Sample records for hospice cancer patients

  1. Lower use of hospice by cancer patients who live in minority versus white areas.

    Haas, Jennifer S; Earle, Craig C; Orav, John E; Brawarsky, Phyllis; Neville, Bridget A; Acevedo-Garcia, Dolores; Williams, David R


    Although hospice care can alleviate suffering at the end of life for patients with cancer, it remains underutilized, particularly by African Americans and Hispanics. To examine whether the racial composition of the census tract where an individual resides is associated with hospice use. Retrospective analysis of the Surveillance, Epidemiology, and End Results-Medicare file for individuals dying from breast, colorectal, lung, or prostate cancer (n = 70,669). Hospice use during the 12 months before death. Hospice was most commonly used by individuals who lived in areas with fewer African-American and Hispanic residents (47%), and was least commonly used by individuals who lived in areas with a high percentage of African-American and Hispanic residents (35%). Hispanics (odds ratio 0.51, 95% confidence interval 0.29-0.91) and African Americans (0.56, 0.44-0.71) were less likely to use hospice if they lived in a census tract with a high percentage of both African Americans and Hispanics than if they lived in a low minority tract. African Americans and whites were less likely to receive hospice care if they lived in a census tract with a high percentage of Hispanics than if they lived in a low minority area. Increasing hospice use may require interventions to improve the delivery of hospice care in minority communities.

  2. A Comparative Study on the Quality of Living for Therapeutic Cancer and Hospice Patients

    Kim, Seung Kook [Dept. of Radiological Technology, Kwangju Health College, Kwangju (Korea, Republic of); Rhee, Dong Soo; Rou, Jae Man; Kim, Jong Deok [Dept. of Therapeutic Radiology, Chonnam University Hospital, Kwangju (Korea, Republic of)


    This study carried a comparative analysis of quality of living perceived by cancer and hospice patients who received radiotherapy, and influential factors in order to provide basic data for nursing goals and establishment of strategy. The subjects of the study were 50 cancer patients who were more than twenty years old and was receiving radiotherapy in therapeutic radiology department of C university hospital, and fourteen hospice patients who were in J hospital in Gwangju. They were conveniently sampled according to the selection standard, and researchers personally interviewed them using questionnaire and patient scripts to obtain necessary data. The results were presented as follows: 1. When cancer and hospice patients were examined demographically, the number of 60 year-old patients were the most. The subjects whose marriage period was more than thirty-one years were the most. In medical expense, more than 70.0% of the patients bore their expenses themselves. 2. When disease-related characteristics of the cancer and pos piece patients were examined, more than 75% of the patients had experience of being in hospital, and more than experienced operation. However, for prevalence period, 57.5% of the cancer patients had less than six months, and 64.3% of the hospice patients had more than two years. 3. For physical symptoms of cancer patients, 77.5% had fatigue, 60.0% had loss of appetite, and 52.5% had loss of weight while for the hospice patients, 100% had loss of weight, and 92.9% had fatigue and loss of appetite. For the cancer patients, 0.0% had swelling, and 7.5% had bleeding, For the hospice patients, 7.1% had change in skin, and 14.3% had diarrhea. 4. Mean score of the cancer subjects were as follows: family support, social support, emotional and spiritual support, physical symptoms, and periods were 3.87, 2.88, 3.10, 2.80, and 2.94 respectively. Those of the hospice patients were 3.80, 1.96, 1.58, 2.64 and 3.24 respectively. 5. Mean score of family support

  3. The effects of hospice-shared care for gastric cancer patients

    Huang, Kun-Siang; Wang, Shih-Ho; Chuah, Seng-Kee; Rau, Kun-Ming; Lin, Yu-Hung; Hsieh, Meng-Che; Shih, Li-Hsueh; Chen, Yen-Hao


    Background Hospice care has been proved to result in changes to the medical behaviors of terminally ill patients. The aim of this study was to evaluate the effects and medical behavior changes of hospice-shared care intervention among terminally ill gastric cancer patients. Methods A total of 174 patients who died of gastric cancer between 2012 and 2014 were identified. These patients were divided into two groups: a hospice-shared care group (n = 93) and a control group (n = 81). Results Among the 174 patients, 84% had advanced stage (stage III or stage IV) cancer. The females and the patients cared by medical oncologists had a higher percentage of hospice-shared care than the males (71% vs 44%, p = 0.001) and those cared by other physicians (63% vs 41%, p = 0.004). Compared to the control group, the hospice-shared care group underwent lower incidence of life sustaining or aggressive medical treatments, including intensive care unit admission (2% vs 26%, phospice-shared care group had a higher percentage of palliative treatments than the control group, including signed Do-Not-Resuscitate (DNR) orders (95% vs 37%, phospice care (16% vs 1%, phospice ward admission rate in the hospice-shared care group increased from 30% to 53% from 2012 to 2014. Conclusion The use of hospice-shared care for gastric cancer patients could increase the rate of signed DNR orders, decrease the use of life sustaining and aggressive/palliative treatments, and improve quality of life. PMID:28158232

  4. Medical care utilization and costs on end-of-life cancer patients: The role of hospice care.

    Chang, Hsiao-Ting; Lin, Ming-Hwai; Chen, Chun-Ku; Chen, Tzeng-Ji; Tsai, Shu-Lin; Cheng, Shao-Yi; Chiu, Tai-Yuan; Tsai, Shih-Tzu; Hwang, Shinn-Jang


    Although there are 3 hospice care programs for terminal cancer patients in Taiwan, the medical utilization and expenses for these patients by programs have not been well-explored. The aim of this study was to examine the medical utilization and expenses of terminal cancer patients under different programs of hospice care in the last 90, 30, and 14 days of life.This was a retrospective observational study by secondary data analysis. By using the National Health Insurance claim database and Hospice Shared Care Databases. We identified cancer descents from these databases and classified them into nonhospice care and hospice care groups based on different combination of hospice care received. We then analyzed medical utilization including inpatient care, outpatient care, emergency room visits, and medical expenses by patient groups in the last 90, 30, and 14 days of life.Among 118,376 cancer descents, 46.9% ever received hospice care. Patients had ever received hospice care had significantly lower average medical utilization and expenses in their last 90, 30, and 14 days of life (all P hospice care group had significantly less medical utilization and expenses in the last 90, 30, and 14 days of life (all P hospice care program have different effects on medical care utilization reduction and cost-saving at different stage of the end of life of terminal cancer patients.

  5. Extending Computer Technology to Hospice Research: Interactive Pentablet Measurement of Symptoms by Hospice Cancer Patients in Their Homes

    Kim, Young Ok; Suarez, Marie L.; Dauw, Colleen M.; Stapleton, Stephen J.; Gorman, Geraldine; Storfjell, Judith; Zhao, Zhongsheng


    Abstract We aimed to determine the acceptability and feasibility of a pentablet-based software program, PAINReportIt®-Plus, as a means for patients with cancer in home hospice to report their symptoms and differences in acceptability by demographic variables. Of the 131 participants (mean age = 59 ± 13, 58% women, 48.1% African American), 44% had never used a computer, but all participants easily used the computerized tool and reported an average computer acceptability score of 10.3 ± 1.8, indicating high acceptability. Participants required an average of 19.1 ± 9.5 minutes to complete the pain section, 9.8 ± 6.5 minutes for the medication section, and 4.8 ± 2.3 minutes for the symptom section. The acceptability scores were not statistically different by demographic variables but time to complete the tool differed by racial/ethnic groups. Our findings demonstrate that terminally ill patients with cancer are willing and able to utilize computer pentablet technology to record and describe their pain and other symptoms. Visibility of pain and distress is the first step necessary for the hospice team to develop a care plan for improving control of noxious symptoms. PMID:19594343

  6. Impact of hospice care on end-of-life hospitalization of elderly patients with lung cancer in Taiwan

    Shih-Chao Kang


    Conclusion: Hospice care has provided a humane and cost-efficient pathway for end-of-life elderly patients with lung cancer. Parenteral nutrition/hydration should be limited for terminal care patients. Opioids should be promoted for the relief of pain and dyspnea in acute ward care. Family physicians and radiation oncologists play important roles in hospice care. Compared with the prevalence of hospice care in the United Kingdom and other developed countries, hospice care in Taiwan is in the position to be expanded.

  7. Hospice Use Among Nursing Home Patients

    Unroe, Kathleen Tschantz; Sachs, Greg A.; Hickman, Susan E.; Stump, Timothy E.; Tu, Wanzhu; Callahan, Christopher M.


    Objectives Among hospice patients who lived in nursing homes, we sought to: (1) report trends in hospice use over time, (2) describe factors associated with very long hospice stays (>6 months), and (3) describe hospice utilization patterns. Design, setting, and participants We conducted a retrospective study from an urban, Midwest cohort of hospice patients, aged ≥65 years, who lived in nursing homes between 1999 and 2008. Measurements Demographic data, clinical characteristics, and health care utilization were collected from Medicare claims, Medicaid claims, and Minimum Data Set assessments. Patients with overlapping nursing home and hospice stays were identified. χ2 and t tests were used to compare patients with less than or longer than a 6-month hospice stay. Logistic regression was used to model the likelihood of being on hospice longer than 6 months. Results A total of 1452 patients received hospice services while living in nursing homes. The proportion of patients with noncancer primary hospice diagnoses increased over time; the mean length of hospice stay (114 days) remained high throughout the 10-year period. More than 90% of all patients had 3 or more comorbid diagnoses. Nearly 20% of patients had hospice stays longer than 6 months. The hospice patients with stays longer than 6 months were observed to have a smaller percentage of cancer (25% vs 30%) as a primary hospice diagnosis. The two groups did not differ by mean cognitive status scores, number of comorbidities, or activities of daily living impairments. The greater than 6 months group was much more likely to disenroll before death: 33.9% compared with 13.8% (P < .0001). A variety of patterns of utilization of hospice across settings were observed; 21 % of patients spent some of their hospice stay in the community. Conclusions Any policy proposals that impact the hospice benefit in nursing homes should take into account the difficulty in predicting the clinical course of these patients, varying

  8. Art therapy for terminal cancer patients in a hospice palliative care unit in Taiwan.

    Lin, Ming-Hwai; Moh, Shwu-Lan; Kuo, Yu-Cheng; Wu, Pin-Yuan; Lin, Chiung-Ling; Tsai, Mei-Hui; Chen, Tzeng-Ji; Hwang, Shinn-Jang


    Even though terminal cancer patients receive help from a hospice palliative care team, they have to suffer the pressure of death with deteriorating conditions. This study aims to evaluate the effect of art therapy for these terminal cancer patients. The patients involved were terminal cancer patients who were under the care of team members, which included physicians, nurses, social workers, clergy, art therapists, and volunteers in a hospice palliative care unit in Taiwan. The art therapy in our study took the form of visual fine art appreciation and hands-on painting. The effects of the art therapy were evaluated according to patients' feelings, cognitions, and behaviors. There were 177 patients (105 males and 72 females; mean age: 65.4 ±15.8 years) in the study. Each patient received a mean of 2.9 ± 2.0 sessions of the art therapy and produced a mean of 1.8 ± 2.6 pieces of art. During the therapy, most patients described their feelings well, and created art works attentively. Patients expressed these feelings through image appreciation and hands-on painting, among which the landscape was the most common scene in their art. After the therapy, the mean score of patients' artistic expressions (one point to each category: perception of beauty, art appreciation, creativity, hands-on artwork, and the engagement of creating artwork regularly) was 4.0 ± 0.7, significantly higher than the score before therapy (2.2 ± 1.4, p therapy, 70% of patients felt much or very much relaxed in their emotional state and 53.1% of patients felt much or very much better physically. Terminal cancer patients in a hospice palliative care unit in Taiwan may benefit from art therapy through visual art appreciation and hands-on creative artwork.

  9. A new hospice consulting system for terminal cancer patients in transferring to post-acute care options in Taiwan.

    Chang, P M-H; Liu, Y-Y L; Chao, T-C; Lin, H-L; Chen, M-B; Chen, P-M; Chiou, T-J


    The terminal cancer patients increase needs for hospice care day by day. A new hospice consulting system has been developed in Taiwan to provide options for terminal cancer patients in choosing a suitable post-acute hospice care while a combined hospice care system is also given by the consulting team in the acute wards. Hereinafter is our report. From March 2005 to January 2006, 313 terminal cancer patients were analysed. These patients had signed consent forms for palliative treatment and had received consultations from the new hospice consulting system. Multivariate analysis showed that the home care patients had better performance status (P = 0.012), less shortness of breath (P = 0.006), less limbs swelling (P = 0.043), less flatulency (P = 0.000) and less constipation (P = 0.018). Among the 162 patients with regular follow-up, the symptoms/signs were significantly improved after intervention of consulting team in pain (P = 0.000), shortness of breath (P = 0.000), difficulty in sleeping (P = 0.002), nausea (P = 0.004), constipation (P = 0.008), changes in skin (P = 0.024) and adoption (P = 0.000). This new system had significant improvement in the terminal cancer patients' symptoms/signs control in acute wards and could contribute to the care quality of home care patients.

  10. Utilization and cost of services in the last 6 months of life of patients with cancer - with and without home hospice care.

    Bentur, Netta; Resnizky, Shirli; Balicer, Ran; Eilat-Tsanani, Tsofia


    This study examined the utilization and cost of all health services consumed during the last six months of life by cancer patients, and compared those with and without home-hospice care. Detailed information was extracted from the health care electronic administrative data files on 193 deceased cancer patients that their family approved the study (out of 429, 45%). About 88% had been hospitalized for 19 days on average and 53% visited the ER. One quarter received home-hospice care. Their average cost was $13,648 compared to $18,503 for patients without home-hospice care. Hospitalization contributed 32% to the total cost of patients with home-hospice care and 64% for those with it. The findings support the justification for significant expansion of home-hospice care.

  11. Hospice in end-of-life patients with cancer: does it lead to changes in nonhospice health care utilization after stopping cancer treatment?

    Breitkopf, Carmen Radecki; Stephens, Elisabeth K; Jatoi, Aminah


    This study assessed the patterns of nonhospice health care utilization among 207 deceased cancer patients and focused on outcomes after cancer treatment was stopped. A total of 117 (57%) were enrolled in hospice. The mean cumulative number of emergency department visits, hospitalizations, or other noncancer clinic visits (standard deviation) among those enrolled and not enrolled in hospice was 1.8 (± 1.8) and 3.11 (± 3.0), respectively (P < .0001). Among hospice enrollees, the mean cumulative visits (standard deviation) was 1.29 (± 1.7) and 0.5 (± 1.0) before and after enrollment, respectively (P < .0001). For patients who eventually enrolled, the rates of nonhospice health care visits (visits per week) yielded a trend to suggest a decline (P = .054). Hospice was associated with a drop in nonhospice-related health care utilization, thus suggesting it provides timely medical interventions and favorable continuity of care.

  12. Predictors of intensive end-of-life and hospice care in Latino and white advanced cancer patients.

    Loggers, Elizabeth T; Maciejewski, Paul K; Jimenez, Rachel; Nilsson, Matthew; Paulk, Elizabeth; Stieglitz, Heather; Prigerson, Holly G


    The role of end-of-life (EOL) care preferences and conversations in receipt of care near death for Latinos is unclear. This study examines rates and predictors of intensive EOL and hospice care among Latino and white advanced cancer patients. Two-hundred-and-ninety-two self-reported Latino (n=58) and white (n=234) Stage IV cancer patients participated in a U.S. multisite, prospective, cohort study from September 2002 to August 2008. The Latino and white, non-Hispanic participants were interviewed and followed until death, a median of 118.5 days from baseline. Patient-reported, baseline predictors of EOL care included EOL care preference; terminal illness acknowledgement; EOL discussion; completion of a DNR order; and religious coping. Caregiver postmortem interviews provided information regarding EOL care received. Intensive EOL care was defined as resuscitation and/or ventilation followed by death in an intensive care unit. Hospice was either in- or outpatient. Latino and white patients received intensive EOL and hospice care at similar rates (5.2% and 3.4% for intensive care, p=0.88; 70.7% versus 73.4% for hospice, p=0.33). No white or Latino patient who reported a DNR order or EOL discussion at baseline received intensive EOL care. Religious coping and a preference for life-extending care predicted intensive EOL care for white patients (adjusted odds ratio [aOR] 6.69 [p=0.02] and aOR 6.63 [p=0.01], respectively), but not for Latinos. No predictors were associated with Latino hospice care. EOL discussions and DNR orders may prevent intensive EOL care among Latino cancer patients. Efforts should continue to engage Latino patients and caregivers in these activities.

  13. Impact of nutritional status on the quality of life of advanced cancer patients in hospice home care.

    Shahmoradi, Negar; Kandiah, Mirnalini; Peng, Loh Su


    Cancer patients frequently experience malnutrition and this is an important factor in impaired quality of life. This cross-sectional study examined the association between global quality of life and its various subscales with nutritional status among 61 (33 females and 28 males) advanced cancer patients cared for by selected hospices in peninsular Malaysia. The Patient Generated-Subjective Global Assessment (PG-SGA) and the Hospice Quality of Life Index (HQLI) were used to assess nutritional status and quality of life, respectively. Nine (14.7%) patients were well-nourished, 32 (52.5%) were moderately or suspected of being malnourished while 20 (32.8%) of them were severely malnourished. The total HQLI mean score for these patients was 189.9-/+51.7, with possible scores ranging from 0 to 280. The most problem areas in these patients were in the domain of functional well-being and the least problems were found in the social/spiritual domain. PG-SGA scores significantly correlated with total quality of life scores (r2= 0.38, pnutritional status exhibited a lower quality of life. Advanced cancer patients with poor nutritional status have a diminished quality of life. These findings suggest that there is a need for a comprehensive nutritional intervention for improving nutritional status and quality of life in terminally ill cancer patients under hospice care.

  14. Hospice care in elderly cancer patients%老年晚期癌症患者的临终关怀

    于正洪; 王苏莉; 史兆荣; 谢昆岭


    The elderly cancer patients are the main object of hospice care,and this is the main content of appeasement medicine.As a new subject,we review the achievement about the concept,aim and implement of hospice care in elderly cancer.%临终关怀与老年人关系密切,老年癌症患者是临终关怀的主要对象,这也是姑息医学的主要内容.作为一门新兴学科,本文对临终关怀的概念、目的及其在老年晚期癌症患者中的实施作一综述.

  15. Hospice Care in Terminally Ⅲ Cancer Patients%末期癌症患者的临终关怀

    吴殷; 吴海玲


    临终关怀与末期癌症关系密切,末期癌症患者是临终关怀的主要对象,这也是姑息医学的主要内容.作为发展中的学科,本文对临终关怀的发展、目的、内容及其在末期癌症患者中的实施作一综述.%Abstract:Terminally ill canccr patients are the main ohject of hospice care,and this is the main coment of appeasement medicine. As a major developing disciplines, we review the achievement about the concept,aim, content and implement of hospice care in terminally ill cancer patients.

  16. Timing of Hospice Referral: Assessing Satisfaction While the Patient Receives Hospice Services*

    Adams, Carolyn E.; Bader, Julia; Horn, Kathryn V.


    Generally, satisfaction with timing of hospice referral was measured in mortality follow back surveys of patients who died in hospice. In contrast in this study, investigators assessed timing of the hospice referral in patients/families enrolled in hospice for a minimum of two weeks. About 1/3 of patients/families identified it would have been easier if they started hospice earlier. Barriers to early hospice access were associated primarily with access to the healthcare system.

  17. Does caregiver knowledge matter for hospice enrollment and beyond? Pilot study of minority hospice patients.

    Chung, Kyusuk; Essex, Elizabeth Lehr; Samson, Linda


    We examined the level of hospice knowledge of caregivers of minority elderly hospice patients and determined how it influences the hospice enrollment decision and the decision on the use of hospice services after enrollment. Based on qualitative analysis of medical records and interviews with caregivers of minority elderly hospice patients who received personal care from paid caregivers (eg, other than family caregivers), we found that hospice knowledge increased access to hospice among minority patients who otherwise would not opt for hospice or enroll too late for comprehensive hospice care services. Furthermore, the highest level of knowledge-acquired through caregivers' health care occupations-appears to influence hospice care after hospice enrollment. Caregivers with that level of knowledge made requests for changes in site of care and/or additional services that may enhance the quality of hospice care that their loved ones receive.

  18. Ethical Dilemmas in Hospice and Palliative Care Units for Advanced Cancer Patients

    Beyhan Bag


    Full Text Available Ethical dilemmas that face heathcare team members referring patients to hospice programs include the ability of clinicians to predict accurately a patient bad prognosis. They affect day-to-day patient management in palliative care programs including healthcare team members concern over the use of morphine because possible respiratory depression in the patient, the question of providing enteral or parenteral nutritional support to patients who refuse to eat and the question of providing parenteral fluids to patients who are unable to take fluids during the terminal phrases of illness. A final ethical dilemma concerns the methodology for quality of life research in palliative care. Understanding and resolving these ethical dilemmas is an important factor determining the quality of the caring for the patient. The ethical dilemmas that are discussed in the article likely to occur in this period can be prevented through his/her participation in the decisions concerning his or her treatment. [Archives Medical Review Journal 2013; 22(1.000: 65-79

  19. Music Therapy is Associated With Family Perception of More Spiritual Support and Decreased Breathing Problems in Cancer Patients Receiving Hospice Care.

    Burns, Debra S; Perkins, Susan M; Tong, Yan; Hilliard, Russell E; Cripe, Larry D


    Music therapy is a common discretionary service offered within hospice; however, there are critical gaps in understanding the effects of music therapy on hospice quality indicators, such as family satisfaction with care. The purpose of this study was to examine whether music therapy affected family perception of patients' symptoms and family satisfaction with hospice care. This was a retrospective, cross-sectional analysis of electronic medical records from 10,534 cancer patients cared for between 2006 and 2010 by a large national hospice. Logistic regression was used to estimate the effect of music therapy using propensity scores to adjust for non-random assignment. Overall, those receiving music therapy had higher odds of being female, having longer lengths of stay, and receiving more services other than music therapy, and lower odds of being married/partnered or receiving home care. Family satisfaction data were available for 1495 (14%) and were more likely available if the patient received music therapy (16% vs. 12%, P music therapy vs. those not. Patients who received music therapy were more likely to report discussions about spirituality (odds ratio [OR] = 1.59, P = 0.01), had marginally less trouble breathing (OR = 0.77, P = 0.06), and were marginally more likely to receive the right amount of spiritual support (OR = 1.59, P = 0.06). Music therapy was associated with perceptions of meaningful spiritual support and less trouble breathing. The results provide preliminary data for a prospective trial to optimize music therapy interventions for integration into clinical practice. Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  20. The Impact of Hospice Care on Survival and Healthcare Costs for Patients with Lung Cancer: A National Longitudinal Population-Based Study in Taiwan.

    Jui-Kun Chiang

    Full Text Available The healthcare costs of cancer care are highest in the last month of life. The effect of hospice care on end-of-life (EOL healthcare costs is not clearly understood.The purpose of this study was to evaluate the effect of hospice care on survival and healthcare costs for lung cancer patients in their final month of life.We adopted Taiwan's National Health Insurance Research Claims Database to analyze data for 3399 adult lung cancer patients who died in 1997-2011. A logistic regression analysis was performed to determine the predictors of high healthcare cost, defined as costs falling above the 90th percentile. Patients who received hospice cares were assigned to a hospice (H group and those who did not were assigned to a non-hospice (non-H group.The patients in the H group had a longer mean (median survival time than those in the non-H group did (1.40 ± 1.61 y (0.86 vs. 1.10 ± 1.47 (0.61, p<0.001. The non-H group had a lower mean healthcare cost than the H group (US $1,821 ± 2,441 vs. US $1,839 ± 1,638, p<0.001. And, there were a total of 340 patients (10% with the healthcare costs exceeding the 90th percentile (US $4,721 as the cutoff value of high cost. The non-H group had a higher risk of high cost than the H group because many more cases in the non-H group had lower costs. Moreover, the risk of high health care costs were predicted for patients who did not receive hospice care (odds ratio [OR]: 3.68, 95% confidence interval [CI]: 2.44-5.79, received chemotherapy (OR: 1.51, 95% CI: 1.18-1.96 and intubation (OR: 2.63, 95% CI: 1.64-4.16, and those who had more emergency department visits (OR: 1.78, 95% CI: 1.24-2.52, longer hospital admission in days (OR: 1.08, 95% CI: 1.07-1.09, and received radiotherapy (OR: 1.33, 95% CI: 1.00-1.78. Lower risks of high health care costs were observed in patients with low socioeconomic status (OR: 0.58, 95% CI: 0.40-0.83, or previous employment (OR: 0.66, 95% CI: 0.47-0.92. After propensity-score matching

  1. Differences between non-profit and for-profit hospices: patient selection and quality.

    Gandhi, Sabina Ohri


    This research compares the behavior of non-profit organizations and private for-profit firms in the hospice industry, where there are financial incentives created by the Medicare benefit. Medicare reimburses hospices on a fixed per diem basis, regardless of patient diagnosis. Because under this system patients with lower expected costs are more profitable, hospices can selectively enroll patients with longer lengths of stay. While it is illegal for hospices to reject potential patients explicitly, they can influence their patient mix through referral networks. A fixed per diem rate also creates an incentive shirk on quality and to substitute lower skilled for higher skilled labor, which has implications for quality of care. By using within-market variation in hospice characteristics, the empirical evidence suggests that for-profit hospices differentially take advantage of these incentives. The results show that for-profit hospices engage in patient selection through significantly different referral networks than non-profits. They receive more patients from long-term care facilities and fewer patients through more traditional paths, such as physician referrals. This mechanism of patient selection is supported by the result that for-profits have fewer cancer patients and more patients with longer lengths of stay. While non-profit and for-profit hospices report similar numbers of staff visits per patient, for-profit firms make significantly less use of skilled nursing providers. We also find some weak evidence of lower levels of quality in for-profit hospices.

  2. Hospice Care for Children With Cancer: Where Do These Children Die?

    Thienprayoon, Rachel; Lee, Simon C; Leonard, David; Winick, Naomi


    Hospice is an important provider of end of life care; many children who die of cancer enroll in hospice programs. How frequently such children remain in hospice to die at home, or disenroll from hospice and die in the hospital, has not been described. A child's location of death has important implications for quality of life and parental adaptation. This represents a subanalysis of a retrospective study of 202 consecutive oncology patients who died at a single center between January 1, 2006 and December 31, 2010. Of 95 children who enrolled in hospice, 82 had known location of death. Sixty (73%) died at home or an inpatient hospice unit, 15 (18%) died in the oncology unit, 5 (6%) died in the intensive care unit, and 2 (2%) died in the emergency department. The median length of hospice services was 41 days, twice the national median of 21 days reported in adults. One quarter of children disenrolled from hospice care, ultimately dying in an acute care setting. Further studies are warranted to explore the hospice experience in children, and to address modifiable factors that may impact a family's choice to withdraw from hospice care.

  3. Application of multicultural nursing philosophy in hospice care of cancer patients%多元文化护理理念在肿瘤病人临终关怀中的应用

    荣晓珊; 何佳倩; 彭幼清


    综述了不同文化、信仰、价值观、习俗的肿瘤病人的临终关怀情况,为在肿瘤病人临终关怀中开展多元文化护理提供借鉴。%It reviewed hospice care for different culture,belief,val-ues,custom of cancer patients,so as to provide references for imple-menting multi culture nursing in hospice care of cancer patients.

  4. Patients with Advanced Cancer, Hospice Care and Ethics%晚期癌症患者宁养疗护与伦理

    王京娥; 康宗林


    晚期癌症患者宁养疗护强调人的生活质量与生命价值,其在实践中得到了长足的发展,正成为姑息医学中的重要部分。随着医学向生物心理社会医学模式转变和姑息医学快速发展,宁养疗护伦理问题日益凸显。宁养疗护伦理在医疗方面强调适度治疗与合理用药,护理方面强调患者生理、心理、灵性、社会和宗教等层面的整体性照顾。梳理宁养疗护伦理有利于在宁养疗护服务中做出最优伦理选择,这种选择需遵循不伤害原则,注重生命质量原则、适度治疗和舒适生存原则、尊重患者意愿原则以及公平正义的原则。%Hospice care on patients with advanced cancer has made a great progress ,which emphasizes life quality and life value .It is becoming an important part of palliative medicine .With the development of medicine mode from biology to biology-psychology-society ,the problems of hospice care ethics becomes more and more obvious .Rational drug use and care for problems of physiological ,psychological ,spiritual ,social and religious aspects are recommended .Hospice care ethics helps to make the optimal choice in nursing service , and it must follow the principle , such as nonmaleficence emphasizing fairness ,quality of life ,proper treatment ,comfortable survival ,and respecting the patient's wishes .

  5. A Qualitative Inquiry of the Lived Experiences of Music Therapists Who Have Survived Cancer Who Are Working with Medical and Hospice Patients

    Lee, Jin Hyung


    Cancer is a debilitating illness that affects more than one in every three Americans at sometime in their life time regardless of their social, cultural, ethnic, religious, or economic status. A few studies in the psychotherapy literature have investigated the impact of cancer on the personal and professional lives of psychotherapists. However, such investigations are yet unknown in medical or music therapy literature. In this descriptive phenomenological study, the researcher interviewed five American music therapists who have survived cancer and also work with patients in medical hospitals or hospice settings. The purpose of this study was to fully describe their lived experience of surviving cancer and examine how the cancer experience affected their clinical work thereafter. The data was analyzed using an open coding method from grounded theory which identified four major themes: (a) personal significance; (b) relational significance; (c) musical significance and (d) professional significance. The descriptions provided by these participants of their cancer experience as patients, survivors, and cancer surviving therapists, have revealed various psychosocial and physical issues encountered, and numerous coping methods they employed, and poignantly explained how their clinical approach evolved and expanded due to the personal experience of cancer. Specific issues in relation to countertransference, self-disclosure, and ways of developing empathic approaches without having such personal experience were discussed in addition to suggestions for future research. PMID:27917147

  6. A Qualitative Inquiry of the Lived Experiences of Music Therapists who have Survived Cancer who are Working with Medical and Hospice Patients

    Jin Hyung Lee


    Full Text Available Cancer is a debilitating illness that affects more than one in every three Americans at sometime in their life time regardless of their social, cultural, ethnic, religious, or economic status. A few studies in the psychotherapy literature have investigated the impact of cancer on the personal and professional lives of psychotherapists. However, such investigations are yet unknown in medical or music therapy literature. In this descriptive phenomenological study, the researcher interviewed five American music therapists who have survived cancer and also work with patients in medical hospitals or hospice settings. The purpose of this study was to fully describe their lived experience of surviving cancer and examine how the cancer experience affected their clinical work thereafter. The data was analyzed using an open coding method from grounded theory which identified four major themes: (a personal significance; (b relational significance; (c musical significance and (d professional significance. The descriptions provided by these participants of their cancer experience as patients, survivors, and cancer surviving therapists, have revealed various psychosocial and physical issues encountered, and numerous coping methods they employed, and poignantly explained how their clinical approach evolved and expanded due to the personal experience of cancer. Specific issues in relation to countertransference, self-disclosure, and ways of developing empathic approaches without having such personal experience were discussed in addition to suggestions for future research.

  7. Characteristics of Prison Hospice Patients: Medical History, Hospice Care, and End-of-Life Symptom Prevalence.

    Cloyes, Kristin G; Berry, Patricia H; Martz, Kim; Supiano, Katherine


    Increasing numbers of prisoners in the United States are dying from age-related and chronic illnesses while incarcerated. This study is among the first to document characteristics of a population of prison hospice patients. Retrospective review of medical records for all patients admitted to the Louisiana State Penitentiary prison hospice program between January 1, 2004, and May 31, 2012 (N = 79) examined demographics, medical history, hospice diagnosis, length of stay, and end-of-life symptom prevalence on admission and during final 72 hours before death. Resulting data were contrasted with community-based end-of-life care study data, demonstrating a unique clinical profile of this group. As prisons consider adopting programs to meet the growing need for inmate end-of-life care, more research concerning the particular characteristics and unique needs of prison hospice patients will inform these efforts.

  8. Oral care for hospice patients with severe trismus.

    Wrigley, Hannah; Taylor, Elizabeth Johnston


    Oral care is a hallmark of attentive, high-quality nursing care. Oral care improves a patient's sense of well-being, communication, and nutritional status, and lowers the risk for pneumonia. However, for patients with severe trismus, oral care may seem impossible. Trismus is the inability to open the mouth more than 35 mm and often results from medical therapies for head and neck cancers. This article details a simple approach to oral care that was implemented successfully with five hospice patients with severe trismus.

  9. Effects of Rational-Emotive Hospice Care Therapy on Problematic Assumptions, Death Anxiety, and Psychological Distress in a Sample of Cancer Patients and Their Family Caregivers in Nigeria

    Kay Chinonyelum Nwamaka Onyechi


    Full Text Available This study was a preliminary investigation that aimed to examine the effects of rational emotive hospice care therapy (REHCT on problematic assumptions, death anxiety, and psychological distress in a sample of cancer patients and their family caregivers in Nigeria. The study adopted a pre-posttest randomized control group design. Participants were community-dwelling cancer patients (n = 32 and their family caregivers (n = 52. The treatment process consisted of 10 weeks of full intervention and 4 weeks of follow-up meetings that marked the end of intervention. The study used repeated-measures analysis of variance for data analysis. The findings revealed significant effects of a REHCT intervention program on problematic assumptions, death anxiety, and psychological distress reduction among the cancer patients and their family caregivers at the end of the intervention. The improvements were also maintained at follow-up meetings in the treatment group compared with the control group who received the usual care and conventional counseling. The researchers have been able to show that REHCT intervention is more effective than a control therapy for cancer patients’ care, education, and counseling in the Nigerian context.

  10. Discuss about hospice care of patients with advanced colorectal cancer%晚期结直肠癌患者的临终关怀护理探析

    刘素琴; 王超鹏


    Objective To explore the nursing process in patients with advanced colorectal cancer.Methods Combining literature review and abundant work experience of clinic medical treatment,the author dis-cussed and analyzed the solutions about the nursing process during hospice care.Results We put forward the integrated application of nurses training,basic nursing,psychological nursing and care to patients'fami-lies.Conclusion Through the comprehensive hospice care for patients,with relieve care principle,the prin-ciple of comprehensive care and the basis of humanitarian principle,we are able to make the patients have a satisfactory life approaching their end.%目的:探讨晚期结直肠癌患者的临终关怀护理措施。方法综合相关文献并结合笔者多年临床工作经验,对晚期结直肠癌患者临终关怀过程中经常遇到的问题及解决方法进行初步探析。结果提出加强医护人员培训、重视患者基础护理及心理护理、关注对患者家属的护理等综合措施。结论全面地为晚期结直肠癌患者提供临终关怀护理,并以舒缓护理、全方位护理、人道主义为根本原则,可使患者在生命的最后阶段满意的达到生命终点。

  11. 宁养疗护能给癌末病人以无痛和尊严——三论“中国的宁养疗护需要什么?”%Hospice Care Can Bring Painlessness and Dignity to Patients with Terminal Cancer-the 3rd Discussion on "What Does the Chinese Hospice Care Need?"



    Reflecting the "localization" practice course of the hospital (Better Nursing of Shengjing Hospital Affiliated to China Medical University) , the paper proposed that: the localization hospice care according to Chinese situation is the root of this service; hospice care not only improved the life quality of cancer patients, but also reduce the medical expenses expenditure; hospice care is the philosophical thinking on the treatment of cancer patients, is an idea but not boundaries. In order to make cancer prevention and control away from the error zone of excessive treatment or palliative shortage, the development of the hospice care service with the characteristic of household care still needs the whole social efforts.%反思中国医科大学附属盛京医院宁养院构建宁养疗护“本土化”实践的历程.认为符合国情的“本土化”宁养服务是宁养疗护的根基所在;宁养疗护在改善癌症病人生活质量的同时,也降低了医药费用的开支;宁养疗护是对癌症患者治疗上的哲学思考,是理念不是界限.为使肿瘤防治走出“治疗过度”和“姑息不足”的误区,发展以居家服务为特色的中国宁养疗护模式,尚需全社会的共同努力.

  12. Hospice, She Yelped: Examining the Quantity and Quality of Decision Support Available to Patient and Families Considering Hospice.

    Finnigan-Fox, Grace; Matlock, Dan D; Tate, Channing E; Knoepke, Christopher E; Allen, Larry A


    Whether to engage hospice is one of the most difficult medical decisions patients and families make. Meanwhile, misperceptions about hospice persist. Within this context, the breadth and depth of patient decision support materials for hospice is unknown. Identify available patient decision aids (PtDAs) relating information about hospice care and compare that information to the informational needs expressed by real-world healthcare consumers. First, the research team conducted an environmental scan of available PtDAs that included hospice as a treatment option and met 6 basic criteria defined by the International Patient Decision Aid Standards (IPDAS). Second, laypersons conducted an organic web search for information regarding hospice, followed by a semi-structured interview eliciting perceptions of the available information. The setting was the University of Colorado Health Care System. Participants included 20 laypersons aged 18 or older. The environmental scan identified 7 PtDAs that included hospice. No PtDAs were designed primarily around hospice; rather, hospice was referenced under the umbrella of another treatment option. The layperson search identified information distinct from the scan; no participant accessed any of the above 7 PtDAs. Many participants found the available online material confusing and biased, while failing to provide clear information on cost and lacking desired patient and caregiver testimonials. We found no formal PtDA designed primarily to help patients/families contemplating hospice. Furthermore, accessible online information about hospice does not appear to meet patient and caregiver decisional needs. These findings support the development and dissemination of high-quality decision support materials for hospice. Copyright © 2017. Published by Elsevier Inc.

  13. Physical function in hospice patients and physiotherapy interventions: a profile of hospice physiotherapy.

    Cobbe, Sinead


    Abstract Objective: There is a dearth of international research on hospice physiotherapy. This study aims to profile hospice physiotherapy in an Irish setting in order to inform practice internationally. Design: The study design consisted of a retrospective chart audit over 6 months. Setting: The study took place at a specialist palliative care inpatient unit (hospice) in Limerick, Ireland. Participants: All patients were discharged (through death or discharge onwards) from January to June 2010. Outcome measure: The Edmonton Functional Assessment Tool (EFAT-2) was used as an outcome measure. Results: Sixty-five percent were referred for physiotherapy; 58% (n=144) were assessed and treated. A wide range of patients was referred (mean functional score 11, range 1-23, SD 5). Rehabilitation activities were widespread: 48% with more than one functional score recorded made improvements; 53% of physiotherapy patients were eventually discharged home; 47% of physiotherapy patients died, of whom 52% received physiotherapy in the last week of life. The median physiotherapy program lasted 11 days (range 1-186, SD 22) whereas the median number of treatments was four (range 1-99, SD 10). The most common interventions were gait re-education (67%), transfer training (58%), and exercises (53%). One third of treatment attempts were unsuccessful because of the unavailability\\/unsuitability of patients. Challenges for physiotherapists included frequent suspension of treatment and large functional fluctuations in patients. Conclusion: There was a high referral rate to physiotherapy in this hospice. Functional changes in hospice patients were mapped, showing that physiotherapy involved both rehabilitative and quality of life\\/supportive measures. The most common treatments were physical activity interventions.

  14. Hospice Care

    Hospice care is end-of-life care. A team of health care professionals and volunteers provides it. ... can remain as alert and comfortable as possible. Hospice programs also provide services to support a patient's ...

  15. 42 CFR 417.423 - Special rules: ESRD and hospice patients.


    ... 42 Public Health 3 2010-10-01 2010-10-01 false Special rules: ESRD and hospice patients. 417.423... Special rules: ESRD and hospice patients. (a) ESRD patients. (1) A Medicare beneficiary who has been... not disenroll the beneficiary except as provided in § 417.460. (b) Hospice patients. A...

  16. Hospice Service for Patients with Advanced Cancer from Utilitarianism%癌症晚期宁养医疗服务决策的功利主义评价

    陈旻; 谭卫华


    Facing increasing advanced cancer patients ,there are three possible healthcare models for the patient ,treatment , abandoning treatment and hospice service .In order to help patients make reasonable healthcare decision that guarantees not only its healthcare scientificity , but also the ethical correctness . The essay discusses possible utilities of these three different types of healthcare models from utilitarianism .It evaluates the rationalities of hospice service ,which reflects the greatest utilities of patients with advanced cancer ,and provides ethical supporting theories for it .Based on that ,people may reconsider the best way of caring the patients ,and be more willing to accept hospice service .%面对日益增多的癌症晚期患者,为了帮助该患病群体在制定医疗服务决策时保证医学疗护手段科学性,又能确保医疗决策伦理价值的正确性,以功利主义伦理理论为进路,通过讨论癌症晚期患者积极抗肿瘤医治、放弃治疗与宁养医疗服务三种不同医疗模式可能带来的结果与效用,阐明宁养医疗服务是癌症晚期患者全面利益观的体现,论证了其伦理价值取向的合理性,从而为广大群众能转变观念,接受、制定并执行宁养疗护计划提供依据与伦理支持,以期广泛推广。

  17. Sources of Stress in Nursing Terminal Patients in a Hospice.

    Gray-Toft, Pamela; Anderson, James G.


    Investigated sources of stress experienced by hospice nurses. Stress sources included: physical characteristics of the unit as well as staffing policies designed to improve the quality of care; procedures followed in admitting patients; policies related to the preparation of meals and open visitation; and greater involvement with the patient and…

  18. [Hospice--an institution of support to the patient].

    Kucharska, Ewa


    The paper summarises the past and the present of the palliative care. The author describes the developement in the field from the times of antiquity, through the deep Christian vocation of middle ages to alleviate pain and misery, the eigthteenth century's enlighted ideas until the relatively recent developement of the idea of hospice pioneered in 1967by dr Cicely Saunders in England, and in 1964 by Chrzanowska in Poland. The role of hospice and palliative care at large is summarised, with special focus on emotional, affirmative, instrumental and information-centered support. The paradox of hospice is discussed, which rests on caring for the incurable patient and helping them comfortably to pass the terminal stages of their disease and life, with dignity, without pain, depression, negligence and deprivation. The hospice movement, drawing form Christian tradition, affirms life while accepting the inevitability of death, opposes the idea of euthanasia, educates the society about the issues related to dying, rests on a set of autonomous units the organisation of which is adapted to local needs, and, finally, acts in concordance with other agendas of the healthcare system. The Polish system constituted by palliative care reach-out teams and palliative units and hospices should be strongly supported and adequately founded to supply best care available to the dying and distressed.

  19. A Brief Report of One Case of Hospice Service for A Patient in Late Stage of Cancer%1例晚期肿瘤患者宁养服务浅谈

    陈柳; 施丽霞; 沈伟


    Through in-home hospice care guidance and psychological counseling ,patients with advanced cancer are provided with a full range of care including body ,mind and soul ,thereby improving the quality of life in patients with advanced cancer .Each patient with advanced cancer is provided with care and guidance of symptom control ,psychological counseling and spiritual communication .The patients with advanced cancer and their families can improve their abilities to take care of themselves and finally the patient's life ends with dignity .Taking care of body and mind plays an important role in the care of hospice services .It can improve the quality of life for the patient ,but its effect depends on the patient's individual characteristics and they should learn some skills .%通过提供居家宁养护理指导和心理疏导的方法,为晚期癌症患者提供身、心、灵全方位的照顾,从而提高晚期癌症患者的生活质量。通过对1例晚期肿瘤患者进行症状控制、护理指导、心理疏导、灵性沟通,该晚期肿瘤患者及家属的自身照顾能力提高,晚期肿瘤患者在生命末期的生活质量有所提高,最终达到善终。身心灵的照顾在宁养服务中起重要作用,有利于患者生活质量的提高,但仍要根据患者的个体特点并掌握一定技巧。




    Family caregivers often suffer higher levels of physical and emotional distress when caring for a chronically or terminally ill family member. Providing this kind of care to a loved one at the end of life contributes to increased stress, health problems, and a decreased quality of life. The Hospice Caregiver Support Project provided support services to caregivers identified by the hospice social worker as needing this support and/or assistance. Results from the project show that offering additional services relieved caregiver stress by allowing the caregiver time away from their caregiving role and reducing feelings of guilt and worry, and increased hospice social worker satisfaction with their ability to respond to the needs of hospice patients and caregivers. PMID:23977779

  1. 舒适护理在肝癌晚期患者临终护理中的临床价值%Clinical Value of Comfortable Nursing in the Hospice Care of Terminal Liver Cancer Patients



    目的:研究分析舒适护理在肝癌晚期患者临终护理中的临床价值。方法选取该院42例肝癌晚期患者研究分析,并随机将其分为治疗组(21例)和对照组(21例),对比两组患者护理效果。结果对比两组患者护理总满意,差异有统计学意义(P<0.05)。结论舒适护理在肝癌晚期患者临终护理中具有显著效果,可有效提高患者临终生活质量及患者家属对护理总满意度。%Objective To study the clinical value of comfortable nursing in the hospice care of terminal liver cancer patients. Methods 42 terminal liver cancer patients admitted in our hospital were selected for the study and analysis. And they were divided into the treatment group (21 cases) and the control group (21 cases), the nursing effects of two groups of patients were compared. Results The difference in the total nursing satisfaction between the two groups of patients was statistically significant (P<0.05). Conclusion Comfortable nursing in the hospice care for terminal liver cancer patients has significant effect, which can effectively improve the quality of life at the end of life of the patients, and the total nursing satisfaction of the families of patients.

  2. 晚期肿瘤患者的姑息照护与临终关怀%Palliative Care and Hospice Care in Patients with Advanced Cancer

    陆琴; 张莎; 蔡婷婷; 王德丽


    Objective: To analyze the effect of palliative care and hospice care in patients with advanced malignant tumor. Methods: 80 patients with advanced malignant tumor patients selected from June 2014 -2016 year in August admitted to the hospital were analyzed, were randomly divided into control group and observation group, control group with routine nursing intervention, the observation group were treated with nursing intervention mode of palliative care and hospice care. Results:Patients with advanced malignant tumor after different nursing intervention, the clinical effects were compared between the two groups, namely the ability to actively cooperate with treatment and patient satisfaction of patients, observation of nursing inter-vention in palliative care and hospice care patients, has significant effect, significantly better than the control group. Conclusion:The nursing intervention measures of palliative care and hospice care for patients with advanced malignant tumor, can signifi-cantly improve the clinical treatment effect, improve the life quality of the patients, at the same time, in view of the hospital, improve the quality of nursing work, improve patient satisfaction, and vigorously promote the application for the clinical work.%目的:分析研究晚期恶性肿瘤患者的姑息照护与临终关怀的应用效果。方法:研究对象为抽取2014年6月-2016年8月医院收治的80例恶性晚期肿瘤患者进行分析,随机分为对照组与观察组,对照组患者实施常规的护理干预措施,观察组患者采用姑息照护与临终关怀的护理干预模式。结果:恶性肿瘤晚期患者经过不同的护理干预后,通过对比两组患者的临床效果,即病人的主动配合治疗能力以及患者的满意度等情况,观察组患者实施姑息照护与临终关怀的护理干预,具有明显的效果,显著优于对照组。结论:针对恶性晚期肿瘤患者实施姑息照护与临终关怀

  3. Selling hospice.

    Halabi, Sam


    Americans are increasingly turning to hospice services to provide them with medical care, pain management, and emotional support at the end of life. The increase in the rates of hospice utilization is explained by a number of factors including a "hospice movement" dating to the 1970s which emphasized hospice as a tool to promote dignity for the terminally ill; coverage of hospice services by Medicare beginning in 1983; and, the market for hospice services provision, sustained almost entirely by governmental reimbursement. On the one hand, the growing acceptance of hospice may be seen as a sign of trends giving substance to the death-with-dignity movement and the growing strength of end-of-life decision-makers and planners who integrate medical, community, family and spiritual networks. On the other hand, the precise relationship between the death-with-dignity and commercial processes driving hospice utilization rates are not well understood. On May 2, 2013, the U.S. Government intervened in a lawsuit brought by former hospice employees alleging that behind Vitas Innovative Hospice Care, the largest for-profit hospice service provider in the United States, lie an intricate web of incentives for patient intake nurses, physicians and marketers which not only drove hospice patients to use more expensive (and medically unnecessary) crisis care services, but influenced patient and family decisions as to whether or not to discontinue curative treatment. The corporate, investment, and regulatory history behind Vitas provides an important insight into the market realities behind Americans' embrace of hospice care and the risks to patient autonomy and health that accompany the commercialization of this ethically and morally complex health care service.

  4. Hospice Use by Hispanic and Non‐Hispanic White Cancer Decedents

    Lackan, Nuha A; Ostir, Glenn V; Freeman, Jean L; Kuo, Yong‐Fang; Zhang, Dong D; Goodwin, James S


    Objective. To investigate rates of hospice use between Hispanic and non‐Hispanic white Medicare beneficiaries diagnosed with cancer using data from a large, population‐based study. Data Sources...

  5. Effect of family hospice in elderly patients with end?stage lung cancer%家庭临终关怀在终末期老年肺癌患者中的应用效果

    叶萍; 谭思源; 汤琪春; 徐枫兰


    Objective To study the effect of family hospice on the quality of life and mental health in elderly patients with end-stage lung cancer. Methods Sixty cases of end-stage lung cancer were selected from December 2013 to December 2014 in our hospital, and divided into control group and experimental group by random number table method. The control group received usual care, and the experimental group received home hospice care on the basis of usual care. Depression Scale ( GDS) and self-rated health measurement scale ( SRHMS) were assessed and compared before and three months after intervention in two groups. The adverse symptoms were recorded and compared between two groups. Results After three months of home hospice care, the GDS score was 44. 65±1. 41 and the incidence rate of adverse reaction was 43. 33% in the experimental group,compared with 56. 78±1. 46, 56. 67% in the control group (P<0. 05). The SRHMS score of experimental group (32. 36±40. 23) was higher than that in control group (3. 72±10. 58,P<0. 05). Conclusions Family hospice can ease psychological stress of patients with end-stage lung cancer, reducing depression, alleviating symptoms, and improving quality of life and mental state of the patients.%目的 研究家庭临终关怀对终末期老年肺癌患者生活质量及精神状态的影响.方法 选取2013年12月至2014年12月我院肿瘤科60例终末期老年肺癌患者作为研究对象,采用随机数字表法将患者分为对照组和试验组,每组各30例.对照组给予一般照护,试验组在此基础上增加家庭临终关怀护理内容.入组干预3月后,分别采用抑郁量表(GDS)和自测健康评定量表(SRHMS)进行评分,并比较2组不良反应的发生情况.结果 在3月的家庭临终关怀后,试验组GDS评分(44.65±1.41)、不良反应发生率(43.33%)均低于对照组(56.78±1.46,56.67%)(P均<0.05).试验组SRHMS评分(32.36±40.23)高于对照组(3.72±10.58,P<0.05).结论 家庭临终关怀能缓解

  6. Ethics seminar: the hospice patient in the ED: an ethical approach to understanding barriers and improving care.

    Zieske, Michael; Abbott, Jean


    Emergency physicians (EPs) are asked to evaluate and treat a growing population of hospice patients who present to the emergency department (ED) for a number of important reasons. Hospice patients pose unique ethical challenges, and "best practices" for these patients can differ from the life-preserving interventions of usual ED care. Having a solid understanding of professional responsibilities and ethical principles is useful for guiding EP management of these patients. In end-of-life care, EPs need to recognize that there are barriers and complexities to the best management of hospice patients, but they need to commit to strategies that optimize their care. This article describes the case of a hospice patient who presented with sepsis and end-stage cancer to the ED. Patient, system, and physician factors made management decisions in the ED difficult. The goal in the ED should be to determine the best way to address terminally ill patient needs while respecting wishes to limit interventions that will only increase suffering near the end of life.

  7. Hospice assist at home : does the integration of hospice care in primary healthcare support patients to die in their preferred location - A retrospective cross-sectional evaluation study

    de Graaf, Everlien; Zweers, Daniëlle; Valkenburg, Anna Ch; Uyttewaal, Allegonda; Teunissen, Saskia Ccm


    BACKGROUND: A majority of patients prefer to die at home. Specialist palliative care aims to improve quality of life. Hospice assist at home is a Dutch model of general/specialised palliative care within primary care, collaboratively built by general practitioners and a hospice. AIM: The aims of thi

  8. Portraits of Caregivers of End-Stage Dementia Patients Receiving Hospice Care

    Sanders, Sara; Butcher, Howard K.; Swails, Peggy; Power, James


    The purpose of this study was to investigate how caregivers respond to the end stages of dementia with the assistance from hospice. Data were collected from 27 family caregivers over the course of 10 months, with each caregiver being interviewed up to 4 times during the time that the patient received hospice care. Chart review data were also…

  9. Hospice Enrollment in Patients With Advanced Heart Failure Decreases Acute Medical Service Utilization.

    Yim, Cindi K; Barrón, Yolanda; Moore, Stanley; Murtaugh, Chris; Lala, Anuradha; Aldridge, Melissa; Goldstein, Nathan; Gelfman, Laura P


    Patients with advanced heart failure (HF) enroll in hospice at low rates, and data on their acute medical service utilization after hospice enrollment is limited. We performed a descriptive analysis of Medicare fee-for-service beneficiaries, with at least one home health claim between July 1, 2009, and June 30, 2010, and at least 2 HF hospitalizations between July 1, 2009, and December 31, 2009, who subsequently enrolled in hospice between July 1, 2009, and December 31, 2009. We estimated panel-negative binomial models on a subset of beneficiaries to compare their acute medical service utilization before and after enrollment. Our sample size included 5073 beneficiaries: 55% were female, 45% were ≥85 years of age, 13% were non-white, and the mean comorbidity count was 2.38 (standard deviation 1.22). The median number of days between the second HF hospital discharge and hospice enrollment was 45. The median number of days enrolled in hospice was 15, and 39% of the beneficiaries died within 7 days of enrollment. During the study period, 11% of the beneficiaries disenrolled from hospice at least once. The adjusted mean number of hospital, intensive care unit, and emergency room admissions decreased from 2.56, 0.87, and 1.17 before hospice enrollment to 0.53, 0.19, and 0.76 after hospice enrollment. Home health care Medicare beneficiaries with advanced HF who enrolled in hospice had lower acute medical service utilization after their enrollment. Their pattern of hospice use suggests that earlier referral and improved retention may benefit this population. Further research is necessary to understand hospice referral and palliative care needs of advanced HF patients. © 2017 American Heart Association, Inc.

  10. Evaluation of Subcutaneous Phenobarbital Administration in Hospice Patients.

    Hosgood, Jessica Richards; Kimbrel, Jason M; McCrate Protus, Bridget; Grauer, Phyllis A


    Phenobarbital is used in hospice and palliative care to treat refractory symptoms. In end-of-life care, Food and Drug Administration approved routes of administration may be unreasonable based on patients' status. In these cases, phenobarbital may be administered subcutaneously for symptom management. However, according to the American Hospital Formulary Service, subcutaneous administration of commercially available injectable phenobarbital is cautioned due to possible skin reactions. This study evaluates the tolerability of phenobarbital administered subcutaneously. Of 69 patients and 774 distinct subcutaneous phenobarbital injections, 2 site reactions were recorded (2.9% of patients; 0.3% of injections). Both were mild, grade 1 reactions. Each patient continued to receive subcutaneous phenobarbital via newly placed ports with no additional reactions. Based on these findings, phenobarbital appears to be well tolerated when administered subcutaneously. © The Author(s) 2014.

  11. A team approach to recruitment in hospice research: engaging patients, close people and health professionals.

    L Campbell, Cathy; Bailey, Cara; Armour, Kathy; Perry, Rachel; Orlando, Rosanna; Kinghorn, Philip; Jones, Louise; Coast, Joanna


    Research is vital to the future development of hospice care. However, research in hospice settings is very challenging. This paper describes a case study of a successful multidisciplinary research team approach (MDRT) to the recruitment of participants (hospice patients, family members and health professionals) for a study in a hospice setting on the economic evaluation of end-of-life care. A successful recruitment plan includes three key strategies: identifying key members of the MDRT early in the research process; having a clear and constant communication stream; and creating an environment where all team members have a shared commitment to the research, all voices are heard and valued, and everyone contributes to the research aims. An MDRT approach will be helpful to guide the development of successful recruitment plans for academic-community research partnerships in the hospice setting.

  12. Patient and family perceptions of hospice services: 'I knew they weren't like hospitals'

    Bray Y


    Full Text Available INTRODUCTION: The vision for palliative care service provision in New Zealand is for all people who are dying and their families to have timely access to culturally appropriate, quality palliative care services. An Auckland hospice's records show that the ethnically diverse population statistics were not reflected in the referrals for hospice services. The aim of this research was to gain a patient-and-their-family perspective on the hospice, including exploration of components of service care that could be improved for various cultural groups. METHODS: Patients currently under the care of the hospice and family members were recruited from hospice records. Semi-structured interviews were conducted to explore the emerging issues. The study collected data from a purposive sample of 18 palliative care patients or carer family members, ranging in age from 39 to 81 years, who reflected the ethnic diversity of the population of the region. Interviewing was carried out by an experienced research assistant and continued until data saturation was reached. FINDINGS: Four key themes emerged-hospice personnel's approach to patients, quality of service, cultural barriers, and strategies for future improvement. It was determined that the latter two were the most significant to address in this article. CONCLUSION: The study revealed the need for information-giving and education, including public profiling of the hospice to strengthen community involvement. Strategies to reduce ethnic disparities include strengthening the awareness of, and access to, services by connecting with cultural groups through churches, community and specific cultural media.

  13. Expectation in Life Review: A Term of Spiritual Needs Easily Understood by Chinese Hospice Patients.

    Deng, Di; Deng, Qing; Liu, Xiaofang; Xie, Cong Hua; Wu, Xin


    Terms such as spirituality and spiritual needs are abstract and difficult to understand. Realization of spirituality of hospice patients was premise in addressing expression of their spiritual needs. This study investigated expectations expressed during life review and tried to prove that the expectation was intelligible term for spiritual needs in Chinese hospice from May 2011 to June 2013. Among the 107 recruited patients, families were the most frequent emotion-expressing recipients, and 133 expectations related to patients' spiritual needs were identified. The emotion-expressing recipients and the patient's expectations were not affected by demographic characteristics. The expectations in life review with hospice patients and their families had the features of spiritual essence. The identified expectation contents could be used to address spiritual needs in hospice care in Chinese.

  14. Extensions to Regret-based Decision Curve Analysis: An application to hospice referral for terminal patients

    Tsalatsanis Athanasios


    Full Text Available Abstract Background Despite the well documented advantages of hospice care, most terminally ill patients do not reap the maximum benefit from hospice services, with the majority of them receiving hospice care either prematurely or delayed. Decision systems to improve the hospice referral process are sorely needed. Methods We present a novel theoretical framework that is based on well-established methodologies of prognostication and decision analysis to assist with the hospice referral process for terminally ill patients. We linked the SUPPORT statistical model, widely regarded as one of the most accurate models for prognostication of terminally ill patients, with the recently developed regret based decision curve analysis (regret DCA. We extend the regret DCA methodology to consider harms associated with the prognostication test as well as harms and effects of the management strategies. In order to enable patients and physicians in making these complex decisions in real-time, we developed an easily accessible web-based decision support system available at the point of care. Results The web-based decision support system facilitates the hospice referral process in three steps. First, the patient or surrogate is interviewed to elicit his/her personal preferences regarding the continuation of life-sustaining treatment vs. palliative care. Then, regret DCA is employed to identify the best strategy for the particular patient in terms of threshold probability at which he/she is indifferent between continuation of treatment and of hospice referral. Finally, if necessary, the probabilities of survival and death for the particular patient are computed based on the SUPPORT prognostication model and contrasted with the patient's threshold probability. The web-based design of the CDSS enables patients, physicians, and family members to participate in the decision process from anywhere internet access is available. Conclusions We present a theoretical

  15. What Patients and Families Don’t Hear: Backstage Communication in Hospice Interdisciplinary Team Meetings


    Backstage communication has been shown to play a vital role in a bona fide group’s teamwork. Hospice interdisciplinary teams are considered bona fide groups, and hospice interdisciplinary team meetings constitute backstage communication because they occur away from patients and families. Video recordings of interdisciplinary team meetings were systematically coded for backstage communication mess ages and the extent to which different interdisciplinary team members participated in backstage c...

  16. Evaluation of hospice care by family members of Hispanic and non-Hispanic patients.

    Kirkendall, Abbie; Holland, Jason M; Keene, Jennifer R; Luna, Nora


    The Hispanic older adult population is increasing rapidly and past research suggests that this demographic group underutilizes hospice services, highlighting the need to improve our understanding of their needs in end of life. This study relied upon information from the family evaluation of hospice care survey provided by 2980 caregivers, 152 of whom cared for a Hispanic patient and 2828 who cared for a non-Hispanic patient. Caregivers of Hispanic patients were more likely to report that hospice was inconsistent with the patient's wishes, and that they received more attention than desired for emotional issues. Caregivers of Hispanic patients were also more likely to express that emotional/spiritual forms of support were insufficient. Similar levels of satisfaction were reported for caregivers of Hispanics and non-Hispanics regarding dignity/respect, information received, care coordination, and overall satisfaction. © The Author(s) 2014.

  17. Hospice care for lung cancer%晚期肺癌的临终关怀护理



    目的:探讨晚期肺癌的临终关怀与护理。方法2014年45例住院晚期肺癌患者进行临终关怀护理。结果患者在有限的时间内,稳定接受各种护理,症状能够缓解,生命质量改善,家属心理压力亦明显减轻。结论生命关怀与护理是为生命即将走到终点的癌症患者及家属提供全面的身心照顾与关怀。%Objective Discuss the hospice care and nursing of advanced lung cancer.Method Give hospice care and nursing of 45 advanced lung cancer in 2014. Result in the limited time, patients accept all kinds of nursing, Symptom can remit, improve life quality, family stress also significantly reduced.Conclusion Life care and nursing is to provide comprehensive physical and psychological care and caring for life is coming to the end of the cancer patients and their families.

  18. Causes of Death in HIV Patients and the Evolution of an AIDS Hospice: 1988–2008

    Ann Stewart


    Full Text Available This paper reports on the transformation that has occurred in the care of people living with HIV/AIDS in a Toronto Hospice. Casey House opened in the pre-HAART era to care exclusively for people with HIV/AIDS, an incurable disease. At the time, all patients were admitted for palliative care and all deaths were due to AIDS-defining conditions. AIDS-defining malignancies accounted for 22 percent of deaths, mainly, Kaposi sarcoma and lymphoma. In the post-HAART era, AIDS-defining malignancies dropped dramatically and non-AIDS-defining malignancies became a significant cause of death, including liver cancer, lung cancer and gastric cancers. In the post-HAART era, people living with HIV/AIDS served at Casey House have changed considerably, with increasing numbers of patients facing homelessness and mental health issues, including substance use. Casey House offers a picture of the evolving epidemic and provides insight into changes and improvements made in the care of these patients.

  19. Does hospital need more hospice beds? Hospital charges and length of stays by lung cancer inpatients at their end of life: A retrospective cohort design of 2002-2012.

    Kim, Sun Jung; Han, Kyu-Tae; Kim, Tae Hyun; Park, Eun-Cheol


    Previous studies found that hospice and palliative care reduces healthcare costs for end-of-life cancer patients. To investigate hospital inpatient charges and length-of-stay differences by availability of hospice care beds within hospitals using nationwide data from end-of-life inpatients with lung cancer. A retrospective cohort study was performed using nationwide lung cancer health insurance claims from 2002 to 2012 in Korea. Descriptive and multi-level (patient-level and hospital-level) mixed models were used to compare inpatient charges and lengths of stay. Using 673,122 inpatient health insurance claims, we obtained aggregated hospital inpatient charges and lengths of stay from a total of 114,828 inpatients and 866 hospital records. Hospital inpatient charges and length of stay drastically increased as patients approached death; a significant portion of hospital inpatient charges and lengths of stay occurred during the end-of-life period. According to our multi-level analysis, hospitals with hospice care beds tend to have significantly lower end-of-life hospital inpatient charges; however, length of stay did not differ. Hospitals with more hospice care beds were associated with reduction in hospital inpatient charges within 3 months before death. Higher end-of-life healthcare hospital charges were found for lung cancer inpatients who were admitted to hospitals without hospice care beds. This study suggests that health policy-makers and the National Health Insurance program need to consider expanding the use of hospice care beds within hospitals and hospice care facilities for end-of-life patients with lung cancer in South Korea, where very limited numbers of resources are currently available. © The Author(s) 2015.

  20. Palliative and hospice care in gynecologic cancer: a review.

    Lopez-Acevedo, Micael; Lowery, William J; Lowery, Ashlei W; Lee, Paula S; Havrilesky, Laura J


    Despite the increasing availability of palliative care, oncology providers often misunderstand and underutilize these resources. The goals of palliative care are relief of suffering and provision of the best possible quality of life for both the patient and her family, regardless of where she is in the natural history of her disease. Lack of understanding and awareness of the services provided by palliative care physicians underlie barriers to referral. Oncologic providers spend a significant amount of time palliating the symptoms of cancer and its treatment; involvement of specialty palliative care providers can assist in managing the complex patient. Patients with gynecologic malignancies remain an ideal population for palliative care intervention. This review of the literature explores the current state of palliative care in the treatment of gynecologic cancers and its implications for the quality and cost of this treatment.

  1. A Positive Association Between Hospice Profit Margin And The Rate At Which Patients Are Discharged Before Death.

    Dolin, Rachel; Holmes, G Mark; Stearns, Sally C; Kirk, Denise A; Hanson, Laura C; Taylor, Donald H; Silberman, Pam


    Hospice care is designed to support patients and families through the final phase of illness and death. Yet for more than a decade, hospices have steadily increased the rate at which they discharge patients before death-a practice known as "live discharge." Although certain live discharges are consistent with high-quality care, regulators have expressed concern that some hospices' desire to maximize profits drives them to inappropriately discharge patients. We used Medicare claims data for 2012-13 and cost reports for 2011-13 to explore relationships between hospice-level financial margins and live discharge rates among freestanding hospices. Adjusted analyses showed positive and significant associations between both operating and total margins and hospice-level rates of live discharge: One-unit increases in operating and total margin were associated with increases of 3 percent and 4 percent in expected hospice-level live discharge rates, respectively. These findings suggest that additional research is needed to explore links between profitability and patient-centeredness in the Medicare hospice program. Project HOPE—The People-to-People Health Foundation, Inc.

  2. The experiences of Batswana families regarding hospice care of AIDS patients in the Bophirima district, North West province, South Africa.

    Makhele, M F; Mulaudzi, F M


    The HIV/AIDS pandemic put significant strain on healthcare services in the country. Hospitals were no longer coping with the escalating number of AIDS patients. This resulted in the early discharge of patients, with some patients, too ill to be nursed at home, being sent to hospices for continued care. The Batswana had mixed feelings about hospice care, because their beliefs on patient care are based on the ubuntu philosophy, which emphasises the principle of caring for one another. The purpose of this study was to explore and describe the experiences of Batswana families regarding hospice care for patients in the Thlabane township in the province of the North West as well as to make recommendations to policy-makers to ensure that hospices are accepted by community members and utilised effectively. A qualitative, explorative, descriptive research design was applied. Purposive sampling was applied to select study participants with whom in-depth unstructured interviews were conducted. A qualitative data analysis was done by categorising, ordering, and summarising the data, and describing the findings. The findings indicated that families of patients in hospice care experienced such care as foreign to their culture. These families also experienced stigmatisation, firstly owing to the stigma associated with AIDS and secondly because they opted for hospice care. However, they also observed the high quality of care provided by the hospice and understood its benefits for AIDS patients. The study concluded that hospice care relieved families of terminally ill AIDS patients of the burden of care and enabled them to keep on working and earning a living. Recommendations to policy-makers included enhancing hospice care and ensuring the provisioning of culturally safe hospice care.

  3. Death Education for Family in the Cancer Hospice Care%肿瘤临终关怀中的家属辞世教育

    刘祖望; 王玉梅


    晚期癌症患者的家属在临终家居照顾及医院宁养照顾中起到重要的作用,对临终患者家属的关怀照顾是临终关怀的重要组成部分,通过从家属心理特点、影响家属心理的因素、家属辞世教育方法三个方面具体阐述在家属辞世教育的工作步骤,从而更好的指导社会医疗实践,促进临终关怀工作在我国的发展.%The family of advanced cancer patients play an important role in home and hospital hospice care, and care for the family of hospice patients is part of hospice care. Following analysis of the psychological characteristics of the family, the factors affecting family psychology and method of family death education from three respects, this article described the work steps of death education for the family, guiding the social medical practice, promoting development of hospice care in our country.

  4. Existential Concerns About Death: A Qualitative Study of Dying Patients in a Danish Hospice

    Moestrup, Lene; Hansen, Helle Ploug


    afterlife and made accurate decisions for practical aspects of their death. The patients wished to focus on positive aspects in their daily life at hospice. It hereby seems important to have ongoing reflections and to include different theoretical perspectives when providing existential support to dying...

  5. Hospice: Rehabilitation in reverse

    Senthilkumar Jeyaraman


    Full Text Available Hospice care is about quality of life at a time when a person has an illness for which curative measures are no longer possible, and for which a physician has determined the patient has a life expectancy of about six months or less, a hospice program can support the process of death and dying in a compassionate way. A growing trend is to utilize physical therapy more frequently in hospice. Physical therapy has several vital roles in hospice care as follows: maximizing functional ability and comfort to enhance quality of life; assuring patient and care giver safety; helping people redesign their lives and life goals; providing support around physical, emotional and spiritual issues at the end of life. The purpose of this review is to provide 1 a description of hospice care, 2 an explanation of the roles of physical therapists in hospice care.

  6. [Aging problem in the home hospice care].

    Watanabe, Go; Yamagiwa, Tetsuya; Nakayama, Shinya; Ito, Satoko; Fukuda, Akiko; Shiotani, Tomohiro; Yamaoka, Yoshio


    Home hospice care is not merely an extension of hospital-based medical care administered at the hospital, but refers to hospice care for patients with life-threatening diseases that can only be given at their homes. The rapid growth of the elderly population in Japan has led to not only the need for home hospice care, but also social problems such as living alone, living with only one elderly family member, and problems that are particularly acute in cancer patients with dementia. We analyzed data for 262 patients for whom home hospice care was provided by our clinic. Overall, elderly persons with dementia tended to request admission before death, but most elderly persons living alone preferred home hospice care. We found that 58% of the patients living with only one elderly family member requested admission before death, which was lower than the rate of the study group as a whole. We further performed an in-depth analysis of the current situation in order to improve home hospice care of terminally ill patients in Japan, focusing on problems related to the aging population.

  7. The Broward County jails hospice program: hospice in the jail.

    Bauersmith, Joan; Gent, Ruth


    Broward County's jail hospice program initiated service in 1995. Infirmary services for both men and women in the jail system are housed in one of Broward County's four jail sites. The County, in partnership with the local Medicare certified hospice, Hospice by the Sea, provides care to inmates both in the detention center and on release to the community. Compassionate release, "community control," and expedited case disposition are sometimes utilized. Jail stays are typically shorter than prison sentences. Consequently, expedient identification and enrollment of hospice-appropriate detainees differentiates hospice in a jail setting from prison hospice. Initial attitudinal resistance to hospice services for detainees has for the most part been overcome. Ongoing challenges largely consist of institutional impediments regarding supplies, special dietary needs of hospice patients, visitation procedures, and potential patient isolation.

  8. "I'm Not Trying to Be Cured, so There's Not Much He Can Do for Me": Hospice Patients' Constructions of Hospice's Holistic Care Approach in a Biomedical Culture

    Nebel Pederson, Sarah; Emmers-Sommer, Tara M.


    The hospice philosophy was founded on a mission to provide comprehensive and holistic services to individuals at the end of life. Hospice interdisciplinary teams work together to offer therapies such as spiritual services, comfort care, and massage therapy to meet patients' physical, psychological, emotional, and spiritual needs. Although the…

  9. "I'm Not Trying to Be Cured, so There's Not Much He Can Do for Me": Hospice Patients' Constructions of Hospice's Holistic Care Approach in a Biomedical Culture

    Nebel Pederson, Sarah; Emmers-Sommer, Tara M.


    The hospice philosophy was founded on a mission to provide comprehensive and holistic services to individuals at the end of life. Hospice interdisciplinary teams work together to offer therapies such as spiritual services, comfort care, and massage therapy to meet patients' physical, psychological, emotional, and spiritual needs. Although the…

  10. Dignity, death, and dilemmas: a study of Washington hospices and physician-assisted death.

    Campbell, Courtney S; Black, Margaret A


    The legalization of physician-assisted death in states such as Washington and Oregon has presented defining ethical issues for hospice programs because up to 90% of terminally ill patients who use the state-regulated procedure to end their lives are enrolled in hospice care. The authors recently partnered with the Washington State Hospice and Palliative Care Organization to examine the policies developed by individual hospice programs on program and staff participation in the Washington Death with Dignity Act. This article sets a national and local context for the discussion of hospice involvement in physician-assisted death, summarizes the content of hospice policies in Washington State, and presents an analysis of these findings. The study reveals meaningful differences among hospice programs about the integrity and identity of hospice and hospice care, leading to different policies, values, understandings of the medical procedure, and caregiving practices. In particular, the authors found differences 1) in the language used by hospices to refer to the Washington statute that reflect differences among national organizations, 2) the values that hospice programs draw on to support their policies, 3) dilemmas created by requests by patients for hospice staff to be present at a patient's death, and 4) five primary levels of noninvolvement and participation by hospice programs in requests from patients for physician-assisted death. This analysis concludes with a framework of questions for developing a comprehensive hospice policy on involvement in physician-assisted death and to assist national, state, local, and personal reflection. Copyright © 2014 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

  11. Developing a nurse led hospice outpatient clinic to improve palliative care services.

    Lawton, Catherine

    A team of palliative care clinical nurse specialists at the Phyllis Tuckwell Hospice in Farnham, Surrey, set up a hospice based outpatient clinic to improve services for patients with cancer. This article examines how the team used clinical audit, a staff questionnaire and patient feedback to evaluate the service and make recommendations for the future development of the clinic.

  12. Hospice Care in America

    ... Patient receives hospice care consisting predominantly of licensed nursing care on a continuous basis at home. Continuous home ... Gozalo PL, Mor V. The Growth of Hospice Care in U.S. Nursing Homes . JAGS. 2010 58:1481-88. © 2015 NHPCO ...

  13. Hospices' enrollment policies may contribute to underuse of hospice care in the United States.

    Aldridge Carlson, Melissa D; Barry, Colleen L; Cherlin, Emily J; McCorkle, Ruth; Bradley, Elizabeth H


    Hospice use in the United States is growing, but little is known about barriers that terminally ill patients may face when trying to access hospice care. This article reports the results of the first national survey of the enrollment policies of 591 US hospices. The survey revealed that 78 percent of hospices had at least one enrollment policy that may restrict access to care for patients with potentially high-cost medical care needs, such as chemotherapy or total parenteral nutrition. Smaller hospices, for-profit hospices, and hospices in certain regions of the country consistently reported more limited enrollment policies. We observe that hospice providers' own enrollment decisions may be an important contributor to previously observed underuse of hospice by patients and families. Policy changes that should be considered include increasing the Medicare hospice per diem rate for patients with complex needs, which could enable more hospices to expand enrollment.

  14. [Hospice program and palliative medicine].

    Nakagami, Y


    Hospice and palliative care have important roles for cancer patients in an incurable state to alleviate their total pain and to achieve the best quality of life. Interdisciplinary team-doctors, nurses, therapists, social workers and so on provide effective support in order to fulfill the varying needs of patients and families. Pain relief as a palliative medicine is most urgently required by seventy percent of patients on admission to our Hospice at the Salvation Army Kiyose Hospital. A case is presented with some comments on pain management. Music therapy is also introduced. This is one of the complementary methods for consolation of the mind and body of patients. Some of them seem to find it beneficial.

  15. Frequency of outpatient antibiotic prescription on discharge to hospice care.

    Furuno, Jon P; Noble, Brie N; Horne, Kristi N; McGregor, Jessina C; Elman, Miriam R; Bearden, David T; Walsh, Eric W; Fromme, Erik K


    The use of antibiotics is common in hospice care despite limited evidence that it improves symptoms or quality of life. Patients receiving antibiotics upon discharge from a hospital may be more likely to continue use following transition to hospice care despite a shift in the goals of care. We quantified the frequency and characteristics for receiving a prescription for antibiotics on discharge from acute care to hospice care. This was a cross-sectional study among adult inpatients (≥18 years old) discharged to hospice care from Oregon Health & Science University (OHSU) from 1 January 2010 to 31 December 2012. Data were collected from an electronic data repository and from the Department of Care Management. Among 62,792 discharges, 845 (1.3%) patients were discharged directly to hospice care (60.0% home and 40.0% inpatient). Most patients discharged to hospice were >65 years old (50.9%) and male (54.6%) and had stayed in the hospital for ≤7 days (56.6%). The prevalence of antibiotic prescription upon discharge to hospice was 21.1%. Among patients discharged with an antibiotic prescription, 70.8% had a documented infection during their index admission. Among documented infections, 40.3% were bloodstream infections, septicemia, or endocarditis, and 38.9% were pneumonia. Independent risk factors for receiving an antibiotic prescription were documented infection during the index admission (adjusted odds ratio [AOR]=7.00; 95% confidence interval [95% CI]=4.68 to 10.46), discharge to home hospice care (AOR=2.86; 95% CI=1.92 to 4.28), and having a cancer diagnosis (AOR=2.19; 95% CI=1.48 to 3.23). These data suggest that a high proportion of patients discharged from acute care to hospice care receive an antibiotic prescription upon discharge.

  16. The Relationship between Confucianism,Buddhism,Taoism and Improving Hospice Care of Cancer Patient%儒释道与改善癌症患者临终关怀的关系

    杨溢; 杜佳慧; 屈韵竹; 欧阳婉璐; 聂敏


    随着中国肿瘤患病率的不断上升,社会对临终关怀的需求也逐渐增大。由于我国基本国情、文化背景和价值观念与西方不同,援引自西方基督教的临终关怀理念与实践方法在中国的发展出现了许多问题。本文旨在从中国传统的儒释道文化中汲取智慧和经验,针对当前的问题,从死亡教育的开展、医护人员的培训、临终关怀机构的发展与社会支持等方面,提出相应的完善策略,促进我国临终关怀的本土化、体系化、制度化与社会化,希望为构建具有中国特色的临终关怀体系提供新的思路。%With an ever increasing prevalence rate of tumor in China ,the demand for hospice care has been rising in our society .Due to different basic national conditions ,cultural backgrounds and values , there are lots of problems in the development of the hospice care thoughts and practices in China invoked from the Christianity in the west .Drawing lessons from the traditional Chinese confucianism , buddhism and taoism culture , this paper aims to put forward thorough strategies for the current problems from the carrying out of death education , the training of medical workers , the development of hospice care institutions and the social support for hospice care , thus to promote the localization , systematization ,industrialization and socialization of hospice care in China ,to provide new ideas for the construction of hospice care system with Chinese characteristics .

  17. Meaning-centered dream work with hospice patients: A pilot study.

    Wright, Scott T; Grant, Pei C; Depner, Rachel M; Donnelly, James P; Kerr, Christopher W


    Hospice patients often struggle with loss of meaning, while many experience meaningful dreams. The purpose of this study was to conduct a preliminary exploration into the process and therapeutic outcomes of meaning-centered dream work with hospice patients. A meaning-centered variation of the cognitive-experiential model of dream work (Hill, 1996; 2004) was tested with participants. This variation was influenced by the tenets of meaning-centered psychotherapy (Breitbart et al., 2012). A total of 12 dream-work sessions were conducted with 7 hospice patients (5 women), and session transcripts were analyzed using the consensual qualitative research (CQR) method (Hill, 2012). Participants also completed measures of gains from dream interpretation in terms of existential well-being and quality of life. Participants' dreams generally featured familiar settings and living family and friends. Reported images from dreams were usually connected to feelings, relationships, and the concerns of waking life. Participants typically interpreted their dreams as meaning that they needed to change their way of thinking, address legacy concerns, or complete unfinished business. Generally, participants developed and implemented action plans based on these interpretations, despite their physical limitations. Participants described dream-work sessions as meaningful, comforting, and helpful. High scores on a measure of gains from dream interpretation were reported, consistent with qualitative findings. No adverse effects were reported or indicated by assessments. Our results provided initial support for the feasibility and helpfulness of dream work in this population. Implications for counseling with the dying and directions for future research were also explored.

  18. Children's hospice: completing the circle of caring.

    Armstrong-Dailey, A


    Often an ignored area of hospice care, children's hospice programs are growing as more and more children contract cancer and AIDS. Children's hospice care differs from adult programs in its approach and requires the cooperation of families and professionals to care for the dying child.

  19. Forgiveness, depressive symptoms, and communication at the end of life: a study with family members of hospice patients.

    Exline, Julie J; Prince-Paul, Maryjo; Root, Briana L; Peereboom, Karen S; Worthington, Everett L


    Forgiveness has begun to receive empirical attention in end-of-life contexts, but primarily among patients. This study examined forgiveness issues and communication priorities among family members of hospice patients. Surveys were distributed to family members of home-care patients in a large not-for-profit hospice in the Great Lakes region of the United States. Family members wrote what they would like to say to patients before they died. They also rated the importance of several expressions (love, gratitude, giving and seeking forgiveness, saying farewell) and the extent to which they had already expressed these messages. Participants rated their depressive symptoms and the quantity of unresolved offenses committed by themselves and the patient. Of 147 surveys returned by participants, 142 were usable. In comparison with forgiveness-related communications, expressions of love, gratitude, and farewell were more consistently rated important; yet many participants rated forgiveness (giving and seeking) as extremely important. If forgiveness was rated important but had not been fully expressed, participants reported more depressive symptoms (plove and gratitude, forgiveness-related communications are seen as extremely important by many family members of hospice patients. If family members see forgiveness (granting or seeking) as important but have not completed the process, these unresolved issues are associated with depressive symptoms. This study suggests that unresolved offenses and forgiveness issues warrant assessment and clinical attention within families receiving hospice care.

  20. Continuing education for hospice staff.

    Conedera, F; Schoessler, M


    Hospice nursing is unique because of the philosophy and issues surrounding hospice care. Program planning for hospice staff follows basic principles. The real challenge in developing programs for orientation, continuing, and inservice education is using a format that will truly enable staff to meet the objectives. A lecture, programmed instruction, or video/slide format works well for the "nuts and bolts," but more creativity is needed for the other issues facing the hospice nurse--death, grief, symptom control, stress, team roles, and helping patients with options. Incorporating into the program some of the methods suggested will offer staff the opportunity to become involved in learning and make that learning more meaningful.

  1. Hospice, et levende hus

    Steenfeldt, Vibeke Østergaard

    Det er formålet med afhandlingen Hospice – et levende hus. En analyse af levet liv og omsorg på hospice som bidrag til forståelse af åndelig omsorg at skabe vi¬den om den oplevelse det uhelbredeligt syge menneske, der tilbringer den sidste del af livet på et hospice, har af omsorgspraksis og levet...... liv på hospice, og at bidrage til udvik¬ling af en ny forståelse af åndelig omsorg som sygeplejefagligt begreb. Undersøgelsen, der har en livsverdensfænomenologisk tilgang, gennem¬føres som et etnografisk feltstudie. I en periode på otte måneder, hvor jeg har været deltagende observatør på to hospicer......, der i første om¬gang er udført uden teoretisk indblanding og efterfølgende perspektiveret ved inddragelse af Medard Boss’ daseinsanalytiske tilgang til forståelse af menne¬ske og krop, sundhed og sygdom og af Kari Martinsens omsorgstænkning. Analysen viser, at den uhelbredeligt syge patienthospice...

  2. Feasibility of Conducting a Music Therapy Study With Hospice Patients with Dementia & Agitation

    Matt Soskins


    Full Text Available This study's purpose was to explore non-pharmacological means for decreasing agitation in hospice patients with late stage dementia administered by caregivers.  Subjects in the study were patients on service with San Diego Hospice and the Institute for Palliative Medicine, diagnosed with late stage dementia, as determined by a FAST (Functional Assessment Staging score of 7, and who were known to become agitated while performing certain tasks (e.g., bathing or eating. A music therapist assessed the subjects using an adaptation of the Music Therapy Assessment (Krout, 2000. The Short Portable Mental Status Questionnaire (SPMSQ and Blessed Dementia Scale were administered pre- and post- intervention to assess cognitive functioning severity of dementia, respectively. Caregivers were trained to administer the Agitated Behavior Scale (ABS after performing the stressful task without music (baseline. The music therapist created a CD for each subject based on the following: a music background/preferences of subject (preferred styles of music, favorite selections or artists, obtained from family/caregiver, and b subject responses observed during the assessment. Caregivers were instructed to complete the agitated task during the music intervention and immediately following the task completed an ABS evaluation. Out of the 51 patients referred for the study, 11 met inclusion criteria and were consented. Eight subjects completed the study. According to demographic information the majority of subjects were female, had previous music experience, and lived in a skilled nursing facility. The most frequent agitated task was bathing, which caused agitation in 75% of subjects. SPMSQ results indicated all patients had severe cognitive impairment and pre-/post-scores were the same. Pre-music intervention ABS scores were a mean of 23.46 (SD=5.8, and a mean of 20.69 (SD=7.1 for post-music intervention. This indicated that subjects became slightly less agitated overall

  3. End-of-Life Dreams and Visions: A Qualitative Perspective From Hospice Patients.

    Nosek, Cheryl L; Kerr, Christopher W; Woodworth, Julie; Wright, Scott T; Grant, Pei C; Kuszczak, Sarah M; Banas, Anne; Luczkiewicz, Debra L; Depner, Rachel M


    End-of-life dreams and visions (ELDVs) are well documented throughout history and across cultures with impact on the dying person and their loved ones having profound meaning. Published studies on ELDVs are primarily based on surveys or interviews with clinicians or families of dead persons. This study uniquely examined patient dreams and visions from their personal perspective. This article reports the qualitative findings from dreams and visions of 63 hospice patients. Inductive content analysis was used to examine the content and subjective significance of ELDVs. Six categories emerged: comforting presence, preparing to go, watching or engaging with the deceased, loved ones waiting, distressing experiences, and unfinished business. © The Author(s) 2014.

  4. Psychological Consultation in an HMO Hospice.

    Gould, Warren

    Hospice care differs from traditional medical care in that it aims to optimize the quality of the patient's remaining life rather than to maximize its duration. The Hayward Hospice project, begun in November of 1977 as a pilot project to evaluate whether hospice quality care could be provided within manageable costs and thus be included as a…

  5. End-of-life dreams and visions: a longitudinal study of hospice patients' experiences.

    Kerr, Christopher W; Donnelly, James P; Wright, Scott T; Kuszczak, Sarah M; Banas, Anne; Grant, Pei C; Luczkiewicz, Debra L


    End-of-life dreams and visions (ELDVs) have been well documented throughout history and across cultures. The impact of pre-death experiences on dying individuals and their loved ones can be profoundly meaningful. Our aim was to quantify the frequency of dreams/visions experienced by patients nearing the end of life, examine the content and subjective significance of the dreams/visions, and explore the relationship of these factors to time/proximity to death. This mixed-methods study surveyed patients in a hospice inpatient unit using a semi-structured interview. Sixty-six patients admitted to a hospice inpatient unit between January 2011 and July 2012 provided informed consent and participated in the study. The semi-structured interviews contained closed and open-ended questions regarding the content, frequency, and comfort/distress of dreams/visions. Fifty-nine participants comprised the final sample. Most participants reported experiencing at least one dream/vision. Almost half of the dreams/visions occurred while asleep, and nearly all patients indicated that they felt real. The most common dreams/visions included deceased friends/relatives and living friends/relatives. Dreams/visions featuring the deceased (friends, relatives, and animals/pets) were significantly more comforting than those of the living, living and deceased combined, and other people and experiences. As participants approached death, comforting dreams/visions of the deceased became more prevalent. ELDVs are commonly experienced phenomena during the dying process, characterized by a consistent sense of realism and marked emotional significance. These dreams/visions may be a profound source of potential meaning and comfort for the dying, and therefore warrant clinical attention and further research.

  6. Medicare Hospice Benefits

    CENTERS for MEDICARE & MEDICAID SERVICES Medicare Hospice Benefits This official government booklet includes information about Medicare hospice benefits: Who’s eligible for hospice care What services are included in hospice ...

  7. Length of hospice enrollment and subsequent depression in family caregivers: 13-month follow-up study.

    Kris, Alison E; Cherlin, Emily J; Prigerson, Holly; Carlson, Melissa D A; Johnson-Hurzeler, Rosemary; Kasl, Stanislav V; Bradley, Elizabeth H


    Although more people are using hospice than ever before, the average length of hospice enrollment is decreasing. Little is known about the effect of hospice length of enrollment on surviving family caregivers. The authors examine the association between patient length of hospice enrollment and major depressive disorder (MDD) among the surviving primary family caregivers 13 months after the patient's death. The authors conducted a three-year longitudinal study of 175 primary family caregivers of patients with terminal cancer who consecutively enrolled in the participating hospice from October 1999 through September 2001. Interviews were conducted with the primary family caregiver when the patient first enrolled with hospice and again 13 months after the patient's death. The authors used multivariate logistic regression models to estimate caregivers' adjusted risk at 13 months postloss for MDD, assessed using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID). The effect of very short hospice length of enrollment (three days or less) compared with longer lengths of enrollment on caregiver MDD 13 months after their loss was nonsignificant in unadjusted analyses. The adjusted risk of MDD was significantly elevated for caregivers of patients who had very short hospice enrollments (adjusted odds ratio: 8.76, 95%confidence interval: 1.09-70.19) only after adjusting for baseline MDD, caregiver gender, caregiver age, kinship relationship to patient, caregiver education, caregiver chronic conditions, and caregiver burden. The adjustment for caregiver burden resulted in the greatest increase in odds ratio for very short hospice length of enrollment on risk of caregiver MDD 13 months after the loss. This study identifies a potential target group of family caregivers, characterized by hospice length of enrollment and several caregiver features, who might be most in need of mental health interventions.

  8. 对晚期肺癌患者实施临终关怀与姑息护理的伦理思考%Ethical Consideration on Hospice and Palliative Care for Patients with Advanced Lung Cancer

    李玉梅; 侯黎莉


    Based on 418 cases of patients with advanced lung cancer early assessment , actively deal with ac-companying symptoms , respect patients psychological needs and families , to provide personalized palliative care , proper view of death education , give family psychological comfort and care .8 patients with in-hospital deaths had not been in the last issue to rescue , family good acceptance .For patients with advanced lung cancer patients under-going palliative nursing care can reduce the pain of dying period and the fear of death , to improve patients′families to treatment satisfaction .%介绍了418例晚期肺癌患者的基本情况,分析了姑息护理中常见的伦理问题,并提出以下伦理建议:尊重患者心理需求,提供个性化护理;尊重患者和家属意见,进行科学的死亡观教育;鼓励家人陪伴和探视,减少患者对死亡的恐惧感;对家属进行心理抚慰和关怀。

  9. [The current state, the possibilities and difficulties of palliative and hospice care in Hungary].

    Hegedűs, Katalin; Lukács, Miklós; Schaffer, Judit; Csikós, Agnes


    Hospice-palliative care has existed in Hungary for more than 20 years but physicians know very little about it. The objective of the study is to give detailed practical information about the possibilities and the reasonability of hospice care and the process of how to have access to it. The authors review and analyze the database of the national Hospice-Palliative Association database to provide most recent national data on hospice-palliative care. In addition, legal, financial and educational issues are also discussed. At present there are 90 active hospice providers in Hungary, which provide service for more than 8000 terminally ill cancer patients. According to WHO recommendations there would be a need for much more service providers, institutional supply and more beds. There are also problems concerning the attitude and, therefore, patients are admitted into hospice care too late. Hospice care is often confused with chronic or nursing care due to lack of information. The situation may be improved with proper forms of education such as palliative licence and compulsory, 40-hour palliative training for residents. The authors conclude that a broad dissemination of data may help to overcome misbeliefs concerning hospice and raise awareness concerning death and dying.

  10. Hospice Agencies

    U.S. Department of Health & Human Services — A list of all Hospice Agencies that have been certified by Medicare. The list includes addresses, phone numbers, and date of original CMS certification, as well as...

  11. Affirming the connection: comparative findings on communication issues from hospice patients and hematology survivors.

    McGrath, Pam


    The following discussion presents comparative findings from hospice patients and hematology survivors on the topic of talking about dying to significant others within their network of family and friends. The insights have been gathered from an Australian research program that is exploring the notion of spirituality in relation to serious illness. The findings document the participants' awareness, acceptance, and fear of dying. It documents the difficulty associated with talking about dying, which creates voids in relationships and deprives seriously ill individuals of their sense of normality, at a time when they have a strong need to talk and share experiences. Six specific blocks to communication are explored, along with as emphasis on the importance of communicating with others who have a similar life experience.

  12. 42 CFR 418.26 - Discharge from hospice care.


    ... 42 Public Health 3 2010-10-01 2010-10-01 false Discharge from hospice care. 418.26 Section 418.26... (CONTINUED) MEDICARE PROGRAM HOSPICE CARE Eligibility, Election and Duration of Benefits § 418.26 Discharge from hospice care. (a) Reasons for discharge. A hospice may discharge a patient if— (1) The...

  13. 42 CFR 418.25 - Admission to hospice care.


    ... 42 Public Health 3 2010-10-01 2010-10-01 false Admission to hospice care. 418.25 Section 418.25... (CONTINUED) MEDICARE PROGRAM HOSPICE CARE Eligibility, Election and Duration of Benefits § 418.25 Admission to hospice care. (a) The hospice admits a patient only on the recommendation of the medical...

  14. Home-Based Hospice Care Reduces End-of-Life Expenditure in Taiwan: A Population-Based Study.

    Chen, Li-Fu; Chang, Chun-Ming; Huang, Chih-Yuan


    Inpatient hospice care can reduce futile treatment and medical costs. However, the cost trimming effect of home-based hospice care in hospital has yet not been explored. This study evaluates the impact of home-based hospice care on end-of-life expenditure in hospitals with different spending intensity. This is a population-based retrospective study in Taiwan. Cancer decedents were identified in the National Health Insurance Research Database (NHIRD) from 2009 to 2011. They are categorized by hospital spending intensity. A hierarchical linear regression model with a random-intercept model was used to analyze the relationship between end-of-life expenditure (dependent variable) with and without home-based hospice, and both patient-level and hospital-level characteristics. A total of 78,613 cancer decedents were identified in the NHIRD from 2009 to 2011. Of these decedents, 17,638, 43,286, and 17,689 were categorized by hospital spending intensity as high, moderate, and low, respectively. Decedents with home-based hospice care were associated with US$2452 less in expenditure per patient compared with those without home-based hospice care. The majority of savings occurred in the last 3 months of life. These savings with home-based hospice care were consistent in hospitals with different levels of spending intensity. Home-based hospice reduced one-fifth expenditure at the end of life of cancer decedents treated in hospitals with different spending intensity.

  15. Perspectives of Cardiac Care Unit Nursing Staff about Developing Hospice Services in Iran for Terminally ill Cardiovascular Patients: A Qualitative Study

    Azami-Aghdash, Saber; Ghojazadeh, Morteza; Naghavi-Behzad, Mohammad; Imani, Shahin; Aghaei, Mir Hossein


    The present study was conducted aiming to determine the points of view of cardiac care units' nursing staff about designing and providing Hospice services in Iran for cardiovascular patients in the final stages of life...

  16. Honouring the age-old commitment to "the patient's good": the promise--and peril--of hospice.

    Loewy, Roberta Springer


    In this article, the rise of hospice in the United States is examined and some of its important strengths and weaknesses are described. It is suggested that, despite the tendency to believe otherwise, hospice is not immune to a kind of alienation between patients and clinicians based on the absorption of doctors with biomedical conditions and their possible technological remedies, thus overlooking or ignoring the patient's good. To protect the age-old fiduciary or "trust" relationship between patients and clinicians requires a re-adjustment of current attitudes and practices--not just in the current cure-oriented health care of conventional medicine, but in the palliation-oriented health care of hospice as well. That is, it requires the development of attitudes and practices that foster a democratic, multidisciplinary process of shared decision-making and the adoption of a genuinely bio/psycho/social understanding and articulation of "the patient's good"--irrespective of where along the continuum of care patients and clinicians find themselves (5, 13).

  17. A Military Hospice Model


    will help to keep the patient as symtom free as possible. Here again differences are readily apparent between routine inpatient hospitalization and... Veterinary Care, dated 10 October 1977. 17CHAMPUS Handbook, 1978-1979, p. 39. 18Glen W. Davidson, "Five Models for Hospice Care." The Journal of Quality

  18. Hospice nursing. Present perspectives and future directives.

    Dobratz, M C


    The specialty of hospice nursing calls for a highly skilled and knowledgeable practitioner. Four categories emerge to define and describe a specialist in hospice/palliative care nursing as one who practices: (a) intensive "caring"--the management of physical, psychological, social, and spiritual problems of dying persons and their families; (b) collaborative sharing--the coordinated and collaborated efforts of the extended and expanded components of hospice care services; (c) continuous knowing--the acquisition of the counseling, managing, instructing, "caring," and communicating skills/knowledge required for the specialty of hospice nursing; and (d) continuous giving--the balance of the hospice nurse's own self-care needs with the complexities and intensities of death and dying. To provide skilled, competent hospice nursing, two levels of hospice education are proposed, and descriptions are given for (a) the "hospice nurse certified (HNC)" who delivers competent, expert, and continuous patient/family care; and (c) the "hospice nurse advanced (HNA)" who provides educational needs and administers hospice care programs. Within the expanded and extended components of hospice care, the nurse works with an interdisciplinary team to provide care that is humanistic and supportive, and that is continuous and comprehensive.

  19. Five things physicians and patients should question in hospice and palliative medicine.

    Fischberg, Daniel; Bull, Janet; Casarett, David; Hanson, Laura C; Klein, Scott M; Rotella, Joseph; Smith, Thomas; Storey, C Porter; Teno, Joan M; Widera, Eric


    Overuse or misuse of tests and treatments exposes patients to potential harm. The American Board of Internal Medicine Foundation's Choosing Wisely® campaign is a multiyear effort to encourage physician leadership in reducing harmful or inappropriate resource utilization. Via the campaign, medical societies are asked to identify five tests or procedures commonly used in their field, the routine use of which in specific clinical scenarios should be questioned by both physicians and patients based on the evidence that the test or procedure is ineffective or even harmful. The American Academy of Hospice and Palliative Medicine (AAHPM) was invited, and it agreed to participate in the campaign. The AAHPM Choosing Wisely Task Force, with input from the AAHPM membership, developed the following five recommendations: 1) Don't recommend percutaneous feeding tubes in patients with advanced dementia; instead, offer oral-assisted feeding; 2) Don't delay palliative care for a patient with serious illness who has physical, psychological, social, or spiritual distress because they are pursuing disease-directed treatment; 3) Don't leave an implantable cardioverter-defibrillator activated when it is inconsistent with the patient/family goals of care; 4) Don't recommend more than a single fraction of palliative radiation for an uncomplicated painful bone metastasis; and 5) Don't use topical lorazepam (Ativan®), diphenhydramine (Benadryl®), and haloperidol (Haldol®) (ABH) gel for nausea. These recommendations and their supporting rationale should be considered by physicians, patients, and their caregivers as they collaborate in choosing those treatments that do the most good and avoid the most harm for those living with serious illness.

  20. Can Faith and Hospice Coexist: Is the African American Church the Key to Increased Hospice Utilization for African Americans?

    Townsend, Apollo; March, Alice L; Kimball, Jan


    African Americans are twice as likely as Caucasian Americans to choose aggressive hospital treatment when death is imminent. Repeat hospitalizations are traumatic for patients and drain patient and health system resources. Hospice care is a specialized alternative that vastly improves patient quality of life at end-of-life. This study was conducted to determine if hospices partnering with African American churches to disseminate hospice education materials could increase utilization of hospice services by African Americans. Members of two African American churches (N = 34) participated in focus group discussions to elicit beliefs about hospice care. Focus group transcripts were coded and comments were grouped according to theme. Six themes were identified. Lack of knowledge about hospice services and spiritual beliefs emerged as the top two contributing factors for underutilization of hospice services. Study findings support partnerships between hospices and African American churches to provide hospice education to the African American community. © The Author(s) 2015.

  1. American Hospice Foundation

    American Hospice Foundation Skip to content Home Caregiving Learning About Hospice Grief Grieving Children Grief at School Grief at ... for all who come after us. The American Hospice Foundation (AHF) closed its doors in June 2014. ...

  2. Hospice - General Information

    U.S. Department of Health & Human Services — The dataset shows characteristics of the hospice agencies that are shown on Hospice Compare, including information about hospice agencies such as address, phone...

  3. 澳大利亚慢性病患者临终关怀政策研究%Hospice Care Policies for Chronic Disease Patients in Australia

    王宇; 黄莉


    According to the research of hospice care policies and literature in Australia ,the authors explored the advantage of hospice care policy of chronic disease patients and argued hospice care in Australia had many characteristics ,such as governmental initiative ,effective regulation ,diversity of service and well functioned system .Based on the further analysis of hospice care policies in Australia ,the authors suggested China should extend its research fields in hospice care for chronic diseases patients and learn to establish a more appropriate mode of hospice care . In addition , hospice care of chronic disease patients in China will be developed by strengthening specialized education and improve the quality of care .%通过对澳大利亚政府颁布的政策和文献研究,剖析澳大利亚慢性病患者临终关怀政策的优点。澳大利亚临终关怀服务呈现出政府重视、监管有力、群众参与、服务多样、制度完善等特点。同时,通过对澳大利亚慢性病患者临终关怀政策的分析,提出我国对于慢性病患者临终关怀的研究方向,积极探索适合我国的慢性病临终关怀模式。建议通过加强从业人员教育,提高服务质量等方法,推进我国慢性病人临终关怀事业的发展。

  4. Demystifying the role of nurse practitioners in hospice: nurse practitioners as an integral part of the hospice plan of care.

    Kennedy, Jennifer


    Beginning January 1, 2011, as a result of the Patient Protection and Affordable Care Act healthcare-reform law that was signed in March 2010, Medicare requires that all patients entering their third or later hospice benefit period must have a face-to-face encounter with a hospice physician or nurse practitioner (NP) to validate hospice eligibility. Medicare has allowed NPs to function as a patient's hospice attending physician since 2003, but they may not certify or recertify a patient's terminal illness or function in the role of the hospice physician in the hospice interdisciplinary team. The allowance of Medicare for the NP to complete the hospice face-to-face encounter allows a greater role for a NP in the realm of hospice care.

  5. Disparities in end of life care for elderly lung cancer patients.

    Nayar, Preethy; Qiu, Fang; Watanabe-Galloway, Shinobu; Boilesen, Eugene; Wang, Hongmei; Lander, Lina; Islam, Monirul


    The objective of this study was to examine geographic and race/ethnic disparities in access to end of life care among elderly patients with lung cancer. The study sample consisted of 91,039 Medicare beneficiaries with lung cancer who died in 2008. The key outcome measures included the number of emergency room visits, the number of inpatient admissions and the number of intensive care unit (ICU) days in the last 90 days of life, hospice care ever used and hospice enrollment within the last 3 days of life. Medicare beneficiaries with lung cancer residing in rural, remote rural, and micropolitan areas had more ER visits in the last 90 days of life as compared to urban residents. Urban residents however, had more ICU days in the last 90 days of life and were more likely to have ever used hospice as compared to residents of rural, remote rural and micropolitan counties. Racial minority lung cancer patients had more ICU days, ER visits and inpatient days than non-Hispanic White patients, and also were less likely to have ever used hospice care or be enrolled in hospice in the last 3 days of life. Lung cancer patients with very low socioeconomic status (SES) were less likely to ever use hospice or be enrolled in hospice care in the last 3 days of life, as compared to those who had very high SES. Geographic, racial and socioeconomic disparities in end of life care call for targeted efforts to address access barriers for these groups of patients.

  6. The Hospice Concept of Care: A Family Centered Approach.

    Story, Marilyn

    This description of the Cedar Valley Hospice program emphasizes palliative and supportive care for terminally ill patients and their families. The history of the hospice movement is outlined along with a description of the Cedar Valley program and the results of a 1980 program evaluation. The appendices contain a statement of the hospice goals and…

  7. Oncology Social Workers' Attitudes toward Hospice Care and Referral Behavior

    Becker, Janet E.


    Members of the Association of Oncology Social Workers completed a survey, which included the Hospice Philosophy Scale (HPS) assessing the likelihood of the worker referring a terminally ill patient to hospice, background and experience, and demographics. The respondents held overwhelmingly favorable attitudes toward hospice philosophy and care,…

  8. Missed Opportunity: Hospice Care and the Family.

    Tabler, Jennifer; Utz, Rebecca L; Ellington, Lee; Reblin, Maija; Caserta, Michael; Clayton, Margaret; Lund, Dale


    A typical mission statement of hospice services is to provide quality, compassionate care to those with terminal illness and to support families through caregiving and bereavement. This study explored the ways that bereavement needs of caregivers, either predeath or postdeath of their spouse/partner, were addressed using qualitative retrospective phone interviews with 19 caregivers whose spouse/partner was enrolled in hospice care for cancer. Overall, participants expressed high satisfaction with hospice care, most often noting a high satisfaction with the quality of care provided to their spouse/partner. During the predeath phase, caregivers recalled being so focused on their spouse/partner's needs that they rarely spoke with hospice staff about their own personal needs and emotions. Participants said that bereavement counseling occurred primarily after the death of the spouse/partner, in the form of generic pamphlets or phone calls from someone they had not met during prior interactions with hospice staff. These findings suggest that caregivers' high satisfaction with hospice may be more associated with the quality of care provided to the spouse/partner than with bereavement support they received. Our findings illustrated a potential missed opportunity for hospices to address the family-oriented goals that are commonly put forward in hospice mission statements.

  9. Pursuit of happiness as the CEO: the business of doing hospice business.

    Telli, Susan G


    The growth of hospice over the past 20 years has been rapid. Hospices have expanded staff and expanded services to meet increasing demand and a greater variety of patients. Hospice CEOs have had to spearhead these changes. This article presents the challenges that one hospice CEO has faced over her 20-year career.

  10. Hospice care at the end of life.

    Herbst, Laurel


    Hospice care in the United States has evolved from a movement and philosophy to a new medical specialty that addresses sources of suffering at many levels. Hospice interdisciplinary teams use Maslow's hierarchy of human need to integrate the multiple domains that influence patients' well-being and assists in the development of treatment plans to prevent or alleviate suffering. Contributing to the effectiveness of this care is the Medicare Hospice Benefit, which since 1983 has served as a model and a reimbursement mechanism that has encouraged proliferation of hospices to deliver care in homes, hospitals, and long-term care facilities. The whole-person approach of hospice care may benefit all patients and can be integrated into all medical management.

  11. Availability of Heart Failure Medications in Hospice Care.

    Lum, Hillary D; Horney, Carolyn; Koets, David; Kutner, Jean S; Matlock, Daniel D


    Availability of cardiac medications in hospice for acute symptom management of heart failure is unknown. This study explored hospice approaches to cardiac medications for patients with heart failure. Descriptive study using a quantitative survey of 46 US hospice agencies and clinician interviews. Of 31 hospices that provided standard home medication kits for acute symptom management, only 1 provided medication with cardiac indications (oral furosemide). Only 22% of the hospice agencies had a specific cardiac medication kit. Just over half (57%) of the agencies could provide intravenous inotropic therapy, often in multiple hospice settings. Clinicians described an individualized approach to cardiac medications for patients with heart failure. This study highlights opportunities for practice guidelines that inform medical therapy for hospice patients with heart failure. © The Author(s) 2015.

  12. Can we be connected while remaining separate? Forging partnerships between all-volunteer & Medicare-certified hospices.

    Walsh, Mary Ellen


    When the Medicare hospice benefit was enacted 20 years ago, many hospices greeted the news with great relief. This benefit helped many fledgling hospices start up and survive. However, a group of hospices realized that some of the people for whom they previously cared were not eligible for services under the Medicare hospice benefit. Thus, volunteer hospices filled that need, supporting and advocating for people who did not fit the hospice benefit criteria, but who wanted hospice support. Since volunteer hospices and Medicare-certified hospices play two very different roles in the hospice care delivery system, there are many opportunities for the two types of hospices to partner to meet patient care needs.

  13. Use of hospice in the United States dialysis population.

    Murray, Anne M; Arko, Cheryl; Chen, Shu-Cheng; Gilbertson, David T; Moss, Alvin H


    Hospice is recognized for providing excellent end-of-life care but may be underused by dialysis patients. Hospice use and related outcomes were measured among dialysis patients, and factors that were associated with hospice use were identified. The 2-yr US Renal Data System dialysis patients who died between January 1, 2001, and December 31, 2002, and hospice claims from the Centers for Medicare & Medicaid Services were examined to measure prevalence, factors, and costs that were associated with dialysis withdrawal and hospice use. Of the 115,239 deceased patients, 21.8% withdrew from dialysis and 13.5% used hospice. Of those who withdrew, 41.9% used hospice. Failure to thrive was the most common reason for dialysis withdrawal (42.9%). On multivariable logistic regression analysis, factors that were significantly associated with hospice referral among patients who withdrew from dialysis were age, race, reason for withdrawal, ability to walk or transfer at dialysis initiation, and state of residence. Among patients who withdrew from dialysis and used hospice, median cost of per-patient care during the last week of life was $1858, compared with $4878 for nonhospice patients (P < 0.001); hospitalization costs accounted for most of that difference. Only 22.9% of dialysis hospice patients died in the hospital, compared with 69.0% of nonhospice patients (P < 0.001). A minority of dialysis patients use hospice, even among patients who withdrew from dialysis, whose death usually is certain. Increased hospice use may enable more dialysis patients to die at home, with substantial cost savings. Research regarding additional benefits of hospice care for dialysis patients is needed.

  14. Children's hospice care.

    Armstrong-Dailey, A


    Facing the inevitable death of a child is a difficult reality for many parents and health care providers as well. Children's Hospice International offers a variety of information and education services to support the provision of children's hospice care.

  15. A pilot study of palliative medicine fellows' hospice home visits.

    Shoemaker, Laura K; Aktas, Aynur; Walsh, Declan; Hullihen, Barbara; Khan, Mohammed I Ahmed; Russell, Kraig M; Davis, Mellar P; Lagman, Ruth; LeGrand, Susan


    This was a prospective descriptive study of hospice physician home visits (HVs) conducted by Hospice and Palliative Medicine Fellows. Our objectives were 1) to improve our knowledge of hospice care at home by describing physician HVs 2) to identify the indications for physician HVs and the problems addressed during the HV. Data was collected on 58 consecutive patients using a standardized form completed before and after the home visit. More than half of the persons were women. Most were Caucasian. Median age was 75 years; 57% had cancer; 77% were do-not-resuscitate. 76% HV occurred in the home. The median visit duration was 60 minutes; median travel distance and time 25 miles and 42 minutes, respectively. A hospice nurse case manager was present in 95%. The most common issues addressed during HVs were: health education, symptom management, and psychosocial support. Medication review was prominent. Physicians identified previously unreported issues. Symptom control was usually pain, although 27 symptoms were identified. Medications were important; all home visits included drug review and two thirds drug change. Physicians had unique responsibilities and identified important issues in the HV. Physicians provided both education and symptom management. Physician HVs are an important intervention. HVs were important in continuity of care, however, time-consuming, and incurred considerable travel, and professional time and costs.

  16. Hospice: Morality and Economics.

    Gibson, Donald E.


    Examines hospice concepts and proposals to identify moral problems presented. Particular attention is given to the relationship between the hospice concept's alleged humanitarianism and emphasis on cost-efficiency. Suggests that cost emphasis raises serious questions about the meaning of hospice concepts. (JAC)

  17. Preferred Place of Care and Death in Terminally Ill Patients with Lung and Heart Disease Compared to Cancer Patients

    Skorstengaard, Marianne H; Neergaard, Mette Asbjørn; Andreassen, Pernille


    OBJECTIVES: The dual aim of this study is, first, to describe preferred place of care (PPOC) and preferred place of death (PPOD) in terminally ill patients with lung and heart diseases compared with cancer patients and second, to describe differences in level of anxiety among patients...... to be cared for and to die at home. Patients with cancer and heart diseases chose hospice as their second most common preference for both PPOC and PPOD, whereas patients with lung diseases chose nursing home and hospice equally frequent as their second most common preference. Regardless of their diagnosis......, all patients had a higher level of anxiety than the average Danish population; patients with heart diseases had a much higher level of anxiety than patients with lung diseases and cancer. CONCLUSION: Patient preferences for PPOC and PPOD vary according to their diagnoses; tailoring palliative needs...

  18. Role of radiotherapy in hospice care

    Nishimura, Tetsuo; Sugiyama, Akira; Shimizu, Teppei; Ichinohe, Kenji; Teshima, Takeshi; Kaneko, Masao; Hara, Yoshio; Chihara, Satoshi.


    The aim of palliative radiotherapy for the terminally ill is to improve the quality of the remaining span of life. From November 1982 to September 1987, 69 patients in the Seirei Hospice have been treated with such radiotherapy, and symptomatic relief was obtained in 64% of these patients. Radiotherapy also proved useful in achieving an improvement in their performance status. While the aim of hospice care is not directed towards treatment of the underlying disease, the use of radiotherapy is considered to have an important role in hospice care.

  19. Nonverbal Communication in Hospice Care.

    Jensen, Marvin D.

    Hospice care (health care for the terminally ill that emphasizes emotional support for the patient and family) is essential to ease emotional, psychological, and social pain, and can be a factor in addressing spiritual and physical pain. Yet to ease the pain of final illness, therapeutic communication must extend beyond words. Physical contact--in…

  20. National Hospice and Palliative Care Organization

    ... Volunteers are the Foundation of Hospice Awards NHPCO’s Affinity Program Regulatory Alerts 2017 Regulatory Alerts 2015 Regulatory ... Patient and Family Centered Care Ethical Behavior and Consumer Rights Clinical Excellence and Safety Inclusion and Access ...

  1. 临终患者家属安宁疗护知识需求调查%Investigation on the Demand of Dying Patients' Families on Hospice Care Knowledge

    张宇平; 诸海燕; 马红丽


    Objective To learn the demand of dying patients' families in general hospital so as to improve the effectiveness and pertinence of education measures.Method Self-designed survey was adopted in the investigation. The questionnaire included general information of patients' families, their demand of hospice care knowledge and its proper forms and methods. Patients' families should fill the questionnaire. However, when they are incompetent, training nurses could fill the questionnaire by means of questions and answers.Results Through this investigation, we found that there was a clear correlation between the awareness of patients' families on hospice care and education level and age. The awareness of patients' families on hospice care knowledge had been significantly improved after intervention.Conclusion Strengthen the education of hospice care knowledge to dying patients' families and meet their demand of relevant knowledge. Various means should be carried out to popularize hospice care knowledge and death education should be promoted so that people could have a rational attitude towards death and accept hospice care.

  2. Hospice agencies' hospital contract status and differing levels of hospice care.

    Chung, Kyusuk; Richards, Nicole; Burke, Sloane


    In response to a 2011 finding that approximately 27% of Medicare-certified hospices do not provide a single day of general inpatient care (GIP), the authors explored the extent to which hospices have contracts with hospitals for GIP. Using the 2007 National Home and Hospice Care Survey, we estimated that 1119 (32%) agencies had no contract with any hospitals in 2007 and half of those with no contract did not have a contract with a skilled nursing facility (SNF) either. As a result, these hospices were unable to provide GIP referrals for those in need of inpatient care for acute pain and symptom management. More importantly, not having a contract with a hospital was just one of the factors influencing GIP provision. In the multivariate logistic model, after controlling for contract status with a hospital and other hospice characteristics, agencies in the second quartile of hospice patient census (12-29 vs 73 or more, adjusted odds ratio = 14.10; 95% confidence interval 4.26-46.62) were independently related to providing only routine home care. These hospices are more likely to rely solely on scatter beds for GIP provision. Given that a significant portion of hospices do not have a contract with a hospital, policy makers need to understand barriers to contracts with a hospital/SNF for GIP and consider a hospice's contract status as one of the standards for hospice certification. In addition, further research is necessary to understand why hospices that do have a contract with a hospital do not make GIP referral.

  3. Medicare Provider Data - Hospice Providers

    U.S. Department of Health & Human Services — The Hospice Utilization and Payment Public Use File provides information on services provided to Medicare beneficiaries by hospice providers. The Hospice PUF...

  4. Hospice and Palliative Nurses Association

    ... HPNF Individual Education Scholarships Official Journals Journal of Hospice and Palliative Nursing Journal of Palliative Medicine Certification ... Contact HPNF Contact HPCC Contact National Coalition for Hospice and Palliative Care HPNA Membership Site Map Hospice ...

  5. Factors associated with the provision of hospice care for children.

    Lindley, Lisa C; Mark, Barbara A; Daniel Lee, Shoou-Yih; Domino, Marisa; Song, Mi-Kyung; Jacobson Vann, Julie


    Children at the end of life often lack access to hospice care at home or in a dedicated facility. The factors that may influence whether or not hospices provide pediatric care are relatively unknown. The purpose of this study was to understand the institutional and resource factors associated with provision of pediatric hospice care. This study used a retrospective, longitudinal design. The main data source was the 2002 to 2008 California State Hospice Utilization Data Files. The sample size was 311 hospices or 1368 hospice observations over seven years. Drawing on institutional and resource dependence theory, this study used generalized estimating equations to examine the institutional and resource factors associated with provision of pediatric hospice care. Interaction terms were included to assess the moderating effect of resource factors on the relationship between institutional factors and provision of care. Membership in professional groups increased the probability (19%) of offering hospice services for children. Small- (-22%) and medium-sized (-11%) hospices were less likely to provide care for children. The probability of providing pediatric hospice care diminished (-23%) when competition increased in the prior year. Additionally, small size attenuated the accreditation-provision relationship and medium size magnified the membership-provision relationship. Professional membership may promote conformity to industry standards of pediatric care and remove the unknowns of providing hospice care for children. Hospices, especially medium-sized hospices, interested in developing or expanding care for children may benefit by identifying a pediatric champion to join a professional group. Copyright © 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

  6. Perspectives of cardiac care unit nursing staff about developing hospice services in iran for terminally ill cardiovascular patients: A qualitative study

    Saber Azami-Aghdash


    Full Text Available Introduction: The present study was conducted aiming to determine the points of view of cardiac care units′ nursing staff about designing and providing Hospice services in Iran for cardiovascular patients in the final stages of life. Materials and Methods: In this qualitative study, the perspectives of 16 Cardiac Care Unit (CCU nurses selected purposefully among hospitals of Tabriz-Iran University of Medical Sciences were investigated using semi-structured interviews and were analyzed in content analysis method. Results: 33 themes were finally extracted. Some nurses were for and some were against designing and providing Hospice services in Iran. The main reasons identified for supporting this plan included: Possibility of designing and providing these services consistent with high ethical values of Iranian society; approval of authorities due to increasing the load of chronic diseases and aged population; need of families due to the problems in taking care of patients and life concerns; better pain relief and respectful death; decrease of costs as a result of lower usage of diagnostic-therapeutic services, less use of expensive facilities and drugs, and better usage of hospital beds. Conclusion: Growing load of chronic diseases has made the need for Hospice as a necessary issue in Iran. In order to provide these services, studying the viewpoints of health service providers is inevitable. Therefore using and applying the results of this study in planning and policy making about designing and providing these services in Iran for cardiovascular patients in their final stages of lives could be helpful.

  7. Hospice Care

    ... Resources Conducting Clinical Trials Statistical Tools and Data Terminology Resources NCI Data Catalog Cryo-EM NCI's Role ... Contacts Other Funding Find NCI funding for small business innovation, technology transfer, and contracts Training Cancer Training ...

  8. 42 CFR 418.110 - Condition of participation: Hospices that provide inpatient care directly.


    ... the dignity, comfort, and privacy of patients. (1) The hospice must provide— (i) Physical space for... throughout the night; and (iii) Physical space for family privacy after a patient's death. (2) The hospice... equipped for nursing care, as well as the dignity, comfort, and privacy of patients. (2) The hospice must...

  9. Interdisciplinary Collaboration in Hospice Team Meetings

    Wittenberg-Lyles, Elaine; Oliver, Debra Parker; Demiris, George; Regehr, Kelly


    Hospice and palliative care teams provide interdisciplinary care to seriously-ill and terminally-ill patients and their families. Care teams are comprised of medical and non-medical disciplines and include volunteers and lay workers in healthcare. The authors explored the perception of collaboration among hospice team members and actual collaborative communication practices in team meetings. The data set consisted of videotaped team meetings, some of which included caregiver participation, an...

  10. Who Knew? Hospice Is a Business. What that Means for All of Us.

    Rahman, Anna N


    A seasoned gerontologist whose work has explored end-of-life care, I thought I knew what I was getting into when I undertook care for my brother Jim. In April 2014, Jim, whose health was then declining rapidly due to liver cancer, moved from his apartment in Minneapolis to my house in Santa Monica. Jim had come for a liver transplant evaluation at the University of California, Los Angeles (UCLA). When the UCLA team declined to list him-his cancer was just too widespread-Jim elected to stay with my family and me, enrolling in hospice. I did my homework when shopping for a hospice provider. Colleagues in the field gave me referrals. I googled their recommendations and read the reviews. I interviewed admissions counselors. When Jim signed the admission papers, I was confident that we were in good hands with the agency we selected. For the most part, we were. Hospice is widely considered an effective program. Studies show that it prevents pain and suffering among dying patients and increases satisfaction with care. Although other health care programs are regularly pilloried in the press, hospice programs are often lauded. Indeed, they sometimes appear so mission driven that one might mistake them for charities. They are not. Whether for-profit or not-for-profit enterprises, they are businesses-and concerned about their bottom line. Through Jim's story and mine, this article highlights the implications of this business orientation for patients and providers. Methods for evaluating hospice programs nationally are critiqued. Finally, recommendations for improving the business of hospice care are offered.

  11. [Quality of diagnosis information given to terminal cancer patients].

    Font-Ritort, Sergi; Martos-Gutiérrez, José Antonio; Montoro-Lorite, Mercedes; Mundet-Pons, Lluís

    To determine the information that terminal cancer patients have about their diagnosis, identifying key words used, and quantifying the conspiracy of silence. A cross-sectional, analytical study was conducted by reviewing the hospice support team data base which contains the medical history and a semi-structured interview with terminal cancer patients in the first visit to the hospice. Demographic and socioeconomic data was collected, as well as relevant clinical information (diagnosis, prevalent symptoms, number of symptoms, patient functionality, QoL, information given, and words used). Out of total of sample of 723 records, 77.87% (95% CI: 74.70-80.74) of the patients were properly informed about their diagnosis. The most used words were cancer in 26% of the patients, tumour in 51.59%, and for the remaining 10.65%, the word inflammation was used. Statistically significant differences of information were found between sexes, age, types of cancer, and hospital ward. Terminal cancer patients have knowledge on their diagnosis, suggesting that the conspiracy of silence is present to a lesser extent. This knowledge is transmitted using different words and with euphemisms. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  12. Interpersonal Communication Instruction in the Non-Traditional Context: Teaching Communication Strategies in a Hospice Setting.

    Fieweger, Margaret A.

    While many health care delivery systems are criticized for the dehumanizing way they treat patients, hospice care presents a refreshing alternative to health care for the terminally ill. Patients appropriate for hospice care are those with six months or less to live. Interpersonal communication education is an important component of hospice care…

  13. Hospice-assisted death? A study of Oregon hospices on death with dignity.

    Campbell, Courtney S; Cox, Jessica C


    Nearly 90% of terminally ill patients who have used Oregon's distinctive death with dignity law to receive a medication to end their lives are enrolled in hospice care programs. In 2009-2010, we conducted a study of the policies developed by Oregon hospices to address patient inquiries and requests for death with dignity. The study examined the stated hospice values and positions and identified the boundaries to participation drawn by the hospice programs to protect personal and programmatic integrity. The boundaries were drawn around 6 key caregiving considerations: (1) language regarding physician-assisted death (PAD); (2) informed decision making by patients; (3) collaboration with physicians; (4) provision of lethal medication; (5) assistance in the patient's act of taking the medication; and (6) staff presence at the time of medication ingestion.

  14. Mapping hospice patients' perception and verbal communication of end-of-life needs: an exploratory mixed methods inquiry

    Arnold Bruce L


    Full Text Available Abstract Background Comprehensive "Total Pain" assessments of patients' end-of-life needs are critical for providing improved patient-clinician communication, assessing needs, and offering high quality palliative care. However, patients' needs-based research methodologies and findings remain highly diverse with their lack of consensus preventing optimum needs assessments and care planning. Mixed-methods is an underused yet robust "patient-based" approach for reported lived experiences to map both the incidence and prevalence of what patients perceive as important end of life needs. Methods Findings often include methodological artifacts and their own selection bias. Moving beyond diverse findings therefore requires revisiting methodological choices. A mixed methods research cross-sectional design is therefore used to reduce limitations inherent in both qualitative and quantitative methodologies. Audio-taped phenomenological "thinking aloud" interviews of a purposive sample of 30 hospice patients are used to identify their vocabulary for communicating perceptions of end-of-life needs. Grounded theory procedures assisted by QSR-NVivo software is then used for discovering domains of needs embedded in the interview narratives. Summary findings are translated into quantified format for presentation and analytical purposes. Results Findings from this mixed-methods feasibility study indicate patients' narratives represent 7 core domains of end-of-life needs. These are (1 time, (2 social, (3 physiological, (4 death and dying, (5 safety, (6 spirituality, (7 change & adaptation. The prevalence, rather than just the occurrence, of patients' reported needs provides further insight into their relative importance. Conclusion Patients' perceptions of end-of-life needs are multidimensional, often ambiguous and uncertain. Mixed methodology appears to hold considerable promise for unpacking both the occurrence and prevalence of cognitive structures represented by

  15. Introducing music therapy in hospice and palliative care: an overview of one hospice's experience.

    Pawuk, Laura G; Schumacher, John E


    A middle-aged man with lung cancer breathes more easily and reduces his need for pain medication after participating in music-focused relaxation. An 8-year-old boy with cancer writes songs and records a CD for his family. An elderly woman in the final stages of Alzheimer's who is no longer able to speak sings a few words of her favorite lullaby to her adult daughter. A much-loved grandmother dies peacefully as her family sings her favorite spiritual songs to the accompaniment of a music therapist's folk harp. These illustrations demonstrate the role that music therapy plays in attending to the physical, emotional, and spiritual needs of hospice and palliative care patients and families while respecting their dignity and celebrating their lives.

  16. Trends of Do-Not-Resuscitate consent and hospice care utilization among noncancer decedents in a tertiary hospital in Taiwan between 2010 and 2014: A Hospital-based observational study.

    Chang, Hsiao-Ting; Lin, Ming-Hwai; Chen, Chun-Ku; Chou, Pesus; Chen, Tzeng-Ji; Hwang, Shinn-Jang


    Do-Not-Resuscitate (DNR) and hospice care are not only applied to cancer patients but also to patients with noncancer progressive illness. However, the trends of DNR consent and hospice utilization are not well explored for noncancer patients. This study aimed to explore the trends of DNR consent and hospice care utilization among noncancer decedents in a tertiary hospital in Taiwan. We analyzed the Death and Hospice Palliative Care Database from the Taipei Veterans General Hospital in Taiwan. The Death and Hospice Palliative Care Database contains information including patient sex, major diagnosis, admission date, date of death, age at death, department at discharge, status of DNR consent, and status of hospice care of patients who died in the Taipei Veterans General Hospital. Data on patients aged 20 years old or more who died of major terminal noncancer diseases, including brain diseases, amyotrophic lateral sclerosis, dementia, chronic obstructive pulmonary disease (COPD) and other lung diseases, heart failure, chronic liver diseases and cirrhosis, and renal failure between 2010 and 2014 were extracted for analysis. A total of 1416 patients aged 20 years or more died of major noncancer diseases in Taipei Veterans General Hospital during the study period. The most common diagnosis was brain diseases, amyotrophic lateral sclerosis, and dementias (n = 510, 36%) followed by chronic obstructive pulmonary disease and other lung diseases (n = 322, 22.7%). Among these noncancer decedents, 1045 (73.8%) had DNR consents, while 134 (9.5%) received hospice care. Patients diagnosed with renal failure had the highest percentage of DNR consent (80%), followed by chronic liver diseases and cirrhosis (77.7%). Patients diagnosed with chronic liver diseases and cirrhosis had the highest percentage of hospice utilization (17.4%), followed by renal failure (15.8%). The percentages of DNR consent and hospice utilization were significantly different across different disease

  17. African Americans and Hospice Care: A Narrative Analysis.

    Dillon, Patrick J; Roscoe, Lori A


    Recent studies suggest that terminally ill African Americans' care is generally more expensive and of lower quality than that of comparable non-Hispanic white patients. Scholars argue that increasing hospice enrollment among African Americans will help improve end-of-life care for this population, yet few studies have examined the experiences of African American patients and their loved ones after accessing hospice care. In this article, we explore how African American patients and lay caregivers evaluated their hospice experiences. Drawing from 39 in-depth interviews with 26 participants, we use a modified version of Bute and Jensen's (2011) narrative typology to organize patients' and caregivers' stories into three general categories: narratives of satisfaction, narratives of regret, and narratives of ambivalence. Building from these categories, we discuss the implications of this research for understanding hospice experiences, promoting hospice access, and improving end-of-life care for marginalized populations.

  18. Cancer Patients Versus Cancer Survivors

    Mosher, Catherine E.; Danoff-Burg, Sharon


    Two studies examined the social and emotional implications of different linguistic classifications of individuals with cancer. Undergraduates were randomly assigned to rate their reactions to either cancer patients or cancer survivors. Across studies, participants held more favorable perceptions of the character of cancer survivors relative to cancer patients and displayed more positive attitudes toward the former group. In addition, participants in Study 1 reported greater willingness to interact with cancer survivors compared with cancer patients. Positive perceptions of prognosis did not appear to account for favorable attitudes toward cancer survivors; most participants in Study 2 did not assume that cancer survivors were beyond the treatment phase of their illness or cured of their disease. Findings point to a potentially powerful effect of word choice on reactions to individuals with cancer. PMID:24371366

  19. Massage, Music, and Art Therapy in Hospice: Results of a National Survey.

    Dain, Aleksandra S; Bradley, Elizabeth H; Hurzeler, Rosemary; Aldridge, Melissa D


    Complementary and alternative medicine (CAM) provides clinical benefits to hospice patients, including decreased pain and improved quality of life. Yet little is known about the extent to which U.S. hospices employ CAM therapists. To report the most recent national data regarding the inclusion of art, massage, and music therapists on hospice interdisciplinary teams and how CAM therapist staffing varies by hospice characteristics. A national cross-sectional survey of a random sample of hospices (n = 591; 84% response rate) from September 2008 to November 2009. Twenty-nine percent of hospices (169 of 591) reported employing an art, massage, or music therapist. Of those hospices, 74% employed a massage therapist, 53% a music therapist, and 22% an art therapist, and 42% expected the therapist to attend interdisciplinary staff meetings, indicating a significant role for these therapists on the patient's care team. In adjusted analyses, larger hospices compared with smaller hospices had significantly higher odds of employing a CAM therapist (adjusted odds ratio 6.38; 95% CI 3.40, 11.99) and for-profit hospices had lower odds of employing a CAM therapist compared with nonprofit hospices (adjusted odds ratio 0.52; 95% CI 0.32, 0.85). Forty-four percent of hospices in the Mountain/Pacific region reported employing a CAM therapist vs. 17% in the South Central region. Less than one-third of U.S. hospices employ art, massage, or music therapists despite the benefits these services may provide to patients and families. A higher proportion of large hospices, nonprofit hospices, and hospices in the Mountain/Pacific region employ CAM therapists, indicating differential access to these important services. Published by Elsevier Inc.

  20. Exploring the dreams of hospice workers.

    Hess, Shirley A; Knox, Sarah; Hill, Clara E; Byers, Tara; Spangler, Patricia


    Nine adults who worked at least 1 year with patients at US hospice centers completed an in-person audiotaped dream session focusing on a dream about a patient. Data were analyzed using consensual qualitative research. Patients were generally manifestly present in participants' dreams, and dreams were typically realistic (i.e., not bizarre). In the dream, the dreamer typically interacted with the patient as a caretaker but was also typically frustrated by an inability to help as fully as desired. Dreams gave dreamers insight into the stress of hospice work, their own fears of death, and inter-/intrapersonal interactions beyond hospice work. Dreamers generally sought to take better care of themselves and find balance in their lives after the dream session. Implications for research and practice are discussed.

  1. Marketing imperatives for hospice and hospitals: implications of hospice headway.

    Dwyer, F R; Kolbe, R H


    This study reports physician perceptions of the administrative fluency of hospice programming and the comparative service qualities of hospice and acute care hospitals on 11 care needs of the terminally ill. Hospice programs evidence organizational sophistication levels which belie their institutional youth. Hospice had a clear advantage within our stacked comparison of care delivery for the terminally ill. Supporting our model of organizational adaptation, however, the performance gap was smallest on those attributes physicians rate as most important to the terminally ill. Finally, hospice referral rates are statistically explained more by administrative prowess than perceived advantages in care delivery. This compels hospital and hospice attention to informational and relational marketing to physicians.

  2. Reflexology for symptom relief in patients with cancer.

    Wilkinson, Susie; Lockhart, Karen; Gambles, Maureen; Storey, Lesley


    Complementary therapies are increasingly being used in hospices and hospitals alongside orthodox treatments in an attempt to improve patients' emotional, spiritual, psychological, and physical well-being. An average of 31% of UK patients with cancer use some form of complementary therapy. Many UK cancer centers, out-patient units, and hospices are providing complementary services. There is strong anecdotal evidence that complementary therapies assist in the palliation of physical and psychological symptoms. This systematic review examines the research evidence base for the effectiveness of reflexology in cancer care. The study reports the results of a systematic review following the Cochrane principles of systematic reviewing. No meta-analysis was possible. Studies were retrieved from a comprehensive search of electronic databases from their start dates. An initial search was carried out in 2003 and updated in 2005 to 2006. Eligible studies were randomized controlled trials, controlled before and after studies, and interrupted time-series studies. Participants were adults with a diagnosis of cancer, receiving care in any healthcare setting. Interventions were limited to reflexology carried out by a qualified therapist as distinguished from another healthcare professional carrying out a reflexology intervention. Outcome measures were patient-reported levels of physical and psychological indices of symptom distress and quality of life (measured using validated assessment tools).

  3. Medicare Hospice Data

    U.S. Department of Health & Human Services — More Medicare beneficiaries are taking advantage of the quality and compassionate care provided through the hospice benefit. As greater numbers of beneficiaries have...

  4. 19 Cases of Elderly Patients on Hospice Care and Nursing%19例老年患者临终关怀与护理



    With the coming of the aging society, nursing elderly terminal patients wil become the biggest and the special group in hospice care. Hospice care is a social group for the dying patients with physiological, psychological, social support and care in al aspects, so that it can take the final journey of life comfortable, three-dimensional imaging in diagnosinggastrointestinal tract diseases.quiet, dignified. Its purpose is to dying patients to reduce the pain of the body, giving service and care the most comfortable, give dying patients physical and mental care, make life be respected.%随着老龄化社会的到来,老年临终患者的护理将成为临终护理中最大而特殊的群体。临终关怀是指由社会各阶层组成的团体为临终患者提供生理、心理、社会全方位的支持与照顾,使其能舒适、安详、有尊严的走完人生最后的旅程。其目的是为临终患者减少肉体的痛苦,给予最舒适的服务与照顾,给予临终患者身心关怀,使生命得到尊重。

  5. Racial/ethnic perspectives on the quality of hospice care.

    Campbell, Cathy L; Baernholdt, Marianne; Yan, Guofen; Hinton, Ivora D; Lewis, Erica


    Diversity in the US population is increasing, and evaluating the quality of culturally sensitive hospice care is important. A survey design was used to collect data from 743 patients enrolled in hospice or their family members or caregivers. Race/ethnicity was not significantly associated with any of the hospice interventions or outcomes. Patients were less likely to be satisfied with the overall hospice care (OR = 0.23, 95% CI = 0.065-0.796, P = .021) compared to other type of respondents.  Satisfaction with emotional support was substantially associated with the increased likelihood of satisfaction with pain management (OR = 3.82, 95% CI = 1.66-8.83, P = .002), satisfaction with other symptom management (OR = 6.17, 95% CI = 2.80-13.64, P hospice care (OR = 20.22, 95% CI = 8.64-47.35, P < .001).

  6. Humanistic Nursing Theory: application to hospice and palliative care.

    Wu, Hung-Lan; Volker, Deborah L


    This article presents a discussion of the relevance of Humanistic Nursing Theory to hospice and palliative care nursing. The World Health Organization has characterized the need for expert, palliative and end-of-life care as a top priority for global health care. The specialty of hospice and palliative care nursing embraces a humanistic caring and holistic approach to patient care. As this resonates with Paterson and Zderad's Humanistic Nursing Theory, an understanding of hospice nurses' experiences can be investigated by application of relevant constructs in the theory. This article is based on Paterson and Zderad's publications and other theoretical and research articles and books focused on Humanistic Nursing Theory (1976-2009), and data from a phenomenological study of the lived experience of Taiwanese hospice nurses conducted in 2007. Theoretical concepts relevant to hospice and palliative nursing included moreness-choice, call-and-response, intersubjective transaction, uniqueness-otherness, being and doing and community. The philosophical perspectives of Humanistic Nursing Theory are relevant to the practice of hospice and palliative care nursing. By 'being with and doing with', hospice and palliative nurses can work with patients to achieve their final goals in the last phase of life. Use of core concepts from Humanistic Nursing Theory can provide a unifying language for planning care and describing interventions. Future research efforts in hospice and palliative nursing should define and evaluate these concepts for efficacy in practice settings. © 2011 Blackwell Publishing Ltd.

  7. End-of-Life Racial and Ethnic Disparities Among Patients With Ovarian Cancer.

    Taylor, Jolyn S; Rajan, Suja S; Zhang, Ning; Meyer, Larissa A; Ramondetta, Lois M; Bodurka, Diane C; Lairson, David R; Giordano, Sharon H


    Purpose To assess disparities in end-of-life care among patients with ovarian cancer. Patients and Methods Using Texas Cancer Registry-Medicare data, we assessed patients with ovarian cancer deceased in 2000 to 2012 with at least 13 months of continuous Medicare coverage before death. Descriptive statistics and multivariate logistic regressions were conducted to evaluate end-of-life care, including chemotherapy in the final 14 days of life, intensive care unit (ICU) admission in the final 30 days of life, more than one emergency room (ER) or hospital admission in the final 30 days of life, invasive or life-extending procedures in the final 30 days of life, enrollment in hospice, enrollment in hospice during the final 3 days of life, and enrollment in hospice while not hospitalized. Results A total of 3,666 patients were assessed: 2,819 (77%) were white, 553 (15%) Hispanic, 256 (7%) black, and 38 (1%) other. A total of 2,642 (72%) enrolled in hospice before death, but only 2,344 (64%) died while enrolled. The median hospice enrollment duration was 20 days. In the final 30 days of life, 381 (10%) had more than one ER visit, 505 (14%) more than one hospital admission, 593 (16%) ICU admission, 848 (23%) invasive care, and 418 (11%) life-extending care. In the final 14 days of life, 357 (10%) received chemotherapy. Several outcomes differed for minorities compared with white patients. Hispanic and black patients were less likely to enroll and die in hospice (black odds ratio [OR], 0.66; 95% CI, 0.50 to 0.88; P = .004; Hispanic OR, 0.76; 95% CI, 0.61 to 0.94; P = .01). Hispanic patients were more likely to be admitted to an ICU (OR, 1.37; 95% CI, 1.05 to 1.78; P = .02), and black patients were more likely to have more than one ER visit (OR, 2.20; 95% CI, 1.53 to 3.16; P life-extending procedure (OR, 2.13; 95% CI, 1.49 to 3.04; P end-of-life care among patients with ovarian cancer.

  8. Future design of a Children's Hospice

    Poulsen, Mikkel; Knudstrup, Mary-Ann; Hoff, Peter


    . The architecture utilises nature as a palliative element. Sensory stimulation for the patients is achieved through nature, lights, window placement, sensory gar-dens, and materiality. Functions are placed according to privacy and proximity to one another. A home-like atmosphere and the promotion of wellbeing...... are key elements in a children’s hospice, and since the relatives are deeply affected by the patient’s condition, there is a need for the relatives to stay at the hospice while also maintaining work and social life. By creating flexible environments where pa-tients and relatives can control furnishings...

  9. Making the Transition to Hospice: Exploring Hospice Professionals' Perspectives

    Waldrop, Deborah P.; Rinfrette, Elaine S.


    Hospice care is available for 6 months before death but the length of use varies widely, suggesting that there are different perspectives on the appropriate timing for this transition. This qualitative study explored hospice professionals' views on the appropriate timing for and communication about hospice. Ethnography of team meetings informed…

  10. Hospice Comics: Representations of Patient and Family Experience of Illness and Death in Graphic Novels.

    Czerwiec, Mk; Huang, Michelle N


    Non-fiction graphic novels about illness and death created by patients and their loved ones have much to teach all readers. However, the bond of empathy made possible in the comic form may have special lessons for healthcare providers who read these texts and are open to the insights they provide.

  11. A Quest for Meaning: Hospice Social Workers and Patients with End-Stage Dementia

    Sanders, Sara; Swails, Peggy


    Research shows that few social workers are interested in working with cognitively impaired older adults, such as those with Alzheimer's disease or a related dementia. As the number of individuals with dementia grows, the demand for social workers to provide services to patients with dementia will increase. Although much attention has been given to…

  12. Comparative analysis of hospice care for elderly patients at home and abroad%国内外高龄病人临终关怀护理的比较分析

    袁丹; 陈晰媛; 石岩; 毕智莹; 孙皎


    It reviewed the contents and development status quo of hospice care for domestic and foreign elderly patients and proposed strengthening the study of hospice care,in order to improve its quality of service and meet the needs of social progress,which is the direction of development of hospice care for the 21st century.%针对国内外高龄病人的临终关怀护理内容和发展现状进行综述,提出应加强对临终关怀的研究,提高临终关怀的服务质量,使其发展能够满足社会进步的需求,是21世纪世界临终关怀的发展方向。

  13. Spreading the word ... hospice information systems.

    Jackson, Avril; Hodson, Melanie; Brady, Denise; Pahl, Nick

    The rapid spread of Saunders' thinking across the world has been facilitated by the Hospice Information service and library at St Christopher's Hospice which she helped to create and further enhanced by Help the Hospices. We have set this article in the context of the Web and other information systems as they are developing today. "Connecting people" and "collecting people's experiences" were terms often used by Cicely Saunders when she described the work of Hospice Information, a service that has in some measure contributed to the rapid spread of her thinking across the world and which is currently in close contact with palliative care workers in over 120 countries. Connecting--or networking--putting people and organizations in touch with each other for mutual benefit and collecting and disseminating people's experiences are central to our work as a U.K. and international resource on hospice and palliative care for professionals and the public. Add to these the crucial role of information provision and advocacy for patients, carers, and health professionals alike and we hope that you may begin to appreciate how our respective organizations have contributed to the spread of Cicely Saunders' vision.

  14. Creating a spiritual tapestry: nurses' experiences of delivering spiritual care to patients in an Irish hospice.

    Bailey, Maria E


    This study aims to describe nurses\\' experiences of delivering spiritual support in a palliative care setting in the Republic of Ireland. The authors conducted semi-structured interviews with 22 nurses working in the area of specialist palliative care. A content analysis of the transcriptions revealed five sub-themes: understanding spirituality; the art of nursing in spiritual care; education and learning; the challenge of spiritual caring; and the dimensions of time. The resulting creation of a spiritual tapestry provided an overall theme. Nurses in this study were spiritually self-aware and placed a high value on the spiritual element of their caring role. Nurses described their individual understanding of spirituality and discussed how they recognized and addressed a patient\\'s spiritual needs. Time was described as essential to the provision of spiritual support and appeared to be a significant resource challenge to the provision of spiritual care. The challenges of assessing spiritual needs and measuring outcomes of care were also reported. Participants in this study described the creation of a spiritual tapestry that \\'weaves\\' together care and compassion with skills and knowledge in their nursing practice.

  15. A comprehensive approach in hospice shared care in Taiwan: Nonelderly patients have more physical, psychosocial and spiritual suffering

    Chiu-Hsien Yang


    Full Text Available While symptomatic differences exist between younger and older advanced cancer patients, few studies have examined the differences in their care with respect to age. Our goals were to examine the influences of age differences on physical, psychosocial and spiritual distress among advanced cancer patients. Advanced cancer patients who resided in Kaohsiung Medical University Hospital during 2007–2008 were recruited. Data were collected through professional consultants. The influences of age variations on physical, psychosocial and spiritual distress in nonelderly (<60 years old and elderly (≧60 years old patients were analyzed. A total of 1013 advanced cancer patients were included in the analyses with 467 nonelderly patients and 546 elderly patients. Nonelderly patients were identified to have a higher baseline pain level (4.0 vs. 2.8, p<0.001, breakthrough pain (19.3% vs. 9.9%, p<0.01, insomnia (6.4% vs. 2.7%, p=0.006, emotional distress (69.0% vs. 60.6%, p=0.013, and unwillingness to pass away because of concern for loved ones (18.8% vs. 11.9%, p=0.003 with significant difference. Elderly ones were concerned about unfulfilled wishes (29.7% vs. 18.4%, p<0.001 in spiritual concerns. After adjustments in regression models, nonelderly age (<60 years old still revealed significant positive or negative impact on all categories of distress. Patients aged under 60 years have more physical, psychosocial and spiritual suffering. This study suggested that professional practitioners should provide intensive care for vulnerable terminally ill cancer patients.

  16. End of Life (Hospice Care)

    Healthy Lifestyle End of life Hospice care might be an option if you or a loved one has a terminal illness. Understand how hospice care ... care is for people who are nearing the end of life. Hospice care services are provided by a team of health ...

  17. The idea of palliative and hospice care: a historical overview

    Grażyna Kowalik


    Full Text Available In face of the final phase of a terminal disease, the patient’s family is always in a difficult position. A progressing chronic disease (especially cancer of one of the family members directly influences the mental and physical state of their closest of kin. Hospice care helps the dying patients and their families. The term “hospitium” is connected through classical Latin to the word “hospes”, which means a person connected with another in a lasting relationship arising out of hospitality, (a host taking care of newcomers, a traveller, or one visiting a road house. Whereas the concept of palliative care was derived from the following English words: palliate – to relieve pain; palliation – making the symptoms of a disease less severe without curing it. The hospice movement has a very long history, and reaches back to pagan traditions. Initially care was provided in shelters, asylums for the poor and inns. In France, a hospice (asylum founded in the 15th century for the care over the poorest stands to this day. A great change in the history of nursing was initiated in the 19th century. It was a time of intensive development for medicine and discoveries in the field of biology. Palliative and hospice care as well as palliative medicine owe their professional origins to C. Sanders, the founder of St Christopher’s Hospice in London in 1967. It is also known that in 1987, a palliative care ward began its functioning in Montreal. In Poland, the need to organise household care over seriously ill patients was noticed by H. Chrzanowska (1964, who is seen as the precursor of this kind of care. In the 1980s and 1990s, the idea of hospices experienced a real boom in Poland. Currently a hospice stands for a centre of care over patients in their so-called terminal phase of the disease, where interdisciplinary care is provided. This care creates the conditions for a dignified life until the very end, and thus suffering, pain and death are no

  18. 社区卫生服务中心晚期癌症病人的临终关怀护理%Deathbed nursing of patients with advanced cancer in community health center

    柴玉萍; 贾锟


      Objective: To explore the function of community health service centers in the implementation of hospice patients with advanced cancer. Methods: To count 98 patients with advanced cancer in our hospice from January 2008 to December 2011, and to observe the reactions of the patients and their families. Results: To give hospice care to patients with advanced cancer, psychological and emotional of hospice patients and their families basically stable. Conclusion: The community service center is the mechanism that carrted out the ideal hospice agencies. Hospice patients with advanced cancer can reduce the psychological stress for themselves and their families, and to improve the patient’s quality of life, as well as provide the basis for the development direction of the hospice.%  目的:探讨社区卫生服务中心在晚期癌症病人中实施临终关怀的作用。方法:统计2008年1月~2011年12月我中心实施临终关怀的98例晚期癌症病人,观察病人及其家属的反应。结果:对癌症晚期病人进行临终关怀,病人及其家属心理及情绪基本稳定。结论:社区服务中心是开展临终关怀较理想的机构。对晚期癌症病人进行临终关怀可减轻病人及其家属的心理压力,提高病人的生活质量,同时为临终关怀事业的发展方向提供依据。

  19. Caregiver Involvement in Hospice Interdisciplinary Team Meetings: A case study

    Wittenberg-Lyles, Elaine; Oliver, Debra Parker; Demiris, George; Petty, Bethany; Day, Michele


    Involving caregivers in hospice interdisciplinary team (IDT) meetings has been offered as a potential solution to caregivers' unmet communication needs. This case study details one caregiver's participation in her mother's hospice interdisciplinary team care planning meetings, both in person and via videophone technology. This preliminary case is offered as part of a larger National Cancer Institute sponsored study investigating involvement of caregivers in team meetings using videophone tech...

  20. Nurses' perceptions of hospice palliative care volunteers.

    Claxton-Oldfield, Stephen; Hastings, Emily; Claxton-Oldfield, Jane


    A total of 50 nurses (hospital and home care) responded to a survey designed to measure: (1) their attitudes toward, and knowledge of, hospice palliative care volunteers; (2) the types of tasks they felt it was appropriate for volunteers to perform; and (3) how valuable they felt different members of the hospice palliative care team are. In addition, they were asked to respond to some open-ended questions (eg, "Do you feel that it is appropriate for hospice palliative care volunteers to know patient medical information?"). The nurses' responses to the "Attitude/Knowledge" part of the survey revealed that they generally held positive attitudes toward volunteers. The majority of the nurses felt that it was appropriate for volunteers to perform most of the tasks listed, except for hands-on patient care. Nurses rated the value of nurses, family members, doctors, and pharmacists significantly higher than volunteers. Fifty-three percent of the nurses felt that volunteers should know patient medical information, and 77% thought that volunteers should have the opportunity to provide input regarding patient care. Also, 75% of the nurses felt that volunteers made their jobs easier, and 56% felt that volunteers should be included in team meetings. When asked to list the topics covered in a hospice palliative care volunteer training program, 73% of the nurses indicated that they were not sure or did not know what topics were covered, indicating a lack of knowledge regarding volunteer training.

  1. Medicare Hospice Benefits

    ... insurance company, or a health care plan for health or prescription drug coverage. Respite care —Temporary care provided in a nursing home, hospice inpatient facility, or hospital so that a family member or friend who is the patient’s caregiver ...

  2. Hospice utilization during the SARS outbreak in Taiwan

    Lin Ming-Hwai


    Full Text Available Abstract Background The severe acute respiratory syndrome (SARS epidemic threw the world into turmoil during the first half of 2003. Many subsequent papers have addressed its impact on health service utilization, but few have considered palliative (hospice care. The aim of the present study was to describe changes in hospice inpatient utilization during and after the SARS epidemic in 2003 in Taiwan. Methods The data sources were the complete datasets of inpatient admissions during 2002 and 2003 from the National Health Insurance Research Database. Before-and-after comparisons of daily and monthly utilizations were made. Hospice analyses were limited to those wards that offered inpatient services throughout these two years. The comparisons were extended to total hospital bed utilization and to patients who were still admitted to hospice wards during the peak period of the SARS epidemic. Results Only 15 hospice wards operated throughout the whole of 2002 and 2003. In 2003, hospice utilization began to decrease in the middle of April, reached a minimum on 25 May, and gradually recovered to the level of the previous November. Hospices showed a more marked reduction in utilization than all hospital beds (e.g. -52.5% vs. -19.9% in May 2003 and a slower recovery with a three-month lag. In total, 566 patients were admitted to hospice wards in May/June 2003, in contrast to 818 in May/June 2002. Gender, age and diagnosis distributions did not differ. Conclusion Hospice inpatient utilization in Taiwan was indeed more sensitive to the emerging epidemic than general inpatient utilization. A well-balanced network with seamless continuity of care should be ensured.

  3. A qualitative study of the emotional and spiritual needs of Hispanic families in hospice.

    Nuñez, Alicia; Holland, Jason M; Beckman, Lisa; Kirkendall, Abbie; Luna, Nora


    As the older U.S. population becomes more ethnically diverse, there will be an increased need for culturally sensitive hospice care services. Hispanics often experience multiple barriers to quality end-of-life care services. To address the underlying disparities in the cultural, emotional, and spiritual aspects of hospice care, the objective of the present qualitative study was to examine the emotional and spiritual needs of Hispanic patients' families while in hospice. Semistructured in-person interviews were conducted with 29 Hispanic patients' families regarding their perceived experience of the hospice-based emotional and spiritual support received. Demographic information was collected on both the family member and the patient. Interviews were digitally recorded, transcribed, and analyzed using thematic content analysis. Participant narratives fell into five main themes: (1) the influence of Hispanic culture in the relationship with hospice care providers; (2) types of social support received from hospice; (3) barriers to receiving support; (4) lack of health literacy regarding hospice care; and (5) cultural preferences for religious/spiritual support in hospice. Our results provide insight into the specific emotional and spiritual needs of Hispanic families receiving hospice services. Our findings highlight that cultural values play an important role in the hospice care experiences of Hispanic families.

  4. Basic Stand Alone Medicare Hospice Beneficiary PUF

    U.S. Department of Health & Human Services — This release contains the Basic Stand Alone (BSA) Hospice Beneficiary Public Use Files (PUF) with information from Medicare hospice claims. The CMS BSA Hospice...

  5. Factors Driving Live Discharge From Hospice: Provider Perspectives.

    Dolin, Rachel; Hanson, Laura C; Rosenblum, Sarah F; Stearns, Sally C; Holmes, George M; Silberman, Pam


    The proportion of patients disenrolling from hospice before death has increased over the decade with significant variations across hospice types and regions. Such trends have raised concerns about live disenrollment's effect on care quality. Live disenrollment may be driven by factors other than patient preference and may create discontinuities in care, disrupting ongoing patient-provider relationships. Researchers have not explored when and how providers make this decision with patients. The objective of this study was to ascertain provider perspectives on key drivers of live discharge from the Medicare hospice program. We conducted semistructured telephone interviews with 18 individuals representing 14 hospice providers across the country. Transcriptions were coded and analyzed using a template analysis approach. Analysis generated four themes: 1) difficulty estimating patient prognosis, 2) fear of Centers for Medicare & Medicaid Services audits, 3) rising market competition, and 4) challenges with inpatient contracting. Participants emphasized challenges underlying each decision to discharge patients alive, stressing that there often exists a gray line between appropriate and inappropriate discharges. Discussions also focused on scenarios in which financial motivations drive enrollment and disenrollment practices. This study provides significant contributions to existing knowledge about hospice enrollment and disenrollment patterns. Results suggest that live discharge patterns are often susceptible to market and regulatory forces, which may have contributed to the rising national rate. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  6. Hospice management. Operational, reimbursement, and financial issues.

    Simione, R J; Preston, J F


    Of the estimated 1,700 hospices in the United States, approximately half are Medicare-certified. In 1990 alone over 200 hospices have become Medicare-certified. Much of this recent growth can be attributed to both a need for hospice services and the 20% increase in hospice rates legislated by the Omnibus Budget Reconciliation Act of 1989. Medicare certification now presents an opportunity for financial success for hospices, non-participating hospices, and certified home health agencies.

  7. Same agency, different teams: perspectives from home and inpatient hospice care.

    Lysaght Hurley, Susan; Barg, Frances K; Strumpf, Neville; Ersek, Mary


    Tremendous growth in hospice over the past 30 years in the United States has increased the number of terminally ill patients dying at home. Recently, however, more hospice patients are dying at inpatient facilities. To understand the varying perceptions about care in the home and inpatient hospice, we conducted semistructured interviews with 24 interdisciplinary team (IDT) members and analyzed the data using the constant comparative method. Core interdisciplinary tasks, including identifying the focus of energy, tailoring family caregiver involvement, acknowledging who is in charge, and knowing both sides differed in the home and inpatient settings. Despite the overarching umbrella of hospice care, home and inpatient hospice settings create different foci for IDT members, burdens and privileges for family caregivers, and control of the care plan. Key differences between home and inpatient hospice processes of care highlight the complexity of patient-centered end-of-life care in the United States.

  8. A Case Study of Hispanics and Hospice Care

    Carrion, Iraida V.; Bullock, Karen


    The issues of death and dying that have given impetus to the hospice movement include the effect on people with terminal illnesses and their families, impending death, renewed attention to long-term care centers and other alternatives to hospitalization, the scarcity of resources, the emphasis on holistic health, and recognition of the rights of people who are dying to die with dignity. Hospice offers patients compassionate care that is focused the pain relief and symptom management so that t...

  9. Enlightenment of the Australian Policies of Hospice Care for Chronic Disease Patients on China%澳大利亚慢性病患者临终关怀政策对中国的启示

    王宇; 黄莉


    The prevention and treatment of chronic diseases is attached with increasingly more importance now,and hospice care for chronic disease patients has become an important issue in public health service. In China,research on hospice care started late,thus hospice care for chronic disease patients has been rarely mentioned. Australia has made great achievement in this area,with effective governmental support,active public participation,a large number of relative agencies and diverse patterns of service. By analyzing the Australian policies of hospice care for chronic disease patients,the study aims to provide suggestions for the formulation of relevant policies in China. A pattern of hospice care with Chinese characteristics should be explored,and social security system of China should be improved,in order to speed up the development of the cause of hospice care in China.%慢性病的防治工作已逐渐被公共卫生事业所重视,对慢性病患者的临终关怀也成了主要焦点。中国对临终关怀的研究起步本身较晚,因此,对慢性病患者的临终关怀更是少有提及。澳大利亚慢性病患者的临终关怀取得较大发展,呈现出政府重视、民众参与度高、机构数量大、服务多样等特点。通过对澳大利亚慢性病患者临终关怀政策的分析,为中国制定慢性病患者临终关怀政策提出建议,探索有中国特色的临终关怀模式,健全中国的社会保障体系,加快中国临终关怀事业的发展。

  10. Treating palliative care patients with pain with the body tambura: A prospective case study at St. Joseph′s hospice for dying destitute in Dindigul South India

    Cordula Dietrich


    Full Text Available Background: The Body Tambura is a recently invented stringed instrument that is used for receptive music therapy designed to be placed and attached on the human body. The aim of this study was to record perceived effects of a treatment with the Body Tambura on palliative care patients with special reference to pain. Materials and Methods: A prospective case study was carried out with patients of St. Joseph′s Hospice for Dying Destitute in Dindigul/South India. Patients were treated with a treatment after baseline assessment and also on the next day. Outcomes were measured quantitatively by using a numeric rating scale (0-10, 10 maximum intensity of pain felt at baseline, directly after treatment, and the day after the treatment to determine the intensity of the pain. Results: Ten patients (five women and five men participated in the study. The majority described the therapy as a pleasant experience. The pain intensity at baseline was reduced from 8.3 ± standard deviation (SD 1.16 to 4.6 ± 1.52 at day 1 and from 4.6 ± 2.07 to 2.4 ± 1.58 at day 2. Conclusion: A clinically relevant pain reduction was described as short time outcome; the therapy was received and perceived well. Forthcoming research should include a control group, randomization, a larger number of participants, and a longer period of treatment.

  11. [Experience of Spiritual Conflict in Hospice Nurses: A Phenomenological Study].

    Lee, Byoung Sook; Kwak, Su Young


    This aim of this phenomenological study was to describe and understand the experience of spiritual conflict in hospice nurses by identifying the meanings and structures of the experience. Participants were 12 nurses working for one year or more at hospice units of general hospitals in a metropolitan city and experiencing of spiritual conflict as hospice nurses. Over six months data were collected using individual in-depth interviews and analyzed with the method suggested by Colaizzi. The experience of spiritual conflict in participants was organized into three categories, six theme-clusters, and 13 themes. The participants felt existential anxiety on death and a fear of death which is out of human control and skepticism for real facts of human beings facing death. They also experienced agitation of fundamental beliefs about life with agitation of the philosophy of life guiding themselves and mental distress due to fundamental questions that are difficult to answer. Also they had distress about poor spiritual care with guilty feelings from neglecting patients' spiritual needs and difficulties in spiritual care due to lack of practical competencies. Findings indicate the experience of spiritual conflict in hospice nurses is mainly associated with frequent experience of death in hospice patients. The experience of spiritual conflict consisted of existential anxiety, agitation of fundamental beliefs and distress over poor spiritual care. So, programs to help relieve anxiety, agitation and distress are necessary to prevent spiritual conflict and then spiritual burnout in hospice nurses.

  12. Morphine use in the last six days of life of patients with HIV/AIDS at ...

    Care provision is shared between professional nurses and non-professional ... For challenging symptoms, respite or terminal care, the hospice has a six-bed IPU ... use of opiates or sedatives hastened death in dying AIDS (or cancer) patients.

  13. Improving cultural competency among hospice and palliative care volunteers: recommendations for social policy.

    Jovanovic, Maja


    This case study of 14 hospice and palliative care volunteers looked for recommendations and suggestions on how to increase cultural competency among hospice volunteers. In-depth interviews were conducted with a hospice in Toronto, Canada, and findings reveal that volunteers have very specific and diverse recommendations on how they prefer to be briefed and educated on cultural competency issues surrounding their patients. Findings also reveal hospice volunteers want more cultural competency training and acknowledge the importance of being culturally competent. This article concludes with a précis on recommendations for increasing cultural competency in hospice and palliative care for both volunteers and agencies and discusses the top 4 future trends in cultural competency for hospice care.

  14. Terminally ill African American elders' access to and use of hospice care.

    Noh, Hyunjin; Schroepfer, Tracy A


    The underuse of hospice care by terminally ill African American elders suggests they are suffering when hospice care could offer quality end of life care. Guided by the Behavioral Model for Vulnerable Populations, this study sought understanding of structural barriers faced when seeking access to hospice care and reasons for using it when access is possible. Data was collected through interviews with 28 African American hospice patients. Themes from directed content analysis provide insights into strategies used to overcome access barriers posed by income, health insurance and administrative procedure, as well as the role religion, family, information and health beliefs played in using it. Distributing educational materials and addressing spiritual/religious concerns in choosing hospice care are key in promoting African Americans' use of hospice care.

  15. Providing nursing care in a children's hospice.

    Day, Alison

    Children who are admitted to hospices need specialist treatment that enables them to enjoy their childhood as much as possible while they receive the care they require. Their parents also have particular needs. During Children's Hospice Week, which started on September 21, the Association of Children's Hospices aims to raise awareness of the work done by children's hospices and the services they provide.

  16. Preventing Infections in Cancer Patients

    ... Caregivers Flu Treatment for Cancer Patients and Survivors Flu Publications Stay Informed Cancer Home Information for Patients and Caregivers Language: English Español (Spanish) Recommend on Facebook Tweet Share Compartir Cancer patients ...

  17. The ACTive Intervention in Hospice Interdisciplinary Team Meetings: Exploring family caregiver and hospice team communication.

    Wittenberg-Lyles, Elaine; Parker Oliver, Debra; Demiris, George; Baldwin, Paula


    This paper presents the theoretical framework and rationale for the ACTive intervention which proposes the use of video technology to facilitate patient and family participation in hospice interdisciplinary team meetings where plans of care are determined. It is surmised that patient and family involvement will improve communication and compliance in hospice care. An analysis of data from a pilot project of the ACTive intervention was conducted to explore active participation among family caregivers and the hospice team. Through the use of videophone technology caregivers participated in video-recorded team meetings. The actual communication behaviors of caregivers and team members were analyzed for active participation. Findings revealed that team-prompted caregiver participation was most common, however, team use of supportive talk in this context was considerably less frequent. The study also found that the team's use of active participation behaviors elicits caregiver active participation behaviors. The results of this study suggest the intervention was an effective way to involve family caregivers as active participants in the designing of care for their loved one. Findings also suggest that hospice staff would benefit from education and training on best practices for communicating with caregivers in the team meeting setting.

  18. Factors associated with the attitudes of oncology nurses toward hospice care in China

    Yang F


    Full Text Available Fei-Min Yang,1 Zhi-Hong Ye,2 Lei-Wen Tang,3 Wei-Lan Xiang,3 Lin-Juan Yan,4 Min-Li Xiang5 1Department of General Surgery, 2Department of Nursing, 3Department of Nursing Education, 4Department of Surgical Oncology, 5Department of Medical Oncology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China Objective: To examine factors that are associated with the apprehension levels of oncology nurses toward hospice care. Factors examined in this study included demographics, nursing experience, education levels, title and post, personal experiences, and attitudes toward end-of-life care. Methods: Questionnaires were provided to nurses (n=201 from three first-tier hospitals in China. A quantitative scale, Professional End-of-life Care Attitude Scale (PEAS, was used to assess personal and professional apprehension levels toward hospice care. The PEAS was translated to Chinese with terms adapted to the cultural environment in China. Statistical analyses were performed to examine the relationships between the apprehension levels and various factors. Results: The total PEAS scores exhibited internal consistency and reliability, with a Cronbach α=0.897 and Pearson’s r=0.9030. Of the 201 nurses, 184 provided a valid response (91.5%. Education level was significantly correlated with personal (P<0.01 and professional apprehension levels (P<0.05. Higher apprehension level was found in nurses with less education. Conclusion: The PEAS quantitative survey is useful for evaluating apprehension levels of nurses toward hospice care. Nurses with more education experienced less anxiety when providing care for terminally ill patients. The findings suggested that education programs on hospice care could be strengthened to help nurses cope with negative attitudes toward end-of-life care. Keywords: end of life, nurses’ perspective, communication, palliative care, cancer patients, terminally ill

  19. Depression in Cancer Patients

    Beyhan Bag


    Full Text Available It is not enough to consider treatment and care depression in the oncology that is the most common psychiatric illness in cancer patient affects of cancer treatment and the patient`s quality of life negatively, which is determined through researches in the field. With development of psycho-oncology it has been demonstrated to establish an important link between the cancer patient`s treatment as well as psycho-social support for the patient and psychiatric treatment and care for the if it is needed. With this connection between them it has been proposed to use of bio-psycho-social-model in cancer patient to improve their care. To achieve this goal, it is expected from medical personnel to realize patients psychosocial need und if he/she has a psychiatric disorders or syndromes. For the medical personnel that work in oncology services, it is inevitable to organize in order to raise the awareness of depression in the cancer patients. In the present study, it is focused on raising the awareness of depression in cancer patient for the medical personnel. [Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry 2014; 6(2.000: 186-198

  20. Hospice in the Nursing Home: Perspectives of Front Line Nursing Home Staff

    Unroe, Kathleen T.; Cagle, John G.; Dennis, M. E.; Lane, Kathleen A.; Callahan, Christopher M.; Miller, Susan


    Objective Use of hospice has been associated with improved outcomes for nursing home residents and attitudes of nursing home staff towards hospice influences hospice referral. The objective of this study is to describe attitudes of certified nursing assistants (CNAs), nurses, and social workers towards hospice care in nursing homes. Design, Setting and Participants We conducted a survey of 1,859 staff from 52 Indiana nursing homes. Measurements Study data include responses to 6 scaled questions and 3 open-ended qualitative prompts. In addition, respondents who cared for a resident on hospice in the nursing home were asked how often hospice: 1) makes their job easier; 2) is responsive when a patient has symptoms or is actively dying; 3) makes care coordination smooth; 4) is needed; 5) taught them something; 6) is appreciated by patients/families. Responses were dichotomized as always/often or sometimes/never. Results 1229 surveys met criteria for inclusion. Of respondents, 48% were CNAs, 49% were nurses, and 3% were social workers; 83% reported caring for a nursing home patient on hospice. The statement with the highest proportion of always/often rating was ‘patient/family appreciate added care’ (84%); the lowest was ‘hospice makes my job easier’ (54%). More social workers responded favorably regarding hospice responsiveness and coordination of care compared with CNAs (p=.03 and p=.05 respectively). Conclusion A majority of staff responded favorably regarding hospice care in nursing homes. About 1/3 of nursing home staff rated coordination of care lower than other aspects, and many qualitative comments highlighted examples of when hospice was not responsive to patient needs, representing important opportunities for improvement. PMID:25239013

  1. Interdisciplinary collaboration in hospice team meetings.

    Wittenberg-Lyles, Elaine; Parker Oliver, Debra; Demiris, George; Regehr, Kelly


    Hospice and palliative care teams provide interdisciplinary care to seriously-ill and terminally-ill patients and their families. Care teams are comprised of medical and non-medical disciplines and include volunteers and lay workers in healthcare. The authors explored the perception of collaboration among hospice team members and actual collaborative communication practices in team meetings. The data set consisted of videotaped team meetings, some of which included caregiver participation, and team member completion of a survey. Findings revealed that the team's reflection on process was most likely to occur in team meetings, however least likely to occur when caregivers were present. Although team members had a high perception of interdependence and flexibility of roles, this was less likely to be enacted in team meetings with and without the presence of caregivers. Caregiver participation in team meetings had a positive impact on collaborative communication and the potential benefit of caregiver inclusion in team meetings is explored.

  2. The evolution of volunteerism and professional staff within hospice care in North Carolina.

    Steinhauser, K E; Maddox, G L; Person, J L; Tulsky, J A


    Although the pursuit of Medicare certification has been one of the most controversial events in hospice history no study has examined its impact using data from a defined population of hospices before, during, and after federal legislation was enacted. This paper revisits the debate over the changing role of volunteers using such a longitudinal data source. Over time, as the patient population grew, aggregate levels of volunteers and professional staff increased. However, the ratios of professional staff and volunteers to patients reveal that regardless of certification status, hospices retained more professional staff per patient and fewer volunteers per patient over time. These data suggest hospices, particularly certified organizations, have transitioned from voluntary organizations to professionally staffed organizations with a strong volunteer component. The most important issue for future research is whether the observed changes have affected the quality of hospice care.

  3. [Nutrition and cancer patients].

    Katsuramaki, T; Hirata, K; Isobe, M


    Nutritional therapy for cancer patients includes various objectives such as improvement of cachexia, elucidation of the mechanism of malnutrition, development of therapy for anorexia, nutrition support during chemotherapy or radiotherapy, and inhibition of tumor growth under controlled caloric intake. This review describes recent remarkable developments in nutritional therapy for cancer patients. Cytokines such as interleukin (IL)-1, IL-6, and tumor necrosis factor which induce proteolysis and lipolysis are involved in the cause of malnutrition and cachexia in cancer patients. IL-1 also plays a significant role in the development of cancer anorexia via direct action in the brain. For anorexia therapy, progestogens have been shown to improve appetite and food intake in cancer patients. Moreover, glutamine supplementation improves the host protein metabolism without enhancement of tumor growth during chemotherapy. Among the effects of caloric intake on anticancer therapy, AO-90, a methionine-free intravenous amino acid solution, has been shown to increase the antitumor effect of 5-fluorouracil in clinical studies. From these observations, recent progress in nutritional therapy for cancer patients has been remarkable. Further study of nutritional therapy is required in order to maintain or improve the quality of life of cancer patients in the future.

  4. Communication Within Hospice Interdisciplinary Teams: A Narrative Review.

    Moore, Angela R; Bastian, Randi Ginger; Apenteng, Bettye A


    Hospice care is coordinated through an interdisciplinary team (IDT), which assures that a holistic care plan based on the patient's wishes is implemented. The extent to which an IDT provides quality care may be associated with how effectively they communicate within the team as well as with patients, caregivers, and families. This review seeks to characterize communication strategies among hospice IDT members and to determine how such strategies impact patient care. Although the existing literature sheds some light on communication within hospice IDTs, further research is needed. Inquiry into the communicative process of IDTs in settings other than team meetings, such as during patient visits or informal settings, would provide a more comprehensive representation of how communication influences IDT dynamics and overall team functioning. © The Author(s) 2015.

  5. Ethical decision-making in hospice care.

    Walker, Andreas; Breitsameter, Christof


    Hospices are based on a holistic approach which places the physical, psychological, social and spiritual welfare of their patients at the forefront of their work. Furthermore, they draw up their own mission statements which they are at pains to follow and seek to conduct their work in accordance with codes of ethics and standards of care. Our study researched what form the processes and degrees of latitude in decision-making take in practice when questions of an ethical and ethically relevant nature arise. We used a qualitative approach. Data collection and evaluation was based on the methods of grounded theory. The study was reported to the relevant Ethics Commission who had raised no objections following the submission of the study protocol. The study at the hospices was approved by the directors of the hospices and the nursing teams. The rights of the participants were protected by obtaining informed consent. Medication in the prefinal phase and questions affecting the provision of solids and liquids in the end-of-life phase have an ethical dimension. In the context of these two fields, decisions are taken collectively. A nurse's individual (and ethically relevant) leeway in decision-making processes is restricted to the nurse's own style of administering care. The nurse's decision-making often depends to a far greater degree on her ability to adapt her concept of ideal care to fit the practical realities of her work than to any conceptual framework. An adaptive process is necessary for the nurse because she is required to incorporate the four pillars of hospice care - namely, physical, psychological, social and spiritual care - into the practice of her daily work. Ethically relevant decisions are often characterised by nurses adjusting their aspiration levels to the practical conditions with which they are confronted. © The Author(s) 2014.

  6. FastStats: Hospice Care

    ... Day Services Centers Home Health Care Hospice Care Nursing Home Care Residential Care Communities Screenings Mammography Pap Tests Disability ... Care National Study of Long-Term Care Providers Nursing Home Care Residential Care Communities Centers for Medicare and Medicaid ...

  7. National CAHPS Hospice Survey data

    U.S. Department of Health & Human Services — This data set contains the national average (mean) “top-box” scores of Medicare-certified hospice agencies on Consumer Assessment of Healthcare Providers and...

  8. Sarcopenia in Cancer Patients.

    Chindapasirt, Jarin


    Sarcopenia, characterized by a decline of skeletal muscle plus low muscle strength and/or physical performance, has emerged to be an important prognostic factor for advanced cancer patients. It is associated with poor performance status, toxicity from chemotherapy, and shorter time of tumor control. There is limited data about sarcopenia in cancer patients and associated factors. Moreover, the knowledge about the changes of muscle mass during chemotherapy and its impact to response and toxicity to chemotherapy is still lacking. This review aimed to provide understanding about sarcopenia and to emphasize its importance to cancer treatment.

  9. The impact of telemonitoring upon hospice referral in the community: a randomized controlled trial.

    Takahashi, Paul Y; Hanson, Gregory J; Thorsteinsdottir, Bjorg; Van Houten, Holly K; Shah, Nilay D; Naessens, James M; Pecina, Jennifer L


    Using telemedicine for older adults with multiple comorbid conditions is a potential area for growth in health care. Given this older, ailing population, providers should discuss end-of-life care with patients. To determine the relationship between telemonitoring and hospice enrollment compared to usual care among older adults with chronic health problems. This was a secondary evaluation of a randomized controlled trial. The trial was performed at an academic medical center. Patients who were over the age of 60 and had a high risk of hospitalization and emergency department visits were recruited to the study. The primary outcome was hospice enrollment, and the secondary outcome was the mean number of days in hospice. The data were analyzed using Chi-squared tests and time-to-event analysis. The average age of the cohort was 80.3 years. Nine patients (9.6%) in the telemonitoring group were enrolled in hospice care, whereas four patients (4.0%) in the usual care group were enrolled (P = 0.12). The mean number of days in hospice was 57.9 (SD ± 99.2) for the telemonitoring group, and 119.3 (SD ± 123.8) for the usual care group (P = 0.36). There was no significant difference regarding time to hospice referral. In this pilot analysis, there were no differences noted between groups in the number of patients that entered into hospice or the amount of time they stayed in hospice care. This was a small trial, and the power to detect a difference was 36%. It was encouraging that twice the number of patients enrolled in hospice care in the telemonitoring group compared to usual care despite the insignificant finding. Further research may determine the effect of telemonitoring upon hospice referral.

  10. Complementary and alternative medicine utilization in Texas hospices: prevalence, importance, and challenges.

    Olotu, Busuyi S; Brown, Carolyn M; Lawson, Kenneth A; Barner, Jamie C


    The purpose of this study was to describe the prevalence, importance, and challenges of complementary and alternative medicine (CAM) utilization in Texas hospices. Mail surveys were sent to 369 hospices in Texas, and 110 useful surveys were returned. Results showed that a majority (n = 62, 56.4%) of hospices offer CAM to their clients, with the most popularly offered CAMs being massage, music, and relaxation therapies. Despite the availability of CAM services in most hospices, and that the utilization of CAM has the potential to improve overall quality of life of patients, our results showed that a sizeable proportion of patients in these hospices are not utilizing the provided CAMs. Funding and personnel constraints were substantial obstacles to offering CAM.

  11. A Problem Solving Intervention for hospice caregivers: a pilot study.

    Demiris, George; Oliver, Debra Parker; Washington, Karla; Fruehling, Lynne Thomas; Haggarty-Robbins, Donna; Doorenbos, Ardith; Wechkin, Hope; Berry, Donna


    The Problem Solving Intervention (PSI) is a structured, cognitive-behavioral intervention that provides people with problem-solving coping skills to help them face major negative life events and daily challenges. PSI has been applied to numerous settings but remains largely unexplored in the hospice setting. The aim of this pilot study was to demonstrate the feasibility of PSI targeting informal caregivers of hospice patients. We enrolled hospice caregivers who were receiving outpatient services from two hospice agencies. The intervention included three visits by a research team member. The agenda for each visit was informed by the problem-solving theoretical framework and was customized based on the most pressing problems identified by the caregivers. We enrolled 29 caregivers. Patient's pain was the most frequently identified problem. On average, caregivers reported a higher quality of life and lower level of anxiety postintervention than at baseline. An examination of the caregiver reaction assessment showed an increase of positive esteem average and a decrease of the average value of lack of family support, impact on finances, impact on schedules, and on health. After completing the intervention, caregivers reported lower levels of anxiety, improved problem solving skills, and a reduced negative impact of caregiving. Furthermore, caregivers reported high levels of satisfaction with the intervention, perceiving it as a platform to articulate their challenges and develop a plan to address them. Findings demonstrate the value of problem solving as a psycho-educational intervention in the hospice setting and call for further research in this area.

  12. Developing design principles for a Virtual Hospice: improving access to care.

    Taylor, Andrea; French, Tara; Raman, Sneha


    Providing access to hospice services will become increasingly difficult due to the pressures of an ageing population and limited resources. To help address this challenge, a small number of services called Virtual Hospice have been established. This paper presents early-stage design work on a Virtual Hospice to improve access to services provided by a hospice (Highland Hospice) serving a largely remote and rural population in Scotland, UK. The study was structured as a series of Experience Labs with Highland Hospice staff, healthcare professionals and patients. Experience Labs employ a participatory design approach where participants are placed at the centre of the design process, helping to ensure that the resultant service meets their needs. Data from the Experience Labs were analysed using qualitative thematic analysis and design analysis. A number of themes and barriers to accessing Highland Hospice services were identified. In response, an initial set of seven design principles was developed. Design principles are high-level guidelines that are used to improve prioritisation and decision making during the design process by ensuring alignment with research insights. The design principles were piloted with a group of stakeholders and gained positive feedback. The design principles are intended to guide the ongoing development of the Highland Hospice Virtual Hospice. However, the challenges faced by Highland Hospice in delivering services in a largely remote and rural setting are not unique. The design principles, encompassing digital and non-digital guidelines, or the design approach could be applied by other hospices in the UK or overseas. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  13. National Hospice Item Set (HIS) data

    U.S. Department of Health & Human Services — This data set includes the national averages (mean) for quality measure scores of Medicare-certified hospice agencies calculated from the Hospice Item Set (HIS) for...

  14. American Academy of Hospice and Palliative Medicine

    ... Back to Meetings Intensive for CEOs and CMOs Hospice Practice VitalTalk Summer Institute Home Board Review Leadership ... to Meetings IBRC Home IBRC Rates IBRC Travel Hospice Course Back to Meetings HMDC Home HMDC Rates ...

  15. Attitudes and knowledge of Iranian nurses about hospice care

    Saber Azami-Aghdash


    Full Text Available Context: Due to expansion of chronic diseases and increase of health care costs, there is a need for planning and delivering hospice care for patients in their final stages of life in Iran. The aim of the present study is to investigate the knowledge and attitudes of nurses about delivering hospice care for End of Life (EOL patients. Materials and Methods: This cross-sectional study was conducted in 2012 with a sample size of 200 nurses that were selected by convenient (available sampling. The data collection instrument was a self-administered questionnaire whose validity was approved by experts′ opinions and its reliability was approved by test-retest method. Results : Among all participants of this study, 87% were female. The mean age of nurses was 32.00 ± 6.72. From all respondents 62% stated that they have no knowledge about hospice care and 80% declared that need for hospice care is increasing. Most of the participants felt that, appropriate services are not presented to patients in the final stages of their lives. About 80% believed that hospice care leads to reduction of health care costs, improvement of physical, mental and social health of patients and finally improvement of the quality of health care services. There was a significant relationship between age, employment history and level of education of nurses and their attitude and knowledge about how this service is provided. Conclusion : In view of the increase in chronic illnesses and the costs of caring, the need for provision of hospice care is felt more and more every day. However the awareness level of nurses about these services is low. Therefore the need for including these issues in nursing curriculum and holding scientific courses and seminars in this field is needed.

  16. Art Therapy in Hospice: A Catalyst for Insight and Healing

    Safrai, Mary B.


    The reach of art therapy in assisting a hospice patient in confronting existential issues at the end of life is illustrated in this article with a case that took place over the course of 22 semiweekly sessions. Painting with an art therapist allowed the patient to shift from a state of anxiety and existential dread to a more accepting, fluid…

  17. Art Therapy in Hospice: A Catalyst for Insight and Healing

    Safrai, Mary B.


    The reach of art therapy in assisting a hospice patient in confronting existential issues at the end of life is illustrated in this article with a case that took place over the course of 22 semiweekly sessions. Painting with an art therapist allowed the patient to shift from a state of anxiety and existential dread to a more accepting, fluid…

  18. Question asking by family caregivers in hospice interdisciplinary team meetings.

    Wittenberg-Lyles, Elaine; Oliver, Debra Parker; Demiris, George; Washington, Karla T; Regehr, Kelly; Wilder, Heidi M


    This article reports findings from a pilot study that enabled family caregivers to use videophone technology to participate in hospice interdisciplinary team meetings. The goal of the study was to ascertain which issues were important to caregivers and the hospice team. A qualitative content analysis of video-recorded team meetings between team members and caregivers was conducted. In a sample of 12 caregivers in 36 discussions, caregivers asked a total of 137 questions, with the majority being Yes/No questions (45.1%), primarily used to seek clarification (19.6%). Hospice staff asked 396 questions, with the majority consisting of Yes/No questions (66.5%), mainly used to ask about the overall condition of the patient (22.2%). Data from this study suggest that when given the opportunity to participate in hospice team meetings, caregivers will ask questions of hospice staff. In addition, in light of prior research, this study's findings suggest that caregivers may have questions that go unaddressed, specifically regarding pain and medication.

  19. A cross-cultural comparison of hospice development in Japan, South Korea, and Taiwan.

    Glass, Anne P; Chen, Li-Kuang; Hwang, Eunju; Ono, Yuzuho; Nahapetyan, Lusine


    By 2050, one out of four people in Eastern Asia will be aged 65 and above. Thus, preparing to care for an older population is imperative. Addressing quality care for elders includes consideration of palliative and end-of-life care. A comparative study of the development of hospice and palliative care services in Japan, South Korea, and Taiwan, is presented, based on an extensive literature review. Both commonalities and differences were found. This article provides information on the origins and administration of hospice services in these three cases, as well as the degree of government involvement. Cultural and religious aspects are also considered, and obstacles to the spread of hospice services are discussed. This review compares experiences with hospice services and identifies factors that influence people's perceptions and adoption of hospice. Stronger financial support for hospice and palliative care through the government and insurance programs would help increase the availability and use of services. Also, the need for continuing education of healthcare providers, patients, families, and the community is urgent. However, promotion of understanding of better pain management and the worth of hospice and palliative care must be conducted in ways that are sensitive to the cultural values and traditions in Japan, South Korea, and Taiwan. Only when hospice and palliative care can be viewed as an admirable choice for one's loved ones, overcoming issues of truth telling, filial piety, worries about how one is judged, and religious considerations, will it become more widely accepted.

  20. Values important to terminally ill African American older adults in receiving hospice care.

    Noh, Hyunjin


    While racial disparity in the use of hospice care by older African Americans is widely acknowledged, little is known about the values that they consider as important in receiving health care services along with direct experiences with having these values respected by hospice care providers. Using individual, face-to-face interviews, data were collected directly from 28 African American hospice patients about their experiences in hospice care. Content analysis was used to identify and categorize themes from multiple readings of the qualitative data. Resulting themes included: dying at home, open communications, independent decision-making, autonomy in daily life, unwillingness to be a burden, and relationships. Through the initial assessment, value preferences can be explored and then shared with hospice team members to ensure that services are provided in such a way that their values and preferences are respected.

  1. [Physiotherapy of cancer patients].

    Gomez, Izabella; Szekanecz, Éva; Szekanecz, Zoltán; Bender, Tamás


    Physiotherapy of cancer patients is one of the most controversial issues in our country. Malignant diseases are firstly mentioned as a contraindication of physiotherapy. Until now, physiotherapy was not suggested (or only in limited accessibility) for those patients who had malignant disease in medical history. International medical practice was less restrictive in managing this topic. The development of imaging techniques put this question in a new light. On the basis of evidence, the majority of articles have reported beneficial effects of physiotherapy in cancer patients, and only few articles mentioned it as harmful. Of course, each patient requires an individual assessment, however, if we exclude the possibility of tumor recurrence and metastasis, most of physiotherapy procedures can be used safely. One of the aims of this review is to support the physicians' decisions when to prescribe treatments, in such a way, that more patients could receive physiotherapy. Orv. Hetil., 2016, 157(31), 1224-1231.

  2. End-of-life care at a community cancer center.

    Cowall, David E; Yu, Bennett W; Heineken, Sandra L; Lewis, Elizabeth N; Chaudhry, Vishal; Daugherty, Joan M


    The evidence-based use of resources for cancer care at end of life (EOL) has the potential to relieve suffering, reduce health care costs, and extend life. Internal benchmarks need to be established within communities to achieve these goals. The purpose for this study was to evaluate data within our community to determine our EOL cancer practices. A random sample of 390 patients was obtained from the 942 cancer deaths in Wicomico County, Maryland, for calendar years 2004 to 2008. General demographic, clinical event, and survival data were obtained from that sample using cancer registry and hospice databases as well as manual medical record reviews. In addition, the intensity of EOL cancer care was assessed using previously proposed indicator benchmarks. The significance of potential relationships between variables was explored using χ(2) analyses. Mean age at death was 70 years; 52% of patients were male; 34% died as a result of lung cancer. Median survival from diagnosis to death was 8.4 months with hospice admission and 5.8 months without hospice (P = .11). Four of eight intensity-of-care indicators (ie, intensive care unit [ICU] admission within last month of life, > one hospitalization within last month of life, hospital death, and hospice referral < 3 days before death) all significantly exceeded the referenced benchmarks. Hospice versus nonhospice admissions were associated (P < .001) with ICU admissions (2% v 13%) and hospital deaths (2% v 54%). These data suggest opportunities to improve community cancer center EOL care.

  3. Assessment of levels of hospice care coverage offered to commercial managed care plan members in California: implications for the California Health Insurance Exchange.

    Chung, Kyusuk; Jahng, Joelle; Petrosyan, Syuzanna; Kim, Soo In; Yim, Victoria


    The implementation of the Affordable Care Act that provides for the expansion of affordable insurance to uninsured individuals and small businesses, coupled with the provision of mandated hospice coverage, is expected to increase the enrollment of the terminally ill younger population in hospice care. We surveyed health insurance companies that offer managed care plans in the 2014 California health insurance exchange and large hospice agencies that provided hospice care to privately insured patients in 2011. Compared with Medicare and Medicaid hospice benefits, hospice benefits for privately insured patients, particularly those enrolled in managed care plans, varied widely. Mandating hospice care alone may not be sufficient to ensure that individuals enrolled in different managed care plans receive the same level of coverage.

  4. 老年晚期癌症临终患者并发消化道出血的相关因素分析%Related factor analysis in elderly advanced cancer hospice inpatients with gastrointestinal bleeding

    余敏; 姜宏宁; 余永春; 龙霖梓


    Objective To investigate related factors of gastrointestinal bleeding in elderly advanced cancer hospice inpatients , in order to facilitate better control. Methods A retrospective investigation of the clinical data of the elderly advanced cancer hospice inpatients was done , 85 cases with gastrointestinal bleeding (experimentalgroup) were compared with 294 cases with non-gastrointestinal bleeding cases (control group). Results Multivariate logistic stepwise regression analysis showed:HP infection [odds ratios (OR) = 3.241,95% confidence interval (CI) 1.792~5.863], non-steroidal anti-inflammatory drugs (OR=3.080,95%CI 1.725~5.497), long-term heart and lung disease (OR=2.323,95%CI 1.315~4.105), stress (OR=1.858,95%CI 1.054 ~ 3.274), albumin (OR =0.760,95%CI 0.679~0.851), enteral nutrition (OR=0.499,95%CI 0.679~0.851) on gastrointestinal bleeding in elderly advanced cancer hospice inpatients were significant (P<0.05). Conclusions We should strengthen the surveillance of elderly advanced cancer hospice inpatients with gastrointestinal bleeding , to improve the quality of life,and according to the risk factors,the early diagnosis and treatment must be regarded.%目的:探讨老年晚期癌症临终患者发生消化道出血的相关因素,以利于合理防治。方法:回顾性调查老年晚期癌症临终住院患者,对85例并发消化道出血病例(观察组)与294例未并发消化道出血病例(对照组)进行比较分析。结果:因素Logistic 逐步回归分析显示:幽门螺杆菌感染[比值比(OR)=3.241,95%置信区间(CI)为1.792~5.863]、非甾体类消炎药的应用(OR=3.080,95%CI为1.725~5.497)、长期心肺疾病(OR=2.323,95%CI 为1.315~4.105)、应激状态(OR=1.858,95% CI 为1.054~3.274)、血白蛋白(OR=0.760,95% CI 为0.679~0.851)、肠内营养(OR=0.499,95%CI 为0.279~0.892)与老年晚期癌症临终患

  5. Gap in the Intensity of End-of-Life Care between Younger and Older Taiwanese Adult Cancer Patients may not Reflect Younger Patients’ Preferences

    Siew-Tzuh Tang


    Conclusions: Except for EOL-care goals, ICU care, hospice care, and place of death, preferences for specific aggressive life-sustaining treatments did not differ by age group of Taiwanese terminally ill cancer patients. We speculate that the age-related gap in intensity of EOL care among Taiwanese cancer decedents (younger cancer decedents received more life-sustaining treatments, i.e., ICU care, CPR, and intubation with mechanical ventilation support in the last month of life may not reflect the preferences of younger patients.

  6. Sleep disturbance, chronic stress, and depression in hospice nurses: testing the feasibility of an intervention.

    Carter, Patricia A; Dyer, Kathleen A; Mikan, Sabrina Q


    To test the feasibility of a cognitive-behavioral therapy for an insomnia (CBT-I) intervention in chronically bereaved hospice nurses. Five-week descriptive correlational. Nonprofit hospice in central Texas. 9 agency nurses providing direct patient and family care. Direct care nurses were invited to participate. Two intervention group sessions occurred at the hospice agency and included identification of dysfunctional thoughts and beliefs about sleep, stimulus control, sleep hygiene, and relaxation techniques to promote sleep. Measurements were taken at baseline and three and five weeks postintervention. Sleep quality, depressive symptoms, and narrative reflections on the impact of sleep quality on self-care. Participants reported moderate-to-severe sleep disturbances and moderate depressive symptoms. The CBT-I intervention was well accepted by the participants, and on-site delivery increased participation. Additional longitudinal study is needed to investigate the effectiveness of CBT-I interventions to improve self-care among hospice nurses who are at high risk for compassion fatigue and, subsequently, leaving hospice care. Hospice nurses are exposed to chronic bereavement that can result in sleep disturbances, which can negatively affect every aspect of hospice nurses' lives. Cognitive-behavioral sleep interventions show promise in teaching hospice nurses how to care for themselves by getting quality sleep. Identifying the risks for sleep disturbances and depressive symptoms in hospice nurses will allow for effective, individualized interventions to help promote health and well-being. If hospice nurses achieve quality sleep, they may remain in the profession without suffering from chronic bereavement, which can result in compassion fatigue. A CBT-I intervention delivered at the agency and in a group format was feasible and acceptable by study participants.

  7. Rehabilitation of cancer patients.

    Pandey M


    Full Text Available With the developments in cancer treatment, more and more patients are surviving their disease. However, very little emphasis is being placed to rehabilitate these cancer survivors. Ignorance, social structure, stigma attached in seeking psychological help, and poor communication skills of oncology staff all contribute to poor rehabilitative efforts. The priority of governmental agencies and health efforts to fight rampant communicable diseases, malnutrition, maternal health, and the frequent natural calamities, puts rehabilitation movements in the back seat. Treatment and prevention of disability and its rehabilitation requires comprehensive and multidisciplinary approach. There is an urgent need to promote physical and psychological rehabilitation.

  8. Hospice and palliation in the English-speaking Caribbean.

    Macpherson, Cheryl Cox; Chiochankitmun, Nina; Akpinar-Elci, Muge


    This article presents empirical data on the limited availability of hospice and palliative care to the 6 million people of the English-speaking Caribbean. Ten of the 13 nations therein responded to a survey and reported employing a total of 6 hospice or palliative specialists, and having a total of 15 related facilities. The evolving socioeconomic and cultural context in these nations bears on the availability of such care, and on the willingness to report, assess, and prioritize pain, and to prescribe opiates for pain. Socioeconomics and culture also impinge on what medications and modalities of care are routinely available for pain or other conditions and can challenge professionalism, empathy, and responsiveness to patients' unrelieved pain. Although all respondents report having a protocol for pain management, hospice, or end-of-life care, their annual medical use of opiates is well below the global mean. The International Narcotics Control Board (INCB), which monitors such use, encourages Caribbean and other low- and middle-income countries to increase their use of opiates to treat pain, and to overcome both unfounded fears of addiction and overly restrictive interpretation of related laws and regulations. Contextual considerations like those described here are important to the success of policies and capacity-building programs aiming to increase access to hospice and palliation, and perhaps to improving other aspects of health and healthcare. Exploring and responding to the realities of socioeconomic and cultural conditions will enhance public and policy dialogue and improve the design of interventions to increase access to palliative and hospice care. Improving access to palliative and hospice care in the Caribbean demonstrates beneficence and helps to fulfill human rights conventions.

  9. Psychometric Properties of the Greek Version of the Patient Dignity Inventory in Advanced Cancer Patients.

    Parpa, Efi; Kostopoulou, Sotiria; Tsilika, Eleni; Galanos, Antonis; Katsaragakis, Stylianos; Mystakidou, Kyriaki


    The patient dignity inventory (PDI) is an instrument to measure dignity distressing aspects at the end of life. The aims of the present study were the translation of the PDI in Greek language as well as to measure its psychometric aspects in a palliative care unit. A back-translation method was obtained at the Greek version. One hundred twenty advanced cancer patients completed the Greek version of the PDI, the Greek hospital anxiety and depression scale, the Greek schedule of attitudes toward hastened death (SAHD-Gr), and the Greek 12-item short form health survey. Confirmatory factor analysis failed to fit to the original instrument's structure and exploratory factor analysis was conducted revealing five factors ("Psychological Distress," "Body Image and Role Identity," "Self-Esteem," "Physical Distress and Dependency," and "Social Support"). The psychometric analysis of the PDI-Gr demonstrated a good concurrent validity, and the instrument discriminated well between subgroups of patients regarding age differences. Cronbach α were between 0.71 and 0.9 showing a good internal consistency. The Greek version of the PDI showed good psychometric properties in advanced cancer patients, supported the usefulness of the instrument assessing the sense of dignity distressing aspects of the terminally ill cancer patients. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  10. A reassuring presence: An evaluation of Bradford District Hospice at Home service

    Daley Andrew


    Full Text Available Abstract Background Within the United Kingdom, a developing role for primary care services in cancer and palliative care has resulted in an increase in palliative home care teams. The provision of professional care in the home setting seeks to provide necessary services and enhanced choice for patients whose preference is to die at home. A mismatch between patient preference for home death and the actual number of people who died at home was identified within Bradford, the locality of this study. In response to this mismatch, and reflecting the policy environment of wishing to enhance community service provision, the four Primary Care Trusts (PCTs in the city sought to offer support to patients who wished to remain in their own homes through the final stages of a terminal illness. To offer this support they set up a dedicated hospice at home team. This would provide services and support for patients in achieving a dignified, symptom free and peaceful death, allowing families to maximise time spent together. The aim of the study was to evaluate the Bradford hospice at home service from the perspective of carers, nurses and General Practitioners. Methods Postal questionnaires were sent to carers (n = 289, district nurses (n = 508 and GP's (n = 444 using Bradford's hospice at home service. Resulting quantitative data was analysed using the Statical Package for Social Sciences (SPSS and qualitative data was analysed using grounded theory techniques. Results The data from carers, district nurses and GPs provide general support for the Bradford hospice at home service. Carers valued highly the opportunity to 'fulfil a promise' to the individual who wished to be cared for at home. District nurses and GPs cited the positive impact of access to specialist expertise. This was a 'reassuring presence' for primary healthcare teams and offered 'relief of carer anxiety' by providing prompt, accessible and sensitive care. Conclusion Carers and health

  11. 42 CFR 418.309 - Hospice cap amount.


    ... 42 Public Health 3 2010-10-01 2010-10-01 false Hospice cap amount. 418.309 Section 418.309 Public...) MEDICARE PROGRAM HOSPICE CARE Payment for Hospice Care § 418.309 Hospice cap amount. The hospice cap amount is calculated using the following procedures: (a) The cap amount is $6,500 per year and is adjusted...

  12. 42 CFR 418.302 - Payment procedures for hospice care.


    ... 42 Public Health 3 2010-10-01 2010-10-01 false Payment procedures for hospice care. 418.302... SERVICES (CONTINUED) MEDICARE PROGRAM HOSPICE CARE Payment for Hospice Care § 418.302 Payment procedures for hospice care. (a) CMS establishes payment amounts for specific categories of covered hospice...

  13. 78 FR 27823 - Medicare Program; FY 2014 Hospice Wage Index and Payment Rate Update; Hospice Quality Reporting...


    ... recognizes that the impending death of an individual warrants a change from curative to palliative care... individuals, provided pain relief and symptom management, and offered the opportunity to die with dignity in... addressed in order to promote the hospice patient's well-being, comfort, and dignity throughout the dying...

  14. Delirium as letting go: An ethnographic analysis of hospice care and family moral experience.

    Wright, David Kenneth; Brajtman, Susan; Cragg, Betty; Macdonald, Mary Ellen


    Delirium is extremely common in dying patients and appears to be a major threat to the family's moral experience of a good death in end-of-life care. To illustrate one of the ways in which hospice caregivers conceptualize end-of-life delirium and the significance of this conceptualization for the relationships that they form with patients' families in the hospice setting. Ethnography. Ethnographic fieldwork was conducted at a nine-bed, freestanding residential hospice, located in a suburban community of Eastern Canada. Data collection methods included 15 months of participant observation, 28 semi-structured audio-recorded interviews with hospice caregivers, and document analysis. Hospice caregivers draw on a culturally established framework of normal dying to help families come to terms with clinical end-of-life phenomena, including delirium. By offering explanations about delirium as a natural feature of the dying process, hospice caregivers strive to protect for families the integrity of the good death ideal. Within hospice culture, there is usefulness to deemphasizing delirium as a pathological neuropsychiatric complication, in favor of acknowledging delirious changes as signs of normal dying. This has implications for how we understand the role of nurses and other caregivers with respect to delirium assessment and care, which to date has focused largely on practices of screening and management. © The Author(s) 2015.

  15. Dementia deaths in hospice: a retrospective case note audit.

    Vries, Kay de; Nowell, Allyson


    Dementia is now recognized as a progressive terminal illness and it is established that people with dementia have significant palliative care needs as they approach the end of life. However, population prevalence studies suggest that very few people with dementia access hospice services in the UK. The literature further suggests that hospice staff may be inadequately prepared to care for people with dementia. A retrospective internal case note audit covering a 3-month period of referrals was undertaken in one hospice in the south of England as part of work to establish staff education requirements arising from patient make-up. Only patients over the age of 65 were included. Of the 288 case notes audited, 9% of the patients had either been diagnosed with dementia or suffered with dementia as a comorbidity. The results of the audit suggest that the number of people with dementia referred to hospice services may have increased in the last decade. This is in keeping with expectations and future predictions resulting from increased disease surveillance and an increasingly ageing population.

  16. Do religious nonprofit and for-profit organizations respond differently to financial incentives? The hospice industry.

    Lindrooth, Richard C; Weisbrod, Burton A


    We study how for-profit and religious nonprofit hospices respond to an exogenous Medicare reimbursement incentive that encourages maximization of patient length of stay. Hospices have the incentive to selectively admit patients with longer expected lengths of stay, and admit patients sooner after a hospital discharge. We find that for-profit hospices are significantly less likely to admit patients with shorter, less profitable, expected lengths of stay. We do not find any difference in the timing of admission by ownership. Incentives for efficiency could be strengthened by a Medicare pricing system that replaced the current flat per diem payment with one that reflected the high costs at the beginning and end of hospice stay and the lower costs in between.

  17. Psychological contracts of hospice nurses.

    Jones, Audrey Elizabeth; Sambrook, Sally


    Psychological contracts have been described as individuals' beliefs regarding the obligations, expectations, and contributions that exist between them and their employer. They can be influenced by the organization's culture and philosophy, through human resources policies, and through the employee's personality and characteristics. Owing to the recent economic crisis, hospices in the UK are currently in a transitional phase and are being expected to demonstrate efficiencies that might be more in line with a business model than a health-care environment. This may conflict with the philosophical views of hospice nurses. To support nurses through this transition, it might be helpful to understand the antecedents of hospice nurses' behaviour and how they construct their psychological contracts. Failure to offer adequate support might lead to negative outcomes such as a desire to leave the organisation, poorer quality work, or disruptive behaviour. This study used a modified grounded theory approach involving in-depth interviews to explore the context and content of the psychological contracts of hospice nurses in the UK. Four main themes emerged: the types of psychological contracts formed, how the contracts are formed, their contents, and the breaches and potential violations the nurses perceive.

  18. Communication Aspects of Hospice Care.

    Jensen, Marvin D.

    No theories of communication can minimize the crisis of dying. But those who study commmunication can suggest ways of offering comfort and dignity to the dying person. Many of these ways go beyond words, for death cannot be addressed with verbal cliches. The theoretical work from which a communication scholar draws can help hospice volunteers and…

  19. Venous thromboembolism in cancer patients

    Mehmet Fuat Eren


    Full Text Available Venous thromboembolism (VTE is a major complication of cancer and represents an important cause of morbidity and mortality. The incidence of VTE is 0.6-7.8% in patients with cancer more than double the incidence of VTE in patients without cancer. The risk of VTE which includes deep venous thrombosis (DVT and pulmonary embolism (PE is increased two to seven fold in patients with cancer. VTE risk is especially high among certain groups such as hospitalized patients with cancer and those receiving active antineoplastic therapy. Also cancer patients, who undergoing major surgery, are increased risk of VTE. Trauma, long-haul travel, increased age, obesity, previous VTE and genetic component are also predisposing factors for VTE. Patients with cancer who develop VTE should be managed multidisciplinary treatment guidelines. The primary goal of thromboprophylaxis in patients with cancer is to prevent VTE. The large majority of cancer patients should be treated with therapeutic doses of unfractioned heparin (UFH or low molecular weight heparin (LMWH. Prophylaxis should include cancer patients who underwent major surgery for cancer and patients with a history of VTE.

  20. Phase of Illness in palliative care: Cross-sectional analysis of clinical data from community, hospital and hospice patients.

    Mather, Harriet; Guo, Ping; Firth, Alice; Davies, Joanna M; Sykes, Nigel; Landon, Alison; Murtagh, Fliss Em


    Phase of Illness describes stages of advanced illness according to care needs of the individual, family and suitability of care plan. There is limited evidence on its association with other measures of symptoms, and health-related needs, in palliative care. The aims of the study are as follows. (1) Describe function, pain, other physical problems, psycho-spiritual problems and family and carer support needs by Phase of Illness. (2) Consider strength of associations between these measures and Phase of Illness. Secondary analysis of patient-level data; a total of 1317 patients in three settings. Function measured using Australia-modified Karnofsky Performance Scale. Pain, other physical problems, psycho-spiritual problems and family and carer support needs measured using items on Palliative Care Problem Severity Scale. Australia-modified Karnofsky Performance Scale and Palliative Care Problem Severity Scale items varied significantly by Phase of Illness. Mean function was highest in stable phase (65.9, 95% confidence interval = 63.4-68.3) and lowest in dying phase (16.6, 95% confidence interval = 15.3-17.8). Mean pain was highest in unstable phase (1.43, 95% confidence interval = 1.36-1.51). Multinomial regression: psycho-spiritual problems were not associated with Phase of Illness ( χ(2) = 2.940, df = 3, p = 0.401). Family and carer support needs were greater in deteriorating phase than unstable phase (odds ratio (deteriorating vs unstable) = 1.23, 95% confidence interval = 1.01-1.49). Forty-nine percent of the variance in Phase of Illness is explained by Australia-modified Karnofsky Performance Scale and Palliative Care Problem Severity Scale. Phase of Illness has value as a clinical measure of overall palliative need, capturing additional information beyond Australia-modified Karnofsky Performance Scale and Palliative Care Problem Severity Scale. Lack of significant association between psycho-spiritual problems and Phase of Illness

  1. Adult Hospice Social Work Intervention Outcomes in the United States.

    Alcide, Amary; Potocky, Miriam


    A descriptive and critical analysis of the available empirical literature on social work psychosocial intervention outcomes for adult hospice patients and caregivers was conducted. The electronic bibliographic databases CINHAL (EBSCO), MEDLINE, ProQuest, EMBASE, Campbell Collaboration, and The Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library) were searched. Search criteria were (a) social work interventions, (b) intervention was tested, (c) adult hospice patients and/or caregivers, (d) studies within the United States, (e) and studies between 2004 and 2014. Of the 21 studies that met the initial search criteria, 5 publications met all review criteria. Based on assessment of study results, intervention effect, and quality of evidence, the ADAPT Problem-Solving Intervention (PSI) and the Hospice Caregiver Support Project have some indications of practical effect on caregiver quality of life, anxiety, stress, and problem-solving skills. The Caregiver Life Line (CaLL) intervention had little to no effect on caregiver role stress or coping skills. The few available studies provide foundational insight into the need for the expansion of research efforts to evaluate hospice social work interventions and document the contributions of social work to the field.

  2. Cancer patients' evaluation of communication

    Ross, Lone; Petersen, Morten Aagaard; Johnsen, Anna Thit


    The aims of this study were to assess how communication with health care staff is perceived by Danish cancer patients and to characterise those patients who report problems in communication.......The aims of this study were to assess how communication with health care staff is perceived by Danish cancer patients and to characterise those patients who report problems in communication....

  3. Lung cancer in younger patients

    Abbasowa, Leda; Madsen, Poul Henning


    INTRODUCTION: Lung cancer remains a leading cause of cancer-related death. The incidence increases with age and the occurrence in young patients is relatively low. The clinicopathological features of lung cancer in younger patients have not been fully explored previously. METHODS: To assess the age...... differences in the clinical characteristics of lung cancer, we conducted a retrospective analysis comparing young patients ≤ 65 years of age with an elderly group > 65 years of age. Among 1,232 patients evaluated due to suspicion of lung cancer in our fast-track setting from January-December 2013, 312 newly...... diagnosed lung cancer patients were included. RESULTS: Patients ≤ 65 years had a significantly higher representation of females (p = 0.0021), more frequent familial cancer aggregation (p = 0.028) and a lower incidence of squamous cell carcinoma (p = 0.0133). When excluding pure carcinoid tumours...

  4. Lung cancer in younger patients

    Abbasowa, Leda; Madsen, Poul Henning


    INTRODUCTION: Lung cancer remains a leading cause of cancer-related death. The incidence increases with age and the occurrence in young patients is relatively low. The clinicopathological features of lung cancer in younger patients have not been fully explored previously. METHODS: To assess the age...... differences in the clinical characteristics of lung cancer, we conducted a retrospective analysis comparing young patients ≤ 65 years of age with an elderly group > 65 years of age. Among 1,232 patients evaluated due to suspicion of lung cancer in our fast-track setting from January-December 2013, 312 newly...... diagnosed lung cancer patients were included. RESULTS: Patients ≤ 65 years had a significantly higher representation of females (p = 0.0021), more frequent familial cancer aggregation (p = 0.028) and a lower incidence of squamous cell carcinoma (p = 0.0133). When excluding pure carcinoid tumours...

  5. On euthanasia, resistance, and redemption: the moralities and politics of a hospice.

    Broom, Alex


    Euthanasia/assisted dying, the desire to hasten death, and religious supportive care at the end of life are controversial issues that have been heavily debated within the academic and medical communities. Little research has been done on hospice patients' views, despite hospices being political spaces, espousing a range of perspectives on assisted dying, religiosity, and "good deaths." In this article I document the presence, articulation, and significance of these issues as perceived and experienced by 20 hospice inpatients in the last 4 weeks of their lives. Key themes to emerge included polarization in desire for hastened death and assisted dying in the hospice; the hospice as a morally bound space situated within particular notions of "dying well"; and the divisive character of religion as part of formalized hospice care. Theoretically, the participants' perspectives on euthanasia/assisted dying and religiosity in the hospice provide a means of unpacking and revealing the moral economy of modern dying practices and the institutional governance and production of "timely deaths."

  6. When do Latinos use hospice services? Studying the utilization of hospice services by Hispanics/Latinos.

    Carrion, Iraida V


    This study focuses on the utilization of hospice services within the Latino community including both hospice and non-hospice users. Data were collected from 20 participants using semi-structured interviews. Verbatim transcripts were examined through a combination of ethnographic, open coding, and thematic categorization of the interviewees' responses. The research uncovers cultural factors that contribute to the underutilization of hospice services by this population. The findings indicate that hospice users learned about their terminal diagnosis during a hospital admission from an attending physician. When hospice services were offered, these individuals accepted the services. Conversely, all of the non-hospice users learned about their terminal diagnosis in a medical office setting from their primary physician. When they were offered hospice services, they refused the services.

  7. Prognostic Tools in Patients With Advanced Cancer: A Systematic Review.

    Simmons, Claribel P L; McMillan, Donald C; McWilliams, Kerry; Sande, Tonje A; Fearon, Kenneth C; Tuck, Sharon; Fallon, Marie T; Laird, Barry J


    In 2005, the European Association for Palliative Care made recommendations for prognostic markers in advanced cancer. Since then, prognostic tools have been developed, evolved, and validated. The aim of this systematic review was to examine the progress in the development and validation of prognostic tools. Medline, Embase Classic and Embase were searched. Eligible studies met the following criteria: patients with incurable cancer, >18 years, original studies, population n ≥100, and published after 2003. Descriptive and quantitative statistical analyses were performed. Forty-nine studies were eligible, assessing seven prognostic tools across different care settings, primary cancer types, and statistically assessed survival prediction. The Palliative Performance Scale was the most studied (n = 21,082), comprising six parameters (six subjective), was externally validated, and predicted survival. The Palliative Prognostic Score composed of six parameters (four subjective and two objective), the Palliative Prognostic Index composed of nine parameters (nine subjective), and the Glasgow Prognostic Score composed of two parameters (two objective) and were all externally validated in more than 2000 patients with advanced cancer and predicted survival. Various prognostic tools have been validated but vary in their complexity, subjectivity, and therefore clinical utility. The Glasgow Prognostic Score would seem the most favorable as it uses only two parameters (both objective) and has prognostic value complementary to the gold standard measure, which is performance status. Further studies comparing all proved prognostic markers in a single cohort of patients with advanced cancer are needed to determine the optimal prognostic tool. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  8. Music Therapy Clinical Practice in Hospice: Differences Between Home and Nursing Home Delivery.

    Liu, Xiaodi; Burns, Debra S; Hilliard, Russell E; Stump, Timothy E; Unroe, Kathleen T


    Hospice music therapy is delivered in both homes and nursing homes (NH). No studies to date have explored differences in music therapy delivery between home and NH hospice patients. To compare music therapy referral reasons and delivery for hospice patients living in NH versus home. A retrospective, electronic medical record review was conducted from a large U.S. hospice of patients receiving music therapy between January 1, 2006, and December 31, 2010. Among the 4,804 patients, 2,930 lived in an NH and 1,847 patients lived at home. Compared to home, NH hospice patients were more likely to be female, older, unmarried, and Caucasian. For home hospice patients, the top referral reasons were patient/family emotional and spiritual support, quality of life, and isolation. The most frequent referral reasons for NH hospice patients were isolation, quality of life, and patient/family emotional and spiritual support. Differences in music therapy delivery depended mainly on patients' primary diagnosis and location of care. Results suggest differences in referral reasons and delivery based on an interaction between location of care and patient characteristics. Delivery differences are likely a result of individualized assessment and care plans developed by the music therapist and other interdisciplinary team members to address the unique needs of the patient. Thus, it is important to have professionally trained music therapists assess and provide tailored music-based interventions for patients with different referral reasons and personal characteristics. This study also supports staffing decisions based on patient need rather than average daily census. © the American Music Therapy Association 2015. All rights reserved. For permissions, please e-mail:

  9. Pain in patients with cancer

    Vissers, K.C.P.; Besse, K.; Wagemans, M.; Zuurmond, W.; Giezeman, M.J.; Lataster, A.; Mekhail, N.; Burton, A.W.; Kleef, M. van; Huygen, F.


    Pain in patients with cancer can be refractory to pharmacological treatment or intolerable side effects of pharmacological treatment may seriously disturb patients' quality of life. Specific interventional pain management techniques can be an effective alternative for those patients. The appropriate

  10. Contradictions in the development of new hospices: a case study.

    Clark, D


    Despite a decade of concern about the 'mushrooming' of new hospice developments within the British Isles, we remain remarkably ignorant about the processes which lead to the initiation of new hospice projects and the factors which affect their progress. Three inter-related issues appear important: (1) policy and resource implications; (2) changing models of hospice care; (3) 'community' factors. This paper explores the interconnections between these, using a case study approach and describes in detail the efforts of a single local voluntary group to establish a programme of community care for dying people. It shows that: (1) local 'communities' are likely to make continued demands for hospice type care, despite official scepticism about proliferation; but also that these communities should not be seen as homogeneous in their aspirations and demands; (2) new models of community care will interact with wider policy changes in the NHS and Social Services to raise questions about how terminal care services can be further developed; (3) shifts away from traditional in-patient models of care are likely to high-light divisions between 'lay' and 'professional' groups in their perceptions of how services can be delivered.

  11. Muscle dysfunction in cancer patients

    Christensen, Jesper Frank; Jones, L W; Andersen, J L


    implications of muscle dysfunction in cancer patients. The efficacy of exercise training to prevent and/or mitigate cancer-related muscle dysfunction is also discussed. DESIGN: We identified 194 studies examining muscular outcomes in cancer patients by searching PubMed and EMBASE databases. RESULTS: Muscle...... dysfunction is evident across all stages of the cancer trajectory. The causes of cancer-related muscle dysfunction are complex, but may involve a wide range of tumor-, therapy- and/or lifestyle-related factors, depending on the clinical setting of the individual patient. The main importance of muscle...... dysfunction in cancer patients lies in the correlation to vital clinical end points such as cancer-specific and all-cause mortality, therapy complications and quality of life (QoL). Such associations strongly emphasize the need for effective therapeutic countermeasures to be developed and implemented...

  12. Association of Early Patient-Physician Care Planning Discussions and End-of-Life Care Intensity in Advanced Cancer

    Tisnado, Diana M.; Walling, Anne M.; Dy, Sydney M.; Asch, Steven M.; Ettner, Susan L.; Kim, Benjamin; Pantoja, Philip; Schreibeis-Baum, Hannah C.; Lorenz, Karl A.


    Abstract Background: Early patient-physician care planning discussions may influence the intensity of end-of-life (EOL) care received by veterans with advanced cancer. Objective: The study objective was to evaluate the association between medical record documentation of patient-physician care planning discussions and intensity of EOL care among veterans with advanced cancer. Methods: This was a retrospective cohort study. Subjects were 665 veteran decedents diagnosed with stage IV colorectal, lung, or pancreatic cancer in 2008, and followed till death or the end of the study period in 2011. We estimated the effect of patient-physician care planning discussions documented within one month of metastatic diagnosis on the intensity of EOL care measured by receipt of acute care, intensive interventions, chemotherapy, and hospice care, using multivariate logistic regression models. Results: Veterans in our study were predominantly male (97.1%), white (74.7%), with an average age at diagnosis of 66.4 years. Approximately 31% received some acute care, 9.3% received some intensive intervention, and 6.5% had a new chemotherapy regimen initiated in the last month of life. Approximately 41% of decedents received no hospice or were admitted within three days of death. Almost half (46.8%) had documentation of a care planning discussion within the first month after diagnosis and those who did were significantly less likely to receive acute care at EOL (OR: 0.67; p=0.025). Documented discussions were not significantly associated with intensive interventions, chemotherapy, or hospice care. Conclusion: Early care planning discussions are associated with lower rates of acute care use at the EOL in a system with already low rates of intensive EOL care. PMID:26186553

  13. Impact of Undertreatment of Cancer Pain With Analgesic Drugs on Patient Outcomes: A Nationwide Survey of Outpatient Cancer Patient Care in Taiwan.

    Shen, Wen-Chi; Chen, Jen-Shi; Shao, Yu-Yun; Lee, Kuan-Der; Chiou, Tzeon-Jye; Sung, Yung-Chuan; Rau, Kun-Ming; Yen, Chia-Jui; Liao, Yu-Min; Liu, Ta-Chih; Wu, Ming-Fang; Lee, Ming-Yang; Yu, Ming-Sun; Hwang, Wen-Li; Lai, Pang-Yu; Chang, Cheng-Shyong; Chou, Wen-Chi; Hsieh, Ruey-Kuen


    Undertreatment of cancer pain among outpatient cancer patients needs to be addressed to enhance care and improve patients' quality of life (QoL). This prospective, cross-sectional, patient-focused study aimed to explore the prevalence of pain and undertreatment of cancer pain in outpatients in Taiwan. A total of 2652 non-selected outpatients with cancer and aged 20 years or older from 16 medical centers across Taiwan were included in this survey. All patients completed a questionnaire based on the Brief Pain Inventory. Pain management index (PMI) was used to evaluate the adequacy of pain management. Possible clinical variables of patients with positive PMI were examined by univariate and multivariate logistic regressions. A total of 1659 (62.6%) outpatients had experienced some degree of pain; among these, 32.4% had negative PMI. Patients with a negative PMI score had significantly poor outcomes of QoL and a significantly higher tendency toward dissatisfaction with pain control by the physician and with the prescribed analgesic drugs. Female gender, primary tumor from breast, non-cancer-related cause of pain, and hospital locations from north Taiwan were independent variables that predicated patients with undertreatment of cancer pain. Most importantly, a forward trend of undertreatment of pain among patients who presented with lower prevalent rate of pain was observed. One-third of Taiwanese outpatients experienced pain because of undertreatment. Awareness of the prevalence of undertreatment of cancer pain and identification of the vulnerable subjects may assist in enhancing patient care and improving patient's QoL. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  14. Hospice or community network? Choices in end-of-life care in Jamaica.

    Mendoza, Roger Lee


    Now considered a subspecialty of medicine and nursing, palliative care is a critical aspect of healthcare at the end of life. National and international healthcare agencies typically attribute its slow or haphazard growth in developing countries to various resource constraints. However, this study provides evidence of the substantial and widening gap between policy advocacy and patient choices in end-of-life care. It does so by establishing the incentives and risks that underlie decision-making by patients and providers against the relative scarcity of palliative care and hospices in these countries. Jamaica offers an illustrative case. It shares the socioeconomic conditions and isolated provision of hospice and palliative care that remain prevalent in many developing countries. Empirical information was collected from all Jamaican hospices, along with agency and media reports, for comparative institutional analysis. Financial and infrastructural challenges hamper hospice expansion and integration into formal healthcare systems in developing countries. Yet, other equally vital considerations are too often neglected. These include the high transaction costs of decision-making, which account for limited hospice accessibility, affordability, and efficiency, particularly to underserved populations. Risk and payoff calculations by patients and their families as well as hospices and their providers lead to two strategic options in maximizing hospice value and/or minimizing transaction costs in end-of-life care. Policy formulation and advocacy for hospice and palliative care should match aggregate demand. The socio-cultural milieu of care is critical and should be equally considered. Otherwise, providing and expanding free or subsidized palliative care at the end-of-life stage can become cost-inefficient relative to robust family and grassroots community networks.

  15. 'Patient satisfaction' in hospitalized cancer patients.

    Skarstein, Jon; Dahl, Alv A; Laading, Jacob; Fosså, Sophie D


    Predictors of 'patient satisfaction' with hospitalization at a specialized cancer hospital in Norway are examined in this study. Two weeks after their last hospitalization, 2021 consecutive cancer patients were invited to rate their satisfaction with hospitalization, quality of life, anxiety and depression. Compliance rate was 72% (n = 1453). Cut-off levels separating dissatisfied from satisfied patients were defined. It was found that 92% of the patients were satisfied with their stay in hospital, independent of cancer type and number of previous admissions. Performance of nurses and physicians, level of information perceived, outcome of health status, reception at the hospital and anxiety independently predicted 'patient satisfaction'. The model explained 35% of the variance with an area under the curve of 0.76 of the Receiver Operator Curve. Cancer patients' satisfaction with their hospital stay was high, and predicted by four independently predictive variables related to the performance of caregivers. These suggest areas for further improvement in the healthcare service.

  16. Management of Anorexia-Cachexia in Late Stage Lung Cancer Patients.

    Del Ferraro, Catherine; Grant, Marcia; Koczywas, Marianna; Dorr-Uyemura, Laura A


    Nutritional deficiencies are experienced by most adults with advanced lung cancer during the course of their disease and treatment. Well-nourished individuals tolerate cancer treatment with less morbidity, mortality, and increased response to treatment as compared to those who are malnourished. Novel anti-cancer therapies cause many deficits that impact nutritional and functional status during the treatment process. Nutritional deficits include weight loss, malnutrition, and anorexia-cachexia. Anorexia-Cachexia is complex, not well understood and seen in many solid tumors in late stage disease. Assessing adequate nutrition is one of the most challenging problems for nurses, their patients and patient's families. The purpose of this review is to define and describe cancer anorexia-cachexia in late stage lung cancer, through case presentation, and to describe palliative strategies for prevention, assessment, and management in the palliative care setting. Early assessment for nutritional imbalances must be done regularly with re-evaluation for intervention effectiveness and should continue throughout the illness trajectory. Management of adverse effects of cancer and cancer-related treatment is critical to improving quality of life. Palliative care and hospice nurses play a critical role in early assessment, education and prevention to support nutritional needs for patients and their families.

  17. Hospice Care in America

    ... 50 patients per year to large, national corporate chains that care for thousands of patients each day. ... spiritual aspects of dying • Provides needed drugs, medical supplies, and equipment • Instructs the family on how to ...

  18. Caregiver participation in hospice interdisciplinary team meetings via videophone technology: A pilot study to improve pain management.

    Parker Oliver, Debra; Demiris, George; Wittenberg-Lyles, Elaine; Porock, Davina; Collier, Jacqueline; Arthur, Antony


    This article discusses a pilot study testing a videophone intervention enabling hospice patients and caregivers to remotely participate in interdisciplinary team meetings, with the goal of improving pain management. The aim of this study was to test potential outcome measures and combine the data with qualitative observations to assess the overall feasibility and promise of the intervention. The outcomes evaluated included hospice patient quality of life, caregiver perceptions of pain medications, caregiver quality of life, and caregiver anxiety related to team participation. The pilot study showed that caregiver participation in the care planning process is feasible and may change caregiver perceptions of pain medication, potentially improving pain management for hospice patients.

  19. Dentinal candidiasis in cancer patients.

    Damm, D D; Neville, B W; Geissler, R H; White, D K; Drummond, J F; Ferretti, G A


    Two examples of an unusual presentation of oropharyngeal candidiasis in cancer patients are offered. The light and scanning electron microscopic appearances of candidiasis involving the dentin of teeth are described. The potential significance of recognition of this form of candidiasis in cancer patients is discussed.

  20. Financial management of a hospice program.

    Simione, Robert J; Simione, Kathleen A


    Agencies interested in starting hospice programs or maximizing the benefits of existing programs need to implement and maintain accurate and effective internal cost accounting systems. Once established, a cost accounting system provides the administrators of the hospice program with information to prepare budget projections, perform break-even analysis, and develop other reports to assist in making sound business decisions to ensure success.

  1. The Hospice Concept: Health Occupation 305.

    Schobel, Deborah A.

    A description is provided of "The Hospice Concept," an elective course offered as part of a two-year college health occupations curriculum. The course is designed to further the students understanding of the multiple facets of death and dying and to prepare them to be hospice volunteers. Following a course description and a glossary of…

  2. Characterizing Hospice Services in the United States

    Smith, Maureen A.; Seplaki, Christopher; Biagtan, Mark; DuPreez, Amanda; Cleary, James


    Purpose: Although caregivers desire specific information about hospice programs, there is little descriptive information available. We characterized agencies that provide formal or informal hospice care in the United States according to four types of services considered important by caregivers: medications and treatments; rehabilitative care;…

  3. Cancer Carepartners: Improving patients' symptom management by engaging informal caregivers

    Silveira Maria J


    Full Text Available Abstract Background Previous studies have found that cancer patients undergoing chemotherapy can effectively manage their own symptoms when given tailored advice. This approach, however, may challenge patients with poor performance status and/or emotional distress. Our goal is to test an automated intervention that engages a friend or family member to support a patient through chemotherapy. Methods/Design We describe the design and rationale of a randomized, controlled trial to assess the efficacy of 10 weeks of web-based caregiver alerts and tailored advice for helping a patient manage symptoms related to chemotherapy. The study aims to test the primary hypothesis that patients whose caregivers receive alerts and tailored advice will report less frequent and less severe symptoms at 10 and 14 weeks when compared to patients in the control arm; similarly, they will report better physical function, fewer outpatient visits and hospitalizations related to symptoms, and greater adherence to chemotherapy. 300 patients with solid tumors undergoing chemotherapy at two Veteran Administration oncology clinics reporting any symptom at a severity of ≥4 and a willing informal caregiver will be assigned to either 10 weeks of automated telephonic symptom assessment (ATSA alone, or 10 weeks of ATSA plus web-based notification of symptom severity and problem solving advice to their chosen caregiver. Patients and caregivers will be surveyed at intake, 10 weeks and 14 weeks. Both groups will receive standard oncology, hospice, and palliative care. Discussion Patients undergoing chemotherapy experience many symptoms that they may be able to manage with the support of an activated caregiver. This intervention uses readily available technology to improve patient caregiver communication about symptoms and caregiver knowledge of symptom management. If successful, it could substantially improve the quality of life of veterans and their families during the stresses of

  4. The Effect of Hospice on Hospitalizations of Nursing Home Residents

    Zheng, Nan Tracy; Mukamel, Dana B.; Friedman, Bruce; Caprio, Thomas V.; Temkin-Greener, Helena


    Objectives Hospice enrollment is known to reduce risk of hospitalizations for nursing home residents who use it. We examined whether residing in facilities with a higher hospice penetration: 1) reduces hospitalization risk for non-hospice residents; and 2) decreases hospice-enrolled residents’ hospitalization risk relative to hospice-enrolled residents in facilities with a lower hospice penetration. Method Medicare Beneficiary File, Inpatient and Hospice Claims, Minimum Data Set Version 2.0, Provider of Services File and Area Resource File. Retrospective analysis of long-stay nursing home residents who died during 2005-2007. Overall, 505,851 non-hospice (67.66%) and 241,790 hospice-enrolled (32.34%) residents in 14,030 facilities nationwide were included. We fit models predicting the probability of hospitalization conditional on hospice penetration and resident and facility characteristics. We used instrumental variable method to address the potential endogeneity between hospice penetration and hospitalization. Distance between each nursing home and the closest hospice was the instrumental variable. Main Findings In the last 30 days of life, 37.63% of non-hospice and 23.18% of hospice residents were hospitalized. Every 10% increase in hospice penetration leads to a reduction in hospitalization risk of 5.1% for non-hospice residents and 4.8% for hospice-enrolled residents. Principal Conclusions Higher facility-level hospice penetration reduces hospitalization risk for both non-hospice and hospice-enrolled residents. The findings shed light on nursing home end-of-life care delivery, collaboration among providers and cost benefit analysis of hospice care. PMID:25304181

  5. Personality traits of British hospice volunteers.

    Claxton-Oldfield, Stephen; Claxton-Oldfield, Jane; Paulovic, Stefan


    In total, 120 British female hospice volunteers completed the NEO five-factor inventory (NEO-FFI) of Costa Jr and McCrae. The NEO-FFI measures the so-called big 5 personality traits of neuroticism, extraversion, openness, agreeableness, and conscientiousness. Compared to both American NEO-FFI norms for adult females and emerging British NEO-FFI norms for adult females, the hospice volunteers scored significantly lower, on average, in neuroticism and significantly higher, on average, in agreeableness and conscientiousness. No significant differences were found on any of the 5 traits between the British female hospice volunteers' scores and the NEO-FFI scores previously collected from a sample of Canadian female hospice palliative care volunteers. Implications for the recruitment of British hospice volunteers are discussed.

  6. 42 CFR 417.531 - Hospice care services.


    ... 42 Public Health 3 2010-10-01 2010-10-01 false Hospice care services. 417.531 Section 417.531... PREPAYMENT PLANS Medicare Payment: Cost Basis § 417.531 Hospice care services. (a) If a Medicare enrollee of... receive hospice care services, payment for these services is made to the hospice that furnishes...

  7. End-of-Life Care Intensity and Hospice Use: A Regional-level Analysis.

    Wang, Shi-Yi; Aldridge, Melissa D; Gross, Cary P; Canavan, Maureen; Cherlin, Emily; Johnson-Hurzeler, Rosemary; Bradley, Elizabeth


    Despite increased hospice use over the last decade, end-of-life care intensity continues to increase. To understand this puzzle, we sought to examine regional variation in intensive end-of-life care and determine its associations with hospice use patterns. Using Medicare claims for decedents aged 66 years and above in 2011, we assessed end-of-life care intensity in the last 6 months of life across hospital referral regions (HRRs) as measured by proportion of decedents per HRR experiencing hospitalization, emergency department use, intensive care unit (ICU) admission, and number of days spent in hospital (hospital-days) and ICU (ICU-days). Using hierarchical generalized linear models and adjusting for patient characteristics, we examined whether these measures were associated with overall hospice use, very short (≤7 d), medium (8-179 d), or very long (≥180 d) hospice enrollment, focusing on very short stay. End-of-life care intensity and hospice use patterns varied substantially across HRRs. Regional-level end-of-life care intensity was positively correlated with very short hospice enrollment. Comparing HRRs in the highest versus the lowest quintiles of intensity in end-of-life care, regions with more intensive care had higher rates of very short hospice enrollment, with adjusted odds ratios (AOR) 1.14 [99% confidence interval (CI), 1.04-1.25] for hospitalization; AOR, 1.23 (CI, 1.12-1.36) for emergency department use; AOR, 1.25 (CI, 1.14-1.38) for ICU admission; AOR, 1.10 (CI, 1.00-1.21) for hospital-days; and AOR, 1.20 (CI, 1.08-1.32) for ICU-days. At the regional level, increased end-of-life care intensity was consistently associated with very short hospice use.

  8. Branding Palliative Care Units by Avoiding the Terms "Palliative" and "Hospice".

    Dai, Ying-Xiu; Chen, Tzeng-Ji; Lin, Ming-Hwai


    The term "palliative care" has a negative connotation and may act as a barrier to early patient referrals. Rebranding has thus been proposed as a strategy to reduce the negative perceptions associated with palliative care. For example, using the term "supportive care" instead of "palliative care" in naming palliative care units has been proposed in several studies. In Taiwan, terms other than "palliative" and "hospice" are already widely used in the names of palliative care units. With this in mind, this study investigated the characteristics of palliative care unit names in order to better understand the role of naming in palliative care. Relevant data were collected from the Taiwan Academy of Hospice Palliative Medicine, the National Health Insurance Administration of the Ministry of Health and Welfare, and the open database maintained by the government of Taiwan. We found a clear phenomenon of avoiding use of the terms "palliative" and "hospice" in the naming of palliative care units, a phenomenon that reflects the stigma attached to the terms "palliative" and "hospice" in Taiwan. At the time of the study (September, 2016), there were 55 palliative care units in Taiwan. Only 20.0% (n = 11) of the palliative care unit names included the term "palliative," while 25.2% (n = 14) included the term "hospice." Religiously affiliated hospitals were less likely to use the terms "palliative" and "hospice" (χ(2) = 11.461, P = .001). There was also a lower prevalence of use of the terms "palliative" and "hospice" for naming palliative care units in private hospitals than in public hospitals (χ(2) = 4.61, P = .032). This finding highlights the strong stigma attached to the terms "palliative" and "hospice" in Taiwan. It is hypothesized that sociocultural and religious factors may partially account for this phenomenon.

  9. Hospice family members’ perceptions and experiences with end-of-life care in the nursing home

    Washington, Karla; Kruse, Robin L.; Albright, David L; Lewis, Alexandria; Demiris, George


    Objective Despite the fact that more than 25% of Americans die in nursing homes, end-of-life care has consistently been found to be less than adequate in this setting. Even for those residents on hospice, end-of-life care has been found to be problematic. This study had two research questions; 1) How do family members of hospice nursing home residents differ in their anxiety, depression, quality of life, social networks, perceptions of pain medication, and health compared to family members of community dwelling hospice patients? 2) What are family members’ perceptions of and experiences with end-of-life care in the nursing home setting? Methods This study is a secondary mixed methods analysis of interviews with family members of hospice nursing home residents and a comparative statistical analysis of standard outcome measures between family members of hospice patients in the nursing home and family member of hospice patients residing in the community. Results Outcome measures for family members of nursing home residents were compared (n=176) with family members of community dwelling hospice patients (n=267). The family members of nursing home residents reported higher quality of life however, levels of anxiety, depression, perceptions of pain medicine, and health were similar for hospice family members in the nursing home and in the community. Lending an understanding to the stress for hospice family members of nursing home residents concerns were found with collaboration between the nursing home and the hospice, nursing home care that did not meet family expectations, communication problems, and resident care concerns including pain management. Some family members reported positive end-of-life care experiences in the nursing home setting. Conclusion These interviews identify a multitude of barriers to quality end-of-life care in the nursing home setting, and demonstrate that support for family members is an essential part of quality end-of-life care for

  10. The Attitudes of Chinese Cancer Patients and Family Caregivers toward Advance Directives

    Qiu Zhang


    Full Text Available Advance directives (ADs have been legislated in many countries to protect patient autonomy regarding medical decisions at the end of life. China is facing a serious cancer burden and cancer patients’ quality at the end of life should be a concern. However, limited studies have been conducted locally to gather information about attitudes toward ADs. The purpose of this study was to investigate the attitudes of Chinese cancer patients and family caregivers toward ADs and to explore the predictors that are associated with attitudes. The study indicated that although there was low awareness of ADs, most cancer patients and family caregivers had positive attitudes toward ADs after related information was explained to them. Participants preferred to discuss ADs with medical staff when they were diagnosed with a life-threatening disease. Preferences for refusing life-sustaining treatment and choosing Hospice-Palliative Care (HPC at the end of life would increase the likelihood of agreeing with ADs. This suggests that some effective interventions to help participants better understand end-of-life treatments are helpful in promoting ADs. Moreover, the development of HPC would contribute to Chinese cancer patients and family caregivers agreeing with ADs.

  11. Cancer

    ... cancer Non-Hodgkin lymphoma Ovarian cancer Pancreatic cancer Testicular cancer Thyroid cancer Uterine cancer Symptoms Symptoms of cancer ... tumor Obesity Pancreatic cancer Prostate cancer Stomach cancer Testicular cancer Throat or larynx cancer Thyroid cancer Patient Instructions ...

  12. Pulmonary embolism in cancer patients

    S P Sawant


    Full Text Available Aims and Objectives: Pulmonary embolism (PE is rare in the Indian population and is under-reported in patients with malignancy. We studied the clinical profile and outcome of patients with PE and cancer in the Indian population. Materials and Methods: Data of cancer patients with PE, admitted in a tertiary cancer centre, was analyzed. The prevalence of PE was calculated as the number of patients with PE per 10,000 hospital admissions. The demographic data, details of cancer, co-morbidities, details of PE, and treatment given for PE and their outcomes were recorded and analyzed. Results: There were 56,425 hospital admissions in the study period. The prevalence of PE was 6.4 per 10,000 hospital admissions .Thirty-six cancer patients were diagnosed to have PE. In females, gynecological malignancies (36.84% and in males gastrointestinal, head and neck cancers, and hematological malignancies were the most common sites (17.7% each. PE was associated with DVT in 41.7%. Dyspnea was the most common presenting symptom. Five patients (13.88% were asymptomatic and were incidentally detected to have PE . The most common echocardiographic finding was right ventricular dysfunction (55.55%. Mortality among the treated patients was 22% (7 / 31 and in untreated patients it was 80% (4 / 5. The factors that had an impact on a three-month survival were, the presence of massive PE (P = 0.019 and the presence of RV dysfunction at presentation (P = 0.005. Conclusion: The prevalence of PE and mortality due to PE is high in cancer patients. Risk stratification for venous thromboembolism (VTE should be done in all cancer patients and thromboprophylaxis should be optimally used.

  13. Children with intellectual disability and hospice utilization.

    Lindley, Lisa C; Colman, Mari Beth; Meadows, John T


    Over 42,000 children die each year in the United States, including those with intellectual disability (ID). Survival is often reduced when children with intellectual disability also suffer from significant motor dysfunction, progressive congenital conditions, and comorbidities. Yet, little is known about hospice care for children with intellectual disability. The purpose of this study was to explore the relationship between intellectual disability and hospice utilization. Additionally, we explored whether intellectual disability combined with motor dysfunction, progressive congenital conditions, and comorbidities influenced pediatric hospice utilization. Using a retrospective cohort design and data from the 2009 to 2010 California Medicaid claims files, we conducted a multivariate analysis of hospice utilization. This study shows that intellectual disability was negatively related to hospice enrollment and length of stay. We also found that when children had both intellectual disability and comorbidities, there was a positive association with enrolling in hospice care. A number of clinical implications can be drawn from the study findings that hospice and palliative care nurses use to improve their clinical practice of caring for children with ID and their families at end of life.

  14. Urotherapy for patients with cancer.

    Eldor, J


    Cancer cells release various antigens, some of which appear in the urine. Oral autourotherapy is suggested as a new treatment modality for cancer patients. It will provide the intestinal lymphatic system with the many tumor antigens against which antibodies may be produced. These antibodies may be pierced through the blood stream and attack the tumor and its cells.

  15. Hospice programs and the hospice movement: an investigation based on general systems theory.

    Russell, G


    This study used General Systems Theory as the framework for examining hospice programs and the hospice movement. Data drawn from program administrators and archival sources were used to test the thesis that two broad types of hospice programs exist in the United States. Results indicate that independent programs tend to be characterized by processes that amplify change in the extant medical delivery system--that is, deviation amplification. Hospices associated with preexisting institutions tend to be characterized by processes that counteract change, thus maintaining the status quo--that is, deviation counteracting processes.

  16. Quality of life of patients with lung cancer

    Polanski J


    Full Text Available Jacek Polanski,1 Beata Jankowska-Polanska,2 Joanna Rosinczuk,3 Mariusz Chabowski,4 Anna Szymanska-Chabowska5 1Lower Silesian Oncology Center, Home Hospice, 2Department of Clinical Nursing, 3Department of Nervous System Diseases, Department of Clinical Nursing, 4Division of Nursing in Surgical Procedures, Department of Clinical Nursing, Faculty of Health Science, 5Department of Internal Medicine, Occupational Diseases and Hypertension, Wroclaw Medical University, Wroclaw, Poland Abstract: Lung cancer is the major cause of oncologic-related death worldwide. Due to delayed diagnosis, 5-year survival rate accounts for only 15%. Treatment includes surgery, adjuvant chemotherapy, and radiation therapy; however, it is burdened by many side effects. Progress of the disease, severity of its symptoms, and side effects decrease significantly the quality of life (QoL in those patients. The level of self-assessed QoL helps in predicting survival, which is especially important among patients receiving palliative care. Patients assess their functioning in five dimensions (physical, psychological, cognitive, social, and life roles, severity of symptoms, financial problems, and overall QoL. The QoL in lung cancer patients is lower than in healthy population and patients suffering from other malignancies. It is affected by the severity and the number of symptoms such as fatigue, loss of appetite, dyspnea, cough, pain, and blood in sputum, which are specific for lung tumors. Fatigue and respiratory problems reduce psychological dimension of QoL, while sleep problems reduce cognitive functioning. Physical dimension (related to growing disability decreases in most of the patients. Also, most of them are unable to play their family and social roles. The disease is a frequent reason of irritation, distress, and depression. Management of the disease symptoms may improve QoL. Controlling the level of fatigue, pulmonary rehabilitation, and social and spiritual support

  17. Perioperative nutrition in cancer patients.

    Daly, J M; Redmond, H P; Gallagher, H


    Cancer patients have the highest incidence of protein-calorie malnutrition seen in hospitalized patients, with significant malnutrition occurring in more than 30% of cancer patients undergoing major upper gastrointestinal procedures. Clinically significant malnutrition occurs as a result of diminished nutrient intake, increased nutrient losses, and tumor-induced derangements in host metabolism. In the absence of adequate exogenous nutrients, the body utilizes endogenous substrates to satisfy the ongoing requirements of both host and tumor for energy and protein. In those patients with malignant obstruction of the gastrointestinal tract, the tumor itself may induce diminished nutrient intake. Present day treatment modalities including gastrointestinal resection, chemotherapy, and radiotherapy compound these metabolic derangements, further increasing the risk of postoperative morbidity and death. The presence of malnutrition in cancer patients has prognostic importance. In a review of more than 3000 cancer patients, DeWys and colleagues identified significantly improved survival in those patients without weight loss compared with those had lost 6% of their body weight (Am J Med 69:491-497, 1980). Other investigators have noted increased postoperative morbidity and mortality associated with malnutrition. Early hypotheses suggested that reversal of weight loss would improve survival. The development and refinements of enteral and parenteral nutrition have provided the opportunity for studying the relationship between nutritional supplementation and postoperative prognosis. Nutrition support is therefore often instituted to improve nutritional status and thereby reduce the risks of postoperative complications. This article addresses the beneficial role of preoperative nutrition therapy in cancer patients.

  18. Cancer Screening in Older Patients.

    Salzman, Brooke; Beldowski, Kathryn; de la Paz, Amanda


    Although cancer is the second leading cause of death among persons 65 years and older, there is a paucity of clinical trial data about the effectiveness and harms of cancer screening in this population. Given the heterogeneous nature of the older population, cancer screening in these patients should not be based on age alone. Studies suggest that a life expectancy of at least 10 years is necessary to derive a survival benefit from screening for breast and colorectal cancers; therefore, screening for these cancers is not recommended in those with a life expectancy of less than 10 years. Prostate cancer screening, if performed at all, should not be performed after 69 years of age. Cervical cancer screening may be stopped after 65 years of age if the patient has an adequate history of negative screening results. An individualized approach to cancer screening decisions involves estimating life expectancy, determining the potential benefits and harms of screenings, and weighing those benefits and harms in relation to the patient's values and preferences.

  19. What their terms of living and dying might be: hospice social workers discuss Oregon's Death with Dignity Act.

    Norton, Elizabeth M; Miller, Pamela J


    This article presents data from a qualitative study of nine social work hospice practitioners and experts as they discuss Oregon's Death with Dignity Act. Three themes emerged from the analysis: (a) values regarding physician-assisted death; (b) agency policies about the option; and (c) the role of hospice social workers with physician-assisted death. Three states now allow terminally ill persons to obtain a lethal prescription if criteria are met. Two other states are actively considering and may pass similar legislation over time. Hospice social work practitioners work with patients and families as they consider this option and their voices reflect the complexities and nuances of these interactions.

  20. Socioeconomic Factors Associated With Posthospitalization Hospice Care Settings: A 5-Year Perspective.

    Kirkendall, Abbie; Shen, Jay J; Greenway, Joseph; Bai, Wenbo


    Investigating whether socioeconomic characteristics determine if hospice is received at home or in a medical facility is important to examine, considering most patients prefer to die at home. This study relied upon The State Inpatient Data of Nevada. A total of 19 206 discharges were analyzed from the data set between 2009 and 2013. The results indicate that increasingly patients are being discharged to home and overall socioeconomic characteristics appear to have less of an influence over whether hospice is received at home or in a medical facility. Further research on the perspectives of patients would provide insight into whether patients' preferences or socioeconomic characteristics are more influential on where hospice services are received.

  1. The effect of music and progressive muscle relaxation on anxiety, fatigue, and quality of life in family caregivers of hospice patients.

    Choi, Yoon Kyung


    The purpose of this study was to examine the effects of music, progressive muscle relaxation (PMR), and music combined with progressive muscle relaxation on the reduction of anxiety, fatigue, and improvement of quality of life in family hospice caregivers. Subjects (N = 32) were divided randomly into 4 groups: control, music only, progressive muscle relaxation only, and music combined with progressive muscle relaxation and were tested twice a week for a duration of 2 weeks. A pre and posttest measuring anxiety and fatigue was administered each session. Quality of life was measured only on the first and last session. Results of three-way mixed design ANOVA indicated no significant main effect for group. However, results revealed a significant main effect for pretest and posttest on anxiety F(1, 28) = 51.82, p fatigue, F(1, 28) = 32.86, p fatigue F(3, 84) = 5.21, p fatigue (r(32) = .55, p fatigue and quality of life (r(32) = -.53, p < .01).

  2. Bone health in cancer patients

    Coleman, R; Body, J J; Aapro, M


    There are three distinct areas of cancer management that make bone health in cancer patients of increasing clinical importance. First, bone metastases are common in many solid tumours, notably those arising from the breast, prostate and lung, as well as multiple myeloma, and may cause major...... in the metastatic processes required for cancer dissemination, and there are emerging data showing that, at least in some clinical situations, the use of bone-targeted treatments can reduce metastasis to bone and has potential impact on patient survival....

  3. Motivations, Death Anxiety, and Empathy in Hospice Volunteers in France.

    Garbay, Meriem; Gay, Marie-Claire; Claxton-Oldfield, Stephen


    This study examined the motivations for volunteering of hospice volunteers in France. In addition, their levels of death anxiety and empathy were measured and compared with those of French non-hospice volunteers and non-volunteers. Three questionnaires-the Inventory of Motivations for Hospice Palliative Care Volunteerism (IMHPCV), the Templer/McMordie Death Anxiety Scale, and the Interpersonal Reactivity Index-were sent via an Internet link to 2 hospice volunteer associations and to non-hospice volunteers and non-volunteers (only the hospice volunteers received the IMHPCV). Altruistic motives had the most influence on the respondents' decision to become a hospice volunteer. French hospice volunteers scored significantly lower on 3 categories of motives on the IMHPCV compared to a sample of Canadian hospice palliative care volunteers (study 2), suggesting that cultural differences may be involved. No significant differences were found in levels of death anxiety or empathy between the 3 groups of respondents of the study.

  4. Needs of family caregivers of advanced cancer patients: a survey in Shanghai of China.

    Cui, J; Song, L J; Zhou, L J; Meng, H; Zhao, J J


    It is important to understand the unmet needs of family caregivers of advanced cancer patients for developing and refining services to address the identified gaps in cancer care. To explore their needs in Chinese mainland and the possible factors associated with their needs, a self-developed questionnaire was used to survey a sample of 649 participants in 15 hospitals of Shanghai. The data were analysed using descriptive statistics, factor analysis, t-test, one-way ANOVA, and Fishers least significant difference t-test. All statistical analyses were performed using SPSS 13.0. Seven dimensions of needs (maintaining health, support from healthcare professionals, knowledge about the disease and treatment, support on funeral, information on hospice care, psychological support for patients and symptoms control for patients) were extracted from the results by factor analysis. The dimension with the highest score was 'knowledge about the disease and treatment' (4.37), and that with the lowest score named 'support on funeral' (2.85). The results showed that the factors including burden of payment for treatment, former caregiving experience of family caregivers and length of caregiving time were associated with their needs. Cancer services need to consider how to tailor resources and interventions to meet these needs of family caregivers of advanced cancer patients.

  5. A pilot study of transformation, attributed meanings to the illness, and spiritual well-being for terminally ill cancer patients.

    Ando, Michiyo; Morita, Tatsuya; Lee, Virginia; Okamoto, Takuya


    The present study investigated what types of transformation terminally ill cancer patients experienced from diagnosis until the terminal stage, what meanings terminally ill cancer patients attributed to their illness, and whether or not those who attributed positive meaning to their illness achieved high levels of spiritual well-being as a preliminary study. Ten terminally ill cancer patients in the hospice wards of two general hospitals participated. A clinical psychologist conducted a semistructured interview with the patients individually for about 60 min. Patients completed the FACIT-Sp and HADS before the interview and talked about the meanings of cancer experience. The contents of the interviews were analyzed qualitatively. Patients were separated into high and low levels of spiritual-well being by the median of FACIT-Sp scores. Three types of transformation were extracted: "group with peaceful mind," "group with both positive attitude and uneasy feeling," and "groups with uneasy feeling." As attributed meanings to the illness, five categories were extracted: "positive meaning," "natural acceptance," "negative acceptance," "search for meaning," and "regret and sorrow." Patients in the high level spiritual well-being group attributed the meaning of illness to "positive meaning" and "natural acceptance," and those in the low level spiritual well-being group attributed it to "regret and sorrow" and "search for meaning." Some Japanese terminally ill cancer patients experienced positive transformation, and patients who attributed "positive meaning" and "natural acceptance" to their illness experience achieved high levels of spiritual well-being.

  6. Psychological aspects of cancer patients

    Graça Cardoso


    Full Text Available Cancer is accompanied by important psychological distress experienced by both patient and family. From the moment of the diagnosis on, the patient has to develop a great number of mechanisms and tasks of adjustment to the illness and its circumstances. The high prevalence of anxiety and depressive disorders during the course of cancer increases in the end stage disea‐ se. Therefore, a global plan of intervention integrating somatic and psychological/ psychiatric care throughout all the phases of the illness is crucial in the treatment of these patients. Health professionals working on this field can also experience emotional reactions to their patients’ suffering. They should be aware of the emotional aspects involved and develop training to help them intervene adequately with the patient and the family. The articulation between oncologists, palliative care professionals, and mental health care teams can be of great help in providing good quality of care to cancer patients.

  7. Febrile neutropaenia in cancer patients.

    Walwyn, M; Nicholson, A; Lee, M G; Wharfe, G; Frankson, M A


    Febrile neutropaenia is a common complication of chemotherapy in cancer patients. Empirical antibiotic regimes are based on the epidemiological characteristics of bacterial isolates globally and locally. This study retrospectively reviewed all cases of febrile neutropaenia in patients with confirmed cancer admitted at the University Hospital of the West Indies in the four-year period between, January 1, 2003 and December 31, 2006 and who received chemotherapy. Cases were identified from blood culture records and hospital charts which were reviewed to determine the aetiological agents causing bacteraemia, their antimicrobial susceptibilities and clinicalfeatures. These cases were compared with non-neutropaenic cancer patients admitted with fever. A total of 197 febrile episodes in cancer patients were reviewed. Thirty-seven per cent had febrile neutropaenia while 62% were non-neutropaenic. Acute myeloid leukaemia was the most common haematological malignancy and the most common solid tumour was breast cancer. Twenty-six per cent of patients had a positive blood culture. In febrile neutropaenic patients, Escherichia coli was the most common organism isolated followed by coagulase-negative staphylococci while in non-neutropaenic patients, coagulase-negative staphylococci was most common. Acinetobacter infections was prominent in non-neutropaenic patients but absent in neutropaenic patients. More than one organism was cultured in 9 neutropaenic and 18 non-neutropaenic patients. Mortality was 10.8% in neutropaenic and 24.4% in non-neutropaenic patients. Gram-negative organisms are the predominant isolates in febrile neutropaenic episodes in this cohort of patients. Non-neutropaenic patients had an increased mortality with an increase in Acinetobacter infections and multiple isolates.

  8. The impact of volunteering in hospice palliative care.

    Claxton-Oldfield, Stephen; Claxton-Oldfield, Jane


    The goal of this study was to examine the impact of hospice palliative care work on volunteers' lives. In-depth interviews were conducted with 23 direct-patient care volunteers. More than half of the volunteers became involved in hospice palliative care because of their own experiences with family members and/or friends who have died. Most of the volunteers reported that they were different now or had changed in some way since they have been volunteering (e.g., they had grown in some way, have learned how to keep things in perspective). In addition, most of the volunteers felt that their outlook on life had changed since they started volunteering (e.g., they were more accepting of death, and they learned the importance of living one day at a time). Volunteers reported doing a number of different things to prevent compassion fatigue or burnout (e.g., reading a book, listening to music, talking to others, and taking time off from volunteering). Most of the volunteers said that they would tell anyone who might be thinking of volunteering in hospice palliative care that it is a very rewarding activity and/or that they should try it. Finally, many of the volunteers offered suggestions for doing things differently in their programs.

  9. Interactional communication challenges in end-of-life care: dialectical tensions and management strategies experienced by home hospice nurses.

    Gilstrap, Cristina M; White, Zachary M


    This study examines the dialectical tensions experienced by home hospice nurses in interactions with patients, families, and health care providers. In-depth, semistructured interviews were conducted with 24 home hospice nurses from a mid-size for-profit hospice organization serving approximately 230 patients on an annual basis. Interviews revealed hospice nurses experience both interpersonal and organizational dialectics during hospice interactions: authoritative-nonauthoritative, revelation-concealment, independence-collaboration, and quality of care-business of care. Dialectics often resulted as a by-product of (a) responding to expectations and care choices of patients and families particular to the emotionally charged home context, (b) obtaining authorization from health care providers who are not members of the interdisciplinary team, and (c) pressures associated with providing quality patient care while fulfilling organizational role requirements. The praxis strategies used to negotiate tensions included segmentation, balance, recalibration, and spiraling inversion. Specifically, nurses employed strategies such as ascertaining family/patient acceptance, using persuasive tactics when communicating with external health care providers, relying on effective time management, and working off the clock to provide more in-person care. Although functional for patients and hospice organizations, nurses who continually rely on these strategies may experience job stress when their interpersonal commitments repeatedly conflict with organizational role demands.

  10. Hospice and palliative social workers' experiences with clients at risk of suicide.

    Washington, Karla T; Albright, David L; Parker Oliver, Debra; Gage, L Ashley; Lewis, Alexandria; Mooney, Megan J


    We sought to determine the frequency with which hospice and palliative social workers encounter patients, family caregivers, and other clients at risk of suicide, and to discover the extent to which hospice and palliative social workers feel prepared to address issues related to suicide in their professional practice. We conducted a cross-sectional survey of hospice and palliative social workers, recruiting a convenience sample of volunteer respondents through advertisements at professional conferences and listservs, and via social media accounts associated with national organizations, state hospice and palliative care associations, and individual healthcare professionals. Most respondents reported having worked with patients, family caregivers, or other clients who had exhibited warning signs of suicide during the previous year. Fewer respondents indicated that they had worked with patients and family members who had attempted or died by suicide. While the majority of respondents believed they possessed sufficient knowledge and skills to intervene effectively with individuals at risk of suicide, they indicated that additional education on this topic would be valuable for their professional practice. These study results suggest that suicide-related competencies are important in the practice of hospice and palliative social work. Future education and training efforts should include skill development in addition to knowledge building.

  11. Reciprocal Suffering: Caregiver Concerns During Hospice Care

    Wittenberg-Lyles, Elaine; Demiris, George; Oliver, Debra Parker; Burt, Stephanie


    Context For many hospice caregivers, the constancy and difficulty of caregiving impact their physical quality of life and cause depression, psychological distress, guilt, loneliness, and restrictions on social activities. Objectives Deviating from traditional unidimensional research on hospice caregivers, this study explored the transactional nature of reciprocal suffering by examining caregiver concerns through four dimensions: physical, psychological, social, and spiritual. Methods Researchers analyzed audiotapes of intervention discussions between hospice caregivers and research social workers. Results Results indicated that of the 125 pain talk utterances, the majority referenced psychological concern (49%), followed by physical (28%), social (22%), and spiritual (2%). Reflections on concerns revealed a global perspective of caregiving, which highlighted the patient’s needs juxtaposed to the caregiver’s recognized limitations. Conclusion By examining the reciprocal nature of suffering for caregivers, this study reinforced the need for assessing caregivers in hospice care, with specific emphasis on the importance of providing caregiver education on pain management. PMID:21146356

  12. Medicares Hospice Benefit - Analysis of Utilization and..

    U.S. Department of Health & Human Services — Descriptive analyses reported in Medicares Hospice Benefit - Analysis of Utilization and Resource Use, published in Volume 4, Issue 3 of the Medicare and Medicaid...

  13. A quarter century of hospice care: the southern california kaiser permanente experience.

    Milch, Mario; Brumley, Richard D


    Kaiser Permanente (KP) has been a pioneer in the development of hospice services in the United States. Since 1978, when hospice services were introduced in the KP Southern California Region, they have been gradually expanded to benefit thousands of patients and their families. However, important barriers to timely, appropriate utilization of hospice care remain. A pilot project conducted in our TriCentral Service Area has shown that palliative care-a newer development in end-of-life care-can be cost-effective in addition to being beneficial for patients and their families. Efforts are underway to emulate this model of care at other KP facilities. Availability of both home-based and inpatient palliative care services can expand the number and type of patients who, as they near the end of life, can benefit from effective symptom control and other support.

  14. Erfaringer med værdighedsterapi på Hospice Limfjord

    Graven, Vibeke Poulsen; Gjørup, Rikke Heller


    Oplever danske palliative patienter tab af værdighed i deres sidste tid? Og kan værdighedsterapi (Dignity Therapy) eventuelt afhjælpe dette? Det undersøger Lise Jul Houmann i sin ph.d.-afhandling; Dignity Therapy in Denmark (Houman 2010). Hospice Limfjord har deltaget i et uddannelsestilbud ved...... Houmann med henblik på at udbrede værdighedsterapi som et landsdækkende tilbud til patienter tilknyttet hospicer og palliative enheder i Danmark. Med stor entusiasme gik vi i gang med at tilbyde vores patienter værdighedsterapi, men stødte undervejs på barrierer af forskellig art. Her i artiklen belyses...... perspektiver og spørgsmål, der har vist sig ved implementeringen af værdighedsterapi i praksis på Hospice Limfjord....

  15. Training intervention for health care staff in the provision of existential support to patients with cancer: a randomized, controlled study.

    Henoch, Ingela; Danielson, Ella; Strang, Susann; Browall, Maria; Melin-Johansson, Christina


    When a patient receives a cancer diagnosis, existential issues become more compelling. Throughout the illness trajectory, patients with cancer are cared for in oncology wards, by home care teams or in hospices. Nurses working with these patients are sometimes aware of the patients' existential needs but do not feel confident when discussing these issues. To determine the effects of a training intervention, where the focus is on existential issues and nurses' perceived confidence in communication and their attitude toward caring for dying patients. This was a randomized, controlled trial with a training intervention comprising theoretical training in existential issues combined with individual and group reflection. In total, 102 nurses in oncology and hospice wards and in palliative home care teams were randomized to a training or non-training group. Primary outcomes, confidence in communication, and attitude toward the care of dying patients were measured at baseline, immediately after the training, and five to six months later. Confidence in communication improved significantly in the training group from baseline (before the training) to both the first and second follow-up, that is, immediately after the training and five months later. The attitude toward caring for the dying did not improve in the training group. This study shows that short-term training with reflection improves the confidence of health care staff when communicating, which is important for health care managers with limited resources. Further studies are needed to explore how patients experience the communication skills of health care staff after such training. Copyright © 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

  16. From concept to practice, is multidimensional care the leading principle in hospice care? An exploratory mixed method study.

    de Graaf, Everlien; van Klinken, Merel; Zweers, Danielle; Teunissen, Saskia


    Hospice care (HC) aims to optimise the quality of life of patients and their families by relief and prevention of multidimensional suffering. The aim of this study is to gain insight into multidimensional care (MC) provided to hospice inpatients by a multiprofessional team (MT) and identify facilitators, to ameliorate multidimensional HC. This exploratory mixed-method study with a sequential quantitative-qualitative design was conducted from January to December 2015. First a quantitative study of 36 patient records (12 hospices, 3 patient records/hospice) was performed. The outcomes were MC, clinical reasoning and assessment tools. Second, MC was qualitatively explored using semistructured focus group interviews with multiprofessional hospice teams. Both methods had equal priority and were integrated during analysis. The physical dimension was most prevalent in daily care, reflecting the patients' primary expressed priority at admission and the nurses' and physicians' primary focus. The psychological, social and spiritual dimensions were less frequently described. Assessment tools were used systematically by 4/12 hospices. Facilitators identified were interdisciplinary collaboration, implemented methods of clinical reasoning and structures. MC is not always verifiable in patient records; however, it is experienced by hospice professionals. The level of MC varied between hospices. The use of assessment tools and a stepped skills approach for spiritual care are recommended and multidimensional assessment tools should be developed. Leadership and commitment of all members of the MT is needed to establish the integration of multidimensional symptom management and interdisciplinary collaboration as preconditions for integrated multidimensional HC. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  17. Holding on to what you have got: keeping hospice palliative care volunteers volunteering.

    Claxton-Oldfield, Stephen; Jones, Richard


    In all, 119 hospice palliative care volunteers from 3 community-based hospice programs completed the Volunteer Retention Questionnaire (VRQ), a 33-item survey designed for this study. The VRQ asks volunteers to rate the importance of each item to their decision to continue volunteering. The items that received the highest mean importance ratings included enjoying the work they do, feeling adequately prepared/trained to perform their role, and learning from their patients' experiences/listening to their patients' life stories. Being recognized (eg, pins for years of service or being profiled in the hospice newsletter), receiving phone calls/cards from their volunteer coordinator on special occasions, and being reimbursed for out-of-pocket expenses were among the items that received the lowest mean importance ratings. Suggestions for improving volunteer retention are provided.

  18. The chaplain profession from the employer perspective: an analysis of hospice chaplain job advertisements.

    Cramer, Emily M; Tenzek, Kelly E


    Hospitals and hospice organizations who are hiring chaplains to provide spiritual care for terminally ill patients post online job advertisements with specific qualifications and communication skills that applicants should possess. An examination of job advertisements can uncover trends in credentials and responsibilities expected of hospice chaplains. Results of a framework analysis of 71 hospice chaplain job advertisements indicated that 44% of chaplain job advertisements did not require chaplain applicants to have completed clinical pastoral education (CPE) and 41% did not required ordination and/or endorsement from a recognized denomination. Only 37% of hiring organizations required or preferred professional certification. Furthermore, patient support (70%), ambassadorship (54%), team collaboration (52%), and interfaith proficiency (46%) were the communication skills that advertisements tended to emphasize. This article focuses on how the study findings reflect ongoing challenges for the chaplain occupational group on its path to professionalization.

  19. The Sacred Circle: a conceptual framework for spiritual care in hospice.

    Paton, L


    Hospice care has consistently recognized the need to integrate spiritual care into holistic plans of care for dying patients and their families. Designing and implementing spiritual care interventions can be potentially difficult for hospice practitioners who have not had specific training in theology or pastoral care. Matthew Fox, a theologian, has developed a model of spiritual development that utilizes an ecumenical, ethical framework that can be directly applied to the care of hospice patients and families. This model employs a Sacred Circle approach that begins with an emphasis upon the sense of awe and wonder (the Via Positiva), moves into the next cycle by recognizing problems and negative emotions (the Via Negativa), that then flows into the creative solutions to problems (the Via Creativa), which finally transforms the problem into a new level of understanding (the Via Transformativa).

  20. Antibiotic resistance in cancer patients.

    Gudiol, Carlota; Carratalà, Jordi


    Bacterial infection is one of the most frequent complications in cancer patients and hematopoietic stem cell transplant recipients. In recent years, the emergence of antimicrobial resistance has become a significant problem worldwide, and cancer patients are among those affected. Treatment of infections due to multidrug-resistant (MDR) bacteria represents a clinical challenge, especially in the case of Gram-negative bacilli, since the therapeutic options are often very limited. As the antibiotics active against MDR bacteria present several disadvantages (limited clinical experience, higher incidence of adverse effects, and less knowledge of the pharmacokinetics of the drug), a thorough acquaintance with the main characteristics of these drugs is mandatory in order to provide safe treatment to cancer patients with MDR bacterial infections. Nevertheless, the implementation of antibiotic stewardship programs and infection control measures is the cornerstone for controlling the development and spread of these MDR pathogens.

  1. Thromboembolism in Patients with Cancer.

    Büyükçelik, Abdullah; Akbulut, Hakan


    One hundred and forty years ago, Armand Trousseau described phlegmasia alba dolens as a sign of internal malignancy. Nowadays, it is commonly believed that the presence malignant tumaor increases the risk of venous thromboembolism (i.e deep vein thrombosis and pulmonary embolism) However, cancer is usually associated with other factors such as old age, extensive surgery,immobility, etc., which may predispose to thromboembolism. The majority of thrombotic events occur in the venous system; the incidence of arterial thrombosis is much lower.Recurrent thromboembolism in cancer patients frequently and diminishes the quality of life of the patients.Furthermore, if the thromboembolism is massive, destipte of early and aggressive treatment, it may result in death. In this article, we review thromboembolic complications in cancer patients.

  2. Hypertension in Patients with Cancer

    Souza, Vinicius Barbosa de; Silva, Eduardo Nani; Ribeiro, Mario Luiz; Martins, Wolney de Andrade, E-mail: [Curso de Pós-Graduação em Ciências Cardiovasculares da Universidade Federal Fluminense, Niterói, RJ (Brazil)


    There is a known association between chemotherapy and radiotherapy for treatment of cancer patients and development or worsening of hypertension. The aim of this article is to review this association. A literature search was conducted for articles reporting this association on the databases PubMed, SciELO and LILACS between 1993 and 2013. There was a high coprevalence of hypertension and cancer, since both diseases share the same risk factors, such as sedentary lifestyle, obesity, smoking, unhealthy diet and alcohol abuse. The use of chemotherapy and adjuvant drugs effective in the treatment of cancer increased the survival rate of these patients and, consequently, increased the incidence of hypertension. We described the association between the use of angiogenesis inhibitors (bevacizumab, sorafenib and sunitinib), corticosteroids, erythropoietin and non-steroidal anti-inflammatory drugs with the development of hypertension. We also described the relationship between hypertension and carotid baroreceptor injury secondary to cervical radiotherapy. Morbidity and mortality increased in patients with cancer and hypertension without proper antihypertensive treatment. We concluded that there is need for early diagnosis, effective monitoring and treatment strategies for hypertension in cancer patients in order to reduce cardiovascular morbidity and mortality.

  3. Hypertension in Patients with Cancer

    Vinicius Barbosa de Souza


    Full Text Available There is a known association between chemotherapy and radiotherapy for treatment of cancer patients and development or worsening of hypertension. The aim of this article is to review this association. A literature search was conducted for articles reporting this association on the databases PubMed, SciELO and LILACS between 1993 and 2013. There was a high coprevalence of hypertension and cancer, since both diseases share the same risk factors, such as sedentary lifestyle, obesity, smoking, unhealthy diet and alcohol abuse. The use of chemotherapy and adjuvant drugs effective in the treatment of cancer increased the survival rate of these patients and, consequently, increased the incidence of hypertension. We described the association between the use of angiogenesis inhibitors (bevacizumab, sorafenib and sunitinib, corticosteroids, erythropoietin and non-steroidal anti-inflammatory drugs with the development of hypertension. We also described the relationship between hypertension and carotid baroreceptor injury secondary to cervical radiotherapy. Morbidity and mortality increased in patients with cancer and hypertension without proper antihypertensive treatment. We concluded that there is need for early diagnosis, effective monitoring and treatment strategies for hypertension in cancer patients in order to reduce cardiovascular morbidity and mortality.

  4. Advance Care Planning Does Not Adversely Affect Hope or Anxiety Among Patients With Advanced Cancer.

    Green, Michael J; Schubart, Jane R; Whitehead, Megan M; Farace, Elana; Lehman, Erik; Levi, Benjamin H


    Many physicians avoid advance care planning (ACP) discussions because they worry such conversations will lead to psychological distress. To investigate whether engaging in ACP using online planning tools adversely affects hope, hopelessness, or anxiety among patients with advanced cancer. Patients with advanced cancer and an estimated survival of two years or less (Intervention group) and a Control group were recruited at a tertiary care academic medical center (2007-2012) to engage in ACP using an online decision aid ("Making Your Wishes Known"). Pre/post and between-group comparisons were made, including hope (Herth Hope Index), hopelessness (Beck Hopelessness Scale), and anxiety (State Trait Anxiety Inventory). Secondary outcomes included ACP knowledge, self-determination, and satisfaction. A total of 200 individuals completed the study. After engaging in ACP, there was no decline in hope or increase in hopelessness in either the Control or Intervention group. Anxiety was likewise unchanged in the Control group but decreased slightly in the Intervention group. Knowledge of ACP (% correct answers) increased in both the groups, but more so in the Intervention group (13% increase vs. 4%; Pplanning tools increases knowledge without diminishing hope, increasing hopelessness, or inducing anxiety in patients with advanced cancer. Physicians need not avoid ACP out of concern for adversely affecting patients' psychological well-being. Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  5. [Weight loss in cancer patients].

    Lordick, Florian; Hacker, Ulrich


    Cancer patients are regularly affected by malnutrition which often leads to a worsened quality of life and activity in daily living, more side effects and complications during anticancer treatment and shorter survival times. The early diagnosis and treatment of malnutrition are therefore relevant components of oncological treatment. The assessment of the nutritional status and determination of the body-mass-index should be done in every patient with cancer. The clinical examination delivers important findings and indications for malnutrition. Bioimpedance analysis can deliver additional objective information. The treatment of malnutrition should start early and follows a step-wise escalation reaching from nutritional counseling to enteral nutritional support to parenteral nutrition.

  6. Cultural competency and diversity among hospice palliative care volunteers.

    Jovanovic, Maja


    This case study examines the current state of cultural competence in hospice and palliative care in the Greater Toronto Area (GTA). Because of changing demographic trends and ethnic minorities underutilizing hospice palliative care services, this research examined the current state of culturally competent care in a hospice setting, and the challenges to providing culturally competent care in a hospice in the GTA. A case study was conducted with a hospice and included in-depth interviews with 14 hospice volunteers. The findings reveal that volunteers encountered cultural clashes when their level of cultural competency was weak. Second, volunteers revealed there was a lack of adequate cultural competency training with their hospice, and finally, there was a lack of ethnic, cultural, and linguistic diversity among the hospice volunteers.

  7. Report of the Geriatrics-Hospice and Palliative Medicine Work Group: American Geriatrics Society and American Academy of Hospice and Palliative Medicine leadership collaboration.


    Although the fields of hospice and palliative medicine and geriatrics have developed from separate origins, they share much in common. They share concerns for optimizing care of older adults with advanced illness. They both seek to address the common problem of care fragmentation for those with chronic illness. Both subspecialties see the patient and their loved ones as a unit requiring thoughtful, integrated care, rather than seeing the patient as a cluster of organ systems and conditions. The fields also share many core principles, including an emphasis on interdisciplinary care and care coordination. As increasing emphasis is placed on the medical home, chronic and advanced illness care, and systems changes to decrease care fragmentation, geriatrics and hospice and palliative medicine stand to benefit by blending efforts and common interests to improve care for patients and their loved ones. In 2009, a collaborative effort was begun involving the leadership of the American Geriatrics Society, the American Academy of Hospice and Palliative Medicine, and the John A. Hartford Foundation. The goal of the collaboration was to convene leaders in geriatrics and hospice and palliative medicine to identify areas of potential synergy between the two subspecialties and to design a plan for exploring and developing these areas of common interest. This article describes the progress of the collaborative effort to date. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.

  8. Functions of Hospice Care Service and Its Resource in Chengdu,Kunming and Hangzhou%成都、昆明、杭州三地注册临终关怀机构的服务功能及资源的调查研究

    陈瑶; 王峻彦; 施永兴


    目的 了解成都市、昆明市、杭州市三地登记注册临终关怀机构的基本情况,分析存在问题及影响因素,为临终关怀事业提供信息数据.方法 采用结构式问卷调查的方法,调查成都市、昆明市、杭州市3所登记注册临终关怀机构的临终关怀服务工作情况.结果 3所临终关怀机构共有临终关怀专用病床200张,占被调查医疗机构核定床位的16.13%.从事临终关怀服务执业(助理)医师44人,占执业(助理)医师总数的14.92%;注册护士占11.95%.晚期恶性肿瘤出院患者数占出院患者总数的35.69%,平均住院44.23 d,平均每一出院者每日医疗费用为501.77元,药品费占42.25%,享有不同类型的医疗保险者占78.78%;生活完全不能自理需全护理者占42.05%,生活基本自理者占27.84%.结论 三地临终关怀机构的总体规模不能满足日益增长的临终关怀需求.应提高临终关怀理念,加大对临终关怀机构的投入,建立政府层面的政策保障和系统性制度.%Objective To know the general situations of registered hospice care service institutions in Chengdu , Kunming and Hangzhou, to analyze the existing problem and its influential factors so as to provide information and data for hospice care service. Methods The structured questionnaire survey was conducted about the states of hospice care service in three regis tered hospice care service institutions in Chengdu, Kunming, and Hangzhou. Results There were 200 appropriative sickbeds in three registered hospice care service institutions , accounting for 16. 13% of the registered appropriative sickbeds in the investigated hospitals. There were 44 doctors engaging in hospice care service, accounting for 14. 92% of total doctors; and there were 11. 95% of the registered nurses engaging in hospice care service. Terminal cancer patient accounted fro 35. 69% in total discharged patients . the average days in hospital per patient was 44. 23 . the

  9. Making decisions about care: what it means for hospice inpatients with terminal progressive disease.

    Fisher, Simon; Colyer, Hazel


    There is very little research into patients who suffer from a terminal and progressive illness making decisions about health care in a hospice setting. What decision-making means to the inpatients in a hospice could be better understood by staff caring for this patient group. The aim of this small qualitative study was to explore the nature of decisions and the process of decision-making with patients who had been admitted to a hospice with a progressive terminal illness. A phenomenological approach was taken using a theoretical framework to explore the patients' life world and its existential meaning, and interviews were conducted with six inpatients. The decisions that came to the fore for the participants were around the driving force behind admission, which was often pain. Beyond this often traumatic event they were able to be robust in decision-making about day-to-day issues. Other decisions related to the purpose of the admission such as symptom control, achieving independence, whether to have further treatment, communication with their families and returning to the community. Patients had an increased awareness of the fragility of their existence, which was brought into focus by the decision to be admitted to the hospice. The findings give an insight into the driving forces behind decision-making and the kind of decisions that are important to the patients in this sample, which staff caring for this patient group may find valuable.

  10. Medicare Program; FY 2018 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements. Final rule.


    This final rule will update the hospice wage index, payment rates, and cap amount for fiscal year (FY) 2018. Additionally, this rule includes new quality measures and provides an update on the hospice quality reporting program.

  11. 42 CFR 418.30 - Change of the designated hospice.


    ... 42 Public Health 3 2010-10-01 2010-10-01 false Change of the designated hospice. 418.30 Section... (CONTINUED) MEDICARE PROGRAM HOSPICE CARE Eligibility, Election and Duration of Benefits § 418.30 Change of the designated hospice. (a) An individual or representative may change, once in each election...

  12. 42 CFR 422.320 - Special rules for hospice care.


    ... 42 Public Health 3 2010-10-01 2010-10-01 false Special rules for hospice care. 422.320 Section 422....320 Special rules for hospice care. (a) Information. An MA organization that has a contract under subpart K of this part must inform each Medicare enrollee eligible to select hospice care under §...

  13. 42 CFR 417.585 - Special rules: Hospice care.


    ... 42 Public Health 3 2010-10-01 2010-10-01 false Special rules: Hospice care. 417.585 Section 417... PREPAYMENT PLANS Medicare Payment: Risk Basis § 417.585 Special rules: Hospice care. (a) No payment is made to an HMO or CMP on behalf of a Medicare enrollee who has elected hospice care under § 418.24 of...

  14. 42 CFR 418.24 - Election of hospice care.


    ... 42 Public Health 3 2010-10-01 2010-10-01 false Election of hospice care. 418.24 Section 418.24... (CONTINUED) MEDICARE PROGRAM HOSPICE CARE Eligibility, Election and Duration of Benefits § 418.24 Election of hospice care. (a) Filing an election statement. An individual who meets the eligibility requirement...

  15. The Grief Group: A University and Hospice Collaboration

    O'Neill, Daniel; Fry, Michele


    This report describes a joint effort of a community hospice and a university counseling center to provide a campus grief group for university students led by a hospice counselor and a counseling center clinical psychologist. Hospice provided a curriculum outlining topics and activities for each of the group's six meetings. Notices announcing…

  16. Barriers to Hospice Use among African Americans: A Systematic Review

    Washington, Karla T.; Bickel-Swenson, Denise; Stephens, Nathan


    The present review was undertaken to explore recent evidence in the professional literature pertaining to use of hospice services by African Americans. The article addresses the research methods that have been used to study African American hospice use, obstacles to African American participation in hospice that have been identified, and…

  17. Nontechnical Service in Hospice Care%临终关怀中的非医疗性服务



    非医疗性临终性关怀服务,是情感支持与精神慰藉层面上服务,在提高生命质量的同时也维护了患者的尊严.但传统观念、医患关系、经济条件等因素制约了临终关怀服务的大力开展,对此提出开展临终关怀谈话、建立关怀目标、设立医学伦理咨询顾问、开展家庭会议、加强医学人文教育等相应措施,以期真正实现临终关怀所内涵的人文性.%Nontechnical service of hospice is the one about mentality and emotion concern, improving the patients'life quality as well as dignity. The factors that restricted the development of hospice care services in China are including; traditional concept, doctor - patient relationship, financial condition and so forth. Some counter-measures were proposed in this paper, which include; carrying out conversation for hospice care; setting the goal for hospice care; medical ethics consultant for hospice care; holding the family meeting; strengthening medical humanistic education and so forth, in order make the humanities contained in hospice care realized.

  18. Swallowing dysfunction in cancer patients

    Raber-Durlacher, J.E.; Brennan, M.T.; Verdonck- de Leeuw, I.M.; Gibson, R.J.; Eilers, J.G.; Waltimo, T.; Bots, C.P.; Michelet, M.; Sollecito, T.P.; Rouleau, T.S.; Sewnaik, A.; Bensadoun, R.J.; Fliedner, M.C.; Silverman, S.; Spijkervet, F.K.L.


    Purpose Dysphagia (swallowing dysfunction) is a debilitating, depressing, and potentially life-threatening complication in cancer patients that is likely underreported. The present paper is aimed to review relevant dysphagia literature between 1990 and 2010 with a focus on assessment tools, prevalen

  19. Swallowing dysfunction in cancer patients

    Raber-Durlacher, Judith E.; Brennan, Mike T.; Leeuw, Irma M. Verdonck-de; Gibson, Rachel J.; Eilers, June G.; Waltimo, Tuomas; Bots, Casper P.; Michelet, Marisol; Sollecito, Thomas P.; Rouleau, Tanya S.; Sewnaik, Aniel; Bensadoun, Rene-Jean; Fliedner, Monica C.; Silverman, Sol; Spijkervet, Fred K. L.

    Purpose Dysphagia (swallowing dysfunction) is a debilitating, depressing, and potentially life-threatening complication in cancer patients that is likely underreported. The present paper is aimed to review relevant dysphagia literature between 1990 and 2010 with a focus on assessment tools,

  20. Pegfilgrastim in pediatric cancer patients

    te Poele, EM; Kamps, WA; Tamminga, RYJ; Leew, JA; Postma, A; de Bont, ESJM


    Chemotherapy-induced neutropenia is a major dose-limiting side effect of intensive chemotherapy in cancer patients. Recently, pegfilgrastim (a product with a long half-life, resulting in once-per-cycle dosage) was introduced to prevent neutropenia in adults. The authors report 32 episodes of pegfilg

  1. Sharing atrocity stories in hospice: A study of niceness message strategies in interdisciplinary team meetings.

    Wittenberg-Lyles, Elaine; Oliver, Debra Parker; Demiris, George; Cunningham, Cody P


    The telling of atrocity stories offers therapeutic benefits to healthcare providers. Transcripts of hospice interdisciplinary team (IDT) meetings were used to analyze strategies for telling atrocity stories in the performance of symbiotic niceness through criticism. Symbiotic niceness draws upon niceness messages to establish reciprocal niceness by others in order to facilitate emotional labor. In IDT meetings the two predominant strategy types used were indirect and direct criticism. Nurses and medical directors engaged in niceness message strategies mostly about patients and other healthcare professionals. The study concludes that hospice IDT meetings are a venue for team members to communicate symbiotic niceness through emotional labor.

  2. A new quality assurance package for hospital palliative care teams: the Trent Hospice Audit Group model.

    Hunt, J; Keeley, V L; Cobb, M; Ahmedzai, S H


    Cancer patients in hospitals are increasingly cared for jointly by palliative care teams, as well as oncologists and surgeons. There has been a considerable growth in the number and range of hospital palliative care teams (HPCTs) in the United Kingdom. HPCTs can include specialist doctors and nurses, social workers, chaplains, allied health professionals and pharmacists. Some teams work closely with existing cancer multidisciplinary teams (MDTs) while others are less well integrated. Quality assurance and clinical governance requirements have an impact on the monitoring of such teams, but so far there is no standardised way of measuring the amount and quality of HPCTs' workload. Trent Hospice Audit Group (THAG) is a multiprofessional research group, which has been developing standards and audit tools for palliative care since the 1990s. These follow a format of structure-process-outcome for standards and measures. We describe a collaborative programme of work with HPCTs that has led to a new set of standards and audit tools. Nine HPCTs participated in three rounds of consultation, piloting and modification of standard statements and tools. The final pack of HPCT quality assurance tools covers: policies and documentation; medical notes review; questionnaires for ward-based staff. The tools measure the HPCT workload and casemix; the views of ward-based staff on the supportive role of the HPCT and the effectiveness of HPCT education programmes, particularly in changing practice. The THAG HPCT quality assurance pack is now available for use in cancer peer review.

  3. Coping in Patients With Incurable Lung and Gastrointestinal Cancers: A Validation Study of the Brief COPE.

    Hagan, Teresa L; Fishbein, Joel N; Nipp, Ryan D; Jacobs, Jamie M; Traeger, Lara; Irwin, Kelly E; Pirl, William F; Greer, Joseph A; Park, Elyse R; Jackson, Vicki A; Temel, Jennifer S


    Patients with incurable cancer engage in several coping styles to manage the impact of cancer and its treatment. The Brief COPE is a widely used measure intended to capture multiple and distinct types of coping. The Brief COPE has not been validated among patients with incurable cancer. We sought to validate seven subscales of the Brief COPE in a large sample of patients newly diagnosed with incurable lung and noncolorectal gastrointestinal cancers (N = 350). Participants completed the Brief COPE and measures assessing quality of life (QOL) (Functional Assessment of Cancer Therapy-General) and psychological distress (Hospital Anxiety and Depression Scale) within eight weeks of diagnosis of incurable cancer. We evaluated the psychometric properties of the Brief COPE using a confirmatory factor analysis and tests of correlation with the QOL and distress scales. The Brief COPE factors were consistent with the original subscales, although the Behavioral Disengagement Scale had low internal consistency. Factors showed anticipated relationships with QOL and distress measures, except emotional support coping, which was correlated with increased depression and anxiety. We also conducted an exploratory high-order factor analysis to determine if subscales' score variances grouped together. The high-order factor analysis resulted in two factors, with active, emotional support, positive reframing, and acceptance loading onto one factor and denial and self-blame loading onto the second. The selected subscales of the Brief COPE are appropriate measures of coping among individuals newly diagnosed with incurable lung and gastrointestinal cancers. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  4. Comfort, hygiene, and safety in veterinary palliative care and hospice.

    Downing, Robin; Adams, Valarie Hajek; McClenaghan, Ann P


    Hygiene, comfort, and safety during pet palliative care and hospice are usually straightforward. The veterinary health care team must coordinate care to ensure that the pet and the family are fully informed and engaged in the process. End-of-life issues, euthanasia, and death are typically not everyday concerns for the pet owner. Pet owners and veterinary patients rely on the veterinary health care team to help create the structure within which the pet will die. The veterinary team can give the family-pet unit the gift of structure and multifaceted comfort. The veterinary profession must take seriously this unique niche of care. 2011 Elsevier Inc. All rights reserved.

  5. Family Relationships and Psychosocial Dysfunction Among Family Caregivers of Patients With Advanced Cancer.

    Nissen, Kathrine G; Trevino, Kelly; Lange, Theis; Prigerson, Holly G


    Caring for a family member with advanced cancer strains family caregivers. Classification of family types has been shown to identify patients at risk of poor psychosocial function. However, little is known about how family relationships affect caregiver psychosocial function. To investigate family types identified by a cluster analysis and to examine the reproducibility of cluster analyses. We also sought to examine the relationship between family types and caregivers' psychosocial function. Data from 622 caregivers of advanced cancer patients (part of the Coping with Cancer Study) were analyzed using Gaussian Mixture Modeling as the primary method to identify family types based on the Family Relationship Index questionnaire. We then examined the relationship between family type and caregiver quality of life (Medical Outcome Survey Short Form), social support (Interpersonal Support Evaluation List), and perceived caregiver burden (Caregiving Burden Scale). Three family types emerged: low-expressive, detached, and supportive. Analyses of variance with post hoc comparisons showed that caregivers of detached and low-expressive family types experienced lower levels of quality of life and perceived social support in comparison to supportive family types. The study identified supportive, low-expressive, and detached family types among caregivers of advanced cancer patients. The supportive family type was associated with the best outcomes and detached with the worst. These findings indicate that family function is related to psychosocial function of caregivers of advanced cancer patients. Therefore, paying attention to family support and family members' ability to share feelings and manage conflicts may serve as an important tool to improve psychosocial function in families affected by cancer. Copyright © 2016 American Academy of Hospice and Palliative Medicine. All rights reserved.

  6. Chronic diseases among older cancer patients.

    Deckx, L.D.; Akker, M.A. van der; Metsemakers, J.M.; Knottnerus, A.K.; Schellevis, F.G.; Buntinx, F.B.


    Introduction: With the growing number of older cancer patients, the burden of chronic diseases among older cancer patients will become increasingly important. Chronic diseases often interfere with treatment decisions and prognosis for cancer patients. However, little is known about the occurrence of

  7. Pain and Distress in Cancer Patients

    Anna Burger-Szabo


    Full Text Available Background: A significant number of patients with cancer suffer from anxiety and depressive disorder. Perceived emotional distress, anxiety and depressive symptoms are significantly more frequent in cancer patients with pain than in patients without pain. Despite their high prevalence cancer pain and distress are frequently undertreated.

  8. Fever of unknown origin in cancer patients.

    Loizidou, A; Aoun, M; Klastersky, J


    Fever of unknown origin (FUO) remains a challenging clinical problem, namely in patients with cancer. In cancer patients, FUO may be due to the cancer itself, as it is the case of hematological malignancies; digestive tumors (colon cancer, liver metastases) are significantly associated with FUO and infection can be demonstrated in some cases. Prevention with G-CSF and empirical antimicrobial therapy are essential approaches for the management of FUO in cancer patients. New diagnostic approaches, such as PET imaging, should be further evaluated in cancer patients with FUO. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  9. Spanish Version of the Patient Dignity Inventory: Translation and Validation in Patients With Advanced Cancer.

    Rullán, María; Carvajal, Ana; Núñez-Córdoba, Jorge M; Martínez, Marina; Carrasco, José Miguel; García, Irene; Arantzamendi, María; Belar, Alazne; Centeno, Carlos


    The Patient Dignity Inventory (PDI) is an instrument to measure sources of distress related to dignity at the end of life. To obtain a Spanish version of the PDI and measure psychometric aspects in patients with advanced cancer. A back-translation method was used to obtain the Spanish version. Inpatients and outpatients with advanced cancer were included. Patients completed the Spanish versions of the PDI (PDI-s), Edmonton Symptom Assessment System (ESAS), Hospital Anxiety and Depression Scale (HADS), and Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-Sp-12) instruments. The psychometric properties evaluated were internal consistency; concurrent validity between PDI-s/ESAS, PDI-s/HADS, and PDI-s/FACIT-Sp-12; discriminant validity, test-retest reliability, and factor analysis. The usefulness of the instrument also was tested. A Spanish version of the PDI was obtained. One hundred twenty-four patients completed the study. Cronbach's alpha coefficient for the PDI-s was 0.89. The PDI-s significantly correlated with the ESAS (rs = 0.669; P < 0.001), HADS (rs = 0.788; P < 0.001), and FACIT-Sp-12 (rs = -0.442; P = 0.008). The instrument distinguished outpatients from inpatients and between patients with differing Karnofsky Performance Status scores (rs = -0.328; P < 0.001). The test-retest method indicated excellent reproducibility (intraclass correlation coefficient = 0.931). Factor analysis showed three factors accounting for 79.4% of the variance. Factors were labeled psychological and existential distress, physical symptoms and dependency, and social support. Patients had no difficulties in understanding or completing the questionnaire (mean time to complete: 7.2 minutes). The Spanish version of the PDI showed adequate psychometric properties when tested with advanced cancer patients. This research provides a three-factor alternative in Spanish to the PDI. Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by

  10. Impact of admission to hospice on pain intensity and type of pain therapies administered.

    Petracci, Elisabetta; Nanni, Letizia; Maltoni, Marco; Derni, Stefania; Campana, Gabriele; Scarpi, Emanuela


    The primary aim of this study was to evaluate pain intensity changes in patients admitted to a hospice. The secondary objective was to evaluate whether these changes in pain were accompanied by modifications in therapies and drugs used to treat pain. This retrospective study included 96 patients admitted to a hospice for a minimum of 7 days who received pain therapy. An 11-point (0-10) numerical rating scale (NRS) was used to assess pain on a daily basis. A repeated measures analysis of variance was performed to evaluate pain intensity changes over time. Mean ± SD pain NRS values of the entire group were 2.58 ± 2.61 on day 1 and 1.40 ± 1.72 on day 7 (P = 0.002). Restricting the analysis to patients with moderate to severe pain at the time of hospice admission, results were even more significant. In fact, mean ± SD pain NRS was 5.51 ± 1.24 for patients with pain ≥4 at admission and 1.76 ± 1.91 for the same patients after 7 days (P < 0.001). A significant increase in the number of patients receiving morphine was observed from day 1 to day 7 (24 to 41, respectively, P = 0.001) and in those receiving drugs via parenteral routes (subcutaneous or intravenous) from 10 to 27 (P = 0.002) CONCLUSIONS: Admission to a hospice and the hospice environment led to a significant reduction in reported pain intensity for the patients included in this study, mainly those with moderate to severe pain at the time of admission. This decrease in pain was accompanied by a significant increase in the use of morphine, especially via parenteral routes, but not by a higher mean equivalent daily dose of oral morphine per patient.

  11. American Thyroid Association guidelines for management of patients with anaplastic thyroid cancer.

    Smallridge, Robert C; Ain, Kenneth B; Asa, Sylvia L; Bible, Keith C; Brierley, James D; Burman, Kenneth D; Kebebew, Electron; Lee, Nancy Y; Nikiforov, Yuri E; Rosenthal, M Sara; Shah, Manisha H; Shaha, Ashok R; Tuttle, R Michael


    Anaplastic thyroid cancer (ATC) is a rare but highly lethal form of thyroid cancer. Rapid evaluation and establishment of treatment goals are imperative for optimum patient management and require a multidisciplinary team approach. Here we present guidelines for the management of ATC. The development of these guidelines was supported by the American Thyroid Association (ATA), which requested the authors, members the ATA Taskforce for ATC, to independently develop guidelines for ATC. Relevant literature was reviewed, including serial PubMed searches supplemented with additional articles. The quality and strength of recommendations were adapted from the Clinical Guidelines Committee of the American College of Physicians, which in turn was developed by the Grading of Recommendations Assessment, Development and Evaluation workshop. The guidelines include the diagnosis, initial evaluation, establishment of treatment goals, approaches to locoregional disease (surgery, radiotherapy, systemic therapy, supportive care during active therapy), approaches to advanced/metastatic disease, palliative care options, surveillance and long-term monitoring, and ethical issues including end of life. The guidelines include 65 recommendations. These are the first comprehensive guidelines for ATC and provide recommendations for management of this extremely aggressive malignancy. Patients with stage IVA/IVB resectable disease have the best prognosis, particularly if a multimodal approach (surgery, radiation, systemic therapy) is used, and some stage IVB unresectable patients may respond to aggressive therapy. Patients with stage IVC disease should be considered for a clinical trial or hospice/palliative care, depending upon their preference.

  12. Pattern of palliative care, pain management and referral trends in patients receiving radiotherapy at a tertiary cancer center

    Kuldeep Sharma


    Full Text Available Background: Pain is a common primary symptom of advanced cancer and metastatic disease, occurring in 50-75% of all patients. Although palliative care and pain management are essential components in oncology practice, studies show that these areas are often inadequately addressed. Materials and Methods: We randomly selected 152 patients receiving palliative radiotherapy (PRT from October 2006 to August 2008, excluding metastatic bone lesions. Patients′ records were studied retrospectively. Results: A median follow-up of 21 weeks was available for 119 males and 33 females with a median age of 55 years. Maximum (60% patients were of head and neck cancers followed by esophagus (14%, lung (10% and others. Dysphagia, growth/ulcer and pain were the chief indications for PRT. Pain was present in 93 (61% cases out of which, 56 (60% were referred to pain clinic. All except one consulted pain clinic with a median pain score of 8 (0-10 point scale. Fifty-three of these 56 patients (96% received opioid-based treatment with adequate pain relief in 33% cases and loss of follow-up in 40% cases. Only five (3% cases were referred to a hospice. Twenty-two (14% cases were considered for radical treatment following excellent response to PRT. Conclusion: In this selective sample, the standard of analgesic treatment was found to be satisfactory. However, there is a lot of scope for improvement regarding referral to pain clinic and later to the hospice. Patients′ follow-up needs to be improved along with future studies evaluating those patients who were considered for further RT till radical dose. Programs to change the patients′ attitude towards palliative care, physicians′ (residents′ training to improve communication skills, and institutional policies may be promising strategies.

  13. Identifying and assessing the risk of opioid abuse in patients with cancer: an integrative review

    Carmichael AN


    Full Text Available Ashley-Nicole Carmichael,1 Laura Morgan,1 Egidio Del Fabbro2 1School of Pharmacy, 2Division of Hematology, Oncology, and Palliative Care, Virginia Commonwealth University, Richmond, VA, USA Background: The misuse and abuse of opioid medications in many developed nations is a health crisis, leading to increased health-system utilization, emergency department visits, and overdose deaths. There are also increasing concerns about opioid abuse and diversion in patients with cancer, even at the end of life. Aims: To evaluate the current literature on opioid misuse and abuse, and more specifically the identification and assessment of opioid-abuse risk in patients with cancer. Our secondary aim is to offer the most current evidence of best clinical practice and suggest future directions for research. Materials and methods: Our integrative review included a literature search using the key terms “identification and assessment of opioid abuse in cancer”, “advanced cancer and opioid abuse”, “hospice and opioid abuse”, and “palliative care and opioid abuse”. PubMed, PsycInfo, and Embase were supplemented by a manual search. Results: We found 691 articles and eliminated 657, because they were predominantly noncancer populations or specifically excluded cancer patients. A total of 34 articles met our criteria, including case studies, case series, retrospective observational studies, and narrative reviews. The studies were categorized into screening questionnaires for opioid abuse or alcohol, urine drug screens to identify opioid misuse or abuse, prescription drug-monitoring programs, and the use of universal precautions. Conclusion: Screening questionnaires and urine drug screens indicated at least one in five patients with cancer may be at risk of opioid-use disorder. Several studies demonstrated associations between high-risk patients and clinical outcomes, such as aberrant behavior, prolonged opioid use, higher morphine-equivalent daily dose

  14. Hospice family members' perceptions of and experiences with end-of-life care in the nursing home.

    Oliver, Debra Parker; Washington, Karla; Kruse, Robin L; Albright, David L; Lewis, Alexandria; Demiris, George


    Even though more than 25% of Americans die in nursing homes, end-of-life care has consistently been found to be less than adequate in this setting. Even for those residents on hospice, end-of-life care has been found to be problematic. This study had 2 research questions; (1) How do family members of hospice nursing home residents differ in their anxiety, depression, quality of life, social networks, perceptions of pain medication, and health compared with family members of community dwelling hospice patients? (2) What are family members' perceptions of and experiences with end-of-life care in the nursing home setting? This study is a secondary mixed methods analysis of interviews with family members of hospice nursing home residents and a comparative statistical analysis of standard outcome measures between family members of hospice patients in the nursing home and family members of hospice patients residing in the community. Outcome measures for family members of nursing home residents were compared (n = 176) with family members of community-dwelling hospice patients (n = 267). The family members of nursing home residents reported higher quality of life; however, levels of anxiety, depression, perceptions of pain medicine, and health were similar for hospice family members in the nursing home and in the community. Lending an understanding to the stress for hospice family members of nursing home residents, concerns were found with collaboration between the nursing home and the hospice, nursing home care that did not meet family expectations, communication problems, and resident care concerns including pain management. Some family members reported positive end-of-life care experiences in the nursing home setting. These interviews identify a multitude of barriers to quality end-of-life care in the nursing home setting, and demonstrate that support for family members is an essential part of quality end-of-life care for residents. This study suggests that nursing


    Quispe, Dolly; Ruiz, Eloy; Celis, Juan; Berrospi, Francisco; Payet, Eduardo


    OBJECTIVE: In order to determine a the clinicopatological features in young patients with gastric cancer and compare them with aged patients.PATIENTS AND METHODS: For this study, we selected the clinical charts from the total of patients with histological proved diagnosis of gastric adenocarcinoma admitted at the INEN between 1980 and 1996 whose age was less than 31 year (Young group, n =92). As a comparison group (Average Group) we chose of the same universe, a random sample of 184 patients between 50 to 70 years of age. Epidemiological, clinical and histological features, operability and resecability, TNM stage, type of surgery and follow-up of both groups were analyzed.RESULTS: In the Young Group in compared with Average Group, females were more frequent (73.9% vs. 50.5% p0.001). The mean survival time in the Young Group was 74.9 months and in the Average Group was 36.03 months (p=0.26), there were no significant differences in the survival between resecability and sex (p=0.10 and p=0.41).CONCLUSION: The females and undifferentiated carcinoma was the most frequent features in the young patients with gastric cancer. The survival in this group is better than the average group but this was a no significant difference because the diagnosis was made in late stages.

  16. Oral complications in cancer patients

    Carl, W.


    Ionizing radiation used in treating the head and neck area produces oral side effects such as mucositis, salivary changes, trismus and radiation caries. Sequelae of cancer chemotherapy often include oral stomatitis, myelosuppression and immunosuppression. Infections of dental origin in compromised patients are potentially lethal. Specific programs to eliminate dental pathology before radiation and chemotherapy, and to maintain oral hygiene during and after therapy, will minimize these complications.

  17. End-of-Life Place of Care, Health Care Settings, and Health Care Transitions Among Cancer Patients: Impact of an Integrated Cancer Palliative Care Plan.

    Casotto, Veronica; Rolfini, Maria; Ferroni, Eliana; Savioli, Valentina; Gennaro, Nicola; Avossa, Francesco; Cancian, Maurizio; Figoli, Franco; Mantoan, Domenico; Brambilla, Antonio; Ghiotto, Maria Cristina; Fedeli, Ugo; Saugo, Mario


    Frequent end-of-life health care setting transitions can lead to an increased risk of fragmented care and exposure to unnecessary treatments. We assessed the relationship between the presence and the intensity of an Integrated Cancer Palliative Care (ICPC) plan and the occurrence of multiple transitions during the last month of life. Decedents of cancer aged 18-85 years residents in two regions of Italy were investigated accessing their integrated administrative data (death certificates, hospital discharges, hospice, and home care records). The principal outcome was defined as having 3+ health care setting transitions during the last month of life. The ICPC plans instituted 90-31 days before death represented the main exposure of interest. Of the 17,604 patients, 6698 included in an ICPC, although spending in hospital a median number of only two days (interquartile range 1-2), experienced 1+ (59.8%), 2+ (21.1%), or 3+ (5.9%) health care transitions. Among the latter group, the most common trajectory of care is home-hospital-home-hospital (36.0%). The intensity of the ICPC plan showed a marked protective effect toward the event of 3+ health care setting transitions; the effect is already evident from an intensity of at least one home visit/week (odds ratio 0.73; 95% confidence interval 0.62-0.87). A well-integrated palliative care approach can be effective in further reducing the percentage of patients who spent many days in hospital and/or undergo frequent and inopportune changes of their care setting during their last month of life. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  18. An Exploration of Specialist Palliative Care Nurses' Experiences of Providing Care to Hospice Inpatients from Minority Ethnic Groups-Implication for Religious and Spiritual Care

    Andrea Henry; Fiona Timmins


      The aim of this research study was to gain an understanding of nurses' experiences of providing care to patients from minority ethnic groups within the specialist palliative care inpatient unit of an Irish hospice...

  19. The effects of music therapy on the quality and length of life of people diagnosed with terminal cancer.

    Hilliard, Russell E


    The purpose of this study was to evaluate the effects of music therapy on quality of life, length of life in care, physical status, and relationship of death occurrence to the final music therapy interventions of hospice patients diagnosed with terminal cancer. Subjects were adults who were living in their homes, receiving hospice care, and were diagnosed with terminal cancer. A total of 80 subjects participated in the study and were randomly assigned to one of two groups: experimental (routine hospice services and clinical music therapy) and control (routine hospice services only). Groups were matched on the basis of gender and age. Quality of life was measured by the Hospice Quality of Life Index-Revised (HQOLI-R), a self-report measure given every visit. Functional status of the subjects was assessed by the hospice nurse during every visit using the Palliative Performance Scale. All subjects received at least two visits and quality of life and physical status assessments. A repeated measures ANOVA revealed a significant difference between groups on self-report quality of life scores for visits one and two. Quality of life was higher for those subjects receiving music therapy, and their quality of life increased over time as they received more music therapy sessions. Subjects in the control group, however, experienced a lower quality of life than those in the experimental group, and without music, their quality of life decreased over time. There were no significant differences in results by age or gender of subjects in either condition. Furthermore, there were no significant differences between groups on physical functioning, length of life, or time of death in relation to the last scheduled visit by the music therapist or counselor. This study provides an overview of hospice/palliative care, explains the role of music therapy in providing care, and establishes clinical guidelines grounded in research for the use of music therapy in improving the quality of life

  20. 75 FR 67905 - National Hospice Month, 2010


    ... caregivers manage the details and emotional challenges of caring for a dying loved one. The decision to place... comprehensive care for terminally ill individuals. As many of our Nation's veterans age and cope with illness... National Hospice Month. I encourage citizens, medical institutions, government and social service...

  1. Life threatening illness and hospice care.

    Stein, A; Forrest, G C; Woolley, H; Baum, J D


    A retrospective study was undertaken of 25 families and their 26 ill children attending the first children's hospice in the United Kingdom. The study examined the family's perceptions of the care offered and the impact of chronic and life threatening illness. Eighteen (72%) of the families felt they had been well supported by the hospice and valued the family like atmosphere, perceiving the staff to be friendly, approachable, and helpful. The actual nature of hospice care, in an environment with other terminally ill children, was, however, considered a drawback for a few families. A number of families still had unmet needs, notably appropriate child minding when away from the hospice. The impact of chronic life threatening illness on the families was substantial. The parents (particularly the mothers), the index children, and their siblings all experienced much higher levels of psychological symptomatology than would have been expected from normal samples. While families felt greatly helped over symptom control, a proportion remained very worried about certain symptoms, particularly breathlessness, seizures, and pain. A high proportion of families were experiencing financial and employment difficulties as a result of their children's illnesses. PMID:2730123

  2. Hospice Decision Making: Diagnosis Makes a Difference

    Waldrop, Deborah P.; Meeker, Mary Ann


    Purpose: This study explored the process of decision making about hospice enrollment and identified factors that influence the timing of that decision. Methods: This study employed an exploratory, descriptive, cross-sectional design and was conducted using qualitative methods. In-depth in-person semistructured interviews were conducted with 36…

  3. Razionalizzare la spesa ospedaliera: Day-Hospital, ADI, Hospice

    Mario Eandi


    Full Text Available In the modern age, advances in processes, technology and clinical imperatives generated an evolution of the health care organization, particularly regarding hospitals, born as generic shelter and poor house. Nowadays the availability of high technologies and the intensity of intervention on patients are the main factors to warrant the modern hospital for acute care. This evolution trend brings out the need for new models of health care, focused on people’s different request about assistance (e.g. day-hospital, day-surgery, integrated home care, hospice. The present study gives an outline of the Italian situation, which is deeply changed in the latest years. New models of heath care emerged in Italy, as it had previously in the United States and other European countries, as able to improve assistance and reduce costs: the average hospital stay decreased, while the number of day-hospital and day-surgery increased. In spite of the rise observed in the last 3-4 years, both integrated home care and hospice availability remain still limited, especially considering the high potential request of the elderly population and the oncologic patients.

  4. Is There a Place for Humor in Hospice Palliative Care? Volunteers Say "Yes"!

    Claxton-Oldfield, Stephen; Bhatt, Anamika


    A survey was conducted to examine the frequency, acceptability, and functions of humor between hospice palliative care volunteers and their patients, from the volunteers' perspective. Thirty-two volunteers completed the survey, which was developed for this study. The results revealed that most patients and volunteers initiated humor either "often" or "sometimes" in their interactions. Over half of the volunteers considered humor to be either "very important" or "extremely important" in their interactions with patients (42% and 13%, respectively), with the patient being the determining factor as to whether and when it is appropriate or not (ie, volunteers take their lead from their patients). Volunteers mentioned a number of functions that humor serves within their patient interactions (eg, to relieve tension, to foster relationships/connections, and to distract). Laughter and humor fulfills one of the main goals of hospice palliative care, namely, improving patients' overall quality of life.

  5. Psychometric Evaluation of Cancer Patients

    S B Bansal, Sanjay Dixit, Geeta Shivram


    Full Text Available Background: Mental health is the balanced development of the individual’s personality and the emotional attitude which will enable him or her to live harmoniously with his or her Fellow citizens. Mental health is not exclusively a matter of relation between persons It is also a matter of relation of individuals towards the community in which they live, towards the society of which the community is a part, and towards the social institutions which for a large part guide their life, determine their way of living, working, leisure, and the way they spends and earns the money, the way they sees happiness, stability and security. Objective: To asses and quantify the prevalence of psychological morbidity in cancer patients of government cancer hospital MGM Medical College Indore, M.P. Material and Methods: 100 cancer patients were chosen randomly all of them were interviewed through a questionnaire survey in ward and OPD of cancer hospital in November and December 2009. Data on demographics, and duration of diagnosis were collected. Results: Gender wise prevalence of psychological morbidity Grade II &III; were 94% in males and 86% in females. Chi square test was not significant. According to age the Grade II & III psychological morbidity were 41(46% in 15-45 years age group and 49 (54% in 46-75 years age group which is significantly higher than previous age group .Chi square test (x2 = 7.54 p value < 0.05 Grade II & III psychological morbidity were 52% in 0-6 months duration while it was 38% in more than 6 months duration Chi square test (x2= 8.04, P value < 0.05 statistically significant Conclusion: the prevalence of psychological morbidity was slightly higher in males and older age group, and also high psychological morbidity was seen in recently diagnosed cancer patients. A good counseling, stress relaxation and life style modification program is required to make such patients live their life in a positive and better way.

  6. Korean hospice nursing interventions using the Nursing Interventions Classification system: a comparison with the USA.

    Hong, Sung-Jung; Lee, Eunjoo


    In this study, nursing interventions used by hospice nurses in Korea were identified and compared with core interventions selected by US end-of-life care nurses in order to determine similarities and differences between the two nations regarding such care. Data were collected from the electronic medical records of 353 hospice patients admitted to a tertiary hospital in Korea over a period of two years. First, extracted narrative interventions were mapped onto the Nursing Interventions Classification for comparison with interventions selected by nurses in the USA. A total of 56,712 intervention statements were mapped onto 147 Nursing Interventions Classification interventions. Hospice nurses in Korea performed more nursing interventions in the physiological basic domain, compared to nurses in the USA. The most frequently-used interventions in Korea were related to patient pain management. Among 47 core Nursing Interventions Classification interventions used in the USA, only 18 were used by Korean nurses in this study. This study highlights cultural differences in hospice care nursing interventions between the two countries. © 2014 Wiley Publishing Asia Pty Ltd.

  7. Access to Cancer Services for Rural Colorectal Cancer Patients

    Baldwin, Laura-Mae; Cai, Yong; Larson, Eric H.; Dobie, Sharon A.; Wright, George E.; Goodman, David C.; Matthews, Barbara; Hart, L. Gary


    Context: Cancer care requires specialty surgical and medical resources that are less likely to be found in rural areas. Purpose: To examine the travel patterns and distances of rural and urban colorectal cancer (CRC) patients to 3 types of specialty cancer care services--surgery, medical oncology consultation, and radiation oncology consultation.…

  8. 5-HTTLPR polymorphism of serotonin transporter and effects of sertraline in terminally ill cancer patients: report of eleven cases.

    Schillani, Giulia; Capozzo, Maria Anna; Aguglia, Eugenio; De Vanna, Maurizio; Grassi, Luigi; Conte, Maria Anna; Giraldi, Tullio


    Depression is difficult to detect in cancer patients, though its determination offers an opportunity to relieve patients' suffering in palliative care. Selective serotonin reuptake inhibitors (SSRIs) are the treatment of choice for mood disorders, but they show a highly variable response. The short allelic variants "s/s" and "s/l" of the 5-HTTLPR polymorphism in the promoter region of the serotonin transporter gene has been consistently associated with a poorer response to SSRIs. The aim of this study has therefore been to examine depression, anxiety and mental adaptation to cancer in terminally ill and depressed cancer patients, in relation to treatment with sertraline and to the 5-HTTLPR genetic polymorphism. Eleven consecutive depressed patients with different forms of advanced cancer who were admitted to the Hospice of the Casa di Cura "Pineta del Carso" (Trieste, Italy) were treated with sertraline for two weeks and their response was determined and related to 5-HTTLPR. Sertraline significantly reduced the average depression and anxiety subscale scores of HADS, as well as the scores of the subscales of Mini-MAC. When the effects of sertraline were analyzed in relation to the 5-HTTLPR polymorphism, only patients with the "l/l" allelic variant had significantly lower scores of HADS anxiety, Mini-MAC hopelessness-helplessness and anxious preoccupation, and a higher score for the fighting spirit of Mini-MAC; the depression score was significantly reduced in patients with both allelic variants. These data indicate that sertraline is effective after two weeks of treatment in terminally ill cancer patients, acting not only on depression but also on anxiety and mental adaptation to cancer. Moreover, the effect of sertraline significantly depended on the genetic polymorphism of the serotonin transporter, being more pronounced in patients carrying the "l/l" genetic variant; these findings seem to encourage the examination of a larger sample of patients.

  9. Serotonin transporter 5-HTTLPR polymorphism and response to citalopram in terminally ill cancer patients: report of twenty-one cases.

    Capozzo, Maria Anna; Schillani, Giulia; Aguglia, Eugenio; De Vanna, Maurizio; Grassi, Luigi; Conte, Maria Anna; Giraldi, Tullio


    The aim of this study was to examine the effects of the SSRI antidepressant drug citalopram on anxiety, depression and mental adjustment to cancer in terminally ill cancer patients, considering also the 5-HTTLPR genetic polymorphism. A group of twenty-one consecutive patients admitted to the hospice of the Casa di Cura Pineta del Carso (Trieste, Italy) with different types of advanced cancer, who were clinically judged to require treatment with an antidepressive drug, was treated with citalopram for two weeks. The response was determined and related to 5-HTTLPR. Citalopram significantly reduced the scores on the depression and anxiety subscales of the Hospital Anxiety and Depression Scale (HADS). When the effects of citalopram were analyzed in relation to the 5-HTTLPR polymorphism, the HADS depression score was significantly decreased only in patients with the "l/l" allelic variant of the serotonin transporter conferring high functional activity, while the score of the Mini-MAC fatalism scale was significantly increased in patients carrying at least one "s" allele. These preliminary findings seem to indicate that two weeks of treatment with citalopram are effective in reducing depressive symptoms in terminally ill cancer patients. Moreover, the effects of citalopram on fatalism as a strategy of mental adaptation to cancer, and on depressive symptoms depend on the allelic variants of the 5-HTTLPR genotype of the patients. These results seem to encourage the examination of a larger patient sample and of different treatment schedules, as well as a more thorough characterization of fatalism as a coping strategy in cancer patients.

  10. Second lung cancers in patients successfully treated for lung cancer.

    Johnson, B E; Cortazar, P; Chute, J P


    The rate of developing second lung cancers and other aerodigestive tumors in patients who have been treated for both small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC) is approximately 10-fold higher than other adult smokers. The risk of second lung cancers in patients surviving resection of NSCLC is approximately 1% to 2% per year. The series reported show that the patients who develop second NSCLCs tend to have early-stage NSCLC (predominantly stage I and II). The survival of patients after the second resection of lung cancer is similar to that of patients presenting with initial NSCLC. The risk of second lung cancers in patients surviving SCLC is 2% to 14% per patient per year and increases two- to seven-fold with the passage of time from 2 to 10 years. The risk of second lung cancers in patients treated for SCLC appears to be higher than that found in patients with NSCLC who were treated only with surgical resection. In addition, the chances of successful resection of second primary NSCLCs in patients who were treated for SCLC is much less than that for patients with metachronous lung cancers after an initial NSCLC. Patients treated for SCLC who continue to smoke cigarettes increase their rate of developing second lung cancers. The contribution of chest radiation and chemotherapy administration to the risk of developing second lung tumors remain to be defined but may be responsible for some of the increased risk in patients treated for SCLC compared to patients undergoing a surgical resection for NSCLC.

  11. Psychiatric Problems in Patients with Breast Cancer

    Munevver Tunel


    Full Text Available Cancer is a physical disorder with concurrent mental and social components. During cancer, the feelings of fear, hopelessness, guilt, helplessness, abandonment perceived as a crisis leading to destruction in the suffering person. Breast cancer is the most common type of cancer among women. Prevalence of psychiatric disorders among cancer patients is approximately 50% and most of disorders are related with the occurrence of cancer and cancer treatment. Majority of patients present with major depression, adjustment disorder, anxiety disorders, sleep disorders, suicidial ideation, and delirium. Treatment of psychiatric disorders and cancer therapy should be conducted along with special consideration of drug interactions. This article reviews the adaptation process experienced by individuals during diagnosis and treatment of breast cancer, it psychological effects, resulting psychiatric comorbidites and their treatments. [Archives Medical Review Journal 2012; 21(3.000: 189-219

  12. Exploring the experiences and perspectives of families using a children's hospice and professionals providing hospice care to identify future research priorities for children's hospice care.

    Malcolm, C; Forbat, L; Knighting, K; Kearney, N


    The main objective of this study is to generate a list of priority topics for children's hospice care research in Scotland from the perspective of its key stakeholders. The method consists of qualitative semi-structured interviews with families using hospice services (n = 5), four focus groups with hospice staff and volunteers (n = 44) and telephone interviews with professionals associated with the hospice (n = 18). Fourteen broad themes emerged following thematic content and interpretive analysis of the interview data. Some of the research themes were specific to certain stakeholder groups, whereas other themes were identified unanimously across all the stakeholder groups as being priority areas for future research. Increasing awareness of and improving access to children's hospice care, hospice and respite care needs of young people, community/home care and issues related to supporting the wider family arose, independently, in all three stakeholder groups as being priority topics for future research. In conclusion, a greater evidence base is required in the field of children's palliative care and the topics researched should be identified and led by those most closely involved in the hospices. Engaging families and care providers in the process of identifying research priorities resulted in the development of an extensive research agenda, which will contribute to quality hospice care for children and families.

  13. Harnessing complex emergent metaphors for effective communication in palliative care: a multimodal perceptual analysis of hospice patients' reports of transcendence experiences.

    Arnold, Bruce L; Lloyd, Linda S


    Terminally ill patients can have unexpected, enigmatic, and profound cognitive shifts that significantly alter their perception of themselves, thereby eliminating their fear of death and dying. However, there are no systematic studies into these remarkable yet ineffable transcendence experiences. They therefore remain easily overlooked or viewed as isolated anomalies and therefore excluded from quality-of-life patient considerations. We use a multimodal methodology for identifying the prevalence and thematic properties of complex emergent metaphors patients use to report these experiences. Although previous research has pioneered the importance of understanding conventional or primary metaphors at the end of life, our findings indicate the considerable potential of more complex metaphors for reducing barriers to effective communication in palliative care.

  14. Petroleum jelly (vaseline balls) for the treatment of constipation: a survey of hospice and palliative care practitioners.

    Tavares, Candice Noelle; Kimbrel, Jason M; Protus, Bridget McCrate; Grauer, Phyllis A


    Constipation is a common symptom at end of life, impacting patient outcomes and healthcare costs. Hospice and palliative care professionals often use practices based on anecdotal evidence. One such intervention is an oral preparation of petroleum jelly (OPJ), referred to as "Vaseline balls." This survey was designed to collect information regarding healthcare practitioners' knowledge and attitudes toward the use of OPJ for the management of constipation in hospice and palliative care. An online survey was distributed to physicians, nurse practitioners, nurses, and pharmacists who work with hospice and palliative care patients. A total of 67% (n=237/353) of responders reported being familiar with the use of OPJ. Results indicate there is a need for further clinical research on the use of OPJ to guide practice.

  15. Communication issues at the end of life: reports from hospice volunteers.

    Planalp, Sally; Trost, Melanie R


    The central goal of this study was to inventory and understand difficult communication issues or dilemmas that arise among hospice volunteers, patients, and their families. Hospice volunteers reported, based on their observations and experience, that denial was the most common communication issue or dilemma for patients, family, and caregivers, followed by negative feelings and family conflicts. Volunteers reported that for themselves, the most common problem was patient impairments such as Alzheimer's or Parkinson's disease that made conversation difficult. Powerful and wide-ranging emotions were also challenging for dying patients and their caregivers. Problematic integration theory and terror management theory could be developed further by expanding the role of emotions, and trauma management theories could be enhanced by developing deeper understanding of how the loss of social bonds may be as traumatic as the loss of life.

  16. Hospice in a zoologic medicine setting.

    Jessup, David A; Scott, Cheryl A


    Forty years ago, Dr. Elizabeth Kubler-Ross in her landmark book On death and dying observed "maybe at the end of our days, when we have worked and given, enjoyed ourselves and suffered, we are going back to the stage that we started out with and the circle of life is closed." Just as human life expectancy has steadily increased over the last 4 or 5 decades, animal life expectancy has increased, including that of zoologic species. With this has come a need for humans to openly and frankly deal with end-of-life issues for themselves and for their animals, including those in zoos. By necessity, zoos have been dealing with problems such as aggressive pain management and triage, and efforts to incorporate end-of-life care into zoologic medicine. But these efforts have yet to include formal acknowledgment that they are a basic form of hospice. Hospice for humans, and now for companion animals, includes much more than pain relief and geriatric care. This article reviews the concepts and basic practices of hospice and the closely related field of palliative care, their relatively recent application to companion animal care, potential applications to zoologic medicine, and the ways this could provide opportunities for personal growth of zoo visitors and staff, including veterinary staff.

  17. Skin cancer in patients with psoriasis

    Egeberg, A; Thyssen, J P; Gislason, G H


    BACKGROUND: Psoriasis is a chronic inflammatory skin disease that is commonly treated with ultraviolet phototherapy and systemic immunosuppressant drugs, which may confer a risk of skin cancer. Previous studies on the risk of skin cancer in patients with psoriasis have shown conflicting results....... OBJECTIVES: We investigated the risk of new-onset melanoma and non-melanoma skin cancer (NMSC), respectively, in a large cohort of patients with psoriasis and psoriatic arthritis. METHODS: Data on all Danish individuals aged ≥18 years between 1 January 1997 and 31 December 2012 were linked at individual...... of skin cancer is only modestly increased in patients with psoriasis, clinicians should remain vigilant....

  18. Application of the VALUE communication principles in ACTIVE hospice team meetings.

    Washington, Karla T; Wittenberg-Lyles, Elaine; Parker Oliver, Debra; Demiris, George; Shaunfield, Sara; Crumb, Edith


    The ACTIVE (Assessing Caregivers for Team Intervention through Video Encounters) intervention uses technology to enable family caregivers to participate in hospice interdisciplinary team (IDT) meetings from geographically remote locations. Previous research has suggested that effective communication is critical to the success of these meetings. The purpose of this study was to explore communication in ACTIVE IDT meetings involving family caregivers and to assess the degree to which hospice teams use specific communication principles (summarized in the mnemonic VALUE: value, acknowledge, listen, understand, and elicit), which have been supported in previous research in intensive care settings. Researchers analyzed team-family communication during 84 video- and/or audio-recorded care plan discussions that took place during ACTIVE team meetings, using a template approach to text analysis to determine the extent and quality of VALUE principles. The total content analyzed was 9 hours, 28 minutes in length. Hospice clinicians routinely employed the VALUE communication principles in communication during ACTIVE IDT meetings with family caregivers, but the quality of this communication was frequently rated moderate or poor. The majority of such communication was task-focused. Less often, communication centered on emotional concerns and efforts to gain a more holistic understanding of patients and families. This analysis suggests an opportunity for improving support for family members during ACTIVE IDT meetings. Members of hospice IDTs should remain aware of the opportunity for additional attention to the emotional realities of the hospice experience for family caregivers and could improve support for family caregivers during IDT meetings by ensuring that messages used to exemplify VALUE principles during team-family communication are of a high quality.

  19. Spiritual concerns in Hindu cancer patients undergoing palliative care: A qualitative study

    Srinagesh Simha


    Full Text Available Aims: Spiritual concerns are being identified as important components of palliative care. The aim of this study was to explore the nature of spiritual concerns in cancer patients undergoing palliative care in a hospice in India. Materials and Methods: The methodology used was a qualitative method: Interpretive phenomenological analysis. A semi-structured interview guide was used to collect data, based on Indian and western literature reports. Certain aspects like karma and pooja, relevant to Hindus, were included. Theme saturation was achieved on interviewing 10 participants. Results: The seven most common spiritual concerns reported were benefit of pooja, faith in God, concern about the future, concept of rebirth, acceptance of one′s situation, belief in karma, and the question "Why me?" No participant expressed four of the concerns studied: Loneliness, need of seeking forgiveness from others, not being remembered later, and religious struggle. Conclusions: This study confirms that there are spiritual concerns reported by patients receiving palliative care. The qualitative descriptions give a good idea about these experiences, and how patients deal with them. The study indicates the need for adequate attention to spiritual aspects during palliative care.

  20. Legal Reflection on Hospice Social Work Service in China%对我国开展宁养服务的法律思考



    我国的宁养服务是专门针对贫困家庭的晚期癌症患者所提供的医学和人文服务。当前,在我国开展宁养服务还存在着医疗服务缺乏规范、社会工作者缺乏培训和志愿服务者缺乏引导等问题,鉴此,应进行专门的立法加以解决。%Hospice social work service in China is a kind of medical and humanistic service provided for pa-tients with advanced cancer from poor families. In the process of providing hospice social work service in China, there are some legal obstacles such as the lack of specifications in medical services, the lack of training for social workers, the lack of guiding for volunteers, etc. , which should be solved by special legislation.

  1. Fostering hope in the patient with cancer.

    Lichwala, Rebecca


    When a patient is diagnosed with cancer, feelings such as fear, anxiety, and hopelessness can negatively affect a person's frame of mind. Hope can help a patient decrease anxiety and increase quality of life. Nurses should assess hope, provide interventions, be empathetic, listen, and treat patients with dignity to help improve hope and quality of life. This article features how hope can have a positive impact and provides specific information about how nurses can promote and foster hope in patients with cancer.

  2. Safety of anticoagulant treatment in cancer patients

    Wilts, Ineke Theodora; Bleker, Suzanne Mariella; Van Es, Nick; Buller, Harry Roger; Di Nisio, Marcello; Kamphuisen, Pieter Willem


    Introduction: Patients with cancer are at increased risk of (recurrent) venous thronnboembolism. They are also at increased risk of bleeding. This makes treatment of venous thromboembolisms (VTE) in cancer patients challenging. Areas covered: In this review, we will focus on the safety of anticoagul

  3. Cancer Care Initiative: Creation of a Comprehensive Cancer Center at Naval Medical Center Dan Diego


    clinic had Cancer Care Initiative 6 a dedicated satellite pharmacy staffed by a part-time pharmacist who prepared chemotherapy solutions...patient education information; 80% want clinical research trials; and 79% want end-of-life palliative care to be included as part of a CCC. Physicians...prevention, early detection, staging evaluation, initial and subsequent treatment, long-term follow-up, palliative and hospice care , and supportive

  4. The lipid peroxidation in breast cancer patients.

    Kedzierska, Magdalena; Olas, Beata; Wachowicz, Barbara; Jeziorski, Arkadiusz; Piekarski, Janusz


    The aim of our study was to estimate oxidative stress (by using different biomarkers of lipid peroxidation--isoprostanes and thiobarbituric acid reactive substances (TBARS)) in patients with invasive breast cancer, patients with benign breast diseases and in a control group. We observed a statistically increased level of TBARS in plasma and isoprostanes in urine of patients with invasive breast cancer in comparison with a control group. The concentration of tested biomarkers in plasma or urine from patients with invasive breast cancer was also higher than in patients with benign breast diseases. Moreover, the levels of tested markers in patients with benign breast diseases and in a control group did not differ. Considering the data presented in this study, we suggest that free radicals induce peroxidation of unsaturated fatty acid in patients with breast cancer.

  5. 235例患者临终关怀现状调查及其影响因素分析%The Current Situation of Hospice Care and Influencing Factors in 235 Cases

    辛爱利; 阎向东; 王彩燕


    Objective:To survey the level of hospice care and the influencing factors in Shaanxi province. Methods:Interview and return visit method was used to investigate. Results:In total 235 patients, 37. 02% patients received hos-pice care. There is not significant difference between hospice users and no hospice users in sex and geographic differ-ences. There was significant difference between hospice users and no hospice users in personal ages, and in gap between urban and rural areas. and in medical payment, and in basic lesions. Malignant tumor patients receive hospice care most-ly. No patient received hospice care patients with acute trauma. The effect of ages on hospice is maximum ( OR =2. 877). Basic lesions is an important cause of influence whether patients receiving hospice care services(OR=1. 569). Conclusion:The level of hospice care is low in Shaanxi. The age and basic lesions is influencing factors of hospice care. The geographic differences has no effect on hospice care.%目的:了解陕西地区临终关怀现状,分析其影响因素。方法采用门诊访谈和回访两种调查方法。结果在235例被调查患者中,37.02%的患者接受了临终关怀服务;患者在性别、所在地区两方面无显著性差异,在年龄、城乡差别、医疗付费方式方面存在显著性差异;基础病变明显影响临终关怀,恶性肿瘤患者接受临终关怀最多,急性外伤患者无1例接受临终关怀服务;年龄对临终关怀影响最大( OR=2.877);基础疾病则是影响患者是否接受临终关怀服务的重要原因( OR=1.569)。结论陕西地区临终关怀处于较低水平;年龄、基础疾病是影响临终关怀的因素;地域差别对临终关怀无影响。

  6. Internet health resources and the cancer patient.

    Huang, George J; Penson, David F


    The last decade has witnessed an explosion of online information regarding cancer and healthcare. Accompanying this has been a large body of research analyzing the quality of this information, how patients perceive these data and how this affects the doctor-patient relationship. This report reviews this literature, summarizing the current state of internet health resources available to the cancer patient and identifying areas for future research. Studies indicate that there are considerable internet resources available to cancer patients and that patients are using these resources as secondary information sources. Specifically, studies indicate that 16-64% of patients are using the internet to obtain health information. For the most part, patients perceive the online information to be reliable but maintain a healthy degree of skepticism. Studies objectively evaluating cancer information on the internet indicate that there is reasonable quality, although the language level of many sites is higher than that of the average American, which may limit the utility of the websites. Finally, while there is widespread internet use by physicians, healthcare providers are skeptical of their patients' ability to use the internet and may even be somewhat threatened by it. In summary, while there is a fairly large literature on internet resources available to the cancer patient, more research is needed. Specifically, it is important to better understand how patients access health information online and their associated preferences so that we can improve cancer patient's access to high quality health information on the internet to facilitate decision-making and health outcomes.

  7. Palliative care experiences of adult cancer patients from ethnocultural groups: a qualitative systematic review protocol.

    Busolo, David; Woodgate, Roberta


    bring about a sense of identity that may encompass a common language and religion. Ethnicity is fluid and should not be confused with nationality or migration or race. In this review, we define ethnicity in relation to the self-identification of participants in studies that will be included in the review.Culture refers to patterns of explanatory models, beliefs, values and customs. These patterns may be informed and expressed in things like diet, clothing or rituals, or in the form of language and social or political systems. Culture may be fluid because of developments in people's lives. In light of the aforementioned definitions, and recognizing the inconsistency in how these terms are sometimes used, the authors of this review define ethnocultural patients, as described in papers to be reviewed, as those who belong to an ethnic group by way of involvement, attachment, self-labelling or attitude towards the group, and who share cultural traditions, ancestry, language, nationality or country of origin.Palliative care in the context of cancer focuses on the improvement of the quality of life of patients by addressing their physical, emotional and spiritual needs, and by supporting their families. Palliative care is often associated with supportive and hospice care. Supportive care emphasizes meeting patients' needs such as physical, mental, social, psychological, emotional and material needs from the period before diagnosis, during diagnosis, treatment to the follow-up period in the cancer trajectory. Hospice care in the context of cancer aims to relieve patients' pain and suffering, and improve their quality of life. Hospice care includes palliative care services and other services such as case management, respite care and bereavement care. Hospice care focuses on patients with terminal illness (i.e. with expected survival of less than six months) and their families. Moreover, hospice care is facilitated by a multidisciplinary team of physicians, nurses, social workers

  8. Understanding male cancer patients' barriers to participating in cancer rehabilitation

    Handberg, Charlotte; Lomborg, Kirsten; Nielsen, Claus Vinther


    . The findings can guide practice to develop research-based rehabilitation approaches focused on preserving control and normality. Further empirical evidence is needed to: (1) explore the conduct of health professionals' towards male cancer patients and (2) address gender inequalities in cancer rehabilitation....

  9. Undergraduate nursing students caring for cancer patients: hermeneutic phenomenological insights of their experiences.

    Charalambous, Andreas; Kaite, Charis


    The care of patients suffering from cancer and especially those facing the death trajectory appears to be complex and demanding not only for student nurses but for professional nurses as well. The educational models often used in nursing require students to face challenging care scenarios, sometimes with minimal or no supervision and guidance. These "worst case scenarios" can be traumatic experiences that can leave the student hopeless and disappointed of themselves and in many cases can "scar" their subsequent professional career. The literature demonstrates that this can be the result of the students' ill-preparation to care for cancer patients and deal with death and dying. The purpose of this study was to interpret the students' experiences of coming face-to-face with cancer care during their clinical placements. This is a hermeneutic phenomenological study influenced by the ideas of the French Philosopher Paul Ricoeur. Based on this philosophical enquiry the interpretation process included three stages: 1) naïve reading, 2) structural analysis and 3) comprehensive understanding. Data were collected through reflective/narrative diaries from the 4th grade undergraduate (pre-registration) nursing students practicing at oncology, hematology, pediatric oncology departments and hospices. Diaries of twelve students met the inclusion criteria and were included in the interpretation process. The study took place during January and May 2011. The interpretation yielded the following themes: a) Being part of the center's life, b) Being sympathetic, c) Being confronted by others, d) Being self-reflective, e) Being trapped in the system, f) Being caring towards the family and g) Being better in clinical practice. The students emphasized the need for appropriate preparation both at a theoretical and at a clinical level, as to better confront situations involving death and dying as well as learning techniques for crisis management. The students perceived the importance of

  10. Analysis of the health resources and service situation of the registered hospice care institutions in Pudong New District of Shanghai%上海市浦东新区注册临终关怀机构卫生资源和服务现状分析

    王华萍; 施永兴


    Objective: To investigate and analyze the health resources and service situation of the hospice care institutions in Pudong New District of Shanghai. Methods:A structure questionnaire survey approach was taken to investigate the hospice care resources and service situation of 2 registered hospice care medical institutions in Pudong New District of Shanghai, whose survey contents included the hardware conifguration, stafifng, utilization of service resources and operation of the medical institutions. Results: There were 20 hospice care sickbeds in the 2 investigated hospice institutions, which accounted for 5.00% of the total approved sickbeds. The practicing physicians accounted for 2.00% of the total numbers of the employees, and the registered nurses 3.32%. The volunteers and care workers also participated in the hospice care. The died patients in the hospice care wards were 71, accounting for 47.97%of the total number of the discharged patients from the hospice care departments. The top ifve diseases of the patients discharged from the institutions were lung cancer, colon cancer, stomach cancer, liver cancer, and cardiovascular and cerebrovascular diseases. The using ratio of the hospice care sickbeds was 46.93%in two medical institutions and the average length for the hospital care was 28.48 days per person. Conclusion:The hospice service conifguration has been initially formed in 2 medical institutions which can provide the related hospice care service. However, there exit low bed utilization rate, the shortage of service personnel and operating funds and other issues. Based on strengthening the construction of the discipline and personnel training of the hospice care, the promotion and awareness of the hospice care should be strengthened.%目的:调查并分析上海市浦东新区临终关怀医疗机构的卫生资源与服务现状。方法:采用结构式问卷调查方法,调查上海市浦东新区2所注册的临终关怀医疗机构

  11. Social Work Assessment Notes: A Comprehensive Outcomes-Based Hospice Documentation System.

    Hansen, Angela Gregory; Martin, Ellen; Jones, Barbara L; Pomeroy, Elizabeth C


    This article describes the development of an integrated psychosocial patient and caregiver assessment and plan of care for hospice social work documentation. A team of hospice social workers developed the Social Work Assessment Notes as a quality improvement project in collaboration with the information technology department. Using the Social Work Assessment Tool as an organizing framework, this comprehensive hospice social work documentation system is designed to integrate assessment, planning, and outcomes measurement. The system was developed to guide the assessment of patients' and caregivers' needs related to end-of-life psychosocial issues, to facilitate collaborative care plan development, and to measure patient- and family-centered outcomes. Goals established with the patient and the caregiver are documented in the plan of care and become the foundation for patient-centered, strengths-based interventions. Likert scales are used to assign numerical severity levels for identified issues and progress made toward goals and to track the outcome of social work interventions across nine psychosocial constructs. The documentation system was developed for use in an electronic health record but can be used for paper charting. Future plans include automated aggregate outcomes measurement to identify the most effective interventions and best practices in end-of-life care.

  12. Cancer surveillance of patients from familial pancreatic cancer kindreds.

    Brentnall, T A


    The family history can be used to determine which family members warrant surveillance and when to start it. Surveillance should be started at least 1 decade before the earliest age of pancreatic cancer in the family. EUS is the basic, least-invasive surveillance tool; however, findings are similar to those seen in chronic pancreatitis. All patients who have a positive EUS or who have symptoms warrant ERCP. Changes on ERCP of ductal stricturing and clubbed or saccular side branches are suggestive of patients who may need pancreatectomy in the setting of hereditary pancreatic cancer. The goal for surveillance of familial pancreatic cancer patients is to diagnose them before the development of cancer, when they have dysplasia or carcinoma in situ, and to perform a complete pancreatectomy. Timing is crucial for determining when a patient warrants surgery; if performed too early, the patient is put at risk for the morbidity and mortality of a total pancreatectomy, which is not inconsequential. If the patient survives the operation, he or she is often left a brittle diabetic. The alternative of diagnosing too late is more worrisome because the patient dies of pancreatic cancer. An essential ingredient to a good patient outcome is a team approach to these patients, using gastroenterologists, surgeons, and pathologists who have expertise and interest in pancreatic disease.

  13. Psychosocial Intervention In Prostate Cancer Patients

    Potočníková Jana


    Full Text Available Prostate cancer is the second most common cancer worldwide for males, and the fifth most common cancer overall. Using of autogenic training could reduce the influence of ADT and raise quality of prostate cancer patients. The aim of this study was to determine the effects of autogenic training in patients with prostate cancer. Patients were divided to experimental and control group. Experimental group participated in fourteen weeks long autogenic training program. Control group performed usual daily activities. Every subject of research performed input and output diagnostics which monitored psychical states of patients by psychological standardized tests - Differential questionnaire of depression (DDF and Questionnaire of anxiety (STAI X1. Our data showed autogenic training program significant improved depressions symptoms and anxiety in experimental research group (p ≤ 0.05, however there was no main change of depression symptoms and anxiety values for control group (p = n.s..

  14. Cancer in Patients With Gabapentin (GPRD)


    Pain, Neuropathic; Epilepsy; Renal Pelvis Cancer; Pancreatic Cancer; Breast Cancer; Nervous System Cancer; Chronic Pancreatitis; Stomach Cancer; Renal Cell Carcinoma; Diabetes; Bladder Cancer; Bone and Joint Cancer; Penis Cancer; Anal Cancer; Cancer; Renal Cancer

  15. Prognostic factors in young ovarian cancer patients

    Klar, M; Hasenburg, A; Hasanov, M;


    OBJECTIVES: We evaluated in a large study meta-database of prospectively randomised phase III trials the prognostic factors for progression-free survival (PFS) and overall survival (OS) in patients 40 years of age with advanced epithelial ovarian cancer. METHODS: A total of 5055 patients...... epithelial ovarian cancer, excellent performance status, who had received complete macroscopic upfront cytoreduction and ≥5 chemotherapy cycles. RESULTS: For patients

  16. The effect of pediatric knowledge on hospice care costs.

    Lindley, Lisa C; Mixer, Sandra J; Cozad, Melanie J


    The cost of hospice care is rising. Although providing care for children at end of life may be costly for hospices, it is unclear whether or not gaining pediatric knowledge and even establishing a pediatric program may be done cost effectively. The purpose of our study was to examine the effect of possessing pediatric knowledge (i.e., pediatric program, pediatric experience) on core hospice care costs. Using 2002 to 2008 California hospice data, the findings of the regression analysis suggest that having pediatric knowledge does not significantly increase nursing, physician, and medical social service costs. Having a pediatric program was related to increased counseling costs. Our findings shed important light on the minimal costs incurred when hospices decide to develop pediatric knowledge.

  17. The impact on families of a children's hospice program.

    Davies, Betty; Collins, John B; Steele, Rose; Pipke, Ingrid; Cook, Karen


    Pediatric hospice is a relatively new development in the field of hospice care. This article reports on an evaluation project that examined the effect of the Canuck Place children's hospice program on the families it served during its first two and a half years of operation. Using the principles of participatory action research, data were collected from individual interviews, focus groups, and mail-out surveys of families who used the program. Sixteen categories of hospice program effect were found to summarize how families regarded, used, and assessed their experiences. Families overwhelmingly endorsed the Canuck Place program. They also provided helpful suggestions for improvement and growth, particularly during the program's formative years. Recommendations are made with a view to promoting and solidifying the ongoing success of the Canuck Place program, as well as of children's hospice programs in general.

  18. 42 CFR 418.400 - Individual liability for coinsurance for hospice care.


    ... 42 Public Health 3 2010-10-01 2010-10-01 false Individual liability for coinsurance for hospice... HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HOSPICE CARE Coinsurance § 418.400 Individual liability for coinsurance for hospice care. An individual who has filed an election for hospice care...

  19. 42 CFR 418.308 - Limitation on the amount of hospice payments.


    ... 42 Public Health 3 2010-10-01 2010-10-01 false Limitation on the amount of hospice payments. 418... HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HOSPICE CARE Payment for Hospice Care § 418.308 Limitation on the amount of hospice payments. (a) Except as specified in paragraph (b) of this section,...

  20. Cancer patients and characteristics of pulmonary embolism

    Hasenberg, U.; Paul, T. [Department of Radiology, University Hospital Essen (Germany); Feuersenger, A. [Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen (Germany); Goyen, M. [Department of Radiology, University Medical Center Hamburg-Eppendorf (Germany); Kroeger, K. [Department of Angiology, University Hospital Essen (Germany)], E-mail:


    Objective: To check the hypothesis that cancer patients suffer from extended pulmonary embolism (PE) more frequently than patients without cancer we analysed PEs proved by computed tomography (CT)-imaging. Patients and methods: One hundred and fifty consecutive CT scans at the University Hospital of Essen from March 2002 until December 2004 which proved a definite case of pulmonary embolism were retrospectively reviewed (79 men, 71 women; mean age 57 {+-} 15 years). Underlying disease and blood parameters were included (haemoglobin, haematocrit, fibrinogen and total protein, if determined within 48 h before the CT scans). Results: Patients with malignant disease were older (59 {+-} 12 years vs. 54 {+-} 19 years, p = 0.05) and tend to have a higher rate of central PEs (52% vs. 34%, p = 0.08) than patients without malignancies. The odds of a central PE in cancer patients was about twice as high as in patients without a malignant disease (Odds ratio: 2.08, 95%-confidence interval: 1.06-4.10; age-adjusted Odds ratio 1.88, 95%-confidence interval: 0.92-3.84). Additional adjustment for the clinical information dyspnoea, inhospital patient and clinically expected PE did not deteriorate the odds. Thrombus density determined in patients with central PE only shows a trend towards a lower density in patients with malignant disease (52 {+-} 13 HE vs. 45 {+-} 15 HE, p = 0.13). There is no statistical evidence that thrombus density is related to one of the blood parameters or even blood density measured in the pulmonary artery. Conclusion: Although this is a retrospective study including a small number of patients it shows that cancer patients are at a higher risk for central PE than patients without cancer. Characteristics of the intrapulmonal thrombus in cancer and non-cancer patients seem to be different.

  1. Oral cancer knowledge among Turkish dental patients

    Melda Misirlioglu


    Full Text Available Aims: To determine the level of oral cancer awareness and knowledge among patients referred to the Department of Oral and Maxillofacial Radiology in Central Anatolia. Settings and Design: The study was conducted with 1,125 patients who applied to the school of dentistry for routine dental examinations. The authors collect information with a 20-item written questionnaire from the participants about oral cancer risk factors, epidemiology, etiology, and signs and symptoms. Statistical Analysis: Descriptive statistics of demographic variables and other data were reported as means and percentages. Statistical analysis was performed by means of SPSS +11.0 statistical package. Results: Overall, only 48.9% of all patients showed awareness of oral cancer, with awareness especially poor among lower socioeconomic groups. Awareness of oral cancer risk factors and signs and symptoms did not vary significantly between men and women (P > 0.5; however, older participants (aged 40-64 years were more familiar with oral cancer signs than younger participants. More than half of all participants (56.8% were unaware of the common clinical presentations of oral cancer. Conclusions: The results of this survey showed knowledge regarding oral cancer to be quite low. Thus, educational programs are needed to increase public awareness about oral cancer, and dentists should request patients undergo examinations for oral cancer to ensure early detection.

  2. [Touching cancer: shiatsu as complementary treatment to support cancer patients].

    Argash, Oz; Caspi, Opher


    In recent years there has been an increase in the interest of cancer patients in receiving complementary medicine therapies as supportive measures to cure the disease. In response, medical units that combine conventional and complementary medicine (integrative medicine) have been established in leading cancer centers worldwide. In Israel, a special integrative medicine unit that combines mind-body, Chinese medicine, nutrition, herbs, supplements, and manual therapies (such as shiatsu) before, during and after conventional anti-cancer therapies has been established as an integral part of the Davidoff Comprehensive Cancer Center in 2006. Shiatsu represents a group of manual therapeutic techniques, including acupressure. Shiatsu offers cancer patients a non-pharmacologic method to relieve symptoms and improve quality of life throughout the course of illness. Research indicates that acupressure is relatively effective and safe for common cancer-related symptoms such as nausea, vomiting and insomnia. In our experience, shiatsu is also relatively effective and safe for other common symptoms such as fatigue, muscular pain and body image dissatisfaction. Yet, insufficient evidence exists to delineate the best means by which shiatsu and other manual therapies could or should be integrated into routine cancer care. The purpose of the present paper is to describe what is currently known about this topic in order to support decision-making that is based on facts, rather than on myths and misconceptions. We call for more research that examines the effectiveness and safety of shiatsu and other manual therapies in the care of cancer patients.

  3. Medicare Program; FY 2017 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements. Final rule.


    This final rule will update the hospice wage index, payment rates, and cap amount for fiscal year (FY) 2017. In addition, this rule changes the hospice quality reporting program, including adopting new quality measures. Finally, this final rule includes information regarding the Medicare Care Choices Model (MCCM).

  4. An exploratory investigation of hospice marketing: How are palliative care providers marketing their services?

    Matthews, Michael; Peters, Cara; Lawson, Stephanie


    Hospice and palliative care is a recent, but fast growing, industry in healthcare. Demographics suggest that hospice care will only increase. The purpose of this article is to examine strategic marketing initiatives hospice organizations currently employ. Data were collected at a hospice regional conference, capturing opinions from hospice organizations located in North and South Carolina. The results show that many hospice organizations do not have a dedicated marketing staff person, have a limited marketing budget, do not fully utilize all strategic planning tools, and have yet to differentiate themselves via branding. Implications of these findings for hospice providers are discussed.

  5. Supportive care needs of Iranian cancer patients

    Azad Rahmani


    Full Text Available Background: A supportive needs assessment is an essential component of any care program. There is no research evidence regarding the supportive care needs of cancer patients in Iran or other Middle Eastern countries. Aims: The aim of this study was to determine the supportive care needs of Iranian cancer patients. Materials and Methods: This descriptive study was conducted in a referral medical center in the northwest of Iran. A total of 274 cancer patients completed the Supportive Care Needs Survey (SCNS-59. Descriptive statistics were used for data analysis. Results: In 18 items of the SCNS, more than 50% of the participants reported that their needs were unmet. Most frequently, unmet needs were related to the health system, information, physical, and daily living domains, and most met needs were related to sexuality, patient care, and support domains. Conclusions: Iranian cancer patients experience many unmet needs and there is an urgent need for establishing additional supportive care services in Iran.

  6. Gastric cancer patients at high-risk of having synchronous cancer

    Jun Ho Lee; Jae-Gahb Park; Jae-Moon Bae; Ja Seong Bae; Keun Won Ryu; Jong Seok Lee; Sook Ryun Park; Chan Gyoo Kim; Myoung Cheorl Kook; Il Ju Choi; Young Woo Kim


    AIM: To identify patients with a high-risk of having a synchronous cancer among gastric cancer patients.METHODS: We retrospectively analyzed the prospective gastric cancer database at the National Cancer Center,Korea from December 2000 to December 2004. The clinicopathological characteristics of patients with synchronous cancers and those of patients without synchronous cancers were compared. Multivariate analysis was performed to identify the risk factors for the presence of a synchronous cancer in gastric cancer patients.RESULTS: 111 of 3291 gastric cancer patients (3.4%)registered in the database had a synchronous cancer.Among these 111 patients, 109 had a single synchronous cancer and 2 patients had two synchronous cancers. The most common form of synchronous cancer was colorectal cancer (42 patients, 37.2%) followed by lung cancer (21 patients, 18.6%). Multivariate analyses revealed that elderly patients with differentiated early gastric cancer have a higher probability of a synchronous cancer.CONCLUSION: Synchronous cancers in gastric cancer patients are not infrequent. The physicians should try to find synchronous cancers in gastric cancer patients,especially in the elderly with a differentiated early gastric cancer.

  7. Depression in cancer patients: a critical review

    Pasquini Massimo


    Full Text Available Abstract Cancer patients experience several stressors and emotional upheavals. Fear of death, interruption of life plans, changes in body image and self-esteem, changes in social role and lifestyle are all important issues to be faced. Moreover, Depressive Disorders may impact the course of the disease and compliance. The cost and prevalence, the impairment caused, and the diagnostic and therapeutic uncertainty surrounding depressive symptoms among cancer patients make these conditions a priority for research. In this article we discuss recent data, focusing on detection of Depressive Disorders, biological correlates, treatments and unmet needs of depressed cancer patients.

  8. Classification of neuropathic pain in cancer patients

    Brunelli, Cinzia; Bennett, Michael I; Kaasa, Stein


    Neuropathic pain (NP) in cancer patients lacks standards for diagnosis. This study is aimed at reaching consensus on the application of the International Association for the Study of Pain (IASP) special interest group for neuropathic pain (NeuPSIG) criteria to the diagnosis of NP in cancer patients...... was found on the statement "the pathophysiology of NP due to cancer can be different from non-cancer NP" (MED=9, IQR=2). Satisfactory consensus was reached for the first 3 NeuPSIG criteria (pain distribution, history, and sensory findings; MEDs⩾8, IQRs⩽3), but not for the fourth one (diagnostic test....../imaging; MED=6, IQR=3). Agreement was also reached on clinical examination by soft brush or pin stimulation (MEDs⩾7 and IQRs⩽3) and on the use of PRO descriptors for NP screening (MED=8, IQR=3). Based on the study results, a clinical algorithm for NP diagnostic criteria in cancer patients with pain...

  9. Second cancers in patients with neuroendocrine tumors.

    Hui-Jen Tsai

    Full Text Available BACKGROUND: Second cancers have been reported to occur in 10-20% of patients with neuroendocrine tumors (NETs. However, most published studies used data from a single institution or focused only on specific sites of NETs. In addition, most of these studies included second cancers diagnosed concurrently with NETs, making it difficult to assess the temporality and determine the exact incidence of second cancers. In this nationwide population-based study, we used data recorded by the Taiwan Cancer Registry (TCR to analyze the incidence and distribution of second cancers after the diagnosis of NETs. METHODS: NET cases diagnosed from January 1, 1996 to December 31, 2006 were identified from the TCR. The data on the occurrence of second cancers were ascertained up to December 31, 2008. Standardized incidence ratios (SIRs of second cancers were calculated based on the cancer incidence rates of the general population. Cox-proportional hazards regression analysis was performed to estimate the hazard ratio (HR and 95% confidence interval (CI for the risk of second cancers associated with sex, age, and primary NET sites. RESULTS: A total of 1,350 newly diagnosed NET cases were identified according to the selection criteria. Among the 1,350 NET patients, 49 (3.63% developed a second cancer >3 months after the diagnosis of NET. The risk of second cancer following NETs was increased compared to the general population (SIR = 1.48, 95% CI: 1.09-1.96, especially among those diagnosed at age 70 or older (HR = 5.08, 95% CI = 1.69-15.22. There appeared to be no preference of second cancer type according to the primary sites of NETs. CONCLUSIONS: Our study showed that the risk of second cancer following NETs is increased, especially among those diagnosed at age 70 or older. Close monitoring for the occurrence of second cancers after the diagnosis of NETs is warranted.

  10. [The first hospice for the dying in Europe? The 'Hundertsuppen'--hospital in Nuremberg 1770-1813].

    Stolberg, Michael


    Hospices for terminally ill and dying patients have so far been considered an 'invention' of the late 19th century. Based on the analysis of admission journals and other archival sources, this paper presents the hospital 'Hundertsuppe' in Nuremberg as an institution which already exhibited most characteristics of a modern hospice 100 years before that. Established, in 1770, as a hospital for chronic diseases, it served almost from the start primarily as an institution for fatally ill, poor patients, who could spend the last months, weeks or days of their life in relative comfort, with nursing and spiritual and medical care. This primary function was explicitly accepted by those in charge of the hospital. It is evidenced by an extraordinarily high mortality of almost 70%, with almost two-thirds of the patients staying for less than 3 months and 'consumption' being the foremost cause of death. In conclusion, the 'Hundertsuppe' is discussed as an exemplary case of an institution for the dying which arose due to the insufficient care for incurable and dying patients in the new 'curative' hospitals; the first English hospices in the late 19th century and the influential St. Christopher's Hospice in the 1960s, commonly attributed to charismatic individual founding figures like Howard Barrett and Cicely Saunders, are shown to have originated from similar contexts.

  11. Understanding the association between employee satisfaction and family perceptions of the quality of care in hospice service delivery.

    York, Grady S; Jones, Janet L; Churchman, Richard


    Families often draw their conclusions about the quality of care received by a family member during the last months of life from their interactions with professional caregivers. A more comprehensive understanding of how these relationships influence the care experience should include an investigation of the association between employee job satisfaction and family perception of the quality of care. This cross-sectional study investigated the association at a regional hospice. Using the Kendall's tau correlation, employee satisfaction scores for care teams trended toward a positive correlation with family overall satisfaction scores from the Family Evaluation of Hospice Care (tau=0.47, P=0.10). A trend for differences in employee satisfaction between the care teams to associate with differences in overall family perceptions of the quality of care also was found using the Kruskal-Wallis analysis of variance (chi(2)(K-W)=9.236, P=0.075). Post hoc tests indicated that overall family perceptions of quality of care differed between the hospice's Residence Team and Non-Hospice Facilities Team. Finally, positive associations between employee satisfaction and the families' Intent to recommend hospice (tau=0.55, P=0.059) and Inform and communicate about patient (tau=0.55, P=0.059) were noted. Selected employee and family comments provide complementarity to further clarify or explain the respondent data. These results suggest that employee satisfaction is associated with family perceptions of the quality of hospice care. Opportunities for improving both employee job satisfaction and family perceptions of the quality of care are discussed.

  12. [Colorectal cancer in spouses of colorectal cancer patients].

    Matsumata, T; Shikada, Y; Hasuda, S; Kishihara, F; Suehiro, T; Funahashi, S; Nagamatsu, Y; Iso, Y; Shima, I; Koga, C; Osamura, S; Ueda, M; Furuya, K; Sakino, I


    Married couples share home environments and life style for years. In the case of colorectal cancer, an association with insulin resistance was reported. We determined the presence of the insulin-resistance syndrome (IRS, 1 or more of the following: body mass index of > 25 kg/m2, diabetes, or hyperlipidemia) in 84 colorectal cancer patients, of whom 61 patients (73%) had IRS. The incidence of the distal colorectal cancer, which has been declining in the United States, was significantly higher in the IRS group than in the non-IRS group (75.4 vs 52.2%, p = 0.0400). Some mechanisms may promote the progression of mucosal lesions to invasive cancers in the distal colorectum. There were no significant differences with respect to the age (64.6 +/- 9.4 vs 64.3 +/- 11.3 yr, p = 0.8298), height (159 +/- 9 vs 157 +/- 8 cm, p = 0.1375), and body mass index (22.2 +/- 3.6 vs 22.4 +/- 2.7 kg/m2, p = 0.6364) between the patients and their spouses. In 84 couples in whom colorectal cancer develops at least in one may then not illustrate the nursery rhyme: "Jack Sprat could eat no fat, His wife could eat no lean...". The spouses had been married for an average of 38 years, and in 30 spouses who had been followed in a colorectal cancer screening, 5 developed colorectal cancer. To diminish the incidence of colorectal cancer in Japan, we might advise screening colonoscopy to the spouses of colorectal cancer patients, or déjà vu all over again?

  13. Optimal management of breast cancer in the elderly patient: current perspectives

    Le Saux O


    Full Text Available Olivia Le Saux,1 Bertrand Ripamonti,2 Amandine Bruyas,3,4 Olivier Bonin,4 Gilles Freyer,1,4 Marc Bonnefoy,4,5 Claire Falandry4,51Medical Oncology Unit, Lyon Sud University Hospital, Hospices Civils de Lyon, Pierre-Bénite, 2Gynaecology-Obstetrics Department, University Hospital, Saint-Etienne, 3Croix Rousse University Hospital, Hospices Civils de Lyon, Pierre-Bénite, 4Lyon University, Lyon, 5Geriatric Unit, Lyon Sud University Hospital, Hospices Civils de Lyon, Pierre-Bénite, FranceAbstract: Breast cancer (BC is the most common female malignancy in the world and almost one third of cases occur after 70 years of age. Optimal management of BC in the elderly is a real challenge and requires a multidisciplinary approach, mainly because the elderly population is heterogeneous. In this review, we describe the various possibilities of treatment for localized or metastatic BC in an aging population. We provide an overview of the comprehensive geriatric assessment, surgery, radiotherapy, and adjuvant therapy for early localized BC and of chemotherapy and targeted therapies for metastatic BC. Finally, we attempt to put into perspective the necessary balance between the expected benefits and risks, especially in the adjuvant setting.Keywords: elderly, breast cancer, geriatric assessment, surgery, chemotherapy, radiotherapy

  14. Escalation of oncologic services at the end of life among patients with gynecologic cancer at an urban, public hospital.

    Wu, Eijean; Rogers, Anna; Ji, Lingyun; Sposto, Richard; Church, Terry; Roman, Lynda; Tripathy, Debu; Lin, Yvonne G


    Use of oncology-related services is increasingly scrutinized, yet precisely which services are actually rendered to patients, particularly at the end of life, is unknown. This study characterizes the end-of-life use of medical services by patients with gynecologic cancer at a safety-net hospital. Oncologic history and metrics of medical use (eg, hospitalizations, chemotherapy infusions, procedures) for patients with gynecologic oncology who died between December 2006 and February 2012 were evaluated. Mixed-effect regression models were used to test time effects and construct usage summaries. Among 116 subjects, cervical cancer accounted for the most deaths (42%). The median age at diagnosis was 55 years; 63% were Hispanic, and 65% had advanced disease. Only 34% died in hospice care. The median times from do not resuscitate/do not intubate documentation and from last therapeutic intervention to death were 9 days and 55 days, respectively. Significant time effects for all services (eg, hospitalizations, diagnostics, procedures, treatments, clinic appointments) were detected during the patient's final year (P care used significantly fewer resources toward the end of life. To our knowledge, this is the first report enumerating medical services obtained by patients with gynecologic cancer in a large, public hospital during the end of life. Marked changes in interventions in the patient's final 2 months highlight the need for cost-effective, evidence-based metrics for delivering cancer care. Our data emphasize continuity of care as a significant determinant of oncologic resource use during this critical period. Copyright © 2015 by American Society of Clinical Oncology.

  15. Impact of subsequent metastases on costs and medical resource use for prostate cancer patients initially diagnosed with localized disease.

    Li, Tracy T; Shore, Neal D; Mehra, Maneesha; Todd, Mary B; Saadi, Ryan; Leblay, Gaetan; Aggarwal, Jyoti; Griffiths, Robert I


    The impact of subsequent metastases on costs and medical resource use (MRU) for prostate cancer (PC) patients initially diagnosed with localized disease was estimated. Surveillance, Epidemiology, and End Results data, linked to Medicare (1999-2012), were used to identify 7482 patients diagnosed with subsequent metastases 12 months or more after the initial diagnosis of localized PC (cases), and they were matched to 25,709 localized PC patients without subsequent metastases (controls). Patients were followed for costs and MRU from 12 months before their index date (subsequent metastases or a matched date for controls) up to 12 months after it. Costs and MRU were stratified by the setting/type of care/service. Multivariate mixed effects regression analyses were used to construct and compare longitudinal trajectories of marginal predicted costs and predicted probabilities of MRU between cases and controls. Among the controls, predicted monthly costs remained relatively stable throughout the entire observation period (weighted mean per patient per month, $2746; range during 24 months, $2603-2858). In contrast, among the cases, costs increased from $2622 (95% confidence interval [CI], $2525-2719) 12 months before the diagnosis of subsequent metastases to $4767 (95% CI, $4623-4910) 1 month before the diagnosis of subsequent metastases, peaked during the month of metastases at $13,291 (95% CI, $13,148-13,435), and remained significantly higher than costs for the controls thereafter (eg, $4677 at + 12 months; 95% CI, $4549-4805). Costs and MRU increased across a wide range of settings/types, including inpatient, outpatient, home health, and hospice settings. In PC patients initially diagnosed with localized disease, a diagnosis of subsequent metastases is associated with substantially increased costs and MRU. Cancer 2017;123:3591-601. © 2017 American Cancer Society. © 2017 American Cancer Society.

  16. Talking about death with terminally-ill cancer patients: What contributes to the regret of bereaved family members?

    Mori, Masanori; Yoshida, Saran; Shiozaki, Mariko; Baba, Mika; Morita, Tatsuya; Aoyama, Maho; Kizawa, Yoshiyuki; Tsuneto, Satoru; Shima, Yasuo; Miyashita, Mitsunori


    Talking about death is an important issue for terminally-ill cancer patients and their families. Little is known about how often and which bereaved families regret not having talked about death with their deceased loved one. To explore the prevalence of a regret of not having talked about death with a deceased loved one among bereaved family members of adult cancer patients, and to systematically explore factors contributing to their regret. We conducted a nationwide survey of 999 bereaved families of cancer patients admitted to 133 inpatient hospices in Japan and surveyed families' regret on talking about death. Exploratory analyses identified the underlying structures of process, option, and outcome subscales of factors contributing to regret. Among 678 bereaved families (response rate, 68%), 224 (33%) regretted not having talked about death sufficiently, while 40 (5.9%) conversely regretted having talked about death. Three process factors ( "prognostic disclosure to patient" (beta=0.082, p=0.039), "upsetting of patient and family" (beta=0.127, p=0.001), and "family's sense of uncertainty about when to act based on terminal awareness" (beta=0.141, p=0.000)) and an outcome factor ("having achieved a good death" (beta=-0.152, p=0.000)) contributed to the regret of talking insufficiently. A third of bereaved families of adult cancer patients regretted not having talked about death sufficiently. Clinicians may minimize this regret by facilitating a shared understanding of the disease and prognosis, advising families explicitly when to talk based on terminal awareness, providing continuous emotional support, and validating their decision on talking about death. Copyright © 2017. Published by Elsevier Inc.

  17. A Pilot Study of a Mobile Health Pain Coping Skills Training Protocol for Patients With Persistent Cancer Pain.

    Somers, Tamara J; Abernethy, Amy P; Edmond, Sara N; Kelleher, Sarah A; Wren, Anava A; Samsa, Greg P; Keefe, Francis J


    Pain coping skills training (PCST) interventions have shown efficacy for reducing pain and providing other benefits in patients with cancer. However, their reach is often limited because of a variety of barriers (e.g., travel, physical burden, cost, time). This study examined the feasibility and acceptability of a brief PCST intervention delivered to patients in their homes using mobile health (mHealth) technology. Pre-to-post intervention changes in pain, physical functioning, physical symptoms, psychological distress, self-efficacy for pain management, and pain catastrophizing also were examined. Patients with a diagnosis of breast, lung, prostate, or colorectal cancer who reported persistent pain (N = 25) participated in a four-session intervention delivered using mHealth technology (videoconferencing on a tablet computer). Participants completed measures of pain, physical functioning, physical symptoms, psychological distress, self-efficacy for pain management, and pain catastrophizing. We also assessed patient satisfaction. Participants completed an average of 3.36 (SD = 1.11) of the four intervention sessions for an overall session completion rate of 84%. Participants reported that the program was of excellent quality and met their needs. Significant preintervention to postintervention differences were found in pain, physical symptoms, psychological distress, and pain catastrophizing. The use of mHealth technology is a feasible and acceptable option for delivery of PCST for patients with cancer. This delivery mode is likely to dramatically increase intervention access for cancer patients with pain compared to traditional in-person delivery. Preliminary data also suggest that the program is likely to produce pretreatment to post-treatment decreases in pain and other important outcomes. Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  18. Utilizing Data from Cancer Patient & Survivor Studies

    Utilizing Data from Cancer Patient & Survivor Studies and Understanding the Current State of Knowledge and Developing Future Research Priorities, a 2011 workshop sponsored by the Epidemiology and Genomics Research Program.

  19. Cognitive Behavioral Therapy in Cancer Patients

    Cem Soylu


    Full Text Available Cognitive behavioral therapy is one of the structured but flexible psychosocial interventions that could be applied to patients with cancer. In many studies the positive effects of cognitive behavioral therapy in reducing psychological morbidity and improving the quality of life of cancer patients have been shown. In this article, the contents and techniques of adapted cognitive behavioral therapy for patients with cancer and its effectiveness in commonly seen psychiatric disorders have been reviewed. The aim of this article is to contribute positively to physicians and nurses in Turkey for early detection of psychological distress and referral to the therapist that would clearly increase the quality of life of cancer patients. [Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry 2014; 6(3.000: 257-270

  20. Cancer Patients' Informational Needs: Qualitative Content Analysis.

    Heidari, Haydeh; Mardani-Hamooleh, Marjan


    Understanding the informational needs of cancer patients is a requirement to plan any educative care program for them. The aim of this study was to identify Iranian cancer patients' perceptions of informational needs. The study took a qualitative approach. Semi-structured interviews were held with 25 cancer patients in two teaching hospitals in Iran. Transcripts of the interviews underwent conventional content analysis, and categories were extracted. The results came under two main categories: disease-related informational needs and information needs related to daily life. Disease-related informational needs had two subcategories: obtaining information about the nature of disease and obtaining information about disease prognosis. Information needs related to daily life also had two subcategories: obtaining information about healthy lifestyle and obtaining information about regular activities of daily life. The findings provide deep understanding of cancer patients' informational needs in Iran.

  1. Ovarian stimulation in patients with breast cancer.

    Muñoz, Elkin; González, Naira; Muñoz, Luis; Aguilar, Jesús; Velasco, Juan A García


    Breast cancer is the most prevalent malignancy among women under 50. Improvements in diagnosis and treatment have yielded an important decrease in mortality in the last 20 years. In many cases, chemotherapy and radiotherapy develop side effects on the reproductive function. Therefore, before the anti-cancer treatment impairs fertility, clinicians should offer some techniques for fertility preservation for women planning motherhood in the future. In order to obtain more available oocytes for IVF, the ovary must be stimulated. New protocols which prevent exposure to increased estrogen during gonadotropin stimulation, measurements to avoid the delay in starting anti-cancer treatment or the outcome of ovarian stimulation have been addressed in this review. There is no evidence of association between ovarian stimulation and breast cancer. It seems that there are more relevant other confluent factors than ovarian stimulation. Factors that can modify the risk of breast cancer include: parity, age at full-term birth, age of menarche, and family history. There is an association between breast cancer and exogenous estrogen. Therefore, specific protocols to stimulate patients with breast cancer include anti-estrogen agents such as letrozole. By using letrozole plus recombinant follicular stimulating hormone, patients develop a multifollicular growth with only a mild increase in estradiol serum levels. Controlled ovarian stimulation (COS) takes around 10 days, and we discuss new strategies to start COS as soon as possible. Protocols starting during the luteal phase or after inducing the menses currently prevent a delay in starting ovarian stimulation. Patients with breast cancer have a poorer response to COS compared with patients without cancer who are stimulated with conventional protocols of gonadotropins. Although many centres offer fertility preservation and many patients undergo ovarian stimulation, there are not enough studies to evaluate the recurrence, breast cancer

  2. Trends in length of hospice care from 1996 to 2007 and the factors associated with length of hospice care in 2007: findings from the National Home and Hospice Care Surveys.

    Sengupta, Manisha; Park-Lee, Eunice; Valverde, Roberto; Caffrey, Christine; Jones, Adrienne


    Using the National Home and Hospice Care Surveys, we examined trends in length of hospice care from 1996 to 2007 and the factors associated with length of care in 2007. Results suggest that the increasing average lengths of care over time reflect the increase in the longest duration of care. For-profit ownership is associated with hospice care received for over a year.

  3. Symptom monitoring in treatment of cancer patients


    Objective To examine self-reported symptoms by the patients receiving cancer therapy, and find out the symptoms that should be coped with and managed during the treatment. Methods A pilot study was conducted on self-reported symptoms on 185 patients receiving chemotherapy and/or radiotherapy for different cancers. The Therapy-Related Symptoms Checklist (TRSC) was used. Results Severe symptoms on the TRSC subscales: loss of appetite, feeling sluggish, weight loss, nausea and hair loss, were reported by the p...

  4. Transdermal fentanyl in cachectic cancer patients.

    Heiskanen, Tarja; Mätzke, Sorjo; Haakana, Soile; Gergov, Merja; Vuori, Erkki; Kalso, Eija


    Fentanyl is an opioid with high lipid solubility, suitable for intravenous, spinal, transmucosal and transdermal administration. The transdermal fentanyl patch has become widely used in the treatment of both malignant and non-malignant chronic pain. The absorption of fentanyl from the patch is governed by the surface area of the patch, by skin permeability and by local blood flow. The aim of this study is to find out whether absorption of fentanyl in cachectic patients with cancer-related pain is different from that of normal weight cancer patients. We recruited ten normal weight (mean body mass index (BMI) 23 kg/m(2)) and ten cachectic (mean BMI 16 kg/m(2)) cancer pain patients. A transdermal fentanyl patch with a dose approximately equianalgesic to the patients' previous opioid dose was administered to the upper arm of the patient for 3 days. Prior to patch application, the height, weight and BMI of the patient, as well as upper arm skin temperature, local sweating, thickness of skin fold and local blood flow were measured. Plasma fentanyl concentrations were analyzed from blood samples taken at baseline, 4, 24, 48 and 72 h. Plasma fentanyl concentrations adjusted to dose were significantly lower at 48 and 72 h in cachectic patients than normal weight patients. The cachectic patients had a significantly thinner upper arm skin fold, but no differences were found in local blood flow, sweating, or skin temperature. Absorption of transdermal fentanyl is impaired in cachectic patients compared with that of normal weight cancer pain patients.

  5. Creatively caring: effects of arts-based encounters on hospice caregivers in South Africa.

    Repar, Patricia Ann; Reid, Steve


    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

  6. Reflections on the development of CHASE Children's Hospice Service.

    Menezes, A


    The tasks along the way to developing a children's hospice service are examined. CHASE Children's Hospice Service aims to establish a network of care for life-limited and life-threatened children, young people and their families. The services will be provided for families living mainly in SW London, Surrey and parts of West Sussex. They will comprise a source of palliative and respite care for the children and their families in their own homes (community care), backed-up by a respite care service in the related hospice at Artington, near Guildford (Christopher's).

  7. History of Depression in Lung Cancer Patients

    Iachina, M; Brønserud, M M; Jakobsen, E


    AIMS: To examine the influence of a history of depression in the process of diagnostic evaluation and the choice of treatment in lung cancer. MATERIALS AND METHODS: The analysis was based on all patients with non-small cell lung cancer who were registered in 2008-2014; in total, 27 234 patients....... To estimate the effect of depression on the diagnostic process and the choice of treatment in lung cancer we fitted a logistic regression model and a Cox regression model adjusting for age, gender, resection and stage. RESULTS: Depression in a patient's anamnesis had no significant effect on the delay...... in diagnostic evaluation (hazard ratio = 0.99 with 95% confidence interval 0.90; 1.09). Patients with a history of periodic depression had a 33% lower treatment rate (odds ratio = 0.66 with 95% confidence interval 0.51; 0.85) than patients without a history of depression. CONCLUSIONS: Our study shows...

  8. Bone health in patients with prostate cancer.

    Miñana, B; Cózar, J M; Alcaraz, A; Morote, J; Gómez-Veiga, F J; Solsona, E; Rodríguez-Antolín, A; Carballido, J


    In patients with prostate cancer, bone health is compromised by advanced age at diagnosis, androgen suppression treatments and the developmentofbone metastases. In this paper the medical literature is reviewed in order to update the state of the art on their incidence, prevention and management. A literature review about bone involvement in patients with prostate cancer in different clinical settings is performed. Decreased bone mineral density is higher in patients diagnosed of prostate cancer before starting treatment than in healthy men with the same age. During the first year of treatment, a severe loss bone density is reported due to androgen suppression therapy. From then on, loss bone density seems to slow down, persisting at long-term. It is important to know the starting point and the dynamics of loss bone in order to prevent its progression. The skeletal events have an important impact on quality of life in patients with prostate cancer. Both Denosumab and Zoledronic Acid have proven effective in reducing loss bone. The prevention and management of bone involvement in patients with prostate cancer is critical to quality of life in these patients and requires an individualized approach. Before starting a prolonged androgen deprivation, baseline risk of fracture should be evaluated in order to adopt the proper protective measures. In patients with metastases, early treatments reducing the risk of bone events should be taken into account. Copyright © 2014 AEU. Published by Elsevier Espana. All rights reserved.

  9. Circulating gangliosides of breast-cancer patients.

    Wiesner, D A; Sweeley, C C


    Gangliosides were isolated from the sera of recently diagnosed breast-cancer patients and from individuals who were apparently free of disease. Quantificative and qualitative analyses were carried out by 2-dimensional high-performance thin-layer chromatography and gas chromatography. The locations of isolated gangliosides on thin-layer chromatograms were determined by visualization with resorcinol, and each spot was quantified by digital image densitometry. The ganglioside profiles of cancer patients were compared to those of the control group, revealing a significant increase in total lipid-bound sialic acid and a specific increase in polysialogangliosides in the patients with breast cancer. Furthermore, an increase was noted in the ratio of gangliosides of the b-series biosynthetic pathway over those of the a-series in the cancer sera, as compared to the controls. Gas chromatographic analysis of the peracetylated methanolysis mixtures derived from the total ganglioside fraction of cancer patients supported the HPTLC data, with an increase in total sialic acid, galactose, and sphingosine residues. No unusual gangliosides were found in the mixture from breast-cancer patients.

  10. 42 CFR 418.112 - Condition of participation: Hospices that provide hospice care to residents of a SNF/NF or ICF/MR.


    ... hospice care to residents of a SNF/NF or ICF/MR. 418.112 Section 418.112 Public Health CENTERS FOR...: Hospices that provide hospice care to residents of a SNF/NF or ICF/MR. In addition to meeting the... of a SNF/NF or ICF/MR must abide by the following additional standards. (a) Standard: Resident...

  11. Clinical Characteristics of Patients with Sporadic Colorectal Cancer and Primary Cancers of Other Organs

    Jung-Yu Kan


    Full Text Available Most cancer patients often neglect the possibility of secondary cancer. Colorectal cancer (CRC is the third leading cause of cancer death in Taiwan. It is important to be aware of the clinical characteristics of double cancer in CRC patients for early diagnosis and treatment. We retrospectively analyzed 1,031 CRC patients who underwent surgical treatment at the Department of Surgery of Kaohsiung Medical University Hospital between January 1998 and December 2004. Among these patients, CRC was accompanied by cancer of other organs in 17 patients (1.65%, either synchronously or metachronously. Therefore, we describe our experience regarding the location of CRC, the clinical symptoms and signs of these patients, the TNM stage, histology, phase, association with other malignancies, interval between cancers and clinical outcomes. Of the 17 patients in whom CRC was accompanied by primary cancer of other organs, there were four synchronous and 13 metachronous multiple cancer patients. Our patient group comprised six men and 11 women with ages ranging from 47 to 88 years (median age, 66 years. The most common location of CRC was the sigmoid colon. Six gastric cancers (35.2% and six breast cancers (35.2% were associated with primary CRC. The remaining six second primary cancers were one lung cancer, one thyroid cancer, one cervical cancer, one ovarian cancer, one skin cancer, and one urinary bladder cancer. Of the 13 metachronous multiple cancer patients, eight patients developed subsequent CRC after primary cancers of other organs, whereas two patients developed a subsequent second primary cancer after CRC. The intervals between the development of metachronous multiple cancers ranged from 2 to 19 years. In this retrospective analysis, breast and gastric cancer patients were at increased risk of developing subsequent secondary CRC. Careful attention should always be paid to the possibility of secondary CRC in treating these cancer patients. Cancer

  12. Trismus release in oral cancer patients.

    Lee, Yao-Chou; Wong, Tung-Yiu; Shieh, Shyh-Jou; Lee, Jing-Wei


    Trismus is a common problem among oral cancer patients. This report aimed to study the inciting factors of trismus and to find out the rationale of trismus release. Between 1996 and 2008, 61 oral cancer patients with retrievable records of interincisor distance (IID) were analyzed by retrospective chart review. The IID decreased from 31.4 (12.4) to 24.9 (12.0) mm in 36 patients undergoing cancer ablation only (P = 0.001). Other variables prompting trismus include buccal cancer (P = 0.017), radiotherapy (P = 0.008), and recurrence (P = 0.001). In contrast, the IID improved from 11.7 (7.1) to 22.7 (11.9) mm in 25 patients receiving cancer ablative and trismus releasing surgeries (P = 0.000). The improvement fared better in individuals with IID less than 15 mm than the others (P = 0.037). In conclusion, involvement of buccal region, ablative surgery, radiotherapy, and recurrence are provocative factors of trismus. Patients with IID less than 15 mm will benefit from releasing surgery significantly. Others may better be handled with conservative managements firstly, and enrolled as candidates of surgical release only until the patients entertained a 28-month period of disease-free interval, by which time the risk of recurrence would be markedly reduced.

  13. Nurses' attitudes to sexuality in caring for cancer patients.

    Cort, E

    The attitudes of hospice nurses towards psychosexual issues in palliative care were surveyed. Sexuality was acknowledged to be both important and relevant in hospice nursing. A high level of awareness of sexual and relationship issues was apparent, reflecting broadly liberal attitudes.

  14. Engagement of Patients With Advanced Cancer


    End of Life; Advanced Cancer; Lung Neoplasm; Gastric Cancer; Colon Cancer; Glioblastoma Multiforme; Head and Neck Neoplasms; Rectum Cancer; Melanoma; Kidney Cancer; Prostate Cancer; Testicular Neoplasms; Liver Cancer; Cancer of Unknown Origin

  15. Patients' attitudes toward internet cancer support groups.

    Im, Eun-Ok; Chee, Wonshik; Lim, Hyun-Ju; Liu, Yi; Guevara, Enrique; Kim, Kyung Suk


    To explore patients' attitudes toward Internet cancer support groups (ICSGs) through an online forum. Qualitative study using a feminist perspective. Internet and real settings. 16 patients with cancer. An online forum was held for one month with six discussion topics. The data were analyzed using thematic analysis. Attitudes toward ICSGs. Through the data-analysis process, four themes were found related to patients' attitudes toward ICSGs. First, the participants universalized patients' needs for and attitudes toward ICSGs. Second, most of the participants wanted to use ICSGs for emotional support, information, and interactions. Third, many of the participants used ICSGs because they could reach out to other patients with cancer without traveling and without interrupting their busy schedules. Finally, many participants were concerned about the security of interactions on ICSGs, so they wanted ICSGs that could ensure privacy and safeguard the anonymity and confidentiality of what they shared online. Patients view ICSGs positively. Additional studies should examine gender-specific and multilanguage ICSGs by recruiting more ethnic minority patients. Despite concerns about the security of Internet interactions, ICSGs would be an excellent source of social support that is acceptable to patients with cancer.

  16. Positive feelings among terminally ill cancer patients.

    Van der Lee, M L; Swarte, N B; Van der Bom, J G; Van den Bout, J; Heintz, A P M


    For a realistic perspective on what it is like to have cancer and be in the last months of life, it is necessary to also study the positive feelings people may still experience. We set out to describe positive feelings experienced by terminally ill patients. The Depression Adjective Checklist was completed by 96 cancer patients with an estimated life expectancy of less than 3 months. On average patients endorsed 30% (3.6/12) of the positive mood items, and 25% (5.4/22) of the negative mood items. The larger part of terminally ill cancer patients with an estimated life expectancy of less than 3 months reported one or more positive mood states. A positive mood state such as 'being interested' was endorsed by more than half (65%) of the patients, other positive feelings were endorsed by a substantial proportion of patients, for example: 38% of patients endorsed feeling 'jovial' and 35% reported being 'optimistic'. Although having incurable cancer often leads to feelings of depression, mood is variable and many patients experience at least some positive feelings.

  17. Multidisciplinary approach for patients with esophageal cancer

    Victoria M Villaflor; Marco E Allaix; Bruce Minsky; Fernando A Herbella; Marco G Patti


    Patients with esophageal cancer have a poor prognosis because they often have no symptoms until their disease is advanced.There are no screening recommendations for patients unless they have Barrett's esophagitis or a significant family history of this disease.Often,esophageal cancer is not diagnosed until patients present with dysphagia,odynophagia,anemia or weight loss.When symptoms occur,the stage is often stage Ⅲ or greater.Treatment of patients with very early stage disease is fairly straight forward using only local treatment with surgical resection or endoscopic mucosal resection.The treatment of patients who have locally advanced esophageal cancer is more complex and controversial.Despite multiple trials,treatment recommendations are still unclear due to conflicting data.Sadly,much of our data is difficult to interpret due to many of the trials done have included very heterogeneous groups of patients both histologically as well as anatomically.Additionally,studies have been underpowered or stopped early due to poor accrual.In the United States,concurrent chemoradiotherapy prior to surgical resection has been accepted by many as standard of care in the locally advanced patient.Patients who have metastatic disease are treated palliatively.The aim of this article is to describe the multidisciplinary approach used by an established team at a single high volume center for esophageal cancer,and to review the literature which guides our treatment recommendations.

  18. Symptom attributions in patients with colorectal cancer

    Jensen, Line Flytkjær; Hvidberg, Line; Pedersen, Anette Fischer


    Størstedelen af kolorektal cancere opdages gennem patienters symptomatiske henvendelse i almen praksis. Man ved dog ikke meget om, hvordan patienter selv oplever deres symptomer. Formålet med studiet var, at undersøge om symptom attributioner er associeret med hvilket symptom man oplevede før...

  19. Myofacial trigger points in advanced cancer patients

    Hideaki Hasuo


    Full Text Available Myofascial pain syndrome is started to be recognized as one of important factors of pain in cancer patients. However, no reports on features of myofascial trigger points were found in terminally-ill cancer populations. This time, we encountered 5 patients with myofascial pain syndrome and terminal cancer in whom delirium developed due to increased doses of opioid without a diagnosis of myofascial pain syndrome on initial presentation. The delirium subsided with dose reductions of opioid and treatment of myofascial pain syndrome. The common reason for a delayed diagnosis among the patients included an incomplete palpation of the painful sites, which led to unsuccessful myofascial trigger points identification. The features of myofascial trigger points included single onset in the cancer pain management site with opioid and the contralateral abdominal side muscles of the non-common sites. Withdrawal reflexes associated with cancer pain in the supine position, which are increasingly seen in the terminal cancer patients, were considered to have contributed to this siuation.We consider that careful palpation of the painful site is important, in order to obtain greater knowledge and understanding of the features of myofascial trigger points.

  20. Fertility preservation in young cancer patients

    Ariel Revel


    Full Text Available As a result of advances in treatment, almost 80% of children and adolescents who receive a diagnosis of cancer become long-term survivors. The increased survival rate of children and adolescents with cancer has resulted in a major interest in the long-term effects of cancer treatment on the possibility for future fertility. Currently established methods for the preservation of fertility are available only for pubertal males and females. Pubertal male cancer patients should be encouraged to freeze numerous sperm samples even when sperm count and motility are poor. In these cases, intracytoplasmic sperm injection is a powerful technique compared with intrauterine insemination since thawed sperm samples with poor parameters can produce relatively high fertilization rates resulting in normal pregnancies and deliveries. Married pubertal women should be proposed ovulation induction, follicular aspiration, and fertilization with husband sperm. Single women could benefit from vitrification of oocytes. This requires a delay of about 3 weeks in the commencement of chemotherapy to enable follicular growth. Fertility preservation for prepubertal patients is more of a problem. Young girls could be offered cryopreservation of gametes in the gonadal tissue. Cryopreservation of testicular tissue was suggested for fertility preservation for young boys, but this method is totally experimental and not currently offered. Discussing future fertility is part of the consultation of young female and male patients facing potentially gonadotoxic cancer therapy. It is the role of reproductive specialists to create various options in their laboratory to preserve fertility potential of cancer patients.

  1. Reflections on the history of occupational stress in hospice/palliative care.

    Vachon, M L


    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.

  2. Understanding taste dysfunction in patients with cancer.

    McLaughlin, Laura; Mahon, Suzanne M


    Taste dysfunction is a significant but underestimated issue for patients with cancer. Impaired taste results in changes in diet and appetite, early satiety, and impaired social interactions. Nurses can play a key role in educating patients and families on the pathophysiology of taste dysfunction by suggesting interventions to treat the consequences of taste dysfunction, when available, and offering psychosocial support as patients cope with this often devastating consequence of treatment. Taste recognition helps humans identify the nutritional quality of food and signals the digestive tract to begin secreting enzymes. Spoiled or tainted foods typically are recognized by their bad taste. Along with the other sensory systems, taste is crucial for helping patients treated for cancer feel normal. This article will review the anatomy and physiology of taste; define the different types of taste dysfunction, including the underlying pathophysiologic basis related to cancer treatment; and discuss potential nursing interventions to manage the consequences of taste dysfunction.

  3. Stress and Burnout: Concerns for the Hospice Volunteer.

    Glass, J. Conrad, Jr.; Hastings, Janice L.


    Sources of stress for hospice volunteers are environmental, ideological, and personal. Attention to volunteer stress and burnout involves defining job requirements and responsibilities, frequent communication and feedback, stress management techniques, flexibility in assignments, and opportunities to verbalize emotions. (SK)

  4. Terminally Ill Obese People Less Likely to Get Hospice Care

    ... Dr. Eric Widera is an associate professor of clinical medicine at the University of California, San Francisco. He ... Detroit; Eric Widera, M.D., associate professor of clinical medicine, University of California, San Francisco, and director, hospice ...

  5. Use of Electronic Documentation for Quality Improvement in Hospice

    Cagle, John G.; Rokoske, Franziska S.; Durham, Danielle; Schenck, Anna P.; Spence, Carol; Hanson, Laura C.


    Little evidence exists on the use of electronic documentation in hospice and its relationship to quality improvement practices. The purposes of this study were to: (1) estimate the prevalence of electronic documentation use in hospice; (2) identify organizational characteristics associated with use of electronic documentation; and (3) determine whether quality measurement practices differed based on documentation format (electronic vs. nonelectronic). Surveys concerning the use of electronic documentation for quality improvement practices and the monitoring of quality-related care and outcomes were collected from 653 hospices. Users of electronic documentation were able to monitor a wider range of quality-related data than users of nonelectronic documentation. Quality components such as advanced care planning, cultural needs, experience during care of the actively dying, and the number/types of care being delivered were more likely to be documented by users of electronic documentation. Use of electronic documentation may help hospices to monitor quality and compliance. PMID:22267819

  6. [Multidisciplinary therapy for 984 cancer patients--hyperthermic immunotherapy].

    Takeda, Tsutomu; Miyazawa, Kenki; Takeda, Takashi; Takeda, Hiroko; Takeda, Yutaka


    We treated 984 advanced or recurrent cancer patients with hyperthermia or immunotherapy (2005/7-2009/12). We have 137 clinical benefit cases (CR, PR and long SD) including 22 complete response (CR) cases. Effective rates of immunotherapy increased from 9.8% to 17.8% using hyperthermia. In the cases of ovarian cancer, head and neck cancer, lung cancer, prostatic cancer, gastric cancer, thyroid cancer and breast cancer, all confirmed high effective rates with hyperthermic immunotherapy.

  7. How Exercise Can Benefit Patients With Cancer.

    Musanti, Rita


    Thirty years ago, the first article on exercise for patients with cancer appeared in the cancer research literature. The time from that first article to the present has included oncology nurses taking the lead in investigations related to exercise and cancer-related symptoms, most notably cancer-related fatigue (CRF). The Oncology Nursing Society (ONS) has been instrumental in publishing much of the research on exercise and cancer and continues in that tradition by issuing this supplement to the Clinical Journal of Oncology Nursing. In addition, ONS has facilitated the translation of research findings to practicing oncology nurses by convening meetings, participating in expert opinion consensus groups, and disseminating evidence through Putting Evidence Into Practice resources.

  8. Infectious complications in patients with lung cancer.

    Akinosoglou, K S; Karkoulias, K; Marangos, M


    Infections remain a part of the natural course of cancer. During the course of their disease, patients with lung cancer frequently present with an infection that can ultimately be fatal. Pathogenesis of infectious syndromes is usually determined by the underlying disease, as well as, the iatrogenic manipulations that occur during its management. Hence, lung cancer infections include lower respiratory tract infections in the context of COPD, aspiration, obstruction and opportunistic infections due to immunosuppression. Moreover, treatment-related infectious syndromes including post operative pneumonia, febrile neutropenia and superimposed infection following radiation/chemotherapy toxicity is common. Importantly, diagnosis of infection in the febrile lung cancer patient is challenging and requires a high index of suspicion in order to distinguish from other causes of fever, including malignant disease and pulmonary embolism. Prompt initiation of treatment is pivotal to avoid increased mortality. Careful consideration of infection pathogenesis can predict most likely pathogens and guide antibiotic management, thus, ensuring most favourable outcome.

  9. PET/MRI in cancer patients

    Kjær, Andreas; Loft, Annika; Law, Ian


    Combined PET/MRI systems are now commercially available and are expected to change the medical imaging field by providing combined anato-metabolic image information. We believe this will be of particular relevance in imaging of cancer patients. At the Department of Clinical Physiology, Nuclear...... described include brain tumors, pediatric oncology as well as lung, abdominal and pelvic cancer. In general the cases show that PET/MRI performs well in all these types of cancer when compared to PET/CT. However, future large-scale clinical studies are needed to establish when to use PET/MRI. We envision...... that PET/MRI in oncology will prove to become a valuable addition to PET/CT in diagnosing, tailoring and monitoring cancer therapy in selected patient populations....

  10. PET/MRI in cancer patients

    Kjær, Andreas; Loft, Annika; Law, Ian


    Combined PET/MRI systems are now commercially available and are expected to change the medical imaging field by providing combined anato-metabolic image information. We believe this will be of particular relevance in imaging of cancer patients. At the Department of Clinical Physiology, Nuclear...... described include brain tumors, pediatric oncology as well as lung, abdominal and pelvic cancer. In general the cases show that PET/MRI performs well in all these types of cancer when compared to PET/CT. However, future large-scale clinical studies are needed to establish when to use PET/MRI. We envision...... that PET/MRI in oncology will prove to become a valuable addition to PET/CT in diagnosing, tailoring and monitoring cancer therapy in selected patient populations....

  11. 上海临终关怀机构卫生资源及服务现状的调查与分析%Survey and analysis of health resources and service situation in hospice care institutions in Shanghai

    龚震晔; 陈立今


    Objective To investigate the health resources and service situation in hospice care institutions in Shanghai.Methods Two registered hospice care institutions (Geriatric Hospital of Pudong New District and Linfen Road Community Health Service Center of Zhabei District) and one social-funded hospice care institution (Hospice Care Center of Xinhua Hospital) in Shanghai were selected,structured questionnaire and expert consultation were employed for survey,which mainly concerned with equipment,staff,service utilization and management of the institutions,and recognition and suggestions of different people were collected.Results There were 48 appropriative sickbeds in two registered hospice care institutions,and the other one only provided door-to-door outreach clinic services instead of setting up sickbeds.Thirty doctors were engaged in hospice care service,accounting for 3.42% of total doctors,and there were 40 registered nurses,accounting for 2.97% of total nurses.Terminal cancer patients (n =645) accounted for 34.4% of total discharged patients,the average duration of hospital stay was 52.33 d,the average medical cost during hospital stay was 4 620.32 yuan per patient,and the average daily medical cost was 108.87 yuan per patient.Psychological nursing was conducted in all the three institutions,and volunteers were recruited,though the volunteer service was less consistent.Conclusion The hospice care service in Shanghai has not yet formed a systemic network and mode.Along with strengthening the construction of hospice service and personnel training,the notion of hospice care service should be enhanced,which may help to establish the legal support for hospice care service as soon as possible.%目的 调查并分析上海市临终关怀医疗机构的卫生资源及服务现状.方法 选择上海市2家注册的临终关怀医疗机构(浦东新区老年医院和闸北区临汾路街道社区卫生服务中心)和1家有社会资助的临终关怀机构(新华

  12. Dying well: How equal is end of life care among gynecologic oncology patients?

    Taylor, Jolyn S; Brown, Alaina J; Prescott, Lauren S; Sun, Charlotte C; Ramondetta, Lois M; Bodurka, Diane C


    To identify disparities in utilization of end of life (EoL) resources by gynecologic oncology (GO) patients. This retrospective analysis of the medical records of GO patients treated 1/2007-12/2011 and deceased 1/2012-8/2014 evaluated patient demographics, disease characteristics, and utilization of EoL resources. Chi-square, Fisher's exact test, Mann Whitney and Kruskal-Wallis tests were used for statistical analysis. Of 189 patients analyzed, 113 (60%) were white, 38 (20%) Hispanic, 31 (16%) black, and seven (4%) Asian. Ninety-five (48%) had ovarian cancer, 51 (26%) uterine, 47 (23%) cervical, seven (3%) vulvar/vaginal. In the last 30days of life (DoL), 18 (10%) had multiple hospital admissions, 10 (5%) admitted to the Intensive Care Unit (ICU), 30 (16%) multiple Emergency Room (ER) visits, 45 (24%) received aggressive medical care and eight (4%) received chemotherapy in the final 14 DoL. Furthermore, 54 (29%) had no Supportive Care referral and 29 (15%) no hospice referral. Only 46 (24%) had a Medical Power of Attorney (PoA) or Living Will (LW) on file. Non-white race was associated with increased odds of dying without hospice (OR 3.07; 95%CI [1.27, 2.46], p=0.013). However, non-white patients who enrolled in hospice did so earlier than white patients (42 v. 27days before death, p=0.054). Non-white patients were also significantly less likely to have PoA/LW documentation (24% v. 76%, p=0.009) even if enrolled in hospice (12% v. 31%, p=0.007). Significant racial disparities in hospice enrollment and PoA/LW documentation were seen in GO patients. This warrants further study to identify barriers to use of EoL resources. Copyright © 2015 Elsevier Inc. All rights reserved.

  13. Patient Delay in Colorectal Cancer Patients

    Pedersen, Anette Fischer; Hansen, Rikke P; Vedsted, Peter


    , at patienter med kolorektal¬kræft, som har oplevet blødning fra endetarmen, har længere forsinkelser i forløbet (39 dage) end patienter, som ikke har haft dette symptom (15 dage). Tidligere studier har tolket det som et tegn på, at patienter med rektal blødning regner med, at blødningen skyldes godartede...... lidelser. Dette studie finder som noget nyt, at mange patienter med rektal blødning har tænkt mere over kræft i perioden op til første lægebesøg end patienter uden dette symptom. En forkert tolkning af symptomet er altså ikke den eneste forklaring på forsinkelserne i forløbet for denne patientgruppe....... Fundene i studiet åbner for den mulighed, at forsinkelserne hos nogle patienter kan skyldes bekymring for, hvad lægen vil finde, og at de derfor tøver med at konsultere lægen. Denne tøven kan hænge sammen med følelses¬mæssige barrierer, fx at patienten er flov over symptomerne eller frygter forestående...

  14. Mental health of patients with lung cancer

    Τogas Κ.


    Full Text Available Background: Lung cancer is a very common type of cancer. The psychological reactions of these patients haven't been studied yet. Aim: The examination of the mental health of lung cancer patients. Methods: A bibliographical review of relevant articles was conducted at the electronic data bases of Pubmed, Pcych Info and Scholar Google by key-words. The quest included researches and reviews which have been published in Greek and English language between 1990- 2013. Results: Lung cancer is the second most common type of cancer and the main cause of death from cancer. The psychological reaction depends on the symptomatology, the co- morbidity, the cell type, the physical and social functionality, the therapy. The most important needs of the patients are the emotional ones as well as the need of information. The patients mention the highest levels of psychological discontent and stigmatization in comparison to other types of cancer. They show lots of psychological disorders, with depression to be the most common (11%- 44%. Very few researches have examine the confrontation strategies. Health professionals are the main source of information for the patients and the help that they provide is correlated with all the dimensions of the quality of life (except of the social ones. Oncologists don't recognize in a satisfying degree the patients with distress. Most of the patients use in a limited degree the mental health services. Important determinants of survival are the emotional distress, depression and the coping strategies. Different methods of psychotherapy can be applied in order to diminish the psychological distress. The behavioural interventions decrease nausea and sickness and the disturbance of pain and anxiety. The palliative and supportive care have to be applied as sooner as possible. Conclusion: The psychological reaction in lung cancer is complicated. There is need for appliance of psychotherapeutic interventions at the patients, in order to

  15. [Venous thromboembolism in patients with cancer].

    Lecumberri, Ramón; Feliu, Jesús; Rocha, Eduardo


    The association between neoplastic diseases and venous thromboembolism (VTE) is known since long time ago. The nature of this association is bidirectional. On one hand, cancer increases the incidence of venous thrombosis and, on the other hand, the hemostatic system does play a key role in the tumorigenesis process. However, despite recent advances in the field, prophylaxis and treatment of VTE in cancer patients is still a challenge, due to the complexity of this type of patients. This review is focused on some important points regarding management of VTE in cancer patients such as physiopathology, epidemiology, search for hidden malignancy, prognostic impact, prophylaxis in the medical and surgical setting, or initial and long-term treatment.

  16. The association of race with timeliness of care and survival among Veterans Affairs health care system patients with late-stage non-small cell lung cancer

    Zullig LL


    Full Text Available Leah L Zullig,1,2 William R Carpenter,2 Dawn T Provenzale,1,3 Morris Weinberger,1,2 Bryce B Reeve,2 Christina D Williams,1 George L Jackson1,4 1Center of Excellence for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA; 2Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; 3Division of Gastroenterology, Duke University, Durham, NC, USA; 4Division of General Internal Medicine, Duke University, Durham, NC, USA Background: Non-small cell lung cancer is the leading cause of cancer-related mortality in the United States. Patients with late-stage disease (stage 3/4 have five-year survival rates of 2%–15%. Care quality may be measured as time to receiving recommended care and, ultimately, survival. This study examined the association between race and receipt of timely non-small cell lung cancer care and survival among Veterans Affairs health care system patients. Methods: Data were from the External Peer Review Program, a nationwide Veterans Affairs quality-monitoring program. We included Caucasian or African American patients with pathologically confirmed late-stage non-small cell lung cancer in 2006 and 2007. We examined three quality measures: time from diagnosis to (1 treatment initiation, (2 palliative care or hospice referral, and (3 death. Unadjusted analyses used log-rank and Wilcoxon tests. Adjusted analyses used Cox proportional hazard models. Results: After controlling for patient and disease characteristics using Cox regression, there were no racial differences in time to initiation of treatment (72 days for African American versus 65 days for Caucasian patients, hazard ratio 1.04, P = 0.80 or palliative care or hospice referral (129 days versus 116 days, hazard ratio 1.10, P = 0.34. However, the adjusted model found longer survival for African American patients than for Caucasian patients (133 days versus 117 days, hazard ratio 0

  17. Survival of ovarian cancer patients in Denmark

    Edwards, Hellen McKinnon; Noer, Mette Calundann; Sperling, Cecilie Dyg;


    BACKGROUND: Ovarian cancer has a high mortality rate, especially in Denmark where mortality rates have been reported higher than in adjacent countries with similar demographics. This study therefore examined recent survival and mortality among Danish ovarian cancer patients over an 18-year study...... period. METHODS: This nationwide registry-based observational study used data from the Danish Gynecology Cancer Database, Danish Pathology Registry, and Danish National Patient Registry. All patients with ovarian cancer diagnosed between 1995 and 2012 were included in the study. The data sources were...... identified 9972 patients diagnosed with ovarian cancer in the period 1995-2012. The absolute one-year mortality rate decreased from 42.8 (CI 40.3-45.6) in 1995-1999 to 28.3 (CI 25.9-30.9) in 2010-2012, and the five-year mortality rate decreased from 28.2 (CI 27.0-29.5) in 1995-1999 to 23.9 (CI 22...


    J. R. Gardanova


    Full Text Available Diagnostics of psycho-emotional disorders of patients with malignant diseases of the prostate is not doubt, because timely correction contributes to the shortening of rehabilitation period and restoration of the quality of life of patients after treatment. Detection and diagnosis of prostate cancer for many patients is stressful and causes changes in the affective sphere, and manifests itself in increased levels of anxiety and depression in men. To cope with stress is possible due to the used coping strategies.Purpose. Studying the coping mechanisms in prostate cancer patients.Materials and methods. 56 men treated in FGBU "LRTS" Russian Ministry of Health. The average age was 65.7 ± 6.1 years. The average duration of the disease prostate cancer is 3 ± 2 months. All men were subjected to the standard algorithm for the evaluation of hormonal status, the PSA, taking a history, inspection and physical examination, magnetic resonance imaging and scintigraphy of bones of a skeleton. All the patients underwent laparoscopic radical prostatectomy. Psychological testing with the use of the method of "Coping test" the scale of reactive and personal anxiety for the differentiated evaluation of anxiety. Results. The most common for prostate cancer revealed constructive coping strategies are "planning solve", "selfcontrol" and "search of social support". According to the scale Spielberg–Hanin a high level of situational anxiety was revealed.Conclusion. According to the results of the research, patients with prostate cancer are likely to use constructive coping strategies, that leads to stabilization of psycho-emotional state of men and promotes more effective adaptation in the terms of stress, that is caused by treatment of prostate cancer.

  19. Palliative care in cancer: managing patients' expectations.

    Ghandourh, Wsam A


    Advanced cancer patients commonly have misunderstandings about the intentions of treatment and their overall prognosis. Several studies have shown that large numbers of patients receiving palliative radiation or chemotherapy hold unrealistic hopes of their cancer being cured by such therapies, which can affect their ability to make well-informed decisions about treatment options. This review aimed to explore this discrepancy between patients' and physicians' expectations by investigating three primary issues: (1) the factors associated with patients developing unrealistic expectations; (2) the implications of having unrealistic hopes and the effects of raising patients' awareness about prognosis; and (3) patients' and caregivers' perspective on disclosure and their preferences for communication styles. Relevant studies were identified by searching electronic databases including Pubmed, EMBASE and ScienceDirect using multiple combinations of keywords, which yielded a total of 65 articles meeting the inclusion criteria. The discrepancy between patients' and doctors' expectations was associated with many factors including doctors' reluctance to disclose terminal prognoses and patients' ability to understand or accept such information. The majority of patients and caregivers expressed a desire for detailed prognostic information; however, varied responses have been reported on the preferred style of conveying such information. Communication styles have profound effects on patients' experience and treatment choices. Patients' views on disclosure are influenced by many cultural, psychological and illness-related factors, therefore individuals' needs must be considered when conveying prognostic information. More research is needed to identify communication barriers and the interventions that could be used to increase patients' satisfaction with palliative care.

  20. Patterns of Care Among Patients Receiving Radiation Therapy for Bone Metastases at a Large Academic Institution

    Ellsworth, Susannah G. [Department of Radiation Oncology and Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Alcorn, Sara R., E-mail: [Department of Radiation Oncology and Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Hales, Russell K.; McNutt, Todd R.; DeWeese, Theodore L. [Department of Radiation Oncology and Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Smith, Thomas J. [Department of Medical Oncology and Harry J. Duffey Family Program in Palliative Care, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States)


    Purpose: This study evaluates outcomes and patterns of care among patients receiving radiation therapy (RT) for bone metastases at a high-volume academic institution. Methods and Materials: Records of all patients whose final RT course was for bone metastases from April 2007 to July 2012 were identified from electronic medical records. Chart review yielded demographic and clinical data. Rates of complicated versus uncomplicated bone metastases were not analyzed. Results: We identified 339 patients whose final RT course was for bone metastases. Of these, 52.2% were male; median age was 65 years old. The most common primary was non-small-cell lung cancer (29%). Most patients (83%) were prescribed ≤10 fractions; 8% received single-fraction RT. Most patients (52%) had a documented goals of care (GOC) discussion with their radiation oncologist; hospice referral rates were higher when patients had such discussions (66% with vs 50% without GOC discussion, P=.004). Median life expectancy after RT was 96 days. Median survival after RT was shorter based on inpatient as opposed to outpatient status at the time of consultation (35 vs 136 days, respectively, P<.001). Hospice referrals occurred for 56% of patients, with a median interval between completion of RT and hospice referral of 29 days and a median hospice stay of 22 days. Conclusions: These data document excellent adherence to American Society for Radiation Oncolology Choosing Wisely recommendation to avoid routinely using >10 fractions of palliative RT for bone metastasis. Nonetheless, single-fraction RT remains relatively uncommon. Participating in GOC discussions with a radiation oncologist is associated with higher rates of hospice referral. Inpatient status at consultation is associated with short survival.


    Maura Gabriela FELEA


    Full Text Available Negative emotions (distress are recognized as part of the psychological profile of patients diagnosed with advanced stage cancer. However, most patients are not accustomed to verbalize feelings towards their physician, and generally towards family and medical care personnel. The purpose of this paper is to analyze the expression of emotions by patients in advanced stages of cancer, respectively the means by which they get to express emotions. To this respect, we identified the most common types of emotions expressed, or metaphors used by patients to describe their emotions and topics that trigger emotions. Words and phrases most commonly used are in relation to: fear, anxiety, depression, guilt, negligence, concern. They are uttered in order to depict the network created between disclosed emotions and topics on health status, symptoms, adverse effects and therapeutic choice, patient privacy, and social and family issues.

  2. Stress and Coping Mechanisms Among Breast Cancer Patients and ...

    Stress and Coping Mechanisms Among Breast Cancer Patients and Family ... It is also the leading cause of cancer mortality, representing 14.1%. ... to cancer and the last 4 on experiences of family members on care of the terminally ill.

  3. Medicare program; FY 2014 hospice wage index and payment rate update; hospice quality reporting requirements; and updates on payment reform. final rule.


    This final rule updates the hospice payment rates and the wage index for fiscal year (FY) 2014, and continues the phase out of the wage index budget neutrality adjustment factor (BNAF). Including the FY 2014 15 percent BNAF reduction, the total 5 year cumulative BNAF reduction in FY 2014 will be 70 percent. The BNAF phase-out will continue with successive 15 percent reductions in FY 2015 and FY 2016. This final rule also clarifies how hospices are to report diagnoses on hospice claims, and provides updates to the public on hospice payment reform. Additionally, this final rule changes the requirements for the hospice quality reporting program by discontinuing currently reported measures and implementing a Hospice Item Set with seven National Quality Forum (NFQ) endorsed measures beginning July 1, 2014, as proposed. Finally, this final rule will implement the hospice Experience of Care Survey on January 1, 2015, as proposed.

  4. VMAT planning study in rectal cancer patients

    Shang, Jun; Kong, Wei; Wang, Yan-Yang; Ding, Zhe; Yan, Gang; Zhe, Hong


    Background To compare the dosimetric differences among fixed field intensity-modulated radiation therapy (IMRT), single-arc volumetric-modulated arc therapy (SA-VMAT) and double-arc volumetric-modulated arc therapy (DA-VMAT) plans in rectal cancer. Method Fifteen patients with rectal cancer previously treated with IMRT in our institution were selected for this study. For each patient, three plans were generated with the planning CT scan: one using a fixed beam IMRT, and two plans using the VM...

  5. Kundalini yoga as a support therapy for cancer patients

    Kröneck, Mia


    This study was designed to describe cancer patient’s experience of kundalini yoga and its effect on their internal coping resources. The intention of this study is to put forward kundalini yoga as a support therapy for cancer patients for improving their wellbeing during active cancer treatment. This is a descriptive study. An academic literature review was conducted for cancer, cancer treatment, internal coping resources and yoga as therapy topics. Four voluntary female cancer patients (...

  6. Cachexia in patients with oesophageal cancer.

    Anandavadivelan, Poorna; Lagergren, Pernilla


    Oesophageal cancer is a debilitating disease with a poor prognosis, and weight loss owing to malnutrition prevails in the majority of patients. Cachexia, a multifactorial syndrome characterized by the loss of fat and skeletal muscle mass and systemic inflammation arising from complex host-tumour interactions is a major contributor to malnutrition, which is a determinant of tolerance to treatment and survival. In patients with oesophageal cancer, cachexia is further compounded by eating difficulties owing to the stage and location of the tumour, and the effects of neoadjuvant therapy. Treatment with curative intent involves exceptionally extensive and invasive surgery, and the subsequent anatomical changes often lead to eating difficulties and severe postoperative malnutrition. Thus, screening for cachexia by means of percentage weight loss and BMI during the cancer trajectory and survivorship periods is imperative. Additionally, markers of inflammation (such as C-reactive protein), dysphagia and appetite loss should be assessed at diagnosis. Routine assessments of body composition are also necessary in patients with oesophageal cancer to enable assessment of skeletal muscle loss, which might be masked by sarcopenic obesity in these patients. A need exists for clinical trials examining the effectiveness of therapeutic and physical-activity-based interventions in mitigating muscle loss and counteracting cachexia in these patients.

  7. Renal cancer in kidney transplanted patients.

    Frascà, Giovanni M; Sandrini, Silvio; Cosmai, Laura; Porta, Camillo; Asch, William; Santoni, Matteo; Salviani, Chiara; D'Errico, Antonia; Malvi, Deborah; Balestra, Emilio; Gallieni, Maurizio


    Renal cancer occurs more frequently in renal transplanted patients than in the general population, affecting native kidneys in 90% of cases and the graft in 10 %. In addition to general risk factors, malignancy susceptibility may be influenced by immunosuppressive therapy, the use of calcineurin inhibitors (CNI) as compared with mammalian target of rapamycin inhibitors, and the length of dialysis treatment. Acquired cystic kidney disease may increase the risk for renal cancer after transplantation, while autosomal dominant polycystic kidney disease does not seem to predispose to cancer development. Annual ultrasound evaluation seems appropriate in patients with congenital or acquired cystic disease or even a single cyst in native kidneys, and every 2 years in patients older than 60 years if they were on dialysis for more than 5 years before transplantation. Immunosuppression should be lowered in patients who develop renal cancer, by reduction or withdrawal of CNI. Although more evidence is still needed, it seems reasonable to shift patients from CNI to everolimus or sirolimus if not already treated with one of these drugs, with due caution in subjects with chronic allograft nephropathy.

  8. Fluorescense laparoscopy in patients with gastric cancer

    V. A. Lukin


    Full Text Available The results of fluorescence laparoscopy in 60 patients with gastric cancer in P.A.Herzen MCRI are represented in the article. All patients had gastric cancer stage III. Undifferentiated cancer was diagnosed in 3 (5% patients, signet ring cell carcinoma – in 42 (70%, low differentiated adenocarcinoma – in 15 (25%. Fluorescence diagnosis was performed using fluorescence laparoscope by Carl Storz (Germany with wavelengths 380-460 nm and alasens given per os at a dose of 30 mg/kg body weight 3 h before study. During the investigation the examination of parietal and visceral peritoneum, great omentum with instrumental revision of pelvic organs was made. The technique of fluorescence diagnosis and assessment of its results are described. According to results of the study occult tumor microdissemination over peritoneum was detected in 10 (16.7% patients. The sensitivity of fluorescence laparoscopy in patients with gastric cancer accounted for 87.5%, specificity – 76%. The data of fluorescence diagnosis allowed to perform staging of tumor process and influenced on following management. 

  9. Internet design preferences of patients with cancer.

    Chernecky, Cynthia; Macklin, Denise; Walter, Jennifer


    To describe computer experience and preferences for multimedia design. Prospective, descriptive. Physician office and outpatient cancer centers in an urban area in the southeastern United States. Convenience sample of 22 volunteer patients with cancer from four racial groups. A questionnaire on computer experiences was followed by a hands-on computer session with questions regarding preferences for seven interface items. Data termination occurred when sample size was obtained. Design of Internet education site for patients. Variables include preferences, computer, cancer, multimedia, and education. Eighty-two percent had personal computers, 41% used a computer daily, and 95% believed that computers would be a good avenue for learning about cancer care. Preferences included display colors in blue and green hues; colored buttons; easy-to-read text; graphics with a simple design and large, clear pictures; serif font in dark type; light-colored background; and larger photo size in a rectangle shape. Most popular graphic icons as metaphors were 911 for emergency, picture of skull and crossbones for danger, and a picture of a string on an index finger representing reminder. The simple layout most preferred for appearances was one that included text and pictures, read from left to right, and was symmetrical in its placement of pictures and text on the page. Preferences are necessary to maintain interest and support navigation through computer designs to enhance the translation of knowledge to patients. Development of multimedia based on patient preferences will enhance education, learning, and, ultimately, quality patient care.

  10. Racial and ethnic differences in end-of-life care in fee-for-service Medicare beneficiaries with advanced cancer.

    Smith, Alexander K; Earle, Craig C; McCarthy, Ellen P


    To examine racial and ethnic variation in use of hospice and high-intensity care in patients with terminal illness. Retrospective, secondary data analysis. Surveillance, Epidemiology, and End Results-Medicare Database from 1992 to 1999 with follow-up data until December 31, 2001. Forty thousand nine hundred sixty non-Hispanic white, non-Hispanic black, Asian, and Hispanic fee-for-service Medicare beneficiaries aged 65 and older with advanced-stage lung, colorectal, breast, and prostate cancer. Hospice use and indicators of high-intensity care at the end of life. Whereas 42.0% of elderly white patients with advanced cancer enrolled in hospice, enrollment was lower for black (36.9%), Asian (32.2%), and Hispanic (37.7%) patients. Differences between white and Hispanic patients disappeared after adjustment for clinical and sociodemographic factors. Higher proportions of black and Asian patients than of white patients were hospitalized two or more times (11.7%, 15.0%, 13.7%, respectively), spent more than 14 days hospitalized (11.4%, 17.4%, 15.6%, respectively), and were admitted to the intensive care unit (ICU) (12.0%, 17.0%, 16.2%, respectively) in the last month of life and died in the hospital (26.5%, 31.3%, 33.7%, respectively). Unadjusted differences in receipt of high-intensity care according to race or ethnicity remained after adjustment. Black and Asian patients with advanced cancer were more likely than whites to be hospitalized frequently and for prolonged periods, be admitted to the ICU, die in the hospital, and be enrolled in hospice at lower rates. Further research is needed to examine the degree to which patient preferences or other factors explain these differences.

  11. Fertility preservation in young patients with cancer

    Virender Suhag


    Full Text Available Infertility can arise as a consequence of treatment of oncological conditions. The parallel and continued improvement in both the management of oncology and fertility cases in recent times has brought to the forefront the potential for fertility preservation in patients being treated for cancer. Many survivors will maintain their reproductive potential after the successful completion of treatment for cancer. However total body irradiation, radiation to the gonads, and certain high dose chemotherapy regimens can place women at risk for acute ovarian failure or premature menopause and men at risk for temporary or permanent azoospermia. Providing information about risk of infertility and possible interventions to maintain reproductive potential are critical for the adolescent and young adult population at the time of diagnosis. There are established means of preserving fertility before cancer treatment; specifically, sperm cryopreservation for men and in vitro fertilization and embryo cryopreservation for women. Several innovative techniques are being actively investigated, including oocyte and ovarian follicle cryopreservation, ovarian tissue transplantation, and in vitro follicle maturation, which may expand the number of fertility preservation choices for young cancer patients. Fertility preservation may also require some modification of cancer therapy; thus, patients' wishes regarding future fertility and available fertility preservation alternatives should be discussed before initiation of therapy.

  12. Depth oriented brief therapy: an ideal technique as hospice lengths-of-stay continue to shorten.

    Thomson, Judith E; Jordan, Merle R


    The authors note that as hospice patients' lengths-of-stay continue to shorten, psychosocial/spiritual counselors are being challenged to help patients and families process the myriad of issues terminal illness gives rise to. Given this reality, the authors suggest that the Depth Oriented Brief Therapy (DOBT) approach should prove especially useful. The DOBT premise is that if people can be helped to experience the emotional meanings of why they hold on to emotionally painful symptoms then they can abandon their symptoms for healthier ways of being.

  13. [Nutritional risk screening and nutrition assessment for gastrointestinal cancer patients].

    Du, Yan-ping; Li, Ling-ling; He, Qing; Li, Yun; Song, Hu; Lin, Yi-jia; Peng, Jun-sheng


    To investigate the nutritional status, and provide evidence for nutritional treatment option. A total of 452 patients with gastrointestinal cancer were selected, including 156 gastric cancer,117 colon cancer, and 180 rectal cancer. The nutritional risk screening 2002(NRS2002) was applied to grade the nutritional risk. A multi-frequency bioelectrical impedance analysis was used to measure the patients' body composition. Albumin (Alb), prealbumin(PA), transferring(Tf), retinol binding protein(RBP), red blood cell(RBC), hemoglobin (Hb), haematocrit(Hct) were measured after fasting. The rate of patients with NRS2002 score more than 3 was 70.5%(110/156) for gastric cancer, 53.8%(63/117) for colon cancer, and 46.7%(86/180) for rectal cancer. The score for impaired nutritional status more than 1 for gastric cancer was higher than that for colorectal cancer(Pgastric cancer(Pobesity degree, fat content, fat percentage, and arm circumference were lower in gastric cancer patients as compared to colorectal cancer patients(Pgastric cancer patients(Pgastric cancer and colon cancer(Pgastric cancer are prone to fat loss and therefore have a higher nutritional risk and malnutrition than those with colorectal cancer. Combination of body composition analysis and laboratory examination may achieve comprehensive evaluation of the nutritional status of patients, and provide the evidence of nutritional therapy by being combined with NRS2002 score.

  14. Cancer Pain Management and Pain Interference with Daily Functioning among Cancer Patients in Gondar University Hospital

    Henok Getachew Tegegn; Eyob Alemayehu Gebreyohannes


    Cancer is an increasing public health burden for Ethiopia. Pain is among the most common symptoms in patients with cancer. Hence, we aimed to assess cancer pain prevalence, cancer pain interference, and adequacy of cancer pain treatment in the oncology ward of an Ethiopian teaching hospital. Of 83 patients, total of 76 (91.6%) cancer patients experienced pain with varying degree of severity, and 7 (8.4%) patients experienced severe pain. Of the 76 cancer patients with pain, 68 (89.2%) experie...

  15. Culturally Competent Palliative and Hospice Care Training for Ethnically Diverse Staff in Long-Term Care Facilities.

    Kataoka-Yahiro, Merle R; McFarlane, Sandra; Koijane, Jeannette; Li, Dongmei


    Between 2013 and 2030, older adults 65 years and older of racial/ethnic populations in the U.S. is projected to increase by 123% in comparison to the Whites (Non-Hispanics). To meet this demand, training of ethnically diverse health staff in long-term care facilities in palliative and hospice care is imperative. The purpose of this study was to evaluate a palliative and hospice care training of staff in two nursing homes in Hawaii - (a) to evaluate knowledge and confidence over three time periods, and (b) to compare staff and family caregiver satisfaction at end of program. The educational frameworks were based on cultural and communication theories. Fifty-two ethnically diverse staff, a majority being Asian (89%), participated in a 10-week module training and one 4 hour communication skills workshop. Staff evaluation included knowledge and confidence surveys, pre- and post-test knowledge tests, and FAMCARE-2 satisfaction instrument. There were nine Asian (89%) and Pacific Islander (11%) family caregivers who completed the FAMCARE-2 satisfaction instrument. The overall staff knowledge and confidence results were promising. The staff rated overall satisfaction of palliative care services lower than the family caregivers. Implications for future research, practice, and education with palliative and hospice care training of ethnically diverse nursing home staff is to include patient and family caregiver satisfaction of palliative and hospice care services, evaluation of effectiveness of cross-cultural communication theories in palliative and hospice care staff training, and support from administration for mentorship and development of these services in long term care facilities.

  16. Dignity, death, and dilemmas: a study of Washington hospices and physician-assisted death

    Campbell, Courtney S; Black, Margaret A


    ... in the Washington Death with Dignity Act. This article sets a national and local context for the discussion of hospice involvement in physician-assisted death, summarizes the content of hospice policies in Washington State, and presents...

  17. Lung cancer in HIV-infected patients

    R Palacios


    Full Text Available Purpose: Several studies have shown that HIV patients are at higher risk of lung cancer. Our aim is to analyse the prevalence and features of lung cancer in HIV-infected patients. Methods: The clinical charts of 4,721 HIV-infected patients seen in three hospitals of southeast Spain (study period 1992–2012 were reviewed, and all patients with a lung cancer were analysed. Results: There were 61 lung cancers, giving a prevalence of 1.2%. There was a predominance of men (82.0%, and smokers (96.6%; mean pack-years 35.2, with a median age of 48.0 (41.7–52.9 years, and their distribution according to risk group for HIV was: intravenous drug use 58.3%, homosexual 20.0%, and heterosexual 16.7%. Thirty-four (56.7% patients were Aids cases, and 29 (47.5% had prior pulmonar events: tuberculosis 16, bacterial pneumonia 9, and P. jiroveci pneumonia 4. The median nadir CD4 count was 149/mm3 (42–232, the median CD4 count at the time of diagnosis of the lung cancer was 237/mm3 (85–397, and 66.1%<350/mm3. 66.7% were on ART, and 70% of them had undetectable HIV viral load. The most common histological types of lung cancer were adenocarcinoma and epidermoid, with 24 (40.0% and 23 (38.3% cases, respectively. There were 49 (80.3% cases with advanced stages (III and IV at diagnosis. The distribution of treatments was: only palliative 23 (39.7%, chemotherapy 14 (24.1%, surgery and chemotherapy 8 (13.8%, radiotherapy 7 (12.1%, surgery 4 (6.9%, and other combined treatments 2 (3.4%. Forty-six (76.7% patients died, with a median survival time of 3 months. The Kaplan-Meier survival rate at 6 months was 42.7% (at 12 months 28.5%. Conclusions: The prevalence of lung cancer in this cohort of HIV-patients is high. People affected are mainly men, smokers, with transmission of HIV by intravenous drug use, and around half of them with prior opportunistic pulmonary events. Most patients had low nadir CD4 count, and were immunosuppressed at the time of diagnosis

  18. Changing patterns in place of cancer death in England: a population-based study.

    Wei Gao

    Full Text Available BACKGROUND: Most patients with cancer prefer to die at home or in a hospice, but hospitals remain the most common place of death (PoD.This study aims to explore the changing time trends of PoD and the associated factors, which are essential for end-of-life care improvement. METHODS AND FINDINGS: The study analysed all cancer deaths in England collected by the Office for National Statistics during 1993-2010 (n = 2,281,223. Time trends of age- and gender-standardised proportion of deaths in individual PoDs were evaluated using weighted piecewise linear regression. Variables associated with PoD (home or hospice versus hospital were determined using proportion ratio (PR derived from the log-binomial regression, adjusting for clustering effects. Hospital remained the most common PoD throughout the study period (48.0%; 95% CI 47.9%-48.0%, followed by home (24.5%; 95% CI 24.4%-24.5%, and hospice (16.4%; 95% CI 16.3%-16.4%. Home and hospice deaths increased since 2005 (0.87%; 95% CI 0.74%-0.99%/year, 0.24%; 95% CI 0.17%-0.32%/year, respectively, p<0.001, while hospital deaths declined (-1.20%; 95% CI -1.41 to -0.99/year, p<0.001. Patients who died from haematological cancer (PRs 0.46-0.52, who were single, widowed, or divorced (PRs 0.75-0.88, and aged over 75 (PRs 0.81-0.84 for 75-84; 0.66-0.72 for 85+ were less likely to die in home or hospice (p<0.001; reference groups: colorectal cancer, married, age 25-54. There was little improvement in patients with lung cancer of dying in home or hospice (PRs 0.87-0.88. Marital status became the second most important factor associated with PoD, after cancer type. Patients from less deprived areas (higher quintile of the deprivation index were more likely to die at home or in a hospice than those from more deprived areas (lower quintile of the deprivation index; PRs 1.02-1.12. The analysis is limited by a lack of data on individual patients' preferences for PoD or a clinical indication of the most appropriate Po

  19. Working with children of cancer patients.

    Slivka, H H; Magill, L


    Through the use of verbal and nonverbal techniques, a social worker and music therapist have combined their fields into an integral therapeutic modality to provide patients with cancer and their children opportunities to experience intimacy in a time of crisis. Skilled verbal interventions and the sensitive application of the expressive and less threatening medium of music create a relaxed environment where families and patients may explore deeply and express freely.

  20. Fatigue in disease-free cancer patients

    Servaes, Petra


    The present thesis consists of 1 literature review and 6 research articles on the subject of fatigue complaints in disease-free cancer patients who have finished curative treatment several years ago. In these articles the prevalence of severe fatigue, the relationship between severe fatigue and

  1. Pharmacogenetics of antiemetics in Indonesian cancer patients

    Perwitasari, Dyah Aryani


    Nausea and vomiting are well known side effects related to chemotherapy. Indeed, nausea and vomiting are the most distressing side effects of chemotherapy in cancer patients. Dopamine, serotonin and neurokinin1 are thought to be the neurotransmitters that play role in the pathophysiology of Chemothe

  2. [Treatment of elderly patients with breast cancer

    Paaschburg, B.; Pedersen, A.; Tuxen, M.K.;


    The latest investigations have been searched in order to present new guidelines for the treatment of elderly patients with primary breast cancer. It is concluded that breast-conserving surgery should be offered as well as the sentinel node technique. Axillary lymph node dissection is not necessary...

  3. Multidimensional fatigue and its correlates in hospitalised advanced cancer patients.

    Echteld, M.A.; Passchier, J.; Teunissen, S.; Claessen, S.; Wit, R. de; Rijt, C.C.D. van der


    Although fatigue is a multidimensional concept, multidimensional fatigue is rarely investigated in hospitalised cancer patients. We determined the levels and correlates of multidimensional fatigue in 100 advanced cancer patients admitted for symptom control. Fatigue dimensions were general fatigue (

  4. Is Chemo Overused in Younger Colon Cancer Patients?

    ... fullstory_163245.html Is Chemo Overused in Younger Colon Cancer Patients? Study found the treatment often wasn't ... 25, 2017 (HealthDay News) -- Young and middle-aged colon cancer patients may be getting chemotherapy more often than ...

  5. Inadequate Nutritional Status of Hospitalized Cancer Patients

    Ali Alkan


    Full Text Available Objective: In oncology practice, nutrition and also metabolic activity are essential to support the nutritional status and prevent malignant cachexia. It is important to evaluate the patients and plan the maneuvers at the start of the therapy. The primary objective of the study is to define the nutritional status of hospitalized patients and the factors affecting it in order to define the most susceptible patients and maneuvers for better nutritional support. Methods: Patients hospitalized in oncology clinic for therapy were evaluated for food intake and nutritional status through structured interviews. The clinical properties, medical therapies, elements of nutritional support were noted and predictors of inadequate nutritional status (INS were analyzed. Results: Four hundred twenty three patients, between 16-82 years old (median: 52 were evaluated. Nearly half of the patients (185, 43% reported a better appetite at home than in hospital and declared that hospitalization is an important cause of loss of appetite (140/185, 75.6%. Presence of nausea/vomiting (N/V, depression, age less than 65 and use of non-steroidal anti-inflammatory drugs (NSAIDs were associated with increased risk of INS in hospitalized cancer patients. On the contrary, steroid medication showed a positive impact on nutritional status of cancer patients. Conclusion: N/V, younger age, presence of depression and NSAIDs medication were associated with INS in hospitalized cancer patients. Clinicians should pay more attention to this group of patients. In addition, unnecessary hospitalizations and medications that may disturb oral intake must be avoided. Corticosteroids are important tools for managing anorexia and INS.

  6. 77 FR 44242 - Medicare Program; Hospice Wage Index for Fiscal Year 2013


    ... activities while remaining primarily in the home environment. A hospice uses an interdisciplinary approach to... determined by the hospice interdisciplinary group (IDG). The hospice conditions of participation (CoPs) at... Affordable Care Act of 2010 (Pub. L. 111-148) as amended by the Health Care Education Reconciliation Act of...

  7. Factors Associated with Attitude and Knowledge Toward Hospice Palliative Care Among Medical Caregivers

    Shih-Yi Lee


    Conclusion: Life and work experience improve the accuracy of medical staff in providing hospice palliative care. A culture-based, case-oriented continuing education program and a timely revision of the Hospice Palliative Care Article are recommended to increase the consistency between the principle and the practice of hospice palliative care.

  8. 42 CFR 418.28 - Revoking the election of hospice care.


    ... 42 Public Health 3 2010-10-01 2010-10-01 false Revoking the election of hospice care. 418.28... SERVICES (CONTINUED) MEDICARE PROGRAM HOSPICE CARE Eligibility, Election and Duration of Benefits § 418.28 Revoking the election of hospice care. (a) An individual or representative may revoke the...

  9. 42 CFR 418.402 - Individual liability for services that are not considered hospice care.


    ... considered hospice care. 418.402 Section 418.402 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HOSPICE CARE Coinsurance § 418.402 Individual liability for services that are not considered hospice care. Medicare payment to the...

  10. 42 CFR 418.21 - Duration of hospice care coverage-Election periods.


    ... 42 Public Health 3 2010-10-01 2010-10-01 false Duration of hospice care coverage-Election periods... HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HOSPICE CARE Eligibility, Election and Duration of Benefits § 418.21 Duration of hospice care coverage—Election periods. (a) Subject to the conditions set forth...

  11. 78 FR 26250 - Payment for Home Health Services and Hospice Care to Non-VA Providers


    ... AFFAIRS 38 CFR Part 17 RIN 2900-AN98 Payment for Home Health Services and Hospice Care to Non-VA Providers... services and hospice care. Because the newly applicable methodology cannot supersede rates for which VA has specifically contracted, this rulemaking will only affect home health and hospice care providers who do...

  12. 76 FR 71920 - Payment for Home Health Services and Hospice Care by Non-VA Providers


    ... AFFAIRS 38 CFR Part 17 RIN 2900-AN98 Payment for Home Health Services and Hospice Care by Non-VA Providers... methodology for non-VA providers of home health services and hospice care. The proposed rulemaking would include home health services and hospice care under the VA regulation governing payment for other...

  13. 76 FR 44010 - Medicare Program; Hospice Wage Index for Fiscal Year 2012; Correction


    ... HUMAN SERVICES Centers for Medicare & Medicaid Services RIN 0938-AQ31 Medicare Program; Hospice Wage... appeared in the notice of CMS ruling published in the Federal Register on May 9, 2011 entitled ``Hospice... (76 FR 26731) was incorrectly titled as ``Hospice Wage Index for Fiscal Year 2012''. We note that...

  14. Resources and Provided Services of Registered Hospice Care Institutions in Beijing%北京市登记注册临终关怀机构的资源及服务功能的调查研究

    潘毅慧; 王俊琪; 施永兴


    Objective To know the status of registered hospice care agencies in Beijing, to analyze the existing problems and influencing factors so as to propose the strategy for development of hospice care. Methods A questionnaire survey approach was taken to investigate the hospice care service work of 2 registered hospice institutions in Beijing. Results There were 179 appropriative sickbeds in the 2 surveyed hospice care institutions. The practitioners ( assistants ) engaging in hospice care services accounted for 15. 85% of the total number of employees, and the registered nurses accounted for 36. 59% . The ratio of practitioners to beds was 1 : 13. 77 ; the ratio of registered nurses to beds was 1 : 5. 97. The average number of discharged patients per year was 398 , of which the number of discharged patients with advanced cancer accounted for 14. 89% , the average hospitalization days was 65. 5 , the average medical cost for each discharged patient a day was RMB 122. 33 yuan, drug costs accounted for 36. 24%. The patients who enjoyed different types of health care insurance accounted for only 40. 45%, and 59. 55% patients should pay by themselves. Patients who failed to take care of themselves and needed full nursing care accounted for 68. 35% , who needed half nursing care accounted for 17. 09% , and who needed basic self - care accounted for 14. 56%. Conclusion The hospice care should be raised, especially the care efforts of the life quality of terminal advanced cancer patients. The hospice care basic medical insurance system should be established and improved. The policy support of government level and systematic system should be improved.%目的 了解北京市登记注册临终关怀机构的现状,分析其存在的问题及影响因素,并提出发展临终关怀事业的对策.方法 采用问卷调查的方法,调查北京市2所登记注册临终关怀机构的临终关怀服务工作情况.结果 被调查的2所临终

  15. [Selenium and oxidative stress in cancer patients].

    Gorozhanskaia, É G; Sviridova, S P; Dobrovol'skaia, M M; Zybrikhina, G N; Kashnia, Sh R


    In order to identify the features of violations of free-radical processes in blood serum of 94 untreated cancer patients with different localization of the tumor (cancer of the stomach, colon, breast, ovarian, hemoblastoses) were determined selenium levels and indicators of oxidative stress (sum of metabolites of nitrogen--NOx, the level of superoxide dismutase--Cu/ZnSOD and malondiialdehyde-MDA, and the activity of catalase). In addition, 40 patients with malignant liver disease and clinical signs of liver failure in the early postoperative period was carried out a comparative evaluation of the efficacy of selenium-containing drug "Selenaze" (sodium selenite pentahydrate). It was found that selenium levels in cancer patients by 25-30% below the norm of 110-120 mg/l at a rate of 73.0 +/- 2.6 mg/l. Low levels of NOx was detected in patients with all tumor localizations (22.1 +/- 1.1 microM, with normal range 28.4 +/- 0.9 microM). The exceptions were patients with extensive malignant process in the liver, in which the NOx levels were significantly higher than normal (p selenium levels by 10-12%, which was accompanied by a decrease in the content of SOD and NOx, and contributed to earlier recovery of detoxic and synthetic liver function. These findings point to an intensification of oxidative stress and metabolic disorders in the malignant process, which is the basis for metabolic correction.

  16. Fungal agents isolated from cancer patients.

    Alvarez Gasca, M A; Argüero Licea, B; Pliego Castañeda, A; García Tena, S


    With the aim to know the frequency of mycotic agents in patients with different types of cancer, samples were obtained from 81 patients from the Hospital de Oncología, Centro Médico Nacional Siglo XXI, IMSS from May 1995 through May 1996. In a conventional grouping seven (7) ambulatory patients were found in early stages, twenty seven (27) occasionally hospitalized patients were found in intermediate stage and forty seven (47) hospitalized patients in terminal stage of cancer. The different samples were processed through routine mycologycal methods and the following fungi species were isolated and identified: fifty four strains (58%) of Candida albicans followed by eleven strains (11.8%) of Candida tropicalis, six strains (6.45%) of Candida parapsilosis, five strains (5.37%) of Candida krusei, four strains (4.3%) of Candida humicola and five strains (5.37%) of Rodothorula rubra. From medical devices like catheter tips, drainage catheters (Pen rouse, Foley) and gallbladder catheters; four (4) strains of C. albicans, three (3) strains of Rodothorula rubra and two (2) strains of Aspergillus sp were isolated. Of the Candida non albicans it was relevant to find C. krusei more frequently than Rodothorula rubra, Aspergillus sp and Penicillum sp. The frequency of the presence of fungi increases commensurately to the advancement of the clincal stage of the cancer.

  17. [Adjuvant chemotherapy for patients with rectal cancer].

    Qvortrup, Camilla; Mortensen, John Pløen; Pfeiffer, Per


    A new Cochrane meta-analysis evaluated adjuvant chemotherapy (5-fluorouracil (5FU)-based, not modern combination chemotherapy) in almost 10,000 patients with rectal cancer and showed a 17% reduction in mortality corresponding well to the efficacy observed in recent studies, which reported a reduction in mortality just about 20%. The authors recommend adjuvant chemotherapy which is in accordance with the Danish national guidelines where 5-FU-based chemotherapy is recommended for stage III and high-risk stage II rectal cancer.

  18. Undergraduate nursing students caring for cancer patients: hermeneutic phenomenological insights of their experiences

    Charalambous Andreas


    Full Text Available Abstract Background The care of patients suffering from cancer and especially those facing the death trajectory appears to be complex and demanding not only for student nurses but for professional nurses as well. The educational models often used in nursing require students to face challenging care scenarios, sometimes with minimal or no supervision and guidance. These “worst case scenarios” can be traumatic experiences that can leave the student hopeless and disappointed of themselves and in many cases can “scar” their subsequent professional career. The literature demonstrates that this can be the result of the students’ ill-preparation to care for cancer patients and deal with death and dying. The purpose of this study was to interpret the students’ experiences of coming face-to-face with cancer care during their clinical placements. Methods This is a hermeneutic phenomenological study influenced by the ideas of the French Philosopher Paul Ricoeur. Based on this philosophical enquiry the interpretation process included three stages: 1 naïve reading, 2 structural analysis and 3 comprehensive understanding. Data were collected through reflective/narrative diaries from the 4th grade undergraduate (pre-registration nursing students practicing at oncology, hematology, pediatric oncology departments and hospices. Diaries of twelve students met the inclusion criteria and were included in the interpretation process. The study took place during January and May 2011. Results The interpretation yielded the following themes: a Being part of the center’s life, b Being sympathetic, c Being confronted by others, d Being self-reflective, e Being trapped in the system, f Being caring towards the family and g Being better in clinical practice. Conclusions The students emphasized the need for appropriate preparation both at a theoretical and at a clinical level, as to better confront situations involving death and dying as well as learning

  19. Cancer Pain Management and Pain Interference with Daily Functioning among Cancer Patients in Gondar University Hospital

    Henok Getachew Tegegn


    Full Text Available Cancer is an increasing public health burden for Ethiopia. Pain is among the most common symptoms in patients with cancer. Hence, we aimed to assess cancer pain prevalence, cancer pain interference, and adequacy of cancer pain treatment in the oncology ward of an Ethiopian teaching hospital. Of 83 patients, total of 76 (91.6% cancer patients experienced pain with varying degree of severity, and 7 (8.4% patients experienced severe pain. Of the 76 cancer patients with pain, 68 (89.2% experienced pain interference with their daily activities. Fifty-four (65% patients were receiving inadequate cancer pain treatment with negative Pain Management Index. Therefore, it is vital to anticipate and assess pain of the cancer patients as routine clinical practice, to optimize analgesic therapy, and to identify and overcome barriers to adequate pain management.

  20. Patient Beliefs About Colon Cancer Screening.

    Ely, John W; Levy, Barcey T; Daly, Jeanette; Xu, Yinghui


    Only about half of eligible individuals undergo colon cancer screening. We have limited knowledge about the patient beliefs that adversely affect screening decisions and about which beliefs might be amenable to change through education. As part of a clinical trial, 641 rural Iowans, aged 52 to 79 years, reported their beliefs about colon cancer screening in response to a mailed questionnaire. Consenting subjects were randomized into four groups, which were distinguished by four levels of increasingly intensive efforts to promote screening. Two of the groups received mailed educational materials and completed a follow-up questionnaire, which allowed us to determine whether their beliefs about screening changed following the education. We also completed a factor analysis to identify underlying (latent) factors that might explain the responses to 33 questions about readiness, attitudes, and perceived barriers related to colon cancer screening. The strongest predictors of a patient's stated readiness to be screened were a physician's recommendation to be screened (1 point difference on 10-point Likert scale, 95 % confidence interval [CI], 0.5 to 1.6 point difference), a family history of colon cancer (0.85-point Likert scale difference, 95 % CI, 0.1 to 1.6), and a belief that health-care decisions should be mostly left to physicians rather than patients (Spearman correlation coefficient 0.21, P beliefs, 11 (33 %) changed favorably following the educational intervention. In the factor analysis, the 33 items were reduced to 8 underlying factors, such as being too busy to undergo screening and worries about screening procedures. We found a limited number of underlying factors that may help explain patient resistance to colon cancer screening.

  1. Perspective of Narrative Medicine on Studying Ethical challenges inhospice for Community terminal cancer patients%叙事医学视角下社区晚期癌症患者临终关怀的伦理挑战∗



    目的:探析社区晚期癌症患者临终关怀面临的伦理挑战。方法选取8例入住社区舒缓疗护病房的晚期癌症患者进行观察,并与之访谈,采用倾听患者叙事、沟通对话、田野日记、工作日志等方法收集资料。结果对社区晚期癌症患者实施临终关怀面临诸多伦理困境。结论社区舒缓照护事业的发展不仅需要仁德之心的关爱,同时要加强优死教育、生命伦理教育,积极改善伦理环境,提高临终者生命质量。%Objective:To investigate the ethical challenges inhospice for community terminal cancer patients. Method:8 members of terminal Cancer Patients in palliative care wards were observed and interviewed. Datas were collected by narrative, communication,field note,work diary. Results:Get to know the ethical challenges in-hospice for community terminal cancer patients,and find the measures. Conclusions:The development of commu-nity hospice career need caring, life and death education,ethicaleducation,ethical environment improving,a harmo-nious ethical relationship and society,and life quality improving.

  2. [Assessment of nutritional status in patients with primary lung cancer].

    Chermiti Ben Abdallah, Fatma; Ben Saïd, Hanène; Chamkhi, Najiba; Ferchichi, Marwa; Chtourou, Amel; Taktak, Sofia; Ben Kheder, Ali


    Lung cancer is the leading cause of cancer-related mortality worldwide. Malnutrition is a common problem among patients with cancer, affecting up to 85% of patients with certain cancers and represents a risk factor for poor prognosis. aim: evaluate nutritional status in patients with lung cancer before and during treatment using nutritional risk index. it's a prospective study conducted in pneumology IV department in Abderahman Mami hospital, from January to May 2011. 30 male patients with a lung cancer were included. Nutritional status was assessed before and during treatment based on anthropometric measures, biological markers and nutritional risk index (NRI). Mean age of patients was 58 ± 12 years, ranging from 19 to 82 years. 29 patients had non small cell lung cancer and one patient had small cell cancer. Malnutrition was noted in 14 patients (47%) before treatment according to the NRI. It was noted in 23 patients (77%) after three cycles of chemotherapy with severe malnutrition in 8 patients. Relationship between body mass index (BMI) and the NRI was linear, but NRI tends to evaluate more objectively risk of malnutrition in patients with lung cancer. Nutritional assessment in patient with lung cancer should be performed systematically, early and repeatedly. Several markers can be used such as BMI and NRI. Nutritional support will reduce morbidity and improve quality of life in patients with lung cancer.

  3. The Overview of Hospice Care and Implementation%宁养的概论及实施

    林维德; 罗敏洁


    When a person is facing the end of life ,the hospice staff will evaluate a patient's total suffering to treat ,listen , care ,respect and to understand the patient .This is done in an effort to assist the patient in re-evaluating the meaning of life ,and leave this world with dignity .Caregivers also need to know their limits and take care of themselves during the process .Hospice team members need to fully equip themselves by understanding the issues that the patient is facing ,in order to provide true holistic care as a patient faces the end of life .%宁养为结合团队力量,在患者面临生命末期时,协助其可以面对身、心、灵、社会之整体性的痛苦,关心患者的心声、生命的意义、生活的维持、使患者被治疗、关怀、尊重、倾听、接受及了解,有尊严地面对死亡。照顾者依自己的需要关心、照顾自己,宁养团队成员需装备好自己,了解面对的病患问题,给予全人的照顾,使患者善终,家属善生。

  4. PET/MRI in cancer patients

    Kjær, Andreas; Loft, Annika; Law, Ian


    described include brain tumors, pediatric oncology as well as lung, abdominal and pelvic cancer. In general the cases show that PET/MRI performs well in all these types of cancer when compared to PET/CT. However, future large-scale clinical studies are needed to establish when to use PET/MRI. We envision...... Medicine & PET at Rigshospitalet in Copenhagen we installed an integrated PET/MRI in December 2011. Here, we describe our first clinical PET/MR cases and discuss some of the areas within oncology where we envision promising future application of integrated PET/MR imaging in clinical routine. Cases...... that PET/MRI in oncology will prove to become a valuable addition to PET/CT in diagnosing, tailoring and monitoring cancer therapy in selected patient populations....

  5. Fertility Preservation for Cancer Patients: A Review

    Tosin Ajala


    Full Text Available Infertility can arise as a consequence of treatment of oncological conditions. The parallel and continued improvement in both the management of oncology and fertility cases in recent times has brought to the fore-front the potential for fertility preservation in patients being treated for cancer. Oncologists must be aware of situations where their treatment will affect fertility in patients who are being treated for cancer and they must also be aware of the pathways available for procedures such as cryopreservation of gametes and/or embryos. Improved cancer care associated with increased cure rates and long term survival, coupled with advances in fertility treatment means that it is now imperative that fertility preservation is considered as part of the care offered to these patients. This can only be approached within a multidisciplinary setting. There are obvious challenges that still remain to be resolved, especially in the area of fertility preservation in prepubertal patients. These include ethical issues, such as valid consent and research in the area of tissue retrieval, cryopreservation, and transplantation.

  6. Medicare Program; FY 2016 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements. Final rule.


    This final rule will update the hospice payment rates and the wage index for fiscal year (FY) 2016 (October 1, 2015 through September 30, 2016), including implementing the last year of the phase-out of the wage index budget neutrality adjustment factor (BNAF). Effective on January 1, 2016, this rule also finalizes our proposals to differentiate payments for routine home care (RHC) based on the beneficiary's length of stay and implement a service intensity add-on (SIA) payment for services provided in the last 7 days of a beneficiary's life, if certain criteria are met. In addition, this rule will implement changes to the aggregate cap calculation mandated by the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act), align the cap accounting year for both the inpatient cap and the hospice aggregate cap with the federal fiscal year starting in FY 2017, make changes to the hospice quality reporting program, clarify a requirement for diagnosis reporting on the hospice claim, and discuss recent hospice payment reform research and analyses.

  7. Family Members’ Experience with Hospice in Nursing Homes

    Gage, L. Ashley; Washington, Karla T.; Oliver, Debra Parker; Lewis, Alexandra; Kruse, Robin L.; Demiris, George


    Research has documented numerous benefits and challenges associated with receipt of hospice care in nursing homes; however, study of this partnership from the perspective of residents’ family members has been limited. The purpose of this qualitative investigation was to explore family members’ experience with hospice services received in the nursing home setting. Researchers conducted a secondary data analysis of 175 family member interviews using a thematic analytic approach. Findings highlighted the critical role of communication in supporting residents and their family members. Care coordination, support and oversight, and role confusion also impacted family members’ experience of hospice care in the nursing home. Efforts directed at enhancing communication and more clearly articulating the roles of members of the health care team are indicated. PMID:25422516

  8. Family Members' Experience With Hospice in Nursing Homes.

    Gage, L Ashley; Washington, Karla; Oliver, Debra Parker; Kruse, Robin; Lewis, Alexandra; Demiris, George


    Research has documented numerous benefits and challenges associated with receipt of hospice care in nursing homes; however, study of this partnership from the perspective of residents' family members has been limited. The purpose of this qualitative investigation was to explore family members' experience with hospice services received in the nursing home setting. Researchers conducted a secondary data analysis of 175 family member interviews using a thematic analytic approach. Findings highlighted the critical role of communication in supporting residents and their family members. Care coordination, support and oversight, and role confusion also impacted family members' experience of hospice care in the nursing home. Efforts directed at enhancing communication and more clearly articulating the roles of members of the health care team are indicated.

  9. High incidence of thyroid cancer among patients with acromegaly.

    Kaldrymidis, Dimitrios; Papadakis, Georgios; Tsakonas, Georgios; Kaldrymidis, Philippos; Flaskas, Theofanis; Seretis, Andreas; Pantazi, Eleni; Kostoglou-Athanassiou, Ifigenia; Peppa, Melpomeni; Roussou, Paraskevi; Diamanti-Kandarakis, Evanthia


    Several studies have suggested that patients with acromegaly have an increased risk of thyroid, colorectal, breast and prostate cancers. In this study we determined the prevalence of malignant neoplasms in patients with acromegaly. Cancer risk was evaluated in a cohort of 110 patients (M/F 48/62, age 58.63±13.8 years, range 30-86) with acromegaly. Mean age at diagnosis of acromegaly was 46.37±13.11 years. Mean period of time since diagnosis of acromegaly was 12.26+9.6 years. From 110 patients, cancer was diagnosed in 26 (23.6%) patients. Thyroid cancer was the most common cancer and was diagnosed in 13 patients (11.8%); other cancers encountered were gastric cancer (N=2), endometrial cancer (N-2), and breast cancer, colon cancer, prostate cancer (N-2), myelodysplastic syndrome, renal cell carcinoma, lung cancer and pancreatic carcinoma, one case each. Age, gender, age at the time of diagnosis of acromegaly, tumor size of pituitary adenoma and duration of disease were not associated with cancer development. This study suggests that patients with acromegaly have an increased risk of thyroid cancer and therefore they should undergo regular screening with hormonal and ultrasound evaluation of the thyroid and FNAB when required.

  10. Fatal hemorrhage in irradiated esophageal cancer patients

    Nemoto, Kenji; Takai, Yoshihiro; Ogawa, Yoshihiro; Kakuto, Yoshihisa; Ariga, Hisanori; Matsushita, Haruo; Wada, Hitoshi; Yamada, Shogo [Tohoku Univ., Sendai (Japan). Dept. of Radiology


    Between 1980 and 1994, 423 patients with esophageal cancer were given curative radiation therapy. Of these patients, 31 died of massive hemorrhage and were used as the subjects of analysis in this study. The incidence of massive hemorrhage in all patients was 7% (31/423). In the 31 patients who died of massive hemorrhage, 27 had local tumors and two had no tumors at hemorrhage (two unknown cases). The mean time interval from the start of radiation to hemorrhage was 9.2 months. In 9 autopsy cases the origin of hemorrhage was a tear of the aorta in 5 cases, necrotic local tumor in 3 cases and esophageal ulcer in 1 case. The positive risk factors for this complication seemed to be excess total dose, infection, metallic stent, and tracheoesophageal fistula. Chest pain or sentinel hemorrhage proceeding to massive hemorrhage was observed in about half of the patients. (orig.)

  11. E-Cigarettes and Cancer Patients

    Dresler, Carolyn M.; Field, John K.; Fox, Jesme; Gritz, Ellen R.; Hanna, Nasser H.; Ikeda, Norihiko; Jassem, Jacek; Mulshine, James L.; Peters, Matthew J.; Yamaguchi, Nise H.; Warren, Graham; Zhou, Caicun


    The increasing popularity and availability of electronic cigarettes (i.e., e-cigarettes) in many countries have promoted debate among health professionals as to what to recommend to their patients who might be struggling to stop smoking or asking about e-cigarettes. In the absence of evidence-based guidelines for using e-cigarettes for smoking cessation, some health professionals have urged caution about recommending them due to the limited evidence of their safety and efficacy, while others have argued that e-cigarettes are obviously a better alternative to continued cigarette smoking and should be encouraged. The leadership of the International Association for the Study of Lung Cancer asked the Tobacco Control and Smoking Cessation Committee to formulate a statement on the use of e-cigarettes by cancer patients to help guide clinical practice. Below is this statement, which we will update periodically as new evidence becomes available. PMID:24736063

  12. Why breast cancer patients seek traditional healers.

    Muhamad, Mazanah; Merriam, Sharan; Suhami, Norhasmilia


    Traditional healing is a common practice in low and middle income countries such as Malaysia. Eighty percent of Malaysians consult traditional healers or "bomoh" at some time in their life for health-related issues. The purpose of our study was to explore why breast cancer patients visit traditional healers. This is a qualitative study utilizing in-depth interviews with 11 cancer survivors who sought both traditional and Western medicine. The findings revealed the following reasons for which patients seek traditional healers: (1) recommendation from family and friends, (2) sanction from family, (3) perceived benefit and compatibility, (4) healer credibility, and (5) reservation with Western medicine and system delay. These factors work together and are strongly influenced by the Malaysian cultural context. The issue with the Western health system is common in a developing country with limited health facilities.

  13. Why Breast Cancer Patients Seek Traditional Healers

    Mazanah Muhamad


    Full Text Available Traditional healing is a common practice in low and middle income countries such as Malaysia. Eighty percent of Malaysians consult traditional healers or “bomoh” at some time in their life for health-related issues. The purpose of our study was to explore why breast cancer patients visit traditional healers. This is a qualitative study utilizing in-depth interviews with 11 cancer survivors who sought both traditional and Western medicine. The findings revealed the following reasons for which patients seek traditional healers: (1 recommendation from family and friends, (2 sanction from family, (3 perceived benefit and compatibility, (4 healer credibility, and (5 reservation with Western medicine and system delay. These factors work together and are strongly influenced by the Malaysian cultural context. The issue with the Western health system is common in a developing country with limited health facilities.

  14. [The value of time in cancer patients].

    Barone, Carlo


    In medicine time is one of the main dimensions used in order to assess the efficacy of a cure. In oncology we measure either the advantage obtained with a treatment or the clinical course of a cancer as time intervals or survival benefit. In the last years we can describe life expectancy in many solid tumors following therapy, not only in terms of median survival, but also in terms of 3-5 years survival. Additional life time, that given by novel drugs, is now a real experience in some solid tumors allowing a reflection on its value and meaning in the personal perception of patients as well in an absolute perspective. The concept of time deformation in physics suggests a metaphorical similarity with rediscovery of the authentic sense of life in an increasing number of patients affected by cancer who experience a significant life prolongation.

  15. Methadone-Induced Neurotoxicity in Advanced Cancer: A Case Report.

    Hoff, Ann M; Hartwig, Kristopher N; Rosielle, Drew A


    Methadone use as a second-line agent for severe cancer-related pain is increasing in the field of hospice and palliative care. It has a number of qualities that make its use favorable, including lack of known active metabolites and presumed relative safety from adverse effects such as opioid-induced neurotoxicity (OIN). This article describes a case of a patient undergoing treatment of severe cancer-related pain who developed OIN in the setting of oral methadone use. As the use of methadone increases, more research into its pharmacologic and pharmacokinetic properties will be necessary.

  16. Family Caregivers for Cancer Patients in Thailand


    This integrative review was conducted to describe findings from Thai studies concerning family caregivers for cancer patients. Twenty-three studies that were published from 1994 to 2009 were considered. There were 15 quantitative studies and 8 qualitative studies. The stress and coping model developed by Lazarus and Folkman was the most popular theory that was used to guide the studies. The variables that were explored...

  17. Hematological Support of a Cancer Patient

    Shear, J.M.; Rock, G.


    Transfusion medicine has come to function as a pivotal support in the treatment of cancer patients in the late 1980s. The authors of this article discuss the indications for, and uses of, various blood components, including packed red blood cells, leukocyte-poor and/or washed blood cells, random donor and single donor platelets, granulocyte concentrates, fresh frozen plasma, and cryoprecipitate. They also discuss common and not-so-common risks, reactions, and diseases associated with the tran...

  18. How to present online information to older cancer patients

    Bol, N.


    Providing information to cancer patients is crucial within cancer care. As the Internet is becoming an increasingly valuable source of cancer information, it is important to consider the rapidly aging population when designing online cancer materials. Yet, the lack of studies and inconsistent findin

  19. Is there a model for demonstrating a beneficial financial impact of initiating a palliative care program by an existing hospice program?

    Passik, Steven D; Ruggles, Carol; Brown, Gretchen; Snapp, Janet; Swinford, Susan; Gutgsell, Terrence; Kirsh, Kenneth L


    The value of integrating palliative with curative modes of care earlier in the course of disease for people with life threatening illnesses is well recognized. Whereas the now outdated model of waiting for people to be actively dying before initiating palliative care has been clearly discredited on clinical grounds, how a better integration of modes of care can be achieved, financed and sustained is an ongoing challenge for the health care system in general as well as for specific institutions. When the initiative comes from a hospital or academic medical center, which may, for example, begin a palliative care consultation service, financial benefits have been well documented. These palliative care services survive mainly by tracking cost savings that can be realized in a number of ways around a medical center. We tried to pilot 3 simple models of potential cost savings afforded to hospice by initiating a palliative care program. We found that simple models cannot capture this benefit (if it in fact exists). By adding palliative care, hospice, while no doubt improving and streamlining care, is also taking on more complex patients (higher drug costs, shorter length of stay, more outpatient, emergency room and physician visits). Indeed, the hospice was absorbing the losses associated with having the palliative care program. We suggest that an avenue for future exploration is whether partnering between hospitals and hospice programs can defray some of the costs incurred by the palliative care program (that might otherwise be passed on to hospice) in anticipation of cost savings. We end with a series of questions: Are there financial benefits? Can they be modeled and quantified? Is this a dilemma for hospice programs wanting to improve the quality of care but who are not able on their own to finance it?

  20. [The cancer patient in science and society].

    Günther, H


    The 2nd Dresden hematonocological meeting, organized by the Department of hematology and oncology of the Medical Academy "Carl Gustav Carus" and by the Tumorzentrum Dresden, focused ethical and anthropological topics. Death and dying, care and health prevention in modern oncology as well as the broad field of supportive care were discussed. The goal of the meeting was to find long time concepts of a patient oriented medical care in cancer patients. This will only be possible in interdisciplinary structures including philosophers, theologians, clinicians and general practitioners. The rapid progress of medical development in Eastern Germany must not forget this goal.


    Renija Valiya


    Full Text Available BACKGROUND Breast cancer is the most common malignant tumour in women worldwide. The relationship between breast cancer and thyroid disease is a controversy. Many of the studies showed hypothyroidism as the commonly found thyroid abnormality in breast cancer. [1] There is considerable evidence for an increased risk of thyroid and breast cancer in patients with iodine deficiency. This ability of iodine to reduce the risk of breast cancer is attributed to the ability of iodine and its compounds to induce apoptosis so that appropriate cell death occurs. Instead, in the absence of optimum level of iodine in the body the transformed cells continue to grow and divide resulting in cancer. AIMS 1. To find out the association of thyroid hormones and breast cancer in early breast cancer patients. 2. To find out the association of thyroid peroxidase antibodies in early breast cancer patients. Settings Cases: 82 breast cancer patients in early stage who attended the breast clinic. Controls: 82 age matched controls (Between 25-80 years. Design: Case control study. MATERIALS AND METHOD In this study, investigated for thyroid function test (T3, T4, TSH and thyroid peroxide antibody level in 82 early breast cancer patients. STATISTICAL ANALYSIS SPSS 16. RESULTS Statistically significant low T4 and high TSH in breast cancer patients, along with elevated thyroid peroxidase antibody. CONCLUSION Compared to hyperthyroidism, hypothyroidism was found to be clinically significant in breast cancer patients

  2. Lymphedema After Surgery in Patients With Endometrial Cancer, Cervical Cancer, or Vulvar Cancer


    Lymphedema; Stage IA Cervical Cancer; Stage IA Uterine Corpus Cancer; Stage IA Vulvar Cancer; Stage IB Cervical Cancer; Stage IB Uterine Corpus Cancer; Stage IB Vulvar Cancer; Stage II Uterine Corpus Cancer; Stage II Vulvar Cancer; Stage IIA Cervical Cancer; Stage IIIA Vulvar Cancer; Stage IIIB Vulvar Cancer; Stage IIIC Vulvar Cancer; Stage IVB Vulvar Cancer

  3. Impact of health care reform on the cancer patient: a view from cancer executives.

    Ferris, Linda W; Farber, Matthew; Guidi, Teri Ursin; Laffey, William J


    Cancer leaders assess the impact on the cancer patient of the historic passage of Patient Protection and Affordable Care Act (HR 3590) (PPACA). The Association of Cancer Executives, a national organization for leadership development of oncology executives and improvements in patient care delivery, and the Association of Community Cancer Centers, a leading education and advocacy organization for the cancer team, weigh in on the impact of PPACA. Oncology leaders assess the impact of PPACA on cancer patients and families, cancer programs in the United States, and provider relations. The provisions of PPACA most impacting cancer patients are reviewed, including reimbursement changes, expansion of prevention and screening services, the development of accountable care organizations, physician relations, and the implementation of integrated electronic health records. Cancer executives prepare their programs for PPACA by changing the care delivery model to ensure the economic survival of private practices and hospital-based programs.

  4. Gastric varicella: two cases in cancer patients

    Violeta María Sastre-Lozano

    Full Text Available Gastric involvement with the varicella-zoster virus is an uncommon clinical condition where early suspicion and diagnosis are important to prevent the consequences deriving from its high morbidity and mortality, which in immunocompromised patients oscillate between 9% and 41% according to the various series. Two cases of gastric involvement with the varicella-zoster virus (VZV in two patients with blood cancer are reported below. Gastric lesions are usually preceded by typical papulovesicular skin lesions. When gastric involvement is the first symptom of the disease its diagnosis and management may be delayed, which may entail severe consequences for immunocompromised patients. It is therefore that we suggest its inclusion in the algorithm for immunocompromised patients with abdominal pain and ulcer-like endoscopic lesions.

  5. Racial and ethnic differences in beliefs about lung cancer care.

    Jonnalagadda, Sirisha; Lin, Jenny J; Nelson, Judith E; Powell, Charles A; Salazar-Schicchi, John; Berman, Andrew R; Keller, Steven M; Smith, Cardinale B; Lurslurchachai, Linda; Halm, Ethan A; Leventhal, Howard; Wisnivesky, Juan P


    Disparities in lung cancer treatment and palliative care are well documented. However,the mechanisms underlying these disparities are not fully understood. In this study, we evaluated racial and ethnic differences in beliefs and attitudes about lung cancer treatment and palliative care among patients receiving a new diagnosis of lung cancer. Patients were recruited from four medical centers in New York City and surveyed about their beliefs regarding lung cancer care, including disease-directed treatments, palliative and end-of-life care, and fatalistic and spiritual beliefs. We used univariate and multiple regression analyses to compare the distribution of beliefs among minority (black and Hispanic) and nonminority patients. Of the 335 patients, 21% were black, 20% were Hispanic, and 59% were nonminority. Beliefs about chemotherapy and radiotherapy were similar across the three groups ( P > .05),whereas black patients were more likely to believe that surgery might cause lung cancer to spread( P =.008). Fatalistic beliefs potentially affecting cancer treatment were more common among both minority groups ( P ≤ .02). No signifi cant differences were found in attitudes toward clinician communication about cancer prognosis ( P > .05). However, both blacks and Hispanics were more likely to have misconceptions about advance directives and hospice care ( P ≤ .02). Similarities and differences in beliefs about disease-directed treatment were observed between minority and nonminority patients with lung cancer. Minority patients hold more fatalistic views about the disease and misperceptions about advance care planning and hospice care. Further research is needed to assess the impact of these beliefs on decisions about lung cancer care and patient outcomes.

  6. Racial and Ethnic Differences in Beliefs About Lung Cancer Care

    Jonnalagadda, Sirisha; Lin, Jenny J.; Nelson, Judith E.; Powell, Charles A.; Salazar-Schicchi, John; Berman, Andrew R.; Keller, Steven M.; Smith, Cardinale B.; Lurslurchachai, Linda; Halm, Ethan A.; Leventhal, Howard


    Background: Disparities in lung cancer treatment and palliative care are well documented. However, the mechanisms underlying these disparities are not fully understood. In this study, we evaluated racial and ethnic differences in beliefs and attitudes about lung cancer treatment and palliative care among patients receiving a new diagnosis of lung cancer. Methods: Patients were recruited from four medical centers in New York City and surveyed about their beliefs regarding lung cancer care, including disease-directed treatments, palliative and end-of-life care, and fatalistic and spiritual beliefs. We used univariate and multiple regression analyses to compare the distribution of beliefs among minority (black and Hispanic) and nonminority patients. Results: Of the 335 patients, 21% were black, 20% were Hispanic, and 59% were nonminority. Beliefs about chemotherapy and radiotherapy were similar across the three groups (P > .05), whereas black patients were more likely to believe that surgery might cause lung cancer to spread (P = .008). Fatalistic beliefs potentially affecting cancer treatment were more common among both minority groups (P ≤ .02). No significant differences were found in attitudes toward clinician communication about cancer prognosis (P > .05). However, both blacks and Hispanics were more likely to have misconceptions about advance directives and hospice care (P ≤ .02). Conclusions: Similarities and differences in beliefs about disease-directed treatment were observed between minority and nonminority patients with lung cancer. Minority patients hold more fatalistic views about the disease and misperceptions about advance care planning and hospice care. Further research is needed to assess the impact of these beliefs on decisions about lung cancer care and patient outcomes. PMID:22700777

  7. Characteristics of critically ill cancer patients in the Netherlands

    Bos, Monique Martina Elisabeth Maria


    The care for acute complications occurring in cancer patients has changed dramatically in recent decades, not only for direct post-operative care following major cancer surgery, but also for cancer patients in need of organ function replacement due to the manifestation of their malignancy or toxicit

  8. Bleeding complications during anticoagulant treatment in patients with cancer

    Kamphuisen, Pieter W.; Beyer-Westendorf, Jan

    Patients with cancer have an increased risk of bleeding complications, of which some are fatal. This risk is influenced by chemotherapy, cancer type and stage, thrombocytopenia, renal function, and previous bleeding. Since many cancer patients receive anticoagulant treatment for prophylaxis or

  9. Coping with cancer : The perspective of patients' relatives

    Hagedoorn, Mariet; Kreicbergs, Ulrika; Appel, Charlotte


    Cancer affects not only patients but also their loved ones. Material and methods. This paper presents a selective, narrative review of psychosocial consequences of cancer and its treatment for relatives of patients, including parents and siblings of children with cancer, children of parents with can

  10. Coping with cancer : The perspective of patients' relatives

    Hagedoorn, Mariet; Kreicbergs, Ulrika; Appel, Charlotte


    Cancer affects not only patients but also their loved ones. Material and methods. This paper presents a selective, narrative review of psychosocial consequences of cancer and its treatment for relatives of patients, including parents and siblings of children with cancer, children of parents with can

  11. Survival Analysis of Breast Cancer Subtypes in Spinal Metastases Patients

    Wang, Miao; Jensen, Anders Bonde; Morgen, Soeren Smith


    STUDY DESIGN: We conducted a retrospective cohort study of 151 patients with breast cancer spinal metastases. OBJECTIVE: To investigate the influence of breast cancer subtypes on survival duration of patients with breast cancer spinal metastases, and to aid spine surgeons in selecting treatments ...

  12. Maslow's hierarchy of needs: a framework for achieving human potential in hospice.

    Zalenski, Robert J; Raspa, Richard


    Although the widespread implementation of hospice in the United States has led to tremendous advances in the care of the dying, there has been no widely accepted psychological theory to drive needs assessment and intervention design for the patient and family. The humanistic psychology of Abraham Maslow, especially his theory of motivation and the hierarchy of needs, has been widely applied in business and social science, but only sparsely discussed in the palliative care literature. In this article we review Maslow's original hierarchy, adapt it to hospice and palliative care, apply the adaptation to a case example, and then discuss its implications for patient care, education, and research. The five levels of the hierarchy of needs as adapted to palliative care are: (1) distressing symptoms, such as pain or dyspnea; (2) fears for physical safety, of dying or abandonment; (3) affection, love and acceptance in the face of devastating illness; (4) esteem, respect, and appreciation for the person; (5) selfactualization and transcendence. Maslow's modified hierarchy of palliative care needs could be utilized to provide a comprehensive approach for the assessment of patients' needs and the design of interventions to achieve goals that start with comfort and potentially extend to the experience of transcendence.

  13. The mass media and the cancer patient--some views.

    Rimer, I


    A study by the National Cancer Institute indicates extensive newspaper coverage of the subject of cancer. Some of the media presentations on cancer are highly emotional in nature, such as the PBS special, "Joan Robinson: One Woman's Story." Other more optimistic stories may have a negative impact on patients facing more advanced stages of the disease. Yet the media appear to be gradually stripping the mystery from cancer and preparing patients to deal with their treatment and physicians more intelligently and more assertively. Breast and lung cancers are the two sites that get the most attention from the press. Unfortunately, colon and rectum cancers rank quite low in press attention. The American Cancer Society (ACS) has studied public attitudes toward these cancers and is preparing programs to reach the public about them. This paper will deal with these topics and make some observations on the impact of media coverage on cancer patients.

  14. Symptom monitoring in treatment of cancer patients

    Yao Wanxia; Lin Miao; Lü Ye; Yang Biao; Yao Cong; Liu Juan; Wang Wenru


    Objective To examine self-reported symptoms by the patients receiving cancer therapy, and find out the symptoms that should be coped with and managed during the treatment. Methods A pilot study was conducted on self-reported symptoms on 185 patients receiving chemotherapy and/or radiotherapy for different cancers. The Therapy-Related Symptoms Checklist (TRSC) was used. Results Severe symptoms on the TRSC subscales: loss of appetite,feeling sluggish, weight loss, nausea and hair loss, were reported by the patients. The frequently reported symptoms by those on chemotherapy were nausea, feeling sluggish, weight loss, vomiting, and taste change. The frequently reported symptoms by those on radiotherapy were feeling sluggish, weight loss, loss of appetite, difficult sleeping, and changing taste. The symptoms of loss of appetite, feeling sluggish, weight loss, hair loss, and nausea were both frequently reported by those on radiotherapy and those on chemotherapy. Conclusion Symptom monitoring may be facilitated by TRSC, based on the severity and frequency of reported symptoms, more patients and caregivers could know which symptoms should be preferential interventions.

  15. Management of patients with metastatic breast cancer.

    Cruz Jurado, J; Richart Aznar, P; García Mata, J; Fernández Martínez, R; Peláez Fernández, I; Sampedro Gimeno, T; Galve Calvo, E; Murillo Jaso, L; Polo Marqués, E; García Palomo, A


    Hormone treatment is one of the key strategies in the management of metastatic breast cancer. Hormone treatment is one of the key strategies in the management of metastatic breast cancer. Aromatase inhibitors (AI) have been extensively studied in this setting. This section summarizes the key data regarding the use of AI in advanced breast cancer. In postmenopausal women, AI are the first line of treatment for untreated patients, or those who had prior AI treatment and progress after 12 months of adjuvant therapy. A longer disease-free interval and absence of visceral disease is associated with a better response. If tumors recur in less than 12 months, it is recommended that tamoxifen (TAM) or the estrogen-receptor antagonist fulvestrant (FUL) treatment be initiated. In the second-line setting, the best option after progression is the administration of either FUL or TAM. In the third-line setting, reintroduction of AI is considered an acceptable option. In premenopausal women who have not received prior treatment or who have progressed after 12 months following adjuvant treatment, it is recommended to initiate therapy with a combination of TAM and a luteinizing hormone-releasing hormone (LHRH) analog. If there is treatment failure with the use of this combination, megestrol acetate or an LHRH agonist plus an AI may be reasonable alternatives. Intensive research is ongoing to understand the mechanisms of resistance to hormone therapy. In human epidermal growth factor receptor 2 positive-patients, combinations with HER2 antagonists are associated with significant clinical activity.

  16. Family Caregivers for Cancer Patients in Thailand

    Warunee Meecharoen


    Full Text Available This integrative review was conducted to describe findings from Thai studies concerning family caregivers for cancer patients. Twenty-three studies that were published from 1994 to 2009 were considered. There were 15 quantitative studies and 8 qualitative studies. The stress and coping model developed by Lazarus and Folkman was the most popular theory that was used to guide the studies. The variables that were explored in the quantitative studies consisted of social support, stress, coping, caregiver burden, quality of life (QOL, and others. The qualitative findings revealed that there were several themes such as the following: the meaning of being family caregivers for cancer patients, the meaning of care, the experiences of caregivers, and the problems and needs of family caregivers in the Thai context. The evidence from the 23 studies reviewed showed that the state of knowledge of cancer caregivers in the Thai context is at an early stage compared with the state of knowledge in Western countries. More research needs to be done to explore the concepts related to negative and positive outcomes of caregiving.

  17. A comparison of sources of nursing stress and job satisfaction among mental handicap and hospice nursing staff.

    Power, K G; Sharp, G R


    This study compares sources of nursing stress and job satisfaction among 181 mental handicap and 24 hospice nurses. It was hypothesized that nursing stress varies as a consequence of nursing specialty. Analysis of variance revealed differing features of nursing stress between the two specialties. Hospice nurses reported stress as primarily associated with death and dying and inadequate preparation to meet the emotional needs of patients and their families, while mental handicap nurses reported stress related to workload, conflict with other nurses and nursing environment. The results suggest that two additional factors that did not differ between specialties require further examination, namely patient behaviour and purposelessness of nursing care. Job satisfaction also differed between specialties with hospice nurses reporting higher satisfaction with supervision, co-workers, and pay, and lower satisfaction with promotion in comparison to mental handicap nurses. Within the mental handicap groups nursing stress correlated with job satisfaction, state-trait anxiety and non-psychotic psychiatric disturbance in predicted directions. Analysis of the above variables with respect to mental handicap nursing grade was also undertaken. Overall results indicate the importance of nursing specialty as a major factor influencing nursing stress.

  18. Factors associated with management of cervical cancer patients at ...

    Factors associated with management of cervical cancer patients at KCMC Hospital, Tanzania: a retrospective cross-sectional ... Abstract: Cervical cancer is an important public health problem among adult women worldwide. ... Article Metrics.

  19. Chemotherapy Regimen Extends Survival in Advanced Pancreatic Cancer Patients

    A four-drug chemotherapy regimen has produced the longest improvement in survival ever seen in a phase III clinical trial of patients with metastatic pancreatic cancer, one of the deadliest types of cancer.

  20. Candidaemia and cancer: patients are not all the same

    Medeiros Lidia


    Full Text Available Abstract Background Most of the studies about invasive Candida infections in cancer patients have focused on haematological patients. The aim of this study was to provide information about risk factors for candidaemia in patients with solid tumours. Methods Retrospective cohort study. During a 9-year period (1995–2003 we reviewed all cases of candidaemia that affected cancer patients in Santa Casa Complexo Hospitalar, Brazil. Results During the period of study, 210 patients had the diagnosis of candidaemia in our medical centre, and 83 of these patients had cancer (39.5%. The majority of patients with cancer had solid tumours (77.1%, mostly in the alimentary tract. Most of solid cancers were non-metastatic (71.9%. Major diagnoses in patients with haematological neoplasia were acute leukaemia (n = 13, high grade non-Hodgkin lymphoma (n = 5 and Hodgkin's disease (n = 1. Non-Candida albicans species caused 57.8% of the episodes of candidaemia in patients with cancer, mainly in patients with haematological malignancies (p = 0.034. Neutropenia and treatment with corticosteroids were more frequent in the haematological group, in comparison with patients with solid tumours. Only 22.2% of patients with solid tumours were neutropenic before candidaemia. Nonetheless, the presence of ileus and the use of anaerobicides were independent risk factors for candidaemia in patients with solid cancers. The overall mortality in cancer patients with candidaemia was 49.4%. We then compared 2 groups of adult patients with candidaemia. The first was composed of non-neutropenic patients with solid tumours, and the second group included patients without cancer. We found that central venous catheters and gastrointestinal surgery were independently associated with candidaemia in patients with solid tumour. Conclusion Cancer patients with candidaemia seem to have very different predisposing factors to acquire the infection when stratified according to baseline diseases