Back to the Basics—Is Comfort Care the Same as Do Not Resuscitate? How Misinterpreting Code Status May Lead to Potential Patient Harm

2021 ◽  
pp. 104990912110462
Author(s):  
David B. Brecher ◽  
Shane M. Morris
Keyword(s):  
Palliative Care ◽  
Care Providers ◽  
Patient Harm ◽  
Do Not Resuscitate ◽  
Medical Specialties ◽  
Comfort Care ◽  
Potential Harm ◽  
Code Status ◽  
Potential Patient ◽  
Hospice And Palliative Care

Several research studies have shown that code status documentation is misinterpreted or incorrectly defined by a significant number of medical professionals. This misinterpretation among the medical team (i.e. equating Do Not Resuscitate (DNR) with comfort care measures only) may lead to false reporting, poor symptom management, and potentially adverse clinical outcomes. Most Hospice and Palliative Care providers are aware of these distinctions, however a shortage (and continued foreseen shortage) of Hospice and Palliative Care providers may mean these conversations and distinctions will fall to non-subspecialists, or providers of other medical specialties or degrees. The literature has demonstrated that these shortfalls and misinterpretations are present and constitute potential harm to our patients.

Translation, cultural adaptation, and validation of the mindful self-care scale among Brazilian palliative care providers

2021 ◽  
pp. 1-7
Author(s):  
Ana Cláudia Mesquita Garcia ◽  
Laura Soares Rodrigues Silva ◽  
Ana Cristina Gonçalves Ferreira ◽  
Vander Monteiro da Conceição ◽  
Everson Meireles ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cultural Adaptation ◽  
Self Care ◽  
Well Being ◽  
Future Research ◽  
Care Providers ◽  
Cross Sectional ◽  
Reliability Indices ◽  
Self Compassion ◽  
Hospice And Palliative Care

Abstract Objective This study aimed to translate, culturally adapt, and validate the Mindful Self-Care Scale (MSCS, 33-item) in a Brazilian hospice and palliative care context. Method This was a cross-sectional study with a sample of 336 Brazilian hospice and palliative care providers. The European Organisation for Research and Treatment of Cancer — Quality of Life Group Translation Procedure protocol was used for the translation and the cultural adaptation process. Psychometric properties supporting the use of the MSCS were examined through confirmatory factor analysis (CFA) and correlation analysis with other instruments to assess congruence to related constructs (resilience and self-compassion). The reliability of the Brazilian-Portuguese version of the MSCS was assessed using Cronbach's α and composite reliability coefficients. Results The six-factor (33-item) model showed a good fit to the data, with satisfactory reliability indices and adequate representation of the scale's internal structure. Further validity is evidenced in the significant, positive correlations found between the MSCS, and similar well-being constructs, namely the Self-Compassion and Resilience scales. Significance of results The findings reveal that the MSCS (33-item) is a valid, reliable, and culturally appropriate instrument to examine the practice of mindful self-care by hospice and palliative care providers in Brazil. More broadly, it represents a promising instrument for future research into self-care practices and well-being among Brazilian healthcare providers.

Volunteering in hospice and palliative care in Germany

2018 ◽  
Author(s):  
Michaela Hesse ◽  
Lukas Radbruch
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
Health Care Providers ◽  
Hospice Care ◽  
Care Service ◽  
Health Care Service ◽  
Care Providers ◽  
Specialist Services ◽  
Patient Groups ◽  
Hospice And Palliative Care

German hospice care developed as a civil society movement in which volunteers were essential from the beginning. Palliative care was, however, led by a few pioneer physicians and started independently from hospices. This separate development is still visible with a clear distinction between palliative care units and inpatient hospices. Over the last two decades these two areas of care have moved more into the regular health care service. As a result volunteer services are increasingly subject to regulations. This also means that there is an increasing amount of competition and economic pressure. Developing trust and high transparency in the local and regional palliative care networks, and open and bilateral collaboration of specialist services with general practitioners (GPs) and other health care providers on the basic palliative care level are prerequisites of integrated palliative care. Ongoing development leads to changes in the patient groups that receive palliative care.

What does 'palliative care' mean? Diverse definitions from cancer care providers.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 40-40
Author(s):  
Erin E. Kent ◽  
Rebecca A. Ferrer ◽  
Michelle Mollica ◽  
Grace Huang ◽  
Angela Falisi ◽  
...  
Keyword(s):  
Palliative Care ◽  
Care Provider ◽  
Healthcare Providers ◽  
Physician Assistants ◽  
Models Of Care ◽  
Care Providers ◽  
Clinical Nurses ◽  
Curative Care ◽  
Wide Range ◽  
Hospice And Palliative Care

40 Background: Existing literature on the epistemology of palliative care has mostly centered on patient/family perspectives. Understanding how multi-disciplinary healthcare providers themselves define palliative care is a critical step towards addressing barriers and harnessing facilitators that affect optimal delivery. Methods: Semi-structured key informant interviews (N = 19) were conducted with members of healthcare provider teams as part of a qualitative study on goals of care for cancer patients enrolled in clinical trials. Purposive sampling included diverse roles: attending physicians/principal investigators, oncology fellows, physician assistants, research and clinical nurses, patient care coordinators, palliative care physicians, social workers, chaplains, and pharmacists. One probe asked participants, “What does palliative care mean to you in your work?” Responses were transcribed and independently coded by two raters using interview-derived deductive and emergent inductive codes. Themes were then identified and analyzed using NVivo. Results: Informants included different elements in their definitions: attributes of palliative care (“Palliative care is helpful”); structure (“We have a pain and palliative team”); patient outcomes “(comfort”), and relation to other services (“adjunct to necessary medical care”). Additional themes also included (1) the charge of palliative care to alleviate suffering; (2) the recognition that palliative care should be holistic; (3) the centrality of symptom management, in particular pain; (4) the conflation of end-of-life, hospice, and palliative care; (5) tensions between palliative and curative care. Provider role and specific team membership appear to influence perspectives on definitions of palliative care. Conclusions: Providers share a wide range of perspectives on the operationalization of palliative care in their work. In addition to soliciting input from patients and family members, the viewpoints of a diverse set of providers should be ascertained often to inform models of care, alleviate tensions between palliative and curative care provider teams, and increase optimal usage of palliative care.

Full Code to Do-Not-Resuscitate: Culturally Adapted Palliative Care Consultations and Code Status Change Among Seriously Ill Hispanic Patients

2021 ◽  
pp. 104990912110423
Author(s):  
Neela K. Patel ◽  
Stacey A. Passalacqua ◽  
Kylie N. Meyer ◽  
Gabriel A. de Erausquin
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Palliative Care Service ◽  
Do Not Resuscitate ◽  
Code Status ◽  
Palliative Care Consultation ◽  
Culturally Adapted ◽  
Hispanic Patients ◽  
The Impact ◽  
Seriously Ill

Background: Palliative care and hospice services are disproportionately underutilized by ethnic minority patients. Addressing barriers to utilization of these services is critical to reducing disparities. The purpose of this study was to assess the impact of a culturally adapted palliative care consultation service for Hispanics on end-of-life decisions, specifically likelihood of changing from full code to do-not-resuscitate (DNR) status during index admission for serious illness. Methods: A cross-sectional study design was applied to data extracted from electronic health records (EHR) of patients seen by a Geriatric Palliative Care service during inpatient stays between 2018 and 2019. The majority of referrals came from critical care sites. Culturally adapted palliative care consultations using the SPIKES tool featured a Spanish-speaking team member leading discussions, involvement of multiple and key family members, and a chaplain who is a Catholic Priest. Results: The analytic sample included 351 patients who were, on average, 72 years old. 54.42% were female, 59.54% were Hispanic, and of Hispanic patients, 47.37% spoke primarily Spanish. Culturally adapted consults resulted in higher rates of conversion to DNR status in palliative cases of the target population. Both primary language and ethnicity were associated with likelihood of change from full code to DNR status, such that Spanish speakers and those of Hispanic ethnicity were more likely to switch to DNR than non-Hispanics and English-Speakers. Conclusion: This study illustrates how culturally adapted palliative care consultations can help reduce barriers and improve end-of-life decision-making, and can be applied with similar populations of seriously ill Hispanic patients.

scholarly journals Factors Associated With DNR Status After Nontraumatic Intracranial Hemorrhage

2019 ◽  
Vol 10 (3) ◽  
pp. 168-175 ◽  
Author(s):  
Kaitlyn Lillemoe ◽  
Aaron Lord ◽  
Jose Torres ◽  
Koto Ishida ◽  
Barry Czeisler ◽  
...  
Keyword(s):  
Palliative Care ◽  
Marital Status ◽  
Intracranial Hemorrhage ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Do Not Resuscitate ◽  
Code Status ◽  
Factors Associated ◽  
Significant Difference ◽  
Active Cancer

Background: We explored factors associated with admission and discharge code status after nontraumatic intracranial hemorrhage. Methods: We extracted data from patients admitted to our institution between January 1, 2013, and March 1, 2016 with nontraumatic intracerebral hemorrhage or subarachnoid hemorrhage who had a discharge modified Rankin Scale (mRS) of 4 to 6. We reviewed data based on admission and discharge code status. Results: Of 88 patients who met inclusion criteria, 6 (7%) were do not resuscitate (DNR) on admission (aDNR). Do not resuscitate on admission patients were significantly older than those who were full code on admission ( P = 0.04). There was no significant difference between admission code status and sex, marital status, active cancer, premorbid mRS, admission Glasgow Coma scale (GCS), Acute Physiology and Chronic Health Evaluation II (APACHE II) score, or bleed severity. At discharge, 66 (75%) patients were full code (dFULL), 11 (13%) were DNR (dDNR), and 11 (13%) were comfort care. African American and Hispanic patients were significantly more likely to be dFULL than Asian or white patients ( P = .01) and less likely to be seen by palliative care ( P = .004). Patients with less aggressive code status had higher median APACHE II scores ( P = .008) and were more likely to have active cancer ( P = .06). There was no significant difference between discharge code status and sex, age, marital status, premorbid mRS, discharge GCS, or bleed severity. Conclusions: Limitation of code status after nontraumatic intracranial hemorrhage appears to be associated with older age, white race, worse APACHE II score, and active cancer. The role of palliative care after intracranial hemorrhage and the racial disparity in limitation and de-escalation of treatment deserves further exploration.

Development of Hospice and Palliative Care in the United States

2008 ◽  
Vol 56 (1) ◽  
pp. 89-99 ◽  
Author(s):  
Stephen R. Connor
Keyword(s):  
United States ◽  
Palliative Care ◽  
Health Care Industry ◽  
The United States ◽  
Regulatory Change ◽  
Care Providers ◽  
Care Industry ◽  
History Of ◽  
Hospice And Palliative Care

More than 30 years have passed since palliative care was introduced in the United States, and what began as a small rebellion has evolved into a fairly large health care industry. Although the palliative care movement has considerably improved the care given to those at the end of life, many challenges remain for palliative care providers in the United States. This article discusses the history of hospice and palliative care in the United States, the Medicare Hospice Benefit, the growth of hospice and palliative care, and challenges such as the need for regulatory change, workforce issues, improving access to care, and improving the quality of palliative care.

scholarly journals Experiences of LGBT Patients and Families With Hospice and Palliative Care: Perspectives of the Palliative Care Team

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 67-67
Author(s):  
Cathy Berkman ◽  
Gary Stein
Keyword(s):  
Palliative Care ◽  
Social Services ◽  
Online Survey ◽  
Healthcare Providers ◽  
Cross Sectional Study ◽  
Care Providers ◽  
Cross Sectional ◽  
Term Care ◽  
Lgbt Community ◽  
Hospice And Palliative Care

Abstract The lesbian, gay, bisexual, and transgender (LGBT) community experiences discrimination and stigma in accessing health care and social services – including palliative, hospice, and long-term care. Healthcare providers not recognize or address disparities in care. Providers and institutions may be uncomfortable with sexual orientation and gender identity and expression issues, and often don’t inquire about these. LGBT patients fear being open about their identities, not receiving equal or safe treatment, and having their family of choice and designated surrogates disrespected or ignored by healthcare staff. This study examines the degree to which hospice and palliative care providers report inadequate, disrespectful, or abusive care to LGBT patients and family members. A cross-sectional study using an online survey was completed by 865 providers, including social workers, physicians, nurses, and chaplains. Among respondents, 55% reported that LGB patients were more likely than non-LGB patients to experience discrimination at their institution; 24% observed discriminatory care; 65% reported that transgender patients were more likely than non-transgender patients to experience discrimination; 20% observed discrimination to transgender patients; 14% observed the spouse/partner of LGBT patients having their treatment decisions disregarded or minimized; and 13% observed the spouse/partner being treated disrespectfully. Qualitative data are presented to illustrate discomfort with LGBT patients and spouses/partners, disrespectful care, gossip and ridicule, inadequate care, and denial of care. Implications and suggestions for implementing non-discriminatory and respectful institutional and public policy, and for staff education and training to provide competent and respectiful care to this population are presented.

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