scholarly journals End-of-Life Care for Hispanic Children

2016 ◽  
Vol 14 (4) ◽  
pp. 164-169 ◽  
Author(s):  
Lisa C. Lindley ◽  
Laura V. Trujillo
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Hospital Admissions ◽  
Family Characteristics ◽  
Care Utilization ◽  
Life Care ◽  
Hispanic Children ◽  
Care Policy ◽  
Source Of Care

Introduction: More than 8,000 Hispanic children die annually in the United States; yet little is known about the end-of-life care utilized. The purpose of this study was to examine the children and family characteristics associated with end-of-life care for Hispanic children. Method: A sample of 370 Hispanic children was created, using the 2009-2010 California Medicaid data. The relationship between child and family characteristics and end-of-life care utilization (i.e., hospice enrollment, emergency room utilization, hospital admissions) was analyzed using multivariate regression. Results: Pediatric hospice accessibility ( p < .05), palliative care policy ( p < .01), congenital anomalies ( p < .01), and cardiovascular conditions ( p < .01) were related to hospice enrollment. Usual source of care ( p < .001), functional status ( p < .001), palliative care policy ( p < .01), and private insurance ( p < .01) were associated with emergency room utilization, while usual source of care ( p < .001), cancer ( p < .001), and disability status ( p < .01) corresponded with hospital admissions. Conclusion: Nursing practices aimed at engaging Hispanic families in their community are critical to end-of-life care utilization for Hispanic children.

scholarly journals Information sharing challenges in end-of-life care: a qualitative study of patient, family and professional perspectives on the potential of an Electronic Palliative Care Co-ordination System

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e037483
Author(s):  
Holly Standing ◽  
Rebecca Patterson ◽  
Mark Lee ◽  
Sonia Michelle Dalkin ◽  
Monique Lhussier ◽  
...  
Keyword(s):  
Palliative Care ◽  
Qualitative Study ◽  
Information Sharing ◽  
End Of Life ◽  
End Of Life Care ◽  
Social Care ◽  
Hospital Admissions ◽  
Sufficient Information ◽  
Life Care ◽  
Health And Social Care

ObjectivesTo explore current challenges in interdisciplinary management of end-of-life care in the community and the potential of an Electronic Palliative Care Co-ordination System (EPaCCS) to facilitate the delivery of care that meets patient preferences.DesignQualitative study using interviews and focus groups.SettingHealth and Social Care Services in the North of England.Participants71 participants, 62 health and social care professionals, 9 patients and family members.ResultsFour key themes were identified: information sharing challenges; information sharing systems; perceived benefits of an EPaCCS and barriers to use and requirements for an EPaCCS. Challenges in sharing information were a source of frustration for health and social care professionals as well as patients, and were suggested to result in inappropriate hospital admissions. Current systems were perceived by participants to not work well—paper advance care planning (ACP) documentation was often unavailable or inaccessible, meaning it could not be used to inform decision-making at the point of care. Participants acknowledged the benefits of an EPaCCS to facilitate information sharing; however, they also raised concerns about confidentiality, and availability of the increased time and resources required to access and maintain such a system.ConclusionsEPaCCS offer a potential solution to information sharing challenges in end-of-life care. However, our findings suggest that there are issues in the initiation and documentation of end-of-life discussions that must be addressed through investment in training in order to ensure that there is sufficient information regarding ACP to populate the system. There is a need for further qualitative research evaluating use of an EPaCCS, which explores benefits and challenges, uptake and reasons for disparities in use to better understand the potential utility and implications of such systems.

Patterns of palliative care utilization and end of life care in adult patients with cancer who died as inpatients at Mayo Clinic.

2016 ◽  
Vol 34 (15_suppl) ◽  
pp. e21681-e21681
Author(s):  
Collin Thomas Zimmerman ◽  
Shivani S. Shinde ◽  
Pashtoon Murtaza Kasi ◽  
Mark Robert Litzow ◽  
Jeanne M. Huddleston
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Mayo Clinic ◽  
End Of Life Care ◽  
Adult Patients ◽  
Care Utilization ◽  
Life Care ◽  
Patients With Cancer

Impact of mortality reviews on supportive care utilization, end-of-life care, and inpatient mortality.

2019 ◽  
Vol 37 (31_suppl) ◽  
pp. 45-45
Author(s):  
Yasmin Karimi ◽  
Vasu Divi ◽  
Sandy Srinivas ◽  
Andrea Segura Smith ◽  
Jennifer Hansen ◽  
...  
Keyword(s):  
Palliative Care ◽  
Supportive Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Health Workers ◽  
Hospital Setting ◽  
Care Plan ◽  
Care Utilization ◽  
Life Care ◽  
Chi Square Analysis

45 Background: 22% of US patients with cancer die in a hospital setting. As part of an effort to reduce unexpected inpatient (inpt) mortality, we reviewed records of all inpt cancer deaths at Stanford Hospital and reported findings to the treatment teams. Methods: Deaths with a cancer related ICD 9/10 code between 5/2017 and 6/2019 were reviewed by a multidisciplinary team. Findings and potential opportunities for improvement were communicated to the pt’s primary outpt oncologist, inpt oncologists and other involved providers. Observed to expected (O:E) mortality for the year prior to the intervention (5/2016–4/2017), Year 1 (5/2017–4/2018) and Year 2 (5/2018–4/2019) of the intervention were compared with two sided t test, α=0.05 (Vizient Inc, Irving TX). Changes in supportive care utilization and end of life care between cases reviewed in Year 1 and Year 2 were compared with chi square analysis. Results: There were 236 inpatient deaths reviewed. The median age was 64 years; 76% had solid tumors; 68% had metastatic disease; 33% had a previous inpt admission; 34% received chemotherapy in the last 2 weeks of life. Median length of stay was 7 days and 37% were admitted to the intensive care unit (ICU). The O:E mortality ratio significantly decreased between the year prior to intervention and Year 2 (0.95 vs. 0.69; p = .019), and Years 1 and 2 (0.90 vs. 0.69; p = .003). There was no noted difference in number of palliative care consults or resuscitation status at the time of death between Years 1 and 2. There was an increased frequency of advance care plan documentation on admission in Year 2 (p = .007). Conclusions: Cancer pts who die in the hospital have high rates of recent hospitalizations, chemotherapy/radiation use in the last 2 weeks of life and ICU admissions. Decrease in O:E is likely multifactorial. Potential factors are improved documentation of comorbidities, increased access to palliative care services, and facilitation of hospice referrals which were partially driven by results of our reviews and resulting awareness around end of life care. Work is ongoing to standardize documentation of goals of care conversations in the electronic medical record and employ lay health workers for earlier end of life discussions.

Improving End-of-Life Care for Ventricular Assist Devices (VAD) Patients: Paradox or Protocol?

2013 ◽  
Vol 67 (1-2) ◽  
pp. 161-166 ◽  
Author(s):  
Peg McGonigal
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Hospital Admissions ◽  
Life Experience ◽  
Care Service ◽  
Palliative Care Service ◽  
Ventricular Assist Devices ◽  
Life Care ◽  
Ventricular Assist

When a person consents to have a ventricular assist device (VAD) implanted in one's heart, the intention is to extend life toward a new heart or toward more time. Complications may develop followed by frequent hospital admissions—most often in an intensive care unit (ICU) setting—rendering a transplant a distant reality and to discontinue the device means certain death. Emotional support for patient and family is critical. Regardless of the original goal for the device, palliative care provides assistance in communication, goal setting, and symptom management and yet its consultation is often more for brink-of-death care than end-of-life care provided at the time of diagnosis of a life-threatening disease such as heart failure. This study examined the recent deaths of hospitalized patients with VADs and the use of the palliative care service. Understanding the benefit and timing of palliative care for VAD patients—particularly in the ICU setting—may improve the end-of-life experience for patients, families, and healthcare providers.

scholarly journals End of life care policy for the dying: Consensus position statement of indian association of palliative care

2014 ◽  
Vol 20 (3) ◽  
pp. 171 ◽  
Author(s):  
Naveen Salins ◽  
Maryann Muckaden ◽  
Vivek Nirabhawane ◽  
Srinagesh Simha ◽  
StanleyC Macaden ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Position Statement ◽  
Life Care ◽  
Care Policy ◽  
Indian Association

Impact of Inpatient Palliative Care on Quality of End-of-Life Care and Downstream Acute and Postacute Care Utilization

2018 ◽  
Vol 21 (7) ◽  
pp. 913-923 ◽  
Author(s):  
Peter S. Khang ◽  
Susan E. Wang ◽  
In-Lu Amy Liu ◽  
Heather L. Watson ◽  
Sandra Y. Koyama ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Care Utilization ◽  
Life Care ◽  
Postacute Care

Paramedics delivering palliative and end-of-life care in community-based settings: A systematic integrative review with thematic synthesis

2021 ◽  
pp. 026921632110593
Author(s):  
Madeleine L Juhrmann ◽  
Priyanka Vandersman ◽  
Phyllis N Butow ◽  
Josephine M Clayton
Keyword(s):  
Palliative Care ◽  
Mixed Methods ◽  
End Of Life ◽  
End Of Life Care ◽  
Hospital Admissions ◽  
Integrative Review ◽  
Economic Evaluations ◽  
Life Care ◽  
Community Based ◽  
Thematic Synthesis

Background: There is a growing demand for community palliative care and home-based deaths worldwide. However, gaps remain in this service provision, particularly after-hours. Paramedicine may help to bridge that gap and avoid unwanted hospital admissions, but a systematic overview of paramedics’ potential role in palliative and end-of-life care is lacking. Aim: To review and synthesise the empirical evidence regarding paramedics delivering palliative and end-of-life care in community-based settings. Design: A systematic integrative review with a thematic synthesis was undertaken in accordance with Whittemore and Knafl’s methodology. Prospero: CRD4202119851. Data sources: MEDLINE, CINAHL, PsycINFO and Scopus databases were searched in August 2020 for primary research articles published in English, with no date limits applied. Articles were screened and reviewed independently by two researchers, and quality appraisal was conducted following the Mixed-Methods Appraisal Tool (2018). Results: The search retrieved 5985 articles; 23 articles satisfied eligibility criteria, consisting of mixed-methods ( n = 5), qualitative ( n = 7), quantitative descriptive ( n = 8) and quantitative non-randomised studies ( n = 3). Through data analysis, three key themes were identified: (1) Broadening the traditional role, (2) Understanding patient wishes and (3) Supporting families. Conclusions: Paramedics are a highly skilled workforce capable of helping to deliver palliative and end-of-life care to people in their homes and reducing avoidable hospital admissions, particularly for palliative emergencies. Future research should focus on investigating the efficacy of palliative care clinical practice guideline implementation for paramedics, understanding other healthcare professionals’ perspectives, and undertaking health economic evaluations of targeted interventions.

‘Supportive and Palliative Care Indicators Tool (SPICT) improves renal nurses’ confidence in recognising patients approaching end of life’

2020 ◽  
pp. bmjspcare-2020-002496
Author(s):  
Laura Lunardi ◽  
Kathy Hill ◽  
Susan Crail ◽  
Adrian Esterman ◽  
Richard Le Leu ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Hospital Admissions ◽  
Multidisciplinary Care ◽  
Time Frame ◽  
Care Planning ◽  
Optimal Management ◽  
Life Care ◽  
Appropriate Care

BackgroundIdentification of people with deteriorating health is essential for quality patient-centred care and optimal management. The Supportive and Palliative Care Indicators Tool (SPICT) is a guide to identifying people with deteriorating health for care planning without incorporating a prognostic time frame.ObjectivesTo improve renal nursing staff confidence in identifying patients approaching end-of-life and advocate for appropriate multidisciplinary care planning.DesignThis pilot feasibility prospective cohort study conducted in the renal ward of a major metropolitan health service during 2019 included a preintervention/postintervention survey questionnaire. A programme of education was implemented training staff to recognise end-of-life and facilitate appropriate care planning.ResultsSeveral domains in the postintervention survey demonstrated a statistically significant improvement in renal nurses’ perception of confidence in their ability to recognise end of life. Of the 210 patients admitted during the study period, 16% were recognised as SPICT positive triggering renal physicians to initiate discussions about end-of-life care planning with patients and their families and to document a plan. Six months poststudy, 72% of those patients recognised as SPICT positive had died with a documented plan of care in place.ConclusionThe use of SPICT for hospital admissions and the application of education in topics related to end-of-life care resulted in a significant improvement in nurses’ confidence in recognising deteriorating and frail patients approaching their end of life. The use of this tool also increased the number of deteriorating patients approaching end of life with goals of care documented.

scholarly journals Honoring Preferences—The Consistency Between End-of-Life Care and a Veteran’s Goal for Comfort Care

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 752-752
Author(s):  
Joan Carpenter ◽  
Winifred Scott ◽  
Mary Ersek ◽  
Cari Levy ◽  
Jennifer Cohen ◽  
...  
Keyword(s):  
Palliative Care ◽  
Logistic Regression ◽  
End Of Life ◽  
End Of Life Care ◽  
Life Care ◽  
Multivariate Logistic Regression ◽  
Comfort Care ◽  
Lower Odds ◽  
Medicare Data ◽  
Life Sustaining Treatment

Abstract This study examined the alignment between Veterans’ end-of-life care and a Life-Sustaining Treatment (LST) goal “to be comfortable.” It includes Veterans with VA inpatient or community living center stays overlapping July 2018--January 2019, with a LST template documented by January 31, 2019, and who died by April 30, 2019 (N = 18,163). Using VA and Medicare data, we found 80% of decedents with a comfort care goal received hospice and 57% a palliative care consult (compared to 57% and 46%, respectively, of decedents without a comfort care goal). Using multivariate logistic regression, a comfort care goal was associated with significantly lower odds of EOL hospital or ICU use. In the last 30 days of life, Veterans with a comfort care goal had 43% lower odds (AOR 0.57; 95% CI: 0.51, 0.64) of hospitalization and 46% lower odds of ICU use (AOR 0.54; 95% CI: 0.48, 0.61).

Help Me Understand: Providing Palliative Care to Individuals With Serious Mental Illness

2021 ◽  
pp. 104990912110107
Author(s):  
Kate L. M. Hinrichs ◽  
Cindy B. Woolverton ◽  
Jordana L. Meyerson
Keyword(s):  
Mental Illness ◽  
Palliative Care ◽  
End Of Life ◽  
Serious Mental Illness ◽  
End Of Life Care ◽  
Psychosocial Support ◽  
Life Care ◽  
Case Examples ◽  
Increased Risk ◽  
Palliative Care Teams

Individuals with serious mental illness (SMI) have shortened life expectancy with increased risk of developing comorbid medical illnesses. They might have difficulty accessing care and can be lost to follow-up due to complex socioeconomic factors, placing them at greater risk of dying from chronic or undiagnosed conditions. This, in combination with stigma associated with SMI, can result in lower quality end-of-life care. Interdisciplinary palliative care teams are in a unique position to lend assistance to those with SMI given their expertise in serious illness communication, values-based care, and psychosocial support. However, palliative care teams might be unfamiliar with the hallmark features of the various SMI diagnoses. Consequently, recognizing and managing exacerbations of SMI while delivering concurrent palliative or end-of-life care can feel challenging. The goal of this narrative review is to describe the benefits of providing palliative care to individuals with SMI with concrete suggestions for communication and use of recovery-oriented language in the treatment of individuals with SMI. The salient features of 3 SMI diagnoses—Bipolar Disorders, Major Depressive Disorder, and Schizophrenia—are outlined through case examples. Recommendations for working with individuals who have SMI and other life-limiting illness are provided, including strategies to effectively manage SMI exacerbations.

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