Medicine and Health Sciences Commons^™

A Case Analysis Of Partnered Research On Palliative Care For Refugees In Jordan And Rwanda, Sonya De Laat, Olive Wahoush, Rania Jaber, Wejdan Khater, Emmanuel Musoni, Ibraheem Abu Siam, Lisa Schwartz, Matthew Hunt, Lynda Redwood-Campbell, Laurie Elit, Elysée Nouvet, Rachel Yantzi, Kevin Bezanson, Carrie Bernard, Takhliq Amir, Ani Chénier, Gautham Krishnaraj, Corinne Schusterwallace

Health Studies Publications

© 2021, The Author(s). Background: This case analysis describes dilemmas and challenges of ethical partnering encountered in the process of conducting a research study that explored moral and practical dimensions of palliative care in humanitarian crisis settings. Two contexts are the focus of this case analysis: Jordan, an acute conflict-induced refugee situation, and Rwanda, a protracted conflict-induced refugee setting. The study’s main goal was to better understand ways humanitarian organizations and health care providers might best support ethically and contextually appropriate palliative care in humanitarian contexts. An unintended outcome of the research was learning lessons about ethical dimensions of transnational …

A Good Life: Palliative Care In The World Of Dementia, Nicola Farmer

Journal of Interdisciplinary Graduate Research

Objective: The World Health Organization (2019) reports that dementia is the seventh leading cause of death with an estimated 50 million people worldwide with this disease. In the United States out of one and a half million Medicare patients on hospice in 2016, only 18% had dementia (The National Hospice and Palliative Care Organization, 2017). McAteer and Wellbery (2013) identified that while referrals to services seem to be on the rise, many are not made until the patient is close to death in the last weeks of an illness. The purpose of this project was to review the literature to …

Examination Of Principles Of Palliative Care To Bolster The Focus On Quality Of Life In Head And Neck Cancer Survivorship, Chelsea A. Macdonald

Electronic Thesis and Dissertation Repository

Introduction: Potential reductions in perceived quality of life (QoL) are associated with the diagnosis of head and neck cancer (HNCa) and the consequences of its treatment. HNCa survivorship care is intended to address the challenges experienced in biopsychosocial domains of functioning that influence perceived QoL. However, owing to the conventionally medicalized provision of HNCa survivorship care, comprehensive consideration of QoL may be excluded and ultimately restricted to the provision of palliative care. If principles of palliative care are included throughout HNCa survivorship care they may serve to bolster the focus on QoL. The purpose of this study centred on the …

Implementation And Outcomes Of Complementary Therapies In Hospice Care: An Integrative Review, Catherine Dingley, Angela Ruckdeschel, Keshia Kotula, Nirmala Lekhak

Nursing Faculty Publications

Complementary therapies are increasingly integrated into hospice care, emphasizing the need to examine the evidence regarding implementation and effects on end-of-life outcomes. This review synthesizes the evidence regarding the implementation of complementary therapies and effects on end-of-life outcomes in hospice care. Whittemore and Knafl’s five-step integrative review process was applied. Using predefined search terms, research-based articles between 2006 and 2020 were reviewed. Twenty-three quantitative/mixed method studies conducted across eight countries met the final review criteria. Most commonly used complementary therapies were music, biofield therapies (reiki, therapeutic touch), and massage therapy. Most studies reported significant findings on physical symptoms (pain, dyspnea, …

Palliative Care And Life-Sustaining/Local Procedures In Colorectal Cancer In The United States Hospitals: A Ten-Year Perspective, Zahra Mojtahedi, Ja Seol Koo, Ji Yoo, Pearl Kim, Hee-Taik Kang, Jinwook Hwang, Moon Kyung Joo, Jay J. Shen

School of Medicine Faculty Publications

Background: In recent years, palliative care utilization has been increasing while life-sustaining/local procedures have been declining at the end of life. Palliative care utilization widely varies based on tumor type. Limited information is available on inpatient palliative care in colorectal cancer. Aims: This study investigated inpatient palliative care utilization and its association with patient demographics, hospital charges, and procedures among colorectal cancer patients admitted to US hospitals between 2008 and 2017. Receipt of life-sustaining and local procedures and surgeries were also investigated during the ten years. Methods: Data were extracted from the National inpatient sample (NIS) database containing de-identified information …

Spiritual Care: The Overlooked Need In End-Of-Life Care, Michael Howard Vrmeer

Doctor of Nursing Practice Scholarly Projects

Background: A number of studies have validated the use of the FICA tool to evaluate a patient’s spirituality. FICA has been helpful in many palliative care settings to screen for spiritual problems that influence the patient's overall health. Aim: The project was a quality improvement initiative with the purpose of implementing the FICA tool as part of the admission assessment to increase chaplain referrals for inpatient palliative care services. Methods: The staff received an in-service on using the FICA questions on admission, and a prompt to complete the screen was placed at each work station in the project setting. Results: …

Palliative Care And Improving Quality Of Life With End Stage Renal Disease: An Integrative Review, Natoya Bender

Doctoral Dissertations and Projects

End-stage renal disease is a rising health care problem effecting greater than 10% of the US population. there are 700,000 patients in dialysis in the U.S who are characterized by multiple comorbidities and increasing, distressing symptom burden. The need for palliative care for patient with end-stage renal disease is becoming standard of care due to their complex medical needs and high symptom burden. The aim of this integrative review investigated the incorporation of palliative care will improve the quality-of-life of patients with end-stage renal disease once introduced in their care. While palliative care provides an ideal opportunity to assess the …

Examining The Course Of Transitions From Hospital To Home-Based Palliative Care: A Mixed Methods Study, Stephanie Saunders, Marianne Weiss, Chris Meaney, Tieghan Killackey, Jaymie Varenbut, Emily Lovrics, Natalie Ernecoff, Amy T. Hsu, Maya Stern, Ramona Mahtani, Kirsten Wentlandt, Sarina R. Isenberg

College of Nursing Faculty Research and Publications

Background:

Hospital-to-home transitions in palliative care are fraught with challenges. To assess transitions researchers have used patient reported outcome measures and qualitative data to give unique insights into a phenomenon. Few measures examine care setting transitions in palliative care, yet domains identified in other populations are likely relevant for patients receiving palliative care.

Aim:

Gain insight into how patients experience three domains, discharge readiness, transition quality, and discharge-coping, during hospital-to-home transitions.

Design:

Longitudinal, convergent parallel mixed methods study design with two data collection visits: in-hospital before and 3–4 weeks after discharge. Participants completed scales assessing discharge readiness, transition quality, and …

Use Of Telehealth In Home-Based End-Of-Life Care For Children In Rural Regions, Meaghann S. Weaver

Theses & Dissertations

A national shortage in pediatric-trained providers results in certain geographies, primarily rural, where children with special needs are not able to access home-based care at their end-of-life. Advances in technology have made the use of telemedicine a potential modality for palliative care subspecialty clinicians to provide clinical care and support for adult-trained hospice teams. This dissertation utilizes four approaches to consider telehealth as an unexplored opportunity in care delivery: (1) a systematic review of telehealth measures and instruments to select the Technology Acceptance Model as a validated metric of telehealth acceptance uniquely now applied to pediatric care; (b) a pilot …

Data From Emergency Medicine Palliative Care Access (Empalla): A Randomized Controlled Trial Comparing The Effectiveness Of Specialty Outpatient Versus Telephonic Palliative Care Of Older Adults With Advanced Illness Presenting To The Emergency Department., Abigail M. Schmucker, Mara Flannery, Jeanne Cho, Keith S. Goldfeld, Corita Grudzen, Empalla Investigators

Student Papers, Posters & Projects

BACKGROUND: The Emergency Medicine Palliative Care Access (EMPallA) trial is a large, multicenter, parallel, two-arm randomized controlled trial in emergency department (ED) patients comparing two models of palliative care: nurse-led telephonic case management and specialty, outpatient palliative care. This report aims to: 1) report baseline demographic and quality of life (QOL) data for the EMPallA cohort, 2) identify the association between illness type and baseline QOL while controlling for other factors, and 3) explore baseline relationships between illness type, symptom burden, and loneliness.

METHODS: Patients aged 50+ years with advanced cancer (metastatic solid tumor) or end-stage organ failure (New York …

A Telehealth Palliative Care Objective Structured Clinical Examination, Lindsey Q. Mcintyre

Dissertations

Problem: Palliative care is a service focused on symptom management and improved quality of life for persons with serious or chronic illnesses and is widely underutilized. Although advanced practice registered nurses (APRNs) possess a unique skillset to contribute to palliative care, there is minimal reporting on palliative care training for this professional group. The purpose of this clinical scholarship project was to implement the End-of-Life Nursing Education Consortium (ELNEC) online training program for APRN students in the BSN-DNP program and evaluate its effect on student performance during a telehealth objective structured clinical examination (OSCE).

Methods: An observational, descriptive …

An Interprofessional Approach To Holistic End-Of-Life., Andrew Aschbacher

Doctor of Nursing Practice Papers

Purpose: The goal of this Doctor of Nursing Practice (DNP) project was to develop and evaluate an evidence-based clinical practice guideline (EBP) for an interprofessional approach across four end-of-life care domains (1) ethnocentric spiritual wellbeing, (2) mental wellbeing, (3) symptom management, and (4) value-based goals of care. Design and Methods: The Iowa Model for the Development of Evidence-Based Practice guided the development of the practice guideline. A multi-phase literature review was conducted to establish and grade the best evidence. A two-phase evaluation plan was developed. The University of Louisville Institutional Review Board approved the project. Results: In evaluation phase one, …

Facing Death: Attitudes Toward Physician-Assisted End Of Life Among Physicians Working At A Tertiary-Care-Hospital In Israel, Keren Dopelt, Dganit Cohen, Einat Amar-Krispel, Nadav Davidovitch, Paul Barach

College of Population Health Faculty Papers

The demand for medical assistance in dying remains high and controversial with a large knowledge gap to support optimal patient care. The study aimed to explore physicians’ attitudes regarding euthanasia and examine the factors that related to these attitudes. We surveyed 135 physicians working at a tertiary-care hospital in Israel. The questionnaire was comprised of demographic and background information, DNR procedure information, encounters with terminally ill patients, familiarity with the law regarding end-of-life questions, and Attitudes toward Euthanasia. About 61% agreed that a person has the right to decide whether to expedite their own death, 54% agreed that euthanasia should …

Optimizing Communication In Palliative And Hospice Care: A Toolkit For Audiologists, Sherry E. Queen

Dissertations, Theses, and Capstone Projects

The prevalence of hearing loss increases with age, with age-related hearing loss (ARHL) being one of the most prevalent forms of sensory decline in older adults. Hearing loss is often overlooked in medical settings including palliative and hospice care. Screening for hearing loss in these settings is rare as is formal staff training on assessing and managing hearing loss in palliative and hospice care. An evidence-based toolkit for integrating audiologists into end-of-life care protocols is presented. This toolkit was developed to optimize communication in palliative and hospice care for patients, caregivers, audiologists, physicians, and other palliative care staff. Effective communication …

Augmented Package Of Palliative Care For Women With Cervical Cancer: Responding To Refractory Suffering, Eric L. Krakauer, Khadidjatou Kane, Xiaoxiao Kwete, Gauhar Afshan, Lisa Bazzett-Matabele, Danta Dona Ruthnie Bien-Aimé, Lawrence F. Borges, Sarah Byrne-Martelli, Stephen Connor, Raimundo Correa

Department of Anaesthesia

The essential package of palliative care for cervical cancer (EPPCCC), described elsewhere, is designed to be safe and effective for preventing and relieving most suffering associated with cervical cancer and universally accessible. However, it appears that women with cervical cancer, more frequently than patients with other cancers, experience various types of suffering that are refractory to basic palliative care such as what can be provided with the EPPCCC. In particular, relief of refractory pain, vomiting because of bowel obstruction, bleeding, and psychosocial suffering may require additional expertise, medicines, or equipment. Therefore, we convened a group of experienced experts in all …

Nur 4050 Family Centered End Of Life Care Across The Life Span Syllabus, Linda Bradley

Open Educational Resources

This course explores the nurses’ involvement in family centered end-of-life care. Principles of hospice and palliative care are used and discussed along with the myriad of needs facing individuals and their families at this time of life. The burden and distress of those facing life’s end and the ability of nurses to offer support for the physical, psychological, social, and spiritual needs of clients and their families are presented.

The Value Of Family Support At The End Of Life, Hannah Butler

The Eleanor Mann School of Nursing Undergraduate Honors Theses

There is little research about the role of the family when a patient is dying. This paper examines the role of family support in end-of-life care. This paper consists of the findings from a service learning project with Circle of Life hospice. Patients with family support are more likely to have a DNR, chaplain visit, die at home, and other indicators of quality care. Patients with family support are more likely to receive higher quality care.

Understanding The Role Of Hospice Care: Reflections From A Service-Learning Project, Avery Mccutcheon

The Eleanor Mann School of Nursing Undergraduate Honors Theses

There is little known about the part end-of-life care plays in patient care. This paper examines the role of end-of-life care in the care of a dying patient and consists of findings from a service-learning project with Circle of Life hospice. To be able to effectively care for those in the end stages of life, healthcare professionals must turn away from the curative aspects of medicine, to treating symptoms and improving quality of whatever life remains for the patient. In order to normalize EOL Care and consequently make it more accessible, we must educate our healthcare practitioners regarding the benefits …

Integration Of Palliative Care For Improving Quality Of Life In Patients With Chronic Obstructive Pulmonary Disease, Christina Davis Rasanen

Physician Assistant Scholarly Project Papers

The purpose of this scholarly project is to determine if the integration of palliative care into COPD management provides an improvement in symptom burden associated with quality of life and end of life care when compared to the standard of care. A review of the literature was performed using the following electronic databases, and the use of keywords and mesh terms were used to define the set of literature that would be critically analyzed. A total of 16 articles achieved the necessary criteria for review and critical assessment. The literature reviewed various aspects related to symptom burden and symptom management …

Improving Family Nurse Practitioners’ Knowledge Of Palliative Care Resources, Michelle L. Bond

Theses and Graduate Projects

The shift in healthcare indicates Americans are living longer with progressive chronic illnesses subsequently reducing quality-of-life. Primary care providers have opportunities to assess the need for and implement palliative care to offer holistic symptom management to improve patient’s quality-of-life. The purpose of this scholarly project, guided by Jean Watson’s Theory of Human Caring, is to assess primary care providers knowledge and comfort regarding initiating palliative care while determining if additional education improves their familiarity. The objectives were to review current palliative care literature identifying barriers and inadequacies, determine evidence-based practice to develop an educational presentation and resources to improve communication, …

"Knowledge, Attitude And Practices Regarding Palliative Care Among Interns And Postgraduate Students In A Medical College ", Rekha Thapar

Faculty work

No abstract provided.

Quality Of Life In Patients With Advanced Cancer According To Place Of Care In A Referral Hospital., Jose Amado Tineo, Moises Apolaya Segura, Elizabeth Che Hidalgo, Otto Vargas-Tineo, Jessika Solis Sarmiento, Teodoro Oscanoa Espinoza

Revista de la Facultad de Medicina Humana

The quality of life perceived by patients with advanced cancer from a tertiary hospital is compared according to home care versus hospital care. Observational, cross-sectional study, included patients older than 18 years with cancer with multiple metastases. EORTC QLQ-C15-PAL quality of life survey was applied to patients with adequate cognitive level (Pfeiffer questionnaire). Chi square and Mann-Whitney, p <0.05, and SPSS 24.0 were used. 83 patients in the hospital group and 69 at home. Median age 66 and 76 years respectively (p <0.01); the female sex predominated (p = 0.60). They presented moderate or severe cognitive impairment, 25% hospital group and 58% home (p <0.01). The median quality of life score was 49.5 in the hospital group and 48 in the home group (p = 0.60), the physical functional aspect had a lower score in the hospital group (p <0.01). The perceived quality of life is acceptable, the home group is older and has cognitive impairment.

The Ant Home Care Model In Palliative And End-Of-Life Care. An Investigation On Family Caregivers’ Satisfaction With The Services Provided., Veronica Zavagli

Translational Medicine @ UniSa

The World Health Organization plan for a Decade of Healthy Ageing 2020-2030 has established some priorities in the field of palliative and end-of-life care. It states that “people require non-discriminatory access to good-quality palliative and end-of-life care” and recommends the “implementation of strategies for the provision of information, training, respite and support for informal caregivers”. The priorities described are in line with the home care services that National Tumor Assistance (ANT) Foundation has been providing in Italy. This 5-years investigation was designed to measure caregivers’ satisfaction and determine what types of support services are associated with greater satisfaction. 5.441 family …

Early Palliative Care Implementation In Metastatic Lung Cancer Patients: A Quality Improvement Project, Megan Joan Biegler, Erin Hamar, Stephanie Spinolo

All Electronic Theses and Dissertations

This was a quality improvement project that will allow improvements to be made in healthcare services offered and the overall health status of Stage IV metastatic lung cancer patients receiving palliative care referrals. Data was collected retrospectively from electronic medical records of Stage IV metastatic lung cancer patients with palliative care referrals between January 2019 and March 2020. The palliative care referrals between January 2019 and August 2019 were given per oncologist discretion in timing compared to August 2019-March 2020 when new patients received nurse navigator driven palliative care referrals immediately upon diagnosis. Data analysis looked at correlations for each …

Clinicians' Delirium Treatment Practice, Practice Change, And Influences: A National Online Survey, Annmarie Hosie, Meera Agar, Gideon A. Caplan, Brian Draper, Stephen Hedger, Debra Rowett, Penny Tuffin, Seong Leang Cheah, Jane L. Phillips, Linda Brown, Manraaj Sidhu, David C. Currow

Nursing Papers and Journal Articles

Background: Recent studies cast doubt on the net effect of antipsychotics for delirium.

Aim: To investigate the influence of these studies and other factors on clinicians’ delirium treatment practice and practice change in palliative care and other specialties using the Theoretical Domains Framework.

Design: Australia-wide online survey of relevant clinicians.

Setting/participants: Registered nurses (72%), doctors (16%), nurse practitioners (6%) and pharmacists (5%) who cared for patients with delirium in diverse settings, recruited through health professionals’ organisations.

Results: Most of the sample (n=475): worked in geriatrics/aged (31%) or palliative care (30%); in hospitals (64%); and saw a new patient with delirium …

Cross-Sectional Nutrition Profile Of Palliative Home Care Clients In Ontario And Performance Of The Interrai Palliative Care Nutrition Clinical Assessment Protocol, Tara Stevens, Heather Keller, Nicole Williams, James Downar, Dawn M. Guthrie

Health Sciences Faculty Publications

Background: The nutrition profile of palliative home care clients is unknown. This study describes this group and their nutrition issues and evaluates the performance of the interRAI nutrition Clinical Assessment Protocol (CAP).

Methods: This was a cross-sectional secondary analysis using Ontario interRAI Palliative Care (interRAI PC) Assessment data. The sample represents 74,963 unique Ontario home care clients assessed between 2011 and 2018. Frequencies and standardized differences (stdiffs) of nutrition characteristics were presented for cancer (n = 62,394) and noncancer (n = 12,569) diagnostic subgroups. Rates of triggering the nutrition CAP were presented by nutrition issue to evaluate its performance.

Results: …

A Propensity-Matched, Mortality-Adjusted Study Of Palliative Care Consult To Reduce 90-Day Hospital Readmission In A Heart Failure Cohort, Janice Shirley

Health Sciences Program Student Theses, Dissertations and Capstones

Centers for Medicare and Medicaid Services (CMS) instituted the Hospital Readmission Reduction Program (HRRP) to reduce the frequency of heart failure (HF) 30-day hospital readmissions. To meet the needs of patients with end-stage HF, palliative care (PC) is promoted to provide additional support to patients and reduceunnecessary hospital readmission. While PC is a plausible and logical intervention, effectiveness in achieving reductions in readmissions has not been assessed ina HF population with adequate controls to assess confounding.

The goal of this research was to assess the effectiveness of Palliative care for HF (HFPC) consult to effect change in 90-day hospital readmissions …

Effectiveness Of Online Communication Skills Training For Cancer And Palliative Care Health Professionals: A Systematic Review, Melissa N. Berg, Irene Ngune, Penelope Schofield, Lisa Grech, Ilona Juraskova, Michelle Strasser, Zoe Butt, Georgia K.B Halkett

Nursing Papers and Journal Articles

Objective: To determine the reported effect of online communication skills training (CST) on health professional (HP) communication skills and patient care outcomes in cancer and palliative care.

Methods: Primary research published in English between January 2003 and April 2019 was identified in bibliographic databases including Medline, Embase and Proquest (Prospero: CRD42018088681). An integrated mixed-method approach included studies describing a CST intervention and its effect, for cancer or palliative care HPs, delivered online or blended with an online component. Included studies' outcomes were categorised then findings were stratified by an evaluation framework and synthesised in an effect direction plot. Risk of …

End-Of-Life Nursing Consortium To Improve The Gap In Palliative Care, Emma Kroger

DNP Projects

Abstract

Objective: The purpose of this project is to implement a palliative care education intervention with a pre- and post-survey to assess knowledge, emotional preparedness, and confidence in undergraduate nursing students at the University of Kentucky.

Aim: The aim of this project is to address the gap in palliative care education by increasing professional knowledge, emotional preparedness, and confidence levels in regards to palliative care of future nurses at the University of Kentucky.

Background: The terms “hospice” and “palliative” are often used interchangeably in the healthcare setting. However, palliative care focuses on symptom management in all stages of acute, chronic, …

Clinical Practice Guideline For Palliative Care Referral, Samantha Jones

Walden Dissertations and Doctoral Studies

Palliative care is a type of specialty care that focuses on the improvement of the quality of life and prevention of suffering of those with progressive serious illnesses by addressing the physical, emotional, and spiritual needs of patients and families. There are many misperceptions about palliative care by providers, patients, and their families. Inconsistent interventions and a lack of palliative care education for providers results in delayed palliative care involvement. Delayed involvement results in patients with unmet palliative care needs. The purpose of this project was to develop clinical practice guidelines to ensure appropriate care based on the best available …