Palliative Care Commons^™

Mortality In Medicine, Maren Dougherty

Honors Projects

Practitioners in the medical field attend to health issues across one’s lifespan from birth to death and everything in between. A common conflict in today’s practice of medicine is establishing the true function of medicine. The complete reliance on medicine to ward off death proliferates the biomedicalization of natural life processes, like death. Biomedicalization is the process in which medical authority and its accompanying technology begin to control other aspects of daily life. With medicine’s ultimate goal being to cure disease and fight death, it interferes with the inevitability of human mortality. End-of-life treatment can be taken too far without …

Occupational Impact Of Caregivers In Pediatric Palliative Care, Lezlye Ramos, Karen Park, Jazminne O. Arteaga

Spring 2024 Virtual OTD Capstone Symposium

The purpose of this study is to understand the occupational impact for caregivers who had a child with a life-limiting or life-threatening condition who had received pediatric palliative care. A lack of understanding of occupational therapy’s role in end-of-life care ultimately underutilizes and under-prepares occupational therapists to work in this practice area. Becoming a medical family caregiver, neglecting personal needs and desires becomes a norm having a in-direct effect on physical and psychological health and well-being. Findings from this study suggest that it is reasonable to infer that occupational participation among caregivers is influenced by finding time for self and …

Values Of Occupational Balance And Harmony Among Bipoc Caregivers, Vanessa Duran, Karen Park

Spring 2024 Virtual OTD Capstone Symposium

Background. Historically minoritized populations are underrepresented within hospice care. The lack of diversity among hospice care recipients impacts the development of culturally responsive programming within hospice care for BIPOC family caregivers.

Objective. To learn of the values and perspectives of BIPOC family caregivers in hospice care regarding occupational balance and occupational harmony.

Methods. A mixed-methods study that included an online survey and an optional interview. Measurements utilized were the Occupational Balance Questionnaire (OBQ-11) and an anonymous survey. Three participants completed the online survey.

Results. Preliminary codes were determined by the student researcher from the online survey responses. Four …

Increasing Palliative Care Team Involvement In Pediatric Hematopoietic Stem Cell Transplant Patients, Meagan Vacek, Lisa Tarbell, Melissa List, Erin Hall, Jennifer Linebarger, Kelstan Ellis, Gina Jones, Joel Thompson

Posters

Background: Palliative care facilitates communication, helps with physical and psychological symptom management, and assists in goals of care and advance care planning discussions.1 Multiple organizations, including the American Academy of Pediatrics and American Society of Clinical Oncology encourage palliative care engagement and their involvement with hematopoietic stem cell transplant (HSCT) patients has been shown to be beneficial as HSCT is associated with a high degree of morbidity and possible mortality.2-3 Objective: To increase the number of PaCT consults for patients receiving HSCT for our targeted diagnoses from 48% to 75% by December 2023. Methods: Chart review was conducted for patients …

Evidence-Based Practice For Terminal Extubation: A Guideline Development For Critical Care, Heather Marica

Student Scholarly Projects

Practice Problem: In the critical care unit it was identified that providers utilized various practices in managing patients who were to be terminally extubated (TE). The variations in TE practice resulted in healthcare providers engaging in the TE process feeling unsure of the care they were providing and questioning if best practice measures were being implemented.

PICOT: The PICOT question guiding this project was: “In acute care adult patients who are to be TE (P), how does the development of an evidence-based TE guideline (I) compared to current TE practices (C) improve critical care healthcare workers perception and ability to …

Racial Disparities In Palliative Care Utilization In The Covid-19 Pandemic, Margaret S. Bove, Benjamin Huber, Myles Hardeman, Daniel Harris, Areeba Jawed, Amber Comer

Medical Student Research Symposium

BACKGROUND

Palliative care is a vital resource for the critically or terminally ill. It has myriad benefits such as improved quality of life, reduced depressive symptoms, and decreased scarce resource utilization. Self-identified Black/African patients, however, are less likely to utilize advanced care directives or engage in hospice/comfort care measures and are more likely to prefer intensive treatment at the end of life. There is no research, however, on how the COVID-19 pandemic may have affected these trends.

METHODS

A retrospective cohort study of patients who experienced in hospital mortality or in hospital hospice due to COVID-19 between March 2020 – …

Using A Virtual, Case-Based Approach To Developing Clinical Competency In Hospice, Melissa Robinson, Sasha Holden, Tara Poulsen

Providence Nursing Research Conference 2023 – Present

Background:

There has been a shift in nursing education away from a teacher-centered approach that is focused on requiring learners to memorize large amounts of content to a concept-based approach that is learner-centered and focuses on the development of critical thinking, clinical judgment, and problem-solving skills (Giddens et al., 2020). Conceptual learning requires learners to connect facts and exemplars to concepts through active learning experiences such as completing case studies or problem-solving activities (Baron, 2017). This allows learners to ‘practice’ thinking and apply new knowledge to clinical practice.

The clinical education team is applying this knowledge to the current competency-based …

Assessment Of Social Vulnerability Impact In Care And Prognosis Of Sinonasal Cancers In The United States, Achilles A. Kanaris, David J. Fei-Zhang, Lily B. Fletcher, Stephanie S. Smith, Urjeet A. Patel, Jill N. D'Souza, Daniel C. Chelius, Anthony M. Sheyn, Jeffrey C. Rastatter

School of Medicine Faculty Publications

Key Points: Social determinants of health interactively influence sinonasal cancer care and prognosis. Housing-transportation and socioeconomic status showed the largest associations with disparities. The social vulnerability index can reveal the social determinants of sinonasal cancers.

The Urologist’S Role In Bowel Management Of Adult Spina Bifida: A Narrative Review, Malcolm Sundell, George E. Koch, Melissa Kaufman

School of Medicine Faculty Publications

Background and Objective: Urologists are central to the coordinated care of patients with spina bifida (SB), and efforts to optimize bladder management and protection of the upper tracts are well established. However, the urologist’s role in treating this population often extends to the management of bowel dysfunction which may be less defined. The methods available to the urologist for bowel management range from lifestyle modifications to medical and surgical therapy, with many patients requiring combinations of multiple strategies to combat conflicting symptoms of constipation and fecal incontinence (FI). This narrative review aims to compile a detailed algorithm of management options, …

Occupational Therapy’S Opportunity To Impact Care At The End Of Life, Macey Genzlinger, Mackenzie L. Feldhacker

Student Journal of Occupational Therapy

Navigating and managing the end of life can be difficult. The focus of occupational therapy in care at the end of life is to aid the patient and caregiver through these challenges by facilitating improved safety, comfort, and quality of life through the participation in meaningful occupations. Despite the ways that occupational therapy benefits these patients, occupational therapy involvement in care at the end of life is misunderstood, under-researched, and underutilized. There is a general lack of awareness regarding this topic and a stigma that occupational therapy focuses only on rehabilitation and therefore does not belong in care at the …

End-Of-Life Care For Patients With End-Stage Heart Failure, Comparisons Of International Guidelines, Frederick Berro Rivera, Sarang Choi, Genquen Philip Carado, Arcel V. Adizas, Nathan Ross B. Bantayan, Gerard Jude P. Loyola, Sung Whoy Cha, John Paul Aparece, Anlene Jane B. Rocha, Siena Placino, Marie Francesca M. Ansay, Gerard Francis E. Mangubat, Mer Lorraine P. Mahilum, Abdullah Al-Abcha, Natasha Suleman, Nishant Shah, Tisha Marie B. Suboc, Annabelle Santos Volgman

Ateneo School of Medicine and Public Health Publications

Heart failure (HF) is a chronic, debilitating condition associated with significant morbidity, mortality, and socioeconomic burden. Patients with end-stage HF (ESHF) who are not a candidate for advanced therapies will continue to progress despite standard medical therapy. Thus, the focus of care shifts from prolonging life to controlling symptoms and improving quality of life through palliative care (PC). Because the condition and prognosis of HF patients evolve and can rapidly deteriorate, it is imperative to begin the discussion on end-of-life (EOL) issues early during HF management. These include the completion of an advance directive, do-not-resuscitate orders, and policies on device …

On The Discontinuation Of Enteral Feeding In Head And Neck Cancer: A Case Report, Kyle Fisk, Ana Sanchez

HCA Healthcare Journal of Medicine

Introduction

The goal of palliative care is to preserve the quality of life or patient “comfort” in patients with serious diseases. Palliative care providers serve a wide range of patients: from those who seek curative treatment to those who are actively dying. Given this range, palliative care must mirror the dynamic goals of the patient at different stages of life and treatment. Throughout these stages, a goal of the palliative care provider would be to avoid hastening death; however, this often leads to clinical decisions that directly pit the patient’s comfort against the patient’s life span. This is most salient …

Education For Primary Care Providers On Advance Care Planning: A Systematic Literature Review, Lindsey Ward

DNP Qualifying Manuscripts

Background: Healthcare providers in primary care treat patients at various stages of life. As patients age, it becomes necessary for providers to support their older patients throughout the aging process and address patient care even into life’s end stages. Primary care providers (PCPs) are well-positioned to provide this support and can do so through incorporating end-of-life (EOL) conversations in practice. Such discussions are called advance care planning (ACP). Though PCPs can play a crucial role in their patients’ EOL care decisions, providers report their limited knowledge of ACP as a barrier to its application.Consequently, further education for providers on utilizing …

Palliative Care Referral Protocol: Best Practice Toolkit For Improving Early Referral Rate For Adult Cancer Patients, Linda Dinh Nguyen

Student Scholarly Projects

Despite the benefits of palliative care being well-documented in studies and early palliative care services being strongly recommended by reputable organizations, such as the American Society of Clinical Oncology, many patients did not receive or received late referrals (Pigni et al., 2022). This mainly occurs because oncologists commonly base their referrals on perceived needs and clinical judgment (Smith et al., 2017). Thus, this program development project aimed to create a toolkit to improve early identification and referral to palliative care for adult patients who would benefit from palliative care services. The PICO question that guides this program is: In ambulatory …

A Mixed Methodological Approach To Study The Feasibility Of An End-Of-Life Care Pathway, Noureen Azizullah Mistry

Theses & Dissertations

Background: The growing significance of end-of-life care in response to the increasing prevalence of chronic illnesses and aging populations has prompted recognition of the need for patient-centred care. Care pathways are employed worldwide to offer comprehensive end-of-life care to patients in various healthcare settings. In Pakistan, there is a recognised need to evaluate the feasibility of introducing an end-of-life care pathway.
Objectives: This study aimed to (a) determine the feasibility of using an end-of-life care pathway for hospital-based and home-based palliative care patients, and (b) explore the experiences and opinions of registered nurses piloting the pathway.
Methods: An explanatory sequential …

Meaningful Engagement Of Patients And Families In A Complex Trial Of Advance Care Planning In Primary Care, Angela K. Combe, Deborah L. Dokken, Mary M. Minniti, Annette M. Totten

Patient Experience Journal

Engagement of Patient and Family Advisors (PFAs) is increasingly recommended as best practice in research. During the design and conduct of a large trial of advance care planning (ACP) in primary care, we expanded on the funder’s (Patient-Centered Outcomes Research Institute®) requirement for an engagement plan and sought to develop an innovative approach to fostering and sustaining meaningful engagement of PFAs throughout all phases of the trial. Structures were developed that integrated PFAs into planning and provided the foundation for their ongoing participation. A continuous quality improvement approach became the framework for ongoing engagement. This involved setting goals; collecting data …

Diabetes Mellitus: Interdisciplinary Medical, Surgical And Psychological Therapeutic Approach, Bogdan Socea, Adrian Silaghi, Laura Florentina Rebegea, Daniela Gabriela Balan, Cristian Balalau, Tiberiu Ștefăniță Tenea-Cojan, Doina Andrada Mihai, Ioana Paunica

Journal of Mind and Medical Sciences

Diabetes mellitus is a complex and widespread metabolic disease, having extremely complex implications (biological, psychological, social) for patients. Understanding the pathophysiology of diabetes (majorly influenced by various factors such as genetic predisposition, age, lifestyle choices, etc.) is essential for the prevention of this condition and the establishment of effective treatment strategies. The latest and relevant literature data related to the epidemiology, pathophysiology, and treatment of diabetes are presented, after an exhaustive review of the articles published on this topic and indexed in the WOS, PubMed, Scopus and Google Scholar databases. Preventing or delaying the onset of diabetes can be achieved …

Discordant Cardiopulmonary Resuscitation At An Academic Midwest Medical Center- Prevalence And Solutions, Jeremy Payne, Anne Skinner, David Gannon, Jenenne A. Geske

Graduate Medical Education Research Journal

Background: Code status orders are important features of patient-centered clinical decisions, patient autonomy, and end-of-life care. Despite proper documentation of “do not resuscitate” (DNR) code status, hospitalized patients may be subjected to cardiopulmonary resuscitation (CPR) efforts that go against their wishes.

Purpose: The objective of this study was to identify and describe the population of hospitalized patients receiving discordant resuscitation efforts at a Midwest academic medical center utilizing electronic health records (EHR).

Method: The study included EHR records between 01/01/2011 and 01/01/2021 for hospitalized patients 19 years and older who experienced cardiac arrest (ICD-10 I46) and were documented as DNR. …

Inpatient Palliative Care Utilization In Sickle Cell Disease: Temporal Trends And Factors Associated With Usage, Lois C. Akpati

Research Colloquium

Background: Sickle cell disease (SCD) is a highly morbid condition notable for recurrent hospitalizations due to vaso-occlusive crises and complications of end-organ damage. Palliative care (PC) aims to provide holistic care to patients with serious chronic illnesses. Little is known about the use of inpatient palliative care services in adult patients with SCD.

Methods: We conducted a retrospective cross-sectional study utilizing data from the National Inpatient Sample (NIS) from 2008-2017. Patients >18 years old hospitalized with a primary or secondary ICD-9-CM and ICD-10-CM diagnosis of SCD were included. Outcome of interest was PC service utilization using ICD-9-CM and ICD-10-CM diagnosis …

Competency-Based Nursing Education And The Future Of Nursing: Where The Faith Community Nurse Fits In, Mary Lynne Knighten Dnp, Rn, Nea-Bc

International Journal of Faith Community Nursing

Abstract

Two significant nursing landmark reports published in 2021 are enhancing standards and providing guidance for nursing education and practice. The American Association of Colleges of Nursing (AACN) Essentials: Core Competencies of Professional Nursing Education (2021) provides a blueprint for educationally and experientially preparing nurses for practice. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity report defines issues such as health disparities and inequities, with recommendations for the role nurses should play in making change to improve the health of the nation.

This paper seeks to explore the intersections of these two reports with the specialty …