician Perspectives ◽  
Internal Medicine Residents ◽  
Terminal Illnesses ◽  
Eol Care

Background There has been an increasing need to address end of life (EOL) care and palliative care in an era when measures to extend life for terminal illnesses are often initiated without consideration of quality of life. Addressing the barriers for resident physicians to initiate EOL conversations with patients is an important step towards eliminating the disconnect between patient wishes and provider goals. Purpose To assess resident physician perspectives on initiating palliative care conversations with terminally ill patients at an urban teaching hospital. Methods This paper solicited the experiences of pediatric, general surgery, and internal medicine residents through an anonymous survey to assess exposure to palliative care during training, comfort with providing palliative care, and barriers to implementing effective palliative care. Results 45% of residents reported exposure to palliative care prior to medical training. Ninety-three percent of these residents reported being formally introduced to palliative care during medical training through formal lecture, although the majority reported also being exposed through either small group discussions or informal teaching sessions. Time constraints and lack of knowledge on how to initiate and continue conversations surrounding EOL care were the greatest barriers to effectively caring for patients with terminal illnesses. Residents concurred that either attending physicians or hospital-designated palliative care providers should initiate palliative care discussions, with care managed by an interdisciplinary palliative care team; this consensus demonstrates a potential assumption that another provider will initiate EOL discussions. Conclusions This study evaluated the current state of physician training in EOL care and provided support for the use of experience-based training as an important adjunct to traditional didactic lectures in physician education.

Palliative Care for AIDS at a Large Urban Teaching Hospital: Program Description and Preliminary Outcomes

2003 ◽  
Vol 6 (3) ◽  
pp. 461-474 ◽  
Author(s):  
Peter A. Selwyn ◽  
Mimi Rivard ◽  
Deborah Kappell ◽  
Bill Goeren ◽  
Hector LaFosse ◽  
...  
Keyword(s):  
Palliative Care ◽  
Teaching Hospital ◽  
Urban Teaching ◽  
Program Description

scholarly journals PROVIDER-IDENTIFIED BARRIERS TO PALLIATIVE CARE FOR MEDICAID PATIENTS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S689-S689
Author(s):  
Susan Enguidanos ◽  
Anna Rahman ◽  
Deborah Hoe ◽  
Kate Meyers
Keyword(s):  
Palliative Care ◽  
Psychosocial Support ◽  
Physician Education ◽  
Theory Approach ◽  
Care Providers ◽  
Cultural Mismatch ◽  
Individual Interviews ◽  
Barriers To Access ◽  
Home Based ◽  
Seriously Ill Patients

Abstract In January 2018, California enacted Senate Bill 1004, which requires Medicaid (or Medi-Cal in California) managed care providers to offer home-based palliative care (HBPC) to their seriously ill patients. Since then, enrollment in HBPC has been lower than projected, which means many across the state continue to suffer without the pain and symptom management and psychosocial support available from a palliative care team. This study elicited clinician-perceived barriers to access to HBPC by Medi-Cal patients. We conducted a qualitative study comprising 25 individual interviews with a range of healthcare leaders and practitioners. Interviews were audio-recorded and transcribed verbatim. Using a grounded theory approach, we analyzed transcripts to determine primary themes. Our findings identified a myriad of access barriers to HBPC for the Medi-Cal population, including lack of physician knowledge about HBPC programs and benefits, a physician office structure that hampers the provision of HBPC education (i.e., one physician per office), cultural and language barriers among both physicians and patients, physicians’ lack of time, and competing demands on physicians. Providers also identified patient-related barriers, including cultural mismatch between HBPC providers and patients, trust issues related to the health-care system, and the complex challenges facing some patients such as lack of adequate and safe housing, behavioral health problems, and limited access to services that meet basic needs. These findings underscore the need for multiple approaches to increase physician education and awareness of HBPC and HBPC Medi-Cal benefits, develop culturally appropriate HBPC services, and develop programs that improve patients’ palliative care health literacy.

Are Health-Care Providers Well Prepared in Providing Optimal End-of-Life Care to Critically Ill Patients? A Cross-Sectional Study at a Tertiary Care Hospital in the United States

2018 ◽  
Vol 35 (10) ◽  
pp. 1080-1094 ◽  
Author(s):  
Kartikeya Rajdev ◽  
Nina Loghmanieh ◽  
Maria A. Farberov ◽  
Seleshi Demissie ◽  
Theodore Maniatis
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
End Of Life ◽  
Critically Ill ◽  
Health Care Providers ◽  
Critically Ill Patients ◽  
The United States ◽  
Care Providers ◽  
Strongly Agree ◽  
Eol Care

It is important for health-care providers to be comfortable in providing end-of-life (EOL) care to critically ill patients and realizing when continuing aggressive measures would be futile. Therefore, there is a need to understand health-care providers’ self-perceived skills and barriers to providing optimum EOL care. A total of 660 health-care providers from medicine and surgery departments were asked via e-mail to complete an anonymous survey assessing their self-reported EOL care competencies, of which 238 responses were received. Our study identified several deficiencies in the self-reported EOL care competencies among health-care providers. Around 34% of the participants either disagreed (strongly disagree or disagree) or were neutral when asked whether they feel well prepared for delivering EOL care. Around 30% of the participants did not agree (agree and strongly agree) that they were well prepared to determine when to refer patients to hospice. 51% of the participants, did not agree (agree and strongly agree) that clear and accurate information is delivered by team members to patients/family. The most common barrier to providing EOL care in the intensive care unit was family not accepting the patient’s poor prognosis. Nursing staff (registered nurse) had higher knowledge and attitudes mean competency scores than the medical staff. Attending physicians reported stronger knowledge competencies when compared to residents and fellows. More than half of the participants denied having received any previous training in EOL care. 82% of the participants agreed that training should be mandatory in this field. Most of the participants reported that the palliative care team is involved in EOL care when the patient is believed to be terminally ill. Apart from a need for a stronger training in the field of EOL care for health-care providers, the overall policies surrounding EOL and palliative care delivery require further evaluation and improvement to promote better outcomes in caring patients at the EOL.

Adherence to Measuring What Matters: Description of an Inpatient Palliative Care Service of an Urban Teaching Hospital

2019 ◽  
Vol 22 (1) ◽  
pp. 75-79
Author(s):  
Dulce M. Cruz-Oliver ◽  
Martha Abshire ◽  
Oscar Cepeda ◽  
Patricia Burhanna ◽  
Jennifer Johnson ◽  
...  
Keyword(s):  
Palliative Care ◽  
Teaching Hospital ◽  
Care Service ◽  
Palliative Care Service ◽  
Urban Teaching ◽  
What Matters

scholarly journals Area Deprivation Index Predicts Readmission Risk at an Urban Teaching Hospital

2018 ◽  
Vol 33 (5) ◽  
pp. 493-501 ◽  
Author(s):  
Jianhui Hu ◽  
Amy J. H. Kind ◽  
David Nerenz
Keyword(s):  
Teaching Hospital ◽  
Quality Metrics ◽  
Deprivation Index ◽  
Area Deprivation ◽  
Neighborhood Characteristics ◽  
Care Providers ◽  
Urban Teaching ◽  
Individual Level ◽  
Disadvantaged Neighborhoods ◽  
Readmission Risk

A growing body of evidence has shown that neighborhood characteristics have significant effects on quality metrics that evaluate health plans or health care providers. Using a data set of an urban teaching hospital patient discharges, this study aimed to determine whether a significant effect of neighborhood characteristics, measured by the Area Deprivation Index, could be observed on patients’ readmission risk, independent of patient-level clinical and demographic factors. This study found that patients residing in more disadvantaged neighborhoods had significantly higher 30-day readmission risks compared to those living in less disadvantaged neighborhoods, even after accounting for individual-level factors. Those who lived in the most extremely socioeconomically challenged neighborhoods were 70% more likely to be readmitted than their counterparts who lived in less disadvantaged neighborhoods. These findings suggest that neighborhood-level factors should be considered along with individual-level factors in future work on adjustment of quality metrics for social risk factors.

How Well were Asthmatic Patients Educated about Their Asthma? A Study at the Emergency Department

2004 ◽  
Vol 16 (1) ◽  
pp. 45-49 ◽  
Author(s):  
P.Y. Lee ◽  
E.M. Khoo
Keyword(s):  
Emergency Department ◽  
Health Care Providers ◽  
Teaching Hospital ◽  
Care Providers ◽  
Self Medication ◽  
Asthmatic Patients ◽  
Management Plans ◽  
Acute Asthma Exacerbation ◽  
The Difference ◽  
Bronchodilator Treatment

70 patients presented with acute asthma exacerbation requiring nebulised bronchodilator treatment at the emergency department of a teaching hospital in Kuala Lumpur, Malaysia, were interviewed over a two-week period in July 2001. The results showed that 45 (64%) patients had not been educated on the nature of asthma; 30 (43%) had not been advised on preventive measures or avoidance of triggers; 54 (77%) were not advised about the medications used and their side effects; 42 (60%) patients did not know the difference between reliever and preventive medications; 37 (53%) were unable to recognize features of worsening asthma and 68 (97%) were not told about the danger of non-prescribed self-medication or traditional medications. Only six (9%) patients were using peak flow meters and were taught self-management plans. The multiple regression results suggest that patients who were followed up at teaching hospital based clinics were better educated on asthma. In conclusion, asthmatic patients are still not educated well about their disease. Health care providers need to put more emphasis on asthma education so that the number of emergency room visits can be reduced. Asia Pac J Public Health 2004; 16(1): 45-49.

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