High–Tech, Aggressive Palliative Care: In the Service of Quality of Life

1993 ◽  
Vol 9 (1) ◽  
pp. 37-41 ◽  
Author(s):  
David M. Dush
Keyword(s):  
Quality Of Life ◽  
United States ◽  
Health Care ◽  
Palliative Care ◽  
Hospice Care ◽  
High Technology ◽  
The United States ◽  
High Tech ◽  
Hospice Movement

The hospice movement grew in part as a reaction to the perception that modern medical care had become too technological at the expense of being impersonal and insensitive to human psychological and spiritual concerns. In the United States, the institutionalization of hospice care under Medicare and other reimbursement systems has further established hospice as an alternative to high-technology, high-cost care. The present paper examines the question: What if hospice care becomes itself high-technology, aggressive, costly health care in order to remain true to its goal of maximizing quality of life? Implications for the goals and philosophical underpinnings of palliative care are discussed.

scholarly journals Uncertainty and Quality of Life Among Men Undergoing Active Surveillance for Prostate Cancer in the United States and Ireland

2007 ◽  
Vol 2 (2) ◽  
pp. 133-142 ◽  
Author(s):  
Josephine M. Hegarty ◽  
Meredith Wallace ◽  
Harry Comber
Keyword(s):  
Quality Of Life ◽  
Prostate Cancer ◽  
United States ◽  
Health Care ◽  
Active Surveillance ◽  
Psychological Health ◽  
Health Care Professionals ◽  
The United States ◽  
Management Option

Background. Prostate cancer continues to be the most common site of male cancers, particularly among older men in Europe and the United States, and the second most common male cancer worldwide. Active surveillance involves the use of no local or systemic therapy once prostate cancer has been diagnosed. A description of uncertainty and quality of life among men undergoing active surveillance in samples from both the United States and Ireland has the potential to enhance global health care delivery. Methods. The specific aim of this study is to enhance the understanding of the experience of active surveillance for prostate cancer among Irish and American men by measuring quality of life and levels of uncertainty among men over the age of 65 in receipt of the active surveillance management option for prostate cancer. A quantitative, descriptive survey design was used. Results. Twenty-nine men completed questionnaires. The results reveal that men undergoing active surveillance in the United States have slightly higher levels of uncertainty. Primary appraisal, opportunity, and danger appraisal were consistent between samples from both countries. Total affective and health-related quality-of-life scores were similar among active surveillance participants in both countries, but subscale scores identified both similarities and differences. Irish men had lower mean role and social function than U.S. men, and higher general health and energy. Irish men reported more urine bother and less sexual bother than U.S. men. Conclusion. To assist men with prostate cancer who are treated with the active surveillance management option, health care professionals must develop an awareness of how prostate cancer affects the man's physical and psychological health care outcomes.

scholarly journals Resisting the hospice narrative in pursuit of quality of life

2017 ◽  
Vol 1 (2) ◽  
Author(s):  
Jillian A. Tullis ◽  
Lori A. Roscoe ◽  
Patrick J. Dillon
Keyword(s):  
Quality Of Life ◽  
United States ◽  
End Of Life ◽  
Hospice Care ◽  
Participant Observation ◽  
Family Members ◽  
The United States ◽  
Curative Treatment ◽  
Model Of Care

The overall hospice philosophy is to provide care that enhances a dying person’s quality of life. Most individual’s quality of life is improved when they embrace hospice eligibility and reimbursement requirements, such as stopping burdensome and ineffective curative treatment, addressing pain and other symptoms, and seeking avenues for closure. However, this institutionalized prescription for enhancing quality of life at the end of life does not work for all patients. This article considers what happens when patients’ personal definitions of quality of life at the end of life resist the prevailing narrative of appropriate hospice care. Using a series of examples from more than 600 hours of participant observation, our findings reveal narratives of resistance that fall into three themes: i) patients and/or family members who deny the imminence of death despite an admission to hospice; ii) patients who request treatments usually defined as curative; and iii) patients who resist the organizational constraints imposed by the institutionalization of the hospice model of care. Analysis of these themes illustrates the subjective nature of quality of life at the end of life and the pressures of standardization that may accompany the growth and maturity of the hospice industry in the United States.

scholarly journals Clinical, Demographic, and Time Trends in Palliative Care Usage after Severe TBI: A Nationwide Analysis

Neurosurgery ◽  
2020 ◽  
Vol 67 (Supplement_1) ◽  
Author(s):  
Syed M Adil ◽  
Chidyaonga Shalita ◽  
Theresa Williamson ◽  
Lefko T Charalambous ◽  
Zidanyue Yang ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Brain Injuries ◽  
Injury Severity ◽  
Hospice Care ◽  
The United States ◽  
Management Style ◽  
Severity Scores ◽  
Severe Tbi

Abstract INTRODUCTION Over 2.8 million people suffer traumatic brain injuries (TBI) annually in the United States (US), leading to 282,000 hospitalizations (2013).1 Palliative care (PC) aims to improve quality of life via optimizing symptom management and/or discussing hospice care. As knowledge of PC’s beneficial role in critically-ill patients grows, there is a need to evaluate the current trends in PC delivery in severe TBI.2 METHODS We queried the National Inpatient Sample database for patients ≥18 years old with a primary diagnosis of any TBI and then specifically severe TBI. We identified the PC subgroup using ICD-9 code V66.7 and tracked proportions from 2001 to September 2015. Demographic and clinical differences were compared between patients with and without PC encounters beginning in 2008. RESULTS We identified 35,456 severe TBI patients from 2001–2015. The proportion receiving PC increased from 1.5% to 34.58% from 2001 to 2015, with a rapid increase starting in 2008. Compared to the No PC group, the PC group had more patients who were older (median 70 years vs. 40 years), female (37.6% vs 27.6%), white (69.5% vs 59.3%), and had a median household income in the bottom 50% (44.5% vs 40.0%). The PC group had a higher rate of subdural/epidural hemorrhage (36.7% vs 22.9%), but groups were comparable in injury severity scores (mean 21.2 vs 22.2) and Elixhauser comorbidity indexes (mean 6.6 vs 6.7). CONCLUSION From 2001 to 2015, there has been a dramatic increase in the utilization of PC among severe TBI patients, reflecting a change in management style and priorities for these patients. The increase beginning in 2008 coincides with the time PC became recognized as a medical sub-specialty.3 Initial results suggest demographic and clinical differences in patients receiving versus not receiving PC. Future efforts should study the drivers of receiving PC, in addition to changes in quality of life and healthcare resource utilization that stem from increased PC use in severe TBI.

scholarly journals Exploring Elder Consumers Interactions With Information Technology

2011 ◽  
Vol 2 (6) ◽  
Author(s):  
Michelle G. Hough
Keyword(s):  
Quality Of Life ◽  
United States ◽  
Health Care ◽  
Information Technology ◽  
The Elderly ◽  
The United States ◽  
Technological Factors ◽  
Older Consumers ◽  
Potential Benefits

Advances in health care are enabling the population of the United States to live longer.  Use of information technology can improve the quality of life for the elderly, yet many older consumers have limited interactions with information technology and so may be denied its potential benefits for enhancing quality of life.  This study explores older peoples’ current interactions with information technology, details personal and technological factors which may impact engagement, and discusses the resulting sociological and commercial implications for encouraging the elderly to embrace information technology toward enhancing quality of life.

A Review of Studies of the Association of Vision-Related Quality of Life with Measures of Visual Function and Structure in Patients with Glaucoma in the United States

2021 ◽  
Vol 28 (3) ◽  
pp. 265-276
Author(s):  
Naira Khachatryan ◽  
Maxwell Pistilli ◽  
Maureen G. Maguire ◽  
Angela Y. Chang ◽  
Marissa R. Samuels ◽  
...  
Keyword(s):  
Quality Of Life ◽  
United States ◽  
Visual Function ◽  
The United States ◽  
Related Quality

What is Happening in the United States? How Social Classes Influence the Political Life of the Country and its Health and Quality of Life

2021 ◽  
pp. 002073142199484
Author(s):  
Vicente Navarro
Keyword(s):  
Quality Of Life ◽  
United States ◽  
Access To Health Care ◽  
Universal Access ◽  
The United States ◽  
Political Context ◽  
Political Life ◽  
The Political ◽  
Race And Gender

This article analyses the political changes that have been occurring in the United States (including the elections for the presidency of the country) and their consequences for the health and quality of life of the population. A major thesis of this article is that there is a need to analyse, besides race and gender, other categories of power - such as social class - in order to understand what happens in the country. While the class structure of the United States is similar to that of major Western European countries, the political context is very different. The U.S. political context has resulted in the very limited power of its working class, which explains the scarcity of labor, political and social rights in the country, such as universal access to health care.

scholarly journals Anxiety- and Health-Related Quality of Life Among Patients With Breast Cancer: A Cross-Cultural Comparison of China and the United States

2018 ◽  
pp. 1-9
Author(s):  
Jin You ◽  
Qian Lu ◽  
Michael J. Zvolensky ◽  
Zhiqiang Meng ◽  
Kay Garcia ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
United States ◽  
Trait Anxiety ◽  
State Anxiety ◽  
Cultural Context ◽  
The United States ◽  
Cross Cultural ◽  
Chinese Patients

Purpose Literature has documented the prevalence of anxiety and its adverse effect on quality of life among patients with breast cancer from Western countries, yet cross-cultural examinations with non-Western patients are rare. This cross-cultural study investigated differences in anxiety and its association with quality of life between US and Chinese patients with breast cancer. Methods Patients with breast cancer from the United States and China completed measures for anxiety (Spielberger State-Trait Anxiety Inventory) and quality of life (Functional Assessment of Cancer Therapy-Breast). Results After controlling for demographic and medical characteristics, Chinese patients reported higher levels of trait and state anxiety than US patients. Although there was an association between anxiety and quality of life in both groups of patients, the association between state anxiety and quality of life was stronger among Chinese patients than among US patients, with the association between trait anxiety and quality of life the same between the two cultural samples. Conclusion These findings suggest that anxiety and its association with quality of life among patients with breast cancer varies depending on cultural context, which reveals greater anxiety and poorer quality of life among Chinese patients compared with US patients. This suggests greater unmet psychosocial needs among Chinese patients and highlights the need to build comprehensive cancer care systems for a better quality of life in Chinese populations.

scholarly journals Patient Suffering in Chronic Digestive Diseases: Will Primary Care-Specialist Collaboration With Effective Interactive Communication and Integrative Medicine in the Plan of Care Improve Quality of Life?

2020 ◽  
Vol 7 (6) ◽  
pp. 989-993
Author(s):  
Andrew Thomas ◽  
Annie Thomas
Keyword(s):  
Quality Of Life ◽  
Primary Care ◽  
Health Care ◽  
Health Care Providers ◽  
The United States ◽  
Care Providers ◽  
Physician Visits ◽  
Digestive Diseases ◽  
Care Specialist

Acute and chronic digestive diseases are causing increased burden to patients and are increasing the United States health care spending. The purpose of this case report was to present how nonconfirmatory and conflicting diagnoses led to increased burden and suffering for a patient thus affecting quality of life. There were many physician visits and multiple tests performed on the patient. However, the primary care physician and specialists could not reach a confirmatory diagnosis. The treatment plans did not offer relief of symptoms, and the patient continues to experience digestive symptoms, enduring this burden for over 2 years. The central theme of this paper is to inform health care providers the importance of utilizing evidence-based primary care specialist collaboration models for better digestive disease outcomes. Consistent with patient’s experience, the authors propose to pilot/adopt the integrative health care approaches that are proven effective for treating digestive diseases.

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