Emergency Medical Services Provider Experiences of Hospice Care

Background: Growing numbers of emergency medical services (EMS) providers respond to patients who receive hospice care. The objective of this investigation was to assess the knowledge, attitudes, and experiences of EMS providers in the care of patients enrolled in hospice care. Methods: We conducted a survey study of EMS providers regarding hospice care. We collected quantitative and qualitative data on EMS provider's knowledge, attitudes, and experiences in responding to the care needs of patients in hospice care. We used Chi-squared tests to compare EMS provider's responses by credential (Emergency Medical Technician [EMT] vs. Paramedic) and years of experience (0–5 vs. 5+). We conducted a thematic analysis to examine open-ended responses to qualitative questions. Results: Of the 182 EMS providers who completed the survey (100% response rate), 84.1% had cared for a hospice patient one or more times. Respondents included 86 (47.3%) EMTs with Intermediate and Advanced training and 96 (52.7%) Paramedics. Respondent's years of experience ranged from 0–10+ years, with 99 (54.3%) providers having 0–5 years of experience and 83 (45.7%) providers having 5+ years of experience. There were no significant differences between EMTs and Paramedics in their knowledge of the care of these patients, nor were there significant differences (p < 0.05) between those with 0–5 and 5+ years of experience. Furthermore, 53 (29.1%) EMS providers reported receiving formal education on the care of hospice patients. A total of 36% respondents felt that patients in hospice care required a DNR order. In EMS providers' open-ended responses on challenges in responding to the care needs of hospice patients, common themes were family-related challenges, and the need for more education. Conclusion: While the majority of EMS providers have responded to patients enrolled in hospice care, few providers received formal training on how to care for this population. EMS providers have expressed a need for a formal curriculum on the care of the patient receiving hospice.     

Perspectives Regarding Hospice Services and Transfusion Access: Focus Groups With Blood Cancer Patients and Bereaved Caregivers

ContextPatients with blood cancers have low rates of timely hospice use. Barriers to hospice use for this population are not well understood. Lack of transfusion access in most hospice settings is posited as a potential reason for low and late enrollment rates.ObjectivesWe explored the perspectives of patients with blood cancers and their bereaved caregivers regarding the value of hospice services and transfusions.MethodsBetween June 2018 and January 2019, we conducted three focus groups with blood cancer patients with an estimated life expectancy of six months or less and two focus groups with bereaved caregivers of patients with blood cancers. We asked participants their perspectives regarding quality of life (QOL) and about the potential association of traditional hospice services and transfusions with QOL. A hematologic oncologist, sociologist, and qualitatively trained research assistant conducted thematic analysis of the data.ResultsTwenty-seven individuals (18 patients and nine bereaved caregivers) participated in the five focus groups. Participants identified various QOL domains that were important to them but focused largely on a desire for energy to maintain physical/functional well-being. Participants considered transfusions a high-priority service for their QOL. They also felt that standard hospice services were important for QOL. Bereaved caregivers reported overall positive experiences with hospice.ConclusionOur analysis suggests that although patients with blood cancers value hospice services, they also consider transfusions vital to their QOL. Innovative care delivery models that combine the elements of standard hospice services with other patient-valued services like transfusions are most likely to optimize end-of-life care for patients with blood cancers.     

Nurses' Attitudes and Practice Related to Hospice Care

Purpose: To describe characteristics, attitudes, and communications of nurses regarding hospice and caring for terminally ill patients.
Design: A cross-sectional study of randomly selected nurses (n=180) from six randomly selected Connecticut community hospitals was conducted in 1998 and 1999.
Methods: Hospice-related training, knowledge and attitudes, demographic and practice characteristics, and personal experience with hospice were assessed with a self-administered questionnaire (response rate=82%). Logistic regression was used to model the effects of hospice-related training, knowledge, and attitudes on these outcomes, adjusting for personal experience and other characteristics of nurses.
Findings: Characteristics associated with discussion of hospice with both patients and families included greater religiousness, having a close family member or friend who had used hospice, and reporting satisfaction with hospice caregivers. Greater self-rated knowledge was significantly associated with discussion of hospice with patients. Attitudinal scores indicating greater comfort with initiating discussion and greater perceived added benefit of hospice were significantly associated with discussion with patients' families.
Conclusions: Nurses' discussion of hospice with terminally ill patients and their families are related to the potentially modifiable factors of self-rated knowledge and attitudes revealing comfort with discussion and perceived benefit of hospice care.     

Family Caregiver Quality of Life: Differences Between Curative and Palliative Cancer Treatment Settings

To compare the impact of cancer caregiving in curative and palliative settings on family caregiver quality of life (QOL), 267 family caregivers of cancer patients receiving curative treatment were compared to 134 family caregivers of cancer patients receiving palliative treatment through hospice. Both groups completed a demographic profile in addition to two self-report QOL questionnaires. Patient performance status and disease site were also recorded. Family caregivers of patients receiving palliative care had significantly lower QOL scores and lower scores on physical health. Hierarchical multiple regressions showed that after accounting for patient performance status, treatment status accounted for no additional significant variability in QOL scores. After accounting for caregiver level of education, treatment status accounted for no additional significant variability in physical health. These results suggest that the lower QOL scores of caregivers in the palliative setting are a reflection of the patients’ poorer performance status. The lower physical health scores of caregivers in the palliative setting appear to be a reflection of their lower educational level. Additional research is needed to evaluate the influence of specific demands of caregiving and emotional distress of the caregiver on caregiver QOL. J Pain Symptom Manage 1999;17:418–428.     

The International Association for Hospice and Palliative Care Web Site

The Web site of the International Association for Hospice and Palliative Care is reviewed. The Association newsletter, resources, links, access to the IAHPC Manual of Palliative Care 2nd Edition, frequently asked questions, and other useful information are provided on this site.     

Clinical Trial Participation as Part of End-of-Life Cancer Care: Associations With Medical Care and Quality of Life Near Death

ContextClinical trials are a common therapeutic option for patients with advanced incurable cancer.ObjectivesTo examine the associations between trial participation and end-of-life (EOL) outcomes, including aggressive care and quality of life (QOL).MethodsCoping with Cancer, a multicenter prospective cohort study of patients with metastatic cancer, progressed after at least first-line chemotherapy. Baseline chart review documented clinical trial participation. Baseline interviews assessed psychosocial characteristics and EOL preferences. Caregiver interview and chart review assessed medical care and QOL near death. The primary outcome was aggressive EOL care (ventilation, resuscitation, or intensive care unit admission in last week of life). Propensity score weighting balanced patient characteristics that differed by trial participation, including care preferences and EOL discussion. Propensity score–weighted regression models estimated the effect of trial participation on outcomes.ResultsOf 352 patients followed to death, 37 were enrolled in a clinical trial at baseline. In propensity score–weighted analyses, trial participation was significantly associated with aggressive EOL care (21.6% vs. 12.0%, adjusted odds ratio [AOR] 2.04, 95% confidence interval [CI] 1.00–4.15), late hospice enrollment (51.4% vs. 42.2%, AOR 1.96, 95% CI 1.10–3.50), hospital death (48.6% vs. 25.7%, AOR 2.74, 95% CI 1.37–5.47), intensive care unit death (16.2% vs. 6.3%, AOR 3.53, 95% CI 1.29–9.65), and inferior QOL near death (least squares mean 5.93 vs. 7.69, P < 0.001). Controlling for EOL care, trial enrollment was no longer associated with QOL near death (P = 0.342).ConclusionClinical trial participation is associated with aggressive EOL care. Aggressive EOL care appears to explain the association between trial participation and QOL near death.     

The International Association for Hospice and Palliative Care

This study examines demographic, medical, and psychosocial variables in relation to preference regarding place of death on the part of 171 patients and their families treated at the Home Care Unit of the Oncology Department at Linn Clinic in Haifa, Israel, in 1992-93. Women who had breast cancer, and patients aged 50-59 with few mobility problems, preferred to die at home. Families with support from an extended family and those who communicated with the patients about the illness preferred to treat the patients at home. The patient’s age, type of cancer, communication about dying, and the number of days hospitalized affected the place of death. Patients with prostate and brain cancer and patients aged 60 and older spent the most time (1-3 weeks) in a nursing home and tended to die there. Patients who were in a hospice tended to speak less about death than other patients. [Article copies available from The Haworth Document Delivery Service: 1-800-342-9678.]     

癌症晚期患者的临终关怀与护理

目的:探讨癌症晚期患者的临终关怀与护理经验。方法:对我院40例癌症晚期患者提供生理、心理上全面、周到的关怀和护理。结果:40例癌症晚期患者安详地走过人生最后阶段,家属表示能接受现实。结论:对晚期癌症患者的临终关怀与护理,能有效解除患者的疼痛,使患者能善终,在临床医疗中值得推广和应用。     

一核多元团队照护模式在免疫肿瘤治疗进展期肺癌患者安宁疗护中的应用

目的:探讨一核多元团队照护模式在免疫肿瘤治疗进展期肺癌患者安宁疗护中的应用效果.方法:将2017年8月1日～2020年10月1日收治的100例行免疫治疗的肺癌患者,随机分为对照组和观察组各50例;对照组实施常规护理干预,研究组实施一核多元团队照护模式;比较两组负性情绪[采用焦虑自评量表(SAS)、抑郁自评量表(SDS)...     

Information Framing Reduces Initial Negative Attitudes in Cancer Patients' Decisions About Hospice Care

Background

Negative attitudes toward hospice care might prevent patients with cancer from discussing and choosing hospice as they approach end of life. When making a decision, people often naturally focus on either expected benefits or the avoidance of harm. Behavioral research has demonstrated that framing information in an incongruent manner with patients' underlying motivational focus reduces their negative attitudes toward a disliked option.

Nationwide Quality of Hospice Care: Findings From the Centers for Medicare & Medicaid Services Hospice Quality Reporting Program

Context

With increasing use of the Medicare hospice benefit, policymakers recognize the need for quality measurement to assure that terminally ill patients receive high-quality care and have the information they need when selecting a hospice. Toward these goals, Centers for Medicare & Medicaid Services has been collecting standardized patient-level quality data via the Hospice Item Set (HIS) since July 1, 2014.

安宁疗护对肿瘤晚期患者死亡认知态度及生活质量的影响

目的:探讨安宁疗护对肿瘤晚期患者死亡认知态度及生活质量的影响。方法:将2016年7月1日~2017年12月31日收治的57例肿瘤晚期患者作为对照组,给予常规护理干预;将2018年1月1日~2019年6月30日收治的57例肿瘤晚期患者作为研究组,给予安宁疗护。比较两组护理前、护理2个月主观幸福感[采用总体幸福感量表(GWB)]、睡眠质量[采用睡眠质量自评量表(SRSS)]、生活质量[采用生活质量核心量表(QLQ-30)]及死亡认知态度情况[采用死亡态度描绘修订表(DAP-R)],并记录护理期间患者不适症状。结果:护理2个月,两组GWB评分、SRSS评分、QLQ-30评分均优于护理前(P<0.05),且研究组优于对照组(P<0.05);护理2个月,研究组DAP-R中趋近导向、中性及逃离导向的死亡接受评分均优于对照组(P<0.05);研究组不适症状发生率低于对照组(P<0.05)。结论:对肿瘤晚期患者应用安宁疗护,不仅可有效改善患者死亡认知态度、睡眠质量,还能提升其主观幸福感和生活质量,减轻患者不适症状。     

History of the National Hospice Organization

The National Hospice Organization grew out of efforts by the founders of the earliest hospice programs in the United States to protect their emotional investments in hospice care, to advocate for hospice interests in Congress and other public policy forums, to define standards for the fledgling movement, and to provide education on the nuts and bolts of running hospice programs for others who were interested in starting hospices in communities from coast to coast. Unlike the model of St. Christopher’s Hospice in England, which began as a free-standing in-patient facility and later added home care services, most U.S. hospices started as home care-based programs, often largely manned by volunteers. Among the crucial issues that have dominated the work of NHO during its first 21 years were passage and maintenance of the Medicare hospice benefit, ideological battles over the hospice philosophy, and efforts to extend hospice care to other populations, such as people with AIDS. [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>]     

Risk Factors for Developing Prolonged Grief During Bereavement in Family Carers of Cancer Patients in Palliative Care: A Longitudinal Study

ContextFamily carers of palliative care patients report high levels of psychological distress throughout the caregiving phase and during bereavement. Palliative care providers are required to provide psychosocial support to family carers; however, determining which carers are more likely to develop prolonged grief (PG) is currently unclear.ObjectivesTo ascertain whether family carers reporting high levels of PG symptoms and those who develop PG disorder (PGD) by six and 13 months postdeath can be predicted from predeath information.MethodsA longitudinal study of 301 carers of patients receiving palliative care was conducted across three palliative care services. Data were collected on entry to palliative care (T1) on a variety of sociodemographic variables, carer-related factors, and psychological distress measures. The measures of psychological distress were then readministered at six (T2; n = 167) and 13 months postdeath (T3; n = 143).ResultsThe PG symptoms at T1 were a strong predictor of both PG symptoms and PGD at T2 and T3. Greater bereavement dependency, a spousal relationship to the patient, greater impact of caring on schedule, poor family functioning, and low levels of optimism also were risk factors for PG symptoms.ConclusionScreening family carers on entry to palliative care seems to be the most effective way of identifying who has a higher risk of developing PG. We recommend screening carers six months after the death of their relative to identify most carers with PG.     

Do Live Discharge Rates Increase as Hospices Approach Their Medicare Aggregate Payment Caps?

Context

The rate of live discharge from hospice and the proportion of hospices exceeding their aggregate caps have both increased for the last 15 years, becoming a source of federal scrutiny. The cap restricts aggregate payments hospices receive from Medicare during a 12-month period. The risk of repayment and the manner in which the cap is calculated may incentivize hospices coming close to their cap ceilings to discharge existing patients before the end of the cap year.