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Proactive Nurse Driven Frailty Screening For Early Palliative Care Intervention, Teresa Ann Hobt-Bingham

Leadership Connection

Session presented on Monday, September 19, 2016:

Our older population is growing, our estimated population of older adults, 65 years of age and older is projected to be 83.7 million by the year 2050 (Ortman, J., Velkoff, V.A., 2014, p. 25). This increase in our older adult population creates an increase in the number of older adult trauma patients admitted to the hospital. Many different variables must be considered when caring for our geriatric population, including their end of life wishes. Palliative care is often a misunderstood term by not only families and patients, but also physicians and nurses. The …

Palliative Care: Improving Eligible Patient Identification To Encourage Early Intervention, Norma H. Clark

Group: Northern Arizona University School of Nursing, DNP Doctoral Papers

Palliative care (PC) encompasses a holistic way of caring for patients and families with chronic disease or life-limiting illness through optimal symptom management. Individuals in need of PC has reached 20 million annually world-wide. Many patients in need of this service never receive a consultation, or if they do, it comes late in the disease process. Some health care specialists see PC as incongruent with treatment, while others have a lack of understanding of what this service provides. Additionally, many providers have few or no resources to guide in the recognition of PC needs. This practice improvement project emphasized identification …

Complex Illness Support Alongside Standard Oncology Care, Kimberly A. Bland

Group: Nebraska Methodist College

Aim. To evaluate the effect of Complex Illness Support alongside standard oncology care for patients with incurable cancer on symptom control, patient satisfaction with care, and chemotherapy utilization within 30 days of death.

Design. This was a descriptive study to evaluate the effect of Complex Illness Support alongside standard oncology care for patients with incurable cancer on symptom control and patient satisfaction with care. Additionally, the use of chemotherapy within 30 days of death was evaluated using inferential statistics.

Method. A convenience sample of consecutive patients with incurable cancer who presented through a lung cancer clinic in a Midwestern urban …

Reliably Assessing Dyspnea In Non-Communicative End-Of-Life Patients, Laura A. Thomas

Group: Nebraska Methodist College

Problem: Will education provided to nurses at a Midwest community hospital about the Respiratory Distress Observation Scale (RDOS) result in increased knowledge on how to assess patients who are unable to self-report dyspnea?

Intervention: Dyspnea is a common and distressing symptom which occurs in critically ill and end-of-life patients. Due to sedation and physiological changes which occur during critical illness and the dying process, many patients are unable to communicate dyspnea. The Respiratory Distress Observation Scale (RDOS) is the only evidence-based tool available to assess dyspnea in uncommunicative end-of-life patients. A pre-intervention survey was sent to participating oncology nurses to …

Treatment Trials - The Need For An End-Of-Life Policy, Mary Ellen Wurzbach

General Submissions: Nursing as Profession

Currently, there is an epidemic of elders in nursing homes with swallowing difficulties, Alzheimer's, and other maladies, which cause diminished decision-making capacity and initiate the discussion of whether to insert a gastrostomy tube. Furthermore, there is an overriding belief among health care practitioners that once inserted the tube will remain until the death of the resident.

The need for policy provisions related to treatment trials of gastrostomy tubes at the end-of-life is discussed. The arguments supporting and opposing treatment trials as applied to the individual and to the community are articulated and the benefits of such a policy discussed from …

The Impact Of A Web-Based Prognostic Calculator On Prognostic Confidence In Outpatient Palliative Care, David Hui, John P Maxwell, Allison De La Rosa, Kristofer Jennings, Marieberta Vidal, Akhila Reddy, Ahsan Azhar, Rony Dev, Kimberson Tanco, Yvonne Heung, Marvin Delgado-Guay, Donna Zhukovsky, Joseph Arthur, Suresh Reddy, Sriram Yennu, Amy Ontai, Eduardo Bruera

Faculty, Staff and Student Publications

Purpose: Clinicians are often uncertain about their prognostic estimates, which may impede prognostic communication and clinical decision-making. We assessed the impact of a web-based prognostic calculator on physicians' prognostic confidence.

Methods: In this prospective study, palliative care physicians estimated the prognosis of patients with advanced cancer in an outpatient clinic using the temporal, surprise, and probabilistic approaches for 6 m, 3 m, 2 m, 1 m, 2 w, 1 w, and 3 d. They then reviewed information from www.predictsurvival.com , which calculated survival estimates from seven validated prognostic scores, including the Palliative Prognostic Score, Palliative Prognostic Index, and Palliative Performance …

Palliative Care And Advance Care Planning Intervention Fidelity Monitoring: Methods And Lessons Learned From Pcori-Funded Large-Scale, Pragmatic Clinical Trials, Manisha Verma, Corita Grudzen, Seiko Izumi, Neil Wenger, Areej El-Jawahri, Deborah Ejem, Rebecca Aslakson

Einstein Health Papers

Over the past decade, the Patient-Centered Outcomes Research Institute (PCORI) funded multiple large-scale, comparative effectiveness clinical trials evaluating palliative care and advance care planning interventions. These are complex multicomponent interventions that need robust but flexible fidelity monitoring. Fidelity is necessary to maintain both internal and external validity within palliative care intervention research and to ultimately evaluate the real-world impact of high-quality interventions. Different trials not only took varying approaches to fidelity monitoring but also uncovered both unique and common challenges and facilitators. This article summarizes 8 of these trials and highlights approaches, adaptations, barriers, and facilitators for intervention fidelity monitoring. …

Challenges In Pediatric Home-Based Hospice And Palliative Care: A Case Series, Jill Ann Jarrell, Daniel H Grossoehme, Sarah Friebert, Toluwalase A Ajayi, Rachel Thienprayoon, Lisa Humphrey

Faculty, Staff and Students Publications

Pediatric home-based hospice and palliative care is a growing and important sub-field within the larger pediatric palliative care landscape. Despite research demonstrating the clinical and systemic efficacy of pediatric home-based hospice and palliative care, there remain barriers to its optimal development, implementation, and dissemination as well as best clinical practice knowledge gaps. This case series presents specific examples of ubiquitous challenges in pediatric home-based hospice and palliative care in hopes of guiding future research, education, advocacy, and program development efforts.

Conducting Comparative Effectiveness, Multisite Palliative Care And Advance Care Planning Trials: Lessons Learned And Future Directions From Pcori-Funded Studies, Areej El-Jawahri, Brittany Waterman, Susan Enguidanos, Lisa Gibbs, Victor Navarro, Maren Olsen, Jennifer Temel, Annette Totten, Corita R. Grudzen

Department of Medicine Faculty Papers

The Patient-Centered Outcomes Research Institute (PCORI) funded multiple large-scale comparative effectiveness clinical trials evaluating palliative care (PC) and advance care planning (ACP) healthcare delivery models. This article provides an overview of the most common barriers our investigative teams encountered while implementing these trials and the strategies we utilized to overcome these challenges, with particular attention to identifying research partners for multisite trials; addressing contracting and regulatory issues; creating a team governance structure; training and engaging study staff across sites; recruiting, consenting, and enrolling study participants; collecting PC and ACP data and study outcomes; and managing multisite collaborations. The goal of …

Use Of Palliative Care Among Adults With Newly Diagnosed Heart Failure: Insights From A Us National Insured Patient Sample, Zidong Zhang, Divya S Subramaniam, Steven W Howard, Kenton J Johnston, William H Frick, Kimberly Enard, Leslie Hinyard

2020-Current year OA Pubs

BACKGROUND: Despite the known benefits for individuals with heart failure (HF), incomplete data suggest a low use of palliative care (PC) for HF in the United States. We aimed to investigate the national PC use for adults with HF by determining when they received their first PC consultation (PCC) and the associations with clinical factors following diagnosis of HF.

METHODS AND RESULTS: We conducted a retrospective cohort study in a national all-payer electronic health record database to identify adults (aged ≥18 years) with newly diagnosed HF between 2011 and 2018. The proportion of those who received PCC within 5 years …

Development And Evaluation Of A Nurse Practitioner Directed Early Palliative Care Initiative And Its Impact On Goal-Concordant Care At A Cancer Center, Ashley V. Weinmann

Dissertations

Seriously ill patients often experience discordant care. Delivering high-quality healthcare requires effective communication to support goal-concordant care.

Pancreatic cancer has a 5-year survival rate of 12% with a high symptom burden. Pancreatic cancer patients often have unmet needs that lead to increased psychological, spiritual, social, and physical needs. Early integration of palliative care can provide high-quality communication and goal-concordant care. A retrospective analysis of MDACC's pancreatic patients found that 34% were referred to palliative care.

Transformative Peer Connections: Early Experiences From The Asco Palliative Care Community Of Practice., Mazie Tsang, Cristiane Bergerot, Natasha Dhawan, Rushil Patel, Darcy Burbage, Tingting Zhang, Jafar Al-Mondhiry, Joseph Mccollom Do, Ramy Sedhom

PCI Publications and Projects

The integration of palliative care into routine oncology practice is the standard of care by most leading cancer organizations. Palliative medicine helps to deliver higher quality of care at a lower cost. However, there are barriers to implementing palliative oncology at many institutions for myriad reasons. In this article, we discuss an innovative strategy that ASCO implemented called the Communities of Practice (CoP). We share our experiences as the Palliative Care CoP and how our group seeks to develop processes and structures to collectively promote systemic change and enhance palliative care delivery for people with cancer. Our Palliative Care CoP …

Review Of Live Discharges From Medicare-Certified Home Hospice Program, Saman Misbah Do, Kavita Sharma Md, Sarah Riutta Phd, Dawn Wankowski Ms, Nora Badi Md

Scientific Day

No abstract provided.

Patients’ Preferred Place Of Death: Documenting Preferred Place Of Death At The Vince Lombardi Palliative Cancer Clinic, Natalia Puig-Marquez Md, Andre Cernasov Do, Kavita Sharma Md, Sarah Riutta Phd, Dawn Wankowski Ms

Scientific Day

No abstract provided.

Exploring Music Therapists' Experiences Of Utilizing A Family-Based Approach With Children Receiving Palliative Care, Faith Anne Agolia

Theses & Dissertations

This research study explored the experiences of three music therapists who employ a family-based approach with families whose children are receiving palliative care. Literature addressing the benefits of music therapy for people in palliative care exists, but little is known about the lived experience of music therapists who work in these settings. Music therapists were recruited through purposive sampling. Through phenomenological microanalysis, eight themes emerged: Family-based approach is natural, yet nuanced; the sacredness of the therapeutic relationship; positive memory making through legacy as a means to family connectedness; vicarious trauma; intentional self-care and coping; feeling siloed and experiencing challenges within …

Perspectives From Patients With Chronic Lung Disease On A Telehealth-Facilitated Integrated Palliative Care Model: A Qualitative Content Analysis Study, Jeannette Kates, Carrie Tompkins Stricker, Kristin L. Rising, Alexzandra Gentsch, Ellen Solomon, Victoria Powers, Venise J. Salcedo, Brooke Worster

Department of Medicine Faculty Papers

BACKGROUND: Chronic lung disease affects nearly 37 million Americans and often results in significant quality of life impairment and healthcare burden. Despite guidelines calling for palliative care (PC) integration into pulmonary care as a vital part of chronic lung disease management, existing PC models have limited access and lack scalability. Use of telehealth to provide PC offers a potential solution to these barriers. This study explored perceptions of patients with chronic lung disease regarding a telehealth integrated palliative care (TIPC) model, with plans to use findings to inform development of an intervention protocol for future testing.

METHODS: For this qualitative …

The Positive Impact Of Reducing Polypharmacy On The Quality Of Life For Older Adults With Serious Illness, Stephanie Orlando

Student Scholarly Projects

Practice Problem

The rising prevalence of chronic health conditions, the aging of the population, and advances in healthcare technology have contributed to the rampant over-prescribing of medications and the prescribing of potentially inappropriate medicines (PIMS) in community-dwelling older adults. Additionally, reluctance by the medical community to deprescribe and resistance among patients and their caregivers due to misperceptions about withdrawing treatment has further perpetuated the problem.

PICOT

The PICOT question for this project was, in community-dwelling older adults over age 60 receiving palliative care, does the implementation of an interprofessional deprescribing intervention compared to standard care by a home-based medical care …

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 – …

The Role Of Palliative Care Consultation In Withdrawal Of Life-Sustaining Treatment Among Icu Patients Receiving Veno-Venous Extracorporeal Membrane Oxygenation (Vv-Ecmo): A Retrospective Case-Control Study, Gabriel Patarroyo-Aponte, Saeed Shoar, Deptmer M Ashley, Ali Noorbaksh, Dev Patel, Alisha Y Young, Bindu H Akkanti, Mark T Warner, Maria M Patarroyo-Aponte, Biswajit Kar, Igor D Gregoric, Caroline Ha, Bela Patel

Faculty, Staff and Student Publications

Background: Extracorporeal membrane oxygenation (ECMO) has extended the survivability of critically ill patients beyond their unsupported prognosis and has widened the timeframe for making an informed decision about the goal of care. However, an extended time window for survival does not necessarily translate into a better outcome and the sustaining treatment is ultimately withdrawn in many patients. Emerging evidence has implicated the determining role of palliative care consult (PCC) in direction of the care that critically ill patients receive. Objective: To evaluate the impact of PCC in withdrawal of life-sustaining treatment (WOLST) among critically ill patients, who were placed on …

The Role Of Peroxisome Proliferator-Activated Receptors In The Development And Physiology Of Gametes And Preimplantation Embryos, Gabriel Patarroyo-Aponte, Saeed Shoar, Deptmer M Ashley, Ali Noorbaksh, Dev Patel, Alisha Y Young, Bindu H Akkanti, Mark T Warner, Maria M Patarroyo-Aponte, Biswajit Kar, Igor D Gregoric, Caroline Ha, Bela Patel

Faculty, Staff and Student Publications

Background: Extracorporeal membrane oxygenation (ECMO) has extended the survivability of critically ill patients beyond their unsupported prognosis and has widened the timeframe for making an informed decision about the goal of care. However, an extended time window for survival does not necessarily translate into a better outcome and the sustaining treatment is ultimately withdrawn in many patients. Emerging evidence has implicated the determining role of palliative care consult (PCC) in direction of the care that critically ill patients receive. Objective: To evaluate the impact of PCC in withdrawal of life-sustaining treatment (WOLST) among critically ill patients, who were placed on …

Experiences Of Patients With Peritoneal Carcinomatosis-Related Complex Care Needs And Their Caregivers, Rachel A Pozzar, Jaclyn A Wall, Anna Tavormina, Embree Thompson, Andrea C Enzinger, Ursula A Matulonis, Susana Campos, Larissa A Meyer, Alexi A Wright

Faculty, Staff and Student Publications

Background: Patients with peritoneal carcinomatosis (PC) frequently undergo palliative procedures, yet these patients and their caregivers report being unprepared to manage ostomies, drains, and other complex care needs at home. The purpose of this study was to characterize the unique needs of these patients and their caregivers during care transitions.

Methods: Patients completed measures of health status and advance care planning, caregivers completed measures of preparedness and burden, and all participants completed measures of depression and anxiety. Participants detailed their experiences in individual, semi-structured interviews. We analyzed data using descriptive statistics and conventional content analysis.

Results: Sixty-one patients and 39 …

The Differences In Code Status Conversation Approaches Reported By Emergency Medicine And Palliative Care Clinicians: A Mixed-Method Study, Kei Ouchi, Thidathit Prachanukool, Emily L Aaronson, Joshua R Lakin, Masaya Higuchi, Shan W Liu, Maura Kennedy, Anna C Revette, Anita N Chary, Jenson Kaithamattam, Brandon Lee, Thanh H Neville, Mohammad A Hasdianda, Rebecca Sudore, Mara A Schonberg, James A Tulsky, Susan D Block

Faculty, Staff and Students Publications

BACKGROUND: During acute health deterioration, emergency medicine and palliative care clinicians routinely discuss code status (e.g., shared decision making about mechanical ventilation) with seriously ill patients. Little is known about their approaches. We sought to elucidate how code status conversations are conducted by emergency medicine and palliative care clinicians and why their approaches are different.

METHODS: We conducted a sequential-explanatory, mixed-method study in three large academic medical centers in the Northeastern United States. Attending physicians and advanced practice providers working in emergency medicine and palliative care were eligible. Among the survey respondents, we purposefully sampled the participants for follow-up interviews. …

Quality Improvement Project To Increase Referrals To Palliative Care For Heart Failure Patients, Stephanie D. Crawford

Dissertations

Palliative care (PC) services include symptom management with advanced care planning (ACP) and establishment of goals of care (GOC) for patients with serious conditions, such as heart failure (HF). Literature demonstrates low hospitalist referrals to PC.

The purpose of this project was to explore if providing evidence-based information and procedural information to hospitalists on ACP and GOC would increase PC referrals for HF patients, providing these patients access to ACP and GOC by the PC team and possibly even reducing 30-day readmissions for these patients.

Palliative Care Quality Of Life Outcomes In Adults With Chronic Illness, Jackie Steigerwald

Master of Science in Nursing Family Nurse Practitioner

In adult populations with chronic illnesses, implementation of palliative care may provide the opportunity to slow the disease process, manage symptoms, and improve patients' overall quality of life. Without palliative care implementation, the aspects of psychosocial needs may go clinically unaddressed with disease progression. Palliative care provides an opportunity for multidisciplinary providers to make interventions to improve all aspects of quality of life. The aim of this project is to evaluate the implementation of palliative care services in patients with chronic illnesses, the World Health Organization Quality of Life Abbreviated (WHOQOL BREF) quality of life scale and compare them with …

Beyond Prognosis Communication: Exploring The Existential Dimensions Of Palliative Care Conversations With Adults With Advanced Cancer, Elise C. Tarbi

Dissertations

Communication about prognosis is integral to effective palliative care. However, prognosis communication often entails considering mortality, which can trigger existential questions. We understand very little about how existential experience is communicated in palliative care conversations. To fill this gap, this dissertation addresses the following aims: (1) Clarify the concept of the existential experience within the context of adults with advanced cancer (Chapter 2); (2) Describe how patients, families, and clinicians communicate about existential experience in palliative care conversations (Chapter 3); and (3) Explore the intersection between prognosis communication and existential dimensions of conversation (Chapter 4).

National Survey On The Availability Of Oncology Palliative Care Services At Tertiary General And Cancer Hospitals In China, Xiaomei Li, Xin Shelley Wang, Haili Huang, Miao Liu, Yinan Wu, Jiaojiao Qiu, Boran Zhang, Linhong Cui, David Hui

Faculty, Staff and Student Publications

Background: This nationwide survey studied the level of palliative care (PC) access for Chinese patients with cancer among cancer care providers either in tertiary general hospitals or cancer hospitals in China.

Methods: Using a probability-proportionate-to-size method, we identified local tertiary general hospitals with oncology departments to match cancer hospitals at the same geographic area. A PC program leader or a designee at each hospital reported available PC services, including staffing, inpatient and outpatient services, education, and research, with most questions adapted from a previous national survey on PC. The primary outcome was availability of a PC service.

Results: Most responders …

Impact Of Delirium Observation Screening Scale On Identifying Delirium In Hospice Patients, Elsie E. Glasu-Atunuwa

Dissertations

Delirium in the elderly can impact health outcomes, making it essential for healthcare workers to identify and manage delirium early. At the project site, there was no evidence based approach to the early identification of delirium. The purpose of this quantitative quasi-experimental quality improvement project was to determine if the translation of Neefjes et al.'s research using the Delirium Observation Screening Scale (DOSS) would impact the identification of delirium with provider notification among adult patients in a hospice facility in South Texas over four weeks. Virginia Henderson's need theory and Kurt Lewin's change theory provided the theoretical foundations for the …

Competencies For Psychology Practice In Pediatric Palliative Care, Amanda L Thompson, Megan R Schaefer, Sarah R Mccarthy, Aimee K Hildenbrand, Melissa K Cousino, Meghan L Marsac, Jill Majeski, Karen Wohlheiter, Rachel A Kentor

Faculty, Staff and Students Publications

Objective: Pediatric psychologists have unique expertise to contribute to the care of youth with serious illnesses yet are not routinely integrated into pediatric palliative care (PPC) teams. To better define the role and unique skillset of psychologists practicing in PPC, support their systematic inclusion as part of PPC teams, and advance trainee knowledge of PPC principles and skills, the PPC Psychology Working Group sought to develop core competencies for psychologists in this subspecialty.

Methods: A Working Group of pediatric psychologists with expertise in PPC met monthly to review literature and existing competencies in pediatrics, pediatric and subspecialty psychology, adult palliative …

Palliative Medicine Integration In The Usa: Cancer Centre Executives’ Attitudes, Joseph Chen, Allison De La Rosa, Dejian Lai, Rony Dev, Frances Lee Revere, David Lairson, Paige Wermuth, Eduardo Bruera, David Hui

Faculty, Staff and Student Publications

OBJECTIVES: To compare cancer centre (CC) executives' attitudes towards palliative care between National Cancer Institute-designated CCs (NCI-CCs) and non-NCI-designated CCs (non-NCI-CCs) in 2018 and to examine the changes in attitudes and beliefs between 2009 and 2018.

METHODS: CC chief executives at all NCI-CCs and a random sample of non-NCI-CCs were surveyed from April to August 2018. Twelve questions examined the executives' attitudes towards palliative care integration, perceived barriers and self-assessments. The primary outcome was agreement on the statement 'a stronger integration of palliative care services into oncology practice will benefit patients at my institution.' Survey findings from 2018 were compared …

Medstopper: An Online Tool To Assist With Deprescribing Medications In Patients Enrolled In Home Hospice, Paige Scholer, Kavita Sharma, Kanwardeep Singh, Lori Cook, Jenny Kaldor, Tamara Schulz, Sarah Riutta

Scientific Day

No abstract provided.