Predictors of Family Members’ Satisfaction with Hospice

This large, long-term study of families served by hospice found that nearly 95 percent said hospice had been helpful. Still, about 30 percent of family members said there was something they wish hospice had done differently. Those who had some complaint were more likely than those who had no complaints to be women, to report the patient had needed a great deal of care, to have a history of depression and greater levels of distress before and after the patient’s death, and to be dissatisfied with the support they received from family members and friends. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: getinfo@haworthpressinc.com <Website: http://www.haworthpressinc.com>]     

Is It Time for Family Presence During Resuscitation in the OR?

Family presence during resuscitation (FPDR) is a growing trend in many areas of health care facilities, and it may be time to consider allowing FPDR in the OR as well. Health care providers cite concerns against FPDR, however, including psychological trauma of family members, medical litigation, performance anxiety of staff members affecting performance quality, team member distractions, problems maintaining sterility, and questions regarding a patient's right to FPDR. The circulating nurse may be an appropriate person to advocate for the patient's wishes to allow family members access to the OR during resuscitation efforts. Two hospitals in Spokane, Washington, have implemented a hospital-wide FPDR policy, allowing family presence in the emergency department, trauma rooms, labor and delivery rooms, and on patient care floors. Committee members developed guidelines for FPDR in the OR, educated hospital staff members, and presented the concept of FPDR to surgery executive committee members.     

The Moment of Death: Is Hospice Making a Difference?

The moment of death was a compelling image and dominant concept through much of history. In recent years this term has become destabilized by technological advances and changes in clinical practice. Perhaps even more significantly, the meanings previously associated with the deathbed scene and the final breath have become increasingly marginalized. Hospice programs continue to demonstrate that enlightened and dedicated care can markedly reduce the suffering of terminally ill people and their families. The vast experience acquired by hospice programs, however, has not yet been translated into a vision of the moment of death and the deathbed scene for our times. Several reasons are identified for the limited interest and even more limited hospice-based research into the deathbed scene and the moment of death. Hospice programs could contribute much to our understanding of the final moments of life if this should ever become a priority. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: getinfo@haworthpressinc.com <Website: http://www.haworthpressinc.com>]     

The Hospice Care

Hospiceisawordthathascomedownfrom[2 ] theMiddleAgesinEurope .Itwasusedtodescribeaway -stationwheretravelers ,pilgrims[3] ,andillpeoplecouldstopanddependonreceivinghumanecare .ThefirstpioneerofthemodernhospicemovementwasDr .CicelySaunderswithherbackgroundinmedicine ,nursing ,andsocialwork .ShefoundedSt.Christopher’shospiceinLondonin 1 96 7,whichrepresentsthebeginningoftoday’shospicesintheworld .Saundersusedthetermofhospicetomeanaway -stationwheredyingpeopleinacar ingenviromentcanliveoutth…     

Genomics: Is It Ready for Primetime?

The next decade will focus on identifying the missing heritability of coronary artery disease (CAD). This process will involve a more comprehensive interrogation of common single nucleotide polymorphisms (SNPs) that impart modest biologic effect and an interrogation of rare SNPs that impart profound biologic effect. In parallel, an investigation of the underlying biology of the described association will likely yield novel pathways that provide therapeutic targets. Once we obtain a more complete inventory of sequence variation that predisposes to CAD, a more realistic assessment of the role of genetic risk scoring allied with standard risk algorithms will be possible.     

Home Hospice Family Caregivers’ Use of Audio Diaries and Reported Prevalence of Patient and Caregiver Symptoms

ContextFamily caregivers are essential to home hospice care for patients with advanced cancer, including reporting patient symptoms to hospice providers for follow-up. Hospice caregiving can also impact personal well-being.Objectives1) Assess home hospice caregivers’ use of prospective, longitudinal audio diaries tracking patient and caregiver wellbeing; 2) Explore how patient-focused vs. caregiver-focused diary prompts perform; 3) Examine the prevalence of interactive voice response (IVR)-tracked symptoms and whether diaries revealed additional symptoms.MethodsCaregivers (N=102) were asked to report patient and caregiver symptoms via daily IVR calls and could record optional diaries responding to patient-focused or caregiver-focused prompts. Diaries were transcribed, classified by presence/absence of new information, and compared by prompt type. Content coding for IVR-tracked symptoms and inductive coding for additional symptoms were summarized by frequency counts and exemplary quotes.ResultsSixty-nine percent of participants (n=70) recorded diaries, and of these 72.86% (n=51) recorded ≥ one new-information diary. The median recording length was 53.00 seconds (SD=53.36). Participants responding to the caregiver-focused prompt (n=33) recorded more diaries than those in the patient-focused group (n=37; U=437.500, P=0.04. Most prevalent IVR-tracked symptoms were patient fatigue/weakness (26.54% of symptoms mentioned) and pain (23.08%), and caregiver anxiety/nervousness (47.51%) and fatigue (22.10%). The most prevalent additional symptoms were patient increasing sleepiness/sleeping (26.32%) and breathing difficulties (24.32%), and negative caregiver emotions (e.g., guilt, resentment, anger; 29.17%).ConclusionProspective audio diaries offer a viable avenue for communicating symptoms and support needs. Future research will focus on leveraging longitudinal data for developing focused and tailored caregiver support interventions.