The Supportive Care Plan: a tool to improve communication in end-of-life care

2009 ◽  
Vol 15 (5) ◽  
pp. 250-255 ◽  
Author(s):  
Jane Thompson-Hill ◽  
Claire Hookey ◽  
Emily Salt ◽  
Trish O’Neill
Keyword(s):  
Supportive Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Care Plan ◽  
Life Care

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.

Opposing Vitalism and Embracing Hospice: How a Theology of the Sabbath Can Inform End-of-Life Care

2021 ◽  
Author(s):  
Sarah K Sawicki
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Hospice Care ◽  
Modern Medicine ◽  
The Body ◽  
Care Plan ◽  
Life Care ◽  
Negative Effects ◽  
Whole Person

Abstract Medicine often views hospice care as “giving up,” which results in a reduced quality of end-of-life care for many patients. By integrating a theology of the Sabbath with modern medicine, hospice becomes a sacred and valuable way to honor the dying patient in a comprehensive and holistic way. A theology of Sabbath as “Sacredness in Time” can provide the foundation for a shift in understanding hospice as a legitimate care plan, which shifts the focus from controlling and manipulating space for the body, to rest and enjoyment of time for the whole person. First, I explore vitalism and its negative effects on the institution of hospice. Second, I address the main misconceptions and biases surrounding hospice in order to establish hospice as an appropriate option for the terminally ill. Finally, I argue for a shift away from sacredness in space (as seen in vitalism) to sacredness in time.

scholarly journals Complexity Analysis of Decision-Making in the Critically Ill

2016 ◽  
Vol 33 (10) ◽  
pp. 557-566 ◽  
Author(s):  
Barbara J. Daly ◽  
Sara L. Douglas ◽  
Elizabeth O’Toole ◽  
James Rowbottom ◽  
Alan Hoffer ◽  
...  
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Critically Ill ◽  
End Of Life Care ◽  
Treatment Effectiveness ◽  
Family Members ◽  
Cognitive Status ◽  
Care Plan ◽  
Life Care ◽  
Icu Discharge

Rationale: Despite multiple trials of interventions to improve end-of-life care of the critically ill, there is a persistent lack of understanding of factors associated with barriers to decision-making at the end of life. Objective: To apply the principles of complexity science in examining the extent to which transitions to end-of-life care can be predicted by physician, family, or patient characteristics; outcome expectations; and the evaluation of treatment effectiveness. Methods: A descriptive, longitudinal study was conducted in 3 adult intensive care units (ICUs). Two hundred sixty-four family surrogates of patients lacking decisional capacity and the physicians caring for the patients were interviewed every 5 days until ICU discharge or patient death. Measurements: Characteristics of patients, physicians, and family members; values and preferences of physicians and family; and evaluation of treatment effectiveness, expectations for patient outcomes, and relative priorities in treatment (comfort vs survival). The primary outcome, focus of care, was categorized as (1) maintaining a survival orientation (no treatment limitations), (2) transitioning to a stronger palliative focus (eg, some treatment limitations), or (3) transitioning to an explicit end-of-life, comfort-oriented care plan. Main Results: Physician expectations for survival and future cognitive status were the only variables consistently and significantly related to the focus of care. Neither physician or family evaluations of treatment effectiveness nor what was most important to physicians or family members was influential. Conclusion: Lack of influence of family and physician views, in comparison to the consistent effect of survival probabilities, suggests barriers to incorporation of individual values in treatment decisions.

scholarly journals Valuing end-of-life care: translation and content validation of the ICECAP-SCM measure

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Uta Gühne ◽  
Marie Dorow ◽  
Jessica Grothe ◽  
Janine Stein ◽  
Margrit Löbner ◽  
...  
Keyword(s):  
Supportive Care ◽  
End Of Life ◽  
Content Validity ◽  
End Of Life Care ◽  
Economic Evaluations ◽  
Life Care ◽  
Content Validation ◽  
The Uk ◽  
Care Measure

Abstract Background The evaluation of care strategies at the end of life is particularly important due to the globally increasing proportion of very old people in need of care. The ICECAP-Supportive Care Measure is a self-complete questionnaire developed in the UK to evaluate palliative and supportive care by measuring patient’s wellbeing in terms of ‘capability’. It is a new measure with high potential for broad and international use. The aims of this study were the translation of the ICECAP-Supportive Care Measure from English into German and the content validation of this version. Methods A multi-step and team-based translation process based on the TRAPD model was performed. An expert survey was carried out to assess content validity. The expert panel (n = 20) consisted of four expert groups: representative seniors aged 65+, patients aged 65+ living in residential care, patients aged 65+ receiving end-of-life care, and professionals in end-of-life care. Results The German version of the ICECAP-Supportive Care Measure showed an excellent content validity on both item- and scale-level. In addition, a high agreement regarding the length of the single items and the total length of the questionnaire as well as the number of answer categories was reached. Conclusions The German ICECAP-SCM is a valid tool to assess the quality of life at the end of life that is suitable for use in different settings. The questionnaire may be utilized in multinational clinical and economic evaluations of end-of-life care.

Challenges in implementing an advance care planning programme in long-term care

2016 ◽  
Vol 24 (1) ◽  
pp. 87-99 ◽  
Author(s):  
Ciara McGlade ◽  
Edel Daly ◽  
Joan McCarthy ◽  
Nicola Cornally ◽  
Elizabeth Weathers ◽  
...  
Keyword(s):  
End Of Life ◽  
Advance Care Planning ◽  
End Of Life Care ◽  
Long Term Care ◽  
Care Plan ◽  
Care Planning ◽  
Life Care ◽  
Term Care ◽  
Advance Care

Background: A high prevalence of cognitive impairment and frailty complicates the feasibility of advance care planning in the long-term-care population. Research aim: To identify challenges in implementing the ‘Let Me Decide’ advance care planning programme in long-term-care. Research design: This feasibility study had two phases: (1) staff education on advance care planning and (2) structured advance care planning by staff with residents and families. Participants and research context: long-term-care residents in two nursing homes and one community hospital. Ethical considerations: The local research ethics committee granted ethical approval. Findings: Following implementation, over 50% of all residents had completed some form of end-of-life care plan. Of the 70 residents who died in the post-implementation period, 14% had no care plan, 10% (with capacity) completed an advance care directive and lacking such capacity, 76% had an end-of-life care plan completed for them by the medical team, following discussions with the resident (if able) and family. The considerable logistical challenge of releasing staff for training triggered development of an e-learning programme to facilitate training. Discussion: The challenges encountered were largely concerned with preserving resident’s autonomy, avoiding harm and suboptimal or crisis decision-making, and ensuring residents were treated fairly through optimisation of finite resources. Conclusions: Although it may be too late for many long-term-care residents to complete their own advance care directive, the ‘ Let Me Decide’ programme includes a feasible and acceptable option for structured end-of-life care planning for residents with variable capacity to complete an advance care directive, involving discussion with the resident (to the extent they were able) and their family. While end-of-life care planning was time-consuming to deliver, nursing staff were willing to overcome this and take ownership of the programme, once the benefits in improved communication and enhanced peace of mind among all parties involved became apparent in practice.

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