Palliative Care Consultation, Quality-of-Life Measurements, and Bereavement for End-of-Life Care in Patients With Lung Cancer

Background: In end-of-life care hygiene, measures concerning multidrug-resistant bacterial microorganisms may contradict the palliative care approach of social inclusion and be burdensome for patients. Objectives: To integrate patients’ perspectives on handling multidrug-resistant bacterial microorganisms at their end of life, their quality of life, the impact of positive multidrug-resistant bacterial microorganisms’ diagnosis, protection and isolation measures on their well-being and patients’ wishes and needs regarding their care. Design: A mixed-methods convergent parallel design embedded quantitative data on the patients’ multidrug-resistant bacterial microorganisms’ trajectory and quality of life assessed by the Schedule for the Evaluation of Individual Quality of Life in qualitative data collection via interviews and focus groups. Data analysis was performed according to Grounded Theory and qualitative and quantitative results were interrelated. Setting/participants: Between March 2014 and September 2015 at two hospitals adult patients diagnosed with multidrug-resistant bacterial microorganisms and treated in a palliative care department or a geriatric ward were included in the sample group. Results: Patients in end-of-life and geriatric care reported emotional and social impact through multidrug-resistant bacterial microorganisms’ diagnosis itself, hygiene measures and lack of information. This impact affects aspects relevant to the patients’ quality of life. Patients’ wishes for comprehensive communication/information and reduction of social strain were identified from the focus group discussion. Conclusion: Patients would benefit from comprehensible information on multidrug-resistant bacterial microorganisms. Strategies minimizing social exclusion and emotional impact of multidrug-resistant bacterial microorganisms’ diagnosis in end-of-life care are needed as well as adaption or supplementation of standard multidrug-resistant bacterial microorganisms’ policies of hospitals.

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mHOMR: a feasibility study of an automated system for identifying inpatients having an elevated risk of 1-year mortality

BMJ Quality & Safety ◽

10.1136/bmjqs-2018-009285 ◽

2019 ◽

pp. bmjqs-2018-009285 ◽

Cited By ~ 2

Author(s):

Pete Wegier ◽

Ellen Koo ◽

Shahin Ansari ◽

Daniel Kobewka ◽

Erin O'Connor ◽

...

Keyword(s):

Palliative Care ◽

End Of Life ◽

Feasibility Study ◽

Mortality Risk ◽

End Of Life Care ◽

Elevated Risk ◽

Life Care ◽

Risk Of Death ◽

Palliative Care Consultation ◽

Care Consultation

ObjectiveThe need for clinical staff to reliably identify patients with a shortened life expectancy is an obstacle to improving palliative and end-of-life care. We developed and evaluated the feasibility of an automated tool to identify patients with a high risk of death in the next year to prompt treating physicians to consider a palliative approach and reduce the identification burden faced by clinical staff.MethodsTwo-phase feasibility study conducted at two quaternary healthcare facilities in Toronto, Canada. We modified the Hospitalised-patient One-year Mortality Risk (HOMR) score, which identifies patients having an elevated 1-year mortality risk, to use only data available at the time of admission. An application prompted the admitting team when patients had an elevated mortality risk and suggested a palliative approach. The incidences of goals of care discussions and/or palliative care consultation were abstracted from medical records.ResultsOur model (C-statistic=0.89) was found to be similarly accurate to the original HOMR score and identified 15.8% and 12.2% of admitted patients at Sites 1 and 2, respectively. Of 400 patients included, the most common indications for admission included a frailty condition (219, 55%), chronic organ failure (91, 23%) and cancer (78, 20%). At Site 1 (integrated notification), patients with the notification were significantly more likely to have a discussion about goals of care and/or palliative care consultation (35% vs 20%, p = 0.016). At Site 2 (electronic mail), there was no significant difference (45% vs 53%, p = 0.322).ConclusionsOur application is an accurate, feasible and timely identification tool for patients at elevated risk of death in the next year and may be effective for improving palliative and end-of-life care.

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The Optimal Delivery of Palliative Care (DRAFT)

10.1093/med/9780190658618.003.0005 ◽

2018 ◽

Author(s):

Jaclyn Yoong ◽

Peter Poon

Keyword(s):

Palliative Care ◽

End Of Life ◽

End Of Life Care ◽

Models Of Care ◽

Global Rating ◽

Life Care ◽

Palliative Care Consultation ◽

Care Consultation ◽

Excellent Care ◽

Veterans Affairs Medical Centers

This study aimed to compare the effect of palliative care consultation teams with that of dedicated palliative care units on the quality of end-of-life care. This was a telephone-base survey conducted in 77 Veterans Affairs medical centers that had provided both models of care. Deceased patients from July 2008 to December 2009 were identified. A family member of the decedent was invited to participate in the survey which consisted of one global rating item and nine core items pertaining to patient’s end-of-life care. Families of patients who received care in a palliative care unit were more likely to report “excellent” care compared to families of those who received at least one palliative care consultation; families of those who received at least one palliative care consultation in turn where more likely to report “excellent” care compared to families of those who received usual care.

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End-of-Life Care for Neonates and Infants: The Experience and Effects of a Palliative Care Consultation Service

MCN The American Journal of Maternal/Child Nursing ◽

10.1097/00005721-200201000-00021 ◽

2002 ◽

Vol 27 (1) ◽

pp. 60

Author(s):

Laura L. Hayman

Keyword(s):

Palliative Care ◽

End Of Life ◽

End Of Life Care ◽

Life Care ◽

Consultation Service ◽

Palliative Care Consultation ◽

Care Consultation ◽

Palliative Care Consultation Service ◽

Neonates And Infants

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End-of-Life Care at a Community Cancer Center

Journal of Oncology Practice ◽

10.1200/jop.2011.000451 ◽

2012 ◽

Vol 8 (4) ◽

pp. e40-e44 ◽

Cited By ~ 9

Author(s):

David E. Cowall ◽

Bennett W. Yu ◽

Sandra L. Heineken ◽

Elizabeth N. Lewis ◽

Vishal Chaudhry ◽

...

Keyword(s):

Quality Of Life ◽

Palliative Care ◽

End Of Life ◽

Symptom Management ◽

End Of Life Care ◽

Cancer Center ◽

Improve Quality ◽

Life Care

Early concurrent palliative care and earlier hospice admission may improve quality of life because of better symptom management and avoidance of aggressive and/or toxic therapies at end of life.

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Investigating Key Factors Related to the Decision of a Do-Not-Resuscitate Consent

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph19010428 ◽

2021 ◽

Vol 19 (1) ◽

pp. 428

Author(s):

Hui-Mei Lin ◽

Chih-Kuang Liu ◽

Yen-Chun Huang ◽

Chieh-Wen Ho ◽

Mingchih Chen

Keyword(s):

Palliative Care ◽

Logistic Regression ◽

Regression Analysis ◽

End Of Life ◽

Logistic Regression Analysis ◽

End Of Life Care ◽

Life Care ◽

Do Not Resuscitate ◽

Palliative Care Consultation ◽

Care Consultation

Background: The decision to sign a do-not-resuscitate (DNR) consent is critical for patients concerned about their end-of-life medical care. Taiwan’s National Health Insurance Administration (NHIA) introduced a family palliative care consultation fee to encourage family palliative care consultations; since its implementation, identifying which families require such consultations has become more important. In this study, the Taiwanese version of the Palliative Care Screening Tool (TW–PCST) was used to determine each patient’s degree of need for a family palliative care consultation. Objective: This study analyzed factors associated with signing DNR consents. The results may inform family palliative care consultations for families in need, thereby achieving a higher DNR consent rate and promoting the effective use of medical resources, including time, labor, and funding. Method: In this retrospective study, logistic regression analysis was conducted to determine which factors affected the DNR decisions of 2144 deceased patients (aged ≥ 20 years), whose records were collected from the Taipei City Hospital health information system from 1 January to 31 December 2018. Results: Among the 1730 patients with a DNR consent, 1298 (75.03%) received family palliative care consultations. The correlation between DNR consent and family palliative care consultations was statistically significant (p < 0.001). Through logistic regression analysis, we determined that participation in family palliative care consultation, TW–PCST score, type of ward, and length of stay were significant variables associated with DNR consent. Conclusions: This study determined that TW–PCST scores can be used as a measurement standard for the early identification of patients requiring family palliative care consultations. Family palliative care consultations provide opportunities for patients’ family members to participate in discussions about end-of-life care and DNR consent and provide patients and their families with accurate medical information regarding the end-of-life care decision-making process. The present results can serve as a reference to increase the proportion of patients willing to sign DNR consents and reduce the provision of ineffective life-prolonging medical treatment.

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End-of-Life Care in Non-Cancer Illnesses

InnovAiT Education and inspiration for general practice ◽

10.1093/innovait/ins080 ◽

2012 ◽

Vol 5 (6) ◽

pp. 351-359 ◽

Cited By ~ 1

Author(s):

Hayley Cousins ◽

Richard Cassell ◽

P.-J. Morey

Keyword(s):

Quality Of Life ◽

Palliative Care ◽

End Of Life ◽

End Of Life Care ◽

Life Care ◽

Specialist Palliative Care ◽

Patients With Cancer ◽

Disease Trajectory ◽

Practical Guidance

End-of-life care is that which is provided to patients experiencing a progressive final decline in their lives, usually with a prognosis of less than a year. End-of-life care in non-cancer illness may be challenging for GPs because of the uncertainty about disease trajectory. Patients with non-cancer illness often experience similar symptoms to patients with cancer but for longer hence with a greater impact on quality of life. Only a minority of such patients need specialist palliative care input so the generalist needs to be confident in assessing, treating and supporting patients and families. This article offers suggestions to overcome the challenges along with practical guidance on managing symptoms in the most common non-cancer illnesses.

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Integrative Nursing in Palliative Care and End-of-Life

Integrative Nursing ◽

10.1093/med/9780190851040.003.0033 ◽

2018 ◽

pp. 491-507

Author(s):

Julie Katseres ◽

William E. Rosa

Keyword(s):

Quality Of Life ◽

Palliative Care ◽

End Of Life ◽

End Of Life Care ◽

Life Care ◽

Popular Belief ◽

Centered Care ◽

Primary Healing

Contrary to popular belief, palliative care, or hospice, is not withdrawing care but rather shifting the focus from curing disease and illness to a journey of living with disease/illness, optimizing quality of life, while at the same time finding value and meaning in the transitions toward conscious dying—guiding the sacred passage. The purpose of this chapter is to disarm the fear and discomfort around illness and death through exploring integrative nursing principles that guide palliative and end-of-life care and by reframing how care is delivered during these crucial moments, inviting an ethic of evolving human-centered care with nurse as the primary healing instrument.

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Family Perceptions of Quality of End-of-Life Care for Veterans with Advanced CKD

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.01560219 ◽

2019 ◽

Vol 14 (9) ◽

pp. 1324-1335 ◽

Cited By ~ 1

Author(s):

Claire A. Richards ◽

Chuan-Fen Liu ◽

Paul L. Hebert ◽

Mary Ersek ◽

Melissa W. Wachterman ◽

...

Keyword(s):

Intensive Care Unit ◽

Palliative Care ◽

Intensive Care ◽

End Of Life ◽

End Of Life Care ◽

Life Care ◽

Acute Dialysis ◽

Palliative Care Consultation ◽

Maintenance Dialysis

Background and objectivesLittle is known about the quality of end-of-life care for patients with advanced CKD. We describe the relationship between patterns of end-of-life care and dialysis treatment with family-reported quality of end-of-life care in this population.Design, setting, participants, & measurementsWe designed a retrospective observational study among a national cohort of 9993 veterans with advanced CKD who died in Department of Veterans Affairs facilities between 2009 and 2015. We used logistic regression to evaluate associations between patterns of end-of-life care and receipt of dialysis (no dialysis, acute dialysis, maintenance dialysis) with family-reported quality of end-of-life care.ResultsOverall, 52% of cohort members spent ≥2 weeks in the hospital in the last 90 days of life, 34% received an intensive procedure, and 47% were admitted to the intensive care unit, in the last 30 days, 31% died in the intensive care unit, 38% received a palliative care consultation in the last 90 days, and 36% were receiving hospice services at the time of death. Most (55%) did not receive dialysis, 12% received acute dialysis, and 34% received maintenance dialysis. Patients treated with acute or maintenance dialysis had more intensive patterns of end-of-life care than those not treated with dialysis. After adjustment for patient and facility characteristics, receipt of maintenance (but not acute) dialysis and more intensive patterns of end-of-life care were associated with lower overall family ratings of end-of-life care, whereas receipt of palliative care and hospice services were associated with higher overall ratings. The association between maintenance dialysis and overall quality of care was attenuated after additional adjustment for end-of-life treatment patterns.ConclusionsAmong patients with advanced CKD, care focused on life extension rather than comfort was associated with lower family ratings of end-of-life care regardless of whether patients had received dialysis.

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