Patterns of Care for Patients with Cancer before and after the Establishment of a Hospice Ward

A majority of people die in acute hospital care, in a culture of quickness primary aimed at curing. There are indications that hospice care in various forms will spread during the present decade in Sweden. The hospice philosophy contributes to a culture of slowness, where the patient is not only allowed but is encouraged to live at his own pace. As a first step in establishing for whom hospice inpatient care is the best alternative, patient flow to a newly started hospice ward was studied. All patients (n = 1464) who died at the Medical Centre Hospital with a primary diagnosis of cancer during the period of study were compared regarding place of death, diagnosis, gender, age and length of the last period of care. The year before the ward was established, 82% of patients died in acute hospital care compared with 59% during the hospice ward's third year of operation. A total of 315 patients (22%) died in the hospice ward during the study period. The percentage of these patients over the age of 80 was significantly higher (p = 0.0001), and they also had a longer continuous final period of care. More women (57%) than men (43%) were cared for at the hospice ward. The hospice ward has in this way influenced the pattern of care in the hospital.     

Provision of Palliative and Hospice Care to Children in the Community: A Population Study of Hospice Nurses

Context

Approximately 500,000 children in the United States suffer from life-limiting illnesses each year, many of whom are hospice eligible each year. Few hospice agencies, however, offer formal pediatric programs.

Palliative Ultrasound for Home Care Hospice Patients

The evolving relationship between emergency and palliative medicine is expected to benefit patients of each. Two collaborative care encounters involving home hospice patients are discussed. Portable bedside ultrasound was performed in the home to diagnose ascites and to guide palliative paracentesis. Specific interventions and outcomes are reported. The interface of emergency and palliative care and the use of paracentesis in cancer palliation are briefly reviewed. It is concluded that home‐performed ultrasound and ultrasound‐guided procedures are promising palliative modalities for care at the end of life. ACADEMIC EMERGENCY MEDICINE 2010; 17:293–296 © 2010 by the Society for Academic Emergency Medicine     

Hospice and Heart Disease: Missed Opportunities

ABSTRACT

A relatively low percentage of eligible heart disease patients receive hospice care in the United States. In 2005, the most recent year with complete reporting, only 18.36% of patients who were dying of heart failure and were hospice eligible actually received hospice care. Reasons for this include the lack of reliable prognostic indicators, the lack of a consensus on when to stop life prolonging therapies, and the relatively high cost of life-prolonging (versus life-enhancing) pharmacotherapy such as dobutamine. In addition, most studies and case reports that address symptom management in hospice care focus on cancer patients, not those with nononcologic diagnoses. This lack of evidence may discourage practitioners who care for cardiac patients from referral to hospice programs, and may keep some hospice practitioners from aggressively targeting this population. Strategies to increase hospice program utilization by heart disease patients are discussed.     

Reflections on the History of Occupational Stress in Hospice/Palliative Care

The concept of hospice and palliative care emerged a quarter of a century ago out of recognition of the unmet needs of dying persons and the social issues of the 1960s and 1970s. The issues of the day included the sexual revolution; a questioning of social values; an increased awareness of death resulting from the murder of the Kennedy brothers and Martin Luther King and daily television exposure to deaths in the Vietnam War, feminism, consumerism, reclaiming a more humanized role in the birth process, and hence in the process of death. The history of the hospice movement and the stress experienced by staff is traced from the early developmental days through to the present. Initially there was sometimes a struggle to integrate the concepts of relief of physical symptoms with meeting the psychosocial and emotional needs of patients and families, caregivers were expected to sacrifice much of their personal life for work, emotional intensity was high and supports were developed to ease some of the stress experienced by caregivers. From the early days team stress and burnout have been issues of concern. In the 1980s issues involved establishing funding sources, dealing with the new crisis of AIDS, and dealing with the gap between the ideal and the real. In the 1990s the economic climate has escalated some of the tensions that have always existed as hospice attempts to position itself within mainstream care with diminishing fiscal resources. These are issues that confront us as we move into the next century. [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?>?]     

中美临终关怀计划相关政策的比较研究

目的对中美两国临终关怀计划相关政策进行比较研究。方法以布雷迪的比较教育学经典四步比较法对两国相关政策进行描述、解释、并列和比较。结果中美临终关怀计划在计划种类、受益人纳入标准、服务控制机制、出入案相关规定、资金来源等相关政策等方面存在异同点。结论临终关怀计划相关政策的影响因素包括：社会经济条件的影响、人口素质的限制、传统医学理念的影响等。     

Medical Aid in Dying,Hastened Death,and Suicide: A Qualitative Study of Hospice Professionals' Experiences From Washington State

ContextMany jurisdictions around the world have passed medical aid in dying (MAID) laws allowing competent eligible individuals facing life-limiting illness to self-administer prescribed medication to control timing of death. These laws do not prevent some patients who are receiving hospice services from dying by suicide without assistance.ObjectivesTo explore hospice professionals' experiences of patients who die by suicide or intentionally hasten death with or without legal assistance in an area where there is legalized MAID.MethodsSemistructured in-depth qualitative interviews were conducted with 21 home hospice professionals (seven nurses, seven social workers, four physicians, and three chaplains). Thematic analysis was carried out to analyze the data.ResultsThree primary themes were identified from the interviews: 1) dealing with and differentiating between hastened death and suicide, 2) MAID access and affordability, and 3) how patients have hastened their own deaths. Analysis of these data indicates that there are some patients receiving hospice services who die by suicide because they are not eligible for, have no knowledge of, or lack access to legalized MAID. Hospice professionals do not consistently identify patients' deaths as suicide when they are self-inflicted and sometimes view these deaths as justified.ConclusionSuicide and hastened deaths continue to be an unexamined cause of death for some home hospice patients who may have requested MAID. Open communication and increased education and training is needed for palliative care professionals regarding legal options, issues of suicide, and suicide assessment.     

A Study of Hospice Administrative Competencies and Delegation of Functions by Program Stage of Development in Michigan

There are definable stages in hospice program development which require significantly different administrative competencies. In many instances, as programs move from one stage to another, there may need to be significant changes in administrative functions, delegation, and perhaps even changes in personnel. This article reports a study of hospice administrators in Michigan in which they determined not only which stage of development they believed their hospice program to be in, but also what essential competencies they needed in managing the day-to-day operations of their hospice programs.     

Safe and Appropriate Use of Methadone in Hospice and Palliative Care: Expert Consensus White Paper

Methadone has several unique characteristics that make it an attractive option for pain relief in serious illness, but the safety of methadone has been called into question after reports of a disproportionate increase in opioid-induced deaths in recent years. The American Pain Society, College on Problems of Drug Dependence, and the Heart Rhythm Society collaborated to issue guidelines on best practices to maximize methadone safety and efficacy, but guidelines for the end-of-life scenario have not yet been developed. A panel of 15 interprofessional hospice and palliative care experts from the U.S. and Canada convened in February 2015 to evaluate the American Pain Society methadone recommendations for applicability in the hospice and palliative care setting. The goal was to develop guidelines for safe and effective management of methadone therapy in hospice and palliative care. This article represents the consensus opinion of the hospice and palliative care experts for methadone use at end of life, including guidance on appropriate candidates for methadone, detail in dosing, titration, and monitoring of patients' response to methadone therapy.     

Finding Peace Beyond the Pain: Sunder's Journey in the Hospice

Dame Cicely Saunders revolutionized the concept of pain by coining the term “total pain”, the sum of the physical, psychological, social, spiritual, emotional components that make up the total pain experience. Optimal pain relief may not be possible until all elements of the pain and suffering are addressed. This narrative describes the journey of Sunder in the hospice. A caring husband, and a doting father, he came to the hospice by force, in immense pain and suffering. He stayed on by choice and found the peace he was looking for beyond his pain and sufferings, ably supported by the dedicated hospice team. He was able to live the last few months of his life as comfortably as was possible, and left this world in peace, with dignity. The narrative reiterates the belief that hospice, with its philosophy of active “total care” is an ideal place for addressing the concept of “total pain.”     

Development of Curricular Milestones for Hospice and Palliative Medicine Fellowship Training in the U.S.

Context

A physician workgroup of the American Academy of Hospice and Palliative Medicine sought to define curricular milestones (CMs) for hospice and palliative medicine (HPM) Fellowship Programs. The developed list of CMs would serve as components upon which to organize curriculum and standardize what to teach during training. These would complement entrustable professional activities previously developed by this group and new specialty-specific reporting milestones (RMs) for HPM developed through the Accreditation Council for Graduate Medical Education.

Missed Opportunities: Integrating Palliative Care into the Emergency Department for Older Adults Presenting as Level I Triage Priority from Long-Term Care Facilities

Background

Early integration of palliative care from the emergency department (ED) is an underutilized care modality with potential benefits, but few studies have identified who is appropriate for such care.

Music Therapy in Hospice and Palliative Care: a Review of the Empirical Data

Although music therapy is an established allied health professionand is used with increasing frequency in the treatment of thosewith a terminal illness, there is a real dearth of empiricalresearch literature supporting the use of music therapy in end-of-lifecare. This article reviews the empirical studies found in theliterature and documents the emergence of an evidenced-basedapproach to the use of music therapy in hospice and palliativecare. A total of 11 studies are reviewed; of these, six showsignificant differences supporting the use of music therapyin this area. Dependent variables positively affected by musictherapy include pain, physical comfort, fatigue and energy,anxiety and relaxation, time and duration of treatment, mood,spirituality and quality of life. Guidelines for future researchare considered, and variables that need to be controlled arepresented. The need to create an evidence-based approach tohospice and palliative care music therapy is articulated, andfuture researchers are empowered to continue to conduct investigationsamong this population.     

Improving Hospice and Palliative Care Through Nurse Practitioner Engagement in a Community Paramedicine Program

More than 80% of Americans would prefer to die at home, but only 20% do. Paramedics have a role in caring for terminally ill patients, especially when involved in a community setting. A knowledge gap was noted with community paramedics (CPs) regarding end-of-life questions and palliative care for paramedics. This evidence-based quality improvement project aimed to provide structured, evidence-based palliative and hospice education to CPs. Nurse practitioners can provide education and training on palliative and hospice care to CPs and help patients remain at home.     

Creatively Caring: Effects of Arts-Based Encounters on Hospice Caregivers in South Africa

International literature and experience suggest that arts-based encounters can be effective in reducing stress and burnout in health care workers. Are these principles universal? Are they as applicable and effective in resource-constrained situations in Africa as in other parts of the world? We describe the impact of creative and arts-based encounters on a group of hospice caregivers at South Coast Hospice in KwaZulu Natal. An experienced facilitator built a caring and trusting relationship with the participants over a three month period through a variety of means, including a singing and songwriting intervention specifically designed to empower and give voice to the hospice caregivers, most of whom were Zulu women. We documented the process through several rounds of interviews, extensive field notes, and audio recordings. This article is a reflection on the experience and draws from the interviews, correspondence among researchers, field notes, and a performance piece written by the facilitator one year after completion of the study. We found that the songwriting and other creative activities of the engagement provided affirmation and acknowledgment of the caregivers as well as an opportunity to release stress, grief, and pain. They experienced changes in terms of hope and freedom both for themselves and their patients. The conceptual themes that emerged from the interviews with the caregivers were interpreted in terms of their inherent cultural assets, a release of agency, a sense of revelation, and transformation. The expressive arts can have a significantly beneficial effect on hospice workers and their patients, and clinical engagement can be enhanced through creative encounters, even in resource-constrained situations. If such creative processes were to be promoted among a wider group of health workers, daily routine work in health care could be not just a repetition of well-rehearsed utilitarian rituals but rather a series of creative and transformative encounters.     

养老机构护理员临终关怀知识、态度、行为现状及其影响因素

目的探讨养老机构护理员临终关怀知识、态度、行为现状及其影响因素。方法 2016年1-5月,便利抽样法选择宁波市20所养老机构的351名养老护理员为研究对象。采用临终关怀知识、态度及行为量表对其进行调查,分析养老护理员临终关怀知识、态度、行为现状及其影响因素。结果养老护理员临终关怀知识、态度、行为评分分别为(0.65±0.15)、(3.47±0.23)、(3.96±0.60)分。不同学历、工作年限的养老护理员,其临终关怀知识评分差异均有统计学意义(均P0.05);不同年龄、职称、家庭型态、临终关怀知识来源及临终关怀知识总均分的养老护理员,其临终关怀态度评分差异均有统计学意义(均P0.05);不同家庭型态、临终关怀知识来源及临终关怀态度评分的养老护理员,其临终关怀行为评分差异亦有统计学意义(均P0.05)。学历和工作年限是养老护理员临终关怀知识评分的主要影响因素;年龄、职称、家庭型态、临终关怀知识来源、临终关怀知识是养老护理员临终关怀态度评分的主要影响因素;家庭型态、临终关怀知识来源和临终关怀态度是养老护理员临终关怀行为评分的主要影响因素(均P0.05)。结论养老机构护理员的临终关怀知识水平较低,临终关怀知识来源渠道局限,应重视养老护理员的临终关怀教育培训。     

The Impact of Combined Use of Opioids,Antipsychotics, and Anxiolytics on Survival in the Hospice Setting

Context

Opioids and sedatives are the cornerstone of symptom management in the end-of-life patients, but undertreatment is a common problem. Although several studies explored the individual effect of opioids, anxiolytics, and antipsychotics on survival, not much is known regarding their combined use. As these drugs share similar and potentially fatal side effects, primarily respiratory depression which occurs more often during night-hours, it is crucial to explore whether their interaction poses a danger for fragile hospice patients.