bluuebunny/crossref_metadata_2025 huggingface dataset:
A Survey of Knowledge and Attitudes of Nurses About Pain Management in End-Stage Liver Disease in a Geriatric Palliative Care Unit
Authors: Perri Giulia-Anna , Yeung Herman , Green Yoel , Bezant Abby , Lee Carman , Berall Anna , Karuza Jurgis , Khosravani Houman
Published: November 2017

Background:

Palliative care is often initiated late for patients with end stage liver disease (ESLD) with pain being a common morbidity that is under-treated throughout the disease trajectory. When admitted to a palliative care unit (PCU), nurses play a pivotal role and must be highly informed to ensure effective pain management. The aim of this study is to determine the baseline level of knowledge and attitudes of PCU nurses regarding pain management in patients with ESLD.

Methods:

A descriptive, cross-sectional self-administered survey design was used for this study. The sample comprised 35 PCU nurses working at a continuing chronic care facility in Toronto, Ontario, Canada. Data on the knowledge and attitudes of the nurses regarding pain management in patients with ESLD, was obtained using a modified version of the “Nurses Knowledge and Attitudes Survey Regarding Pain” (NKASRP) tool.

Results:

Thirty-one PCU nurses were included for the analysis, giving a response rate of 89%. The mean total percentage score for the nurses on the modified version of the NKASRP was 72%. Only 26% of the nurse participants obtained a passing score of 80% or greater. There were no significant differences in mean total scores by age, gender, years of nursing experience or education level.

Conclusions:

The findings of this study provide important information about the inadequate knowledge and attitude in nurses regarding pain management for patients with ESLD. It is suggested that targeted educational programs and quality improvement initiatives in pain management for patients with ESLD could improve knowledge and attitudes for PCU nurses.
Palliative Care Processes Embedded in the ICU Workflow May Reserve Palliative Care Teams for Refractory Cases
Authors: Mun Eluned , Umbarger Lillian , Ceria-Ulep Clementina , Nakatsuka Craig
Published: November 2017

Context:

Palliative Care Teams have been shown to be instrumental in the early identification of multiple aspects of advanced care planning. Despite an increased number of services to meet the rising consultation demand, it is conceivable that the numbers of palliative care consultations generated from an ICU alone could become overwhelming for an existing palliative care team.

Objective:

Improve end-of-life care in the ICU by incorporating basic palliative care processes into the daily routine ICU workflow, thereby reserving the palliative care team for refractory situations.

Methods:

A structured, palliative care, quality-improvement program was implemented and evaluated in the ICU at Kaiser Permanente Medical Center in Hawaii. This included selecting trigger criteria, a care model, forming guidelines, and developing evaluation criteria.

Main Outcome Measures:

These included the early identification of the multiple features of advanced care planning, numbers of proactive ICU and palliative care family meetings, and changes in code status and treatment upon completion of either meeting.

Results:

Early identification of Goals-of-Care, advance directives, and code status by the ICU staff led to a proactive ICU family meeting with resultant increases in changes in code status and treatment. The numbers of palliative care consultations also rose, but not significantly.

Conclusions:

Palliative care processes could be incorporated into a daily ICU workflow allowing for integration of aspects of advanced care planning to be identified in a systematic and proactive manner. This reserved the palliative care team for situations when palliative care efforts performed by the ICU staff were ineffective.
Race as a Predictor of Palliative Care Referral Time, Hospice Utilization, and Hospital Length of Stay: A Retrospective Noncomparative Analysis
Authors: Worster Brooke , Bell Declan Kennedy , Roy Vibin , Cunningham Amy , LaNoue Marianna , Parks Susan
Published: November 2017

Background:

Palliative care is associated with significant benefits, including reduced pain and suffering, an increased likelihood of patients dying in their preferred location, and decreased health-care expenditures. Racial and ethnic disparities are well-documented in hospice use and referral patterns; however, it is unclear whether these disparities apply to inpatient palliative care services.

Objective:

To determine if race is a significant predictor of time to inpatient palliative care consult, patient enrollment in hospice, and patients’ overall hospital length of stay among patients of an inpatient palliative care service.

Design:

Retrospective noncomparative analysis.

Setting:

Urban academic medical center in the United States.

Patients:

3207 patients referred to an inpatient palliative care service between March 2006 and April 2015.

Measurements:

Time to palliative care consult, disposition of hospice/not hospice (excluding patients who died), and hospital length of stay among patients by racial (Asian, black, Native American/Eskimo, Hispanic, white, Unknown) and ethnic (Hispanic/Latino, non-Hispanic, Unknown) background.

Results:

Race was not a significant predictor of time to inpatient palliative care consult, discharge to hospice, or hospital length of stay. Similarly, black/white, Hispanic/white, and Asian/white variables were not significant predictors of hospice enrollment ( Ps > .05).

Limitations:

Study was conducted at 1 urban academic medical center, limiting generalizability; hospital race and ethnicity categorizations may also limit interpretation of results.

Conclusions:

In this urban hospital, race was not a predictor of time to inpatient palliative care service consult, discharge to hospice, or hospital length of stay. Confirmatory studies of inpatient palliative care services in other institutions are needed.
Race/Ethnicity as a Predictor for Location of Death in Patients With Acute Neurovascular Events
Authors: Salomon Say , Chuang Elizabeth , Bhupali Deepa , Labovitz Daniel
Published: November 2017

Background:

Site of death is an important quality indicator for patients with terminal illness. Racial and ethnic disparities exist in the quality of end-of-life care. This study explores the site of death of patients admitted for and dying of complications of acute neurovascular events in a hospital network in an urban, low-income, predominantly minority community.

Methods:

This is a retrospective cohort study of patients admitted to 1 of 3 general hospitals that are part of an academic medical center in Bronx, New York, with the diagnosis of acute ischemic stroke, intracerebral hemorrhage, or subarachnoid hemorrhage who died during the index admission or were discharged with hospice services. The main outcome was location of death (palliative care inpatient unit [IPU] at the medical center or hospice services at discharge vs death on any other IPU).

Results:

A total of 655 patients admitted with acute neurovascular events from January 1, 2009, to March 1, 2015, died or were discharged with hospice services and were included in the analysis. Of those patients, 238 (36.3%) were black, 233 (35.5%) were Hispanic, and 184 (28.1%) were white. A total of 178 (24.4%) died on the palliative care unit or were discharged with hospice services, including 55 black patients (23.1%), 52 (28.3%) white patients, and 53 (22.7%) Hispanic patients. These differences were not statistically significant, even when controlling for confounders.

Conclusion:

This study did not show a difference in site of death in our institution by race or ethnicity, which is considered an important quality end-of-life care metric.
Integrating Palliative Care to Promote Earlier Conversations and to Increase the Skill and Comfort of Nonpalliative Care Clinicians: Lessons Learned From an Interventional Field Trial
Authors: Szekendi Marilyn K. , Vaughn Jocelyn , McLaughlin Beth , Mulvenon Carol , Porter-Williamson Karin , Sydenstricker Chris , Williamson Mary
Published: November 2017

While the uptake of palliative care in the United States is steadily improving, there continues to be a gap in which many patients are not offered care that explicitly elicits and respects their personal wishes. This is due in part to a mismatch of supply and demand; the number of seriously ill individuals far exceeds the workload capacities of palliative care specialty providers. We conducted a field trial of an intervention designed to promote the identification of seriously ill patients appropriate for a discussion of their goals of care and to advance the role of nonpalliative care clinicians by enhancing their knowledge of and comfort with primary palliative care skills. At 3 large Midwestern academic medical centers, a palliative care physician or nurse clinician embedded with a selected nonpalliative care service line or unit on a regularly scheduled basis for up to 6 months. Using agreed-upon criteria, patients were identified as being appropriate for a goals of care conversation; conversations with those patients and/or their families were then conducted with the palliative care specialist providing education, coaching, and mentoring to the nonpalliative care clinician, when possible. All of the sites increased the presence of palliative care within the selected service line or unit, and the nonpalliative care clinicians reported increased comfort and skill at conducting goals of care conversations. This intervention is a first step toward increasing patients’ access to palliative care to alleviate distress and to more consistently deliver care that honors patient and family preferences.
The Case for Dual Training in Geriatric Medicine and Palliative Care: The Time is Now
Authors: Gabbard Jennifer , McNabney Matthew
Published: November 2017

The majority of older adults die from chronic illnesses which are preceded by years of progressive decline and increasing symptom burden. Delivery of high-quality care cannot take place without sufficient numbers of health professionals with appropriate training and skills in both geriatric and palliative care medicine. Despite the surge in aging population and the majority of deaths being attributed to patients with multiple comorbidities, very few health-care providers undergo dual training in these areas. Thus, the nation is facing a health-care crisis as the number of geriatric patients with chronic disease increasingly outpaces the number of physicians with adequate skills to manage them. Joint training in palliative care and geriatric medicine could prepare physicians to better manage our aging population by addressing all their health-care needs irrespective of their stage of disease emphasizing patient-directed care.
Association Between Nursing Visits and Hospital-Related Disenrollment in the Home Hospice Population
Authors: Phongtankuel Veerawat , Adelman Ronald D. , Trevino Kelly , Abramson Erika , Johnson Phyllis , Oromendia Clara , Henderson Charles R. , Reid M. C.
Published: November 2017

Background:

Over 10% of hospice patients experience a transition out of hospice care during the last months of life. Hospice transitions from home to hospital (ie, hospital-related hospice disenrollment) result in fragmented care, which can be burdensome for patients and caregivers. Nurses play a major role in delivering home hospice care, yet little is known about the association between nursing visits and disenrollment.

Objectives:

The study’s purpose is to examine the association between the average number of nursing visits per week and hospital-related disenrollment in the home hospice population. We hypothesize that more nursing visits per week will be associated with reduced odds for disenrollment.

Design:

A retrospective cohort study using Medicare data.

Participants:

Medicare hospice beneficiaries who were ≥18 years old in 2012.

Outcome measured:

Hospitalization within 2 days of hospice disenrollment.

Results:

The sample included 115 103 home hospice patients, 6450 (5.6%) of whom experienced a hospital-related disenrollment. The median number of nursing visits per week was 2 (interquartile range 1.3-3.2), with a mean of 2.5 (standard deviation ±1.6). There was a decreased likelihood of a hospital-related disenrollment when comparing enrollments that had <3 nursing visits per week on average to 3 to <4 visits (odds ratio [OR] 0.39; P value <.001), 4 to <5 visits (OR 0.29; P value <.001), and 5+ visits (OR 0.21; P value <.001).

Conclusions:

More nursing visits per week was associated with a decreased likelihood of a hospital-related hospice disenrollment. Further research is needed to understand what components of nursing care influence care transitions in the home hospice setting.
Compassion Fatigue Among Palliative Care Clinicians: Findings on Personality Factors and Years of Service
Authors: O’Mahony Sean , Ziadni Maisa , Hoerger Michael , Levine Stacie , Baron Aliza , Gerhart James
Published: November 2017

Objectives:

Palliative medicine is a rewarding field, but providers encounter patient trauma on a routine basis. Compassion fatigue, marked by burnout, secondary traumatic stress, and low satisfaction may result. However, professionals differ markedly in how they respond to patient trauma. The objective of the current study was to determine whether personality traits of neuroticism and agreeableness relate to aspects of compassion fatigue, after accounting for time spent working in the field.

Methods:

Sixty-six palliative medicine physicians, nurses, social workers, and chaplains completed validated measures of personality traits, compassion fatigue, and work background.

Results:

Providers who had worked longer reported higher levels of satisfaction and lower levels of burnout. Neuroticism demonstrated strong significant associations with secondary traumatic stress and burnout ( Ps < .001). Agreeableness was significantly and strongly associated with compassion satisfaction ( P < .001). These associations held after accounting for years spent working in the field.

Significance of Results:

Personality traits of neuroticism and agreeableness may convey risk and resilience, respectively, for palliative care professionals. More research is needed to determine if assessing personality traits can help identify providers at risk for adverse reactions to patient trauma.
Nurses’ Interest in Independently Initiating End-of-Life Conversations and Palliative Care Consultations in a Suburban, Community Hospital
Authors: Mehta Ambereen K. , Wilks Steven , Cheng M. Jennifer , Baker Karen , Berger Ann
Published: November 2017

Background:

Patients who receive early palliative care consults have clinical courses and outcomes more consistent with their goals. Nurses have been shown to be advocates for early palliative care involvement and are able to lead advanced care planning discussions.

Objective:

The purpose of this study was to assess whether after a brief educational session, nurses at a suburban, community hospital could demonstrate knowledge of palliative care principles, would want to independently initiate end-of-life conversations with patients and families, and would want to place specialty palliative care consults.

Design:

Four 1 hour presentations were made at 4 nursing leadership council meetings from November through December 2015. Anonymous pre- and post-presentation surveys were distributed and collected in person.

Setting/Participant:

Nonprofit, suburban, community hospital in Maryland. Participants were full-time or part-time hospital employees participating in a nursing leadership council who attended the presentation.

Measurements:

We compared responses from pre- and post-presentation surveys.

Results:

Fifty nurses (19 departments) completed pre-presentation surveys (100% response rate) and 49 nurses completed post-presentation surveys (98% response rate). The average score on 7 index questions increased from 71% to 90%. After the presentations, 86% strongly agreed or agreed that nurses should be able to independently order a palliative care consult and 88% strongly agreed or agreed with feeling comfortable initiating an end-of-life conversation.

Conclusion:

Brief educational sessions can teach palliative care principles to nurses. Most participants of the study would want to be able to directly consult palliative care and would feel comfortable initiating end-of-life conversations after this educational session.
Expanding the Palliative Care Domains to Meet the Needs of a Community-Based Supportive Care Model
Authors: Anderson Eric W. , Frazer Monica S. , Schellinger Sandra E.
Published: November 2017

Background:

Whole person care is appropriate for seriously ill persons. The current framework of palliative care domains in the National Consensus Project (NCP) Guidelines for Quality Palliative Care offers an opportunity to reassess the domains of care delivered at home, earlier in the course of illness.

Objective:

This qualitative study was used to test the applicability of a proposed, expanded set of domains. The results were used to inform a home-based, upstream model of supportive care for serious illness.

Methods:

Quotes relating to the experience of late-life serious illness were derived from transcripts of 12 semi-structured group interviews conducted with patients, family, and professionals. Quotes originally coded to the NCP domains of palliative care were then coded to the proposed domain set, which included new categories of family/caregiver, legal/financial, and legacy/bereavement domains.

Results:

A total of 489 quotes were assigned to the proposed expanded set of domains. One hundred one (19%) coded to the family/caregiver domain, 28 (5%) to the legacy/bereavement domain, and 27 (5%) to the legal/financial domain. Ninety-seven (87%) of the 111 quotes coded to family/caregiver had been initially coded to the NCP social aspects of care. Family/caregiver themes included challenges, rewards, insights, and family growth.

Conclusion:

The preponderance of family-related issues suggests that including the family domain may promote recognition and support of family caregivers and the services they provide. Although this study provides some support for including the legacy/bereavement and legal/financial domains, additional research is needed to determine whether there is a basis for including them in the domain structure.
Factors Associated With End-of-Life Planning in Huntington Disease
Authors: Downing Nancy R. , Goodnight Siera , Chae Sena , Perlmutter Joel S. , McCormack Michael , Hahn Elizabeth , Barton Stacey K. , Carlozzi Noelle
Published: November 2017

Objective:

Knowledge of one’s gene status for adult onset conditions provides opportunity to make advance end-of-life (EOL) plans. The purposes of these analyses were to (1) determine the prevalence of EOL plans, including advance directives (ADs) among persons across 3 stages of Huntington disease (HD) and (2) examine factors associated with having ADs in this sample.

Methods:

Data are from 503 participants in the HD Quality of Life study. Participants completed an online health-related quality-of-life survey that included questions regarding EOL planning and self-reported HD symptoms. Frequencies were calculated for EOL planning by the HD stage. Bivariate analysis and logistic regression were used to identify variables associated with having ADs.

Results:

A total of 38.2% of participants stated they had ADs and fewer than half had other EOL plans. Being older, increased HD stage, more years of education, lower anxiety, more swallowing symptoms, and higher meaning and purpose were associated with having ADs.

Conclusion:

The prevalence of ADs in our sample is comparable to the general US population, but surprisingly low, considering the severity and long disease course of HD. Practice Implications: Health-care providers should develop specific interventions early in the disease process to increase ADs in this population.
A Review of Prognostic Tools in Heart Failure
Authors: Treece Jennifer , Chemchirian Hrak , Hamilton Neil , Jbara Manar , Gangadharan Venkataramanan , Paul Timir , Baumrucker Steven J.
Published: November 2017

A minority of patients with end-stage disease are referred to palliative medicine for consultation in advanced heart failure. Educating stakeholders, including primary care, cardiology, and critical care of the benefits of hospice and palliative medicine for patients with poor prognosis, may increase appropriately timed referrals and improve quality of life for these patients. This article reviews multiple tools useful in prognostication in the setting of advanced heart failure.
Strategies to Improve Quality of Life at the End of Life: Interdisciplinary Team Perspectives
Authors: Sagha Zadeh Rana , Eshelman Paul , Setla Judith , Sadatsafavi Hessam
Published: November 2017

This ethnographic study draws on the experiences of members of interdisciplinary care teams working with end-of-life care patients to identify strategies to improve quality of life through care practices. We surveyed 133 staff and volunteers (physicians, physician assistants, nurse practitioners, registered nurses, social workers, chaplains, administrators, and volunteers) who provide end-of-life care to patients in both home and institutional settings for 4 organizations in 2 counties in Upstate New York. Survey responses were analyzed using qualitative content analysis. The results identified numerous strategies to enhance and safeguard quality of life for end-of-life care patients and their family members. These strategies can be categorized into 6 domains: organization philosophy and mission; organizational policies; caregivers’ behaviors and practices; symptom management; facility design, operation and management; and patient, family member, and caregiver experience. The diverse list of identified strategies indicates that improving care to address the unique, complex, multilayered dimensions of quality of life at the end of life requires a multidisciplinary approach and consistency among care providers, including administration, clinical management, front-line caregivers, and support staff. When all of these strategies are used in harmony, care can truly be enhanced.
Awareness and Misperceptions of Hospice and Palliative Care: A Population-Based Survey Study
Authors: Shalev Ariel , Phongtankuel Veerawat , Kozlov Elissa , Shen Megan Johnson , Adelman Ronald D. , Reid M. C.
Published: November 2017

Background:

Despite the documented benefits of palliative and hospice care on improving patients’ quality of life, these services remain underutilized. Multiple factors limit the utilization of these services, including patients’ and caregivers’ lack of knowledge and misperceptions.

Objectives:

To examine palliative and hospice care awareness, misperceptions, and receptivity among community-dwelling adults.

Design:

Cross-sectional study.

Subjects:

New York State residents ≥18 years old who participated in the 2016 Empire State Poll. Outcomes Measured: Palliative and hospice care awareness, misperceptions, and receptivity.

Results:

Of the 800 participants, 664 (83%) and 216 (27%) provided a definition of hospice care and palliative care, respectively. Of those who defined hospice care, 399 (60%) associated it with end-of-life care, 89 (13.4%) mentioned it was comfort care, and 35 (5.3%) reported hospice care provides care to patients and families. Of those who defined palliative care (n = 216), 57 (26.4%) mentioned it provided symptom management to patients, 47 (21.9%) stated it was comfort care, and 19 (8.8%) reported it was applicable in any course of an illness. Of those who defined hospice or palliative care, 248 (37.3%) had a misperception about hospice care and 115 (53.2%) had a misperception about palliative care.

Conclusions:

Most community-dwelling adults did not mention the major components of palliative and hospice care in their definitions, implying a low level of awareness of these services, and misinformation is common among community-dwelling adults. Palliative and hospice care education initiatives are needed to both increase awareness of and reduce misperceptions about these services.
Utilizing the Electronic Health Record to Improve Advance Care Planning: A Systematic Review
Authors: Huber Michael Todd , Highland Janelle Deneen , Krishnamoorthi Venkatesan Ram , Tang Joyce Wing-Yi
Published: November 2017

Purpose:

Advance care planning may ensure care that is concordant with patient wishes. However, advance care plans are frequently absent when needed due to failure to engage patients in planning, inability to access prior documentation, or poor documentation quality. Interventions utilizing tools within the electronic health record (EHR) may address these barriers at the point of care. We aimed to identify EHR interventions previously utilized to improve advance care plans.

Methods:

We systematically searched 7 databases for observational and experimental studies of EHR interventions associated with advance care plans. We abstracted information on the study populations, EHR and non-EHR components of the interventions, and the efficacy for advance care plan–related outcomes.

Results:

We identified 16 articles that contained an EHR intervention to improve advance care plans. Study populations, study designs, and EHR components of the interventions were heterogeneous. Documentation templates were the most common EHR tool reported (n = 8), followed by automated prompts (n = 7) and electronic order sets (n = 5). The most common reported outcomes were documentation of an advance care planning conversation in the EHR (n = 7) and the placement of code status orders (n = 7). All studies reporting efficacy (n = 9) demonstrated an improvement in 1 or more advance care planning outcomes.

Conclusions:

The use of EHR interventions may improve advance care plan completion and availability at the point of care. Further work should seek to develop and evaluate standardized EHR tools for advance care planning.
Subcutaneous Botulinum Toxin Injection for Post-Thoracotomy Pain Syndrome in Palliative Care: A Case Report
Authors: Rashid Saima , Fields Amanda R. , Baumrucker Steven J.
Published: November 2017

Post-thoracotomy pain syndrome (PTPS) is a traumatic neuropathy that can affect as many as 50% of patients undergoing thoracotomy. Patients are often refractory to conservative management and may require multiple analgesics for adequate pain control. Botulinum toxin, derived from Clostridium botulinum, has many uses in treating conditions involving spasticity, dystonia, chronic migraine, and a variety of pain disorders including neuropathies. Botulinum toxin type A injections may provide an alternative or adjunct to improve symptom management in patients with PTPS.
Delivering End-of-Life Cancer Care: Perspectives of Providers
Authors: Patel Manali I. , Periyakoil Vyjeyanthi S. , Moore David , Nevedal Andrea , Coker Tumaini R.
Published: November 2017

Objectives:

Persistent gaps in end-of-life cancer care delivery and growing associated expenditures remain imminent US public health issues. The objective of this study was to understand clinical providers’ experiences delivering cancer care for patients at the end of life and their perspectives on potential solutions to improve quality of care.

Methods:

Semistructured interviews were conducted with 75 cancer care providers across the United States. The interviews were recorded, transcribed, and analyzed using constant comparative method of qualitative analysis.

Results:

Providers identified 3 major cancer care delivery challenges including lack of time to educate patients and caregivers due to clinical volume and administrative burdens, ambiguity in determining both prognosis and timing of palliative care at the end-of-life, and lack of adequate systems to support non-face-to-face communication with patients. To address these challenges, providers endorsed several options for clinical practice redesign in their settings. These include use of a lay health worker to assist in addressing early advance care planning, proactive non-face-to-face communication with patients specifically regarding symptom management, and community and in-home delivery of cancer care services.

Discussion:

Specific strategies for cancer care redesign endorsed by health-care providers may be used to create interventions that can more efficiently and effectively address gaps in end-of-life cancer care.
Addressing the Challenges of Palliative Care for Homeless Veterans
Authors: Hutt Evelyn , Albright Karen , Dischinger Hannah , Weber Mary , Jones Jacqueline , O’Toole Thomas P.
Published: November 2017

Background:

Veterans who nearing the end of life (EOL) in unstable housing are not adequately served by current palliative care or homeless programs.

Methods:

Multidisciplinary focus groups, interviews with community and Veterans Affairs (VA) leaders and with 29 homeless veterans were conducted in five cities. A forum of national palliative and homelessness care leaders (n=5) and representatives from each focus group (n=10), then convened. The forum used Nominal Group Process to suggest improvements in EOL care for veterans without homes. Modified Delphi Process was used to consolidate and prioritize recommendations during two subsequent tele-video conferences. Qualitative content analysis drew on meeting transcripts and field notes.

Results:

The Forum developed 12 recommendations to address the following barriers: (1) Declining health often makes independent living or plans to abstain impossible, but housing programs usually require functional independence and sobriety. (2) Managing symptoms within the homelessness context is challenging. (3) Discontinuities within and between systems restrict care. (4) VA regulations challenge collaboration with community providers. (5) Veterans with unstable housing who are at EOL and those who care for them must compete nationally for prioritization of their care.

Conclusion:

Care of veterans at EOL without homes may be substantially improved through policy changes to facilitate access to appropriate housing and care; better dissemination of existing policy; cross-discipline and cross-system education; facilitated communication among VA, community, homeless and EOL providers; and pilot testing of VA group homes or palliative care facilities that employ harm reduction strategies.
Young Adults’ Perspectives on Advance Care Planning
Authors: Tripken Jennifer L. , Elrod Cathy S.
Published: November 2017

Objective:

To describe the knowledge, attitudes, beliefs, and behaviors of young adults regarding advance care planning (ACP).

Methods:

A cross-sectional sample of young adults (N = 310) from a single metropolitan university during September to November 2016 completed an online survey about their knowledge, attitudes, beliefs, and behaviors regarding ACP. Descriptive statistics and correlation tests were conducted.

Results:

Young adults lacked familiarity and knowledge regarding ACP. Those who were most familiar with ACP terminology were more likely to be older, female, enrolled in a graduate program, and employed full time. Although the majority of respondents had positive attitudes and beliefs about ACP, only one-third had talked with their family/loved ones about their wishes for end-of-life care.

Discussion:

Our study findings suggest a strong need to inform and engage young adults in ACP and end-of-life care discussions. As young adults are likely to become a caregiver for an aging family member, they can have an important role in initiating and facilitating conversations with loved ones and be instrumental in ACP for older adults.
Patient Reported Outcomes After Radiation Therapy for Bone Metastases as a Function of Age: A Secondary Analysis of the NCIC CTG SC—Twenty-Three Randomized Trial
Authors: Chow Selina , Ding Keyue , Wan Bo Angela , Brundage Michael , Meyer Ralph M. , Nabid Abdenour , Chabot Pierre , Coulombe Genevieve , Ahmed Shahida , Kuk Joda , Dar A. Rashid , Mahmud Aamer , Fairchild Alysa , Wilson Carolyn F. , Wu Jackson S. Y. , Dennis Kristopher , DeAngelis Carlo , Wong Rebecca K. S. , Zhu Liting , Chow Edward
Published: November 2017

Purpose:

To explore the age difference in response and patient-reported outcomes in patients with cancer having bone metastases undergoing palliative radiotherapy.

Methods:

Patients completed the European Organisation for Research and Treatment of Cancer (EORTC) Quality-of-Life (QOL) Bone Metastases module (QLQ-BM22), EORTC QOL Core-15-Palliative (QLQ-C15-PAL), and Dexamethasone Symptom Questionnaire (DSQ) before a single 8-Gy radiation treatment, on days 10 and 42 after treatment. Patient demographics, performance status, analgesic consumption, BM22, C15, and DSQ were compared with multivariant analysis between patients under 75 years and 75 years and older. Multiple linear regression models were used to assess the differences between age-groups, adjusting for baseline demographics and primary disease sites.

Results:

There were 298 patients (170 male) with 209 (70%) less than 75 years of age. Most common primary cancer sites include lung, prostate, and breast. At baseline, younger patients had better performance status, consumed more analgesic, and reported worse scores in nausea, insomnia, and functional interference, while older patients more commonly had prostate cancer. There were no significant differences in the incidence of radiation-induced pain flare; response to radiation; changes from baseline for BM22, C15-PAL; and DSQ, nor overall survival at day 42 between the 2 groups. Responders to radiation in the elderly group reported better improvement in physical and emotional domains when compared with nonresponders.

Conclusions:

In patients with cancer having bone metastases undergoing palliative radiotherapy, there was no significant difference in general with age in response to radiation and patient-reported outcomes. Palliative radiotherapy should be offered to elderly patients when needed.
Educational Intervention to Improve Code Status Discussion Proficiency Among Obstetrics and Gynecology Residents
Authors: Margolis Benjamin , Blinderman Craig , de Meritens Alexandre Buckley , Chatterjee-Paer Sudeshna , Ratan Rini B. , Prigerson Holly G. , Hou June Y. , Burke William M. , Wright Jason D. , Tergas Ana I.
Published: November 2017

Background:

Obstetrics and gynecology (OB/GYN) residents receive little formal training in conducting code status discussions (CSDs).

Objective:

We piloted an educational intervention to improve resident confidence and competence at conducting CSDs.

Design:

The OB/GYN residents at a single institution participated in a 3-part educational program. First, participants reviewed a journal article and completed an online module. Second, they received a didactic lecture followed by a resident-to-resident mock CSD. Finally, participants had a videotaped CSD with a standardized patient (SP). Pre- and postintervention surveys and performance evaluations were analyzed. A subgroup analysis was performed on those with completed data sets.

Results:

Participants included 24 residents in postgraduate years (PGY) 1 to 4: 85% were female with a mean age of 29 years; 83% completed the entrance survey; 63% completed the SP CSD; and 42% completed of all parts of the intervention. Residents initially felt most prepared to discuss treatment options (3.3/5 on a Likert scale) and less prepared to discuss hospice, end-of-life care, and code status (2.2/5, 2.2/5, and 2.3/5, respectively). Performance during the resident-to-resident CSD was variable with scores (% of skills achieved) ranging from 27% to 93% (mean 64%). Performance at the SP encounter was similar with scores ranging from 40% to 73% (mean 56%). After intervention, residents felt more prepared for CSDs (3.7/5) and end-of-life care (3.9/5). The subgroup analysis failed to show a significant change in skill performance from the first to the second CSD.

Conclusion:

Participants found the components of this intervention helpful and reported improved confidence at conducting CSDs.
Predictors of Placement of Inpatient Palliative Care Consult Orders Among Patients With Breast, Lung, and Colon Cancer in a Safety Net Hospital System
Authors: Smith Lauren N. , Rhodes Ramona L. , Xuan Lei , Halm Ethan A.
Published: November 2017

Background:

The provision of palliative and end-of-life care to patients who are underrepresented and underserved provides unique challenges and opportunities.

Objectives:

To examine predictors of placement of inpatient palliative care consult orders among patients with breast, lung, and colorectal cancer hospitalized in a safety net hospital in 2010.

Methods:

Simple and multivariable logistic regression of data on selected patients with cancer was performed to identify predictors of placement of inpatient palliative care consult orders.

Results:

Of 979 patients, 56% had colorectal cancer, 23% had lung cancer, and 21% had breast cancer. Of those patients, 16% received an order for inpatient palliative care consultation during the study period. Patients who had more than 20 prescriptions for opioids ordered (adjusted odds ratio [AOR]: 9.10, 95% confidence interval [CI]: 4.62-17.95), had an order for a radiation oncology consult (AOR: 2.60, 95% CI: 1.50-4.49), or had low albumin (AOR: 2.75, 95% CI: 4.71) were more likely to have an order for an inpatient palliative care consult placed. Race and ethnicity were not statistically significant predictors.

Conclusion:

In this cohort of patients in a safety net hospital, markers of pain, advanced disease, and poor prognosis were associated with placement of inpatient palliative care consult orders.
Physical Signs and Clinical Findings Before Death in Ill Elderly Patients
Authors: Matsunami Keiji , Tomita Katsuyuki , Touge Hirokazu , Sakai Hiromitsu , Yamasaki Akira , Shimizu Eiji
Published: November 2017

Few studies have examined variations in both the physical signs and clinical findings in the final days and hours before the death of elderly patients. We determined the physical signs and clinical findings in patients who were at least 75 years old or were diagnosed with cancer with impending death and examined the association of these parameters with the profile and timing of their endocardiography (ECG) and oxygen saturation (SpO2) changes prior to death. In this prospective, observational study, between April 2014 and June 2017, we enrolled elderly patients who were admitted to the Respiratory Medicine Ward in our hospital and were near death, which was determined based on certain symptoms such as a loss of oral intake. We recorded their physical signs (oral intake, consciousness level, and respiration with mandibular movement) 4 times a day from admission to death. We evaluated their changes in ECG and in SpO2 levels for up to 24 hours preceding death. For the 70 patients who died in our ward, we found a loss of oral intake at 6 days, consciousness impairment at 1.3 days, and then respiration with mandibular movement at 12 hours before death were the most consistent findings before death. When we analyzed the ECG and SpO2 changes during impending death, 83% of the patients showed undetectable SpO2 levels followed by a loss of heart rate. The loss of P wave in the ECG was characterized as process on impending death. Respiration with mandibular movement was one of the specific signs of impending death in ill elderly patients. The monitoring of ECG and SpO2 levels may be a useful tool to predict the impending time of death.
Examining the Role of Primary Care Physicians and Challenges Faced When Their Patients Transition to Home Hospice Care
Authors: Shalev Ariel , Phongtankuel Veerawat , Lampa Katherine , Reid M. C. , Eiss Brian M. , Bhatia Sonica , Adelman Ronald D.
Published: November 2017

Background:

The transition into home hospice care is often a critical time in a patient’s medical care. Studies have shown patients and caregivers desire continuity with their physicians at the end of life (EoL). However, it is unclear what roles primary care physicians (PCPs) play and what challenges they face caring for patients transitioning into home hospice care.

Objectives:

To understand PCPs’ experiences, challenges, and preferences when their patients transition to home hospice care.

Design:

Nineteen semi-structured phone interviews with PCPs were conducted. Study data were analyzed using standard qualitative methods.

Participants:

Participants included PCPs from 3 academic group practices in New York City.

Measured:

Physician recordings were transcribed and analyzed using content analysis.

Results:

Most PCPs noted that there was a discrepancy between their actual role and ideal role when their patients transitioned to home hospice care. Primary care physicians expressed a desire to maintain continuity, provide psychosocial support, and collaborate actively with the hospice team. Better establishment of roles, more frequent communication with the hospice team, and use of technology to communicate with patients were mentioned as possible ways to help PCPs achieve their ideal role caring for their patients receiving home hospice care.

Conclusions:

Primary care physicians expressed varying degrees of involvement during a patient’s transition to home hospice care, but many desired to be more involved in their patient’s care. As with patients, physicians desire to maintain continuity with their patients at the EoL and solutions to improve communication between PCPs, hospice providers, and patients need to be explored.
Is There a Role for 5-HT3 Receptor Antagonists in the Treatment of Opioid-Induced Pruritus?
Authors: Rashid Saima , Trivedi Disha D. , Al-Shathir Mudher , Moulton Marie , Baumrucker Steven J.
Published: November 2017

Pruritus is an unpleasant irritation symptom that can be related to various systemic and dermatological conditions. Although underreported, pruritus is a common adverse event noted after use of opioid pain medications. This article reviews the current understanding of the mechanism of opioid-induced pruritus (OIP) and various pharmacological therapies. 5-Hydroxytryptamine 3 (5-HT3) receptor antagonists are potentially effective for treating OIP and may be a valuable treatment option if further controlled studies are encouraging.
Self-Care Performance of Middle-Aged Stroke Patients in Korea
Authors: Jang Dong Eun , Shin Juh Hyun
Published: November 2017

The incidence rate of middle-aged ischemic stroke patients has been increasing. Because of their high risk of recurrence, it is important for them to adhere to their self-care performance. The purpose of this study was to investigate predictors of self-care performance among middle-aged ischemic stroke patients. A descriptive correlational and cross-sectional survey design was used. About 140 participants who had been diagnosed with ischemic stroke within a year and visited neurological outpatients were investigated. Participants answered self-report questionnaires, the Secondary Stroke Prevention Knowledge Scale, the Health-Related Hardiness Scale, and the Subjective Self-Care Performance Scale. Hardiness, secondary-stroke-prevention knowledge, age, and stroke-diagnosis duration had statistically significant influences on self-care performance; hardiness had the largest effect. This study highlighted hardiness as the major predictor of self-care performance. To improve middle-aged ischemic stroke patients’ self-care performance, nurses need an integrated approach that considers a patient’s age, diagnosis duration, secondary-stroke-prevention knowledge, and, especially, hardiness.
Defying Tradition
Authors: Anand Leena , Du Bois Steve N. , Sher Tamara G. , Grotkowski Karolina
Published: November 2017

The marriage–health association has been investigated extensively among proximal couples (i.e., those living geographically near each other). On average, married men trend toward better health and relationship outcomes from their marital status compared to married women. This may be attributed to gender role socialization that encourages women to adopt a caretaking role toward their partners. Current literature has not addressed whether there are differential relationship or health outcomes by gender within long-distance relationship (LDR). The present study investigated LDR relationship and health indices by gender. Using Qualtrics and Amazon’s Mechanical Turk, married LDR participants ( n = 93, 21 years or older, English speakers) completed an online survey. Relationship measures assessed satisfaction, maintenance, stress, and sex. Health variables included the Patient Reported Outcomes Measurement Information System-29, Perceived Stress Scale, and surveys examining substance use, diet, and exercise. t Tests were used to measure group differences by gender. Women in LDR reported few relationship and health benefits relative to men in LDR. Men reported higher levels of relational distress and increased smoking, yet better physical functioning. Men also trended toward higher levels of relational maintenance and healthier eating as a function of partner presence. This study provides counterevidence for the gender role socialization model within the LDR framework.
An Examination of Construal Effects on Price Perceptions in the Advance Selling of Experience Services
Authors: Wakefield Lane T. , Wakefield Kirk L.
Published: November 2017

Service research in the advance selling of experience services is limited in regard to how individual and situational differences influence price information processing. Applying construal-level theory in the context of advance selling of tickets for experience services, this research demonstrates that who (near vs. far social distance), when (near vs. far temporal distance), and where (spatial distance) influence price sensitivity and perceived value of the experience service. Study 1 finds that consumers are more price sensitive when they consider the advance purchase of events taking place further in the future, unless they are experienced, as Study 2 finds. Across both studies, buyers perceive greater value when the time and location of the event are psychologically near. Compared to when social distance is near (self-reference), consumers construe other average buyers in the market to be relatively more price sensitive and to perceive relatively higher value for experience services. Since an important factor at work in the minds of buyers is other buyers, the results imply that service providers should frame offers in reference more to others than the self for experiences. The effects of time and distance suggest managers should carefully geo-target offers customized to when and where customers are when buying tickets. As experienced buyers have learned to be price sensitive for tickets, managers should identify these individuals to provide relevant value-added offers.