Ellington, Lee; Clayton, Margaret F; Reblin, Maija; Cloyes, Kristin; Beck, Anna C; Harrold, Joan K; Harris, Pamela; Casarett, David
Hospice provides intensive end-of-life care to patients and their families delivered by an interdisciplinary team of nurses, aides, chaplains, social workers, and physicians. Significant gaps remain about how team members respond to diverse needs of patients and families, especially in the last week of life. The study objective was to describe the frequency of hospice team provider visits in the last week of life, to examine changes in frequency over time, and to identify patient characteristics that were associated with an increase in visit frequency. This was a retrospective cohort study using electronic medical record data. From U.S. not-for-profit hospices, 92,250 records were used of patients who died at home or in a nursing home, with a length of stay of at least seven days. Data included basic demographic variables, diagnoses, clinical markers of illness severity, patient functioning, and number of hospice team member visits in the last seven days of life. On average the total number of hospice team member visits in the last week of life was 1.36 visits/day. Most were nurse visits, followed by aides, social workers, and chaplains. Visits increased over each day on average across the last week of life. Greater increase in visits was associated with patients who were younger, male, Caucasian, had a spouse caregiver, and shorter lengths of stay. This study provides important information to help hospices align the interdisciplinary team configuration with the timing of team member visits, to better meet the needs of the patients and families they serve.
Wittenberg-Lyles, Elaine; Debra, Parker Oliver; Demiris, George; Rankin, Anna; Shaunfield, Sara; Kruse, Robin L
The goal of this study was to explore empathic communication opportunities presented by family caregivers and responses from interdisciplinary hospice team members. Empathic opportunities and hospice team responses were analyzed from bi-weekly web-based videoconferences between family caregivers and hospice teams. The authors coded the data using the Empathic Communication Coding System (ECCS) and identified themes within and among the coded data. Data analysis identified 270 empathic opportunity-team response sequences. Caregivers expressed statements of emotion and decline most frequently. Two-thirds of the hospice team responses were implicit acknowledgements of caregiver statements and only one-third of the team responses were explicit recognitions of caregiver empathic opportunities. Although hospice team members frequently express emotional concerns with family caregivers during one-on-one visits, there is a need for more empathic communication during team meetings that involve caregivers. Hospice clinicians should devote more time to discussing emotional issues with patients and their families to enhance patient-centered hospice care. Further consideration should be given to training clinicians to empathize with patients and family caregivers. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.
English, David J.; Mortenson, Lee E.
This monograph, the first in a series of five, provides training information for hospice staff in improving interdisciplinary team functions and humanistic care provisions. Its purpose is to assist hospice directors, educators, and other administrative staff members to understand the focus of the proposed training and its applicability to their…
Wilson, Dottie C.; Grady, Kathleen A.
This monograph, the fourth in a series of five, provides training information for hospice staff in improving interdisciplinary team functions and humanistic care provisions. Its purpose is to prepare a skilled team of trainers with information about hospices that is relevant to hospice interdisciplinary team training and to document experiences in…
Wilson, Dottie C.; Grady, Kathleen A.
This monograph, the second in a series of five, provides information for trainers on interdisciplinary team training and humanistic patient care in hospices. Designed to help outside trainers who may be invited by a hospice to conduct its training, the materials help instructors to understand the nature of hospices, to determine whether or not the…
Parker Oliver, Debra; Demiris, George; Washington, Karla; Kruse, Robin L; Petroski, Greg
Untrained family caregivers struggle with complicated medical management regimens for hospice patients. An intervention was tested to improve caregiver's perception of pain management and patient's pain. The intervention was tested with a 2-group (usual care vs intervention) randomized controlled trial using parallel mixed-methods analysis of 446 caregivers in 3 Midwestern hospice programs representing rural and urban settings. Web conferencing or telephones were used to connect caregivers with the hospice care team during care plan meetings. Caregiver's perceptions of pain management were the primary outcome. Secondary outcomes included caregiver quality of life, patient's pain, and anxiety. Video recordings, field notes, and caregiver and staff interviews provided qualitative data. The overall perception of pain management was not changed by the participation in hospice team meetings. Perceptions of fatalism improved for intervention participants, and the intervention participants perceived their patients' pain was better controlled than those in the control group. The intervention was found to be feasible to deliver in rural areas. Caregiver's anxiety and patient's pain were correlated ( r = .18; P = .003), and subanalysis indicated that caregivers of patients with cancer may benefit more from the intervention than other hospice caregivers. Qualitative analyses provided understanding of caregiver's perceptions of pain, cost, and facilitators and barriers to routine involvement of family in care plan meetings. Limitations and Conclusion: The hospice philosophy is supportive of caregiver involvement in care planning, and technology makes this feasible; the intervention needs modification to become translational as well as additional measurement to assess effectiveness. Caregiver education and emotional support should occur outside the meeting, and a strong leader should facilitate the meeting to control efficiency. Finally, the intervention may benefit caregivers
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…
English, David J.; Mortenson, Lee E.
This monograph, the third in a series of five, provides training information for hospice staff in improving interdisciplinary team functions and humanistic care provisions. Its purpose is to describe the steps in designing a training program for a particular hospice and the activities undertaken between the selection of the trainers and the…
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. © The Author(s) 2014.
Chihara, S; Hara, Y
Terminal care for cancer patients must be oriented to the dignity of human being. For this purpose our hospice has five principles, that is, to control physical pain, to relieve spiritual problems, to settle socio-economical matters, to give religious support and lighten family loads. To put into practice these five principles, various kinds of staff take their places as caregivers: physicians, nurses, helpers, chaplains, psychiatrists and voluntary workers. Moreover, the Hospice has many facilities such as a community hall, a kitchen for family members, guestrooms for family members and friends, a chapel for services and patient's rooms with one bed which make it possible for the patients to communicate intimately with family members or friends. During these 7 years, from April '81 to March '88, 398 terminally ill cancer patients have been treated at the Seirei Hospice. Through these experience, we have observed that most of terminally ill cancer patients do wish to live as long as possible in good condition without physical pain. So, we should conclusively emphasize that medical treatment including radiotherapy and cancer chemotherapy, attempting to reduce the physical distresses, ought to be continued until the time when the treatment might come to waste the patient's energy and only increase their agony.
Kegye, Adrienne; Pádi, Eva
Hospice care has been developing for 20 years. In the framework of the high standard palliative treatment hospice care involves symptom control as well as the psychosocial support of patients and their relatives. Developed as a model, the aims of the psychoeducational and supporting program were to reduce the psychological symptoms, form the active coping mechanisms, reduce feeling of isolation and help the communication of the patients treated in the Oncological Rehabilitation and Hospice Department of the Vaszary Kolos Hospital in Esztergom, Hungary. The program consisted of the following elements: analiticly orientated team psychoterapy, creative occupation, physiotherapy, dietetics guidance and oncological consulting. During the model supporting program the authors observed significant changes in both the patients and staff members which had a positive impact on the department's operation and the atmosphere, too. The model program showed that in team work can give beneficial and cost-efficient psychosocial support to patients using the carers' energy in the most effective way.
Boucher, Nathan A; Kuchibhatla, Maragatha; Johnson, Kimberly S
Describe social goods and services for which hospices assist patients and families and the resources hospices use to do so. Basic social supports and services not routinely covered by insurers may be needed by terminally ill patients and their families. Little is known about hospices' provision of such social supports and services. A 2014-2015 cross-sectional survey of hospices nationwide. Participating hospices had been in operation for at least 3 years and were located in any of the 50 states or District of Columbia. Hospices were surveyed about availability and sources of internal funds and referral to obtain basic social supports for patients. Descriptive statistics, bivariate analysis, and categorization were used to describe hospice practices. Measures included frequency and nature of goods and services provision in the prior year; and extent to which hospices used internal funds or community referral for goods and services. Over 80% (n = 203) reported internal funds covered services not reimbursed by insurers; 78% used funds in last year. Hospices used internal funds for food (81.7%), shelter (57.8%), utility bills (73.5%), and funeral costs (50%). Hospices referred patients/families to community organizations to obtain a similar range of services, including transportation, clothing, linens/towels, furniture/appliances, home repairs, and caregiver support. Hospices are using internal resources and accessing community resources to provide patients with basic social needs not routinely covered by insurance.
Grady, Kathleen A.; Wilson, Dottie C.
This monograph, the fifth in a series of five, provides training information for hospice staff in improving interdisciplinary team functions and humanistic care provisions. Its purpose is to provide a skilled group trainer with the hospice-specific insights necessary to conduct training in humanistic patient care. Chapter 1 covers training program…
Qaseem, Brye; Shea, Judy; Connor, Stephen R; Casarett, David
Despite the emotional and interpersonal challenges that hospice staff face in providing care to patients near the end of life, no systematic effort has been made to evaluate the work environment that hospices provide to their staff. The aim of this project was to develop a job satisfaction survey that could be used to evaluate the hospice work environment and, ultimately, to guide interventions to improve the work experience for hospice staff. A first draft of the Survey of Team Attitudes and Relationships (STAR) was developed through semi-structured interviews with an interdisciplinary sample of staff from nine hospices, and then refined with input from additional interviews and from an expert panel. The draft was tested on larger samples of staff (n=160) from six hospices and revised with input from the expert panel. The final survey was tested with 599 staff from 10 hospices. The final survey contains 45 items in six domains: individual work rewards, teamwork, management support, organizational support, workload issues, and global assessment of job satisfaction. Items had excellent psychometric characteristics, with acceptable floor and ceiling effects. The overall STAR had a Cronbach's alpha of 0.93, indicating good homogeneity, and each domain had alpha values that are appropriate for between-group comparisons (range 0.74-0.84). These results suggest that the STAR offers a unique instrument to measure the work environment hospices provide to their staff.
Taylor, Johanna; Aldridge, Jan
Children's hospices are a key provider of palliative care for children and young people with life-limiting and life-threatening conditions. However, despite recent policy attention to the provision of paediatric palliative care, little is known about the role of children's hospice staff and the factors that may impact on their wellbeing at work. This study explored the rewards and challenges of working in a children's hospice with an aim to identify staff support and development needs. We conducted an exploratory, qualitative study involving thematic analysis of semi-structured interviews with 34 staff and three focus groups with 17 staff working in a multi-disciplinary care team in a UK children's hospice. Participants identified rewards and challenges related to the direct work of caring for children and their families; team dynamics and organisational structures; and individual resilience and job motivation. Participants described the work as emotionally intensive and multi-faceted; 'getting it right' for children was identified as a strong motivator and reward, but also a potential stressor as staff strived to maintain high standards of personalised and emotional care. Other factors were identified as both a reward and stressor, including team functioning, the allocation of work, meeting parent expectations, and the hospice environment. Many participants identified training needs for different aspects of the role to help them feel more confident and competent. Participants also expressed concerns about work-related stress, both for themselves and for colleagues, but felt unable to discuss this at work. Informal support from colleagues and group clinical reflection were identified as primary resources to reflect on and learn from work and for emotional support. However, opportunities for this were limited. Providing regular, structured, and dedicated clinical reflection provides a mechanism through which children's hospice staff can come together for support and
Tornøe, Kirsten; Danbolt, Lars Johan; Kvigne, Kari; Sørlie, Venke
.... The aim of this study is to illuminate a pioneering Norwegian mobile hospice nurse teaching team's experience with teaching and training care workers in spiritual and existential care for the dying...
Schroeder, Todd A.; Loveland, Thomas; Wulder, Michael A.; Irons, James R.
The summer meeting of the joint U.S. Geological Survey (USGS)-NASA Landsat Science Team (LST) was held July 26-28, 2016, at South Dakota State University (SDSU) in Brookings, SD. LST co-chair Tom Loveland [USGS’s Earth Resources Observation and Science Center (EROS)] and Kevin Kephart [SDSU] welcomed more than 80 participants to the three-day meeting. That attendance at such meetings continues to increase—likely due to the development of new data products and sensor systems—further highlights the growing interest in the Landsat program. The main objectives of this meeting were to provide a status update on Landsat 7 and 8, review team member research activities, and to begin identifying priorities for future Landsat missions.
Gopinath, Deepa; Jha, Swati
The concept of multidisciplinary team (MDT) is well accepted in the current National Health Service (NHS) and is considered good practice for the management of chronic conditions. There has been a recent drive to have MDTs in managing women with incontinence and complex prolapse as a result of recommendations by National Institute for Health and Care Excellence (NICE) guidance, Medicines and Healthcare Products Regulatory Agency (MHRA) etc. Currently, there are no data on the outcome of case discussion at urogynaecology MDTs. The aim of this study was to review the clinical impact of discussion of a select group of cases at an urogynaecology MDT and review the clinical literature to justify the MDT approach. MDT proformas of cases discussed from October 2012 to December 2013 were reviewed. Outcomes of the MDT were compared with recommendations at the initial consultation. This included change in management plan, type of surgery and surgeon as well as time delay due to MDT discussion. One hundred six proformas were available for analysis. Age range was 23-89 (58) years. Average time from clinic visit to MDT discussion was 8.32 + 5.9 days. The MDT recommended a change in management plan in 31 cases (29.3%), with 11 cases (10.4%) resulting in alternative surgery and 1 case (0.9%) with an alternative surgeon. In 18.5% of cases, MDT discussion formulated the initial management plan. Case discussions at our MDT provide an effective clinical forum to formulate management plans for complex cases. The decision-making process is made robust, without significant impact on waiting time. Investment in setting up MDTs has financial implications but provides patient benefit.
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.
Schroeder, Todd A.; Loveland, Thomas; Wulder, Michael A.; Irons, James R.
The summer meeting of the joint U.S. Geological Survey (USGS)–NASA Landsat Science Team (LST) was held at the USGS’s Earth Resources Observation and Science (EROS) Center July 7-9, 2015, in Sioux Falls, SD. The LST co-chairs, Tom Loveland [EROS—Senior Scientist] and Jim Irons [NASA’s Goddard Space Flight Center (GSFC)—Landsat 8 Project Scientist], opened the three-day meeting on an upbeat note following the recent successful launch of the European Space Agency’s Sentinel-2 mission on June 23, 2015 (see image on page 14), and the news that work on Landsat 9 has begun, with a projected launch date of 2023.With over 60 participants in attendance, this was the largest LST meeting ever held. Meeting topics on the first day included Sustainable Land Imaging and Landsat 9 development, Landsat 7 and 8 operations and data archiving, the Landsat 8 Thermal Infrared Sensor (TIRS) stray-light issue, and the successful Sentinel-2 launch. In addition, on days two and three the LST members presented updates on their Landsat science and applications research. All presentations are available at landsat.usgs.gov/science_LST_Team_ Meetings.php.
Hillier, Janet; Dunn-Jensen, Linda M.
Although most business students participate in team-based projects during undergraduate or graduate course work, the team experience does not always teach team skills or capture the team members' potential: Students complete the task at hand but the explicit process of becoming a team is often not learned. Drawing from organizational learning…
Schroeder, Todd; Loveland, Thomas; Wulder, Michael A.; Irons, James R.
The summer meeting of the joint U.S. Geological Survey (USGS)–NASA Landsat Science Team (LST) was held at the USGS’s Earth Resources Observation and Science (EROS) Center July 7-9, 2015, in Sioux Falls, SD. The LST co-chairs, Tom Loveland [EROS—Senior Scientist] and Jim Irons [NASA’s Goddard Space Flight Center (GSFC)—Landsat 8 Project Scientist], opened the three-day meeting on an upbeat note following the recent successful launch of the European Space Agency’s Sentinel-2 mission on June 23, 2015 (see image on page 14), and the news that work on Landsat 9 has begun, with a projected launch date of 2023.
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…
Gillon, Suzie; Hurlow, Adam; Rayment, Clare; Zacharias, Hannah; Lennard, Rosemary
Corneal donation is a sight restoring procedure. Internationally demand exceeds supply. It is a tissue that palliative care patients may be able to donate, yet donation rates from this group are low. To explore the attitudes, knowledge, practice, and experience of corneal donation from hospice staff with direct clinical contact with patients. Anonymous paper questionnaire with fixed response and free text components. Questionnaires were delivered to 704 clinical multi-disciplinary team members in 12 hospices within the Yorkshire Palliative Medicine Regional Learning Group, UK. 434 completed questionnaires were received. Most respondents believed that corneal donation is a rewarding opportunity of which patients and families should be aware, but over 90% of respondents rarely or never raised the topic, and only 33% felt that it was part of their role. Key reasons for not engaging in discussions were: concerns about the impact of the discussion on patients and families, a belief held by hospice staff that they lacked essential knowledge, negative experiences of corneal donation, concern about enucleation, a perception that donation is not part of hospice culture, low levels of training and the personal significance of eyes. Despite positive staff attitudes towards corneal donation, many barriers to discussing donation were identified, which may reduce donation rates. This could be improved by local policies encompassing further education, prompts in documentation and availability of leaflets.
Tornøe, Kirsten; Danbolt, Lars Johan; Kvigne, Kari; Sørlie, Venke
Nursing home and home care nursing staff must increasingly deal with palliative care challenges, due to cost cutting in specialized health care. Research indicates that a significant number of dying patients long for adequate spiritual and existential care. Several studies show that this is often a source of anxiety for care workers. Teaching care workers to alleviate dying patients' spiritual and existential suffering is therefore important. The aim of this study is to illuminate a pioneering Norwegian mobile hospice nurse teaching team's experience with teaching and training care workers in spiritual and existential care for the dying in nursing homes and home care settings. The team of expert hospice nurses participated in a focus group interview. Data were analyzed using a phenomenological hermeneutical method. The mobile teaching team taught care workers to identify spiritual and existential suffering, initiate existential and spiritual conversations and convey consolation through active presencing and silence. The team members transferred their personal spiritual and existential care knowledge through situated "bedside teaching" and reflective dialogues. "The mobile teaching team perceived that the care workers benefitted from the situated teaching because they observed that care workers became more courageous in addressing dying patients' spiritual and existential suffering. Educational research supports these results. Studies show that efficient workplace teaching schemes allowexpert practitioners to teach staff to integrate several different knowledge forms and skills, applying a holisticknowledge approach. One of the features of workplace learning is that expert nurses are able to guide novices through the complexities of practice. Situated learning is therefore central for becoming proficient. Situated bedside teaching provided by expert mobile hospice nurses may be an efficient way to develop care workers' courage and competency to provide spiritual and
Nisbet, Gillian; Dunn, Stewart; Lincoln, Michelle
This study explores the potential for workplace interprofessional learning, specifically the learning that occurs between health professionals as part of their attendance at their regular interprofessional team meetings. While most interprofessional learning research to date has focused on formal structured education programs, this study adds to our understanding of the complexities of the learning processes occurring between health professionals as part of everyday practice. Through observations of team meetings and semi-structured interviews, we found that the interprofessional team meeting provided a practical, time-efficient, and relevant means for interprofessional learning, resulting in perceived benefits to individuals, teams, and patients. The learning process, however, was influenced by members' conceptions of learning, participation within the meeting, and medical presence. This study provides a basis for further research to assist health professionals capitalize on informal learning opportunities within the interprofessional meeting.
Brunner, Markus; Gore, Sinclair M; Read, Rebecca L; Alexander, Ashlin; Mehta, Ankur; Elliot, Michael; Milross, Chris; Boyer, Michael; Clark, Jonathan R
The purpose of this study was for us to present our findings on the prospectively audited impact of head and neck multidisciplinary team meetings on patient management. We collected clinical data, the pre-multidisciplinary team meeting treatment plan, the post-multidisciplinary team meeting treatment plans, and follow-up data from all patients discussed at a weekly multidisciplinary team meeting and we recorded the changes in management. One hundred seventy-two patients were discussed in 39 meetings. In 52 patients (30%), changes in management were documented of which 20 (67%) were major. Changes were statistically more likely when the referring physician was a medical or radiation oncologist, when the initial treatment plan did not include surgery, and when the histology was neither mucosal squamous cell cancer nor a skin malignancy. Compliance to the multidisciplinary team meeting treatment recommendation was 84% for all patients and 70% for patients with changes in their treatment recommendation. Head and neck multidisciplinary team meetings changed management in almost a third of the cases. © 2014 Wiley Periodicals, Inc.
Jubin, Robert Thomas [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)
This documents the completion of the FCR&D Level 3 milestone for the Off-Gas Sigma Team - ORNL work package (FTOR11SW0309), “Sigma Team Coordination Meeting” (M31SW030904), due 30 November 10. The subject meeting was held at Idaho National Laboratory on October 12 and 13, 2010. The agenda and meeting minutes are attached to this memo.
Berntorp, Erik; Dargaud, Yesim; Hart, Daniel; Lobet, Sébastien; Mancuso, Maria Elisa; d'Oiron, Roseline; Perry, David; Pollard, Debra; van den Berg, Marijke; Blatný, Jan; Chambost, Hervé; Doria, Andrea S; Holme, Pål André; Kaczmarek, Radoslaw; Mantovani, Lorenzo; McLaughlin, Paul; Nanayakkara, Lochana; Petrini, Pia; Sannié, Thomas; Laane, Edward; Maia, Raquel; Dettoraki, Athina; Farrell, Anna; Halimeh, Susan; Raza, Sayma; Taylor, Stephanie
The first Team Haemophilia Education (THE) Meeting was held on 7-8 May 2015 in Amsterdam, The Netherlands. It aimed to promote the optimal care of patients with haemophilia through education of the multidisciplinary treatment team. This was achieved by reviewing the latest developments in
This document contains the summaries of papers presented in poster format at the March 2010 Atmospheric System Research Science Team Meeting held in Bethesda, Maryland. More than 260 posters were presented during the Science Team Meeting. Posters were sorted into the following subject areas: aerosol-cloud-radiation interactions, aerosol properties, atmospheric state and surface, cloud properties, field campaigns, infrastructure and outreach, instruments, modeling, and radiation. To put these posters in context, the status of ASR at the time of the meeting is provided here.
... rhythms that are resistant to therapy ( arrhythmias ). Stroke patients referred to hospice may have severe lack of consciousness or coma greater than three days duration, difficulty chewing or ...
... It Talk to your Doctor Find a Provider Meet the Team Blog Articles & Stories News Resources Links ... to Your Doctor 2. Find a Provider 3. Meet the Team Palliative Care Team The palliative care ...
Ong, Jeremy; Brennsteiner, Alex; Chow, Elizabeth; Hebert, Randy S
The quality of communication and support provided to families is associated with greater satisfaction with hospice care. Prior work has not explored whether the predictors of family satisfaction are different in different hospice care settings. The study objective was to explore whether correlates of family satisfaction are different in general inpatient hospice care versus routine home hospice care. Survey data from bereaved family members of approximately 1600 patients from a nonprofit, midsized hospice in western Pennsylvania were used. Data was obtained from Family Evaluation of Hospice Care (FEHC) survey responses from 2008-2013 and separated into two groups, general inpatient hospice care and routine home hospice care. The analysis was completed using a binomial logistic regression model. Three variables were associated with greater overall satisfaction in both care settings: being kept informed about the patient's condition (adjusted odds ratio [AOR]: 9.64, CI: 6.56-14.36); being provided with clear/consistent information (AOR: 2.34, CI: 1.47-3.72); and the perception that patients were provided with adequate treatment for anxiety (AOR: 2.64, CI: 1.19-5.81). Two variables, sufficient discussion with hospice team members concerning family members' religious or spiritual beliefs (AOR: 1.64, CI: 1.17-2.30) and being provided with the correct amount of emotional support after the patient's death (AOR: 2.01, CI: 1.10-3.66), were correlated with greater satisfaction in routine home hospice care only. Good communication is strongly associated with greater family satisfaction across hospice care settings. Hospices must ensure that they provide patients and families with consistent information and support.
Presentation at the 24797-16 Earth Observing System (EOS) Aura Science Team Meeting (Mission Operations Work Group (MOWG)) at Rotterdam, Netherlands August 29, 2016. Presentation topics include mission summary, spacecraft subsystems summary, recent and planned activities, spacecraft anomalies, data capture, propellant usage and lifetime estimates, spacecraft maneuvers and ground track history, mission highlights and past spacecraft anomalies and reliability estimates.
Drielen, E. van; Vries, A.W. de; Ottevanger, P.B.; Hermens, R.P.M.G.
Discussing a patient in an oncology multidisciplinary team meeting (MTM) increases the value of the quality of the treatment chosen. MTMs are increasingly mentioned in guidelines and indicator sets. Based on literature review and observations, the Comprehensive Cancer Centre Netherlands (CCCNL), in
Gray, Helen; Adam, Joan; Brown, Duncan; McLaughlin, Patricia; Hill, Vicky; Wilson, Lorraine
St Columba's Hospice, Edinburgh, is a busy specialist palliative care unit with 30 inpatient beds. A previous publication reported the first strand of a qualitative exploratory study evaluating the impact of open visiting on patients at the hospice. This paper reports on the second strand, which sought to elicit the views of the hospice staff through focus group interviews. The main themes identified were valuing the family and friends as visitors, involving the family as part of the care team, patient powerlessness over visiting, shared rooms and their impact on visitors and patients, and the staff role as advocates or gatekeepers. Several strategies for developing a flexible and 'patient-controlled' visiting policy were identified, including quiet times without visitors, restriction of visitor numbers in shared rooms, and encouraging breaks from visiting. Since the study was completed, the hospice's visiting policy has been modified to ensure that it is patient-centred and meets the needs of patients and families.
... death. The goal is to give comfort and peace instead of a cure. Hospice care provides: Support ... D.A.M. is among the first to achieve this important distinction for online health information and ...
... http://www.cancer.org The American Cancer Society (ACS) provides free fact sheets and publications about hospice. The address of a local ACS chapter can be obtained by calling the organization’s ...
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...
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...
Jung, Jaewoo; Larrow, Jarrett
This is NASA FAA UTM Research Transition Team Communications and Navigation working group kick off meeting presentation that addresses the followings. Objectives overview Overall timeline and scope Outcomes and expectations Communication method and frequency of meetings Upcoming evaluation Next steps.
... palliative care can also provide tailored support to meet the needs of these heroes. The Affordable Care Act... individuals in their final days. Hospice care gives medical services, emotional support, and spiritual...
Hamilton, Gillian; Ortega, Rosio; Hochstetler, Vicki; Pierson, Kristen; Lin, Peiyi; Lowes, Susan
Communication skills are critical in hospice care but challenging to teach. Therefore, a hospice agency developed a communication skills laboratory for nurses and social workers. Learners role-played 3 common hospice scenarios. The role-play modalities were in-person, Second Life, and telephone. Learners were scored on 4 communication aspects. Learners in all modalities rated the laboratory as very effective. However, learners in the Second Life and phone modality showed greater improvements from scene 1 to 3 than those in the in-person modality. There were no significant differences in improvement between the Second Life and phone modalities. Results support the effectiveness of this communication skills laboratory while using different teaching modalities and show phone and Second Life role-plays were more effective than an in-person role-play. © The Author(s) 2013.
Loke, Song-Seng; Rau, Kung-Ming; Huang, Chih-Fang
Many patients with advanced cancer will develop physical and psychological symptoms related to their disease. These symptoms are infrequently treated by conventional care. Palliative care programs have been developed to fill this gap in care. However, there are limited beds in hospice units. To allow more terminal cancer patients to receive care from a hospice team, a combined hospice care system was recently developed in Taiwan. This study is a report of our experiences with this system. From January to December 2009, terminal cancer patients who accepted consultation from a hospice team for combined hospice care were enrolled in the study. Demographic data, clinical symptoms, referring department, type of cancer, and outcome were analyzed. A total of 354 terminal cancer patients in acute wards were referred to a hospice consulting team. The mean patient age was 61 years, and the proportion of males was 63.28%. After combined hospice care, there was a significant improvement in the sign rate of do-not-resuscitate (DNR) orders from 41.53% to 71.47% (p care also enabled 64.21% of terminal cancer patients who were not transferred to hospice ward to receive combined care by a hospice consulting team while in acute wards, thus increasing the hospice utilization of terminal cancer patients. The major symptoms presented by the patients were pain (58%), dyspnea (52%), constipation (45%), and fatigue (23%). Through the hospice consulting system, hospice combined care has a positive effect on the utilization of hospice care, rate of DNR signing and quality of end-of-life care for terminal cancer patients.
Kang, Jina; Kim, Yeol; Yoo, Yang Suk; Choi, Jin Young; Koh, Su Jin; Jho, Hyun Jung; Choi, Youn Seon; Park, Jeanno; Moon, Do Ho; Kim, Do Yeun; Jung, Yun; Kim, Won Chul; Lim, Seung Hee; Hwang, Seung Joo; Choe, Sang Ok; Jones, Desiree
Competency-based assessment helps to improve performance and to standardize education programs for hospice and palliative care professionals. This paper aims to report the process and results of developing the hospice and palliative care competencies by multidisciplinary experts in Korea. The competency development task force team of Korean hospice and palliative care professionals was comprised of seven physicians, four nurses, two social workers, and two clergy. To build consensus regarding competencies, the team performed a two-round Delphi survey. The importance of competency domains was assessed by using a 5-point Likert scale. After the completion of the Delphi survey, final competency domains were decided in a consensus meeting. The competencies were composed of knowledge, skills, and attitudes. The competency domains were identified as the following: 11 domains and 16 subdomains for physicians, 11 domains for nurses, 5 domains and 15 subdomains for social workers, as well as 3 domains and 5 subdomains for spiritual care providers. The high importance domains were different by specialties. Physical care and treatment for physicians, symptom management for nurses, bereavement care for social workers, and communication for spiritual care providers were ranked as highly important. For nurses and spiritual care providers, attitude-related domains were ranked the highest in importance. The competencies developed by multidisciplinary professionals are useful to identify the appropriate roles of each hospice and palliative care specialist involved in a team approach to patient care.
Hahlweg, P.; Hoffmann, J.; Harter, M.; Frosch, D.L.; Elwyn, G.; Scholl, I.
BACKGROUND: Multidisciplinary team meetings and shared decision-making are potential means of delivering patient-centred care. Not much is known about how those two paradigms fit together in cancer care. This study aimed to investigate how decisions are made in multidisciplinary team meetings and
Tyson, S F; Burton, L; McGovern, A
To explore how multi-disciplinary team meetings operate in stroke rehabilitation. Non-participant observation of multi-disciplinary team meetings and semi-structured interviews with attending staff. Twelve meetings were observed (at least one at each site) and 18 staff (one psychologist, one social worker; four nurses; four physiotherapists four occupational therapists, two speech and language therapists, one stroke co-ordinator and one stroke ward manager) were interviewed in eight in-patient stroke rehabilitation units. Multi-disciplinary team meetings in stroke rehabilitation were complex, demanding and highly varied. A model emerged which identified the main inputs to influence conduct of the meetings were personal contributions of the members and structure and format of the meetings. These were mediated by the team climate and leadership skills of the chair. The desired outputs; clinical decisions and the attributes of apparently effective meetings were identified by the staff. A notable difference between the meetings that staff considered effective and those that were not, was their structure and format. Successful meetings tended to feature a set agenda, structured documentation; formal use of measurement tools; pre-meeting preparation and skilled chairing. These features were often absent in meetings perceived to be ineffective. The main features of operation of multi-disciplinary team meetings have been identified which will enable assessment tools and interventions to improve effectiveness to be developed. © The Author(s) 2014.
Tiew, Lay Hwa; Kwee, Jian Hui; Creedy, Debra K; Chan, Moon Fai
To explore Singapore hospice nurses' perspectives of spirituality and spiritual care. A descriptive, cross-sectional design was used. Spiritual care is integral to providing quality end-of-life care. However, patients often report that this aspect of care is lacking. Previous studies suggest that nurses' neglect of this aspect of care could be attributed to poor understanding of what spirituality is and what such care entails. This study aimed to explore Singapore hospice nurses' perspectives about spirituality and spiritual care. A convenience sample of hospice nurses was recruited from the eight hospices in Singapore. The survey comprised two parts: the participant demographic details and the Spirituality Care-Giving Scale. This 35-item validated instrument measures participants' perspectives about spirituality and spiritual care. Sixty-six nurses participated (response rate of 65%). Overall, participants agreed with items in the Spiritual Care-Giving Scale related to Attributes of Spiritual Care; Spiritual Perspectives; Spiritual Care Attitudes; and Spiritual Care Values. Results from general linear model analysis showed statistically significant main effects between race, spiritual affiliation and type of hospice setting, with the total Spiritual Care-Giving Scale score and four-factor scores. Spirituality was perceived to be universal, holistic and existential in nature. Spiritual care was perceived to be relational and centred on respecting patients' differing faiths and beliefs. Participants highly regarded the importance of spiritual care in the care of patients at end-of-life. Factors that significantly affected participants' perspectives of spirituality and spiritual care included race, spiritual affiliation and hospice type. Study can clarify values and importance of spirituality and care concepts in end-of-life care. Accordingly, spirituality and care issues can be incorporated in multi-disciplinary team discussions. Explicit guidelines regarding
Abstract The German National Hospice and Palliative Care Register was implemented in 2011 by the German Association for Palliative Medicine to provide a nationwide description of the quality of hospice and palliative care. Every year, the register joints data of daily palliative care for a period of at least 3 months per year or up to 30 palliative care patients per palliative care service (palliative care units, hospices, palliative care teams and palliative counselling services). The reg...
van Dongen, Jerôme Jean Jacques; Habets, Iris Gerarda Josephine; Beurskens, Anna; van Bokhoven, Marloes Amantia
The number of people with multiple chronic conditions increases as a result of ageing. To deal with the complex health-care needs of these patients, it is important that health-care professionals collaborate in interprofessional teams. To deliver patient-centred care, it is often recommended to include the patient as a member of the team. To gain more insight into how health-care professionals and patients, who are used to participate in interprofessional team meetings, experience and organize patient participation in the team meetings. A qualitative study including observations of meetings (n=8), followed by semi-structured interviews with participating health-care professionals (n=8), patients and/or relatives (n=11). Professionals and patients were asked about their experiences of patient participation immediately after the team meetings. Results from both observations and interviews were analysed using content analysis. The findings show a variety of influencing factors related to patient participation that can be divided into five categories: (i) structure and task distribution, (ii) group composition, (iii) relationship between professionals and patients or relatives, (iv) patients' characteristics and (v) the purpose of the meeting. Patient participation during team meetings was appreciated by professionals and patients. A tailored approach to patient involvement during team meetings is preferable. When considering the presence of patients in team meetings, it is recommended to pay attention to patients' willingness and ability to participate, and the necessary information shared before the meeting. Participating patients seem to appreciate support and preparation for the meeting. © 2016 The Authors. Health Expectations Published by John Wiley & Sons Ltd.
... years, AHF worked to improve access to quality hospice care through public education, professional training, and consumer advocacy. Our vision was that hospice would be an integral part of our society, ...
Full Text Available Organizational life encompasses complex processes and daily activities aimed at increasing efficiency and effectiveness. Workplace meetings are one of such activities that, despite their usefulness in helping organizations to achieve their goals, can be an overlooked practice, with high financial burdens. This exploratory study intends to build an organizational diagnosis formula aimed at assessing the cost-benefit effectiveness of workplace meetings. Based on a sample of seven meetings in a management unit of a higher education public institution, our data show that each meeting results, on average, in six decisions, with the estimated cost in personnel time for each meeting of 496.68€ and a resulting productivity ratio of 198.67€ per decision. The application of our diagnosis formula might contribute to maximize the effectiveness of meetings and organizational performance.
Molleman, Eric; Broekhuis, Manda; Stoffels, Renee; Jaspers, Frans
This study examines the consequences for medical specialists of participating in multidisciplinary medical team meetings in terms of perceived clinical autonomy, domain distinctiveness, and professional accountability. These consequences may influence their willingness to cooperate and the quality
... in the meeting from remote locations by calling into a central phone number. DATES: The NCST Advisory... his phone number is (301) 975-5412. SUPPLEMENTARY INFORMATION: The NCST Advisory Committee was... into a central phone number. The primary purpose of this meeting is to discuss the NCST Advisory...
... able to participate in the meeting from remote locations by calling into a central phone number. DATES... is [email protected] and his phone number is (301) 975-5412. SUPPLEMENTARY INFORMATION: The NCST... into a central phone number. The primary purpose of this meeting is to discuss the NCST Advisory...
Basta, Yara L.; Baur, Onno L.; van Dieren, Susan; Klinkenbijl, Jean H. G.; Fockens, Paul; Tytgat, Kristien M. A. J.
Multidisciplinary cancer team meetings are intended to optimize the diagnosis of a patient with a malignancy. The aim of this study was to assess the number of correct diagnoses formulated by the multidisciplinary team (MDT) and whether MDT decisions were implemented. In a prospective study, data of
Hahlweg, Pola; Hoffmann, Jana; Härter, Martin; Frosch, Dominick L; Elwyn, Glyn; Scholl, Isabelle
Multidisciplinary team meetings and shared decision-making are potential means of delivering patient-centred care. Not much is known about how those two paradigms fit together in cancer care. This study aimed to investigate how decisions are made in multidisciplinary team meetings and whether patient perspectives are incorporated in these decisions. A qualitative study was conducted using non-participant observation at multidisciplinary team meetings (also called tumor boards) at the University Cancer Center Hamburg-Eppendorf, Germany. Two researchers recorded structured field notes from a total of N = 15 multidisciplinary team meetings. Data were analyzed using content analysis and descriptive statistics. Physicians mainly exchanged medical information and based their decision-making on this information. Individual patient characteristics or their treatment preferences were rarely considered or discussed. In the few cases where patient preferences were raised as a topic, this information did not seem to be taken into account in decision-making processes about treatment recommendations. The processes in multidisciplinary team meetings we observed did not exhibit shared decision-making. Patient perspectives were absent. If multidisciplinary team meetings wish to become more patient-centred they will have to modify their processes and find a way to include patient preferences into the decision-making process.
Full Text Available Multidisciplinary team meetings and shared decision-making are potential means of delivering patient-centred care. Not much is known about how those two paradigms fit together in cancer care. This study aimed to investigate how decisions are made in multidisciplinary team meetings and whether patient perspectives are incorporated in these decisions.A qualitative study was conducted using non-participant observation at multidisciplinary team meetings (also called tumor boards at the University Cancer Center Hamburg-Eppendorf, Germany. Two researchers recorded structured field notes from a total of N = 15 multidisciplinary team meetings. Data were analyzed using content analysis and descriptive statistics.Physicians mainly exchanged medical information and based their decision-making on this information. Individual patient characteristics or their treatment preferences were rarely considered or discussed. In the few cases where patient preferences were raised as a topic, this information did not seem to be taken into account in decision-making processes about treatment recommendations.The processes in multidisciplinary team meetings we observed did not exhibit shared decision-making. Patient perspectives were absent. If multidisciplinary team meetings wish to become more patient-centred they will have to modify their processes and find a way to include patient preferences into the decision-making process.
... National Oceanic and Atmospheric Administration RIN 0648-XT76 False Killer Whale Take Reduction Team... (NOAA), Department of Commerce. ACTION: Notice of establishment of a False Killer Whale Take Reduction... Insular, and Palmyra Atoll stocks of false killer whales (Pseudorca crassidens) in the Hawaii-based deep...
Conclusions: Students reflected that the storytelling helped them recognize the importance of relieving the suffering, respecting and understanding, communicating, team working, and family supporting in the hospice care.
This document contains the summaries of papers presented at the 1993 Atmospheric Radiation Measurement (ARM) Science Team meeting held in Morman, Oklahoma. To put these papers in context, it is useful to consider the history and status of the ARM Program at the time of the meeting. Individual papers have been cataloged separately.
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.
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...
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.
Csikos, Agnes; Busa, Csilla; Muszbek, Katalin
During the past 25 years, many developmental steps have occurred in Hungary in palliative care. Further education and service development is needed to provide a quality palliative care for all the Hungarian people. Hungary has a universal health care system with a developed infrastructure. The first Hungarian hospice team started in 1991. At that time, the concept of hospice care was unknown. Symptom control and psychosocial support for the dying patient was inadequate. The regulatory framework was based on the 1997 Health Care Act which was followed by significant palliative care legislation including documents on the legal requirements for palliative care (2004). National guidelines were developed in 2002. Home and inpatient hospice care are reimbursed by the National Insurance Fund. Patients and families pay nothing. The multidisciplinary team provides care for patients and families and hospice home care is widely available across the country. Inpatient units are still lacking in Hungary. Strong opioids are readily available in the country and can be prescribed for cancer and noncancer patients. Palliative care is taught in medical and nursing undergraduate and postgraduate education. From 2014, physicians in Hungary can take a one-year course to qualify for a license in palliative medicine. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
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...
Irene A Slootweg; Scherpbier, Albert; de Leeuw, Ren?e; Heineman, Maas Jan; Vleuten, Cees; Lombarts, Kiki M. J. M. H.
The importance of team communication, or more specifically speaking up, for safeguarding quality of patient care is increasingly being endorsed in research findings. However, little is known about speaking up of clinical teachers in postgraduate medical training. In order to determine how clinical teachers demonstrate speaking up in formal teaching team meetings and what factors influence this, the authors carried out an exploratory study based on ethnographic principles. The authors selected...
Kruis, Annemarije L; Soljak, Michael; Chavannes, Niels H; Elkin, Sarah L
Over the last 10 years, community and hospital-based multidisciplinary teams (MDTs) have been set up for the management of patients with chronic obstructive pulmonary disease (COPD) in the UK. Meetings of the MDTs have become a regular occurrence, mostly on healthcare professionals' own initiatives. There are no standardized methods to conduct an MDT meeting, and although cancer MDT meetings are widely implemented, the value and purpose of COPD MDT meetings are less clear. Therefore, the aim of this study was to conduct a cross-sectional descriptive online survey to explore COPD MDT members' perceptions of the purpose and usefulness of MDT meetings, and to identify suggestions or requirements to improve the meetings. In total, we received 68 responses from 10 MDTs; six teams (n = 36 members) were located in London and four (n = 32 members) outside. Analysis of the replies by two independent researchers found that MDT meetings aim to optimise management and improve pathways for respiratory patients by improving communication between providers across settings and disciplines. Education of the MDT members also occurs with the aim of safer practice. Discussed patients are characterised by (multiple) co-morbidities, frequent exacerbations and admissions, social and mental health problems, unclear diagnosis and suboptimal responses to interventions. Members reported participating in a COPD MDT as very useful (74%) or useful (20%). Meetings could be improved by ensuring attendance through requirement in job plans, by clear documentation and sharing of derived plans with a wider audience including general practitioners and patients.
St. Peter's Hospice, Albany, NY, is dedicated to meeting the emotional needs of patients, families, and staff. Creative ritual, hospice leaders have found, is a powerful tool that can: Provide an "arena" for healing, affirmation, reconciliation, and celebration Serve as a reminder of the sacred Evoke heartfelt emotion Effect renewal and inspiration Offer an opportunity to cleanse the soul of grief, anger, frustration, or guilt Provide tangible experiences of bonding and interdependence Prevent staff burnout St. Peter's staff show a good deal of imagination and variety in creating rituals. Possible themes include patients' birthdays or wedding anniversaries, religious celebrations, national holidays, and changes of seasons. A lighted candle, bouquet of flowers, or incense burner may be used to give the ritual a focus. Music is often played to help set the tone. Rituals involve a major shift in consciousness. They often allow participants to express feelings it would otherwise be difficult for them to put into words. At St. Peter's, participants may begin to communicate by sharing favorite prayers, poems, photos, or works of art. Or they may make music--the hospice provides the instruments--or pass around a Native American "talking stick." Such methods facilitate the bonding of patients and their families. Particularly important are those rituals which allow patients and estranged family members to reconcile. Others enable patients to acknowledge God-given gifts. Still other rituals are held for staff members, who thereby deal with the anger and sadness their work inevitably brings. For all at St. Peter's Hospice ritual is a source of healing, affirmation, renewal, inspiration, and grace.
Dennis, Mary Kate; Washington, Karla T; Koenig, Terry L
Ethical decision making is critically important in hospice social work. Through in-depth interviews, researchers explored ethical dilemmas faced by 14 hospice social workers and the processes they used to move toward resolution. The dilemmas were integrated into a framework focused on the sources of ethical conflict: the client system, the agency, and the profession. Processes involved in resolving ethical dilemmas included consulting with other professionals, weighing the pros and cons of options, and bringing about desired outcomes. Findings suggest that hospice teams should be provided with opportunities to meaningfully discuss ethical decision making. Further, the involvement of social workers in administrative leadership is recommended to increase the likelihood that discipline-specific perspectives are incorporated into formal policies and procedures that shape practice in ethically complex situations.
Developing a rheumatology team to meet a growing need in Africa: let's not forget to feed the cow. MR Backhouse, M Ndosi, S Oliver. Abstract. No Abstract. Full Text: EMAIL FULL TEXT EMAIL FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · AJOL African Journals Online. HOW TO USE AJOL.
Fu, Lee-Lueng (Editor)
This third TOPEX/POSEIDON Science Working Team meeting was held on December 4, 1994 to review progress in defining ocean tide models, precision Earth orbits, and various science algorithms. A related workshop on ocean tides convened to select the best models to be used by scientists in the Geophysical Data Records.
Recognizes the need for improved professional training in the care of the dying. Discusses ways in which such training might be provided in the light of British experience. Suggests that hospice programs should incorporate an education program aimed to meet deficiencies revealed in recent studies. (Author)
O'Briain D Sean
Full Text Available Abstract Background The development of multidisciplinary team meetings (MDTMs for radiology and pathology is a burgeoning area that increasingly impacts on work processes in both of these departments. The aim of this study was to examine work processes and quantify the time demands on radiologists and pathologists associated with MDTM practices at a large teaching hospital. The observations reported in this paper reflect a general trend affecting hospitals and our conclusions will have relevance for others implementing clinical practice guidelines. Methods For one month, all work related to clinical meetings between pathology and radiology with clinical staff was documented and later analysed. Results The number of meetings to which pathology and radiology contribute at a large university teaching hospital, ranges from two to eight per day, excluding grand rounds, and amounts to approximately 50 meetings per month for each department. For one month, over 300 h were spent by pathologists and radiologists on 81 meetings, where almost 1000 patients were discussed. For each meeting hour, there were, on average, 2.4 pathology hours and 2 radiology hours spent in preparation. Two to three meetings per week are conducted over a teleconferencing link. Average meeting time is 1 h. Preparation time per meeting ranges from 0.3 to 6 h for pathology, and 0.5 to 4 for radiology. The review process in preparation for meetings improves internal quality standards. Materials produced externally (for example imaging can amount to almost 50% of the material to be reviewed on a single patient. The number of meetings per month has increased by 50% over the past two years. Further increase is expected in both the numbers and duration of meetings when scheduling issues are resolved. A changing trend in the management of referred patients with the development of MDTMs and the introduction of teleconferencing was noted. Conclusion Difficulties are being experienced by
Ung, Kim Ann; Campbell, Belinda A; Duplan, Danny; Ball, David; David, Steven
Multidisciplinary team (MDT) meetings are increasingly regarded as a component of multidisciplinary cancer care. We aimed to prospectively measure the impact of MDT meetings on clinicians' management plans for lung oncology patients, and the implementation rate of the meeting recommendations. Consecutive patient cases presented at the weekly lung oncology MDT meetings were prospectively enrolled. Investigators compared the clinicians' management plans pre-meeting with the consensus plans post-meeting. The meeting was considered to have an impact on management plans if ≥1 of the following changes were detected: tumor stage, histology, treatment intent or treatment modality, or if additional investigations were recommended. Investigators reviewed hospital patient records at 4 months to determine if the meeting recommendations were implemented. Reasons for non-implementation were also recorded. Of the 55 eligible cases, the MDT meeting changed management plans in 58% (CI 45-71%; P oncology patients. The majority of MDT recommendations (72%) were implemented into patient care. These findings provide further evidence to support the role of MDT meetings as an essential part of the decision-making process for the optimal multidisciplinary management of patients with cancer. © 2014 Wiley Publishing Asia Pty Ltd.
Llewellyn-Jones, Glyn; Pereira, John
There is little information about the role of the radiologist at multidisciplinary team meetings; in particular their influence on patient management. To evaluate the influence of radiologists on clinical patient management during multidisciplinary meetings. Prospective data were collected over a 5-week period from multidisciplinary team meetings across four paediatric clinical domains. Radiological input was recorded for each case discussion, including the type of influence and its potential effect on clinical patient management. One hundred and forty paediatric cases were reviewed. Radiological advice was requested from the radiologist for 25.7% (N = 36) of cases. In 17.9% (N = 25) this advice was judged to have influenced clinical patient management. There were two cases where new imaging findings were discovered. Radiologists influence clinical patient management during multidisciplinary team meetings primarily by providing differential diagnoses and guidance regarding future imaging, with respect to both the necessity and the modality. Occasionally, when imaging is reviewed at these meetings, new findings are discovered that impact on patient management. © 2016 The Royal Australian and New Zealand College of Radiologists.
National Highway Traffic Safety Administration (DOT), Washington, DC.
This document presents materials covering the television campaign against drunk driving called "TEAM" (Techniques for Effective Alcohol Management). It is noted that TEAM's purpose is to promote effective alcohol management in public facilities and other establishments that serve alcoholic beverages. TEAM sponsors are listed, including…
Ellington, Lee; Cloyes, Kristin G; Xu, Jiayun; Bellury, Lanell; Berry, Patricia H; Reblin, Maija; Clayton, Margaret F
Our intention was to describe and compare the perspectives of national hospice thought leaders, hospice nurses, and former family caregivers on factors that promote or threaten family caregiver perceptions of support. Nationally recognized hospice thought leaders (n = 11), hospice nurses (n = 13), and former family caregivers (n = 14) participated. Interviews and focus groups were audiotaped and transcribed. Data were coded inductively, and codes were hierarchically grouped by topic. Emergent categories were summarized descriptively and compared across groups. Four categories linked responses from the three participant groups (95%, 366/384 codes): (1) essentials of skilled communication (30.6%), (2) importance of building authentic relationships (28%), (3) value of expert teaching (22.4%), and (4) critical role of teamwork (18.3%). The thought leaders emphasized communication (44.6%), caregivers stressed expert teaching (51%), and nurses highlighted teamwork (35.8%). Nurses discussed teamwork significantly more than caregivers (z = 2.2786), thought leaders discussed communication more than caregivers (z = 2.8551), and caregivers discussed expert teaching more than thought leaders ( z = 2.1693) and nurses (z = 2.4718; all values of p schism of family-centered hospice care as a clinical ideal to one where hospice team members can fully support and empower family caregivers as a hospice team member.
Chaouki, Wahid; Mimouni, Mohsine; Boutayeb, Saber; Hachi, Hafid; Errihani, Hassan; Benjaafar, Noureddine
The multidisciplinary team meeting has become a standard medical practice in oncology. However, no evaluation of this activity was carried out in Morocco. The aim of this study was to evaluate the multidisciplinary team meeting of gynecological mammary cancers in a National Tertiary Referral Center. The study was carried out by retrospective analysis of 207 cases of patients randomly selected among the 1190 cases recruited during the year 2015. Completeness and quality criteria were evaluated. The global completeness rate of passage in multidisciplinary team meeting is 38%. According to the therapeutic specialities, the completeness of passage in multidisciplinary team meeting is 68% of surgery, 35% of medical oncology and 19% of radiotherapy. As far as localizations are concerned, the completeness of passage in multidisciplinary team meeting is 43% for the breast and only 19% for the cervix. A quorum was met 100% of the cases. In 96% of cases the treatment performed is in accordance with the decision of the multidisciplinary team meeting. Eighty-four percent of cases performed multidisciplinary team meeting within less than one month. This analysis shows that the completeness of the transition to multidisciplinary team meeting has not reached the 100% planned by our institution. However, the requirements for conducting the multidisciplinary team meeting were generally met. This study shows an organizational evolution of our structure based on collective and multidisciplinary medical decision. The national obligation measure of multidisciplinary team meeting is necessary. Copyright © 2017 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.
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...
Alexandersson, Nathalie; Rosell, Linn; Wihl, Jessica
BACKGROUND: Multidisciplinary team meetings (MDTMs) have developed into standard of care to provide expert opinion and to grant evidence-based recommendations on diagnostics and treatment of cancer. Though MDTMs are associated with a range of benefits, a growing number of cases, complex case...... influenced by cancer diagnosis, hospital type and use of video facilities. When preparatory work, participation and post-MDTM work were considered, physicians spent mean 4.1 h per meeting. The cost per case discussion was mean 212 (range 91-595) EUR and the cost per MDTM was mean 2675 (range 1439-4070) EUR...
The development of multidisciplinary team meetings (MDTMs) for radiology and pathology is a burgeoning area that increasingly impacts on work processes in both of these departments. The aim of this study was to examine work processes and quantify the time demands on radiologists and pathologists associated with MDTM practices at a large teaching hospital. The observations reported in this paper reflect a general trend affecting hospitals and our conclusions will have relevance for others implementing clinical practice guidelines.
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.
Haspel, Richard L; Ali, Asma M; Huang, Grace C
Accumulating data suggest that team-based learning (TBL) is more effective than lecture-based teaching strategies. Educational sessions at national meetings, however, tend to be lecture-based, and unlike most examples of TBL, involve participants who do not know each other or the instructor. We evaluated a 1-day TBL genomic pathology workshop for residents held at 3 national meetings. A committee of experts developed the workshop. Prior to attending, participants were provided access to readings and asked to answer preparation questions. Each of the 4 modules within the workshop consisted of a 60-minute TBL activity flanked by 15- to 30-minute preactivity and postactivity lectures. We used surveys to acquire participant evaluation of the workshop. From 2013-2014, 86 pathology residents from 61 programs participated in 3 workshops at national meetings. All workshops were well received, with over 90% of attendees indicating that they would recommend them to other residents and that the material would help them as practicing pathologists. An incremental approach facilitated decreasing faculty presence at the workshops: the first 2 workshops had 7 faculty each (1 facilitator for each team and 1 circulating faculty member), while the final workshop involved only 2 faculty for 6 teams. For this final session, participants agreed that circulating faculty provided adequate support. Participant "buy-in" (requiring completion of a preworkshop survey) was critical in enabling a TBL approach. These results demonstrate that TBL is a feasible and effective strategy for teaching genomic medicine that is acceptable to pathology residents at national meetings.
Wilwert, Monica M; Watkins, Catherine A; Ettinger, Ronald L; Cowen, Howard J; Qian, Fang
The relationships between dentist characteristics and professional education with involvement of Iowa dentists in hospice care were investigated. Using the 1999 Iowa Health Professional database, a survey requesting information regarding involvement in and training for care of hospice patients was mailed to all licensed dentists (N = 1,210). Two mailings yielded a 54.6% response rate. Of the 638 dentist respondents, the mean age was 47, 86% were male, 88% general dentists, and 295 (46%) reported providing some treatment for hospice patients. At least one dentist reported providing hospice patient care in 72 of Iowa's 99 counties. About 90% of dentists treating hospice patients were general practitioners. Males were more likely to provide treatment (p hospice patients in the office (IO, 40%). The most prevalent treatments were denture relines (31% IO; 71% OO), examinations (16% IO; 68% OO), and emergency treatment (12.5% IO; 53% OO). More than 86% of surveyed dentists indicated that their professional education did not adequately train them to meet the clinical, psychosocial, communication, or spiritual needs of hospice patients. © 2011 Special Care Dentistry Association and Wiley Periodicals, Inc.
Hospice is considered the "gold standard" for end-of-life care, providing dying patients and their families access to a broad array of services across settings. Despite its comprehensive approach, hospice care remains underutilized; many patients who might benefit from hospice do not enroll, or enroll only in the last days of life. This Issue Brief summarizes a series of studies that shed light on the decision making process about hospice, and describes a simple, effective way to improve referrals to hospice among nursing home residents.
Boxer, Miriam M; Duggan, Kirsten J; Descallar, Joseph; Vinod, Shalini K
Clinical guidelines provide evidence-based management recommendations to guide practice. This study aimed to evaluate whether patients discussed at a lung cancer multidisciplinary team meeting received guideline-recommended treatment and determine reasons for not receiving guideline-recommended treatment. All new lung cancer patients discussed at the Liverpool/Macarthur lung cancer multidisciplinary team meeting between 1 December 2005 and 31 December 2010 were included. Guideline-recommended treatment was assigned according to pathology, stage and ECOG (Eastern Co-operative Oncology Group) performance status as per the 2004 Australian Lung Cancer Guidelines. This was compared with actual treatment received to determine adherence to guidelines. For those patients who did not receive guideline-recommended treatment, the medical record was reviewed to determine the reason(s) for this. Survival was compared between those who did and did not receive guideline-recommended treatment. 808 new patients were discussed at the multidisciplinary team meeting. Guideline-recommended treatment could not be assigned in 2% of patients due to missing data. 435 patients (54%) received guideline-recommended treatment, and 356 (44%) did not. The most common reasons for not receiving guideline-recommended treatment were a decline in ECOG performance status (24%), large tumor volume precluding radical radiotherapy (17%), comorbidities (15%) and patient preference (13%). Patients less than 70 years who received guideline-recommended treatment had improved survival compared with those who did not. A significant proportion of lung cancer patients did not receive guideline-recommended treatment due to legitimate reasons. Alternative guidelines are needed for patients not suitable for current best practice. Treatment according to guidelines was a predictor for survival. © 2015 Wiley Publishing Asia Pty Ltd.
C van deventer
Full Text Available Abstract Introduction The multidisciplinary team at the wellness clinic, Potchefstroom hospital has been having regular meetings since the clinic was accredited as a treatment site for HAART. The meetings have concentrated on patients who have experienced problems on treatment. The aim was to understand and overcome barriers to adherence and any other patient related issues at the clinic. Method. Minutes of 2006 were audited in order to acquire an understanding of the difficulties faced by patients and to investigate outcomes of corrective interventions. Results 17% of the files could not be traced in order to obtain more information. 36% of patients had stabilized with improved or undetectable viral loads. Alcohol and work related matters played an important role in poor adherence. There were however many other factors identified
Patkar, Vivek; Acosta, Dionisio; Davidson, Tim; Jones, Alison; Fox, John; Keshtgar, Mohammad
Multidisciplinary team (MDT) model in cancer care was introduced and endorsed to ensure that care delivery is consistent with the best available evidence. Over the last few years, regular MDT meetings have become a standard practice in oncology and gained the status of the key decision-making forum for patient management. Despite the fact that cancer MDT meetings are well accepted by clinicians, concerns are raised over the paucity of good-quality evidence on their overall impact. There are also concerns over lack of the appropriate support for this important but overburdened decision-making platform. The growing acceptance by clinical community of the health information technology in recent years has created new opportunities and possibilities of using advanced clinical decision support (CDS) systems to realise full potential of cancer MDT meetings. In this paper, we present targeted summary of the available evidence on the impact of cancer MDT meetings, discuss the reported challenges, and explore the role that a CDS technology could play in addressing some of these challenges. PMID:22295234
Full Text Available Multidisciplinary team (MDT model in cancer care was introduced and endorsed to ensure that care delivery is consistent with the best available evidence. Over the last few years, regular MDT meetings have become a standard practice in oncology and gained the status of the key decision-making forum for patient management. Despite the fact that cancer MDT meetings are well accepted by clinicians, concerns are raised over the paucity of good-quality evidence on their overall impact. There are also concerns over lack of the appropriate support for this important but overburdened decision-making platform. The growing acceptance by clinical community of the health information technology in recent years has created new opportunities and possibilities of using advanced clinical decision support (CDS systems to realise full potential of cancer MDT meetings. In this paper, we present targeted summary of the available evidence on the impact of cancer MDT meetings, discuss the reported challenges, and explore the role that a CDS technology could play in addressing some of these challenges.
Barbare, Jean-Claude; Franco, Dominique; André, Thierry; Bronowicki, Jean-Pierre; Merle, Philippe; Péron, Jean-Marie; Raoul, Jean-Luc; Seitz, Jean-François; Ychou, Marc
The treatment of hepatocellular carcinoma (HCC) is difficult due to the underlying cirrhosis which has its own influence on therapeutic issues. An inquiry was performed in centres with specialized multidisciplinary team meetings dedicated to HCC (HCC-MTM) or in centres with non-specialized (digestive oncology or general oncology) multidisciplinary team meetings (NS-MTM). The number of cases of HCCs taken in charge yearly was significantly higher in HCC-MTM than in NS-MTM (p=0,0014). Interventional radiologists and transplant surgeons were more frequently implied in HCC-MTM than in NS-MTM (respectively p=0,009 and p=0,02). On site availability of every treatment of HCC was higher in RCP-MTM than in NS-MTM (p=0,015). There were no inclusion in clinical trials in 40.5 % of NS-MTM versus only 17.6 % of HCC-MTM (p=0,0086). In three clinical cases out of seven there were discrepancies between the therapeutic options of HCC-MTM and NS-MTM. In all three cases, the treatment offered to the patient by HCC-MTM was more consistent with clinical standards. These results prompt to perform more studies on the quality of management of patients with HCCs by MTMs.
Lehmann-Willenbrock, N.K.; Allen, J.A.
Research on humor in organizations has rarely considered the social context in which humor occurs. One such social setting that most of us experience on a daily basis concerns the team context. Building on recent theorizing about the humor–performance link in teams, this study seeks to increase our
In reviewing the literature, there are few articles describing the role of the speech-language pathologist in hospice. Communication impairments can impact upon the hospice team's ability to provide symptom control and supportive psychosocial care, and diminish the patient's ability to guide the decision making process and maintain social closeness with family. Swallowing difficulties may result in discomfort for patients and concern from caregivers. Patient care provided by the speech-language pathologist can align with the framework of the World Health Organization's components of palliative care. Four primary roles of the speech-language pathologist in hospice can be described. (1) To provide consultation to patients, families, and members of the hospice team in the areas of communication, cognition, and swallowing function; (2) To develop strategies in the area of communication skills in order to support the patient's role in decision making, to maintain social closeness, and to assist the client in fulfillment of end-of-life goals; (3) To assist in optimizing function related to dysphagia symptoms in order to improve patient comfort and eating satisfaction, and promote positive feeding interactions for family members and (4) To communicate with members of the interdisciplinary hospice team, to provide and receive input related to overall patient care. Further development of the speech-language pathologist as a participating member of the hospice interdisciplinary team would support the overall goal of providing quality care for patients and families served by hospice.
Krauss, Oliver; Holzer, Karl; Schuler, Andreas; Egelkraut, Reinhard; Franz, Barbara
Multidisciplinary team meetings (MDTMs) are already in use for certain areas in healthcare (e.g. treatment of cancer). Due to the lack of common standards and accessibility for the applied IT systems, their potential is not yet completely exploited. Common requirements for MDTMs shall be identified and aggregated into a process definition to be automated by an application architecture utilizing modern standards in electronic healthcare, e.g. HL7 FHIR. To identify requirements, an extensive literature review as well as semi-structured expert interviews were conducted. Results showed, that interoperability and flexibility in terms of the process are key requirements to be addressed. An architecture blueprint as well as an aggregated process definition were derived from the insights gained. To evaluate the feasibility of identified requirements, methods of explorative prototyping in software engineering were used. MDTMs will become an important part of modern and future healthcare but the need for standardization in terms of interoperability is imminent.
Hahlweg, Pola; Didi, Sarah; Kriston, Levente; Härter, Martin; Nestoriuc, Yvonne; Scholl, Isabelle
The quality of decision-making in multidisciplinary team meetings (MDTMs) depends on the quality of information presented and the quality of team processes. Few studies have examined these factors using a standardized approach. The aim of this study was to objectively document the processes involved in decision-making in MDTMs, document the outcomes in terms of whether a treatment recommendation was given (none vs. singular vs. multiple), and to identify factors related to type of treatment recommendation. An adaptation of the observer rating scale Multidisciplinary Tumor Board Metric for the Observation of Decision-Making (MDT-MODe) was used to assess the quality of the presented information and team processes in MDTMs. Data was analyzed using descriptive statistics and mixed logistic regression analysis. N = 249 cases were observed in N = 29 MDTMs. While cancer-specific medical information was judged to be of high quality, psychosocial information and information regarding patient views were considered to be of low quality. In 25% of the cases no, in 64% one, and in 10% more than one treatment recommendations were given (1% missing data). Giving no treatment recommendation was associated with duration of case discussion, duration of the MDTM session, quality of case history, quality of radiological information, and specialization of the MDTM. Higher levels of medical and treatment uncertainty during discussions were found to be associated with a higher probability for more than one treatment recommendation. The quality of different aspects of information was observed to differ greatly. In general, we did not find MDTMs to be in line with the principles of patient-centered care. Recommendation outcome varied substantially between different specializations of MDTMs. The quality of certain information was associated with the recommendation outcome. Uncertainty during discussions was related to more than one recommendation being considered. Time constraints
Beresford, L; Connor, S R
The National Hospice Organization grew out of efforts by the founders of the earliest hospice programs in the United States to protect their emotional investments in hospice care, to advocate for hospice interests in Congress and other public policy forums, to define standards for the fledgling movement, and to provide education on the nuts and bolts of running hospice programs for others who were interested in starting hospices in communities from coast to coast. Unlike the model of St. Christopher's Hospice in England, which began as a free-standing in-patient facility and later added home care services, most U.S. hospices started as home care-based programs, often largely manned by volunteers. Among the crucial issues that have dominated the work of NHO during its first 21 years were passage and maintenance of the Medicare hospice benefit, ideological battles over the hospice philosophy, and efforts to extend hospice care to other populations, such as people with AIDS.
Devitt, Bianca; Philip, Jennifer; McLachlan, Sue-Anne
Multidisciplinary cancer care is a standard feature of high quality care. In many centers, the multidisciplinary meeting (MDM) is an integral component. A qualitative study was performed to explore health professionals' attitudes towards this model of care, the decision making processes, and dynamics among team members. A series of focus groups was conducted with health professionals who attend MDMs at our institution. Focus groups followed a semistructured format with open-ended questions. A thematic analysis was performed. Four focus groups were held, attended by 23 participants including allied health professionals, specialist nurses, medical oncologists, and surgeons. All participants believed the primary objective of the MDM was to develop an individualized treatment plan. Several other key themes emerged. The MDM provided opportunities to improve communication, efficiency, and education as well as enhance professional relationships. Medical information was prioritized ahead of psychosocial details, with allied health professionals describing difficulty contributing to MDM discussion. Patient attendance at MDMs was opposed by health professionals because of concerns about the patient's ability to cope with the information discussed and the effect their presence would have on the dynamics of the decision-making process. Health professionals endorse MDMs as a useful tool in treating patients with cancer. Within this forum, both opportunities and constrains exist, with many benefits extending beyond the meeting itself into other clinical areas. Further study is warranted to establish an evidence base to ensure that both the possibilities and the limitations of this model of care are fully understood.
This document contains the summaries of papers presented at the 1996 Atmospheric Radiation Measurement (ARM) Science Team meeting held at San Antonio, Texas. The history and status of the ARM program at the time of the meeting helps to put these papers in context. The basic themes have not changed. First, from its beginning, the Program has attempted to respond to the most critical scientific issues facing the US Global Change Research Program. Second, the Program has been strongly coupled to other agency and international programs. More specifically, the Program reflects an unprecedented collaboration among agencies of the federal research community, among the US Department of Energy`s (DOE) national laboratories, and between DOE`s research program and related international programs, such as Global Energy and Water Experiment (GEWEX) and the Tropical Ocean Global Atmosphere (TOGA) program. Next, ARM has always attempted to make the most judicious use of its resources by collaborating and leveraging existing assets and has managed to maintain an aggressive schedule despite budgets that have been much smaller than planned. Finally, the Program has attracted some of the very best scientific talent in the climate research community and has, as a result, been productive scientifically.
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.
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
de Graaf, Everlien; Zweers, Daniëlle; Valkenburg, Anna Ch; Uyttewaal, Allegonda; Teunissen, Saskia Ccm
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. The aims of this study are to explore whether hospice assist at home service enables patients at hometo express end-of-life preferences and die in their preferred location. In addition, this study provides insight into symptomburden, stability and early referral. A retrospective cross-sectional evaluation study was performed (December 2014-March 2015), using hospice assist at home patient records and documentation. Primary outcome includes congruence between preferred and actual place of death. Secondary outcomes include symptom burden, (in)stability and early identification. Between June 2012 and December 2014, 130 hospice assist at home patients, living at home with a life expectancy home, a collaboration between general practitioners, district nurses, trained volunteers and a hospice team, facilitates (1) general practitioner-initiated consultation by Nurse Consultant Hospice, (2) fortnightly interdisciplinary consultations and (3) 24/7 hospice backup for patients, caregivers and professionals. A total of 130 patients (62 (48%) men; mean age, 72 years) were enrolled, of whom 107/130 (82%) died and 5 dropped out. Preferred place of death was known for 101/107 (94%) patients of whom 91% patients died at their preferred place of death. Hospice assist at home service supports patients to die in their preferred place of death. Shared responsibility of proactive care in primary care collaboration enabled patients to express preferences. Hospice care should focus on local teamwork, to contribute to shared responsibilities in providing optimal palliative care. © The Author(s) 2016.
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.
Casarett, David J; Spence, Carol; Haskins, Matthew; Teno, Joan
Job satisfaction is particularly important in the hospice industry, given the emotional and interpersonal challenges that hospice staff face in providing care to patients near the end of life and their families. However, little is known about the job satisfaction of hospice providers, or about variation in satisfaction among disciplines. Staff at participating hospices completed the Survey of Team Attitudes and Relationships (STAR) using an online user interface. The STAR has 6 domains that comprise 45 items. Results were submitted for 8,495 staff from 177 hospices in 41 states. The mean total score was 28 on a 0-100 scale (range, 0-100; interquartile range, 8-45) and hospice-level scores ranged from 15 to 44. Nonclinical staff (n = 3260) and clinical staff (n = 5235) had similar total scores (28 for both). Among clinical staff, in a mixed effects model adjusting for individual and hospice characteristics, physicians had the highest total scores (adjusted mean 42; 95% confidence interval: 35-46) compared to chaplains (30; 28-33), bereavement coordinators (27; 24-30), nurses' aides (29; 27-33); nurses (26; 28-33), and social workers (25; 23-26). There is significant variation in job satisfaction both among hospices and disciplines.
Draeger, Erik W. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States)
The theme of this year’s meeting was “Predictivity: Now and in the Future”. After welcoming remarks, Erik Draeger gave a talk on the NNSA Labs’ history of predictive simulation and the new challenges faced by upcoming architecture changes. He described an example where the volume of analysis data produced by a set of inertial confinement fusion (ICF) simulations on the Trinity machine was too large to store or transfer, and the steps needed to reduce it to a manageable size. He also described the software re-engineering plan for LLNL’s suite of multiphysics codes and physics packages with a new push toward common components, making collaboration with teams like the CCMSC who already have experience trying to architect complex multiphysics code infrastructure on next-generation architectures all the more important. Phil Smith then gave an overview outlining the goals of the project, namely to accelerate development of new technology in the form of high efficiency carbon capture pulverized coal power generation as well as further optimize existing state of the art designs. He then presented a summary of the Center’s top-down uncertainty quantification approach, in which ultimate target predictivity informs uncertainty targets for lower-level components, and gave data on how close all the different components currently are to their targets. Most components still need an approximately two-fold reduction in uncertainty to hit the ultimate predictivity target, but the current accuracy is already rather impressive.
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) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Rankin, Nicole M; Lai, Michelle; Miller, Danielle; Beale, Philip; Spigelman, Allan; Prest, Gabrielle; Turley, Kim; Simes, John
Multidisciplinary care is advocated as best practice in cancer care. Relatively little is documented about multidisciplinary team (MDT) meeting functioning, decision making and the use of evidence to support decision making in Australia. This descriptive study aimed to examine team functioning, the role of team meetings and evidence use in MDTs whose institutions are members of Sydney Catalyst Translational Cancer Research Centre. We designed a structured 40-item survey instrument about topics that included meeting purpose, organization, resources and documentation; caseload estimates; use of evidence and quality assurance; patient involvement and supportive care needs; and open-ended items about the MDTs strengths and weaknesses. Participants were invited to participate via email and the survey was administered online. Data were analyzed using descriptive and comparative statistics. Thirty-seven MDTs from seven hospitals participated (100% response) and represented common (70%) and rare tumor groups (30%). MDT meeting purpose was reported as treatment (100%) or diagnostic decision making (88%), or for education purposes (70%). Most MDTs based treatment decisions on group consensus (92%), adherence to clinical practice guidelines (57%) or other evidence-based medicine sources (33%). The majority of MDTs discussed only a proportion of new patients at each meeting emphasizing the importance of educational aspects for other cases. Barriers exist in the availability of data to enable audit and reflection on evidence-based practice. MDT strengths included collaboration and quality discussion about patients. MDT meetings focus on treatment decision making, with group consensus playing a significant role in translating research evidence from guidelines into clinical decision making. With a varying proportion of patients discussed in each MDT meeting, a wider audit of multidisciplinary care would enable more accurate assessments of whether treatment recommendations are in
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Bibby, Anna C; Williams, Katie; Smith, Sarah; Bhatt, Nidhi; Maskell, Nick A
Multidisciplinary team meetings are standard care for cancer in the UK and Europe. Professional bodies recommend that mesothelioma cases should be discussed at specialist multidisciplinary team meetings. However, no evidence exists exploring the role of the specialist mesothelioma multidisciplinary team meeting. To evaluate the clinical activity of 1 specialist mesothelioma multidisciplinary team meeting and to determine how often a definitive diagnosis was made, whether the core requirements of the meeting were met and whether there was any associated benefit or detriment. A service evaluation using routinely collected data from 1 specialist mesothelioma multidisciplinary team meeting in a tertiary referral hospital in the South-West of England. All cases discussed between 1/1/2014 and 31/12/2015. The primary outcome measure was whether a definitive diagnosis was made. Secondary outcomes included whether treatment advice was offered, information on clinical trials provided or further investigations suggested. Additional benefits of the multidisciplinary team meeting and time taken from referral to outcome were also collected. A definitive diagnosis was reached in 171 of 210 cases discussed (81%). Mesothelioma was diagnosed in 153/210 (73%). Treatment advice was provided for 127 of 171 diagnostic cases (74%) and further investigations suggested for all 35 non-diagnostic cases. 86/210 cases (41%) were invited to participate in a trial, of whom 43/86 (50%) subsequently enrolled. Additional benefits included the avoidance of postmortem examination if the coroner was satisfied with the multidisciplinary team decision. The overall process from referral to outcome dispatch was multidisciplinary team meeting was effective at making diagnoses and providing recommendations for further investigations or treatment. The core requirements of a specialist mesothelioma multidisciplinary team meeting were met. The process was timely, with most outcomes returned within 2 weeks of
De Vries, Kay; Plaskota, Marek
Palliative sedation is a method of symptom management frequently used in hospices to treat uncontrolled symptoms at the end of life. There is a substantial body of literature on this subject; however, there has been little research into the experiences of hospice nurses when administering palliative sedation in an attempt to manage the terminal restlessness experienced by cancer patients. Semistructured interviews were conducted with a purposive sample of seven hospice nurses who had cared for at least one patient who had undergone palliative sedation within the past year in a hospice in the south of England in the United Kingdom. A phenomenological approach and Colaizzi's stages of analysis were employed to develop themes from the data. Facilitating a "peaceful death" was the primary goal of the nurses, where through the administration of palliative sedation they sought to enable and support patients to be "comfortable," "relaxed," and "calm" at the terminal stage of their illness. Ethical dilemmas related to decision making were a factor in achieving this. These were: medication decisions, "juggling the drugs," "causing the death," sedating young people, the family "requesting" sedation, and believing that hospice is a place where death is hastened. Hospice nurses in the U.K. frequently encounter ethical and emotional dilemmas when administering palliative sedation. Making such decisions about using palliative sedation causes general discomfort for them. Undertaking this aspect of care requires confidence and competence on the part of nurses, and working within a supportive hospice team is of fundamental importance in supporting this practice.
Kirolos, Irene; Tamariz, Leonardo; Schultz, Elizabeth A; Diaz, Yvonne; Wood, Barbara A; Palacio, Ana
Hospice and palliative care are underutilized among patients at the end of their lives despite evidence that they improve patient satisfaction and reduce costs. To synthesize evidence regarding interventions to increase hospice referral/enrollment. We conducted a systematic review of the literature and selected studies that evaluated interventions aimed at increasing hospice use. We performed a MEDLINE search (1979 to April 2013) supplemented by manual searches of bibliographies of key articles. Study design, quality criteria, population, interventions, and outcomes for each study were extracted. The main outcome evaluated was hospice referral/enrollment. Our search strategy yielded 419 studies, of which only 6 met our eligibility criteria. Three studies included nursing home populations; 1 included home care patients, 1 targeted care managers, and 1 reported on heart failure patients. Three studies had a cohort design, 2 were pre-post, and only 1 was randomized. Two studies evaluated a process to identify eligible subjects. Two evaluated the impact of advance care planning programs and 2 only provided education. Interventions that only provided education showed a median increase in referral of 5% (2.8%-17%) while interventions that identified hospice candidates showed a median increase in hospice referral of 19.5 % (19%-20%). Interventions of different levels of complexity can improve the use of hospice services among subjects with high mortality risk. An approach that allows the medical team to assess patients' treatment goals and that engages the treating physician seems to be the most successful one.
Armstrong, Edward M.; Bingham, Andrew; Vazquez, Jorge; Thompson, Charles; Huang, Thomas; Finch, Chris
In 2010/2011 the Global Data Assembly Center (GDAC) at NASA's Physical Oceanography Distributed Active Archive Center (PO.DAAC) continued its role as the primary clearinghouse and access node for operational Group for High Resolution Sea Surface Temperature (GHRSST) datastreams, as well as its collaborative role with the NOAA Long Term Stewardship and Reanalysis Facility (LTSRF) for archiving. Here we report on our data management activities and infrastructure improvements since the last science team meeting in June 2010.These include the implementation of all GHRSST datastreams in the new PO.DAAC Data Management and Archive System (DMAS) for more reliable and timely data access. GHRSST dataset metadata are now stored in a new database that has made the maintenance and quality improvement of metadata fields more straightforward. A content management system for a revised suite of PO.DAAC web pages allows dynamic access to a subset of these metadata fields for enhanced dataset description as well as discovery through a faceted search mechanism from the perspective of the user. From the discovery and metadata standpoint the GDAC has also implemented the NASA version of the OpenSearch protocol for searching for GHRSST granules and developed a web service to generate ISO 19115-2 compliant metadata records. Furthermore, the GDAC has continued to implement a new suite of tools and services for GHRSST datastreams including a Level 2 subsetter known as Dataminer, a revised POET Level 3/4 subsetter and visualization tool, a Google Earth interface to selected daily global Level 2 and Level 4 data, and experimented with a THREDDS catalog of GHRSST data collections. Finally we will summarize the expanding user and data statistics, and other metrics that we have collected over the last year demonstrating the broad user community and applications that the GHRSST project continues to serve via the GDAC distribution mechanisms. This report also serves by extension to summarize the
Butler, Robert N.
There has been little comment in the hospice literature about the special problems of the elderly. Promotes the continued refinement of hospice concepts and practices in relation to both disease and age. (Author/CMG)
Pereira, José; Contant, Jocelyne; Barton, Gwen; Klinger, Christopher
Regionalization promotes planning and coordination of services across settings and providers to meet population needs. Despite the potential advantages of regionalization, no regional hospice palliative care program existed in Ontario, Canada, as of 2010. This paper describes the process and early results of the development of the first regional hospice palliative care program in Ontario. The various activities and processes undertaken and the formal agreements, policies and documents are described. A participative approach, started in April 2009, was used. It brought together over 26 health service providers, including residential hospices, a palliative care unit, community and hospital specialist consultation teams, hospitals, community health and social service agencies (including nursing), individual health professionals, volunteers, patients and families. An extensive stakeholder and community vetting process was undertaken that included work groups (to explore key areas such as home care, the hospital sector, hospice and palliative care unit beds, provision of care in rural settings, e-health and education), a steering committee and input from over 320 individuals via e-mail and town-halls. A Transitional Leadership Group was elected to steer the implementation of the Regional Program over the summer of 2010. This group established the by-laws and details regarding the governance structure of the Regional Program, including its role, responsibilities, reporting structures and initial performance indicators that the Local Health Integration Network (LHIN) approved. The Regional Program was formally established in November 2010 with a competency-based Board of 14 elected members to oversee the program. Early work involved establishing standards and performance indicators for the different sectors and settings in the region, and identifying key clinical needs such as the establishment of more residential hospice capacity in Ottawa and a rural framework to ensure
Whitebird, Robin R; Asche, Stephen E; Thompson, Gretchen L; Rossom, Rebecca; Heinrich, Richard
Working in hospice care is a highly challenging yet rewarding profession. However, the challenges of working with dying patients and their families can overwhelm even the most highly dedicated professional, leading to burnout, compassion fatigue, anxiety, and depression. The aim of this study was to better understand how stress affects the mental health of hospice workers in terms of burnout and compassion fatigue and how they cope with these issues. Data for this study are from Compassion Fatigue and You, a cross-sectional survey of hospice staff from across Minnesota. We surveyed 547 hospice workers throughout Minnesota to better understand the overall mental health of staff, including levels of stress, burnout, and compassion fatigue, and how they cope with these issues. The study was conducted in 2008 and 2009 through a private, not-for-profit research institute affiliated with a large Midwestern health plan. Hospice staff reported high levels of stress, with a small but significant proportion reporting moderate-to-severe symptoms of depression, anxiety, compassion fatigue, and burnout. Staff reported managing their stress through physical activity and social support, and they suggested that more opportunities to connect with coworkers and to exercise could help decrease staff burnout. Poor mental health places staff at risk for burnout and likely contributes to staff leaving hospice care; this is a critical issue as the profession attempts to attract new staff to meet the expanding demands for hospice care.
Wang, Xiao; Knight, Louise S; Evans, Anne; Wang, Jiangxia; Smith, Thomas J
The benefits of hospice for patients with end-stage disease are well established. Although hospice use is increasing, a growing number of patients are enrolled for ≤ 7 days, a marker of poor quality of care and patient and family dissatisfaction. In this study, we examined variations in referrals among individuals and groups of physicians to assess a potential source of suboptimal hospice use. We conducted a retrospective chart review of 452 patients with advanced cancer referred to hospice from a comprehensive cancer center. We analyzed patient length of service (LOS) under hospice care, looking specifically at median LOS and percent of short enrollments (%LOS ≤ 7), to examine the variation between individual oncologists and divisions of oncologists. Of 394 successfully referred patients, median LOS was 14.5 days and %LOS ≤ 7 was 32.5%, consistent with national data. There was significant interdivisional variation in LOS, both by overall distribution and %LOS ≤ 7 ( P hospice referral practices between providers (coefficient of variation > 125%). As one example, median LOS of physicians in the Division of Thoracic Malignancies varied from 4 to 33 days, despite similarities in patient population. Nearly one in three patients with cancer who used hospice had LOS ≤ 7 days, a marker of poor quality. There was significant LOS variability among different divisions and different individual physicians, suggesting a need for increased education and training to meet recommended guidelines.
The author summarizes the experiences of four long-term hospice staff support groups in which he served as facilitator. From these experiences he identifies what seem to be the key elements in the success or failure of a hospice staff support group, including its membership, the group contract, and the facilitator's leadership style. He outlines three developmental stages of the long-term staff support group: trust-building, individual support and team-focus. He suggests that the team-focused group is ideally suited to deal with crucial staff and agency sources of worker stress.
Unger, Kenneth M
When ventilatory support is withdrawn in an intensive care unit (ICU), the place of death for most patients is the hospital. However, the majority of terminally ill patients prefer to die at home. Few articles have addressed taking adult mechanically ventilated patients home from the ICU for withdrawal of ventilatory support (WVS). To determine the outcomes of a protocol-driven program of WVS in the home under hospice care. A retrospective chart review of 14 consecutive patients who had WVS at home. All subjects were mechanically ventilated ICU patients referred to hospice with a request for WVS to be performed in the patient's home. A protocol/checklist guided care. Medical records were reviewed to obtain demographic and medical information, particularly for duration of mechanical ventilation, the use of premedication, level of consciousness at the time of WVS, symptoms following WVS, pharmacologic measures used for symptom control after WVS, and survival time after WVS. At the time of WVS, five patients were awake or arousable and nine were stuporous or comatose. Ten patients required no medication before WVS; only four required medications for symptom control after WVS. Median survival after WVS was 18.15 hours. In all cases, symptomatic control was judged to be excellent. Successful WVS and a natural death at home is possible with logistic support from the hospice organization and the expertise of the hospice team, guided by a comprehensive protocol/checklist. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
'The nice thing about doctors is that you can sometimes get a day off school': an action research study to bring lived experiences from children, parents and hospice staff into medical students' preparation for practice.
Spalding, Jessica; Yardley, Sarah
Patient and public involvement in healthcare is important to ensure services meet their needs and priorities. Increasingly, patient experiences are being used to educate healthcare professionals. The potential contribution to medical education of children and parents using hospice services has not yet been fully explored. (1) To explore perceptions of what medical students must learn to become 'good doctors' among children, parents and staff in a hospice. (2) To collaborate with children/parents and staff to develop educational materials based on their lived experiences for medical students. (3) To assess feasibility of student-led action research in a children's hospice to develop research skills. Prospective ethical approval received. Volunteer children (n=7), parents (n=5) and staff (n=6) were recruited from a children's hospice. Data were generated in audio-recorded semistructured focus groups, individual interviews and/or activity workshops. Participants discussed what newly qualified doctors' needed to care for children with life-limiting conditions. Audio data were transcribed and combined with visual data for thematic analysis. Findings were refined by participant feedback. This paper presents thematic findings and educational material created from the project. Thematic analysis identified six learning themes: (1) treat children as individuals; (2) act as a person before being a doctor; (3) interpersonal communication; (4) appreciate the clinical environment; (5) learn from children, parents and other staff; (6) how to be a doctor as part of a team. The student researcher successfully developed qualitative research skills, coproducing materials with participants for sharing learning derived from lived experiences. All participants were willing and able to make valuable contributions, and believed that this was a worthwhile use of time and effort. Further work is required to understand how best to integrate the experiences of children in hospices into
Scherer, Edson Arthur; Campos, Maria Auxiliadora; Scherer, Zeyne Alves Pires
This naturalistic study was realized through observation and aimed to characterize general staff meetings held at a day hospital regarding theme and the professionals' participation in the use of time...
Ashley, Laura; Armitage, Gerry; Neary, Maria; Hollingsworth, Gillian
Failure Mode and Effects Analysis (FMEA) is a proactive risk assessment tool used to identify potential vulnerabilities in complex, high-risk processes and to generate remedial actions before the processes result in adverse events. FMEA is increasingly used to proactively assess and improve the safety of complex health care processes such as drug administration and blood transfusion. A central feature of FMEA is that it is undertaken by a multidisciplinary team, and because it entails numerous analytical steps, it takes a series of several meetings. Composing a team of busy health care professionals with the appropriate knowledge, skill mix, and logistical availability for regular meetings is, however, a serious challenge. Despite this, information and advice on FMEA team assembly and meetings scheduling are scarce and diffuse and often presented without the accompanying rationale. Assemble an eight-member team composed of clinically active health care staff, from every profession involved in delivery of the process-and who regularly perform it; staff from a range of seniority levels; outsider(s) to the process-and perhaps even to health care; a leader (and facilitator); and researchers. Plan for 10-15 hours of team meeting time for first-time, narrowly defined FMEAs, scheduled as four to six meetings lasting 2 to 3 hours each, spaced weekly to biweekly. Meet in a venue that seats the team around one table and is off the hospital floor but within its grounds. FMEA, generally acknowledged to be a useful addition to the patient safety toolkit, is a meticulous and time- and resource-intensive methodology, and its successful completion is highly dependent on the team members' aptitude and on the facility's and team members' commitment to hold regular, productive meetings.
Chiaramonte, Francis; Motil, Brian; McQuillen, John
The Two-phase Heat Transfer International Topical Team consists of researchers and members from various space agencies including ESA, JAXA, CSA, and RSA. This presentation included descriptions various fluid experiments either being conducted by or planned by NASA for the International Space Station in the areas of two-phase flow, flow boiling, capillary flow, and crygenic fluid storage.
Iris Habets; Anna Beurskens; Marloes Amantia van Bokhoven; Jerôme Jean Jacques van Dongen
Background: The number of people with multiple chronic conditions increases as a result of ageing. To deal with the complex health-care needs of these patients, it is important that health-care professionals collaborate in interprofessional teams. To deliver patient-centred care, it is often
Slootweg, Irene A.; Scherpbier, Albert; van der Leeuw, Renée; Heineman, Maas Jan; van der Vleuten, Cees; Lombarts, Kiki M. J. M. H.
The importance of team communication, or more specifically speaking up, for safeguarding quality of patient care is increasingly being endorsed in research findings. However, little is known about speaking up of clinical teachers in postgraduate medical training. In order to determine how clinical
Slootweg, Irene A.; Scherpbier, Albert; van der Leeuw, Renée; Heineman, Maas Jan; van der Vleuten, Cees; Lombarts, Kiki M. J. M. H.
The importance of team communication, or more specifically speaking up, for safeguarding quality of patient care is increasingly being endorsed in research findings. However, little is known about speaking up of clinical teachers in postgraduate medical training. In order to determine how clinical teachers demonstrate speaking up in formal…
choice patients make to forego aggressive treatment measures when they enroll in hospice. In a literal sense, to enroll in hospice means to bring in support for end-of-life care. It means to identify the need for expertise around symptom management at end-of-life, and agree to having a care team come and manage someone’s physical, psychosocial, and/or spiritual needs. As with all care, hospice can be stopped if it is no longer considered appropriate. To uncover the communication tensions undergirding a hospice admission interaction, we use Street’s ecological theory of patient-centered communication to analyze a case exemplar of a hospice admission interaction. This analysis reveals diverse points of struggle within hospice decision-making processes around hospice care and the need for communication techniques that promote trust and acceptance of end-of-life care. Lessons learned from talking about hospice care can inform other quality initiatives around communication and informed decision-making in the context of advance care planning, palliative care, and end-of-life care.
Candrian, Carey; Tate, Channing; Broadfoot, Kirsten; Tsantes, Alexandra; Matlock, Daniel; Kutner, Jean
to forego aggressive treatment measures when they enroll in hospice. In a literal sense, to enroll in hospice means to bring in support for end-of-life care. It means to identify the need for expertise around symptom management at end-of-life, and agree to having a care team come and manage someone’s physical, psychosocial, and/or spiritual needs. As with all care, hospice can be stopped if it is no longer considered appropriate. To uncover the communication tensions undergirding a hospice admission interaction, we use Street’s ecological theory of patient-centered communication to analyze a case exemplar of a hospice admission interaction. This analysis reveals diverse points of struggle within hospice decision-making processes around hospice care and the need for communication techniques that promote trust and acceptance of end-of-life care. Lessons learned from talking about hospice care can inform other quality initiatives around communication and informed decision-making in the context of advance care planning, palliative care, and end-of-life care. PMID:28420191
... PDF - 5.6 MB] Hospice patients Number of patients: 1.3 million (2013) Source: Long-Term Care Providers and Services Users in the United States: Data From the National Study of Long-Term Care Providers, 2013-2014, table 1 [PDF - 5.6 MB] More Data Alzheimer’s disease Long-Term Care Services in the United ...
Full Text Available Helen Morement,1 Rachel Harrison,2 Simon D Taylor-Robinson3 1AMMF – The Cholangiocarcinoma Charity, Enterprise House, Stansted, Essex, 2Department of South East Asia, School of Oriental and African Studies, London, 3Division of Digestive Health, Department of Surgery and Cancer, Imperial College London, London, UK Background: The multidisciplinary team (MDT meeting has become the hallmark for cancer care in the UK. While standardizing care through adherence to guidelines, the MDT process can make the decision-making process somewhat remote from the patient perspective. The Cholangiocarcinoma Charity (AMMF is the UK’s only cholangiocarcinoma charity and is at the forefront of patient empowerment for those with this condition and for their families. It provides much needed support not only via personal contact but also through its website and on the social media platforms, Facebook and Twitter. Methods: AMMF conducted a survey of patient attitudes to and experience of the MDT process through a simple questionnaire posted on Facebook in 2014. We report the results of the responses received, which we believe are worthy of further thought. Findings: In the main, while treatment decisions are not queried, there is distress at the lack of involvement, the lack of representation, the lack of communication and at not knowing who to approach for answers to questions. Conclusion: This snapshot, although small, provides some insight to clinicians not to forget the constituency they serve, as communication is all important. Keywords: cholangiocarcinoma, multidisciplinary team meeting, management, patient perspectives
Aghdam, Alireza Mohajjel; Aghaei, Mir Hossein; Hassankhani, Hadi; Rahmani, Azad
Awareness and attitudes of nurses regarding end of life care are important factors in providing hospice care. In an extensive literature review, we found no related articles investigating Iranian nurses awareness and attitudes about providing such care. The aims of this study were to investigate the awareness and attitudes of Iranian nurses in providing hospice care. In this descriptive-correlational study, 240 nurses employed in six educational centers were selected by non-randomized stratified sampling. The data collection instruments included an awareness test and attitudes regarding providing end of life care in hospice questionnaire. The data were analyzed using descriptive statistics and independent sample t-tests, one-way ANOVA, and Pearson correlation tests. The nurses' awareness score was 14.3 out of 29 and 55.7% of them stated that they had not received any education in providing end of life care. Also, by obtaining the score of 91.7 out of 120 the attitudes of participants in providing end of life care in hospices were positive. In addition, the highest attitudes score of nurses were in the dimensions of benefits of implementation and health care team. Considering low awareness of nurses about end of life care in hospices, continuing education should be provided for them in this regard. Especially, by considering the positive attitude of nurses, providing such programs could help develop hospice care in Iran.
van Dongen, Jerôme Jean Jacques; de Wit, Maarten; Smeets, Hester Wilhelmina Henrica; Stoffers, Esther; van Bokhoven, Marloes Amantia; Daniëls, Ramon
The number of people with multiple chronic conditions receiving primary care services is growing. To deal with their increasingly complex health care demands, professionals from different disciplines need to collaborate. Interprofessional team (IPT) meetings are becoming more popular. Several studies describe important factors related to conducting IPT meetings, mostly from a professional perspective. However, in the light of patient-centeredness, it is valuable to also explore the patients' perspective. The aim was to explore the patients' perspectives regarding IPT meetings in primary care. A qualitative study with a focus group design was conducted in the Netherlands. Two focus group meetings took place, for which the same patients were invited. The participants, chronically ill patients with experience on interprofessional collaboration, were recruited through the regional patient association. Participants discussed viewpoints, expectations, and concerns regarding IPT meetings in two rounds, using a focus group protocol and selected video-taped vignettes of team meetings. The first meeting focused on conceptualization and identification of themes related to IPT meetings that are important to patients. The second meeting aimed to gain more in-depth knowledge and understanding of the priorities. Discussions were audio-taped and transcribed verbatim, and analyzed by means of content analysis. The focus group meetings included seven patients. Findings were divided into six key categories, capturing the factors that patients found important regarding IPT meetings: (1) putting the patient at the center, (2) opportunities for patients to participate, (3) appropriate team composition, (4) structured approach, (5) respectful communication, and (6) informing the patient about meeting outcomes. Patients identified different elements regarding IPT meetings that are important from their perspective. They emphasized the right of patients or their representatives to take part
Korte, E. de; Kuijt, L.; Kleij, R. van der
This study examines the effects of spatial characteristics of meeting rooms on the divergent phase in the creativity process of a group and on the mood states arousal and psychological safety. Thirty participants (12 male and 18 female) were randomly allocated to 10 mixed-gender three-person groups.
Ehrlich, Olga; Walker, Rachel K
Hospice cancer patients experience poorly-controlled pain in spite of widely-disseminated evidence-based guidelines for use by hospice care practitioners. Pain management occurs in the context of the interdisciplinary team, centered on a caring triad in the home: the person with pain, their caregiver, and their nurse. This review: 1) Summarizes what is known about differing ways that members of the hospice caring triad (patients, caregivers, and nurses) interpret and respond to cancer pain, in order to develop a cancer pain social processes theoretical framework, 2) Identifies gaps in understanding of hospice cancer pain social processes, and 3) Identifies framework concepts for research-based clinical practice with potential to improve pain outcomes. Our integrative review of the literature resulted in the identification and synthesis of 21 unique studies of cancer pain social processes, which were categorized according to a social processes framework and hospice caring triad member roles, using a social processes concepts matrix. Pain meanings, goals, and related responses vary for persons with pain, caregivers, and nurses. Studies have explored individual social processes concepts or triad member roles. Studies identify the need for pain meaning to be included in hospice pain management plans. To our knowledge, no single study has generated a framework for hospice cancer pain social processes addressing and incorporating the roles of all three caring triad members. Therefore, comprehensive hospice cancer pain clinical evaluation and interventions plans may be missing key elements of pain management, especially for persons with ongoing poorly controlled pain. Copyright © 2016 Elsevier Ltd. All rights reserved.
The relationship between acculturation and attitudes of Latinos toward hospice was examined in a sample of 380 Latinos from southern New Jersey. A survey design, using self-administered questionnaires, including a bi-dimensional acculturation scale, examined attitudes toward hospice. The sample represented a cross-section of socioeconomic groups and various nationalities of Latinos. Findings revealed that education and income were significantly related to attitudes toward hospice but acculturation was not. Findings also revealed that more than one-half of participants were unfamiliar with the word "hospice" prior to the study. Respondents with higher incomes, higher levels of education, and who were older were more familiar and had more positive attitudes. Overall, despite respondents' limited knowledge of hospice, the majority would use it. These findings underscore the need to intensify hospice education in Latino communities taking into account Latinos' socioeconomic status.
McConnell, Tracey; Porter, Sam
More attention is being paid to the wellbeing of staff working in stressful situations. However, little is known about staff experience of providing end-of-life care to children within a hospice setting. This study aims to explore the experiences of care team staff who provide end-of-life care within a children's hospice. Qualitative research incorporating interviews and a focus group. Data were analysed using thematic analysis. Purposeful sampling led to a total of 15 care team staff recruited from a children's hospice offering palliative and specialist care to life-limited children and young people. The hospice setting provides a model of excellence in supporting staff and mitigating challenging aspects of their role, which includes peer/organisational support, and regular ongoing training in key aspects of children's palliative care. Key recommendations for improving their experience included advanced communication training and knowledge sharing with other children's palliative care specialists within the acute setting. Service and policy initiatives should encourage open, informal peer/organisational support among the wider children's palliative care sector. Further research should focus on paediatric palliative care education, particularly in relation to symptom management and communication at end-of-life, harnessing the expertise and breadth of knowledge that could be shared between children's hospices and hospital settings.
Leo, Silvia Di; Bono, Laura; Romoli, Vittoria; West, Emily; Ambrosio, Raffaella; Gallucci, Michele; Pilastri, Paola; Ciura, Pietro La; Morino, Piero; Piazza, Massimo; Valenti, Danila; Franceschini, Catia; Costantini, Massimo
The Liverpool Care Pathway (LCP) is extensively used in hospices, but the literature on the process of implementation is scarce. Developing, piloting, and preliminarily assessing the LCP program within the inpatient hospice setting. This is a phase 0-1 study, according to the Medical Research Council (MRC) Framework, divided into three phases: literature review on LCP in hospice and development of the Italian version of the LCP program (LCP-I), development of a procedure for assessing the quality of the implementation process and assessing the feasibility of the implementation process, and piloting the procedure in 7 inpatient Italian hospices. The LCP was implemented in all the hospices involved. A high proportion of physicians (50%-100%) and nurses (94%-100%) attended the self-education program. The self-implementation of the LCP-I program was completed in all hospices. The proportion of patients who died on LCP-I ranged between 35.6% and 89.1%. Professionals from 2 hospices reported a positive impact of the LCP-I. Conversely, professionals from 2 hospices did not recognize a positive impact of the program and did not agree to maintain the LCP-I in hospice. Finally, professionals from the other 3 hospices reported intermediate evaluations (1 stopped to use the LCP-I). Some weaknesses emerged from the external audits, related to the self-education and the self-implementation approach. Professionals required an external support from a trained palliative care team with reference to both phases. The LCP-I implementation within hospices is feasible, and the process of implementation is evaluable. Issues that occurred within the implementation process suggest the introduction of an external support from a trained palliative care team in implementing the LCP program.
Harrold, Joan; Harris, Pam; Green, Dena; Craig, Teresa; Casarett, David J
Although many patients enter hospice close to death, some enroll for more than six months. In 2011 the U.S. Centers for Medicare and Medicaid Services (CMS) required that these long-stay patients receive a face-to-face visit by a physician or nurse practitioner to ensure that they continue to meet eligibility criteria. This study proposed to determine whether the face-to-face visit requirement increased the rate at which patients were decertified from hospice. The study was a retrospective cohort study in six U.S. hospices. Decertification from hospice within 10 months of enrollment was measured. Of 23,638 patients, 11,788 (49.9%) would have been affected by the face-to-face requirement. In bivariate analysis, there was a significant decrease in the decertification rate after the requirement was implemented-371/11,788 (3.2%) versus 578/11,850 (4.9%); odds ration (OR): 0.63; 95% CI 0.55-0.72; p<0.001. In a multivariable logistic regression model adjusting for changes in patient characteristics and clustered by hospice, there was still a reduction in decertifications-3.4% versus 5.2%; OR 0.67; 95% CI 0.47-0.97; p=0.034. Although the impact of the face-to-face requirement varied among hospices, all hospices had a decrease in decertification rates (absolute adjusted reduction between 1.4% and 3.6%). The face-to-face requirement may decrease hospice discharges, contrary to its intention.
... Grief & Loss Resources Hospice and Palliative Care > Palliative Care Palliative Care Palliative Care Questions and Answers Palliative Care Questions and Answers Question Palliative Care Hospice Care ...
Dean, Stephanie; Libby, Katherine; McAuley, William J; Van Nostrand, Joan
Hospice bereavement services, though often overlooked in hospice research, are an important area of study due not only to the potential value of bereavement support but also the emphasis placed on such services by the Centers for Medicare and Medicaid Services. Moreover, access to these services is seldom understood or researched. Therefore, using the patient public use file of the 2007 National Home and Hospice Care Survey, we explored the relationships between patient, informal caregiver, and agency characteristics as well as discharges from hospice to gain perspective into bereavement service access to informal caregivers. Findings suggested that death at discharge from hospice may be an important moderator variable between access to hospice bereavement support and many other factors. However, even under controls for death at discharge, two agency characteristics remain significantly associated with access. Bereavement access tends to be more likely in agencies that provide only hospice care as opposed to other services, and in micropolitan agencies. Furthermore, death at discharge is less likely among African Americans, suggesting the value of enhanced culturally-appropriate and more targeted hospice care and hospice bereavement support for this population. Future research should explore the strategies used to effectively deliver bereavement services and how these strategies may benefit from targeted and culturally sensitive approaches.
Wladkowski, Stephanie P
Hospice offers holistic support for individuals living with terminal illness and their caregivers. Some individuals receiving hospice services experience a slower decline in health as than expected, resulting in a 'live discharge' from hospice. A live discharge affects both patient and caregiver(s).The current study (N=24) explored the experiences of caregivers of adults with dementia who experienced a live discharge from hospice. Findings emphasize the comprehensive services covered under the Medicare Hospice benefit and those lost after a live discharge. Implications for social workers supporting caregivers are discussed, including the need to view the patient-caregiver unit during a live discharge.
Lamb, B W; Sevdalis, N; Vincent, C; Green, J S A
The quality of decision-making in cancer multidisciplinary team (MDT) meetings is variable, which can result in suboptimal clinical decision making. We developed MDT-QuIC, an evidence-based tool to support clinical decision making by MDTs, which was evaluated by key users. Following a literature review, factors important for high-quality clinical decision making were listed and then converted into a preliminary checklist by clinical and safety experts. Attitudes of MDT members toward the tool were evaluated via an online survey, before adjustments were made giving rise to a final version: MDT-QuIC. The checklist was evaluated by 175 MDT members (surgeons = 38, oncologists = 40, specialist nurses = 62, and MDT coordinators = 35). Attitudes toward the checklist were generally positive (P < 0.001, 1-sample t test), although nurses were more positive than other groups regarding whether the checklist would improve their contribution in MDT meetings (P < 0.001, Mann-Whitney U test). Participants thought that the checklist could be used to prepare cases for MDT meetings, to structure and guide case discussions, or as a record of MDT discussion. Regarding who could use the checklist, 70% thought it should be used by the MDT chair, 54% by the MDT coordinator, and 38% thought all MDT members should use it. We have developed and validated an evidence-based tool to support the quality of MDT decision making. MDT members were positive about the checklist and felt it may help to structure discussion, improve inclusivity, and patient centeredness. Further research is needed to assess its effect on patient care and outcomes.
Story, Marilyn D.
Hospice is a family-centered concept of care which needs home economists from all subject-matter areas in volunteer or paid professional roles. In turn, home economists can grow personally as well as professionally through their involvement with hospice. (Author)
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: email@example.com.
Lau, Denys T; Joyce, Brian; Clayman, Marla L; Dy, Sydney; Ehrlich-Jones, Linda; Emanuel, Linda; Hauser, Joshua; Paice, Judith; Shega, Joseph W
Managing and administering medications to relieve pain and symptoms are common, important responsibilities for informal caregivers of patients receiving end-of-life care at home. However, little is known about how hospice providers prepare and support caregivers with medication-related tasks. This qualitative study explores the key approaches that hospice providers use to facilitate medication management for caregivers. Semistructured, open-ended interviews were conducted with 22 providers (14 nurses, four physicians, and four social workers) from four hospice organizations around an urban setting in the midwestern U.S. Based on the interviews, the following five key approaches emerged, constituting how the hospice team collectively helped caregivers manage medications: 1) establishing trust; 2) providing information; 3) promoting self-confidence; 4) offering relief (e.g., provided in-home medication assistance, mobilized supportive resources, and simplified prescriptions); and 5) assessing understanding and performance. Each hospice discipline used multiple approaches. Nurses emphasized tailoring information to individual caregivers and patients, providing in-home assistance to help relieve caregivers, and assessing caregivers' understanding and performance of medication management during home visits. Physicians simplified medication prescriptions to alleviate burden and reassured caregivers using their perceived medical authority. Social workers facilitated medication management by providing emotional support to promote self-confidence and mobilizing resources in caregivers' support networks and the community at large. Hospice nurses, physicians, and social workers identified distinct, yet overlapping, approaches in aiding caregivers with medication management. These findings emphasize the importance of interdisciplinary teamwork among hospice providers. Future research should investigate how common, standardized, effective, and efficient these approaches are in
Lau, Denys T.; Joyce, Brian; Clayman, Marla L.; Dy, Sydney; Ehrlich-Jones, Linda; Emanuel, Linda; Hauser, Joshua; Paice, Judith; Shega, Joseph W.
Context Managing and administering medications to relieve pain and symptoms are common, important responsibilities for informal caregivers of patients receiving end-of-life care at home. However, little is known about how hospice providers prepare and support caregivers with medication-related tasks. Objectives This qualitative study explores the key approaches that hospice providers employ to facilitate medication management for caregivers. Methods Semi-structured, open-ended interviews were conducted with 22 providers (14 nurses, four physicians, and four social workers) from four hospice organizations around an urban setting in the Midwest U.S. Results Based on the interviews, the following five key approaches emerged, constituting how the hospice team collectively helped caregivers manage medications: 1) establishing trust; 2) providing information; 3) promoting self-confidence; 4) offering relief (e.g., provided in-home medication assistance, mobilized supportive resources, and simplified prescriptions); and 5) assessing understanding and performance. Each hospice discipline employed multiple approaches. Nurses emphasized tailoring information to individual caregivers and patients, providing in-home assistance to help relieve caregivers, and assessing caregivers’ understanding and performance of medication management during home visits. Physicians simplified medication prescriptions to alleviate burden and reassured caregivers using their perceived medical authority. Social workers facilitated medication management by providing emotional support to promote self-confidence and mobilizing resources in caregivers’ support networks and the community at large. Conclusion Hospice nurses, physicians, and social workers identified distinct, yet overlapping, approaches in aiding caregivers with medication management. These findings emphasize the importance of teamwork among hospice providers. Future research should investigate how common, standardized, effective
Full Text Available The child’s illness, suffering and death provoke many emotions in the family. The ill child and its family both experience grief which is an emotional reaction to the danger of losing health or life. Support offered by home hospices for children aims at overcoming the destructive influence of illness. A hospice counsellor’s task is to improve the ill child and its family’s quality of life. He is helping the family overcome grief and prepare for the child’s death. The hospice team supports the family members who experience anticipatory and later, actual mourning. Preventing pathological effects of grief is a basic challenge for people who offer help.
Campbell, Courtney S; Cox, Jessica C
Although the overwhelming majority of terminally ill patients in Oregon who seek a physician's aid in dying are enrolled in hospice programs, hospices do not take a major role in this practice. An examination of fifty-five Oregon hospices reveals that both legal and moral questions prevent hospices from collaborating fully with physician-assisted death.
Jenkins, Todd M; Chapman, Kathryn L; Ritchie, Christine S; Arnett, Donna K; McGwin, Gerald; Cofield, Stacey S; Maetz, H Michael
The literature predominately describes hospice utilization among Medicare recipients, with a limited number of reports describing use among all age groups. This study aimed to describe and compare patterns of hospice use among decedents of all ages in Alabama using a population-based approach. We obtained death certificates for Alabama residents who died from January 1, 2002 to December 31, 2005 (n=178,420). To ascertain hospice use, we linked death certificates to the hospice administering care using state-mandated listings of deaths reported by hospices. Additionally, each decedent's residence at death was geocoded and area-level socioeconomic status (SES) measures were added. From 2002 to 2005, a total of 43,638 Alabamians died while under hospice care, representing a quarter (24.5%) of all deaths in the state. During this four-year span, the rate of hospice use increased by nearly 15% (22.2%-25.6%). As expected, rates of hospice use increased with age at death. For the SES indicators for poverty, education, and income, rates of hospice use increased as SES improved. However, this pattern was found to vary by race and metro/nonmetro status. In addition to revealing racial, geographic, and other disparities in hospice care across Alabama, our results indicate usage rates in Alabama trail behind those observed nationally. We also identified previously unreported interactions between race, urbanization level, and poverty classification. Future studies should explore whether such relationships exist elsewhere and the rationale for their occurrence. Copyright © 2011 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.
.... The article concludes that continuity of care is optimized by care management across care sites. (True... comprehensive care plan for each resident that meets the resident's medical, nursing, mental, and psychosocial... medical direction and management of the patient's hospice care; nursing; counseling (including spiritual...
Casarett, David J; Quill, Timothy E
Hospice programs offer unique benefits for patients who are near the end of life and their families, and growing evidence indicates that hospice can provide high-quality care. Despite these benefits, many patients do not enroll in hospice, and those who enroll generally do so very late in the course of their illness. Some barriers to hospice referral arise from the requirements of hospice eligibility, which will be difficult to eliminate without major changes to hospice organization and financing. However, the challenges of discussing hospice create other barriers that are more easily remedied. The biggest communication barrier is that physicians are often unsure of how to talk with patients clearly and directly about their poor prognosis and limited treatment options (both requirements of hospice referral) without depriving them of hope. This article describes a structured strategy for discussing hospice, based on techniques of effective communication that physicians use in other "bad news" situations. This strategy can make hospice discussions both more compassionate and more effective.
DIANE E. MEIER
.... It also defines palliative care and hospice, synthesizes studies of the outcomes of palliative care and hospice services, reviews variables predicting access to palliative care and hospice services...
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
Bercovitz, Anita; Sengupta, Manisha; Jones, Adrienne; Harris-Kojetin, Lauren D
Objective-This report presents national estimates on the provision and use of complementary and alternative therapies (CAT) in hospice. Comparisons of organizational characteristics of hospice care providers are presented by whether the provider offered CAT. Comparisons of selected characteristics of patients discharged from hospice are presented by whether they received care from a provider that offered CAT, and whether they received a CAT service. Methods-Estimates are based on data from the 2007 National Home and Hospice Care Survey (NHHCS), conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics. Results-In 2007, 41.8% of hospice care providers offered CAT services, had a CAT provider on staff or under contract, or both. Among hospice care providers offering CAT, over one-half offered massage (71.7%), supportive group therapy (69.0%), music therapy (62.2%), pet therapy (58.6%), or guided imagery or relaxation (52.7%). Of the hospice care providers that offered CAT, 21.5% had at least one discharged hospice patient who received CAT during hospice care. Overall, 4.9% of all discharged hospice patients received at least one CAT from the hospice care provider. Over one-half of discharged patients (56.5%) received care from a provider that offered CAT, and of those, 8.6% received at least one CAT from the hospice care provider during their stays. There were no differences in demographics, health, functional status, or admission diagnoses between patients discharged from hospice either by whether they received care from a provider that offered CAT or whether they received CAT.
Pillay, Brindha; Wootten, Addie C; Crowe, Helen; Corcoran, Niall; Tran, Ben; Bowden, Patrick; Crowe, Jane; Costello, Anthony J
Conducting regular multidisciplinary team (MDT) meetings requires significant investment of time and finances. It is thus important to assess the empirical benefits of such practice. A systematic review was conducted to evaluate the literature regarding the impact of MDT meetings on patient assessment, management and outcomes in oncology settings. Relevant studies were identified by searching OVID MEDLINE, PsycINFO, and EMBASE databases from 1995 to April 2015, using the keywords: multidisciplinary team meeting* OR multidisciplinary discussion* OR multidisciplinary conference* OR case review meeting* OR multidisciplinary care forum* OR multidisciplinary tumour board* OR case conference* OR case discussion* AND oncology OR cancer. Studies were included if they assessed measurable outcomes, and used a comparison group and/or a pre- and post-test design. Twenty-seven articles met inclusion criteria. There was limited evidence for improved survival outcomes of patients discussed at MDT meetings. Between 4% and 45% of patients discussed at MDT meetings experienced changes in diagnostic reports following the meeting. Patients discussed at MDT meetings were more likely to receive more accurate and complete pre-operative staging, and neo-adjuvant/adjuvant treatment. Quality of studies was affected by selection bias and the use of historical cohorts impacted study quality. MDT meetings impact upon patient assessment and management practices. However, there was little evidence indicating that MDT meetings resulted in improvements in clinical outcomes. Future research should assess the impact of MDT meetings on patient satisfaction and quality of life, as well as, rates of cross-referral between disciplines. Copyright © 2015 Elsevier Ltd. All rights reserved.
Morement, Helen; Harrison, Rachel; Taylor-Robinson, Simon D
The multidisciplinary team (MDT) meeting has become the hallmark for cancer care in the UK. While standardizing care through adherence to guidelines, the MDT process can make the decision-making process somewhat remote from the patient perspective. The Cholangiocarcinoma Charity (AMMF) is the UK's only cholangiocarcinoma charity and is at the forefront of patient empowerment for those with this condition and for their families. It provides much needed support not only via personal contact but also through its website and on the social media platforms, Facebook and Twitter. AMMF conducted a survey of patient attitudes to and experience of the MDT process through a simple questionnaire posted on Facebook in 2014. We report the results of the responses received, which we believe are worthy of further thought. In the main, while treatment decisions are not queried, there is distress at the lack of involvement, the lack of representation, the lack of communication and at not knowing who to approach for answers to questions. This snapshot, although small, provides some insight to clinicians not to forget the constituency they serve, as communication is all important.
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.
The modern hospice movement emerged in the late 1960s largely as a reaction to the way in which death and dying were dealt with in the hospital building. From the early development of the hospice movement, setting was considered to be very important. Hospice buildings were more residential and "homely" than their hospital counterparts. However, with the widespread development of "hospice home-care" programmes in the 1980s, this emphasis on place and setting changed, and along with it the meaning of the term "hospice" has changed. The current claim of the hospice movement is that "hospice" is a philosophy of care not a building or place.Home is now widely considered to be the best place to die, a place of familiar surroundings and the company of family and friends. The modern preference to die at home relies on traditional models of home, family and community. Dying at home was at one time commonplace and envisioned within the design of the home, and caring was a normal expectation of key family members. In modern society, however, dying is generally not a considered function within the design brief of the home and families may be unable, through economic, geographical or other reasons, to be carers. Thus, for some, home may not be the best place to die and family may not be the best carer. As a result, many people, despite their preference for home, still end up dying in the hospital building. This paper discusses the spatial issues surrounding the concept of home as hospice and questions the universal suitability of the contemporary home as a hospice.
Vangrieken, Katrien; Dochy, Filip; Raes, Elisabeth
This study aimed to investigate team learning in the context of teacher teams in higher vocational education. As teacher teams often do not meet all criteria included in theoretical team definitions, the construct "team entitativity" was introduced. Defined as the degree to which a group of individuals possesses the quality of being a…
Poulsen, Mikkel; Knudstrup, Mary-Ann; Hoff, Peter
and the promotion of wellbeing are key elements in a children’s hospice, and since the relatives are deeply affected by the pa- tient’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 patients and relatives can...... control furnishings, light, and climate, the users have personal control over the environment and can create a tempo- rary home. Creating a stable environment for the relatives and patients alike benefits the well-being of all users. In conclusion, the architecture of a children’s hospice must facilitate...
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.
Sirriyeh, Reema; Armitage, Gerry; Lawton, Rebecca; Gardner, Peter
This study explores the experiences of health professionals in managerial roles at various levels in child and adult hospice care in northern England, studying perspectives around managing medical error, the issues that arise, and the challenges faced. A multicentred, descriptive, exploratory design was adopted. The sample comprised 10 hospice managers (five deputy and five senior managers) from four hospices (two adult and two children's) in the north of England. Participants took part in individual semi-structured interviews, which lasted between 45-60 minutes each. Interviews were transcribed and analysed by a team of three researchers, including two health psychologists and one nurse using a qualitative analytic framework. Emerging themes appeared to be inter-related and were ultimately linked to two meta-concepts; underpinning and fundamental to the data, these issues were intrinsically tied to all emerging themes. Primary themes were defined by their explanatory power and regularity. Primary themes highlighted the impact of managing error on management teams at a professional and personal level, the challenges for error management in hospice settings, the use of error management tools, and the conceptualization of blame in these settings. The strong influence of the health-care setting in which an error takes place on the outcomes of an error event for the health professional, managers, health-care organizations, and ultimately patients was evident.
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.
Woitha, K; Schneider, N; Wünsch, A; Wiese, B; Fimm, S; Müller-Mundt, G
Palliative care is an approach that improves the quality of life of patients with incurable and progressive illnesses; therefore, in these situations physiotherapy can play an important role. This study was carried out to examine the integration and utilization of physiotherapy in palliative and hospice care services in Germany. A cross-sectional survey including all palliative care units, specialized outpatient palliative care teams and hospices in Germany (n = 680) in 2013 was carried out. The response rate was 43.5 % (n = 296). Physiotherapy is predominantly applied in palliative care units (79 %) but rarely in hospices (38 %) and outpatient palliative care teams (30 %). A structured physiotherapeutic assessment is rarely carried out even on palliative care units (26 %). Positive effects of physiotherapy are especially described for symptoms, such as edema, pain, constipation and dyspnea. Despite its significant potential to relieve symptoms, physiotherapy is not systematically integrated into palliative care practice in Germany.
Teno, Joan M; Bowman, Jason; Plotzke, Michael; Gozalo, Pedro L; Christian, Thomas; Miller, Susan C; Williams, Cindy; Mor, Vincent
Little is known about how hospice live discharges vary by hospice providers' tax status and chain affiliation. To characterize hospices with high rates of problematic patterns of live discharges. Three hospice-level patterns of live discharges were defined as problematic when the facility rate was at the 90th percentile or higher. A hospice with a high rate of patients discharged, hospitalized, and readmitted to hospice was considered to have a problematic live discharge pattern, which we have referred to as burdensome transition. The two other problematic live discharge patterns examined were live discharge in the first seven days of a hospice stay and live discharge after 180 days in hospice. A multivariate logistic model examined variation in the hospice-level rate of each discharge pattern by the hospice's chain affiliation and profit status. This model also adjusted for facility rates of medical diagnoses, nonwhite patients, average age, and the state in which the hospice program is located. In 2010, 3028 hospice programs had 996,208 discharges, with 18.0% being alive. Each proposed problematic pattern of live discharge varied by chain affiliation. For-profit providers without a chain affiliation had a higher rate of burdensome transitions than did for-profit providers in national chains (18.2% vs. 12.1%, P live discharges are higher among for-profit providers, especially those not affiliated with a hospice chain. Copyright © 2015 American Academy of Hospice and Palliative Medicine. All rights reserved.
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...
Dealing with a death in the family is always difficult. Hospice professionals can ease some of the burden by learning about each family's particular religious and cultural beliefs, ensuring that everyone's emotional and cultural needs are addressed.
... care? • How long has the hospice been in business? • How often will a nurse or social worker ... the service follows rules for patient safety and quality. Go to Quality Check ® at www. qualitycheck. org ...
Snapp, Janet; Kelley, Debra; Gutgsell, Terence L
Implementing a Pharmacy and Therapeutics Committee (P&T) as a management strategy for Hospice of the Bluegrass in Lexington, Kentucky, has proven to be effective in reducing costs and improving patient outcomes. Early efforts of the committee yielded the establishment of protocols and guidelines, educational programs, pharmacy newsletters for nurses, and patient education material. In the spring of 2000, Hospice of the Bluegrass developed a preferred drug list (PDL) consisting of the medications it considered essential for effective pain and symptom control. The addition of a clinical pharmacist and a P&T committee has resulted in significant cost savings and improved pharmacotherapeutic care for patients of Hospice of the Bluegrass. This model is an option for any hospice looking to achieve the same outcomes.
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Walsh, Simon L F; Wells, Athol U; Desai, Sujal R; Poletti, Venerino; Piciucchi, Sara; Dubini, Alessandra; Nunes, Hilario; Valeyre, Dominique; Brillet, Pierre Y; Kambouchner, Marianne; Morais, António; Pereira, José M; Moura, Conceição Souto; Grutters, Jan C; van den Heuvel, Daniel A; van Es, Hendrik W; van Oosterhout, Matthijs F; Seldenrijk, Cornelis A; Bendstrup, Elisabeth; Rasmussen, Finn; Madsen, Line B; Gooptu, Bibek; Pomplun, Sabine; Taniguchi, Hiroyuki; Fukuoka, Junya; Johkoh, Takeshi; Nicholson, Andrew G; Sayer, Charlie; Edmunds, Lilian; Jacob, Joseph; Kokosi, Maria A; Myers, Jeffrey L; Flaherty, Kevin R; Hansell, David M
Diffuse parenchymal lung disease represents a diverse and challenging group of pulmonary disorders. A consistent diagnostic approach to diffuse parenchymal lung disease is crucial if clinical trial data are to be applied to individual patients. We aimed to evaluate inter-multidisciplinary team agreement for the diagnosis of diffuse parenchymal lung disease. We did a multicentre evaluation of clinical data of patients who presented to the interstitial lung disease unit of the Royal Brompton and Harefield NHS Foundation Trust (London, UK; host institution) and required multidisciplinary team meeting (MDTM) characterisation between March 1, 2010, and Aug 31, 2010. Only patients whose baseline clinical, radiological, and, if biopsy was taken, pathological data were undertaken at the host institution were included. Seven MDTMs, consisting of at least one clinician, radiologist, and pathologist, from seven countries (Denmark, France, Italy, Japan, Netherlands, Portugal, and the UK) evaluated cases of diffuse parenchymal lung disease in a two-stage process between Jan 1, and Oct 15, 2015. First, the clinician, radiologist, and pathologist (if lung biopsy was completed) independently evaluated each case, selected up to five differential diagnoses from a choice of diffuse lung diseases, and chose likelihoods (censored at 5% and summing to 100% in each case) for each of their differential diagnoses, without inter-disciplinary consultation. Second, these specialists convened at an MDTM and reviewed all data, selected up to five differential diagnoses, and chose diagnosis likelihoods. We compared inter-observer and inter-MDTM agreements on patient first-choice diagnoses using Cohen's kappa coefficient (κ). We then estimated inter-observer and inter-MDTM agreement on the probability of diagnosis using weighted kappa coefficient (κw). We compared inter-observer and inter-MDTM confidence of patient first-choice diagnosis. Finally, we evaluated the prognostic significance of a
v AJ: The bachelor thesis deals with feeding of seniors in hospice. The aim of the thesis is to investigate the nutritional state of seniors in hospice, their dietary habits, and their satisfaction with feeding. The importance of nutrition, the main components of diet (proteins, saccharides, lipids, vitamins, minerals, and trace elements), examinational methods of nutritional state, and dietary system is emphasized in the theoretical part of the thesis. Further, the trophotherapy and the meth...
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. © The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org.
Corcoran, Amy M; True, Gala; Charles, Natasha; Margo, Katherine L
Since the Association of American Medical Colleges geriatric competencies were released, educators are striving to incorporate them into medical student curricula. The purpose of this study is to examine medical students' reflections after an interdisciplinary, hospice staff-precepted clinical experience, and whether these reflections relate to the geriatric competencies which focus on palliative care. From July 2010 to June 2011, 155 2nd- and 3rd-year medical students participated in a required, half-day hospice experience, with 120 (77%) submitting narrative reflections for analysis. The narratives were analyzed using the constant comparative method associated with grounded theory, followed by consensus-building in an iterative process, to identify themes. Six themes were identified from the analysis of student narratives: demonstrating a new or expanded knowledge of hospice care (79%, 95/120), developing new insights about self and others (74%, 89/120), changing attitudes toward hospice care (63%, 76/120), linking patient needs with appropriate team members (43%, 52/120), understanding patient goals of care (43%, 51/120), and discussing palliative care as a treatment option (27%, 32/120). The authors conclude that a brief, interdisciplinary, hospice staff-precepted clinical experience is an effective model to inspire medical students to reflect on geriatric palliative care. Students clearly reflected on the geriatric palliative care competencies of symptom assessment and management, and gained insight into the role of the hospice team members and how hospice care can be a positive treatment option. Future educators should think about building on this type of high impact learning experience, and developing items to measure application of knowledge gained.
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.
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.
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.
Full Text Available Abstract Background While most people faced with a terminal illness would prefer to die at home, less than a third in England are enabled to do so with many dying in National Health Service hospitals. Patients are more likely to die at home if their carers receive professional support. Hospice rapid response teams, which provide specialist palliative care at home on a 24/7 on-call basis, are proposed as an effective way to help terminally ill patients die in their preferred place, usually at home. However, the effectiveness of rapid response teams has not been rigorously evaluated in terms of patient, carer and cost outcomes. Methods/Design The study is a pragmatic quasi-experimental controlled trial. The primary outcome for the quantitative evaluation for patients is dying in their preferred place of death. Carers’ quality of life will be evaluated using postal questionnaires sent at patient intake to the hospice service and eight months later. Carers’ perceptions of care received and the patient’s death will be assessed in one to one interviews at 6 to 8 months post bereavement. Service utilisation costs including the rapid response intervention will be compared to those of usual care. Discussion The study will contribute to the development of the evidence base on outcomes for patients and carers and costs of hospice rapid response teams operating in the community. Trial registration: Current controlled trials ISRCTN32119670.
Park, K S; Yeom, H A
While the need for hospice care is increasing in Korea, there is limited research describing the way hospice care is understood by hospital ward nurses who may have relatively limited opportunities for hospice education in their workplace. This study aimed to describe Korean nurses' attitudes towards hospice care and to examine the relationships between nurses' attitudes towards hospice care and their demographic and work-related characteristics. This was a cross-sectional descriptive study. A total of 348 registered nurses recruited from six general hospitals were surveyed using a structured questionnaire. Measurements included general and work-related characteristics and the Frommelt Attitude Toward Care of the Dying Scale. The mean score for nurses' attitudes towards hospice care was 2.52 out of a maximum of 3.0. More positive attitudes towards hospice care were associated with older age, married status, a higher level of education, working at a hospice unit, a higher job position, more years of work experience, having previous experience caring for dying patients and having received education in hospice care. Factors predicting nurses' attitudes towards hospice care included the number of years of work experience and working at a hospice unit in a hospital, with an explanatory power of 22%. The study was conducted in tertiary care hospitals in Seoul metropolitan area; results may therefore differ in other geographical regions. Education on hospice care should be targeted to less experienced, younger staff nurses who have no previous education on hospice care or have not worked in a hospice unit. Tertiary hospitals need to provide more opportunities for their nurses to obtain continuing education on hospice care or increase the number of courses available at the institutional level in order to enhance their nurses' attitudes towards hospice care. © 2014 International Council of Nurses.
Washington, Karla T.; Pike, Kenneth C.; Demiris, George; Oliver, Debra Parker
Purpose The purpose of this study was to describe the unique characteristics of informal hospice cancer caregiving. Methods Researchers conducted a secondary analysis of data drawn from a randomized clinical trial of an informal hospice caregiving intervention (N=348). Demographic characteristics and measures of the informal caregiving experience of hospice patients and their informal caregivers were compared based on the patient’s diagnosis using chi-square tests for association of categorical variables and t tests for continuous variables. Results Informal caregivers of cancer patients differed from their non-cancer counterparts in a number of respects including patient age, caregiver age, patient residence, relationship between patient and caregiver, amount and duration of care provided, likelihood to incur out-of-pocket expenses related to patient care, caregiver problem-solving style, and impact on caregiver daily schedule. There were no statistically significant differences between cancer and non-cancer caregivers in terms of gender, race, employment status, anxiety, and quality of life. Conclusions While cancer and non-cancer caregivers are similar in many respects, a number of unique features characterize the informal hospice cancer caregiving experience. Attention to these unique features will allow hospice providers to tailor supportive care interventions to better address cancer caregivers’ needs. PMID:25547480
HCS, Inc., Potomac, MD.
This publication contains a curriculum to prepare nurses for delivery of hospice care for the terminally ill. It provides training manuals for both participant and facilitator in a preservice or inservice Hospice Education Program. Each manual (participant and facilitator) includes nine modules: (1) Hospice Care Concept; (2) Communication Skills;…
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,…
van der Haar, Selma; Koeslag-Kreunen, Mieke; Euwe, Eline; Segers, Mien
Due to their crucial and highly consequential task, it is of utmost importance to understand the levers leading to effectiveness of multidisciplinary emergency management command-and-control (EMCC) teams. We argue that the formal EMCC team leader needs to initiate structure in the team meetings to support organizing the work as well as facilitate team learning, especially the team learning process of constructive conflict. In a sample of 17 EMCC teams performing a realistic EMCC exercise, including one or two team meetings (28 in sum), we coded the team leader's verbal structuring behaviors (1,704 events), rated constructive conflict by external experts, and rated team effectiveness by field experts. Results show that leaders of effective teams use structuring behaviors more often (except asking procedural questions) but decreasingly over time. They support constructive conflict by clarifying and by making summaries that conclude in a command or decision in a decreasing frequency over time.
Fairman, Nathan; Montross Thomas, Lori P.; Whitmore, Stephanie; Meier, Emily A.
Abstract Background: Patient suicides can affect clinicians both personally and professionally, with frequent reports of psychological and behavioral changes occurring in response to this type of patient death. Although hospice clinicians have regular exposure to dying patients, the impact of patient suicide on this group has been understudied. Objectives: This study examined the personal and professional impact of patient suicides among hospice clinical staff, the coping strategies used by this group, and their recommendations for staff support after a patient suicide. Design: Utilizing an online survey, 186 hospice staff qualitatively described the impact of patient suicides on them as people and professionals, their resulting coping strategies, and any recommendations for supporting others. Three study investigators coded all of the staff responses at a paragraph level and summarized the most common emergent themes using grounded theory procedures. Setting/Subjects: One hundred eighty-six clinical staff members who worked in an academic nonprofit hospice setting. Measurements: An open-ended, qualitative survey was used to gather data about demographics, clinical experience, exposure to known or suspected suicides, recommendations for support in the event of a patient suicide, the personal and professional impacts of suicide, and coping strategies. Results: The themes expressed by the hospice staff in reaction to patient suicides included: psychological responses such as feelings of guilt and self-doubt, changes in professional attitudes, and changes in clinical practice such as greater sensitivity to signs of suicide. When coping with a patient suicide, hospice staff described the use of team-based support strategies, debriefings, and personal spiritual practices. Recommendations for future support included facilitated debriefings, individual counseling, spiritual practices, leaves of absence, self-care activities, and educational interventions. Conclusion: Data
17 April 2008 - Head of Internal Audit Network meeting visiting the ATLAS experimental area with CERN ATLAS Team Leader P. Fassnacht, ATLAS Technical Coordinator M. Nessi and ATLAS Resources Manager M. Nordberg.
17 April 2008 - Head of Internal Audit Network meeting visiting the ATLAS experimental area with CERN ATLAS Team Leader P. Fassnacht, ATLAS Technical Coordinator M. Nessi and ATLAS Resources Manager M. Nordberg.
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.
Shin, Jennifer; Casarett, David
Hospice programs provide comprehensive, compassionate care to dying patients and their families. However, many patients do not enroll in hospice, and those who do generally receive hospice care only in the last weeks of life. Although patients and families rely on their physicians to discuss hospice, there is often inadequate communication between patients and physicians about end-of-life issues. We describe a Six-Step Roadmap for navigating discussions about hospice adapted from the SPIKES protocol for delivering bad news: setting up the discussion, assessing the patient's perception, inviting a patient to discuss individual goals and needs, sharing knowledge, empathizing with the patient's emotions, and summarizing and strategizing the next steps.
Dillon, Ellis C
Little is known about how patient and family engagement manifests in home hospice care. This qualitative study included interviews and observation of home hospice care with 18 patients, 11 caregivers, and 26 hospice workers in the United States. Structural factors (e.g., home setting, ample time, personal relationships), hospice worker strategies (e.g., patient education and presenting choices), and family member support facilitated engagement. Barriers to engagement included difficult relationships and unavailable or unwilling family members. Home hospice care demonstrates potential strategies for continuous, informed, and holistic engagement. These engagement strategies may translate to other arenas of health care.
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
At the invitation of the Regional Research laboratory, Hyderabad, the Academy held its 53rd. Annual Meeting at RRl from Saturday 7 November to Monday 9 November 1987. The meeting began with the inaugural function in the RRl Auditorium at 0930 hours on Saturday 7. November. Dr A V Rama Rao, Director, RRL,.
for the creation of a special thanatology team called "The Care Team". This interdisciplinary team consisting of volunteer physicians, nurses, social...the status quo, (2) establish a fully operational hospice, or (3) establish a thanatology team that is specifically designed to help dying patients... Thanatology Team To some the status quo is not acceptable, yet at the same time establishing a fully operational hospice at Walter Reed Army Medical Center
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.
Cooper, Lesley; Gray, Helen; Adam, Joan; Brown, Duncan; McLaughlin, Patricia; Watson, Julie
Over the past 20 years, visiting policies within adult care settings have progressed from strictly enforced times to more flexible arrangements. The Scottish Commission for the Regulation of Care (SCRC, 2003) advocates open visiting in hospices, which allows access at all times of day. However, little research has been carried out to investigate the assumption that an 'open visiting' policy in a hospice benefits patients and carers and improves the quality of care. This article describes the first strand of a qualitative exploratory study designed to evaluate the impact that open visiting has on patients and the multidisciplinary team in a hospice. A purposive sample of ten inpatients was interviewed. Data were analysed thematically. Patients acknowledged the benefits of contact with family and friends, such as maintaining links with the outside world and improvement in mood. However, they also reported that visitors could be intrusive and, depending on the nature of the relationship, were not always sensitive to cues that the patient was tiring or in pain. Patients indicated a need for more control of visiting arrangements, particularly related to timing, visitor numbers and restrictions on who could visit. These data will contribute to the second strand of the study which involves interviewing multidisciplinary team members.
Casarett, David J; Harrold, Joan; Oldanie, Betty; Prince-Paul, MaryJo; Teno, Joan
There is very little high-quality evidence to guide clinical practice in hospice care. In the areas of medical therapy, patient-centered and family-centered outcomes, and patient safety, there are numerous high-impact questions for which answers are needed. Although randomized controlled trials are the gold standard for research, such trials are difficult, time consuming, and expensive to conduct in a hospice population. Moreover, they cannot examine the implementation of therapies in real-world settings. Therefore, there is a need for novel, complementary approaches to research in this unique population. This article describes the initial experience of the Coalition of Hospices Organized to Investigate Comparative Effectiveness (CHOICE). CHOICE is a national network of hospices that use electronic health record-based data collection procedures to answer key questions relevant to clinical care and policy. By using a rich source of existing data to conduct observational studies, CHOICE is able to overcome many of the most significant challenges of randomized controlled trials in hospice. However, this approach also created unique challenges related to governance and privacy concerns. CHOICE is a growing research network that has the potential to make a contribution to the science of palliative care in a hospice population.
Connor, Stephen R; Gwyther, Elizabeth
The Worldwide Hospice Palliative Care Alliance (WHPCA) is an international non-governmental organization registered as a charity in England and Wales that was established in 2008 following a series of international gatherings that highlighted the important need for palliative care to be included in global policy and health planning. The vision of the WHPCA is a world with universal access to hospice and palliative care. Its mission is to foster, promote and influence the delivery of affordable, quality palliative care. This article describes the evolution of the WHPCA and what it has been able to accomplish in the eight years since its formation. These accomplishments include effective advocacy with United Nations bodies, acceptance as a non-governmental organization in official relations with the World Health Organization and the UN Economic and Social Council, publication of many position papers on critical aspects of palliative care, publication of the Global Atlas of Palliative Care at the End of Life, development of toolkits for palliative care development, publication of the international edition of ehospice, and management of World Hospice and Palliative Care Day each year. Some of the many challenges to the growth and development of palliative care globally are described along with future plans. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
Gable, Robert A.; Manning, M. Lee
Discusses interdisciplinary team collaboration for teachers, including structuring a successful team meeting, the 10-step interdisciplinary problem-solving meeting, evaluation of team collaboration, and effective team communication. (SR)
Edelstein, Michael; Wallensten, Anders; Zetterqvist, Inga; Hulth, Anette
Norovirus outbreaks severely disrupt healthcare systems. We evaluated whether Websök, an internet-based surveillance system using search engine data, improved norovirus surveillance and response in Sweden. We compared Websök users' characteristics with the general population, cross-correlated weekly Websök searches with laboratory notifications between 2006 and 2013, compared the time Websök and laboratory data crossed the epidemic threshold and surveyed infection control teams about their perception and use of Websök. Users of Websök were not representative of the general population. Websök correlated with laboratory data (b = 0.88-0.89) and gave an earlier signal to the onset of the norovirus season compared with laboratory-based surveillance. 17/21 (81%) infection control teams answered the survey, of which 11 (65%) believed Websök could help with infection control plans. Websök is a low-resource, easily replicable system that detects the norovirus season as reliably as laboratory data, but earlier. Using Websök in routine surveillance can help infection control teams prepare for the yearly norovirus season. PMID:24955857
Edelstein, Michael; Wallensten, Anders; Zetterqvist, Inga; Hulth, Anette
Norovirus outbreaks severely disrupt healthcare systems. We evaluated whether Websök, an internet-based surveillance system using search engine data, improved norovirus surveillance and response in Sweden. We compared Websök users' characteristics with the general population, cross-correlated weekly Websök searches with laboratory notifications between 2006 and 2013, compared the time Websök and laboratory data crossed the epidemic threshold and surveyed infection control teams about their perception and use of Websök. Users of Websök were not representative of the general population. Websök correlated with laboratory data (b = 0.88-0.89) and gave an earlier signal to the onset of the norovirus season compared with laboratory-based surveillance. 17/21 (81%) infection control teams answered the survey, of which 11 (65%) believed Websök could help with infection control plans. Websök is a low-resource, easily replicable system that detects the norovirus season as reliably as laboratory data, but earlier. Using Websök in routine surveillance can help infection control teams prepare for the yearly norovirus season.
Collins, Michael W; Kontos, Anthony P; Okonkwo, David O; Almquist, Jon; Bailes, Julian; Barisa, Mark; Bazarian, Jeffrey; Bloom, O Josh; Brody, David L; Cantu, Robert; Cardenas, Javier; Clugston, Jay; Cohen, Randall; Echemendia, Ruben; Elbin, R J; Ellenbogen, Richard; Fonseca, Janna; Gioia, Gerard; Guskiewicz, Kevin; Heyer, Robert; Hotz, Gillian; Iverson, Grant L; Jordan, Barry; Manley, Geoffrey; Maroon, Joseph; McAllister, Thomas; McCrea, Michael; Mucha, Anne; Pieroth, Elizabeth; Podell, Kenneth; Pombo, Matthew; Shetty, Teena; Sills, Allen; Solomon, Gary; Thomas, Danny G; Valovich McLeod, Tamara C; Yates, Tony; Zafonte, Ross
Conventional management for concussion involves prescribed rest and progressive return to activity. Recent evidence challenges this notion and suggests that active approaches may be effective for some patients. Previous concussion consensus statements provide limited guidance regarding active treatment. To describe the current landscape of treatment for concussion and to provide summary agreements related to treatment to assist clinicians in the treatment of concussion. On October 14 to 16, 2015, the Targeted Evaluation and Active Management (TEAM) Approaches to Treating Concussion meeting was convened in Pittsburgh, Pennsylvania. Thirty-seven concussion experts from neuropsychology, neurology, neurosurgery, sports medicine, physical medicine and rehabilitation, physical therapy, athletic training, and research and 12 individuals representing sport, military, and public health organizations attended the meeting. The 37 experts indicated their agreement on a series of statements using an audience response system clicker device. A total of 16 statements of agreement were supported covering (1) Summary of the Current Approach to Treating Concussion, (2) Heterogeneity and Evolving Clinical Profiles of Concussion, (3) TEAM Approach to Concussion Treatment: Specific Strategies, and (4) Future Directions: A Call to Research. Support (ie, response of agree or somewhat agree) for the statements ranged from to 97% to 100%. Concussions are characterized by diverse symptoms and impairments and evolving clinical profiles; recovery varies on the basis of modifying factors, injury severity, and treatments. Active and targeted treatments may enhance recovery after concussion. Research is needed on concussion clinical profiles, biomarkers, and the effectiveness and timing of treatments. ARS, audience response systemCDC, Centers for Disease Control and PreventionDoD, Department of DefensemTBI, mild traumatic brain injuryNCAA, National Collegiate Athletic AssociationNFL, National
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.
Zheng, Nan Tracy; Li, Qinghua; Hanson, Laura C; Wessell, Kathryn L; Chong, Natalie; Sherif, Noha; Broyles, Ila H; Frank, Jennifer; Kirk, M Alexis; Schwartz, Carol R; Levitt, Alan F; Rokoske, Franziska
With increasing use of the Medicare hospice benefit, policymakers recognize the need for quality measurement to assure that terminally ill patients receive high-quality care and have the information they need when selecting a hospice. Toward these goals, Centers for Medicare & Medicaid Services has been collecting standardized patient-level quality data via the Hospice Item Set (HIS) since July 1, 2014. This article presents a first look at the national hospice HIS quality data. We calculated seven quality measures using the HIS data. These measures are endorsed by the National Quality Forum and focus on important care processes hospice providers are required to perform at admission, including discussion of patient preferences regarding life-sustaining treatments, care for spiritual and existential concerns, and symptom management (pain, opioid-induced constipation, and dyspnea). Our sample included 1,218,786 hospice patients discharged from 3922 hospices from October 1, 2014 to September 30, 2015. More than 90% of patients received screenings and assessments captured by six of the seven quality measures. The only exception was pain assessment, for which the national mean score was 78.2%. A small number of hospices (156, 4.0%) had perfect scores for all seven quality measures. Most hospices conduct critical assessments and discuss treatment preferences with patients at admission, although few hospices have perfect scores. Copyright © 2017. Published by Elsevier Inc.
Tsalatsanis, Athanasios; Barnes, Laura E; Hozo, Iztok; Djulbegovic, Benjamin
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...
... provide coverage for hospice care under Part A. See Tax Equity and Fiscal Responsibility Act of 1982...-hospice's cap determinations in future cap years. See, e.g., Los Angeles Haven Hospice, Inc. v. Leavitt...
The Business Meeting of Fellows was held in the Space Applications Centre Auditorium late in the evening on 8 November. There were brief talks by P K Kaw on .... specifically the "Antarctic Ozone. Hole" are well-known. Another recent development relates to the Greenhouse Effect and the Global Warming phenomenon.
This article, Part 2 of a 2-part series, continues the examination of the Medicare compliance climate and its impact on hospice providers. This 2nd part focuses on hospice-specific compliance risk areas and specific risk-reduction strategies. The case example from Part 1 is continued.
Walker, Andreas; Breitsameter, Christof
The present article considers conflicts and conflict regulation in hospices. The authors carried out a qualitative study in three hospices in North Rhine-Westphalia, Germany, to explore how conflicts arise and how conflict regulation proceeds. Hospice nurses should act according to a set of ethical codes, to mission statements of the institution and to professional standards of care. In practice the subjective interpretations of codes and/or models concerning questions of care are causes of c...
Hofmarcher, Maria M.; Röhrling, Gerald; Riedel, Monika
In 2000 the idea of a Family Hospice Sabbatical was generated to further unburden the public health care sector facilitating family care for dying relatives or severely ill children at home. Austrian employees would have three options: uncompensated reduction of work time, change of work time or uncompensated sabbatical. The care giver can take care of spouses, partners, parents, grant parents, children, step children, foster kids, siblings and step parents.
Walton, Henry; Munro, Wendy
Handover is a "major preventable cause of patient harm" and this project aims to improve the quality of night handover within a teaching hospitals general medicine department, resulting in the safe transfer of patient care to the night team. Quality of handover was assessed both qualitatively, via structured qualitative interviews with trainees and a baseline survey assessing doctor's opinions of night handover, and quantitatively through the collection of a data set during regular observation of night handover. The initial intervention instituted a new handover meeting with a set time and new location and invited the night nurse practitioner to attend. A prompt card, standardised documentation, defined leadership, and an attendance register were also introduced. Successive PDSA cycles introduced technology to the intervention, enabled the nurse night practitioners to actually attend and re-branded the prompt card as an agenda. Results show a sustained reduction in length of handover from 70 minutes (n=7) to 34 minutes (n=13) post-intervention as well as a reduction in the number of distractions occurring during each handover from a mean of 14 to a mean of 8.5. An improved quality of handover was also demonstrated with an overall increase in the percentage of task handovers containing hospital number, an admitting diagnosis, comorbidities and a time allocated for the task to be performed of at least 10%. When trainees were surveyed post-implementation they unanimously identified the new handover system as safer than the previous handover process (n=30). This project demonstrates that replacing an ad-hoc system of handover with a multi-disciplinary, team based approach to handover improves handover quality. In addition it provides a useful guide to introducing a new handover meeting to a department and contains useful lessons on how to combat cultural barriers to change within a department.
Jacoby, Liva H; Beehler, Connie J; Balint, John A
Medical educators agree that training in end-of-life care (EOLC) must be an integral part of medical education at all levels. While progress in this area of education has taken place, many gaps still exist. This article describes the self-reported impact of a required one-week hospice rotation for third-year medical students. Students completing their hospice rotation during a one-year period were asked to write an essay describing the most important lessons they learned. Qualitative analyses of the essays revealed 10 core themes and generated a coding schema for detailed analysis. Students' essays reflected knowledge gained, emotional reactions, cognitive insights, and relationship-centered skills. Comments focused on the following themes: benefits and philosophy of hospice; impact on future practice; interdisciplinary team approach; management of pain and suffering; facts about hospice; personal impact; communication with patients and families; dedication and skill of staff; role of families; and value of home care. Students consistently recognized the significance of positive role models. Learning about a new field of medicine helped broaden students' knowledge, skills, and beliefs, and expanded their assumptions about illness and suffering, the role of health care professionals, and the goals of medicine. Reflection and writing brought about self-awareness of the learning process itself. The study demonstrates that a robust clinical EOLC exposure can be effectively incorporated into undergraduate education and that student self-reports constitute a valuable mode of evaluation. Longitudinal assessments of trainees' competencies in EOLC are needed to optimize these educational endeavors.
Bliss, Julie; While, Alison E
General practitioners and district nurses have a long history of providing care outside the hospital setting. With health care increasingly moving out of the hospital setting, there are more opportunities for general practitioners and district nurses to work together to meet the health needs of the local population. However, the reduction in qualiﬁed specialist practitioner district nurses over the last decade is concerning. The need for an effective district nursing service has been recognised by the Department of Health in their own model - the nature of district nursing work, often over a long period, enables relationships to develop with the patient, family and informal carers as a basis for anticipatory care to manage long-term conditions. Communication and understanding of the role are central to enhance effective working between general practitioners and district nurses, which can be fostered by engagement in community-oriented integrated care and case management.
Waquet, Arnaud; Vincent, Joris
The First World War is traditionally considered in history as a temporary halt for cultural and sporting activities. If the Olympic Games and the Tour de France were actually cancelled, football and rugby were in fact stimulated by the circumstances of war. Indeed, the gathering of allied nations behind the Western Front emerged as the main factor in the development of these two sports. Reading the sporting press and military archives shows that international sporting exchanges were stimulated during the Great War. To be specific, France benefited from the golden opportunity provided by the presence of the masters of the game to strengthen its practices and affirm its status as a sporting nation. Inter-allied sporting exchanges were primarily characterised by informal encounters between military selections. Then, following the recognition of these sports by the military authorities, the number of exchanges increased. At the end of 1917, the official status acquired by sport within the military forces created the conditions for the structuring of the French sporting elite. From that point, we can witness the birth of the first French military rugby and football teams, as they demonstrate, through their good performances during the demobilisation period, the progressive build-up of the international dimension of French sport during the war years.
Collins, Michael W.; Kontos, Anthony P.; Okonkwo, David O.; Almquist, Jon; Bailes, Julian; Barisa, Mark; Bazarian, Jeffrey; Bloom, O. Josh; Brody, David; Cantu, Robert; Cardenas, Javier; Clugston, Jay; Cohen, Randall; Echemendia, Ruben; Elbin, R.J.; Ellenbogen, Richard; Fonseca, Janna; Gioia, Gerard; Guskiewicz, Kevin; Heyer, Robert; Hotz, Gillian; Iverson, Grant L.; Jordan, Barry; Manley, Geoffrey; Maroon, Joseph; McAllister, Thomas; McCrea, Michael; Mucha, Anne; Pieroth, Elizabeth; Podell, Kenneth; Pombo, Matthew; Shetty, Teena; Sills, Allen; Solomon, Gary; Thomas, Danny G.; Valovich McLeod, Tamara C.; Yates, Tony; Zafonte, Ross
Background Conventional management for concussion involves prescribed rest and progressive return to activity. Recent evidence challenges this notion and suggests that active approaches may be effective for some patients. Previous concussion consensus statements provide limited guidance regarding active treatment. Objective To describe the current landscape of treatment for concussion and provide summary agreements related to treatment in order to assist clinicians in the treatment of concussion. Methods On October 14–16, 2015, the Targeted Evaluation & Active Management (TEAM) Approaches To Treating Concussion meeting was convened in Pittsburgh, Pennsylvania, USA. 37 concussion experts from neuropsychology, neurology, neurosurgery, sports medicine, physical medicine and rehabilitation, physical therapy, athletic training, and research, and 12 individuals representing sport, military, and public health organizations attended the meeting. The 37 experts indicated their agreement on a series of statements using an audience response system clicker device. Results A total of 16 statements of agreement were supported covering: 1) Summary of the Current Approach to Treating Concussion, 2) Heterogeneity and Evolving Clinical Profiles of Concussion, 3) Targeted Evaluation and Active Management Approach to Concussion Treatment: Specific Strategies, and 4) Future Directions: A Call to Research. Support (ie, response of agree or somewhat agree) for the statements ranged from to 97–100%. Conclusion Concussions are characterized by diverse symptoms and impairments and evolving clinical profiles; recovery varies based on modifying factors, injury severity, and treatments. Active and targeted treatments may enhance recovery following concussion. Research is needed on concussion clinical profiles, biomarkers, and the effectiveness and timing of treatments. PMID:27741219
Wilson, Janet; Steers, Julie; Steele, Kath; Turner, James; Tinker, Alison
Background: Hospices and other palliative and end-of-life care providers are now required to develop services that aim to improve the quality of end-of-life care and choice in terms of place of care and death for those living with or dying from a life-threatening illness. In 2010, an NHS clinical commissioning group in South Yorkshire, UK, produced a strategic plan that aimed to improve the quality and choice of end-of-life care locally. To that end, it established a project team to review th...
Johnson, Kimberly S; Kuchibhatla, Maragatha; Tulsky, James A
Previous research suggests that lack of knowledge of hospice is a barrier to the use of hospice care by African Americans. However, there is little data examining racial differences in exposure to hospice information. Examine racial differences in self-reported exposure to hospice information and determine how this exposure impacts beliefs about hospice care. We surveyed 200 community-dwelling older adults (65 or older). We used Spearman's correlations to examine the relationship between responses to individual items on the Hospice Beliefs and Attitudes Scale (HBAS) and self-reported exposure to hospice information (never heard of hospice, heard a little, or heard a lot). We used multivariate analyses to examine predictors of exposure to hospice information and beliefs about hospice care (total score on HBAS). Compared to whites (n = 95), African Americans (n = 105) reported significantly less exposure to hospice information (p = 0.0004). Nineteen percent of African Americans and 4% of whites had never heard of hospice; 47.6% of African Americans and 71.6% of whites had heard a lot about hospice. In multivariate analysis controlling for demographics and health status, African Americans had a two times higher odds of reporting that they had never heard of hospice or heard only a little about hospice versus heard a lot about hospice (odds ratio [OR] = 2.24 [1.17, 4.27]. Greater exposure to hospice information was associated with more favorable beliefs about hospice care (outcome: total score on HBAS; parameter estimate 1.34, standard error 0.44, p = 002). African Americans reported less exposure to information about hospice than whites. Greater exposure to hospice information was associated with more favorable beliefs about some aspects of hospice care. Because knowledge is power, educational programs targeting older African Americans are needed to dispel myths about hospice and to provide minorities with the tools to make informed choices about end-of-life care.
Pediatric palliative care and pediatric hospice care (PPC-PHC) are often essential aspects of medical care for patients who have life-threatening conditions or need end-of-life care. PPC-PHC aims to relieve suffering, improve quality of life, facilitate informed decision-making, and assist in care coordination between clinicians and across sites of care. Core commitments of PPC-PHC include being patient centered and family engaged; respecting and partnering with patients and families; pursuing care that is high quality, readily accessible, and equitable; providing care across the age spectrum and life span, integrated into the continuum of care; ensuring that all clinicians can provide basic palliative care and consult PPC-PHC specialists in a timely manner; and improving care through research and quality improvement efforts. PPC-PHC guidelines and recommendations include ensuring that all large health care organizations serving children with life-threatening conditions have dedicated interdisciplinary PPC-PHC teams, which should develop collaborative relationships between hospital- and community-based teams; that PPC-PHC be provided as integrated multimodal care and practiced as a cornerstone of patient safety and quality for patients with life-threatening conditions; that PPC-PHC teams should facilitate clear, compassionate, and forthright discussions about medical issues and the goals of care and support families, siblings, and health care staff; that PPC-PHC be part of all pediatric education and training curricula, be an active area of research and quality improvement, and exemplify the highest ethical standards; and that PPC-PHC services be supported by financial and regulatory arrangements to ensure access to high-quality PPC-PHC by all patients with life-threatening and life-shortening diseases. Copyright © 2013 by the American Academy of Pediatrics.
... do not want, thus decreasing health care costs and increasing quality. However, delivery of high-quality hospice and palliative care cannot take place without sufficient number of health professionals with appropriate training and skills. The rapid expansion of hospice and palliative care programs over the past two to three decades has tak...
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. ... 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 ...
Harris, Pamela S; Stalam, Tapati; Ache, Kevin A; Harrold, Joan E; Craig, Teresa; Teno, Joan; Smither, Eugenia; Dougherty, Meredith; Casarett, David
To determine whether it is possible to predict, at the time of hospice enrollment, which patients will die within 6 months. Electronic health record-based retrospective cohort study. Patients admitted to 10 hospices in the CHOICE network (Coalition of Hospices Organized to Investigate Comparative Effectiveness). Hospice patients. Mortality at 6 months following hospice admission. Among 126,620 patients admitted to 10 hospices, 118,532 (93.6%) died within 6 months. In a multivariable logistic regression model, five characteristics were independent predictors of 6-month mortality. For instance, patients younger than 65 years were less likely to die within 6 months (odds ratio [OR] 0.64; 95% confidence interval [CI] 0.45-0.91; p=0.014). Conversely, male patients were more likely to die within 6 months (OR 1.47; 95% CI 1.05-2.02; p=;0.036). After adjusting for other variables in this model, there were several subgroups with a low probability of 6-month probability (e.g., stroke and Palliative Performance Scale [PPS] score=50; adjusted probability of 6-month mortality=39.4%; 95% CI: 13.9%-72.5%). However, 95% confidence intervals of these 6-month mortality predictions extended above 50%. Hospices might use several variables to identify patients with a relatively low risk for 6-month mortality and who therefore may become ineligible to continue hospice services if they fail to show significant disease progression.
...) The discharge planning process must include planning for any necessary family counseling, patient education, or other services before the patient is discharged because he or she is no longer terminally ill. ... from hospice care. (a) Reasons for discharge. A hospice may discharge a patient if— (1) The patient...
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.
Gotay, Carolyn Cook
There is little research documenting the psychosocial support needs of hospice patients and their families. To assess hospice patients' and families' use of and perceptions of need for support, 77 patients and their families were interviewed during home care for terminal illness (Group 1), and 50 family members (84% spouses) were interviewed 1…
Honore, Russel L; Boslego, David V
The Provincial Reconstruction Team (PRT) training mission completed by First U.S. Army in April 2006 was a joint Service effort to meet a requirement from the combatant commander to support goals in Afghanistan...
Andersson, Kjell [ed.] [Karinta-Konsult, Taeby (Sweden)
The meeting addressed the question how it is possible to make decision processes and risk assessment for deep repository development more transparent. The two dominant decision approaches used in Sweden and the UK, review/decide(r/d) and inquiry/decide(i/d), were discussed. The main conclusions from group discussions were: It was acknowledged that the concept of transparency includes three equally important aspects: factual issues, value issues, and stake holder`s authenticity. There is a need in both countries to bring in the best aspects of both the r/d and the i/d approaches. Both approaches seem to offer possibilities and suffer limitations with respect to the segregation of facts, uncertainties and value judgements, and some sort of combination of the two may present a valuable development. However, neither the i/d nor the r/d approach seems to provide a good framework for clarification of the value issue. Experts have dominated the decision process in both countries. There is a need for a more genuine consultation process. The Swedish EIA is evolving in this direction. The regulator should take part in the process, also at an early stage. It is important that the integrity of the regulator is maintained. Rules and responsibilities of implementers, regulators, planning authorities and other decision-makers should be established early in the process. The public should know that they have access to a process that clarifies value judgements, facts, uncertainties and questions. It is necessary for the public to know what the technical issues are, and to have the means to evaluate the authenticity of the experts. It is important that political decisions are not taken without due consideration of scientific and technical arguments. There are factors beside safety assessments which are completely legitimate to consider. An approach with intense interaction between politicians, experts and the public is needed.
Ache, Kevin; Harrold, Joan; Harris, Pamela; Dougherty, Meredith; Casarett, David
To describe individuals with advance directives at the time of hospice enrollment and to determine whether they have patterns of care and outcomes that are different from those of individuals without advance directives. Electronic health record-based retrospective cohort study with propensity score-adjusted analysis. Three hospice programs in the United States. Individuals admitted to hospice between January 1, 2008, and May 15, 2012 (N = 49,370). Timing of hospice enrollment before death, rates of voluntary withdrawal from hospice, and site of death. Most participants (35,968, 73%) had advance directives at the time of hospice enrollment. These participants were enrolled in hospice longer (median 29 vs 15 days) and had longer survival times before death (adjusted hazard ratio = 0.62; 95% confidence interval (CI) 0.58-0.66; P < .001). They were less likely to die within the first week after hospice enrollment (24.3% vs 33.2%; adjusted odds ratio (aOR) = 0.83, 95% CI = 0.78-0.88; P < .001). Participants with advance directives were less likely to leave hospice voluntarily (2.2% vs 3.4%; aOR = 0.82, 95% CI = 0.74-0.90; P = .003) and more likely to die at home or in a nursing home than in an inpatient unit (15.3% vs 25.8%; aOR = 0.82, 95% CI = 0.77-0.87; P < .001). Participants with advance directives were enrolled in hospice for a longer period of time before death than those without and were more likely to die in the setting of their choice. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.
Barnette Donnelly, Cassandra; Armstrong, Karen Andrea; Perkins, Molly M; Moulia, Danielle; Quest, Tammie E; Yancey, Arthur H
Growing numbers of emergency medical services (EMS) providers respond to patients who receive hospice care. The objective of this investigation was to assess the knowledge, attitudes, and experiences of EMS providers in the care of patients enrolled in hospice care. We conducted a survey study of EMS providers regarding hospice care. We collected quantitative and qualitative data on EMS provider's knowledge, attitudes, and experiences in responding to the care needs of patients in hospice care. We used Chi-squared tests to compare EMS provider's responses by credential (Emergency Medical Technician [EMT] vs. Paramedic) and years of experience (0-5 vs. 5+). We conducted a thematic analysis to examine open-ended responses to qualitative questions. Of the 182 EMS providers who completed the survey (100% response rate), 84.1% had cared for a hospice patient one or more times. Respondents included 86 (47.3%) EMTs with Intermediate and Advanced training and 96 (52.7%) Paramedics. Respondent's years of experience ranged from 0-10+ years, with 99 (54.3%) providers having 0-5 years of experience and 83 (45.7%) providers having 5+ years of experience. There were no significant differences between EMTs and Paramedics in their knowledge of the care of these patients, nor were there significant differences (p education on the care of hospice patients. A total of 36% respondents felt that patients in hospice care required a DNR order. In EMS providers' open-ended responses on challenges in responding to the care needs of hospice patients, common themes were family-related challenges, and the need for more education. While the majority of EMS providers have responded to patients enrolled in hospice care, few providers received formal training on how to care for this population. EMS providers have expressed a need for a formal curriculum on the care of the patient receiving hospice.
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.
Cobbe, Sinead; Kennedy, Norelee
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. The study design consisted of a retrospective chart audit over 6 months. The study took place at a specialist palliative care inpatient unit (hospice) in Limerick, Ireland. All patients were discharged (through death or discharge onwards) from January to June 2010. The Edmonton Functional Assessment Tool (EFAT-2) was used as an outcome measure. 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. 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.
Mendieta, Maximiliano; Buckingham, Robert W
By starting to understand Muslim culture, we can seek common ground with Islamic culture within the American experience and bridge opportunities for better palliative and hospice care here and in Middle Eastern countries. The United States, Canada, and Europe are education hubs for Middle Eastern students, creating an opportunity for the palliative and hospice care philosophy to gain access by proxy to populations of terminally ill patients who can benefit from end-of-life care. The aim was to assess the state of research and knowledge about palliative and hospice care within the context of Muslim culture and religion. Within the guide of the key search terms, we learned that at a glance, over 100 articles meet the search criteria, but after a closer inspection, only a portion actually contributed knowledge to the literature. This confirmed the need for research in this vein. More importantly, we posit that once the layers of culture, religion, norms, and nationality are removed, human beings share a kinship based on family, spirituality, death and dying, and fear of pain. This is evident when we compare the Middle Eastern end-of-life experience with the western end-of-life care. A true opportunity to make a lasting impact at the patient level exists for palliative and hospice care researchers if we seek to understand, gain knowledge, and respect Muslim culture and Islamic issues at the end of life.
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.
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
Teno, Joan M; Shu, Janet E; Casarett, David; Spence, Carol; Rhodes, Ramona; Connor, Stephen
Previous research has noted that many persons are referred to hospice in the last days of life. The National Hospice and Palliative Care Organization collaborated with Brown Medical School to create the Family Evaluation of Hospice Care (FEHC) data repository. In 2005, 106,514 surveys from 631 hospices were submitted with complete data on the hospice length of stay and bereaved family member perceptions of the timing of hospice care. Of these surveys, 11.4% of family members believed that they were referred "too late" to hospice. This varied from 0 to 28.1% among the participating hospice programs with 30 or more surveys. Among those with hospice lengths of stay of less than a month, only 16.2% reported they were referred "too late." Although the bereaved family member perceptions of the quality of end-of-life care did not vary by length of stay for each of the FEHC domains, the perception of being referred "too late" was associated with more unmet needs, higher reported concerns, and lower satisfaction. Our results suggest that family members' perception of the timing of hospice referral-not the length of stay-is associated with the quality of hospice care. This perception varies substantially among the participating hospice programs. Future research is needed to understand this variation and how hospice programs are delivering high quality of care despite short length of stay.
Kirby, Eric G
As a result of a drastic increase in new patients, two major shifts are occurring in the US hospice care industry: an increase in the number of for-profit providers, and hospices are increasing in size through acquisitions and mergers. Hospices are trying to both increase the number of innovative programs they offer and decrease their operating expenses to improve their margins and attract more patients. This study seeks to investigate if strategic groups exist within the industry as hospices try to become more innovative and efficient, which grouping factors are most significant, and to determine whether there is a relationship between group membership and performance. Cluster analysis and ANOVA are used to analyze data from 93 California hospices. Three strategic groups exist within the market, innovative practices significantly affect group membership, and innovation-oriented groups outperform others in terms of quality of care. Many hospices focus on innovation, and evidence suggests that continued pursuit of innovative practices is critical, whereas efficiency does not appear to have a significant impact on quality of care. Focus on such evidence-based practices is important for long-term success. This is the first study to investigate strategic group formation in the hospice care industry.
Bakanic, Von; Singleton, Margaret; Dickinson, George E
The purpose of this study was to gauge the attitudes of internal medicine (IM) physicians and hospice nurses on the hospice programs in a Southeastern US county. A postal survey sought views on the following issues: (1) the level of control that hospice affords dying patients; (2) health care professionals' education and communication involving the dying process; (3) the hospice referral process; (4) characteristics of a "good death"; and (5) gender versus professional role regarding hospice attitudes. The data revealed that occupational role in hospice care has a more significant function in the development of cognitive attitudes than of gender regarding hospice programs and that professional education needs more emphasis on the study of end-of-life issues, as well as open communication between health care professionals and patients during the dying process. Physicians were less likely than nurses to agree that patient control was important. Additionally, what constitutes a good death was similar to previous studies. © The Author(s) 2014.
Gerry, Edwina M
A clinical audit was developed and conducted at St Gemma's Hospice, Leeds, to provide evidence of the standard of privacy and dignity afforded to patients in the wards and Day Hospice. It involved setting standards from key documents and including patients, carers, and staff in developing questionnaires. The questionnaires were administered to 30 patients and 130 members of the multidisciplinary team. The response rates were 91% (patients) and 78% (staff). Evaluation of the questionnaires showed that 70% of patients rated their satisfaction with privacy and dignity as 'excellent', with the remaining 30% rating it 'very good'. For the most part, the ratings of staff and patients were in agreement and indicated achievement of the expected standard. However, some areas of concern were identified, including providing opportunity for hand washing prior to meals, closer monitoring of visitor numbers, avoiding interruption to staff, and maintaining privacy during conversations with staff. Disseminating the results of the audit resulted in some important discussions in the clinical teams and the formulation of an action plan to address the concerns.
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.
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.
Full Text Available Mary Ellen Purkis1, Elizabeth Borycki1,2, Craig Kuziemsky3, Fraser Black4, Denise Cloutier-Fisher5, Lee Ann Fox6, Patricia MacKenzie7, Ann Syme1,8, Coby Tschanz1,41School of Nursing, 2School of Health Information Science, University of Victoria, Victoria, British Columbia; 3Telfer School of Management, University of Ottawa, Ottawa, Ontario; 4Victoria Hospice Society, Victoria, British Columbia; 5Department of Geography, University of Victoria, Victoria, British Columbia; 6Kingston General Hospital, Kingston, Ontario; 7School of Social Work, University of Victoria, Victoria, British Columbia; 8British Columbia Cancer Agency, Vancouver Island Centre, Victoria, British Columbia, CanadaBackground: Each year more than 240,000 Canadians die from terminal and chronic illnesses. It is estimated that 62% of those deaths require palliative care. Palliative care is a specialized domain of health professional team practice that requires discipline-specific knowledge, skills, judgment, and expertise in order to address patient hopes, wishes, symptoms, and suffering. With the emergence of palliative care as a specialized area of interdisciplinary practice, new practice models have also emerged, eg, the Latimer ethical decision-making model for palliative care. The purpose of this research was to undertake a descriptive ethnographic field study of palliative care team practices to understand better the interdisciplinary team communication and the issues that arise when members of different health professions work together as a team.Methods: Study data were collected by observing and videotaping palliative care team meetings. Data were then analyzed using direct content analysis.Results: The study findings substantiated many of the team practice concepts outlined in Latimer's model. Palliative care teams engage in a number of processes that address patient symptoms, suffering, hopes, and plans. However, several new findings also emerged from the data that were
De Lima, Liliana; Radbruch, Lukas
The International Association for Hospice and Palliative Care (IAHPC) is a membership-based organization dedicated to the development and improvement of hospice and palliative care worldwide. The mission of IAHPC is to improve the quality of life of adults and children with life-threatening conditions and their families. The vision of IAHPC is universal access to high-quality palliative care, integrated into all levels of health care systems in a continuum of care with disease prevention, early diagnosis, and treatment, to assure that any patient's or family caregiver's suffering is relieved to the greatest extent possible. IAHPC focuses on the advancement of four areas of palliative care: education, access to medicines, health policies, and service implementation. IAHPC works on three levels: at the grass roots, developing resources, and educational strategies that enable health workers to provide cost-effective palliative care; at the national level, working with government representatives to improve national policies to ensure adequate care and access to medicines; and at the international level, advocating with the UN organizations to ensure that access to palliative care and to essential medicines for palliative care and pain treatment is stipulated and incorporated as an obligation of member states. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
... Committee Meeting, Health Fair, VAVS Representative and Deputy training, and the opening awards dinner... mechanics of social media, women's health, hospice and family volunteering. ] On April 29, the educational...
Shega, Joseph W; Ellner, Lynn; Lau, Denys T; Maxwell, Terri L
Cholinesterase inhibitors and N-methyl-D-aspartic acid (NMDA) receptor antagonists are Food and Drug Administration (FDA) approved for the treatment of moderate to severe Alzheimer's disease. As dementia progresses to the end stage and patients become hospice-eligible, clinicians consider whether or not to continue these therapies without the benefit of scientific evidence. We sought to describe hospice medical directors practice patterns and experiences in the use and discontinuation of cholinesterase inhibitors and NMDA receptor antagonists in hospice patients that meet the Medicare hospice criteria for dementia. Mail survey of hospice medical directors from a random sample from the National Hospice and Palliative Care Organization. Of the 413 eligible participants, 152 completed surveys were returned, yielding a response rate of 37%. Of the respondents, 75% and 33% reported that at least 20% of their patients were taking a cholinesterase inhibitor or memantine, respectively, at the time of hospice admission. The majority of respondents do not consider these therapies effective in persons with end-stage dementia, however, a subset believe that these medications improved patient outcomes including stabilization of cognition (22%), decrease in challenging behaviors (28%), and maintenance of patient function (22%) as well as caregiver outcomes namely reduced caregiver burden (20%) and improved caregiver quality of life (20%). While 80% of respondents recommended discontinuing these therapies to families at the time of hospice enrollment, 72% of respondents reported that families experienced difficulty stopping these therapies. A subset of respondents observed accelerated cognitive (30%) and functional decline (26%) or emergence of challenging behaviors (32%) with medication discontinuation. The findings from this survey indicate that cholinesterase inhibitors and/or NMDA receptor antagonists are prescribed for a subset of patients with advanced dementia and that a
Poulsen, Mikkel; Knudstrup, Mary-Ann; Hoff, Peter
connection to nature. The architecture utilises nature as a palliative element. Sensory stimulation for the patients is achieved through nature, lights, window placement, senso- ry gardens, and materiality. Functions are placed according to privacy and proximity to one another. A home-like atmosphere...... the integrated design approach to sustaina- ble architecture (Knudstrup, 2004) in an architectural Master’s thesis project. The architecture should aid and facilitate palliative treatment for the patients, while relatives and staff also benefit from the healing architecture. The hos- pice is designed...... on the foundations of accessibility requirements, the theory of healing (Frandsen et al., 2011) and palliative architecture (REHPA, 2016), as well as experiences from “Lukashuset”. The hospice is to be placed in Hammer Bakker, allowing the building to have a calm and natural environment that provides a closer...
Johnson, Kimberly S; Elbert-Avila, Katja; Kuchibhatla, Maragatha; Tulsky, James A
To examine the characteristics of hospice enrollees with dementia who were discharged alive because their condition stabilized or improved and predictors of death in the year after discharge. Cross-sectional analysis of clinical and administrative data. For-profit hospice provider. Hospice enrollees aged 65 and older with an admission diagnosis of dementia who died or were discharged alive because their condition stabilized or improved between January 1, 1999, and December 31, 2003. Demographic variables and hospice length of stay; data did not include functional status or comorbidities. Of 24,111 enrollees with dementia, 1,204 (5.0%) were discharged alive because their condition stabilized or improved; the remainder died while receiving hospice. The median length of stay for those who died was 12 versus 236 days for those discharged alive. Those discharged alive were more likely to be female or have a length of stay exceeding 180 days and less likely to be in the oldest age group (≥ 85), be African American, or reside in a nursing home. In a subgroup of 303 patients discharged alive, 75.5% were still alive at 1 year; none of the demographic variables were associated with death after hospice discharge. A small proportion of hospice enrollees with dementia was discharged alive. Most died shortly after enrollment. Future research should examine other factors that may predict which hospice enrollees with dementia are likely to be discharged alive and their subsequent trajectory, such as functional status, comorbidities, and preferences for care. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.
O'Connor, Nina R; Dougherty, Meredith; Harris, Pamela S; Casarett, David J
Textbooks report that patients with ESRD survive for 7-10 days after discontinuation of dialysis. Studies describing actual survival are limited, however, and research has not defined patient characteristics that may be associated with longer or shorter survival times. The goals of this study were to determine the mean life expectancy of patients admitted to hospice after discontinuation of dialysis, and to identify independent predictors of survival time. Data for demographics, clinical characteristics, and survival were obtained from 10 hospices for patients with ESRD who discontinued dialysis before hospice admission. Data were collected for patients admitted between January 1, 2008 and May 15, 2012. All hospices were members of the Coalition of Hospices Organized to Investigate Comparative Effectiveness network, which obtains de-identified data from an electronic medical record. Of 1947 patients who discontinued dialysis, the mean survival after hospice enrollment was 7.4 days (range, 0-40 days). Patients who discontinued dialysis had significantly shorter survival compared with other patients (n=124,673) with nonrenal hospice diagnoses (mean survival 54.4 days; hazard ratio, 2.96; 95% confidence interval, 2.82 to 3.09; P<0.001). A Cox proportional hazards model identified seven independent predictors of earlier mortality after dialysis discontinuation, including male sex, referral from a hospital, lower functional status (Palliative Performance Scale score), and the presence of peripheral edema. Patients who discontinue dialysis have significantly shorter survival than other hospice patients. Individual survival time varies greatly, but several variables can be used to predict survival and tailor a patient's care plan based on estimated prognosis.
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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.
Enguidanos, Susan; Yonashiro-Cho, Jeanine; Cote, Sarah
Despite dramatic increases in hospice enrollment, ethnic disparities persist. With rapidly growing populations of Asian Americans, research is needed to elucidate factors that contribute to hospice underenrollment in subgroups of Asian populations. The purpose of this study was to explore older Chinese Americans' knowledge, understanding, and perceptions of hospice care. Three focus groups were conducted, one each in English, Mandarin, and Cantonese, all recruited from a Chinese social service agency. Focus groups were audiotaped and transcribed and then coded for themes. Thirty-four Chinese Americans participated in the groups, all but one reporting primary language other than English. Themes included lack of knowledge, death timing, burden (financial, emotional, physical toward family or government), peaceful death (relief of suffering), and quality of care (and its influence on perception of best care location). Findings indicate the need for hospice education and outreach to Chinese Americans. Additionally, to address concerns about burden and death in the home, efforts to improve access to hospice facilities are needed. Findings from this study provide direction for healthcare providers to address potential barriers to increasing access to hospice of Chinese Americans. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.
Boucher, Nathan A; Nix, Harvey
Patients with advanced or terminal illness, especially racial and ethnic minorities, would benefit from greater access to hospice and palliative care. Expanding the PA role in these areas would help fill gaps in both access and patients' understanding of what hospice and palliative care can offer. This article describes why hospice and palliative care are needed, what PAs can and do offer hospice and palliative care delivery, and what challenges should be overcome to expand PA practice in hospice and palliative care. The article also reviews the legislative outlook for PA practice in hospice care.
Jack, Barbara A; Baldry, Catherine R; Groves, Karen E; Whelan, Alison; Sephton, Janice; Gaunt, Kathryn
To explore health care professionals' perspective of hospice at home service that has different components, individually tailored to meet the needs of patients. Over 50% of adults diagnosed with a terminal illness and the majority of people who have cancer, prefer to be cared for and to die in their own home. Despite this, most deaths occur in hospital. Increasing the options available for patients, including their place of care and death is central to current UK policy initiatives. Hospice at home services aim to support patients to remain at home, yet there are wide variations in the design of services and delivery. A hospice at home service was developed to provide various components (accompanied transfer home, crisis intervention and hospice aides) that could be tailored to meet the individual needs of patients. An evaluation study. Data were collected from 75 health care professionals. District nurses participated in one focus group (13) and 31 completed an electronic survey. Palliative care specialist nurses participated in a focus group (9). One hospital discharge co-ordinator and two general practitioners participated in semi-structured interviews and a further 19 general practitioners completed the electronic survey. Health care professionals reported the impact and value of each of the components of the service, as helping to support patients to remain at home, by individually tailoring care. They also positively reported that support for family carers appeared to enable them to continue coping, rapid access to the service was suggested to contribute to faster hospital discharges and the crisis intervention service was identified as helping patients remain in their own home, where they wanted to be. Health care professionals perceived that the additional individualised support provided by this service contributed to enabling patients to continue be cared for and to die at home in their place of choice. This service offers various components of a hospice
Klick, Jeffrey C; Friebert, Sarah; Hutton, Nancy; Osenga, Kaci; Pituch, Kenneth J; Vesel, Tamara; Weidner, Norbert; Block, Susan D; Morrison, Laura J
In 2006, hospice and palliative medicine (HPM) became an officially recognized subspecialty. This designation helped initiate the Accreditation Council of Graduate Medical Education Outcomes Project in HPM. As part of this process, a group of expert clinician-educators in HPM defined the initial competency-based outcomes for HPM fellows (General HPM Competencies). Concurrently, these experts recognized and acknowledged that additional expertise in pediatric HPM would ensure that the competencies for pediatric HPM were optimally represented. To fill this gap, a group of pediatric HPM experts used a product development method to define specific Pediatric HPM Competencies. This article describes the development process. With the ongoing evolution of HPM, these competencies will evolve. As part of the Next Accreditation System, the Accreditation Council of Graduate Medical Education uses milestones as a framework to better define competency-based, measurable outcomes for trainees. Currently, there are no milestones specific to HPM, although the field is designing curricular milestones with multispecialty involvement, including pediatrics. These competencies are the conceptual framework for the pediatric content in the HPM milestones. They are specific to the pediatric HPM subspecialist and should be integrated into the training of pediatric HPM subspecialists. They will serve a foundational role in HPM and should inform a wide range of emerging innovations, including the next evolution of HPM Competencies, development of HPM curricular milestones, and training of adult HPM and other pediatric subspecialists. They may also inform pediatric HPM outcome measures, as well as standards of practice and performance for pediatric HPM interdisciplinary teams. Copyright © 2014 by the American Academy of Pediatrics.
Dy, Sydney Morss; Kiley, Kasey B; Ast, Katherine; Lupu, Dale; Norton, Sally A; McMillan, Susan C; Herr, Keela; Rotella, Joseph D; Casarett, David J
Measuring quality of hospice and palliative care is critical for evaluating and improving care, but no standard U.S. quality indicator set exists. The Measuring What Matters (MWM) project aimed to recommend a concise portfolio of valid, clinically relevant, cross-cutting indicators for internal measurement of hospice and palliative care. The MWM process was a sequential consensus project of the American Academy of Hospice and Palliative Medicine (AAHPM) and Hospice and Palliative Nurses Association (HPNA). We identified candidate indicators mapped to National Consensus Project (NCP) Palliative Care Guidelines domains. We narrowed the list through a modified Delphi rating process by a Technical Advisory Panel and Clinical User Panel and ratings from AAHPM and HPNA membership and key organizations. We narrowed the initial 75 indicators to a final list of 10. These include one in the NCP domain Structure and Process (Comprehensive Assessment), three in Physical Aspects (Screening for Physical Symptoms, Pain Treatment, and Dyspnea Screening and Management), one in Psychological and Psychiatric Aspects (Discussion of Emotional or Psychological Needs), one in Spiritual and Existential Aspects (Discussion of Spiritual/Religious Concerns), and three in Ethical and Legal Aspects (Documentation of Surrogate, Treatment Preferences, and Care Consistency with Documented Care Preferences). The list also recommends a global indicator of patient/family perceptions of care, but does not endorse a specific survey instrument. This consensus set of hospice and palliative care quality indicators is a foundation for standard, valid internal quality measurement for U.S. Further development will assemble implementation tools for quality measurement and benchmarking. Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
Aeling, Jennifer Annette; Chavez, Ernest
The current study sought to understand the differences hospice nurses perceived in caring for older adult patients who utilize hospice for longer and shorter periods, older adult patients' experience of hospice services, and if length of hospice stays influenced the patients' end-of-life experience. Interpretative Phenomenological Analysis was used to extract themes and subthemes from 10 interviews conducted with hospice nursing staff. Four major themes were identified pertaining to nurses perspective on older adults' views of hospice and how length of hospice use impacts end-of-life care. These themes suggest hospice nursing staff believe longer hospice stays are more positive and that older adults identify more positive aspects of hospice when using it for longer periods of time. Results suggest that nurses believe length of use directly impacts patient care and the experience of hospice services. Participating nurses reported that older adults have a lack of information on hospice services. It was suggested that more information is needed and that providing such education may lead to longer hospice stays.
Dingfield, Laura; Bender, Laura; Harris, Pamela; Newport, Kristina; Hoover-Regan, Margo; Feudtner, Chris; Clifford, Sheila; Casarett, David
Most pediatric hospice patients receive services from agencies typically oriented to adults. Information regarding how pediatric hospice patients differ from adult hospice patients is lacking. We aim to assess differences between pediatric and adult hospice patients regarding patient characteristics and outcomes. We compiled a retrospective inception cohort of patients enrolled at nine hospices in the CHOICE network (Coalition of Hospices Organized to Investigate Comparative Effectiveness) between August 1, 2008 and June 30, 2012. Measurements included patient characteristics and outcomes, including discharge from hospice and site of death. Among 126,620 hospice patients, 986 (0.8%) were 18 years of age or younger. Pediatric patients were less likely to have an admitting diagnosis of cancer (odds ratio [OR] 0.62; 95% confidence interval [CI]: 0.54-0.72). Although children were less likely to use oxygen at enrollment (OR 0.31; 95% CI: 0.26-0.37), they were more likely to have an enteral feeding tube (OR 4.04; 95% CI: 3.49-4.67). Pediatric patients were half as likely as adults to have a do-not-resuscitate order (DNR) order upon hospice enrollment (OR 0.52; 95% CI: 0.46-0.59). The average hospice length of stay for pediatric patients was longer than that of adults (103 days versus 66 days, p<0.001). Children were more likely to leave hospice care (OR 2.59; 95% CI: 2.00-3.34), but among patients who died while enrolled in hospice, pediatric patients were more likely to die at home (OR 3.25; 95% CI: 2.27-3.88). Pediatric hospice patients differ from adult patients in their broader range of underlying diagnoses and their use of hospice services.
Dobrina, Raffaella; Tenze, Maja; Palese, Alvisa
Current literature reports that nurses are the members of the health-care team who have the most contact with patients facing a life-threatening illness. The multidisciplinary palliative care approach means that hospice and palliative care nurses require a consistent theoretical foundation in order to be confident of and able to explain their role. The aim of this paper is to describe existing palliative care and hospice nursing models and theories and to identify their core concepts. Literature published between 2002 and 2012 on such models was reviewed and subjected to content analysis. Ten core concepts were identified that fell into three categories: patient, nurse, and therapeutic relationship. The themes and values identified in the end-of-life nursing models and theories are congruent with palliative care best practices based on a patient-centred and an interdisciplinary teamwork approach. In developing a therapeutic relationship with patients, nurses have a 'privileged' experience that may lead to existential growth and job satisfaction.
Belbin, R Meredith Meredith
Meredith Belbin's work on teams has become part of everyday language in organizations all over the world. All kinds of teams and team behaviours are covered. At the end of the book is a self-perception inventory so that readers can match their own personalities to particular team roles. Management Teams is required reading for managers concerned with achieving results by getting the best from their key personnel.
Kozak, Leila E; Kayes, Lucy; McCarty, Rachelle; Walkinshaw, Catharine; Congdon, Sean; Kleinberger, Janis; Hartman, Valerie; Standish, Leanna J
To assess the use of complementary and alternative medicine in hospice care in the state of Washington. Hospices offering inpatient and outpatient care in Washington State were surveyed by phone interview. Response rate was 100%. Results indicated that 86% of Washington State hospices offered complementary and alternative services to their patients, most frequently massage (87%), music therapy (74%), energy healing (65%), aromatherapy (45%), guided imagery (45%), compassionate touch (42%), acupuncture (32%), pet therapy (32%), meditation (29%), art therapy (22%), reflexology (19%), and hypnotherapy (16%). Most hospices relied on volunteers with or without small donations to offer such services. Complementary and alternative therapies are widely used by Washington State hospices but not covered under hospice benefits. Extensive use of these therapies seems to warrant the inclusion of complementary and alternative providers as part of hospice staff, and reimbursement schedules need to be integrated into hospice care.
Chung Yul Lee, RN, PhD
Conclusions: Based on the comparison of three countries, the most interesting thing was that home hospice care accounted for more than 90% of all hospice services in the United States and Taiwan. The results of this study will aid the countries that are in the process of developing a hospice system including Korea, which has been implementing a pilot project only for hospital hospice services.
Marleide da Mota Gomes
Full Text Available The modern Brazilian Neurology was born in the campus of Praia Vermelha, Universidade Federal do Rio de Janeiro (UFRJ. The former National Hospice for the Insane (NHI as well as some of its facilities were fundamental for the teaching about diseases of the nervous system to the students of the UFRJ's Medical School, caring for patients with neurosyphilis and epilepsy, as well as children with neurological impairment. We highlight the role of Juliano Moreira, director of the NHI (1903-1930, and his team, including Antonio Austregésilo Rodrigues Lima, the "father" of the Brazilian Neurology, in the construction of the modern Brazilian Psychiatry and Neurology.
Vivi Gusrini Rahmadani Pohan; Djamaludin Ancok
This research attempted to observe team learning from the level of team diversity and team efficacy of work teams. This research used an individual level of analysis rather than the group level. The team members measured the level of team diversity, team efficacy and team learning of the teams through three scales, namely team learning scale, team diversity scale, and team efficacy scale. Respondents in this research were the active team members in a company, PT. Alkindo Mitraraya. The total ...
Pohan, Vivi Gusrini Rahmadani; Ancok, Djamaludin
This research attempted to observe team learning from the level of team diversity and team efficacy of work teams. This research used an individual level of analysis rather than the group level. The team members measured the level of team diversity, team efficacy and team learning of the teams through three scales, namely team learning scale, team diversity scale, and team efficacy scale. Respondents in this research were the active team members in a company, PT. Alkindo Mitraraya. The total ...
... 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 Medicare...
Lim, Taekyu; Nam, Seung-Hyun; Kim, Mi Sun; Yoon, Kyung Sook; Kim, Bong-Seog
Hospice care is perceived as enhancing life quality for patients with advanced, incurable illness, but cost comparisons to nonhospice patients are difficult to make. Several studies demonstrated that palliative hospice care reduced medical expenditure in terminally ill patients compared with that of nonhospice care. Patients with terminal cancer who were registered in Hospice Care Program (HCP) by the written consent and died during same admission period in Seoul Veterans Hospital, Seoul, Korea, between January 2009 and December 2009 were included. We compared medical expenditure according to the ward type (hospice ward and general ward) in patients who received palliative hospice care in Seoul Veterans Hospital, Korea. The daily total average expenditure for each inpatient was 193 930 and 266 161 in the hospice and general ward, respectively (P = .001). Daily expenditure of parenteral nutrition and laboratory blood tests/X-ray was also significantly lower in hospice ward compared with general ward (P = .002 and P = .006), respectively; 12 (17%) of 72 patients had been admitted in the intensive care unit during hospice care period in general ward (P = .014); 1 (3%) of 32 patients received blood products in hospice ward, but 13 (18%) patients received blood products in general ward during palliative hospice care (P = .039). Hospice ward type in palliative hospice therapy may contribute to reduce economic medical costs as well as to more specific total care for terminally ill patients with cancer.
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.
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…
Amano, Koji; Morita, Tatsuya; Tatara, Ryohei; Katayama, Hirofumi; Aiki, Sayo; Kitada, Namiki; Fumimoto, Hiromi; Sato, Emi
Our objective was to explore the effectiveness of a palliative care team (PCT) by investigating potential differences in opioid prescription between patients who had had PCT involvement before admission to an inpatient hospice and those who had not. A total of 221 patients met the criteria; they were divided into an intervention group (n = 140) and a control group (n = 81). The daily dose of opioid before admission to the hospice was significantly higher in the intervention group (P < .001). The difference between the maximum opioid dose and the initial dose, the rate of increase in opioids until death, and the length of stay in the hospice were not significantly different between the groups. A PCT contributes to more appropriate use of opioids before admission to a hospice. © The Author(s) 2014.
This project included a literature review and summary that focused on subjects related to team building, team/committee member : motivational strategies, and tools for effective and efficient committee meetings. It also completed an online survey of ...
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 art therapy through visual art appreciation and hands-on creative artwork.
Azami-Aghdash, Saber; Jabbari, Hossein; Bakhshian, Fariba; Shafaei, Leila; Shafaei, Soheyla; Kolahdouzan, Kasra; Mohseni, Mohammad
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. 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. 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. 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.
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.
In June 2015, hospices were described as ‘dingy’ on two popular British television dramas. This spurred a social media protest using the hashtag #notdingy. Images were a central component of the #notdingy campaign, which asserted that hospices are positive places in which to be cared for, in many cases until death. In this essay I analyse both the formal qualities of these images as well as their encoded meanings and symbolism (Pauly 2005). I argue that the value of these kinds of images lies...
The mission of the Hydrogen Storage Technical Team is to accelerate research and innovation that will lead to commercially viable hydrogen-storage technologies that meet the U.S. DRIVE Partnership goals.
The Fuel Cell Technical Team promotes the development of a fuel cell power system for an automotive powertrain that meets the U.S. DRIVE Partnership (United States Driving Research and Innovation for Vehicle efficiency and Energy sustainability) goals.
Walker, Andreas; Breitsameter, Christof
The present article considers conflicts and conflict regulation in hospices. The authors carried out a qualitative study in three hospices in North Rhine-Westphalia, Germany, to explore how conflicts arise and how conflict regulation proceeds. Hospice nurses should act according to a set of ethical codes, to mission statements of the institution and to professional standards of care. In practice the subjective interpretations of codes and/or models concerning questions of care are causes of conflicts among nurses, with doctors, patients and family members. The management has two choices to react to these conflicts. It can either tolerate the conflicts, as long as they do not disturb the daily routine. Or it can increase the degree of organisation by integrating the different viewpoints into its own program and/or by restructuring its organisational units.
Ankuda, Claire K; Fonger, Evan; O'Neil, Thomas
It is unknown how many hospice enrollees elect to be full code and if this is associated with higher hospice live discharge rates. To measure the rates of hospice enrollees electing full code, the characteristics predicting full code status, and the association of full code status with various hospice live discharge patterns. Retrospective cohort study of electronic medical record data. A total of 25,636 decedents enrolled in two Michigan hospices between 2009 and 2014. Code status was defined as full code versus do-not-resuscitate (DNR) orders. Covariates include demographics, location (home, hospice facility, nursing home, and hospital), primary diagnosis, and length of stay. Hospice live discharge was defined as short (0-14 days), medium (15-179 days), and long (>179 days). A total of 12.9% of hospice enrollees elected full code status. This was significantly (p live discharge compared with those with DNR orders (95% confidence interval [CI] 1.44-2.16) and 2.47 times the odds of short live discharge (95% CI 1.69-3.62) with no significant difference in long live discharge. The association of full code orders with hospice live discharge was stronger for nonwhite enrollees, with a live discharge rate of 23.8% versus 11.6% for African Americans with full code versus DNR orders. Those electing full code status on admission to hospice are at high risk of live hospice discharge after short enrollments, particularly nonwhite enrollees.
Lindley, Lisa C
Children with intellectual disability commonly lack access to pediatric hospice care services. Residential care may be a critical component in providing access to hospice care for children with intellectual disability. This research tested whether residential care intensifies the relationship between intellectual disability and hospice utilization (ie, hospice enrollment, hospice length of stay), while controlling for demographic characteristics. Multivariate regression analyses were conducted using 2008 to 2010 California Medicaid claims data. The odds of children with intellectual disability in residential care enrolling in hospice care were 3 times higher than their counterparts in their last year of life, when controlling for demographics. Residential care promoted hospice enrollment among children with intellectual disability. The interaction between intellectual disability and residential care was not related to hospice length of stay. Residential care did not attenuate or intensify the relationship between intellectual disability and hospice length of stay. The findings highlight the important role of residential care in facilitating hospice enrollment for children with intellectual disability. More research is needed to understand the capability of residential care staff to identify children with intellectual disability earlier in their end-of-life trajectory and initiate longer hospice length of stays.
Tse, Chung Sang; Morrison, Laura J; Ellman, Matthew S
Physicians' lack of comfort and skill in communicating about hospice care results in deficits and delays in hospice referrals. Preclinical exposure to hospice may lay a foundation to improve medical students' knowledge and comfort with hospice care. To understand how preclinical medical student (MS)-2s respond both educationally and emotionally to a required hospice care experience (HCE). Accompanied by hospice clinicians, MS-2s spent 3 hours seeing inpatient or home hospice patients followed by a 1-hour debriefing. Students submitted written reflections to e-mailed educational and emotional prompts. Two hundred and two MS-2s from 2 academic cohorts completed the HCE at 1 of 2 hospice sites. Written reflective responses were analyzed qualitatively, where salient themes extracted and responses were coded. Ninety-two students submitted 175 responses to Prompt #1 (educational impact) and 85 students entered 85 responses to prompt #2 (emotional impact) of the HCE. Eleven themes were identified for prompt #1, most frequently focusing on hospice services and goals and hospice providers' attitudes and skills. Prompt #2 elicited a diverse spectrum of emotional responses, spanning positive and negative emotions. Most often, students reported "no specified emotional reaction," "sad/depressed," "difficult /challenging," "heartened/encouraged," and "mixed emotions." In an HCE, preclinical students reported learning core aspects of hospice care and experiencing a broad spectrum of emotional responses. These findings may assist educators in the planning of HCEs for preclinical students, including debriefing sessions with skilled clinicians and opportunities for triggered reflection.
Full Text Available Abstract Background An aging population, rise in chronic illnesses, increase in life expectancy and shift towards care being provided at the community level are trends that are collectively creating an urgency to advance hospice palliative care (HPC planning and provision in Canada. The purpose of this study was to analyze the evolution of HPC in seven provinces in Canada so as to inform such planning and provision elsewhere. We have endeavoured to undertake this research out of awareness that good future planning for health and social care, such as HPC, typically requires us to first look backwards before moving forward. Methods To identify key policy and practice events in HPC in Canada, as well as describe facilitators of and barriers to progress, a qualitative comparative case study design was used. Specifically, the evolution and development of HCP in 7 strategically selected provinces is compared. After choosing the case study provinces, the grey literature was searched to create a preliminary timeline for each that described the evolution of HPC beginning in 1970. Key informants (n = 42 were then interviewed to verify the content of each provincial timeline and to discuss barriers and facilitators to the development of HPC. Upon completion of the primary data collection, a face-to-face meeting of the research team was then held so as to conduct a comparative study analysis that focused on provincial commonalities and differences. Results Findings point to the fact that HPC continues to remain at the margins of the health care system. The development of HPC has encountered structural inheritances that have both sped up progress as well as slowed it down. These structural inheritances are: (1 foundational health policies (e.g., the Canada Health Act; (2 service structures and planning (e.g., the dominance of urban-focused initiatives; and (3 health system decisions (e.g., regionalization. As a response to these inheritances, circumventions
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.
Freund, Katherine; Weckmann, Michelle T; Casarett, David J; Swanson, Kristi; Brooks, Mary Kay; Broderick, Ann
Hospice is a service that patients, families, and physicians find beneficial, yet a majority of patients die without receiving hospice care. Little is known about how many hospitalized patients are hospice eligible at the time of hospitalization. Retrospective chart review was used to examine all adult deaths (n = 688) at a tertiary care center during 2009. Charts were selected for full review if the death was nontraumatic and the patient had a hospital admission within 12 months of the terminal admission. The charts were examined for hospice eligibility based on medical criteria, evidence of a hospice discussion, and hospice enrollment. Two hundred nine patients had an admission in the year preceding the terminal admission and a nontraumatic death. Sixty percent were hospice eligible during the penultimate admission. Hospice discussions were documented in 14% of the hospice-eligible patients. Patients who were hospice eligible had more subspecialty consults on the penultimate admission compared to those not hospice eligible (P = 0.016), as well as more overall hospitalizations in the 12 months preceding their terminal admission (P = 0.0003), and fewer days between their penultimate admission and death (P = 0.001). The majority of terminally ill inpatients did not have a documented discussion of hospice with their care provider. Educating physicians to recognize the stepwise decline of most illnesses and hospice admission criteria will facilitate a more informed decision-making process for patients and their families. A consistent commitment to offer hospice earlier than the terminal admission would increase access to community or home-based care, potentially increasing quality of life. Copyright © 2011 Society of Hospital Medicine.
Olthuis, G.J.; Leget, C.J.W.; Dekkers, W.J.M.
This article discusses the relationship between personal and professional qualities in hospice nurses. We examine the notion of self-esteem in personal and professional identity. The focus is on two questions: (1) what is self-esteem, and how is it related to personal identity and its moral
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…
Quinn-Lee, Lisa; Olson-McBride, Leah; Unterberger, April
Hospice work has been regarded as particularly stressful due to the complexity inherent in the provision of end-of-life care. Burnout and death anxiety are especially relevant to hospice social workers because they regularly function in a high-stress, high-loss environment. The purpose of this study was threefold: to determine the prevalence of burnout and death anxiety among hospice social workers; to examine associations between burnout and death anxiety; and to explore the factors which may contribute to the development of death anxiety and burnout. Participants completed four items: the Maslach Burnout Inventory-Human Services Survey (MBI-HSS), the Death Anxiety Questionnaire (DAQ), a demographic questionnaire, and a set of open-ended questions. Findings indicate that mean scores on the subscales of the MBI-HSS ranged from the low to moderate range and that a strong positive correlation existed between death anxiety and the depersonalization subscale of the MBI. Three key themes emerged from the qualitative data: (a) personal interest in hospice social work developed through a variety of ways; (b) although death anxiety decreased from exposure and understanding of the death process, there was increased death anxiety surrounding working with certain patients; and (c) burnout was primarily related to workload or difficult cases.
Warhuus, Jan; Günzel-Jensen, Franziska; Robinson, Sarah
Questions we care about (Objectives): When students have to work on challenging tasks, as it is often the case in entrepreneurship classrooms that leverage experiential learning, team success becomes central to the students learning. Yet, the formation of teams is often left up to the students....... A rigorous coding and inductive analysis process was undertaken. Pattern and relationship coding were used to reveal underlying factors, which helped to unveil important similarities and differences between student in different teams’ project progress and perception of learning. Results: When students...... functioning entrepreneurial student teams as most teams lack personal chemistry which makes them anchor their work too much in a pre-defined project. In contrast, we find that students that can form their own teams aim for less diverse teams than what is achieved by random assignment. However, the homophily...
Thompson, Britta M; Haidet, Paul; Borges, Nicole J; Carchedi, Lisa R; Roman, Brenda J B; Townsend, Mark H; Butler, Agata P; Swanson, David B; Anderson, Michael P; Levine, Ruth E
The purpose of this study was to explore the relationships among variables associated with teams in team-based learning (TBL) settings and team outcomes. We administered the National Board of Medical Examiners (NBME) Psychiatry Subject Test first to individuals and then to teams of Year three students at four medical schools that used TBL in their psychiatry core clerkships. Team cohesion was analysed using the Team Performance Scale (TPS). Bivariate correlation and linear regression analysis were used to analyse the relationships among team-level variables (mean individual TPS scores for each team, mean individual NBME scores of teams, team size, rotation and gender make-up) and team NBME test scores. A hierarchical linear model was used to test the effects of individual TPS and individual NBME test scores within each team, as well as the effects of the team-level variables of team size, team rotation and gender on team NBME test scores. Individual NBME test and TPS scores were nested within teams and treated as subsampling units. Individual NBME test scores and individual TPS scores were positively and statistically significantly (p team NBME test scores, when team rotation, team size and gender make-up were controlled for. Higher team NBME test scores were associated with teams rotating later in the year and larger teams (p teams at four medical schools suggest that larger teams on later rotations score higher on a team NBME test. Individual NBME test scores and team cohesion were positively and significantly associated with team NBME test scores. These results suggest the need for additional studies focusing on team outcomes, team cohesion, team size, rotation and other factors as they relate to the effective and efficient performance of TBL teams in health science education. © 2015 John Wiley & Sons Ltd.
.... Statement of Need B. Overall Impact 1. Introduction 2. Detailed Economic Analysis 3. Cost Allocation of... compassionate care philosophy and practice for those who are terminally ill. It is a holistic approach to..., access to information, and choice'' (42 CFR 418.3). Palliative care is at the core of hospice philosophy...
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.
Zheng, Nan Tracy; Mukamel, Dana B; Caprio, Thomas V; Temkin-Greener, Helena
Hospice care provided to nursing home (NH) residents has been shown to improve the quality of end-of-life (EOL) care. However, hospice utilization in NHs is typically low. This study examined the relationship between facility self-reported EOL practices and residents' hospice use and length of stay. The study was based on a retrospective cohort of NH residents. Medicare hospice claims, Minimum Data Set, Online Survey, Certification, and Reporting system and the Area Resource File were linked with a survey of directors of nursing (DON) regarding institutional EOL practice patterns (EOLC Survey). In total, 4,540 long-term-care residents who died in 2007 in 290 facilities which participated in the EOLC Survey were included in this study. We measured NHs' tendency to offer hospice to residents and to initiate aggressive treatments (hospital transfers and feeding tubes) for EOL residents based on DON's responses to survey items. Residents' hospice utilization was determined using Medicare hospice claims. The prevalence of hospice use was 18%. The average length of stay was 93 days. After controlling for individual risk factors, facilities' self-reported practice measures associated with residents' likelihood of using hospice were tendency to offer hospice (p = .048) and tendency to hospitalize (p = .002). Residents in NHs reporting higher tendency to hospitalize tended to enroll in hospice closer to death. Residents' hospice utilization is not only associated with individual and facility characteristics but also with NHs' self-reported EOL care practices. Potential interventions to effect greater use of hospice may need to focus on facility-level care processes and practices.
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Home; Journals; Pramana – Journal of Physics. Aditya Team. Articles written in Pramana – Journal of Physics. Volume 55 Issue 5-6 November-December 2000 pp 727-732 Contributed Papers. Tokamak Plasmas : Mirnov coil data analysis for tokamak ADITYA · D Raju R Jha P K Kaw S K Mattoo Y C Saxena Aditya Team.
Bunyan, L. W.
The purpose of this study was to review current developments in team teaching and to assess its potential in the Calgary, Alberta, schools. An investigation into team teaching situations in schools in the eastern half of the United States and Canada revealed characteristics common to successful programs (e.g., charismatic leadership and innovative…
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
Teno, Joan M; Casarett, David; Spence, Carol; Connor, Stephen
Many family members of patients enrolled in hospice for less than seven days state that the hospice referral was made "at the right time." To examine bereaved family members' perceptions of the timing of hospice referral to identify aspects of the referral process that can be improved. Open-ended interviews were conducted in seven hospice programs, interviewing bereaved family members of hospice patients who died within the first week of hospice enrollment. Of the 100 narrative interviews, 99 respondents stated that their family member was either referred "too late" (n=41) or "at the right time" (n=58) to hospice services. When families stated that referral was "at the right time," their perceptions were based on the patient having refused earlier referral (n=8), a rapid decline in the patient's condition resulting in the late referral (n=20), or a belief in all things coming together as they were meant to (n=11). In contrast, when families stated that referral was "too late," their reasons were centered on concerns with the health care providers' role in decision making (n=24), with the leading concerns being inadequate physician communication (n=7), not recognizing the patient as dying (n=11), or problematic hospice delays in referral from the nursing home or home health agency (n=4). Despite the patient refusing an earlier hospice referral, five family members believed the referral was "too late." Whereas family members identified expected concerns with communication, more than one in three stated an earlier hospice referral was not possible. Copyright © 2012 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.
Shaw, Eric K; Ohman-Strickland, Pamela A; Piasecki, Alicja; Hudson, Shawna V; Ferrante, Jeanne M; McDaniel, Reuben R; Nutting, Paul A; Crabtree, Benjamin F
The purpose of this study was to evaluate a primary care practice-based quality improvement (QI) intervention aimed at improving colorectal cancer screening rates. The Supporting Colorectal Cancer Outcomes through Participatory Enhancements (SCOPE) study was a cluster randomized trial of New Jersey primary care practices. On-site facilitation and learning collaboratives were used to engage multiple stakeholders throughout the change process to identify and implement strategies to enhance colorectal cancer screening. Practices were analyzed using quantitative (medical records, surveys) and qualitative data (observations, interviews, and audio recordings) at baseline and a 12-month follow-up. Comparing intervention and control arms of the 23 participating practices did not yield statistically significant improvements in patients' colorectal cancer screening rates. Qualitative analyses provide insights into practices' QI implementation, including associations between how well leaders fostered team development and the extent to which team members felt psychologically safe. Successful QI implementation did not always translate into improved screening rates. Although single-target, incremental QI interventions can be effective, practice transformation requires enhanced organizational learning and change capacities. The SCOPE model of QI may not be an optimal strategy if short-term guideline concordant numerical gains are the goal. Advancing the knowledge base of QI interventions requires future reports to address how and why QI interventions work rather than simply measuring whether they work.
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
This literature review aimed to identify the evidence base for a hospice at home service at the end of life for facilitating death at home to narrow the gap between preference and reality. This study defines ‘hospice at home’ as hospice style care provided in the home environment; this means specialist palliative care, equipment and medication is available 24/7. However, services operating under this term are not uniform across the literature. Terms encountered in the literature that are used...
Dougherty, Meredith; Harris, Pamela S; Teno, Joan; Corcoran, Amy M; Douglas, Cindy; Nelson, Jackie; Way, Deborah; Harrold, Joan E; Casarett, David J
To compare residents of assisted living facilities receiving hospice with people receiving hospice care at home. Electronic health record-based retrospective cohort study. Nonprofit hospices in the Coalition of Hospices Organized to Investigate Comparative Effectiveness network. Individuals admitted to hospice between January 1, 2008, and May 15, 2012 (N = 85,581; 7,451 (8.7%) assisted living facility, 78,130 (91.3%) home). Hospice length of stay, use of opioids for pain, and site of death. The assisted living population was more likely than the home hospice population to have a diagnosis of dementia (23.5% vs 4.7%; odds ratio (OR) = 13.3, 95% confidence interval (CI) = 12.3-14.4; P < .001) and enroll in hospice closer to death (median length of stay 24 vs 29 days). Assisted living residents were less likely to receive opioids for pain (18.1% vs 39.7%; OR = 0.33, 95% CI = 0.29-0.39, P < .001) and less likely to die in an inpatient hospice unit (9.3% vs 16.1%; OR = 0.53, 95% CI = 0.49-0.58, P < .001) or a hospital (1.3% vs 7.6%; OR = 0.16, 95% CI = 0.13-0.19, P < .001). Three are several differences between residents of assisted living receiving hospice care and individuals living at home receiving hospice care. A better understanding of these differences could allow hospices to develop guidelines for better coordination of end-of-life care for the assisted living population. © 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.
Parast, Layla; Elliott, Marc N; Hambarsoomian, Katrin; Teno, Joan; Anhang Price, Rebecca
To examine the effect of mode of survey administration on response rates and response tendencies for the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey and develop appropriate adjustments. Survey response data were obtained after sampling and fielding of the CAHPS Hospice Survey in 2015. Sampled caregivers and decedents were randomized to one of three modes: mail only, telephone only, and mixed mode (mail with telephone follow-up). Linear regression analysis was used to examine the effect of mode on individual responses to questions (6 composite measures and 2 global measures that examine hospice quality). U.S. hospice programs (N = 57). Primary caregivers of individuals who died in hospice (N = 7,349). Outcomes were 8 hospice quality measures (6 composite measures, 2 global measures). Analyses were adjusted for differences in case-mix (e.g., decedent age, payer for hospice care, primary diagnosis, length of final episode of hospice care, respondent age, respondent education, relationship of decedent to caregiver, survey language, and language spoken at home) between hospices. Response rates were 42.6% for those randomized to mail only, 37.9%, for those randomized to telephone only, and 52.6% for those randomized to mixed mode (P mode effects (P mode experiments for hospital CAHPS, hospice primary caregivers tend to respond more negatively by telephone than by mail. Valid comparisons of hospice performance require that reported hospice scores be adjusted for survey mode. © 2018, Copyright the Authors Journal compilation © 2018, The American Geriatrics Society.
Weng, Tzu-Chieh; Yang, Ya-Chun; Chen, Ping-Jen; Kuo, Wen-Fu; Wang, Wei-Lin; Ke, Ya-Ting; Hsu, Chien-Chin; Lin, Kao-Chang; Huang, Chien-Cheng; Lin, Hung-Jung
Abstract Hospice and palliative care has been recognized as an essential part of emergency medicine; however, there is no consensus on the optimal model for the delivery of hospice and palliative care in the emergency department (ED). Therefore, we conducted a novel implementation in a tertiary medical center in Taiwan. In the preintervention period, we recruited a specialist for hospice and palliative medicine in the ED to lead our intervention. In the early stage of the intervention, starti...
Hwang, Deborah; Teno, Joan M; Clark, Melissa; Shield, Renée; Williams, Cindy; Casarett, David; Spence, Carol
Nursing homes (NHs) are increasingly the site of hospice care. High quality of care is dependent on successful NH-hospice collaboration. To examine bereaved family members' perceptions of NH-hospice collaborations in terms of what they believe went well or could have been improved. Focus groups were conducted with bereaved family members from five diverse geographic regions, and included participants from inner city and rural settings, with oversampling of African Americans. A total of 28 participants (14.8% African American, mean age 61.4 years) identified three major aspects of collaboration as important to care delivery. First, most (67.9%) voiced concerns with knowing who (NH or hospice) is responsible for which aspects of patient care. Second, nearly half (42.9%) stated concern about information coordination between the NH and hospice. Finally, 67.9% of the participants mentioned the need for hospice to advocate for high-quality care rather than their having to directly do so on behalf of their family members. The important concerns raised by bereaved family members about NH-hospice collaboration have been incorporated into the revised Family Evaluation of Hospice Care, a post-death survey used to evaluate quality of hospice care. Published by Elsevier Inc.
Lafferty, C L
This article asserts that in light of changing conditions in the healthcare environment, transformational leadership is the most appropriate leadership style for the hospice registered nurse case manager. The author defines transformational leadership and, tracing from early leadership theories, demonstrates how the transformational-transactional leadership paradigm emerged from preceding leadership theories. The components of transformational leadership--transformational behavior and transformational characteristics--are linked to hospice theory and hospice-specific nursing practices. The expanding role of the hospice R.N. case manager is addressed in light of transformational leadership and culture building. Specific actions are proposed in the arenas of research, education, and community, corporate, and legislative involvement.
Kim, Mee-Ok; Lee, Kun-Sei; Kim, Jung-Hoe; Joo, Ji-Soo
It is necessary to develop a proper payment system for more health care facilities to provide hospice and palliative cares. In deciding the proper level of payment for hospice per diem fee, willingness to pay (WTP) may provide one of the critical information. This study was conducted to determine WTP for hospice care and to analyze those factors affecting WTP. A contingent valuation method with a double-bounded dichotomous-choice model was used. Interview survey was organized and conducted by a survey company from April 4 to 18, 2008. The mean WTP was calculated through an infinite integration of survival functions. The average willingness to pay was found to be 42,240 Korean won (KRW) (USD 35), with the amount becoming higher as hospice services were deemed more necessary or where average monthly household income was higher. The amount was also higher among male respondents than females. To compare this WTP with actual cost (32,500 KRW) (USD 27) for hospice care. To facilitate hospice service, hospice specific payment system should be developed. This study provides information regarding the general public's preference of hospice service and their WTP for hospice care, and it may be useful in the decision-making process.
Kamal, Arif H; Nicolla, Jonathan M; Power, Steve
Rapid changes in how palliative care clinicians are evaluated and paid present an imperative for clinicians to adeptly and routinely perform quality improvement in usual practice. Like empathic communication and facilitating goals of care discussions, quality improvement skills must be learned, honed, and practiced, so identifying problems and brainstorming solutions becomes a natural component of delivering serious illness care. Using our experience in both failures and successes in performing quality improvement, here we provide a prioritized list of 10 pearls specifically aimed to palliative care and hospice professionals. We aim to demystify quality improvement, highlight areas where rigor and a systematic approach are needed for success, and offer our own lessons learned and mistakes made to promote success for our colleagues and our field. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
Hriceniak, J; Bauce, K
A theory is an explanation of the interrelation among facts, concepts, or propositions. A number of theories are used in the process of hospice program assessment, including nursing process, change systems, and role theory. Collaboration between systems is crucial to the development of a smooth-running, effective hospital-community network. As a result of the theories utilized, the tools and skills needed to effect change, the driving and restraining forces that need to be identified, and the need to focus on a specific goal have been described. Although the theories utilized in this hospice study will not predict the outcome of the project, they have provided us with structure that enables us to guide our action and organize our approach to program analysis.
Raffaeli, William; Andruccioli, Jessica; Florindi, Stefania; Ferioli, Isabella; Monterubbianesi, Maria Cristina; Sarti, Donatella; Castellani, Francesca; Giarelli, Guido
In this study, we investigated patient's meaning attribution to pain in hospice and pain therapy unit, using a qualitative approach: narrative-based medicine. The data presented here were related to patients (n = 17) hospitalized in Rimini Hospice (Italy). These data were compared to those of patients (n = 21) with noncancer pain (control sample). The interviews were then analyzed according to the technique of thematic narrative analysis. The results of our research identified a differential process in pain processing in relationship to the meaning that the patient attributed to pain. The thematic analysis of the interviews allowed the inductive construction of a specific network of pain dimensions, which were summarized in "the pain chronogram."
Taylor, Vanessa; Middleton-Green, Laura; Carding, Sally; Perkins, Paul
The involvement of two nurses to dispense and administer controlled drugs is routine practice in most clinical areas despite there being no legal or evidence-based rationale. Indeed, evidence suggests this practice enhances neither safety nor care. Registered nurses at two hospices agreed to change practice to single nurse dispensing and administration of controlled drugs (SNAD). Participants' views on SNAD were evaluated before and after implementation. The aim of this study was to explore the views and experiences of nurses who had implemented SNAD and to identify the views and concerns of those who had not yet experienced SNAD. Data was obtained through semi-structured interviews. Qualitative thematic analysis of interview transcripts identified three key themes: practice to enhance patient benefit and care; practice to enhance nursing care and satisfaction; and practice to enhance organisational safety. The findings have implications for the understanding of influences on medicines safety in clinical practice and for hospice policy makers.
Finch, Caleb E
A symposium in January 2011 "The Paleocardiology of Ancient Egypt" reviewed old and new evidence for the presence of advanced atherosclerotic lesions in ancient Egyptian mummies. This symposium was dedicated as a Centenary for the pioneering report of Marc Ruffer in 1911 (Ruffer, 1911). Based on CT scans, the Horus Study team concluded that atherosclerosis was present in the ancient Egyptian elites and is not a disease new to the 20th Century. Presentations included radiological data on vasculature, skeleton, and teeth, indicating degenerative diseases and poor health before age 50 in these specimens. Comparisons were made with the Bolivian Tsimane, a 20th Century population living without access to modern medicine with short life expectancy. Further research is needed to develop an epidemiological context for estimating population level prevalence of vascular disease and its risk factors in ancient Egyptian societies. Copyright © 2011 Elsevier Inc. All rights reserved.
Bodell, J; Weng, M A
Culturally competent nursing care regarding the ethical dilemma of terminal dehydration (withholding or withdrawing food and fluid) for the Jewish hospice patient involves applying the ethical principles of justice, autonomy, beneficence, and nonmaleficence to nursing interventions by identifying outcomes that focus on the high value Jews place on life; avoiding stereotyping as to what it means to be Jewish; knowledge of various Jewish traditions surrounding death and dying; and good communication with the patient and his or her family.
Szeliga, Marta; Mirecka, Jadwiga
The subject of the presented work was an attempt at optimization of the methods used for verification of the candidates for medical voluntary workers in a hospice and decreasing the danger of a negative influence of an incompetent volunteer on a person in a terminal stage of a disease and his or her relatives. The study was carried out in St. Lazarus Hospice in Krakow, Poland, and included 154 adult participants in four consecutive editions of "A course for volunteers - a guardian of the sick" organized by the hospice. In order to improve the recruitment of these workers, the hitherto methods of selection (an interview with the coordinator of volunteering and no less than 50% of attendance in classes of a preparatory course for volunteers") were expanded by additional instruments-the tests whose usefulness was examined in practice. Knowledge of candidates was tested with the use of a written examination which consisted of four open questions and an MCQ test comprising 31 questions. Practical abilities were checked by the Objective Structured Clinical Examination (OSCE). A reference point for the results of these tests was a hidden standardized long-term observation carried out during the subsequent work of the volunteers in the stationary ward in the hospice using the Amsterdam Attitude and Communication Scale (AACS). Among the tests used, the greatest value (confirmed by a quantitative and qualitative analysis) in predicting how a given person would cope with practical tasks and in contact with the sick and their relatives had a practical test of the OSCE type.
Goparaju Purna SUDHAKAR
Full Text Available Popularity ofteams is growing in 21st Century. Organizations are getting theirwork done through different types of teams. Teams have proved that thecollective performance is more than the sum of the individual performances.Thus, the teams have got different dimensions such as quantitative dimensionsand qualitative dimensions. The Quantitative dimensions of teams such as teamperformance, team productivity, team innovation, team effectiveness, teamefficiency, team decision making and team conflicts and Qualitative dimensionsof teams such as team communication, team coordination, team cooperation, teamcohesion, team climate, team creativity, team leadership and team conflictshave been discussed in this article.
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.
The hospice movement was launched by the Croatian Society of Hospice and Palliative Care, Croatian Medical Association, founded and headed by the author until 2009. In this article, the author describes the development of the hospice movement in four periods, as follows: first period 1994-1999, the beginnings; second period 2000-2005, a period of great hopes and initial achievement of first goals; third period 2006-2008, a period of stagnation, the 'burn-out' syndrome, looking for new ways and people; and fourth period 2009-? Let us hope it will bring true finding way out, a new period of struggling for acceptable solutions, which has already been accomplished in many countries. The hope dies last, the hope in positive powers among the citizens of Croatia. Only the most important facts are presented, whereas citations from numerous lectures, events held all over Croatia and publications in many books and newspapers are omitted. Descriptions of numerous trips for training, education, for one month, two weeks, one week or several days in the USA, Canada, UK, Poland, Hungary, Austria, Switzerland, Norway, etc., and of visits paid by many guests from the UK, USA, Canada, Italy, Germany, Switzerland, Poland, Hungary, Romania, Bulgaria, Israel, Bosnia and Herzegovina, Serbia, Macedonia, etc. are also omitted. All these facts will be presented in the monograph that has been prepared for publication.
Armando Carlos Roca Socarrás
Full Text Available Background: Dementia presents a high prevalence both in developed and developing countries. It is one of the main causes of terminal stage for a non oncological illness. Objective: To determine the behaviour of some biological variables in terminal stage patients with dementia. Method: A descriptive study was conducted in 16 patients with a diagnostic of dementia in terminal stage. These patients were admitted in the Seychelles´ Hospice between February 2010 and February 2011. The behaviour of dementia in relation to patient’s age, type of dementia, responses to the Folstein´s cognitive mini-test, Charlson´s and Barthel´s indexes, presence of non communicable chronic diseases, and health settings responsible for the remission was analyzed. Results: 31,3 % of patients admitted in the Hospice presented dementia. The age group with more cases was that from 75 to 84 years old. Vascular dementia and Alzheimer’s Disease presented the same number of cases (37,5 % each. 56% of the patients died during the first 15 days of admission and only 12,5 % lived more than 6 months. Hypertension and cerebrovascular disease were the most common non communicable chronic diseases. 56% of cases had been remitted from hospitals. Conclusions: Dementia in terminal stages follows a behaviour that allows anticipating an appropriate strategy for palliative care in the Hospice.
In the state of Pennsylvania, a collaborative model has been developed for improving pediatric palliative care and end-of-life care services to children with life-limiting conditions and their families. The inspiration and efforts of several bereaved parents provided the initial impetus for this encouraging model. Pennsylvania's model involves cooperation and collaboration among several groups and initiatives across the state, as well as the integration of parent-professional collaboration at all levels and in each initiative. The collaborating groups include 1) a volunteer grassroots resource and education initiative, Helping Hands-Healing Hearts; 2) the Pittsburgh Pediatric Palliative Care Coalition, a coalition of concerned parents and experienced palliative and hospice care providers working together to improve service availability; and 3) the Pennsylvania Children's Hospice and Palliative Care Coalition, which developed as an outcome of a state-level Pennsylvania Pediatric Hospice Care Task Force, and which, among other activities, works with the Pennsylvania Department of Public Welfare and several Pennsylvania legislators on pertinent policy and legislative initiatives.
Parker, Glenn; Hoffman, Robert
... Chapter 17 - TELECONFERENCE TIPS Chapter 18 - ACHIEVING CLEAR COMMUNICATION IN A MULTICULTURAL MEETING Chapter 19 - HOW TO MAKE A DECISION Chapter 20 - PRESENTING AT A TEAM MEETINGChapter 21 - ...
... Accident DME Durable Medical Equipment FEHC Family Evaluation of Hospice Care FY Fiscal Year GIP General.... 6 436 CVA/Stroke....... 26,897 4 7 185 Prostate Cancer.. 20,262 3 8 783.7 Adult Failure 18,304 3 To... Alzheimer's 58,200 6 Disease. 7 290.0 Senile Dementia 37,667 4 Uncomp.. 8 436 CVA/Stroke....... 31,800 3 9...
Christakis, N A; Iwashyna, T J
Hospice terminal care is now used by 10% to 15% of elderly Americans at variable points before their deaths. By examining the duration of patient survival after enrollment in hospice care, we sought to identify individual and market factors associated with the timing of hospice use. We linked Medicare claims, census information, and Area Resource File data to form a national cohort of 151,410 hospice patients admitted in 1993 and followed up until late 1996. We examined this cohort with Cox regression and other means. The primary outcome measure was survival after hospice enrollment. The patients had a mean +/- SD age of 79.0 +/- 7.4 years; 10.2% were nonwhite; 51.4% were female; and 71.3% had cancer. Median survival after hospice enrollment was 30 days (interquartile range, 10-86 days). After adjustment for measured patient, provider, and market factors, several variables were associated with relatively earlier hospice enrollment, farther from death. Compared with complementary groups, nonwhites were enrolled in hospice 4 days earlier; women, 5 days earlier; older people, 1 day earlier; and those with substance abuse, psychiatric disease, or dementia, each 3 days earlier. After adjustment, income and education were not associated with the timing of enrollment. Patients residing in markets with more hospital beds, greater hospice capacity, or a higher proportion of generalists were enrolled earlier. Even after adjustment for certain clinical attributes, individual social factors and local market factors were associated with survival after hospice enrollment. Certain socially disadvantaged groups were enrolled earlier, as were those residing in areas with more medical institutions. The decision to enroll patients in hospice may depend on both nonclinical and clinical factors.
Riggs, Alexa; Breuer, Brenda; Dhingra, Lara; Chen, Jack; Portenoy, Russell K; Knotkova, Helena
In the U.S., palliative care programs improve access to hospice through enhanced communication and efficiencies in hospice eligibility review and enrollment. For community-based programs, this task may begin with telephone contact. To evaluate the incidence and predictors of hospice enrollment following telephonic outreach by a nurse after referral to a community-based, specialist palliative care program. During 2012-2014, 299 consecutive patients who were referred to a palliative care program and subsequently enrolled in hospice provided electronic health record data for a retrospective cohort study. Those who elected hospice after telephonic outreach and before the first palliative care home visit, were compared with those who enrolled in hospice after palliative care visits began, using both bivariate and multivariate analyses. Mean (SD) age was 74.1 (18.7) years; 60.2% were women, 44.4% were White, 22.5% were Hispanic, 20.9% were Black, and 9.6% were Asian. In total, 177 patients (59.2%) elected hospice following telephonic outreach and 122 (40.8%) enrolled after home visits began. The former group received a mean of 4.5 calls (median = 3.0) before hospice election. In multivariate analysis, hospice enrollment following telephonic outreach alone was associated with hospital or nursing home referral, not married status, and poor performance status (all P palliative care program did so following telephonic outreach alone. Both sociodemographic and clinical characteristics predicted this outcome. Palliative care programs can improve hospice access through initial telephonic outreach by trained professionals. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
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.
Unroe, Kathleen T; Bernard, Brittany; Stump, Timothy E; Tu, Wanzhu; Callahan, Christopher M
To describe differences in hospice services for patients living at home, in nursing homes or in assisted living facilities, including the overall number and duration of visits by different hospice care providers across varying lengths of stay. Retrospective cohort study using hospice patient electronic medical record data. Large, national hospice provider. Data from 32,605 hospice patients who received routine hospice care from 2009 to 2014 were analyzed. Descriptive statistics were calculated for utilization measures for each type of provider and by location of care. Frequency and duration of service contacts were standardized to a 1 week period and pairwise comparisons were used to detect differences in care provided between the three settings. Minimal differences were found in overall intensity of service contacts across settings, however, the mix of services were different for patients living at home versus nursing home versus assisted living facility. Overall, more nurse care was provided at the beginning and end of the hospice episode; intensity of aide care services was higher in the middle portion of the hospice episode. Nearly 43% of the sample had hospice stays less than 2 weeks and up to 20% had stays greater than 6 months. There are significant differences between characteristics of hospice patients in different settings, as well as the mix of services they receive. Medicare hospice payment methodology was revised starting in 2016. While the new payment structure is in greater alignment with the U shape distribution of services, it will be important to evaluate the impact of the new payment methodology on length of stay and mix of services by different providers across settings of care. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.
Highet, Bridget H; Hsieh, Yu-Hsiang; Smith, Thomas J
Hospice is underutilized, with over 25% of enrolled patients receiving hospice care for 3 days or less. The inner city emergency department (ED) is a highly trafficked area for patients in the last 6 months of life, and is a potential location for identification of hospice-eligible patients and early palliative care (PC) intervention. We evaluated the feasibility of an ED PC intervention to identify hospice-eligible patients to accelerate PC consultation and hospice enrollment. This prospective, pilot study established a program in the ED via education and a direct line of communication between the ED and PC to identify hospice-eligible patients, with the goal of facilitating disposition to hospice within 24 h. Data were analyzed for time to PC consultation, length of stay, emergency physician (EP) appropriateness of referral, and time from hospitalization to mortality. In a 6-month period, EPs identified 88 hospice-eligible patients with 91% accuracy. Of the patients identified, 59% died within 3 months of their visit to the ED. Time to PC consultation was 2.3 days (SD 2.3), and 57% of those seen by PC were discharged to hospice, vs. 30% of those not consulted (p = 0.038). The potential median hospice length of stay was 31.5 days, better than for the institution as a whole. Our pilot study presents a unique approach to early identification and disposition of hospice-appropriate patients, and suggests EPs may have sufficient prognostic accuracy to perform this task. Copyright © 2016 Elsevier Inc. All rights reserved.
Wang, Shi-Yi; Aldridge, Melissa D.; Gross, Cary P.; Canavan, Maureen; Cherlin, Emily; Johnson-Hurzeler, Rosemary; Bradley, Elizabeth
Objectives We sought to characterize the number and types of care transitions in the last 6 months of life made by patients who used hospice and examined factors associated with having multiple transitions in care. Design, Setting, and Participants We performed a retrospective cohort study of fee-for-service Medicare beneficiaries, aged 66 years or older who died between July 1, 2011 and December 31, 2011, and were enrolled in hospice at some time during the last 6 months of life. We used hierarchical generalized linear modeling to identify patient, hospice, and regional factors associated with transitions. We also described the sequence of transitions across healthcare settings. Measures Healthcare transitions after hospice enrollment included from/to hospital, skilled nursing facility, home health agency program, hospice, or home without receiving any service above. Results Among 311,090 hospice decedents, 31,675 (10.2%) had at least one transition after hospice enrollment and this varied substantially across the United States. A total of 6.6% of all decedents had more than one transition in care after hospice enrollment, with a range from 2–19 transitions. Among hospice users with transitions, 53.4% were admitted to hospitals, 17.7% were admitted to skilled nursing facilities, 9.6% used home health agencies, and 25.8% had transitions to home without receiving services we examined. In adjusted analyses, decedents who were younger, nonwhite, enrolled in a for-profit or small hospice program, or had less access to hospital-based palliative care had significantly higher odds of having at least one transition. Conclusion A notable proportion of hospice users experience at least one transition in care in the last 6 months of life, suggesting further research on their impact on patients and families is warranted. PMID:26889841
Metcalfe, Alison; Pumphrey, Rachel; Clifford, Collette
The overall aim of this study is to determine hospice nurses' perception of the importance of genetics to hospice care provision and their personal level of confidence in carrying out genetics-related activities within an end-of-life care context. Hospices nurses regularly care for patients and their families affected by inherited genetic conditions (e.g. some cancers). Therefore, nurses need knowledge and awareness of the implications of genetic conditions and confidence in their abilities to provide appropriate care and support for patients and families. Survey. Questionnaires were sent to a stratified sample of hospice nurses (n = 1149) in England and Wales. Using Likert scales, nurses were asked to rate the importance of and their confidence in undertaking a range of scenario-based activities that accompany caring for a patient and family affected by a genetic condition in the hospice setting. Open questions invited comments on their experiences of nursing patient/family in similar situations. Follow-up telephone interviews were carried out with hospice nurse educators to explore emerging issues. Response rate was 29% (n = 328). Hospice nurses felt that all aspects of genetics-related care were 'very important' to hospice care, but lacked confidence in their ability to carry out the activities. Many respondents had not considered the relevance of genetics to hospice-care prior to completing the questionnaire but now considered it essential to end-of-life care even if they were not confident to provide it. Hospice nurses' need genetics education focusing on the psychosocial implications of caring for patients and families affected by genetic conditions to enable them to provide the complex care and support in face of the difficult issues that arise in practice. This study highlights the genetics education needs of hospice nurses in providing end-of life care for patients and their families affected by inherited genetic conditions.
This article, Part 1 of a 2-part series, provides an overview of the current Medicare compliance climate and its implications for hospice providers. Content focuses on the 7 elements of a comprehensive compliance framework as defined by the Health and Human Services Office of the Inspector General in its 1999 Compliance Guidance for Hospices. A brief case example is provided and serves to set the stage for Part 2, which will explore hospice-specific risk areas and specific risk-reduction strategies.
Conclusion: Due to lack of experience in hospice care in developing countries, research for identifying probable barriers and appropriate management for reducing unsuccessfulness in designing and delivering hospice care service seems necessary. Input from the facilitators and their suggested solutions can be useful in planning the policy for hospice care system.
Goparaju Purna SUDHAKAR
Popularity of teams is growing in 21st Century. Organizations are getting their work done through different types of teams. Teams have proved that the collective performance is more than the sum of the individual performances. Thus, the teams have got different dimensions such as quantitative dimensions and qualitative dimensions. The Quantitative dimensions of teams such as team performance, team productivity, team innovation, team effectiveness, team efficiency, team decision making and tea...
... evaluation and counseling services. 418.205 Section 418.205 Public Health CENTERS FOR MEDICARE & MEDICAID... Services § 418.205 Special requirements for hospice pre-election evaluation and counseling services. (a... evaluation and counseling services as specified in § 418.304(d) may be made to a hospice on behalf of a...
Lepore, Michael J.; Miller, Susan C.; Gozalo, Pedro
Purpose: Medicare hospice is a valuable source of quality care at the end of life, but its lower use by racial minority groups is of concern. This study identifies factors associated with hospice use among urban Black and White nursing home (NH) decedents in the United States. Design and Methods: Multiple data sources are combined and multilevel…
Stensland, Meredith; Landsman, Miriam
Burnout is a critical problem for hospice care system, particularly given the potential increase in hospice utilization because of the increasing older adult population. Hospice care requires social workers and other professionals to work in interdisciplinary settings under conditions of prolonged stress. Guided by the Job Demands-Resources (JDR) model, this study sought to: (1) understand Iowa hospice workers' level of burnout, indicated by emotional exhaustion (EE); (2) identify organizational and personal determinants of EE. This web-based study used a cross-sectional survey administered to hospice staff across Iowa. Seventeen hospice organizations participated as study sites, and 244 out of 825 employees, consisting of interdisciplinary clinical workers and administrative personnel, completed the survey. Descriptive, correlational, and regression statistics were used to test study hypotheses. Regarding EE levels, 59% of participants were experiencing low EE, while the other 41% had moderate or high EE. Those lacking empathy, working full-time, and working for larger hospice organizations had greater EE. While findings largely support the JDR model, interactions between demands and resources offer only partial support. Results indicate the importance of hospices fostering supportive work environments and providing employee education about emotional benefits of respect, strategies for displaying workplace respect, and evaluation of respect-related initiatives.
Olthuis, G.J.; Dekkers, W.J.M.; Leget, C.J.W.; Vogelaar, P.J.W.
Good nursing is more than exercising a specific set of skills. It involves the personal identity of the nurse. The aim of this article is to answer two questions: (1) what kind of person should the hospice nurse be? and (2) how should the hospice nurse engage in caring conversations? To answer these
Kayser-Jones, Jeanie S.; Kris, Alison E.; Miaskowski, Christine A.; Lyons, William L.; Paul, Steven M.
Purpose: The purpose of this study was to investigate pain management among 42 hospice and 65 non-hospice residents in two proprietary nursing homes. Design and Methods: In this prospective, anthropological, quantitative, and qualitative study, we used participant observation, event analysis, and chart review to obtain data. The Medication…
Mesler, Mark A.
Participant-observation research was conducted in the home care components of a free-standing inpatient facility associated with several hospice organizations over three years. The data are reported using negotiated order theory as a framework for understanding the hospice movement and its attempts to change the experience of dying. (JPS)
...: Organizational Environment § 418.110 Condition of participation: Hospices that provide inpatient care directly. A... hospice must have a written disaster preparedness plan in effect for managing the consequences of power... changes in the edition of the Code are incorporated by reference, CMS will publish a notice in the Federal...
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.
This paper describes the Portage County, Ohio community hospice program, emphasizing the linkages between family life specialists, health professionals, volunteers, and students. Hospice service is defined as a specialized, home-based program for the management of pain and other symptoms of terminal illness, with the family as the unit of care.…
Darrah, Neha J; O'Connor, Nina R
Patient handoffs are an increasingly emphasized skill in medical and nursing education, and handoff education is required by the Accreditation Council for Graduate Medical Education. Traditional handoff tools lack content that is unique to hospice and palliative medicine. The objective of the study was to develop a comprehensive curriculum to teach and assess patient handoffs in hospice and palliative medicine fellowships. Eight hospice physicians, nurse practitioners, and nurses were interviewed to determine core content for a hospital-to-hospice handoff. This content was used to create a verbal handoff template and direct observation assessment tool, which were reviewed by the same hospice providers for content validity. The handoff template was taught to two groups of palliative medicine fellows and one group of internal medicine residents using an interactive didactic and role play, and feedback was obtained to further refine the curriculum. After refinement, the complete handoff curriculum (verbal handoff template, didactic with role play, assessment by faculty using direct observation tool) was successfully integrated into a hospice and palliative medicine fellowship, satisfying Accreditation Council for Graduate Medical Education requirements related to transitions in care. The hospital-to-hospice handoff is a unique opportunity to teach patient safety in a palliative medicine context. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
Cartwright, Juliana C.; Miller, Lois; Volpin, Miriam
Purpose: The purpose of this study was to describe good quality care at the end of life (EOL) for hospice-enrolled residents in assisted living facilities (ALFs). Design and Methods: A qualitative descriptive design was used to obtain detailed descriptions of EOL care provided by ALF medication aides, caregivers, nurses, and hospice nurses in…
Koopmann, Rebecca A.; Higdon, S.; Balonek, T. J.; Haynes, M. P.; Giovanelli, R.
The Undergraduate ALFALFA (Arecibo Legacy Fast ALFA) Team is a consortium of 16 institutions engaged in an NSF-sponsored program to promote undergraduate research within the extragalactic ALFALFA HI blind survey project. In the first two years of the program, more than three dozen undergraduate students have been closely involved in ALFALFA science, observing, and data analysis. A total of 34 students have attended the annual undergraduate workshops at Arecibo Observatory, interacting with faculty, their peers, ALFALFA experts, and Arecibo staff in lectures, group activities, tours, and observing runs. Team faculty have supervised 26 summer research projects and 14 academic year (e.g., senior thesis) projects. Students and faculty have traveled to Arecibo Observatory for observing runs and to national meetings to present their results. Eight Team schools have joined to work collaboratively to analyze HI properties of galaxy groups within the ALFALFA volume. (See O'Brien et al., O'Malley et al., and Odekon et al. posters, this meeting.) Students involved in this program are learning how science is accomplished in a large collaboration while contributing to the scientific goals of a major legacy survey. This work has been supported by NSF grants AST-0724918, AST-0725267, and AST-0725380.
Miller, Susan C
The use of hospice care in nursing homes (NHs) has grown exponentially, but an increasing concern is the lack of access to resident and family-centered palliative care when residents do not elect hospice, and in time periods prior to election. This concern is amplified by the high magnitude of palliative care needs present for NH residents (and their families) when the NH will be their final residence; and, it is amplified because of short hospice stays, half of which are 22 days or less. This manuscript describes the use of the Medicare hospice care in NHs and discusses the policy, staff and physician barriers to timely hospice referral. It also describes the challenges NHs face in expanding residents' access to palliative care. Opportunities and approaches for increasing palliative care expertise and practice in NHs are presented.
Mizell, Deborah; Washington-Brown, Linda J; Russell, Angela
Today, most medical professionals focus on a cure. However, hospice care provides a quality of life for those persons nearing the end of life or persons experiencing a life-limiting illness. The distressing reality is that most nurses are not taught the full scope of end of life care (EOL) in schools of nursing. Because of this educational deficit, a variance in care is created that may adversely affect the dying patient and family's wishes. In our RN to BSN program, we established a partnership with a national hospice organization to provide (1) leadership in end-of-life course development, (2) lecturers experienced in hospice and palliative care, (3) field placement for students with hospice nurses, and (4) nursing scholarships to complete the bachelor's degree. The end result of this partnership is to educate registered nurses about hospice and palliative care, as well as to increase the nursing workforce in this area.
Mixer, Sandra J; Lindley, Lisa; Wallace, Heather; Fornehed, Mary Lou; Wool, Charlotte
Wide variations exist among perinatal hospices, and barriers to perinatal palliative care exist at the healthcare level. Research in the area of culturally sensitive perinatal palliative care has been scarce, a gap which this study addresses. To evaluate the relationship between the nurse work environment and the delivery of culturally sensitive perinatal hospice care. This retrospective, correlational study used data from the National Home and Hospice Care Survey, which includes a nationally representative sample of hospice care providers. A multivariate logistic regression model was used to estimate the relationship between the delivery of culturally sensitive care and the nurse work environment. Accreditation, teaching status, and baccalaureate-prepared registered nurse staff had an impact on the provision of culturally sensitive perinatal care Conclusions: The hospice and nursing unit environments, specifically in regards to education and technology, may be important contributors to the delivery of culturally sensitive care.
Badke-Schaub, Petra; Lauche, Kristina; Neumann, Andre
categorised referring to underlying cognitive acts and design strategies. The results are largely consistent with the assumptions of the model indicating a lack of sharedness. This was confirmed by changes of frequencies linked to task-, team-, and processrelated cognitive acts within and between the two......In this article, an analysis of the development of team mental models in two engineering meetings is described. The authors present a two-stage model of the development of sharedness in teams, which formed the basis for a communication analysis of both meetings. The transcripts of the meetings were...... meetings. Implications of the findings and the model are discussed....
What are the communication challenges for politicians, experts and stakeholders in order to enhance transparency in nuclear waste management decisions? Report from a Team Syntegrity Meeting. The European Project RISCOM-II. Work Package 3
Andersson, Kjell [Karinta-Konsult, Taeby (Sweden); Espejo, Raul [Syncho Ltd., Birmingham (United Kingdom); Wene, Clas-Otto [Wenergy, Lund (Sweden)
The Team Syntegrity Meeting is a special part of the project. It aims for increased awareness among key stakeholder groups in Europe about how nuclear waste decision processes should be developed in order to increase transparency and trust. Team Syntegrity is conducted with a special meeting format. The self-organisation of the meeting is a strong positive feature of the format. Instead of having a project leader setting the agenda, the participants formulate their own topics of relevance starting from an opening question. This report documents the meeting that was held in Lanaken, Belgium on 14-17 May 2002. The opening question for the meeting was: What are communication challenges for politicians, experts and stakeholders in order to enhance transparency in nuclear waste management decisions? There are different opinions about how communication on nuclear waste issues should be done. There are differences between stakeholder groups, and there are different approaches taken in various countries. Still it should be possible to reach a deeper understanding of social communications, that is, understanding the requirements to have effective communications between policy makers, experts and stakeholders. The aim was thus not to develop common views on the nuclear waste problem as such, but rather common grounds for developing procedures for effective communication. Hopefully, this meeting made some progress in this direction. The call for the Team Syntegrity (TS) Meeting resulted in 105 Statements of Importance given in Appendix 2. Following the TS format the meeting then formed its own agenda by first producing 30 Aggregated Statements of Importance (Appendix 3), which were grouped into 12 Consolidated Statements of Importance or topics. The group discussions were thus held under the twelve topics of: Consultation, communication and participation; Mutual learning; Roles and arenas; Heritage; Transparency; Wider context; Process; Risk; Institutional cultures
Full Text Available The objective is to examine hospice utilization among Medicare beneficiaries in Hawai‘i compared to other states. Data were from the 2014 Medicare Hospice Utilization and Payment Public Use File, which included information on 4,025 hospice providers, more than 1.3 million hospice beneficiaries, and over $15 billion in Medicare payments. Multivariable linear regression models were estimated to compare hospice utilization in Hawai‘i to that of other states. Control variables included age, gender, and type of Medicare coverage. Medicare beneficiaries using hospice in Hawai‘i differed significantly from beneficiaries in other states in several ways. Hawai‘i beneficiaries were more likely to be Asian (57% vs. 1%, p < .001 and “other race” (10% vs. 0.1%, p < .001, and less likely to be White (28% vs. 84%, p < .001. Hawai‘i beneficiaries were also more likely to have Medicare Advantage (55% vs. 30%, p = .05. Regarding primary diagnoses, hospice users in Hawai‘i were significantly more likely to have a primary diagnosis of stroke (11% vs. 8%, p = .03 and less likely to have respiratory disease (5% vs. 11%, p = .003. In addition, hospice users in Hawai‘i were more likely to use services in their homes (74% vs. 52%, p = .03. Hawai‘i hospice users were also less likely to die while in hospice (42% vs. 47%, p = .002. Characteristics of Medicare beneficiaries in Hawai‘i differ from those in other states, regarding demographic characteristics, type of coverage, primary diagnoses, likelihood of using services in their homes, and death rates. Further research is needed to better understand factors affecting these differences and whether these differences warrant changes in policy or practice.
Shalev, Ariel; Phongtankuel, Veerawat; Kozlov, Elissa; Shen, Megan Johnson; Adelman, Ronald D; Reid, M C
Despite the documented benefits of palliative and hospice care on improving patients' quality of life, these services remain underutilized. Multiple factors limit the utilization of these services, including patients' and caregivers' lack of knowledge and misperceptions. To examine palliative and hospice care awareness, misperceptions, and receptivity among community-dwelling adults. Cross-sectional study. New York State residents ≥18 years old who participated in the 2016 Empire State Poll. Palliative and hospice care awareness, misperceptions, and receptivity. Of the 800 participants, 664 (83%) and 216 (27%) provided a definition of hospice care and palliative care, respectively. Of those who defined hospice care, 399 (60%) associated it with end-of-life care, 89 (13.4%) mentioned it was comfort care, and 35 (5.3%) reported hospice care provides care to patients and families. Of those who defined palliative care (n = 216), 57 (26.4%) mentioned it provided symptom management to patients, 47 (21.9%) stated it was comfort care, and 19 (8.8%) reported it was applicable in any course of an illness. Of those who defined hospice or palliative care, 248 (37.3%) had a misperception about hospice care and 115 (53.2%) had a misperception about palliative care. Most community-dwelling adults did not mention the major components of palliative and hospice care in their definitions, implying a low level of awareness of these services, and misinformation is common among community-dwelling adults. Palliative and hospice care education initiatives are needed to both increase awareness of and reduce misperceptions about these services.
Pawłowski, Leszek; Lichodziejewska-Niemierko, Monika; Pawłowska, Iga; Leppert, Wojciech; Mróz, Piotr
Volunteers working in hospice and palliative care facilities in Poland undertake various activities which are performed in accordance with legal regulations and the individual policies of each hospice. The aim of this study was to explore the roles and training of volunteers working in hospice and palliative care settings. A cross-sectional survey was carried out that investigated the services performed by volunteers and their preparation for work within residential hospices. Questionnaires were distributed to volunteers and hospice representatives, and the responses obtained underwent statistical analysis. A total of 180 volunteers and 28 hospice representatives from 29 residential hospices participated in this survey. All hospices surveyed were supported by volunteers. 79% of volunteers worked alongside patients and performed the following services: accompanying patients (76%), feeding patients (61%), cleaning rooms (48%), dressing and bathing (42%) and organising leisure time (40%). Fewer volunteers were involved in activities outside of patient support-for example, charity work and fundraising (34%), cleaning hospice buildings (23%) as well as providing information and education (22%). According to volunteers, prior to undertaking their duties, 64% participated in theoretical training and 37% took part in a practical course. The majority attended courses relating to general knowledge of hospice and palliative care (64%) and volunteer rights and duties (55%). Overall, proper training was an essential requirement needed to be fulfilled by volunteers, particularly when involved in direct patient support. Most volunteers were simultaneously involved in various areas of service; therefore, their training should be comprehensive. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Denise J. Stokholm, Marianne
Future wellbeing is depending on human competences in order to strengthen a sustainable development. This requires system thinking and ability to deal with complexity, dynamic and a vast of information. `We need to move away from present principles of breaking down problems into components and give...... and intercultural teams in design and the understanding of design as a process of transformation and information management call for a model with capacity to facilitate both `the what` and `the how` This paper will describe a systemic model of design based on a holistic approach to design developed by the author...... in relation to a design-engineering education at Aalborg University. It will exemplify how the model has been used in workshops on team designing, challenged design learning and affected design competence. In specific it will investigate the influence of visual models of the perception of design, design...
MEET ISOLDE - Target Production. Everything at ISOLDE starts with a target and the target production team realise on more then 50 years of experience to build and develop new targets for ISOLDE’s wide physics program.
Nowak, Bryan P
With the implementation of the Affordable Care Act, the U.S. government committed to a transition in payment policy for health care services linking reimbursement to improved health outcomes rather than the volume of services provided. To accomplish this goal, the Department of Health and Human Services is designing and implementing new payment models intended to improve the quality of health care while reducing its cost. Collectively, these novel payment models and programs have been characterized under the moniker of value-based purchasing (VBP), and although many of these models retain a fundamental fee-for-service (FFS) structure, they are seen as essential tools in the evolution away from volume-based health care financing toward a health system that provides "better care, smarter spending, and healthier people." In 2014, approximately 20% of Medicare provider FFS payments were linked to a VBP program. The Department of Health and Human Services has committed to a four-year plan to link 90% of Medicare provider FFS payments to value-based purchasing by 2018. To achieve this goal, all items and services currently reimbursed under Medicare FFS programs will need to be evaluated in the context of VBP. To this end, the Medicare Hospice benefit appears to be appropriate for inclusion in a model of VBP. This policy analysis proposes an adaptable model for a VBP program for the Medicare Hospice benefit linking payment to quality and efficiency in a manner consistent with statutory requirements established in the Affordable Care Act. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
Chopra, Raj K.
Some Kansas school administrators are spending less time in meetings and accomplishing more by (1) asking if a meeting is necessary; (2) being punctual; (3) stating the focus of the meeting; (4) limiting meetings to five to seven participants; (5) providing minutes; and (6) using team-based management. (MLF)
Wilson, Christopher M; Stiller, Christine H; Doherty, Deborah J; Thompson, Kristine A
Little is known regarding the extent to which physical therapy is integrated into Hospice and Palliative Care (HPC). The purpose of this study was to describe perceptions of physical therapists (PTs) regarding their role within HPC or working with patients having life-threatening illnesses and to develop a conceptual framework depicting a PTs role within HPC and factors affecting it. Ten PTs, 5 from the United States and 5 from Canada, with at least 5 years of physical therapy experience and 5 years working experience with patients having life-threatening illnesses or in HPC. Demographic data were collected by electronic questionnaire. A semistructured interview was conducted with each participant to investigate their perceptions about the role of PTs in HPC. Interview results were analyzed for trends between participants, practice settings, regions, and other sociocultural aspects. The constant comparative method of qualitative data analysis was used to identify similarities and differences and to develop themes and concepts relative to the role of PT in HPC. Participants identified their 3 primary roles in HPC: providing patient/family care, serving as an interdisciplinary team member, and fulfilling professional responsibilities outside of direct patient care. They described factors within and outside direct patient care which influenced their roles. Concepts included shifting priorities, care across the continuum, and changing perceptions of PTs within HPC. This study described perceptions of the role of PTs within HPC that may be utilized when coordinating future strategies to appropriately promote and expand the role.
Casarett, David; Harrold, Joan; Harris, Pamela S; Bender, Laura; Farrington, Sue; Smither, Eugenia; Ache, Kevin; Teno, Joan
In the U. S., hospices sometimes provide high-intensity "continuous care" in patients' homes. However, little is known about the way that continuous care is used or what impact continuous care has on patient outcomes. To describe patients who receive continuous care and determine whether continuous care reduces the likelihood that patients will die in an inpatient unit or hospital. Data from 147,137 patients admitted to 11 U.S. hospices between 2008 and 2012 were extracted from the electronic medical records. The hospices are part of a research-focused collaboration. The study used a propensity score-matched cohort design. A total of 99,687 (67.8%) patients were in a private home or nursing home on the day before death, and of these, 10,140 (10.2%) received continuous care on the day before death. A propensity score-matched sample (n = 24,658) included 8524 patients who received continuous care and 16,134 patients who received routine care on the day before death. Using the two matched groups, patients who received continuous care on the day before death were significantly less likely to die in an inpatient hospice setting (350/8524 vs. 2030/16,134; 4.1% vs. 12.6%) (odds ratio [OR] 0.29; 95% CI 0.27-0.34; P < 0.001). When patients were cared for by a spouse, the use of continuous care was associated with a larger decrease in inpatient deaths (OR 0.12; 95% CI 0.09-0.16; P < 0.001) compared with those patients cared for by other family members (OR 0.37; 95% CI 0.32-0.42; P < 0.001). It is possible that unmeasured covariates were not included in the propensity score match. Use of continuous care on the day before death is associated with a significant reduction in the use of inpatient care on the last day of life, particularly when patients are cared for by a spouse. Copyright © 2015. Published by Elsevier Inc.
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.
Johnson-Hurzeler, Rosemary; Barnum, Evelyn; Leary, Robert; Hill, Claire
This paper describes the new management information system at The Connecticut Hospice in Branford, Connecticut. The system is of particular interest for three reasons: (1) it represents the application of computer technology to a new and important field of medicine in the care of those patients with a terminal illness and their families; (2) it is a real life example of the successful application of state-of-the-art data-based, integrated systems design techniques; and (3) as a comprehensive and responsive on-line system which was implemented on a micro-computer, it demonstrates the realization of big-system capabilities on a small machine.
Teno, Joan M; Plotzke, Mike; Christian, Thomas; Gozalo, Pedro
In the final days of life, symptoms are exacerbated and often families need both education and emotional support from hospice professional staff. The Medicare Hospice Benefit provides a per-diem payment with no requirements on the frequency of patient visits. To examine individual characteristics, hospice program, and geographic variation in hospice visits by professional staff during the last 2 days of life. This retrospective cohort study of 661 557 Medicare hospice beneficiaries included all patients who died in federal fiscal year 2014 (October 1, 2013-September 30, 2014) in hospice services while receiving routine home care in the last 2 days of life. Data analysis was conducted from March 9 to August 25, 2015. Medicare regulations require that hospice care centers report daily the frequency and duration of patient visits by professional staff, as well as the type of hospice staff who conduct these visits. We examined visit variation by hospice professional staff (physician, nursing staff, and social worker) during the last 2 days of life using a multivariable logistic model adjusting for decedent and hospice program characteristics. Of the 661 557 patients in the study, 81 478 (12.3%) received no professional staff visits in the last 2 days of life. State variation ranged from 590 of 15 399 patients (3.8%) in Wisconsin to 97 of 492 patients (19.7%) in Alaska, and hospice program interquartile variation ranged from 3.2% (25th percentile) to 19.5% (75th percentile). Black patients were less likely to have any visits than were white patients (7352 of 48 221 [15.2%] vs 70 365 of 585 377 [12.0%]; adjusted odds ratio, 1.30; 95% CI, 1.24-1.37). Those dying in a nursing home were 1.74 times less likely to have any visits than those dying at home (30 880 of 186 649 [16.5%] vs 40 973 of 386 654 [10.6%]; 95% CI, 1.62-1.88). Those dying on a Sunday were 3.35 times less likely to have a visit compared with persons dying on a Tuesday (19 519 of 95 979 [20.3%] vs 6784 of 92
Blomenberg, Emily M
Radiology administrators often are challenged to do more with less. In today's fast-paced work environment, leaders must be creative. They must surround themselves with good people in order to successfully achieve their organizations' goals. Once a radiology administrator is satisfied and comfortable that he or she has, the right staff involved, a leadership team can be formally establislished. Howard Regional Health System established an Imaging Services Leadership Team with a vision to provide leaders for the staff to "follow," just as team members learn from the radiology administrator. In addition, team members are vital in assisting the radiology administrator in managing the department The process of building the team consisted of 3 steps: selecting team members (the most challenging and time-consuming component), formalizing a functional team, and putting the team into action. Finding the right people, holding regular meetings, and making those team meetings meaningful are keys to a successful leadership team. The implementation of the team has had a positive effect on imaging services: the number of procedures has increased, the team is used as a communication tool for front-line staff, front-line staff are becoming more comfortable with making decisions.
Kapo, Jennifer; MacMoran, Holly; Casarett, David
Hospice has become the major provider of comprehensive end-of-life care in the United States, but is underutilized by African American patients. It is likely that whatever factors are responsible for lower rates of hospice utilization among African Americans also lead to lower rates of return to hospice after discharge, but this is not known. To determine whether African American patients who leave hospice are less likely to return before death. Retrospective cohort study. University-affiliated hospice. All patients discharged after a first admission. All patient characteristics were defined by abstraction of electronic medical records at the time of hospice discharge. Of 358 discharged patients, 98 (27%) were decertified and 260 (73%) left voluntarily. Ninety-six patients returned to hospice during the study period. In bivariate analysis, African Americans were less likely to return than were other patients (odds ratio (OR) 0.47, 95% CI: 0.28-0.80; p = .005). In a multivariable logistic regression model, African American ethnicity was independently associated with a decreased likelihood of return. Ethnic disparities in hospice utilization may extend even to those patients who do enroll in hospice. African Americans who leave hospice during their first admission and their families may be less likely to have access to the comprehensive services that hospice programs provide near the end of life, including intensive nursing care, pain and symptom management, and education.
Moore Johnson, Susan; Reinhorn, Stefanie K.; Simon, Nicole S.
Teachers in high-poverty schools often feel stressed and fatigued. We might expect that if we ask these teachers to take on even more work by meeting regularly in collaborative improvement teams, they will respond with skepticism, even resentment. But in a study of 83 teachers in six outstanding high-poverty schools, these researchers found the…
Sonne, Anne-Mette; Harmsen, Hanne
development process is by using teams. Teams are considered one of the best tools for exchanging especially tacit knowledge, since this kind of knowledge is transferred best through personal interaction and face-to-face meetings (Madhavan & Grover, 1998; Nonaka, 1994). In accordance with this, more and more...... multinational firms rely on international product development teams (McDonough et al., 2001) as a means to make the most effective use of the company's resources scattered around the world. While a substantial amount of research exists on groups in general, research into new product development teams is more...... limited and especially empirical research on global new product development teams is sparse (McDonough, et al., 2001). Findings from research on teams cannot automatically be generalized and applied to multinational product development teams, since these differ on a range of parameters from domestic teams...
Watkins, Michael D
Most leaders don't have the luxury of building their teams from scratch. Instead they're put in charge of an existing group, and they need guidance on the best way to take over and improve performance. Watkins, an expert on transitions, suggests a three-step approach: Assess. Act quickly to size up the personnel you've inherited, systematically gathering data from one-on-one chats, team meetings, and other sources. Reflect, too, on the business challenges you face, the kinds of people you want in various roles, and the degree to which they need to collaborate. Reshape. Adjust the makeup of the team by moving people to new positions, shifting their responsibilities, or replacing them. Make sure that everyone is aligned on goals and how to achieve them--you may need to change the team's stated direction. Consider also making changes in the way the team operates (reducing the frequency of meetings, for example, or creating new subteams). Then establish ground rules and processes to sustain desired behaviors, and revisit those periodically. Accelerate team development. Set your people up for some early wins. Initial successes will boost everyone's confidence and reinforce the value of your new operating model, thus paving the way for ongoing growth.
Nielsen, Louise Møller; Tollestrup, Christian
if they have reached an agreement and everyone nods their approval. Everyone leaves the meeting, confident that they know what to do. A few weeks after, it is time for the second meeting. The team spirit is still high and there is a nice buzz in the meeting room, before the meeting starts. The introduction...... and that nobody really understood each other. The situation described above could perhaps be taken out of several different contexts and scenarios. Most people, who have been working in teams, probably recognize it, and especially people with experi-ences from interdisciplinary teams can confirm...... that this situation is part of many projects. Lack of shared understanding or frames is just one of the difficulties facing interdisciplinary design teams working in the early phases of innovation. Besides managing their different values, perspectives and interests that cause them to see different things as important...
Casarett, David; Spence, Carol; Clark, Melissa A; Shield, Renée; Teno, Joan M
Despite progress towards safer care in most settings, there has been much less attention to improving safety in hospices, which care for more than 1,500,000 patients every year. In this article, we describe three serious conflicts that arise when safety measures from other settings are applied to hospice. First, safety measures that are imposed in order to reduce morbidity and mortality may be irrelevant for a hospice patient whose goals focus on comfort. Second, safety measures that are defined in patients with a life expectancy of years can be inappropriate for hospice patients whose typical survival is measured in days. Third, it can be very difficult to assign responsibility for the safety of hospice patients, whose care is provided mostly by family and friends. Therefore, generally accepted safety measures are often inappropriate for hospice care, and can lead to unintended consequences if they are applied without critical evaluation or modification. Instead, we suggest three principles that can guide the development of hospice-appropriate safety measures by considering a patient's goals and life expectancy, and the degree to which responsibility for a patient's care is shared.
Cherlin, Emily J; Brewster, Amanda L; Curry, Leslie A; Canavan, Maureen E; Hurzeler, Rosemary; Bradley, Elizabeth H
Despite evidence that enrollment with hospice services has the potential to reduce hospital readmission rates, previous research has not examined exactly how hospitals may promote the appropriate use of hospice and palliative care for their discharged patients. Therefore, we sought to explore the strategies used by hospitals to increase the use of hospice and palliative care for patients at risk of readmission. We conducted a secondary analysis of qualitative data from a study of hospitals that were participating in the State Action on Avoidable Readmissions (STAAR) initiative, a quality improvement collaborative. We used data attained from 46 in-depth interviews conducted during 10 hospital site visits using a standard discussion guide and protocol. We used a grounded theory approach using the constant comparative method to generate recurrent and unifying themes. We found that a positive effect for hospitals participating in the STAAR initiative was enhanced engagement in efforts to promote greater use of hospice and palliative care as a possible method of reducing unplanned readmissions, the central goal of the STAAR initiative. Hospital staff described strategies to increase the use of hospice and palliative care that included (1) designing and implementing tracking systems to identify patients most at risk of being readmitted, (2) providing education about hospice and palliative care to family, internal and external clinical groups, and (3) establishing closer links to posthospital settings. National efforts to reduce rehospitalizations may result in improved integration of hospice and palliative care for patients who are at risk of readmission.
Lindley, Lisa C; Edwards, Sheri L
To map and describe the geographic distribution of pediatric hospice care need versus supply in California over a 4-year time period (2007-2010). Multiple databases were used for this descriptive longitudinal study. The sample consisted of 2036 children and adolescent decedents and 136 pediatric hospice providers. Geocoded data were used to create the primary variables of interest for this study-need and supply of pediatric hospice care. Geographic information systems were used to create heat maps for analysis. Almost 90% of the children and adolescents had a potential need for hospice care, whereas more than 10% had a realized need. The highest density of potential need was found in the areas surrounding Los Angeles. The areas surrounding the metropolitan communities of Los Angeles and San Diego had the highest density of realized hospice care need. Sensitivity analysis revealed neighborhood-level differences in potential and realized need in the Los Angeles area. Over 30 pediatric hospice providers supplied care to the Los Angeles and San Diego areas. There were distinctive geographic patterns of potential and realized need with high density of potential and realized need in Los Angeles and high density of realized need in the San Diego area. The supply of pediatric hospice care generally matched the needs of children and adolescents. Future research should continue to explore the needs of children and adolescents at end of life at the neighborhood level, especially in large metropolitan areas.
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.
Lai, Wei-Shu; Ying, Wan-Ping; Chao, Co-Shi Chantal
The aim of hospice palliative education care is to train nurses in hospice philosophy, terminal care skills, nursing care competencies, and professional reliability. Student nurses, staff nurses, and advanced practice nurses must be taught through a proper sequence, from novice to expert. Working together with patients and their families, nurses can educate and care for the physical, social and spiritual needs of terminally ill patients. Currently, problems faced in hospice palliative care education include: 1. The lack of a systematic plan focusing on hospice palliative care and terminal care in nursing schools; 2. The absence of comfort care, communications, ethics, and other relevant issues in extant education and training; 3. The limited number of institutes that currently provide in-service training; 4. The shortage of teachers proficient in both hospice care knowledge and practice; and 5. The current overdependence on traditional nursing education models, which hinders student nurse originality and delays staff nurse growth. Faced with the present issues, self-reflection, localization, and multiple teaching strategies should be the critical developmental directions of hospice palliative education. In order to improve terminal care quality, it is also important to integrate practice, education, and research in order to train more hospice palliative nurses.
Kraynik, Sally E; Casarett, David J; Corcoran, Amy M
Dying patients whose implantable cardioverter defibrillators (ICDs) continue to deliver shocks may experience significant pain, and the National Quality Forum has endorsed routine deactivation of ICDs when patients near the end of life. The overarching goal of this quality improvement project was to increase rates of ICD deactivation among hospice patients. ICD deactivation rates pre- vs. post-intervention; and clinicians' knowledge and confidence regarding ICD management. A multifaceted intervention included clinical tools, education, and standardized documentation templates in the electronic medical record. The proportion of patients whose ICD was deactivated increased after the intervention (pre- vs. post-intervention: 39/68, 57% vs. 47/56, 84%; odds ratio 3.88; 95% confidence interval 1.54-10.37; P = 0.001). Clinicians' knowledge and confidence regarding ICD management improved (pre- vs. post-intervention median questionnaire scores: 5 vs. 9 on a scale of 0 to 10; Wilcoxon signed-rank test Z = -5.01; P < 0.001). A multifaceted intervention can increase rates of ICD deactivation among patients near the end of life. Copyright © 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
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.
Harrold, Joan; Byhoff, Elena; Harris, Pamela; Szolarova, Robertina; Bender, Laura; Craig, Teresa; Casarett, David
Although hospices need to be able to anticipate patient acuity, there are currently no published models that predict the frequency of visits that a new hospice patient is likely to receive. To identify patient characteristics that are associated with the frequency of health care provider visits in the first 8 days of hospice care. An electronic health record (EHR)-based retrospective cohort study was conducted in seven hospice programs in the United States. Participants were 35,232 patients who were admitted between October 1, 2008 and May 31, 2011 and received hospice care at home on the day of enrollment. The main outcome measure was the average number of visits per day by nurses, social workers, chaplains, and home health aides in the first 8 days of home hospice care (day of admission plus up to 7 subsequent days). In a mixed effects regression model, 14 independent predictors of visit frequency were identified. For instance, several demographic characteristics were associated with more frequent visits, as were lower Palliative Performance Scale (PPS) scores (60: 1.41 visits/day, 95% CI 1.36-1.47; p<0.001), the presence of pain (pain: 1.77 visits/day; 95% CI 1.72-1.82 versus no pain: 1.44 visits/day, 95% CI .39-1.59; p<0.001). Patients admitted to home hospice from a hospital also received more frequent visits compared with other patients (hospital: 1.73 visits/day, 95% CI 1.67-1.79 versus home: 1.42 visits/day, 95% CI 1.40-1.44; p<0.001). An acuity index based on these variables could help hospices to better anticipate patient needs and staff workload, and could be used to guide strategic planning as hospices take part in accountable care organizations (ACOs).
Johnson, Margaret O; Frank, Samuel; Mendlik, Matthew; Casarett, David
Although the early and middle stages of Huntington's Disease (HD) and its complications have been well described, less is known about the course of late-stage illness. In particular, little is known about the population of patients who enroll in hospice. Our goal is to describe the characteristics of patients with HD who enrolled in hospice. Retrospective cohort study of electronic medical record data from 12 not-for-profit hospices in the United States from 2008 to 2012. Of 164,032 patients admitted to these hospices, 101 (0.06%) had a primary diagnosis of HD. Their median age was 57 (IQR: 48-65) and 53 (52.5%) were female. Most patients were cared for by a spouse (n=36, 36.6%) or adult child (n=20, 19.8%). At the time of admission, most patients were living either at home (n=39, 38.6%) or in a nursing home (n=41, 40.6%). All were either bedbound or could ambulate only with assistance. The most common symptom reported during enrollment in hospice was pain (n=34, 33.7%) followed by anxiety (n=30, 29.7%), nausea (n=18, 17.8%) and dyspnea (n=10, 9.9%). Patients had a median length of stay in hospice of 42 days, which was significantly longer than that of other hospice patients in the sample (17 days) p<0.001. Of 101 patients who were admitted to hospice, 73 died, 11 were still enrolled at the time of data analysis, and 17 left hospice either because they no longer met eligibility criteria (n=14, 13.7%) or because they decided to seek treatment for other medical conditions (n=3, 3.0%). Of the 73 patients who died while on hospice, most died either in a nursing home (n=29; 40%) or a hospital (n=27; 37%). Seventeen patients (23%) died at home. No patient that started in a facility died at home. Patients with HD are admitted to hospice at a younger age compared to other patients (57 versus 76 years old), but have a significant symptom burden and limited functional status. Although hospice care emphasizes the importance of helping patients to remain in their homes, only a
Trauger-Querry, B; Haghighi, K R
Pain and symptom management are a major part of hospice care. Literature and direct experience suggest that pain can be resistant if psychological, emotional, or spiritual issues are not addressed. This article explains how art and music therapies can work in conjunction with traditional medical treatment of pain control in the hospice setting. The process of pain modulation through the use of art and music interventions is diagrammed and described. Brief clinical examples demonstrate the use of art and music therapies for pain reduction with a variety of hospice patients. Information regarding appropriate education and training necessary for art and music therapists to practice in their field is presented.
The residential hospice care movement is increasingly accepted and supported globally, and yet, unfortunately, the amount of literature on best practices in the planning and design of residential hospice facilities and adjacent outdoor spaces remains relatively small. This paper reports on a compendium of architectural and landscape design considerations that reflect the fundamental dimensions of the residential hospice experience: site and context, arrival spaces, communal and private spaces of the residential milieu, transitional spaces, and nature connectivity. Additionally, key staffing and administrative ramifications of this built-environment compendium are addressed, as are prognostications and challenges for the future.
Cimino, Nina M; McPherson, Mary Lynn
Palliative and hospice care are increasingly being provided in nursing home settings. The current article reviews the existing evidence relevant to nursing homes to provide practitioners with a greater understanding of the impact of palliative and hospice care on clinical care outcomes (e.g., pain, symptom management), processes of care outcomes (e.g., hospitalizations, cost of care), and family member or health care proxy perceptions of care. Overall, the provision of hospice or palliative care in nursing facilities can improve the clinical care residents receive, reduce hospitalizations, and improve family members' perception of care. Copyright 2014, SLACK Incorporated.
As hospital-based hospice programs proliferate across the country, most are under the leadership of a nurse administrator. Nurse administrators must be prepared to manage the many components that constitute the broad scope of this role. Cost-effective management is the greatest challenge. The author explores this management role, including a discussion of hospice-program reimbursement, hospital-based program advantages, options to increase staff productivity, management of drugs and durable medical equipment, inpatient admissions, volunteer services, and fund-raising. Cost-effective measures are explored throughout the discussion, along with a history and explanation of the hospice concept of care.
Andrews, James; Seaver, Earl; Stevens, George; Whiteley, Joseph
Family members (N=83) who participated in professional team staffing concerning treatment plans for their child with a craniofacial difference (typically, cleft lip and/or palate) were surveyed. Ninety-seven percent of respondents said they would choose to meet with the team on their next visit to the clinic. The role of early interventionists on…
Full Text Available Abstract Background There are few studies that examine the processes that interdisciplinary teams engage in and how we can design health information systems (HIS to support those team processes. This was an exploratory study with two purposes: (1 To develop a framework for interdisciplinary team communication based on structures, processes and outcomes that were identified as having occurred during weekly team meetings. (2 To use the framework to guide 'e-teams' HIS design to support interdisciplinary team meeting communication. Methods An ethnographic approach was used to collect data on two interdisciplinary teams. Qualitative content analysis was used to analyze the data according to structures, processes and outcomes. Results We present details for team meta-concepts of structures, processes and outcomes and the concepts and sub concepts within each meta-concept. We also provide an exploratory framework for interdisciplinary team communication and describe how the framework can guide HIS design to support 'e-teams'. Conclusion The structures, processes and outcomes that describe interdisciplinary teams are complex and often occur in a non-linear fashion. Electronic data support, process facilitation and team video conferencing are three HIS tools that can enhance team function.
Azoulay, Daniel; Jacobs, Jeremy M; Cialic, Ron; Mor, Eliana Ein; Stessman, Jochanan
Although pain is common among advanced cancer patients, it can be controlled in a large proportion of patients. Several barriers hinder this, including the concern that opioids hasten death. We examined whether opioids influence survival among advanced cancer patients. Retrospective observational study from September 2006 to October 2007. In-patient hospice unit. Participants were 114 consecutive hospice patients (mean age 71.7 ± 13.9 years). Analysis of survival (days) following admission, according to opioid usage. Standardized Oral Morphine Equivalents (OME mg/d) were calculated. On admission 74.6% received opioids, rising to 92.1% at death. Mean opioid dosage was OME of 146 ± 245 mg/d, and mean survival was 12.3 ± 12.15 days. Mean survival, according to opioid dosage of 0, 1 to 119, and greater than or equal to 120 OME mg/d respectively at admission, was 16.7 ± 13.4, 11.2 ± 12.1, 10.0 ± 10.2 (P = .009), and according to dose at death was 17.0 ± 15.1, 12.3 ± 12.1, 11.1 ± 11.3 (P = ns). Increasing overall opioid dosage was associated with improved survival compared with no change or decreasing overall dosage (mean survival 14.0 ± 12.7 days versus 9.3 ± 9.8 versus 9.1 ± 11.4, days respectively, P = .01). Adjusting for clinical variables in Cox proportional hazards models, no significant association was found between mortality and of the following aspects of opioid usage: (1) dose on admission (Hazard Ratio [HR] 1.009, 95% confidence interval [CI] 0.999-1.019); (2) dose at death (HR 1.004, 95% CI 0.996-1.013); (3) mean dose (HR 1.006, 95% CI 0.997-1.016); (4) overall dose increase (HR 0.733, 95% CI 0.417-1.288) and decrease (HR 0.967, 95% CI 0.472-1.984); (5) day-by-day dosage changes (HR 1.005, 95% CI 0.996-1.013). Opioid usage, even at high dosages, had no effect on survival among advanced cancer patients in a hospice setting. Copyright © 2011 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.
Niedzielski, Oksana K; Rodin, Gary; Emmerson, Debbie; Rutgers, Job; Sellen, Katherine M
Residential hospices are often purpose-built to enhance the experience of patients and families. However, there has been relatively little research on ambient and sensory experiences of patients and families. This study explored the ambient and sensory experience of residents and families in a residential hospice. Hospice users participated in personalizing environments and experiences, adapting and developing rituals, and enjoying the experience (including smells and sounds) of communal spaces and private rooms. Opportunity for developing new rituals, in particular, suggests an environment supportive of sense of control, social support, and positive distractors. The design of an inpatient hospice can offer a platform through which to support the delivery of flexible care practices, providing opportunities for personal expression, shared experiences, and the maintenance or development of rituals. © The Author(s) 2016.
Olthuis, Gert; Dekkers, Wim; Leget, Carlo; Vogelaar, Paul
Good nursing is more than exercising a specific set of skills. It involves the personal identity of the nurse. The aim of this article is to answer two questions: (1) what kind of person should the hospice nurse be? and (2) how should the hospice nurse engage in caring conversations? To answer these questions we analyse a nurse's story that is intended to be a profile of an exemplary hospice nurse. This story was constructed from an analysis of five semistructured interviews with hospice nurses, based on the 'ethics of the caring conversation', which is inspired by the ethical perspective of Paul Ricoeur. The research questions concentrate on the norms of respect, responsibility and reciprocity, which are integral parts of the 'ethics of the caring conversation'.
...: Patient Care Non-Core Services § 418.76 Condition of participation: Hospice aide and homemaker services.... (iii) Assistance in ambulation or exercises. (iv) Assistance in administering medications that are...
Ghesquiere, Angela; Thomas, Julie; Bruce, Martha L
Approximately 10% of the bereaved are at risk of bereavement-related mental health disorders. Hospices' bereavement services could potentially address needs of many at risk, but little is known about their service use. We analyzed data from 6160 bereaved family members of hospice patients. Risk of mental health problems was identified by hospice providers postloss. Of those characterized as "at-risk," 52% used services compared to 18% of the "low risk." Factors associated with service use among at-risk were female gender and younger age of death. Those who lost a child used services less than other bereaved. Although hospices appear to be skilled at identifying and providing bereavement services to the at-risk, services do not reach almost half. Results suggest the need to improve care access, especially among men and those losing a child. © The Author(s) 2014.
The use of arts in hospices is now well established. However, the voluntary nature of much hospice work in England encourages most regular creative activities to be provided by volunteers with minimal financial support. This article looks at how a successful arts and crafts exhibition for a hospice community was staged by a volunteer arts worker, helped by art and design students from the local university. It was not intended that the exhibition should be a research project; however, it became clear that to learn more about arts practice within a hospice environment, it would need to be appraised in some way. The project leader (and author) adopted an approach which reflected on the responses of people involved in the preparation and staging of the exhibition.
Lindley, Lisa C; Mixer, Sandra J; Cozad, Melanie J
The nursing shortage is projected to intensify in the United States. Organizations providing specialized hospice and palliative care will be particularly hard hit. The purpose of our study was to examine the influence of the nursing unit on registered nurse (RN) vacancies and test the moderating role of recruitment strategies in perinatal hospices. We estimated the association between the nursing unit and RN vacancies and tested the interaction effects of recruitment strategies (signing bonus and recruitment bonus). Our findings showed that increasing RN unit size and nursing leadership directly affected vacancies and that recruitment bonuses had stronger influence on reducing vacancies than signing bonuses. The findings offer critical insights for hospice administrators in attracting nurses among specialized hospice and palliative care providers. © The Author(s) 2015.
...) must provide, or arrange for the provision of, nursing and related services and specialized...), dietary services, physician services, dental services, pharmacy services, specialized rehabilitative... hospices to provide care for LTC facility residents largely parallels the language and intent of the...
Reese, Dona J; Buila, Sarah; Cox, Sarah; Davis, Jessica; Olsen, Meaghan; Jurkowski, Elaine
Research documents a lack of access to, utilization of, and satisfaction with hospice care for African Americans. Models for culturally competent hospice services have been developed but are not in general use. Major organizational barriers include (1) lack of funding/budgeting for additional staff for community outreach, (2) lack of applications from culturally diverse professionals, (3) lack of funding/budgeting for additional staff for development of culturally competent services, (4) lack of knowledge about diverse cultures, and (5) lack of awareness of which cultural groups are not being served. A participatory action research project addressed these organizational barriers through a multicultural social work student field placement in 1 rural hospice. The effectiveness of the student interventions was evaluated, including addressing organizational barriers, cultural competence training of staff, and community outreach. Results indicated that students can provide a valuable service in addressing organizational barriers through a hospice field placement.
Fairfield, Kathleen M; Murray, Kimberly M; Wierman, Heidi R; Han, Paul K J; Hallen, Sarah; Miesfeldt, Susan; Trimble, Edward L; Warren, Joan L; Earle, Craig C
Timely hospice referral is an essential component of quality end-of-life care, although a growing body of research suggests that for patients with various types of cancer, hospice referrals often occur very late in the course of care, and are marked by sociodemographic disparities. However, little is known about the ovarian cancer patient population specifically. We examined the extent and timing of hospice referrals in ovarian cancer patients over age 65, and the factors associated with these outcomes. We used the Surveillance, Epidemiology, and End Results (SEER)-Medicare database to identify 8211 women aged 66+ with ovarian cancer who were diagnosed between 2001 and 2005 and died by December 31, 2007. We excluded women who were not eligible for Medicare A continuously during the 6 months prior to death. Outcomes studied included overall hospice use in the last 6 months of life and late hospice enrollment, defined as within 3 days of death. We examined variations in these two measures based on year of diagnosis and sociodemographic characteristics (age, race, marital status, rural residence, income, education) and type of Medicare received (fee-for-service vs. managed care). Among 8211 women in the cohort who died from ovarian cancer, 39.7% never received hospice care (3257/8211). Overall hospice care increased over the period of observation, from 49.7% in 2001 to 63.6% [corrected] in 2005, but the proportion of women receiving hospice care within 3 days of death did not improve. Among those who received hospice care, 11.2% (556/4954) and 26.2% (1299/4954) received such care within 3 and 7 days of death, respectively. A higher proportion of black women (46.5% vs. 38.4% among whites), women in the lowest income group (42.8% vs. 37.0% in the highest income group), and those receiving fee-for-service Medicare (41.3% vs.33.5% for women in managed care) never received hospice care. In multivariable models, factors associated with lack of hospice care included age
Daily, B.; Loveland, J.; Whatley, A. [New Mexico State Univ., Las Cruces, NM (United States)] [and others
This is a preliminary report of a multi-year collaboration of the authors addressing the subject: Can a facility be designed for team learning and would it improve the efficiency and effectiveness of team interactions? Team learning in this context is a broad definition that covers all activities where small to large groups of people come together to work, to learn, and to share through team activities. Multimedia, networking, such as World Wide Web and other tools, are greatly enhancing the capability of individual learning. This paper addresses the application of technology and design to facilitate group or team learning. Many organizational meetings need tens of people to come together to do work as a large group and then divide into smaller subgroups of five to ten to work and then to return and report and interact with the larger group. Current facilities were not, in general, designed for this type of meeting. Problems with current facilities are defined and a preliminary design solution to many of the identified problems is presented.
Full Text Available Paul Y Takahashi,1 Gregory J Hanson,1,2 Bjorg Thorsteinsdottir,1 Holly K Van Houten,3 Nilay D Shah,3 James M Naessens,3 Jennifer L Pecina41Division of Primary Care Internal Medicine, 2Kogod Center of Aging, 3Division of Health Science Research, 4Department of Family Medicine, Mayo Clinic, Rochester, MN, USABackground: 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.Objective: To determine the relationship between telemonitoring and hospice enrollment compared to usual care among older adults with chronic health problems.Methods: 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.Results: 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.Conclusion: 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
Olthuis, Gert; Leget, Carlo; Dekkers, Wim
This article discusses the relationship between personal and professional qualities in hospice nurses. We examine the notion of self-esteem in personal and professional identity. The focus is on two questions: (1) what is self-esteem, and how is it related to personal identity and its moral dimension? and (2) how do self-esteem and personal identity relate to the professional identity of nurses? We demonstrate it is important that the moral and personal goals in nurses' life coincide. If nurses' personal view of the good life is compatible with their experiences and feelings as professionals, this improves their performance as nurses. We also discuss how good nursing depends on the responses that nurses receive from patients, colleagues and family; they make nurses feel valued as persons and enable them to see the value of the work they do.
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.
Kerr, Christopher W; Tangeman, John C; Rudra, Carole B; Grant, Pei C; Luczkiewicz, Debra L; Mylotte, Kathleen M; Riemer, William D; Marien, Melanie J; Serehali, Amin M
Outpatient programs have been traditionally offered in the U.S. under programs such as the Medicare Hospice Benefit. Recommendations now emphasize a blended model in which palliative care is offered concurrently with curative approaches at the onset of serious or life-limiting disease. The efficacy of nonhospice outpatient palliative care programs is not well understood. The aim of the study was to evaluate the clinical impact of a home-based palliative care program, Home Connections, implemented as a partnership between a not-for-profit hospice and two private insurers. This was a prospective, observational, database study of 499 Home Connections participants enrolled between July 1, 2008, and May 31, 2013. Measured outcomes were advance directive completion, site of death, symptom severity over time, program satisfaction, and hospice referral and average length of stay. Seventy-one percent of participants completed actionable advance directives after enrollment, and the site of death was home for 47% of those who died during or after participation in the program. Six of eight symptom domains (anxiety, appetite, dyspnea, well-being, depression, and nausea) showed improvement. Patients, caregivers, and physicians gave high program satisfaction scores (93%-96%). Home Connections participants who subsequently enrolled in hospice care had a longer average length of stay of 77.9 days compared with all other hospice referrals (average length of stay 56.5 days). A home-based palliative care program was developed between two local commercial payers and a not-for-profit hospice. Not only did this program improve symptom management, advance directive completion, and satisfaction, but it also facilitated the transition of patients into hospice care, when appropriate. Copyright © 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
Casarett, David J; Fishman, Jessica M; Lu, Hien L; O'Dwyer, Peter J; Barg, Frances K; Naylor, Mary D; Asch, David A
To be eligible for the Medicare Hospice Benefit, cancer patients with a life expectancy of 6 months or less must give up curative treatment. Our goal was to determine whether willingness to make this choice identifies patients with greater need for hospice services. Three hundred patients with cancer and 171 family members were recruited from six oncology practices. Respondents completed conjoint interviews in which their perceived need for five hospice services was calculated from the choices they made among combinations of services. Patients' preferences for treatment were measured, and patients were followed for 6 months or until death. Thirty-eight patients (13%) said they would not want cancer treatment even if it offered an almost 100% chance of 6-month survival. These patients, who would have been eligible for hospice, did not have greater perceived need for hospice services compared with other patients (n = 262; mean, 1.75 v 1.98; Wilcoxon rank sum test, P = .46), nor did their family members (mean, 1.95 v 2.04; Wilcoxon rank sum test, P = .80). Instead, independent predictors of patients' perceived need for hospice services included African American ethnicity, less social support, worse functional status, and a greater burden of psychological symptoms. For families, predictors included caregiver burden, worse self-reported health, working outside the home, and caring for a patient with worse functional status. The requirement that patients forgo life-sustaining treatment does not identify patients with greater perceived need for hospice services. Other characteristics offer a better way to identify the patients who are most likely to benefit from hospice.
DiBiasio, Eleanor L; Teno, Joan M; Clark, Melissa A; Spence, Carol; Casarett, David
Key to high-quality care of dying hospice patients at home is whether the hospice provides adequate training so the caregiver can safely care for the patient. The study objective was to develop and validate a survey of hospice training for caregivers to ensure safe, high-quality care in the home setting. Our survey design was cross-sectional. Bereaved respondents of individuals who died at home under the care of hospice were surveyed three to six months postdeath. Items were developed based on advice of an expert panel, focus groups of hospice caregivers, and literature review, with 12 items developed for testing and examining 8 key processes of care. We examined the validity and reliability of the assessment using factor analysis, correlational analyses, and multivariable modeling. Our sample consisted of 262 primary caregivers (mean age 62.4, 76.7% female, 58.8% non-Hispanic white). Six questions focused on providing the caregiver with information, while another six focused on the training that hospice provided. Based on model fit and Cronbach's alpha, we dropped the information items. The items that examined hospice training demonstrated a one-factor solution and a Cronbach's of 0.90. We examined correlations of the multi-item composite with overall rating of quality of care (0.53), overall distress (0.31), and whether the respondent would recommend this hospice to others (0.49). There were no significant sociodemographic correlates of concerns with training. Sufficient preliminary reliability and validity warrants further testing of this composite to examine the adequacy of training provided to family members to care safely for the patient.
To analyse the processes by which the hospice concept was translated into a reimbursable model of care in the USA and what was gained and what was lost in translation. Existing scholarship of the modern hospice movement typically focuses on the contributions of physicians to its inception and development. However, very little is known about the multifaceted role of nurses in the development of hospice care and the impact of Medicare policy on contemporary hospice care in the USA. Primary data were collected and interpreted using a blended social/policy history framework. Archival data were drawn from the papers of individuals and organisations integral to the American hospice movement; Congressional testimony; and, primary and secondary research data and reports. Interviews with key individuals were taped and transcribed verbatim. Data were analysed for emergent patterns, themes and subthemes. These were then contextualised within historiographical framework of twentieth century healthcare reforms. Nurses were central to the inception and development of hospice care in the United States. While they were intricately involved with most aspects of the hospice movement and helped to frame the policy debate, they were ultimately unable to wholly determine national policy or extend their influence beyond their own circles. The standardisation of hospice care in the USA served to improve the quality of care for many dying patients and their families. Yet, it also served to reinforce a false dichotomy between care for the living and care for the dying. As a result, the integration of palliative care concepts into standard clinical nursing practice remains problematic. This study illuminates the socio-political complexities that shape health policy and the subsequent impact on nursing practice. Its findings have broad implications for contemporary palliative care initiatives regardless of locale.
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.
Shega, Joseph W; Hougham, Gavin W; Stocking, Carol B; Cox-Hayley, Deon; Sachs, Greg A
To evaluate the impact hospice enrollment has on the terminal care of patients with dementia and describe the symptom burden these patients experience, caregivers of dementia decedents were assessed in a mortality follow-back survey. Patients had been managed through academic outpatient geriatric clinics in Chicago, IL. A total of 135 family members or other knowledgeable informants of persons who had died with dementia were queried about the patient's preferred location of death, location of death, satisfaction with patient care, and assessment of patient's pain and most bothersome symptom. Patients who were enrolled in hospice were significantly more likely to die in their location of choice (odds ratio [OR] 9.67; 95% confidence interval [CI] 2.57-37.0), and less likely to die in the hospital, (OR 0.04; 95% CI 0.01-0.18), compared to nonenrollees. Caregivers of hospice enrollees were more likely to rate patient care as excellent or very good (OR 5.65; 95% CI 2.61-10.34), compared to nonenrollees. Over 50% of caregivers of hospice enrollees and nonenrollees reported patient pain at a moderate intensity or higher on average in the last two weeks of life. No effect was observed between a caregiver reporting pain at a moderate level or higher and whether the patient was enrolled in hospice (OR 0.58; 95% CI 0.22-1.54). Hospice enrollees did not experience improvement in their most bothersome symptom's frequency, severity, or amount of distress caused (P=0.21, 0.39, 0.95, respectively), compared to nonenrollees. These results suggest that dying patients with dementia who are enrolled in hospice programs are more likely to die in their locations of choice and their caregivers are more likely to perceive that care is excellent or good than those who do not obtain hospice services. No effect on pain or other symptoms could be demonstrated in this analysis.
Tsalatsanis, Athanasios; Barnes, Laura E; Hozo, Iztok; Djulbegovic, Benjamin
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. 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. 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. We present a theoretical framework to facilitate the hospice referral process. Further rigorous
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
Monroe, Todd B; Carter, Michael A; Feldt, Karen S; Dietrich, Mary S; Cowan, Ronald L
One condition associated with severe end-of-life pain that can lead to a poor quality of death is cancer. Cancer pain in people with dementia is of particular concern because of communication problems that occur with worsening disease. The aim of the current pilot study was to examine the association between hospice enrolment, dementia severity and pain among nursing home residents who died from advanced cancer. Between-groups cross-sectional chart audits of 55 nursing home residents with dementia who died from cancer were carried out. A total of 45% of residents were in hospice at the end-of-life. Residents in hospice were more likely to receive an opioid (80% vs 43%, P = 0.005); but less likely to show severe cognitive impairment (20% vs 50%, P = 0.050). Enrolment in hospice was associated with an increased likelihood of receiving an opioid after controlling for level of cognitive impairment (OR = 3.9, 95% CI = 1.1-14.0, P = 0.037). Lower levels of cognitive functioning were associated with a decreased likelihood of receiving an opioid after controlling for enrolment in hospice (OR = 0.3, 95% CI = 0.1-0.8, P = 0.030). Notably, 40% of nursing home residents with dementia who died from cancer did not receive any opioid during this time. Preliminary results suggest that hospice enrolment might be influenced by the facility or region of this particular country. Hospice enrolment predicts more opioid pain treatment in residents with dementia and terminal cancer; however, no resident with very severe dementia and terminal cancer was placed in hospice care. Severely cognitively impaired nursing home residents requiring opioids are at great risk of suffering from untreated advanced cancer pain. New methods are urgently required to improve end-of-life palliative care for nursing home residents with terminal cancer and severe dementia. © 2013 Japan Geriatrics Society.
...The Department of Veterans Affairs (VA) amends its regulations concerning the billing methodology for non-VA providers of home health 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 not have existing negotiated contracts with VA. This rule also rescinds internal guidance documents that could be interpreted as conflicting with this final rule.
Payne, Richard; Kuchibhatla, Maragatha N.
Abstract Background: Experts and national organizations recommend that hospices work to increase service to African Americans, a group historically underrepresented in hospice. Objective: The study objective was to describe strategies among hospices in North and South Carolina to increase service to African Americans and identify hospice characteristics associated with these efforts. Methods: The study was a cross-sectional survey using investigator-developed scales to measure frequency of community education/outreach, directed marketing, efforts to recruit African American staff, cultural sensitivity training, and goals to increase service to African Americans. We used nonparametric Wilcoxon tests to compare mean scale scores by sample characteristics. Results: Of 118 eligible hospices, 79 (67%) completed the survey. Over 80% were at least somewhat concerned about the low proportion of African Americans they served, and 78.5% had set goals to increase service to African Americans. Most were engaged in community education/outreach, with 92.4% reporting outreach to churches, 76.0% to social services organizations, 40.5% to businesses, 35.4% to civic groups, and over half to health care providers; 48.0% reported directed marketing via newspaper and 40.5% via radio. The vast majority reported efforts to recruit African American staff, most often registered nurses (63.75%). Nearly 90% offered cultural sensitivity training to staff. The frequency of strategies to increase service to African Americans did not vary by hospice characteristics, such as profit status, size, or vertical integration, but was greater among hospices that had set goals to increase service to African Americans. Conclusions: Many hospices are engaged in efforts to increase service to African Americans. Future research should determine which strategies are most effective. PMID:26840854
Barclay, Joshua; Kuchibhatala, Maragatha; Tulsky, James A.; Johnson, Kimberly S.
Background Terminally ill patients with lower incomes are less likely to die at home, even with hospice care. Methods Analysis of VITAS hospice patients admitted to routine care in a private residence between January 1, 1999 and December 31, 2003. We matched zip codes to U.S. census tracts to generate annual median household incomes and divided the measure into $10,000 increments from ≤$20,000 to >$50,000). To examine the relationship between income and transfer from home before death, we used logistic regression (adjusted for demographics, diagnosis, region, length of stay). We also examined the interaction between income and level of hospice care (any vs. no continuous care) as a predictor of transfer from home. Unlike routine care which includes periodic visits by hospice, continuous care is a higher level of care, used for short periods of crisis to keep a patient at home and includes hospice services in the home at least 8 hours in a 24 hour period. Results Of the 61,063 enrollees admitted to routine care in a private residence, 13,804 (22.6%) transferred from home to another location (i.e. inpatient hospice unit, nursing home) with hospice care before death. Patients who transferred had a lower average median household income ($42,585 vs. $46,777, Pcare (49.38% vs. 30.61%, Pcare was 4. For patients who did not receive continuous care, the odds of transfer from home before death increased with decreasing annual median household incomes (OR range 1.26—1.76). For patients who received continuous care, income was not a predictor of transfer from home. Conclusions Patients with limited resources may be less likely to die at home, especially if they are not able to access needed support beyond what is available with routine hospice care. PMID:23420383
Wang, Shi-Yi; Aldridge, Melissa D.; Gross, Cary P.; Canavan, Maureen; Cherlin, Emily; Johnson-Hurzeler, Rosemary; Bradley, Elizabeth
Objectives 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. Methods Using Medicare claims for decedents age ≥ 66 years 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 (ED) 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 days), medium (8–179 days), or very long (≥180 days) hospice enrollment, focusing on very short stay. Results 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; 1.23 (CI: 1.12–1.36) for ED 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. Conclusions At the regional level, increased end-of-life care intensity was consistently associated with very short hospice use. PMID:27111747
Holmes, Holly M; Kaiser, Karen; Jackson, Steve; McPherson, Mary Lynn
Reconciling medication use and performing drug utilization review on admission of a patient into hospice care are essential in order to safely prescribe medications and to prevent possible adverse drug events and drug-drug interactions. As part of this process, fully assessing herbal medicine and supplement use in hospice patients is crucial, as patients in hospice may be likely to use these medications and may be more vulnerable to their potential adverse effects. Our purpose was to identify herbals, vitamins, and supplements that should be routinely assessed on every hospice admission because of their higher likelihood of use or higher risk of adverse effects or drug interactions. Experts in the fields of palliative medicine, pharmacy, and alternative medicine were asked to complete a Web-based survey on 37 herbals, vitamins, supplements, and natural products, rating likelihood of use, potential for harm, and recommendation to include it on the final list on a scale of 1 to 5 (least to most likely to agree). Twenty experts participated in the survey. Using a cutoff of 3.75 for inclusion of a medication on the final list, 12 herbal medicines were identified that should be routinely and specifically assessed on hospice admission. Although assessing all herbal medicine use is ideal, thorough detection of herbals may be challenging. The list of herbals and supplements identified by this survey could be a useful tool for medication reconciliation in hospice and could aid in identifying potentially harmful medication use at the end of life.
Haines, Krista L; Jung, Hee Soo; Zens, Tiffany; Turner, Scott; Warner-Hillard, Charles; Agarwal, Suresh
End-of-life and palliative care are important aspects of trauma care and are not well defined. This analysis evaluates the racial and socioeconomic disparities in terms of utilization of hospice services for critically ill trauma patients. Trauma patients ≥15 years old from 2012 to 2015 were queried from the National Trauma Databank. Chi-square and multivariate logistic regression analyses for disposition to hospice were performed after controlling for age, gender, comorbidities, injury severity, insurance, race, and ethnicity. Negative binomial regression analysis with margins for length of stay (LOS) was calculated for all patients discharged to hospice. Chi-square analysis of 2 966 444 patient's transition to hospice found patients with cardiac disease, bleeding and psychiatric disorders, chemotherapy, cancer, diabetes, cirrhosis, respiratory disease, renal failure, cirrhosis, and cerebrovascular accident (CVA) affected transfer ( P care than Caucasian patients (OR: 0.65, 0.60, 0.73; P care and significantly affect LOS. Our data demonstrate prominent racial and socioeconomic disparities exist, with uninsured and minority patients being less likely to receive hospice services and having a delay in transition to hospice care when compared to their insured Caucasian counterparts.
Clayton, Margaret F; Reblin, Maija; Carlisle, McKenzie; Ellington, Lee
To identify and describe communication behaviors used by hospice nurses when eliciting and addressing concerns of patients with cancer and their caregivers. Secondary analysis. Home hospice in Salt Lake City, UT. Audio recordings from seven patient and caregiver dyads and five hospice nurses. Audio recordings were coded using the Roter Interaction Analysis System for patient and caregiver concern statements indicating negative affect and distress and the surrounding nurse communication behaviors. Concern content was categorized using domains developed by the National Consensus Project for Quality Palliative Care. Patient and caregiver concern statements and nurse communication behaviors. 180 patient and caregiver speaking turns containing concerns were identified across 31 hospice visits. Patients and caregivers expressed at least one concern in the vast majority of visits. The most prevalent distress areas reflected psychological and physical issues. Nurses used proportionally more positive emotion statements before patient and caregiver concerns, compared to the visit overall. Nurses asked proportionally more physical questions after concern statements. Nurses also used more emotional responses before and after patient and caregiver concerns, relative to the entire visit. Patients with cancer and caregivers frequently talk about distressing issues. Hospice nurses use specific communication behaviors to elicit and address those issues. Home hospice provides a venue to examine nurse communication behaviors used to elicit and respond to patient and caregiver distress. These strategies could be taught to nurses who encounter patient distress less frequently or are less comfortable with emotional conversations.
Thienprayoon, Rachel; Marks, Emily; Funes, Maria; Martinez-Puente, Louizza Maria; Winick, Naomi; Lee, Simon Craddock
Many children who die are eligible for hospice enrollment but little is known about parental perceptions of the hospice experience, the benefits, and disappointments. The objective of this study was to explore parental perspectives of the hospice experience in children with cancer, and to explore how race/ethnicity impacts this experience. We held 20 semistructured interviews with 34 caregivers of children who died of cancer and used hospice. Interviews were conducted in the caregivers' primary language: 12 in English and 8 in Spanish. Interviews were recorded, transcribed, and analyzed using accepted qualitative methods. Both English and Spanish speakers described the importance of honest, direct communication by medical providers, and anxieties surrounding the expectation of the moment of death. Five English-speaking families returned to the hospital because of unsatisfactory symptom management and the need for additional supportive services. Alternatively, Spanish speakers commonly stressed the importance of being at home and did not focus on symptom management. Both groups invoked themes of caregiver appraisal, but English-speaking caregivers more commonly discussed themes of financial hardship and fear of insurance loss, while Spanish-speakers focused on difficulties of bedside caregiving and geographic separation from family. The intense grief associated with the loss of a child creates shared experiences, but Spanish- and English-speaking parents describe their hospice experiences in different ways. Additional studies in pediatric hospice care are warranted to improve the care we provide to children at the end of life.
Casarett, D J; Hirschman, K B; Henry, M R
To assess the possible benefits and challenges of hospice involvement in nursing home care by comparing the survival and needs for palliative care of hospice patients in long-term care facilities with those living in the community. Retrospective review of computerized clinical care records. A metropolitan nonprofit hospice. The records of 1,692 patients were searched, and 1,142 patients age 65 and older were identified. Of these, 167 lived in nursing homes and 975 lived in the community. Patient characteristics, needs for palliative care, and survival. At the time of enrollment, nursing home residents were more likely to have a Do Not Resuscitate order (90% vs 73%; P home residents also had different admitting diagnoses, most notably a lower prevalence of cancer (44% vs 74%; P home residents, including constipation (1% vs 5%; P = .02), pain (25% vs 41%; P home residents had fewer needs for care (median 0, range 0-3 vs median 1, range 0-5; rank sum test P home residents had a significantly shorter survival (median 11 vs 19 days; log rank test of survivor functions P home residents who are referred to hospice, although nursing home residents may have fewer identifiable needs for care than do community-dwelling older people. However, the finding that nursing home residents' survival is shorter may be of concern to hospices that are considering partnerships with nursing homes. An increased emphasis on hospice care in nursing homes should be accompanied by targeted educational efforts to encourage early referral.
Stein, Gary L; Cagle, John G; Christ, Grace H
Few data are available describing the involvement and activities of social workers in advance care planning (ACP). We sought to provide data about (1) social worker involvement and leadership in ACP conversations with patients and families; and (2) the extent of functions and activities when these discussions occur. We conducted a large web-based survey of social workers employed in hospice, palliative care, and related settings to explore their role, participation, and self-rated competency in facilitating ACP discussions. Respondents were recruited through the Social Work Hospice and Palliative Care Network and the National Hospice and Palliative Care Organization. Descriptive analyses were conducted on the full sample of respondents (N = 641) and a subsample of clinical social workers (N = 456). Responses were analyzed to explore differences in ACP involvement by practice setting. Most clinical social workers (96%) reported that social workers in their department are conducting ACP discussions with patients/families. Majorities also participate in, and lead, ACP discussions (69% and 60%, respectively). Most respondents report that social workers are responsible for educating patients/families about ACP options (80%) and are the team members responsible for documenting ACP (68%). Compared with other settings, oncology and inpatient palliative care social workers were less likely to be responsible for ensuring that patients/families are informed of ACP options and documenting ACP preferences. Social workers are prominently involved in facilitating, leading, and documenting ACP discussions. Policy-makers, administrators, and providers should incorporate the vital contributions of social work professionals in policies and programs supporting ACP.
Jones, Diane; Edes, Thomas; Shreve, Scott; Casarett, David J
Growing evidence indicates that there are abundant opportunities to improve the care that patients receive near the end of life. Hospice care has been associated with improvements in these and other outcomes, but hospice is underused by most patient populations. Therefore, the Department of Veterans Affairs (VA) has made hospice access a priority in its plan to improve end-of-life care for all veterans. In addition to committing funding for hospice care, the VA has also established a national network of Hospice-Veteran Partnerships (HVPs) whose goal is to improve access to hospice for veterans. This article describes the results of a nationwide consensus project to develop measures of the success of HVPs and recommends key measures that should be used to track improvements and to identify opportunities for highly successful collaborative strategies.
Diploma work Prevention of "Burn-out syndrome of health care workers in Hospice Štrasburk and in Hospice Anežka Česká" deals with the care of staff. This care includes development of workers, psychosocial support, psychological hygiene and work organization. These aspect were checked by answer sheets and by talks with the leaders and the hospice staff. Evaluation demonstrated divergence between kinds of managment and in varied access to personnel. The management of Hospice Štrasburk prefers a...
NXT tool for annotating dialogue acts in a multiparty conversation. designer, marketing expert and interface designer), and the team participated in a series of four meetings. The meetings took place over 3–4 hours: about half of this time was spent in meetings, the remainder was spent in preparation, with each participant ...
Sagin, Alana; Kirkpatrick, James N; Pisani, Barbara A; Fahlberg, Beth B; Sundlof, Annika L; O'Connor, Nina R
Despite national requirements mandating collaboration between palliative care specialists and mechanical circulatory support (MCS) teams at institutions that place destination therapy ventricular assist devices, little is known about the nature of those collaborations or outcomes for patients and families. To assess how Centers for Medicare & Medicaid Services' regulations have changed collaboration between palliative care and MCS teams and how this collaboration is perceived by MCS team members. After obtaining verbal consent, members of MCS teams were interviewed using semistructured telephone interviews. Interviews were transcribed, and content was coded and analyzed using qualitative methods. Models for collaboration varied widely between institutions. Several expected themes emerged from interviews: 1) improvements over time in the relationship between palliative care specialists and MCS teams, 2) palliative care specialists as facilitators of advance care planning, and 3) referral to hospice and ventricular assist device deactivation as specific areas for collaboration. Several unexpected themes also emerged: 4) the emergence of dedicated heart failure palliative care teams, 5) palliative care specialists as impartial voices in decision making, 6) palliative care specialists as extra support for MCS team members, and 7) the perception of improved patient and family experiences with palliative care team exposure. Although the structure of collaboration varies between institutions, collaboration between MCS teams and palliative care specialists is increasing and often preceded the Centers for Medicare & Medicaid Services requirement. Overall impressions of palliative care specialists are highly positive, with perceptions of improved patient and family experience and decreased burden on MCS team members. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
Conway Hughston, Veronica
Since 1996 ABET has mandated that undergraduate engineering degree granting institutions focus on learning outcomes such as professional skills (i.e. solving unstructured problems and working in teams). As a result, engineering curricula were restructured to include team based learning---including team charters. Team charters were diffused into engineering education as one of many instructional activities to meet the ABET accreditation mandates. However, the implementation and execution of team charters into engineering team based classes has been inconsistent and accepted without empirical evidence of the consequences. The purpose of the current study was to investigate team effectiveness, operationalized as team viability, as an outcome of team charter implementation in an undergraduate engineering team based design course. Two research questions were the focus of the study: a) What is the relationship between team charter quality and viability in engineering student teams, and b) What is the relationship among team charter quality, teamwork mental model similarity, and viability in engineering student teams? Thirty-eight intact teams, 23 treatment and 15 comparison, participated in the investigation. Treatment teams attended a team charter lecture, and completed a team charter homework assignment. Each team charter was assessed and assigned a quality score. Comparison teams did not join the lecture, and were not asked to create a team charter. All teams completed each data collection phase: a) similarity rating pretest; b) similarity posttest; and c) team viability survey. Findings indicate that team viability was higher in teams that attended the lecture and completed the charter assignment. Teams with higher quality team charter scores reported higher levels of team viability than teams with lower quality charter scores. Lastly, no evidence was found to support teamwork mental model similarity as a partial mediator of the team charter quality on team viability
O'Connor, Nina R; Hu, Rong; Harris, Pamela S; Ache, Kevin; Casarett, David J
To define patient characteristics associated with hospice enrollment in the last 3 days of life, and to describe adjusted proportions of patients with late referrals among patient subgroups that could be considered patient-mix adjustment variables for this quality measure. Electronic health record-based retrospective cohort study of patients with cancer admitted to 12 hospices in the Coalition of Hospices Organized to Investigate Comparative Effectiveness network. Of 64,264 patients admitted to hospice with cancer, 10,460 (16.3%) had a length of stay ≤ 3 days. There was significant variation among hospices (range, 11.4% to 24.5%). In multivariable analysis, among patients referred to hospice, patients who were admitted in the last 3 days of life were more likely to have a hematologic malignancy, were more likely to be male and married, and were younger (age < 65 years). Patients with Medicaid or self-insurance were less likely to be admitted to hospice within 3 days of death. Quality measures of hospice lengths of stay should include patient-mix adjustments for type of cancer and site of care. Patients with hematologic malignancies are at especially increased risk for late admission to hospice. © 2014 by American Society of Clinical Oncology.
Casarett, David J.
Hospice is a system of end-of-life care that’s not used to its full potential. That is, hospice is not used in the way that would benefit patients and families as much as it could. My argument is that this is an issue of usability, or ergonomics—the science of design. I illustrate how to take what we have learned from the science of usability to make hospice more accessible and approachable, and to increase hospice use among those who would benefit from it. Underneath this discussion, though,...
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.
Full Text Available 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.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.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%, p<0.001, intubation (1% vs 27%, p<0.001, cardiopulmonary-cerebral resuscitation (0% vs 11%, p = 0.001, ventilator use (1% vs 27%, p<0.001, inotropic agent use (8% vs 46%, p<0.001, total or partial parenteral nutrition use (38% vs. 58%, p = 0.029, and blood transfusion (45% vs 74%, p<0.001. Besides, the hospice-shared care group had a higher percentage of palliative treatments than the control group, including signed Do-Not-Resuscitate (DNR orders (95% vs 37%, p<0.001, receiving home hospice care (16% vs 1%, p<0.001, and indicating home as the realistically preferred place of death (41% vs 19%, p = 0.001. The hospice ward admission rate in the hospice-shared care group increased from 30% to 53% from 2012 to 2014.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.
Casarett, David; Karlawish, Jason; Morales, Knashawn; Crowley, Roxane; Mirsch, Terre; Asch, David A
Hospice care may improve the quality of end-of-life care for nursing home residents, but hospice is underutilized by this population, at least in part because physicians are not aware of their patients' preferences. To determine whether it is possible to increase hospice utilization and improve the quality of end-of-life care by identifying residents whose goals and preferences are consistent with hospice care. Randomized controlled trial (December 2003-December 2004) of nursing home residents and their surrogate decision makers (N=205) in 3 US nursing homes. A structured interview identified residents whose goals for care, treatment preferences, and palliative care needs made them appropriate for hospice care. These residents' physicians were notified and asked to authorize a hospice informational visit. The primary outcome measures were (1) hospice enrollment within 30 days of the intervention and (2) families' ratings of the quality of care for residents who died during the 6-month follow-up period. Of the 205 residents in the study sample, 107 were randomly assigned to receive the intervention, and 98 received usual care. Intervention residents were more likely than usual care residents to enroll in hospice within 30 days (21/107 [20%] vs 1/98 [1%]; P<.001 [Fisher exact test]) and to enroll in hospice during the follow-up period (27/207 [25%] vs 6/98 [6%]; P<.001). Intervention residents had fewer acute care admissions (mean: 0.28 vs 0.49; P = .04 [Wilcoxon rank sum test]) and spent fewer days in an acute care setting (mean: 1.2 vs 3.0; P = .03 [Wilcoxon rank sum test]). Families of intervention residents rated the resident's care more highly than did families of usual care residents (mean on a scale of 1-5: 4.1 vs 2.5; P = .04 [Wilcoxon rank sum test]). A simple communication intervention can increase rates of hospice referrals and families' ratings of end-of-life care and may also decrease utilization of acute care resources.
Lau, Denys T; Dwyer, Lisa L; Shega, Joseph W
To examine laxative use by individuals in hospice who were taking opioids during the last week of life. Retrospective cross-sectional. 2007 National Home and Hospice Care Survey. Individuals in hospice aged 65 and older who were taking opioids during the last week of life (N = 2,825). Hospice staff were asked the names of all medications and drugs that participants were taking 7 days before and on the day of death while in hospice, including any standing, routine, or as-needed medications." Medications "used" included medications taken and as-needed medications provided in case a symptom developed. Opioids included all opioid-combination drugs. Laxatives included fibers, lubricants, stimulants, and suppositories. Forty-one percent of participants had cancer as the primary hospice diagnosis, 13% heart disease, 12% debility, 11% dementia, 8% lung disease, and 15% other. Overall, 52% of opioid users used a laxative in the last week of life; the proportions of opioid and laxative users did not differ according to diagnosis. Racial minorities taking opioids had lower odds than white participants (odds ratio (OR) = 0.57, 95% confidence interval (CI) = 0.33-0.99) of using laxatives. Participants taking opioids enrolled in hospice for 7 days or less had lower odds of using laxatives than those enrolled for more than 7 days (OR = 0.65, 95% CI = 0.37-0.95), as did those in hospice inpatient, hospital, or other settings (OR = 0.45, 95% CI = 0.43-0.93) than those in long-term care settings. Participants using five or fewer medications had lower odds of using laxatives than those using six to 10 (OR = 6.01, 95% CI = 3.88-9.32) or 11 to 25 medications (OR = 13.80, 95% CI = 8.74-21.80). In 2007, slightly more than half of older adults in hospice who were taking opioids used laxatives during the last week of life. Recent quality indicators from the Centers for Medicare and Medicaid Services recommend laxative treatment when opioid therapy is initiated to prevent opioid
Full Text Available Work Team 2016 (Jan-Jul1. Editorial TeamChief-editorsBayardo Bapstista Torres, Instituto de Química (USP, BrasilEduardo Galembeck, Depto. Bioquímica, Instituto de Biologia, Universidade de Campinas (Unicamp, Brasil Co-editorsGabriel Gerber Hornink, Depto. Bioquímica, Instituto de Ciências Biomédicas, Universidade - Federal de Alfenas (Unifal-MG, BrasilVera Maria Treis Trindade, Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul (UFRGS, Brasil Editorial BoardAdriana Cassina, Department of Biochemistry, Facultad de Medicina, Universidad de la República, UruguayAngel Herráez, Departamento de Bioquímica y Biología molecular, Universidad de Alcalá de Henares, Madrid, SpainAndré Amaral Gonçalves Bianco, Universidade Federal de São Paulo (Unifesp, BrasilDenise Vaz de Macedo, Depto. Bioquímica, Instituto de Biologia, Universidade Estadual de Campinas (Unicamp, BrasilEneida de Paula, Depto. Bioquímica, Instituto de Biologia, Universidade Estadual de Campinas (Unicamp, BrasilJose Antonio Martinez Oyanedel, Universidad de Concepción, ChileJosep Maria Fernández Novell, Department of Molecular Biology & Biochemistry, Universitat de Barcelona, SpainLeila Maria Beltramini, Instituto de Física de São Carlos, Universidade Estadual de São Paulo (USP, BrasilManuel João da Costa, Escola de Ciências da Saúde, Universidade do Minho, PortugalMaria Lucia Bianconi, Instituto de Bioquímica Médica, Universidade Federal do Rio de Janeiro (UFRJ, BrasilMaría Noel Alvarez, Department of Biochemistry, Facultad de Medicina, Universidad de la República, UruguayMiguel Ángel Medina Torres, Department of Molecular Biology & Biochemistry Faculty of Sciences University of Málaga, SpainNelma Regina Segnini Bossolan, Instituto de Física de São Carlos, Universidade de São Paulo (USP, BrasilPaulo De Avila Junior, Centro de Ciências Naturais e Humanas (CCNH Universidade Federal do ABC (UFABC
Multicultural membership and diversity in teams are important to maintain effectiveness in organizations in a global business environment. Multicultural teams offer great potential in international collaboration just as top management teams are becoming increasingly diversified. However......, maintaining team cohesiveness in multicultural teams to collaborate effectively presents a number of challenges. The present study employs the concept of trust to explore influences on team collaboration in high performing teams. The study is based on observation of teams in seven multinational corporations...... as nationalities, gender, functional expertise and international experience. The study contributes insights to diverse teams through a processual study of micro-processes in global organizational contexts crossing multicultural boundaries....
Jul 21, 2011 ... between motivation, personal satisfaction of team members, conformity to team norms and team players generally rendered their services in order to meet certain needs as highlighted in Maslow's hierarchy of needs. Locke and. Latham (1998) also argued that an individual motivation is enhanced when.
Bennett, Roger; Kane, Suzanne
This paper presents the outcomes of a study of the factors that contribute to teaching team effectiveness in situations where team members rarely meet face to face. Academic faculty within a university Business School were asked to report the degrees to which they believed that the module teaching teams to which they belonged contained members who…
Gurtner, Andrea; Tschan, Franziska; Semmer, Norbert K.; Nagele, Christof
This study examines the effect of guided reflection on team processes and performance, based on West's (1996, 2000) concept of reflexivity. Communicating via e-mail, 49 hierarchically structured teams (one commander and two specialists) performed seven 15 min shifts of a simulated team-based military air-surveillance task (TAST) in two meetings, a…
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...
... not limited to the following: Providing medical direction and management of the patient; nursing... eligibility, election, and duration of benefits. Medicare patients receiving hospice services and residing in... are to communicate with each other and document such communications to ensure that the needs of...
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.
Ko, Eunjeong; Lee, Jaehoon; Ramirez, Carlos; Martinez, Stephanie; Lopez, Denicka
Hospice is an important method of promoting quality end-of-life (EoL) care, yet its utilization is relatively low in underserved populations. The unique characteristics of a border community-such as a lack of healthcare resources and cultural integration-impact EoL decision making. The aim of our study was to assess the willingness to use hospice care services and its predictors among family caregivers of Latino patients in the United States (U.S.)-Mexico border region of Southern California. This study analyzes secondary data from a home health agency in the U.S.-Mexico border region. Quantitative data were collected via a face-to-face interview with 189 caregivers of patients enrolled in the agency. Bivariate tests and logistic regression were employed to address our study objectives. The majority (83%) of family caregivers were willing to use hospice services for their loved ones. The factors impacting willingness to use hospice services included the primary language of the caregiver (OR = 6.30, CI 95% = 1.68, 23.58); trust in doctors to make the right decisions (OR = 3.77, CI 95% = 1.05, 13.57); and the belief that using hospice care means giving up on life (OR = 0.52, CI 95% = 0.30; 0.88). Caregivers who trusted doctors to make the best decisions for their loved ones and English-speaking caregivers were more willing to utilize hospice services, while caregivers who held a strong belief that hospice care means giving up on life were less likely to consider using hospice care for their loved ones. The willingness of family caregivers to use hospice services for their loved ones is influenced by cultural perspectives about hospice care. As the importance of family involvement in EoL care planning has been highlighted, family caregivers' beliefs about hospice care services need to be addressed within their particular cultural context.
Frey, Rosemary; Gott, Merryn; Raphael, Deborah; Black, Stella; Teleo-Hope, Linda; Lee, Hyeonjoo; Wang, Zonghua
Do hospice services as shaped by a western perspective adequately fulfil the needs of persons from non-Western cultures? Based on a Western view of palliative care, the vision outlined in the New Zealand Palliative Care Strategy (2001) is to deliver palliative care services, including hospice services, to all patients and their families requiring them in the context of an increasingly pluralistic and multicultural society. It is predicted that over the next two decades the proportion of people identifying as Māori, Pacific and Asian will dramatically increase within New Zealand. Ministry of Health information provided through a GAP analysis identified hospices as facing access-to-care pressures for Māori, Pacific and Asian patients. It is therefore critical to identify the challenges to hospice service access for Māori, Asian and Pacific patients. This project involved qualitative interviews with 37 cancer patients (Māori, Pacific and Asian self-identified ethnicities), whānau/family and bereaved whanua/family, as well as 15 health professionals (e.g. referring GPs, oncologists, allied health professionals) within one District Health Board. Patients and their families included both those who utilised hospice services, as well as those non-users of hospice services identified by a health professional as having palliative care needs. Challenges to hospice service utilisation reported in the findings include a lack of awareness in the communities of available services, as well as continuing misconceptions concerning the nature of hospice services. Language barriers were particularly reported for Asian patients and their families. Issues concerning the ethnic representativeness of the hospice services staff were raised. The findings highlight the importance of patient and family knowledge of hospice care for utilisation of services. This information can be used for future planning to enable hospices to both provide high quality evidence based palliative care
develop teams which provide them capacity and diversity to make sound decisions.1 Strategic leader and top management teams exist throughout...looks at whether a leader should use a team to make a decision; it does not look at how to manage a team process to produce desired outcomes. Yet, the...choices on how to operate his/her team. Leaders of strategic leader teams must recognize and understand how they can manage the processes utilized
Hung, Yen-Ni; Wen, Fur-Hsing; Liu, Tsang-Wu; Chen, Jen-Shi; Tang, Siew Tzuh
Evidence for the association of hospice exposure with lower health care expenditures at end of life (EOL) remains inconclusive and neglects EOL care being concentrated in patients' last few months. The association between hospice exposure and health care expenditures in cancer patients' last one, three, six, and 12 months was evaluated. In this population-based, retrospective cohort study, Taiwanese cancer decedents in 2001-2010 (N = 195,228) were matched 1:1, with proportions of matched hospice users reaching 87.8%, by a hospice-utilization propensity score. For each matched pair, exposure to hospice (time from hospice enrollment to death) was matched to equivalent periods for hospice nonusers before death. Hospice-care associations with health care expenditures were evaluated by hospice use/exposure interactions with multilevel linear regression modeling using generalized estimating equations. The unadjusted main effect showed lower total mean health care expenditures for hospice users than for hospice nonusers only in the last one and three months (rate ratio [95% CI]: 0.86 [0.81, 0.90] and 0.93 [0.89, 0.96], respectively). However, after accounting for exposure time, hospice care was significantly associated with lower health care expenditures at exposures of ≤30, ≤60, and ≤180 days for health care expenditures measured in the last one and three months, six months, and 12 months, respectively. Savings for patients with lengthy hospice stays were neutralized or even disappeared. Hospice care was associated with lower health care expenditures when it could actively intervene in EOL care. Hospice philosophy should be applied not only shortly before death but also throughout the dying trajectory to achieve maximum cost savings. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
In a corporate setting, the term "team" usually refers to members of a group with different responsibilities and/or skills working together to achieve a common goal or objective. The major reason why a company desires group as opposed to individual involvement is to derive sounder decisions. Two essential issues to resolve in establishing teams or committees are 1) who should be a member or representative; and 2) what is the charter or mandate for the group. Representatives join a team or group in numerous ways; four common methods are 1) appointment by the group member's supervisor; 2) recruitment by the team leader; 3) appointment by a senior manager; and 4) volunteering. There are various profiles of how groups can approach a decision, including "groupthink," the "ideal group process" and the "debating society" approach. Group meetings must be structured to ensure that decisions are reached and then implemented. Foresight and planning are essential prerequisites to have efficient teams and committees that work effectively and achieve their goals. (c) 1998 Prous Science. All rights reserved.
Cole, Kenneth D; Waite, Martha S; Nichols, Linda O
For a nationwide Geriatric Interdisciplinary Team Training (GITT) program evaluation of 8 sites and 26 teams, team evaluators developed a quantitative and qualitative team observation scale (TOS), examining structure, process, and outcome, with specific focus on the training function. Qualitative data provided an important expansion of quantitative data, highlighting positive effects that were not statistically significant, such as role modeling and training occurring within the clinical team. Qualitative data could also identify "too much" of a coded variable, such as time spent in individual team members' assessments and treatment plans. As healthcare organizations have increasing demands for productivity and changing reimbursement, traditional models of teamwork, with large teams and structured meetings, may no longer be as functional as they once were. To meet these constraints and to train students in teamwork, teams of the future will have to make choices, from developing and setting specific models to increasing the use of information technology to create virtual teams. Both quantitative and qualitative data will be needed to evaluate these new types of teams and the important outcomes they produce.
Hartgerink, J M; Cramm, J M; Bakker, T J E M; van Eijsden, A M; Mackenbach, J P; Nieboer, A P
To identify predictors of relational coordination among professionals delivering care to older patients. Relational coordination is known to enhance quality of care in hospitals. The underlying mechanisms, however, remain poorly understood. This cross-sectional study was part of a larger evaluation study examining the opportunity to prevent loss of function in older patients due to hospitalization in the Netherlands. This study was performed in spring 2010 among team members delivering care to older hospitalized patients (192 respondents; 44% response rate) in one hospital. Relational coordination was measured by the Relational Coordination survey; team climate by the Team Climate Inventory and questions were asked about participation in multidisciplinary team meetings and disciplines represented in these meetings. To account for the hierarchical structure, a multilevel analysis was performed. Correlation analysis revealed a positive relationship among being female, being a nurse and relational coordination; medical specialists showed a negative relationship. The number of disciplines represented during multidisciplinary team meetings and team climate were positively related with relational coordination. The multilevel analysis showed a positive relationship between the number of disciplines represented during multidisciplinary team meetings and team climate with relational coordination. The enhancement of team climate and attendance of diverse professionals during multidisciplinary team meetings are expected to improve relational coordination. Furthermore, this study underscores the importance of enhancing relational coordination between medical specialists and other professionals. © 2013 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.
Carrion, Iraida V; Park, Nan Sook; Lee, Beom S
This study examined the characteristics of individuals in hospice care by racial/ethnic groups. A total of 22,936 patients served by a hospice in Central Florida during a four-year period, from 2002 to 2006, were included. Of these, 80.6% were White, 9.6% were Black/African-American, 9.3% were Hispanic and 0.5% were Asian American/Pacific Islander. We examined the associations between the characteristics of hospice users and race/ethnicity, and change of hospice user characteristics over time using chi-square and ANOVA tests. More females than males were represented. Spouse caregivers were most common for Whites (35%) and Asian/Pacific Islanders (36%). However, "other" (41%) caregivers were most frequent for African Americans and daughters (33%) were most often caregivers for Hispanics. Cancer was the primary diagnosis across the four groups. Racial/ethnic minorities were more likely to rely on Medicaid than Whites (10-70% vs. 4%) and African Americans were most likely to be transferred from hospital (57%), whereas Whites were referred from assisted living/nursing homes more frequently than others(16% vs. 7-10%). As the hospice settings become more racially/ethnically diverse, it is essential to attend to the different circumstances and needs of the various groups in providing optimal care.
Taylor, Donald H; Bhavsar, Nrupen A; Bull, Janet H; Kassner, Cordt T; Olson, Andrew; Boucher, Nathan A
On January 1, 2016, Medicare implemented a new "two-tiered" model for hospice services, with per diem rates increased for days 1 through 60, decreased for days 61 and greater, and service intensity add-on payments made retrospectively for the last seven days of life. To estimate whether the Medicare hospice benefit's potential for cost savings will change as a result of the January 2016 change in payment structure. Analysis of decedents' claims records using propensity score matching, logistic regression, and sensitivity analysis. All age-eligible Medicare decedents who received care and died in North Carolina in calendar years 2009 and 2010. Costs to Medicare for hospice and other healthcare services. Medicare costs were reduced from hospice election until death using both 2009-2010 and new 2016 payment structures and rates. Mean cost savings were $1,527 with actual payment rates, and would have been $2,105 with the new payment rates (p period, hospice increased costs to Medicare. Medicare savings could continue with the 2016 payment rate change. Cost savings were found for all primary diagnoses analyzed except dementia.
Teno, Joan M; Gozalo, Pedro L; Lee, Ian C; Kuo, Sylvia; Spence, Carol; Connor, Stephen R; Casarett, David J
To examine the effectiveness of hospice services for persons dying from dementia from the perspective of bereaved family members. Mortality follow-back survey. Death certificates were drawn from five states (AL, FL, TX, MA, and MN). Bereaved family members listed as the next of kin on death certificates when dementia was listed as the cause of death. Ratings of the quality of end-of-life care, perceptions of unmet needs, and opportunities to improve end-of-life care. Two questions were also asked about the peacefulness of dying and quality of dying. Of 538 respondents, 260 (48.3%) received hospice services. Family members of decedents who received hospice services reported fewer unmet needs and concerns with quality of care (adjusted odds ratio (AOR)=0.49, 95% confidence interval (CI)=0.33-0.74) and a higher rating of the quality of care (AOR=2.0, 95% CI=1.53-2.72). They also noted better quality of dying than those without hospice services. Bereaved family members of people with dementia who received hospice reported higher perceptions of the quality of care and quality of dying. © 2011, Copyright the Authors. Journal compilation © 2011, The American Geriatrics Society.
McMillan, Susan C; Rodriguez, Carmen; Wang, Hsiao-Lan; Elliott, Amanda
The purpose of this study was to explore issues reported by caregivers of Head and Neck cancer (HNC) patients newly admitted to hospice homecare. 26 caregivers providing hospice homecare to patients with HNC were induded. Caregiver depressive symptoms, social support and perceived health data were analyzed. The caregivers reported few depressive symptoms, good perceived social support, and good perceived health; however, there was large variation in the group with some individuals having significant problems. Caregivers appeared to be doing well physically, emotionally and socially, but baseline data were used, so follow-up data are needed. Further research is warranted. Family caregivers also are affected by the experience of cancer and may have depressive symptoms needing assessment and management. Hospice patients with HNC have a variety of symptoms specific to their disease and treatment that need assessment and management by their family caregivers. Caregivers of HNC patients in hospice and palliative care need and deserve attention from hospice providers as they care for patients.
Cagle, John G; Zimmerman, Sheryl; Cohen, Lauren W; Porter, Laura S; Hanson, Laura C; Reed, David
Concerns about pain medications are major barriers to pain management in hospice, but few studies have focused on systematic methods to address these concerns. The objective of this study was to test the preliminary efficacy of the Effective Management of Pain: Overcoming Worries to Enable Relief (EMPOWER) intervention, which included hospice staff education, staff screening of barriers to pain management at admission, and discussion about misunderstandings regarding pain management with family caregivers and patients. We conducted a pilot, cluster randomized, controlled trial with four hospices. One hundred twenty-six family caregivers (55 interventions and 71 controls) were interviewed at two weeks after admission. If patients survived three months after admission, caregivers were reinterviewed. At two weeks, caregivers in the intervention group reported better knowledge about pain management (P = 0.001), fewer concerns about pain and pain medications (P = 0.008), and lower patient pain over the past week (P = 0.014) and trended toward improvement in most other areas under study. Exploratory analyses suggest that EMPOWER had a greater effect for black subjects (vs. whites) on reducing concern about stigma. At three months, the intervention group trended better on most study outcomes. EMPOWER is a promising model to reduce barriers to pain management in hospice. Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
Tse, Chung Sang; Ellman, Matthew S
To explore the application of an online learning tool to teach preclinical medical students terminal and hospice care in a blended curricula. We created and evaluated a 30 min interactive online module at the Yale School of Medicine. Second-year medical students were randomly assigned to complete the online module or not (control group) prior to attending a required half-day hospice clinical experience. We assessed the students' knowledge and attitudes with a 23-item survey. 152 students (response rate 51%) participated in this study from 2012 to 2014. 56% (n=85) completed the online module, 37% (n=56) did not and 7% (n=11) did not indicate whether they had completed the module or not. Students who completed the online module prior to the hospice experience scored higher (phospice and palliative care, but their attitudes were similar to those who did not complete the online module. Overall, the students felt somewhat uncomfortable caring for dying patients although they regarded it as a physician's duty and felt that palliative/hospice care education is important in medical school. When combined with a mentored clinical hospice experience, an online module appears to enhance the teaching of the dying process and terminal care for preclinical medical students. This online module may prove useful for other institutions. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
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.
Robberstad, Mari; Bentsen, Signe Berit; Berg, Tore Julsrud; Iversen, Marjolein M
The national clincial guidelines for diabetes recommend that diabetic foot ulcers be treated by interdisciplinary diabetic foot ulcer teams. This study aims to survey the extent of diabetic foot ulcer teams in the specialist health service in Norwegian hospitals and to describe their clinical composition, organisation and working routines. The study is cross-sectional with the use of a questionnaire survey. The criteria for participating were somatic hospitals with 24-hour operations and a specialist function for patients with diabetes mellitus. A total of 41 hospitals participated of the 51 that fulfilled the criteria. Altogether 17 of 41 hospitals had diabetic foot ulcer teams. The teams had a broad clinical composition and followed national recommendations for surveying risk factors and treatment of diabetic foot ulcers. Nine foot ulcer teams had written routines for assessment, five used the Noklus diabetes patient records to document ulcer treatment, and ten had planned interdisciplinary meetings. Only one-quarter of the teams included both medical and surgical competence in the planned interdisciplinary collaboration. The diabetic foot ulcer teams had broad clinical competence and followed national clinical guidelines. The teams had a short waiting time for the initial consultation, half had written guidelines, and 60 % had planned interdisciplinary meetings. Far fewer had included both medical and surgical competence in the planned interdisciplinary collaboration.
Phoenix Vuong; Jason Sample; Mary Ellen Zimmermann; Pierre Saldinger
Specialized trauma teams have been shown to improve outcomes in critically injured patients. At our institution, an the American College of Surgeons Committee on trauma level I Trauma center, the trauma team activation (TTA) criteria includes both physiologic and anatomic criteria, but any attending physician can activate the trauma team at their discretion outside criteria. As a result, the trauma team has been activated for noninjured patients meeting physiologic criteria secondary to nontr...
Singh, Arun L; Klick, Jeffrey C; McCracken, Courtney E; Hebbar, Kiran B
Hospice and Palliative Medicine (HPM) competencies are of growing importance in training general pediatricians and pediatric sub-specialists. The Accreditation Council for Graduate Medical Education (ACGME) emphasized pediatric trainees should understand the "impact of chronic disease, terminal conditions and death on patients and their families." Currently, very little is known regarding pediatric trainee education in HPM. We surveyed all 486 ACGME-accredited pediatric training program directors (PDs) - 200 in general pediatrics (GP), 57 in cardiology (CARD), 64 in critical care medicine (CCM), 69 in hematology-oncology (ONC) and 96 in neonatology (NICU). We collected training program's demographics, PD's attitudes and educational practices regarding HPM. The complete response rate was 30% (148/486). Overall, 45% offer formal HPM curriculum and 39% offer a rotation in HPM for trainees. HPM teaching modalities commonly reported included conferences, consultations and bedside teaching. Eighty-one percent of all respondents felt that HPM curriculum would improve trainees' ability to care for patients. While most groups felt that a HPM rotation would enhance trainees' education [GP (96%), CARD (77%), CCM (82%) and ONC (95%)], NICU PDs were more divided (55%; p training, there remains a paucity of opportunities for pediatric trainees. Passive teaching methods are frequently utilized in HPM curricula with minimal diversity in methods utilized to teach HPM. Opportunities to further emphasize HPM in general pediatric and pediatric sub-specialty training remains.
Fainsinger, R L; Landman, W; Hoskings, M; Bruera, E
The need to sedate terminally ill patients for uncontrolled symptoms has been previously documented in a few reports. A retrospective consecutive chart review was undertaken at a hospice in Cape Town, South Africa, to develop an understanding of the local experience and assess the potential for improved patient management. Twenty-three of seventy-six (30%) patients received sedating therapies: twenty patients for delirium, two patients for delirium and dyspnea, and one patient for dyspnea alone. Fourteen patients were sedated with a continuous subcutaneous infusion of midazolam, seven patients with intermittent doses of benzodiazepines, and two patients with chlorpromazine and lorazepam. The mean midazolam dose was 29 mg per day (median 30 mg; range 15-60 mg per day). Patients were sedated on average 2.5 days before death (median 1 day; range 4 hours-12 days). The mean equivalent daily dose of parenteral morphine in the last week of life showed a significantly higher mean for the sedated group, as compared to the nonsedated group. There was minimal investigation of reversible causes for delirium, none of the patients underwent an opioid rotation, and the opioid dose was seldom decreased. None of the patients received parenteral hydration. The prevalence for the use of sedating treatment is consistent with the range of other literature reports. Nevertheless, the wide disparity in the reported prevalence of these problems, and the ethical concerns raised by the relative frequency of this sedative approach, cannot be ignored.
Welch, Lisa C.; Miller, Susan C.; Martin, Edward W.; Nanda, Aman
Purpose: Given concerns about end-of-life care for many nursing home (NH) residents, this study sought to understand factors influencing hospice referral or nonreferral as well as timing of referral. Design and Methods: We conducted semistructured interviews with personnel from seven participating NHs and two hospices. We interviewed NH directors…
Phongtankuel, Veerawat; Paustian, Shawn; Reid, Manney Carrington; Finley, Amanda; Martin, Angela; Delfs, John; Baughn, Rosemary; Adelman, Ronald D
Approximately 25% of hospice disenrollments in the United States occur as the result of hospitalization, which can lead to burdensome transitions and undesired care. Informal caregivers (e.g., spouses, children) play a critical role in caring for patients on home hospice. Research examining hospital-related disenrollment among these patients is limited. To understand the events surrounding the hospitalization of patients discharged from home hospice through the perspective of their informal caregivers. Thirty-eight semistructured phone interviews with caregivers were conducted, and data regarding the events leading to hospitalization and hospice disenrollment were collected. Study data were analyzed by using qualitative methods. Subjects included caregivers of 38 patients who received services from one not-for-profit home hospice organization in New York City. Participants were English speaking only. Caregiver recordings were transcribed and analyzed by using content analysis. Content analysis revealed four major themes contributing to hospitalization: (1) distressing/difficult-to-witness signs and symptoms, (2) needing palliative interventions not deliverable in the home setting, (3) preference to be cared for by nonhospice physicians or at a local hospital, and (4) caregivers not comfortable with the death of their care recipient at home. Over half of all caregivers called 911 before calling hospice. Our study provides insight into the events leading to hospitalization of home hospice patients from the caregivers' perspective. Further research is needed to quantify the drivers of hospitalization and to develop interventions that reduce utilization, while improving care for home hospice patients and their caregivers.
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 care group. Each hospice care group had significantly less medical utilization and expenses in the last 90, 30, and 14 days of life (all P 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.
Hwang, Shinn-Jang; Chang, Hsiao-Ting; Hwang, I-Hsuan; Wu, Chen-Yi; Yang, Wang-Hsuan; Li, Chung-Pin
Hospice care is important for patients with terminal hepatocellular carcinoma (HCC), especially in endemic areas of viral hepatitis. Differences between hospice care and usual care for geriatric HCC inpatients have not yet been explored in a nationwide survey. The study's purpose was to analyze differences between hospice care and usual care for geriatric HCC inpatients in a nationwide survey. This nationwide, population-based study used data obtained from the Taiwan National Health Insurance Database. Patients with terminal HCC who were ≥65 years old and received their end-of-life care in the hospital between January 2001 and December 2004 were recruited. The comparison group was selected by propensity score matching from patients receiving usual care in acute wards. We enrolled 729 terminal HCC patients receiving inpatient hospice care and 729 matched controls selected from 2482 HCC patients receiving usual care. Hospice care patients were treated mainly by family medicine doctors (36%) and oncologists (26%), while usual care patients were treated mainly by gastroenterologists (60.2%). The natural opium alkaloids were used more in the hospice care group than in the usual care group (72.7% versus 25.5%, Pcare group. HCC patients in hospice wards received more narcotic palliative care, underwent fewer aggressive procedures, and incurred lower costs than those in acute wards. Hospice care should be promoted as a viable option for terminally ill, elderly HCC patients.
Kwak, Jung; Haley, William E.; Chiriboga, David A.
Purpose: We investigated the role of race in predicting the likelihood of using hospice and dying in a hospital among dual-eligible (Medicare and Medicaid) nursing home residents. Design and Methods: This follow-back cohort study examined factors associated with hospice use and in-hospital death among non-Hispanic Black and non-Hispanic White…
Trimble, Susan; Rottier, Jerry
Interdisciplinary middle school level teams capitalize on the idea that the whole is greater than the sum of its parts. Administrators and team members can maximize the advantages of teamwork using team assessments to increase the benefits for students, teachers, and the school environment. Assessing team performance can lead to high performing…
Edmondson, Amy; Bohmer, Richard; Pisano, Gary
A study of 16 cardiac surgery teams looked at how the teams adapted to new ways of working. The challenge of team management is to implement new processes as quickly as possible. Steps for creating a learning team include selecting a mix of skills and expertise, framing the challenge, and creating an environment of psychological safety. (JOW)
Football fans will always converge at a stadium on the day of the match to watch their favourite team play against a visiting team. The atmosphere at these matches is almost always electric with fans cheering their favourite teams on. The focus for everybody is ultimately on the performance of the teams on the playing field ...
Finlay, Esmé; Casarett, David
Patients with advanced cancer face difficult decisions regarding their treatment, and many will need to make difficult choices about end-of-life care because although cancer-directed therapies are increasingly available, few provide a cure. High-quality cancer care includes access to palliative care throughout the cancer care continuum, and increasing evidence suggests that timely enrollment in hospice can increase quality of life for patients dying from cancer. Therefore, clinicians must learn to recognize patients who are hospice-eligible and to develop prognostication and communication skills that enable honest provider-patient dialogue about end-of-life options. In this article, the authors review available tools for prognostication in advanced cancer and present a method for discussing prognosis by using the SPIKES acronym. In addition, by using patient-identified goals and service needs, the authors recommend a method for making a hospice referral after disclosure of poor prognosis.
Blacker, Susan; Head, Barbara A; Jones, Barbara L; Remke, Stacy S; Supiano, Katherine
The importance of interprofessional collaboration in achieving high quality outcomes, improving patient quality of life, and decreasing costs has been growing significantly in health care. Palliative care has been viewed as an exemplary model of interprofessional care delivery, yet best practices in both interprofessional education (IPE) and interprofessional practice (IPP) in the field are still developing. So, too, is the leadership of hospice and palliative care social workers within IPE and IPP. Generating evidence regarding best practices that can prepare social work professionals for collaborative practice is essential. Lessons learned from practice experiences of social workers working in hospice and palliative care can inform educational efforts of all professionals. The emergence of interprofessional education and competencies is a development that is relevant to social work practice in this field. Opportunities for hospice and palliative social workers to demonstrate leadership in IPE and IPP are presented in this article.
LaValley, Susan A
Caregivers of those with life-limiting illness face many complicated tasks, including providing direct patient care, communicating with professionals, and managing the logistical demands of daily activities. To assist with caregiving responsibilities, caregivers require social support from social network members at all points in the illness process. This study analyzes themes from interviews with 61 caregivers of patients enrolled in hospice services to identify the types of support caregivers mobilize from new social network members for social support during the end-of-life care process. Themes indicate that caregivers receive accessible, immediate, caregiver-centered emotional support from hospice health care professionals, and situationally tailored, understandable informational support from other types of professionals. In addition, caregivers received overlapping emotional and informational support from hospice health care professionals. Findings enhance the understanding of how caregivers receive tailored emotional and informational support.
Janssens, R J; ten Have, H A; Zylicz, Z
This contribution is a report of a two months' participant observation in a Dutch hospice. The goal of the observation was to gain an overview of moral decisions in a hospice in which euthanasia, a tolerated practice in the Netherlands, is not accepted as an option. In an introduction, the development of palliative care in the Netherlands will be briefly presented. Subsequently, various moral decisions that were taken during the participant observation are presented and analysed by means of case reports. Attention is especially drawn to decisions that directly or indirectly relate to euthanasia. These moral decisions will be clarified in the light of the philosophy behind the concept of palliative care as it has evolved since the foundation of St Christopher's Hospice, London in 1967. PMID:10536767
Lee, Lung-Chun; Hu, Chung-Chieh; Loh, El-Wui; Hwang, Sheau-Feng
Some patients who receive hospice home care still end up dying in hospital. The significance of the variables possibly affecting the place of death in patients with terminal cancer who received hospice home care was examined. Retrospective study. Four hundred and thirty-nine patients were enrolled in this study. In all, 60.8% of the patients died at home and 39.2% of the patients died in hospital. Multiple logistic regression analysis revealed that preferred place of death was the prior factor associated with home death, followed by average days of rehospitalization, education level, distance between home and hospital, and age. For a better hospice care service, it is essential to inquire patients or their relatives on preferred place of death while concerning the influences of other factors.
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.
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.
Stressors, coping and demographic variables were examined as predictors of burnout in a sample of hospice nurses. The study aimed to investigate the level of burnout among hospice nurses; to ascertain which aspects of nursing work were positively or negatively related to burnout; to examine the relative contributions made by these different variables and to suggest individual and organizational interventions to reduce levels of burnout. Eighty-nine female nurses from nine hospices completed a battery of questionnaires comprising the Maslach Burnout Inventory, Nursing Stress Scale, Ways of Coping Scale and a demographic information form. In general, the level of burnout (characterized by high emotional exhaustion, high depersonalization of patients and low personal accomplishment) was found to be low. In multiple regression analyses, 'death and dying', "conflict with staff', 'accepting responsibility' and higher nursing grade contributed to emotional exhaustion. 'Conflict with staff', 'inadequate preparation', 'escape' and reduced 'planful problem-solving' contributed to depersonalization. 'Inadequate preparation', 'escape', reduced 'positive reappraisal' and fewer professional qualifications contributed to lower levels of personal accomplishment. Overall, stressors made the greatest contribution to burnout and demographic factors contributed the least. The importance of not labelling individuals as good and bad 'copers' was discussed, as the effectiveness of a strategy may depend on the situation. It was concluded that the investigation of problem-focused and emotion-focused coping in relation to burnout, was oversimplifying the coping-burnout relationship. Suggestions for stress management included staff training in counselling skills, monitoring staff conflict, implementing stress inoculation training to teach appropriate use of coping skills and finally, monitoring particularly vulnerable groups of hospice staff such as unqualified nursing assistants and
Lindley, Lisa C; Held, Mary L; Henley, Kristen M; Miller, Kathryn A; Pedziwol, Katherine E; Rumley, Laurie E
Provision of language services in pediatric hospice enables nurses to communicate effectively with patients who have limited English proficiency. Language barriers contribute to ethnic disparities in health care. While language service use corresponds with improved patient comprehension of illness and care options, we lack an understanding of how the nurse work environment affects the provision of these services. Data were obtained from the 2007 National Home and Hospice Care Survey and included a study sample of 1251 pediatric hospice agencies. Variable selection was guided by structural contingency theory, which posits that organizational effectiveness is dependent upon how well an organization's structure relates to its context. Using multivariate logistic regression, we analyzed the extent to which nursing unit environment predicted provision of translation services and interpreter services. The majority of hospices provided translation services (74.9 %) and interpreter services (87.1 %). Four variables predicted translation services: registered nurse (RN) unit size, RN leadership, RN medical expertise, and for-profit status. RN medical expertise and having a safety climate within the hospice corresponded with provision of interpreter services. Findings indicate that nursing unit environment predicts provision of language services. Hospices with more specialized RNs and a stronger safety climate might include staffs who are dedicated to best care provision, including language services. This study provides valuable data on the nurse work environment as a predictor of language services provision, which can better serve patients with limited English proficiency and ultimately reduce ethnic disparities in end-of-life care for children and their families.
Demiris, George; Parker Oliver, Debra; Wittenberg-Lyles, Elaine; Washington, Karla; Doorenbos, Ardith; Rue, Tessa; Berry, Donna
Problem-solving therapy (PST) has been found effective when delivered to informal caregivers of patients with various conditions. In hospice, however, its translation to practice is impeded by the increased resources needed for its delivery. The study purpose was to compare the effectiveness of a PST intervention delivered face-to-face with one delivered via videophone to hospice primary caregivers. The study design was a randomized noninferiority trial with two groups, Group 1 in which caregivers received PST face-to-face, and Group 2 in which caregivers received PST via videophone. Family hospice caregivers were recruited from two urban hospice agencies and received the PST intervention (in three visits for Group 1 or three video-calls in Group 2) in an approximate period of 20 days after hospice admission. Standard caregiver demographic data were collected. Psychometric instruments administered to caregivers at baseline and at study completion included the CQLI-R (Caregiver Quality of Life Index-Revised), the STAI (State-Trait Anxiety Inventory), and the PSI (Problem-Solving Inventory). One hundred twenty-six caregivers were recruited in the study; 77 were randomly assigned to Group 1 and 49 to Group 2. PST delivered via video was not inferior to face-to-face delivery. The observed changes in scores were similar for each group. Caregiver quality of life improved and state anxiety decreased under both conditions. The delivery of PST via videophone was not inferior to face-to-face. Audiovisual feedback captured by technology may be sufficient, providing a solution to the geographic barriers that often inhibit the delivery of these types of interventions to older adults in hospice.
Almost anyone has held various roles on a team, be it a family unit, sports team, or a project-oriented team. As an educator, one must make a conscious decision to build and invest in a team. Gathering the best team possible will help one achieve one's goals. This article explores some of the key reasons why it is important to focus on the team…
Strnadová, Iva; Cumming, Therese M; Knox, Marie; Parmenter, Trevor
Inclusive research teams typically describe their experiences and analyse the type of involvement of researchers with disability, but the process of building research teams and the need for research training still remain underexplored in the literature. Four researchers with intellectual disabilities and four academic researchers developed an inclusive research team. The team conducted 15 research training sessions, focused on investigating the well-being of older women with intellectual disabilities. They used mobile technology to support research skills acquisition. Findings included the experiences of all team members regarding the team building during training. To become an effective inclusive research team, all team members, regardless of ability, need to bring their own experiences and also learn necessary research skills. This paper highlights the need for team building, joint research training among all members of the research team and strategies supporting the peer-mentoring within the team. We are a team of four researchers with intellectual disabilities and four academic researchers without an intellectual disability. Our aim has been to learn about research together. We want to do this so that we can carry out a research project together about how older women with intellectual disabilities live. We have decided to call our team 'Welcome to our Class'. We have been working together for 9 months. In this time we have had 15 research training meetings. We have learned What research is How to work out a research question, that is what we want to find out about How to get information on what we want to find out. Here we thought of interview questions we could ask older women with intellectual disabilities. We are now meeting once a month, and have just begun our research on finding out how older women with intellectual disabilities live. We are now starting to use what we have learned. © 2013 John Wiley & Sons Ltd.
Rossfeld, Zachary M; Tumin, Dmitry; Humphrey, Lisa M
To describe our institutional experience with a four-week pediatric HPM elective rotation and its impact on residents' self-rated competencies. In the spirit of bolstering primary hospice and palliative medicine (HPM) skills of all pediatricians, it is unclear how best to teach pediatric HPM. An elective rotation during residency may serve this need. An anonymous online survey was distributed to pediatric and internal medicine/pediatrics residents at a single, tertiary academic children's hospital. Respondents were asked to rate education, experience, and comfort with five aspects of communication with families of children with terminal illnesses and six domains of managing the symptoms of terminal illnesses. Self-ratings were recorded on a 1-5 scale: none, minimal, moderate, good, or excellent. Demographic data, including details of training and prior HPM training, were collected. Respondents completed a set of six questions gauging their attitude toward palliative care in general and at the study institution specifically. All respondents desire more HPM training. Those residents who self-selected to complete a pediatric HPM elective rotation had significantly higher self-ratings in 10 of 11 competency/skill domains. Free-text comments expressed concern about reliance on the specialty HPM team. A pediatric HPM elective can significantly increase residents' self-rated competency. Such rotations are an under-realized opportunity in developing the primary HPM skills of pediatricians, but wider adoption is restricted by the limited availability of pediatric HPM rotations and limited elective time during training.
Pizzi, Michael A
The purpose of this phenomenological study was to answer the broad questions: what do professional caregivers for the dying think about what they do, and how does that thinking influence their practice in end-of-life care? The participants were 12 hospice professionals working in four specific disciplines: occupational therapy, physical therapy, social work, and nursing. In-depth interviews were conducted and audiotaped, and transcripts were printed. Constant comparison and thematic analysis was performed. One overarching theme and five subthemes were generated. The central theme, "promoting a good death," emerged from the data, as the participants continually discussed health, wellness, and quality-of-life work in which they engaged that were discipline-specific yet overlapping. The subthemes that emerged were: holism; framing and re-framing practice; client- and family-centered care; being with dying; and interdisciplinary team. All participants concluded that their work emanated from a health and wellness lens, and that quality of life at the end of life was their ultimate goal. Quality of life, for each discipline, included doing, being, and becoming one's authentic self until the end of life.
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
...The Department of Veterans Affairs (VA) proposes to amend its regulation and internal policy documents concerning the billing 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 non-VA health care providers. Because the newly applicable methodology cannot supersede rates for which VA has specifically contracted, this rulemaking will only affect providers who do not have existing negotiated contracts with VA. The proposed rule would also rescind internal guidance documents that could be interpreted as conflicting with the proposed rule.
Cagle, John G; Kovacs, Pamela J
This study examined the perceptions of preparedness and support of informal caregivers of hospice oncology patients. Respondents included coresiding, proximate, and long-distance caregivers. Thematic analysis was used to analyze the qualitative data from 2 caregiver surveys, one administered prior to the care recipient's death and another completed 3 months postdeath. Respondents (N = 69) interpreted preparedness broadly and identified multiple sources of support including hospice personnel, family, friends, neighbors, and spiritual beliefs. Additionally, informational support, such as education, information, and enhanced communication were considered essential for preparing and supporting caregivers. Implications for social work research and practice are provided.
effectively complete complex tasks that are beyond the scope of what an individual could reasonably accomplish. In particular, teams ...conditions for team effectiveness (Tannenbaum, Mathieu, Salas, & Cohen, 2012). When compared to traditional or conventional teams , organizational leaders may...following topics will be combined: global teams , virtual teams , multicultural teams , distributed teams , team diversity, S. Miloslavic et al. 21 22 23
Schaafstal, A.M.; Hoeft, R.M.; Schaik, M. van
The process of training teams increasingly occurs in synthetic environments. However, it is often still modeled after live team training, including the disadvantages of live training, for example, the fact that all teammates must be available. This paper explores overcoming the disadvantages of
Full Text Available The article is based on literature review and authors’ own recent experience in managing multicultural project teams, in international environment. This comparative study considers two groups of projects: technical assistance (TA projects versus information technology (IT projects. The aim is to explore the size and structure of the project teams – according to the team formation and its lifecycle, and to identify some distinctive attributes of the project teams – both similarities and differences between the above mentioned types of projects. Distinct focus of the research is on the multiculturalism of the project teams: how the cultural background of the team members influences the team performance and team management. Besides the results of the study are the managerial implications: how the team managers could soften the cultural clash, and avoid inter-cultural misunderstandings and even conflicts – in order to get a better performance. Some practical examples are provided as well.
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. © The Author(s) 2014.
An, Ah Reum; Lee, June-Koo; Yun, Young Ho; Heo, Dae Seog
Previous studies on hospice/palliative care indicated that patients' socio-demographic factors, disease status, and availability of health-care resources were associated with hospice/palliative care utilization. However, the impact of family caregivers on hospice/palliative care utilization has not been thoroughly investigated. To evaluate the association between attitudes toward hospice/palliative care of both patients with terminal cancer (defined as progressive, advanced cancer in which the patient will die within months) and their family caregivers and utilization of inpatient hospice/palliative care facilities. A prospective observational cohort study was performed in 12 hospitals in South Korea. Attitude toward hospice/palliative care was assessed immediately after terminal cancer diagnosis. After the patient's death, caregivers were interviewed whether they utilized hospice/palliative care facilities. A total of 359 patient-caregiver dyads completed baseline questionnaires. After the patients' death, 257 caregivers were interviewed. At the baseline questionnaire, 137/359 (38.2%) patients and 185/359 (51.5%) of caregivers preferred hospice/palliative care. Preference for hospice/palliative care was associated with awareness of terminal status among both patients (adjusted odds ratio: 1.87, 95% confidence interval: 1.16-3.03) and caregivers (adjusted odds ratio: 2.14, 95% confidence interval: 1.20-3.81). Religion, metastasis, and poor performance status were also independently associated with patient preference for hospice/palliative care. At the post-bereavement interview, 104/257 (40.5%) caregivers responded that they utilized hospice/palliative care facilities. Caregiver's preferences for hospice/palliative care were significantly associated with actual utilization (adjusted odds ratio: 2.67, 95% confidence interval: 1.53-4.67). No patient-related factors were associated with hospice/palliative care utilization. Promoting awareness of prognosis and to
Report on the 9th International Exchange/Inspection Team - 2000 ASHRAE Winter Meeting and the situation of the U.S. being activated by deregulation/IT technology innovation; Dai 9 kai kokusai koryu shisatsudan hokoku. 2000 nen ASHRAE toki taikai to kisei kanwa IT gijutsu kakumei de kakkizuku Beikoku no genjo
Miyata, Y. [Tokyo Electric Power Co. Inc., Tokyo (Japan)
We (25 members) attended ASHRAE Winter Meeting held in Dallas, Texas, as the 9th international exchange/inspection team sponsored by The Society of Heating, Air-Conditioning and Sanitary Engineers of Japan. About 3000 researchers, engineers, etc. participated in the meeting from 25 countries including not only the whole U.S. but Europe and Asia, and had vigorous discussions. At the same time, AHR EXPO 2000 was held in a convention center of the city. More than 1,000 companies joined in the exposition, and the participants numbered approximately 20,000, according to the sponsor. Further, using this opportunity, visits were paid to official research institutes and 5 companies in the Central West with the aim of investigating the present situation in the U.S. where new businesses of energy service are being developed by various new comers. The inspection of the related facilities and useful information exchanges with researchers were made. (translated by NEDO)
Kilgore, Meredith L; Grabowski, David C; Morrisey, Michael A; Ritchie, Christine S; Yun, Huifeng; Locher, Julie L
Home health and hospice services can constitute important elements in the continuum of care for older adults diagnosed with cancer. The Balanced Budget Act (BBA) of 1997 included provisions affecting those services. The first objective of this study is to assess the effect of the BBA of 1997 on home health and hospice service utilization in older cancer patients. The second objective is to estimate the effect of the BBA of 1997 on costs associated specifically with home health and hospice services and on total costs of care. The final objective is to evaluate the effect of the BBA of 1997 on mortality in these patients. Longitudinal analysis using the Surveillance, Epidemiology, and End Results-Medicare Database, covering a service area that includes 26% of the US population. Community-dwelling Medicare beneficiaries 65 years of age and older. Utilization rates of home health and hospice services; costs associated with those services, and total costs of care; and mortality. Home health utilization rates dropped substantially and hospice utilization rates increased after the BBA. Medicare costs for home health services declined as did total Medicare costs but hospice costs increased. There was no discernable effect on mortality rates. The BBA was successful in containing the costs of home health services and resulted in savings in overall costs of care for older cancer patients. Reduction in utilization of home health services did not seem to negatively affect outcomes. The BBA may have contributed to the trend of increasing use of hospice care.
Huo, Jinhai; Du, Xianglin L; Lairson, David R; Chan, Wenyaw; Jiang, Jing; Buchholz, Thomas A; Guadagnolo, B Ashleigh
To examine the patterns of utilization of radiation therapy, chemotherapy, surgery, and hospice at the end-of-life care for patients diagnosed with metastatic melanoma. We identified 816 Medicare beneficiaries toward who were 65 years of age or older, with pathologically confirmed metastatic malignant melanoma between January 1, 2000, and December 31, 2007. We evaluated trends and associations between sociodemographic and health service characteristics and the use of hospice care, chemotherapy, surgery, and radiation therapy. We found increasing use of surgery for patients with metastatic melanoma from 13% in 2000 to 30% in 2007 (P=0.03 for trend), and no significant fluctuation in the use of chemotherapy (P=0.43) or radiation therapy (P=0.46). Older patients were less likely to receive radiation therapy or chemotherapy. The use of hospice care increased from 61% in 2000 to 79% in 2007 (P=0.07 for trend). Enrollment in short-term (1 to 3 d) hospice care use increased, whereas long-term hospice care (≥4 d) remained stable. Patients living in the SEER (Surveillance, Epidemiology and End Results) northeast and south regions were less likely to undergo surgery. Patients enrolled in long-term hospice care used significantly less chemotherapy, surgery, and radiation therapy. Surgery and hospice care use increased over the years of this study, whereas the use of chemotherapy and radiation therapy remained consistent for patients diagnosed with metastatic melanoma.
... 290), other organic psychotic conditions–chronic (294), and Alzheimer’s disease (331.0). Diagnoses —One or more diseases or injuries in the home health care or discharged hospice care patient’s medical record. Diagnoses were recorded as: + Home health ...
... an individual warrants a change in the focus from curative to palliative care, for relief of pain and... subpart G provides for payment in one of four prospectively-determined rate categories (routine home care, continuous home care, inpatient respite care, and general inpatient care) to hospices based on each day a...
... warrants a change in the focus from curative to palliative care, for relief of pain and for symptom...-determined rate categories (routine home care, continuous home care, inpatient respite care, and general... hospice payment. Currently, the labor portion of the payment rates is as follows: for Routine Home Care...
... palliative care for relief of pain and for symptom management. The goal of hospice care is to help terminally... categories (routine home care, continuous home care, inpatient respite care, and general inpatient care) to... of the payment rates is as follows: For Routine Home Care, 68.71 percent; for Continuous Home Care...
Freeman, Shannon; Heckman, George; Naus, Peter J.; Marston, Hannah R.
The need to attend to terminally ill persons and provide improved quality of living and dying should be a national priority in Canada. Hospice palliative care (HPC), a person-centered approach that addresses the needs of the whole person, improves the quality of living and dying of persons facing a life-threatening illness. To ensure Canadians are…
Ellington, Lee; Clayton, Margaret F; Reblin, Maija; Donaldson, Gary; Latimer, Seth
First, to describe communication of home hospice nurse visits to cancer patient-caregiver dyads. Second, to assess change in communication related to domains of care over the course of visits. Multi-site prospective observational longitudinal study of audio-recorded home hospice visits (N=537 visits; 101 patient-caregiver dyads; 58 nurses). Communication was coded using the Roter Interaction Analysis System to describe content and process. Conversation representing three care domains (physical, psychosocial/daily life, and emotional) was calculated from RIAS categories across speakers and analyzed to assess change in communication over time. On average, nurses spoke 54% of total utterances, caregivers 29%, and patients 17%. For all participants, the predominant conversational focus was on physical care. Linear mixed effects models indicated that combined participant emotional talk showed a small systematic decrease over time; however, the results for all domains indicated variability unexplained by time or speaker effects. Home hospice conversations are predominantly focused on physical care. Systematic change in communication versus responsiveness to the dynamic effects of patient death and family response over time are discussed. Communication strategies already in use by hospice nurses could be leveraged and expanded upon to better facilitate family competence and confidence. Copyright © 2017 Elsevier B.V. All rights reserved.
Buss, Mary K; Rock, Laura K; McCarthy, Ellen P
Palliative care provides invaluable clinical management and support for patients and their families. For most people, palliative care is not provided by hospice and palliative medicine specialists, but rather by their primary care providers. The recognition of hospice and palliative medicine as its own medical subspecialty in 2006 highlighted the importance of palliative care to the practice of medicine, yet many health care professionals harbor misconceptions about palliative care, which may be a barrier to ensuring that the palliative care needs of their patients are identified and met in a timely fashion. When physicians discuss end-of-life concerns proactively, many patients choose more comfort-focused care and receive care more aligned with their values and goals. This article defines palliative care, describes how it differs from hospice, debunks some common myths associated with hospice and palliative care, and offers suggestions on how primary care providers can integrate palliative care into their practice. Copyright © 2016 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
Sardiwalla, N; VandenBerg, H; Esterhuyse, K G F
The helping professions have always been associated with high levels of stress and burnout because of the emotional intensity of the relationships with patients. The nature of hospice work can be both rewarding and challenging. Hospice workers encounter a variety of work- and client-related stressors. The work-related stressors they face include organizational stressors and role ambiguity they experience in their work environment. Social factors make up a third set of work-related stressors. Chronic exposure to these stressors may result in burnout if they are not adequately dealt with. Coping strategies can be divided into 3 categories, namely, problem-focused coping strategies, emotionally focused coping strategies, and ineffective coping strategies. The focus of this research is to determine how the stressors experienced by hospice workers in and outside the working environment as well as the coping strategies adopted by them can be used to predict the extent to which they experience burnout. The findings of this study suggest that hospice workers do experience a great deal of burnout, which affects their work performance and general functioning. The burnout is mainly the result of work-related stressors. Recommendations to alleviate this problematic situation are made.
Nakayama, Hisako; Kikuta, Fumio; Takeda, Hidekatsu
This study aims at determining the effectiveness of music therapy in a hospice setting. We employed the salivary cortisol level, which is widely used to measure stress level, as an objective and physical indicator and the Mood Inventory, which measures mood change, as the subjective and psychological indicators. Though many preceding studies have demonstrated that listening to music lowers cortisol levels and reduces stress, no study seems to have included hospice patients. This study measured, with the consent of 10 hospice inpatients, their salivary cortisol levels. Individual interviews, according to the Mood Inventory, were conducted before and after a small-group session. Since all the participants had terminal cancer, the 40-minute live session of songs of seasons and the participants' requests was given in a mostly passive manner considering their physical strength. Results showed significant lowering of salivary cortisol levels after the therapy session. As for the parameters of mood, refreshment was significantly increased. Though fatigue remained unchanged, anxiety and depression decreased while the score for excitement tended to increase. Thus, it was indicated that music therapy in a hospice setting reduces the stress level of patients and thereby plays a positive role in improving patients' quality of life.
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.…
...-Reclassified Hospital Wage Index) 2. Definition of Rural and Urban Areas 3. Areas Without Hospital Wage Data 4... index data on which to base the calculation of the hospice wage index. Beginning in FY 2006, we adopted... geographic areas where there are no hospitals, and no hospital wage data on which to base the calculation of...
Chao, Co-Shi Chantal
This article uses four examples to illustrate the recent rise of hospice palliative care as a universal value. These examples include the story of Dame Cecily Saunders, the pioneer of the palliative care movement in the U.K.; the national healthcare plan currently promoted by United States' President Obama; a survey on the topic of quality of death in 40 countries conducted by the Lien Foundation (Singapore); and the story of the Hospice Movement in Taiwan. This article further describes how hospice palliative care has changed the healthcare culture and presents the World Health Organization's definition of palliative care and the implications of this definition. Additionally, this article identifies the common palliative-care mistakes that have been made by the general public and by healthcare workers. Healthcare professionals must acquire essential relevant knowledge and skills in order to ensure that hospice palliative care addresses the needs of terminally ill patients adequately. Finally, the author describes a novel approach to instilling proper palliative-care concepts and practices that is entitled Life, Peace, Care, and Honor (LPCH or the "3344" concept).
Blignaut-van Westrhenen, Nadine; Fritz, E.
Object: This article explores the experiences of professional hospice workers using a creative process for debriefing them in order to facilitate the expression and communication of complex thoughts and feelings. The creative arts workshops were developed with the understanding in mind that caring
von Gunten, Charles F; Mullan, Patricia B; Nelesen, Richard; Garman, Karen; McNeal, Helen; Savoia, Maria; Muchmore, Elaine; Ikeda, Tyson; Amundson, Stan; McKennett, Marianne; Diamant, Joel; Pepper, Patricia; Gray, Cynthia; Weissman, David
Effective approaches to teaching attitudes, knowledge, and skills to resident physicians in primary care that can be implemented in any residency program are needed. We examined the feasibility and impact of a single palliative care residency curriculum, including a clinical rotation with a hospice program, across 5 cohorts of residents in 7 divergent primary care residency programs (both family medicine and internal medicine). The didactic content was drawn from the national Education for Physicians on End-of-Life Care Project. A total of 448 residents completed the curriculum. A large effect size was seen in measures of knowledge change (*Cohen d = .89) when compared to a national sample of primary care residency programs. Additionally, measures of confidence to perform palliative care skills and ethical concerns also improved significantly ( P hospice setting. In a separate, ancillary evaluation, the average length of stay of patients enrolled in hospice care was 18.5 days longer for the alumni of this program when compared to physicians referring for hospice care who hadn't experienced the curriculum.
Yang, Fei-Min; Ye, Zhi-Hong; Tang, Lei-Wen; Xiang, Wei-Lan; Yan, Lin-Juan; Xiang, Min-Li
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. 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. 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 education. 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.
The article presents the views on the problems of post-graduate education in the sphere of palliative and hospice care in Ukraine. The need to modernize and adjust training programs according to modern international approaches is underlined. Labor et Educatio
Price, Jayne; Dornan, Jean; Quail, Lorraine
Children's palliative care has evolved in recent years and is now recognised as a distinct area of health and social care practice. Whilst children's hospices are viewed as central to quality care for these children and families, lack of knowledge regarding the exact nature of care they provide exists. Education can go part way to changing attitudes and knowledge about the key contribution of hospices, thus improving future care. Alternative and innovative strategies to stimulate meaningful learning are pivotal to children's nurse education and this paper examines one such innovation adopted with 2nd year children's nursing students. Aiming to help students explore the ethos of children's hospice an educational visit was arranged, followed by an on line discussion. Although some practical challenges were encountered, the visit heightened student awareness moving them from the readily held perception that children's hospices were exclusively for dying children and was viewed by students as more effective than a traditional classroom session. Copyright © 2012 Elsevier Ltd. All rights reserved.
Salloch, Sabine; Breitsameter, Christof
Hospices consider themselves places that practise a holistic form of terminal care, encompassing physical and psychological symptoms, and also the social and spiritual support for a dying patient. So far, the underlying ethical principles have been treated predominantly in terms of a normative theoretical discussion. The interview study discussed in this paper is a qualitative investigation into general and hospice-related conceptions of morality among full-time and voluntary workers in German inpatient hospices. It examines moral conflicts and efforts leading to their solution. The main ideas identified include moral neutrality towards the patients and their requests, the capability of acceptance, the idea of self-restraint with respect to the dying patient and the principle of respect for the natural course of dying. Essential triggers for moral conflicts were the inadequate education of patients, problems of acceptance in view of incurable disease, and disagreements between members of patients' families. The interviewees expressed their scepticism towards formal institutions of ethical counselling. The study has shown a type of virtue ethics that forms an integral part of the overall concept of hospice care, which cannot be treated separately from a holistic idea of care at the end of life.
Hoda, Rashina; Babb, Jeff; Nørbjerg, Jacob
Today's software development challenges require learning teams that can continuously apply new engineering and management practices, new and complex technical skills, cross-functional skills, and experiential lessons learned. The pressure of delivering working software often forces software teams...... to sacrifice learning-focused practices. Effective learning under pressure involves conscious efforts to implement original agile practices such as retrospectives and adapted strategies such as learning spikes. Teams, their management, and customers must all recognize the importance of creating learning teams...
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
Sandsdalen, Tuva; Grøndahl, Vigdis Abrahamsen; Hov, Reidun; Høye, Sevald; Rystedt, Ingrid; Wilde-Larsson, Bodil
Patients' perceptions of care quality within and across settings are important for the further development of palliative care. The aim was to investigate patients' perceptions of palliative care quality within settings, including perceptions of care received and their subjective importance, and contrast palliative care quality across settings. A cross-sectional study including 191 patients in late palliative phase (73 % response rate) admitted to hospice inpatient care, hospice day care, palliative units in nursing homes, and home care was conducted, using the Quality from the Patients' Perspective instrument-palliative care (QPP-PC). QPP-PC comprises four dimensions and 12 factors; "medical-technical competence" (MT) (2 factors), "physical-technical conditions" (PT) (one factor), "identity-orientation approach" (ID) (4 factors), "sociocultural atmosphere" (SC) (5 factors), and three single items (S); medical care, personal hygiene and atmosphere. Data were analysed using paired-samples t-test and analysis of covariance while controlling for differences in patient characteristics. Patients' perceptions of care received within settings showed high scores for the factors and single items "honesty" (ID) and "atmosphere" (S) in all settings and low scores for "exhaustion" (MT) in three out of four settings. Patients' perceptions of importance scored high for "medical care" (S), "honesty" (ID), "respect and empathy" (ID) and "atmosphere" (S) in all settings. No aspects of care scored low in all settings. Importance scored higher than perceptions of care received, in particular for receiving information. Patients' perceptions of care across settings differed, with highest scores in hospice inpatient care for the dimensions; ID, SC, and "medical care" (S), the SC and "atmosphere" (S) for hospice day care, and "medical care" (S) for palliative units in nursing homes. There were no differences in subjective importance across settings. Strengths of services related to
Team building activities are an excellent way to challenge students and teach them the critical communication and problem solving skills that encourage trust, empathy, and ability to work together. They create an atmosphere that enhances the ability to meet fitness and skill goals because students, regardless of skill level, will possess increased…
De Rooij, J.P.G.
The aim of this dissertation was to study the little examined, yet important issue of leadership for distributed teams. Distributed teams are defined as: “teams of which members are geographically distributed and are therefore working predominantly via mediated communication means on an