Palliative Care Commons^™

Randomized Control Trial Of Advanced Cancer Patients At A Private Hospital In Kenya And The Impact Of Dignity Therapy On Quality Of Life, John Weru, Miriam Gatehi, Alice Musibi

Internal Medicine, East Africa

Background: Palliative care is a modality of treatment that addresses physical, psychological and spiritual symptoms. Dignity therapy, a form of psychotherapy, was developed by Professor Harvey Chochinov, MD in 2005.The aim of the study was to assess the effect of one session of dignity therapy on quality of life in advanced cancer patients.

Methods: This was a randomized control trial of 144 patients (72 in each arm) randomized into group 1 (intervention arm) and group 2 (control arm). Baseline ESAS scores were determined in both arms following which group 1 received Dignity therapy while Group 2 received usual care only. …

Clinical And Socioeconomic Predictors Of Palliative Care Utilization, Rohan Reddy Tummala, Andrew Manuel De Jesus, Natasha Danielle Tillett, Jeffrey Scott Nelson, Christine Marie Lamey

Longitudinal Scholar's Project

INTRODUCTION: Palliative care continues to gain recognition among primary care providers, as patients suffering from chronic conditions may benefit from use of this growing service.

OBJECTIVES: This single-institution quality improvement study investigates the clinical characteristics and socioeconomic status (SES) of palliative care patients and identifies predictors of palliative care utilization.

METHODS: Retrospective chart review was used to compare clinical and SES parameters for three groups of patients: (1) palliative care patients who attended at least one visit since the inception of the University Clinical Health Palliative Care Clinic in Memphis, TN in October 2018 (n = 61), …

Benefits Of Palliative Care In The Intensive Care Unit, Stephen Swenson, Stephen M. Swenson

Nursing Masters Papers

Abstract

The use of palliative care is often overlooked until the terminal phase of serious illness when life-prolonging interventions are deemed futile and death is considered imminent.

Alongside the well regarded Clinical Practice Guidelines for Quality Palliative Care (National Coalition for Hospice and Palliative Care, 2018), numerous critical care societies including the American Association of Critical-Care Nurses (Medina & Puntillo, 2006), American College of Critical Care Medicine (Davidson et al., 2008), American College of Chest Physicians (Selecky et al., 2005), American College of Surgeons (2017), and the American Thoracic Society (Lanken et al., 2007) have each published individual policies highlighting …

To Anticoagulate Or Not: Decision Making Surrounding Anticoagulation In Patients In Hospice And Palliative Care Programs, Erin Kelly, Do, John Liantonio, Md, Mba, Hdmc, Debra Vermette, Md

Health Equity and Quality Improvement (HEQI) Summit

Objectives

• Describe the current guidelines for CAT treatment. - Assess risk factors for bleeding and thrombosis in cancer patients and risk/benefits of anticoagulation.
• Recognize the need for individualized anticoagulation plans in order to make informed decisions that may differ from the guidelines.
• Propose anticoagulation in hospice if it will achieve the goals of the patient.

A Quality Improvement Project To Improve Financial Sustainability Of Home-Based Palliative Care Program, Andrea L. Giffel

Doctoral Projects

Background and Objectives: Home palliative care services are challenging to bill due to the complexity of services and competing time demands. Objectives and protocol were developed to guide coding and billing to increase Relative Value Unit generation and improve financial sustainability.

Design: A quality improvement project.

Setting: A home-based palliative care program in one health system in the Midwest.

Participants: Participants included 7 nurse practitioners.

Intervention: Coding protocol were developed, providers were educated, electronic health record audits were conducted to collect data on improvement, and feedback provided to prompt improvement.

Measurement and Analysis: Documentation of advanced care planning and billing, …

Anticipation, Accompaniment, And A Good Death In Perinatal Care., Bryanna S. Moore, Brian S. Carter, Bryan Beaven, Katie House, Joel House

Manuscripts, Articles, Book Chapters and Other Papers

The ethics of perinatal care, and the experiences of families who receive such care, remains a nascent area of inquiry. It can be hard to see how existing "good death" constructs apply to the experiences of fetal patients and their families. In this paper, we explore two themes raised by a case at our fetal health center: anticipation and accompaniment. In this case, a mother presented to our fetal health center; her unborn son, our fetal patient, was diagnosed with life-threatening hypoplastic left heart syndrome and endocardial fibroelastosis. The parents were told that their son's life expectancy, upon birth, was …

"Farewell" To Prognosis In Shared Decision-Making, Robert F. Johnson

Peer Reviewed Articles

Whether because of a cultural pattern or personal preference, palliative care clinicians encounter persons approaching the end of life who wish to limit or forego prognostic information relating to their situation. This scenario has received attention in a recent motion picture as well as a newly available advance directive modification—the Prognosis Declaration form. The ordinary expectation for end-of-life shared decision-making with a capable person is clinician disclosure of the best effort at prognostic assessment. The optimal match between the expressed values, goals, and preferences of the person with available clinician expertise is hopefully achieved. For the clinician, a person’s choice …

Impact Of Palliative Care Consultation On End Of Life Care Measures: A Retrospective Analysis Of Patients In The Oncology Care Model, Alison Greidinger, Md, Maria Vershvovsky, Md, Evan Lapinsky, Md, Alison Rhoades, Md, Amy Leader, Drph, Vittorio Maio, Pharmd, Jared Minetola, Karen Walsh, Ms, Mba, Valerie Csik, Mph, Cpps, Ruben Rhoades, Md

Department of Medical Oncology Posters

Introduction

• In 2016 ASCO recommended that patients with advanced cancer receive dedicated palliative care (PC) services1. Early PC involvement is associated with lower spending, fewer 30-day readmission rates, decreased chemotherapy administration at the end of life (EOL) and increased hospice referrals2.
• Many patients are not referred and continue to receive chemotherapy and utilize high-acuity services near the EOL.
• The Oncology Care Model (OCM) is a CMS episode-based alternative payment model promoting high-value care.
• We evaluated the effect of PC visits on EOL outcomes including code status (CS) and spending in the last 30 days of life.

Development Of An Outpatient Palliative Care Protocol To Monitor Fidelity In The Emergency Medicine Palliative Care Access Trial., Corita R. Grudzen, Abigail M. Schmucker, Deborah J. Shim, Aminat Ibikunle, Jeanne Cho, Frank R. Chung, Susan E. Cohen

Student Papers, Posters & Projects

Introduction: Palliative care is recommended for patients with life-limiting illnesses; however, there are few standardized protocols for outpatient palliative care visits. To address the paucity of data, this article aims to: (1) describe the elements of outpatient palliative care that are generalizable across clinical sites; (2) achieve consensus about standardized instruments used to assess domains within outpatient palliative care; and (3) develop a protocol and intervention checklist for palliative care clinicians to document outpatient visit elements that might not normally be recorded in the electronic heath record.

Methods: As part of a randomized control trial of nurse-led telephonic case management …

Implementation Of The Integrated Palliative Outcome Scale (Ipos) Into Palliative Care Practice, Lisa A. Pezold

Dissertations

Abstract

Problem: The Visiting Nurse Association of Greater St. Louis (VNA) has a grant-funded, palliative care program called Advanced Illness Management (AIM). The Integrated Palliative Outcome Scale (IPOS) is a tool for providers to identify symptoms. The VNA implemented the IPOS in 2017. A previous quality improvement project revealed that IPOS symptoms were addressed less than 95% of the time leaving patients to suffer from burdensome symptoms, thereby reducing their quality of life.

Methods: Providers were educated on the importance of addressing all symptoms with pharmacologic or nonpharmacologic interventions and the impact the interventions have on the AIM program, grant …

What’S Happening To Our Patients In Their Final Year Of Life?, Teresa Letellier, Amy Haskins, Christina Holt

MaineHealth Maine Medical Center

We want to “die well” which includes:

• Effective symptom management

• Receiving care consistent with wishes Who achieves this, and how?

• Primary care physicians (PCPs) – Insufficient time and training

• Palliative care physicians – Better quality care and decreased health care cost in last years of life

• “Surprise Question” – “Would you be surprised if this patient dies in the next year?”

• To recognize our sickest patients and discuss goals of care and consult palliative care, if appropriate • “Advance care planning tab” – To record code status, advance directive, POLST forms, medical power of …

An Integrated Model Of Palliative Care In The Emergency Department To Improve Referrals, Jennifer L. Schlatter

Doctoral Projects

Introduction: The emergency department plays a critical role in the trajectory of in-hospital patient care. The Center to Advance Palliative Care (CAPC) along with the American College of Emergency Physicians (AECP) recommend early referral to palliative care for patients with life limiting illnesses that present to the emergency department. Research demonstrates that early palliative care consultations result in patient directed goals of care, improved symptom management, decreased length of stay, and reduced direct costs for inpatient hospitalizations.

Objectives: The goal of this project was to implement evidence-based recommendations for early palliative care referrals in an adult emergency department to improve …

Evidence-Based Toolkit To Evaluate Telemedicine Delivery Of Palliative Care, Aubrey E. Dwyer

Doctoral Projects

Advances in healthcare have led to many individuals with cancer to live longer, however the quality of life of these individuals has decreased. Palliative care is a medical sub-specialty that can assist to care for individuals with a life-limiting illness such as cancer. However, the access to palliative care services in rural communities is limited. According to the Institute of Medicine (IOM) report Dying in America, increasing access to palliative care will not only enhance the quality of life for patients with a life-limiting illness, but also contribute to a more sustainable healthcare system. The key stakeholders within a Midwest …

Single-Subject Designs And Practice-Based Research In Palliative Care: A Letter To The Editor., James Gerhart, Dennis J. Hand, Michael Hoerger, Sean O'Mahony

Department of Obstetrics and Gynecology Faculty Papers

No abstract provided.

Integrating Art And Narrative To Enhance Quality Of Life In Palliative Care, Jennifer Fortuna

The Open Journal of Occupational Therapy

Lacie Lee Wallace, a mixed-media artist from Wheeling, West Virginia, is featured on the cover of the Fall 2018 issue of The Open Journal of Occupational Therapy (OJOT). The photograph depicts Lacie holding a self-portrait painted by artist CeCey Rose. Lacie’s physical appearance in the photograph is strikingly different from the physical appearance of the woman featured in the painting. The portrait was created 4 years before Lacie was diagnosed with advanced stage colon cancer. In the year following the diagnosis, Lacie lost nearly 100 lbs. as a result of an aggressive treatment regimen. When the palliative care team at …

A Provider-Based Survey On Quality Of Care And Identification Of Quality Gaps In Inpatient Palliative Care, Adam Pennarola, Md, Mph, Matthew Murphy, Md, Elizabeth Collins, Md, Beth Wagner, Msn, Crnp, Achpn, John Liantonio, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Background

Inpatient Palliative Care Teams (IPCTs) are often called upon to provide multidisciplinary care across hospital settings at Jefferson. However, there is currently no mechanism in place wherein providers consulting the IPCT can provide feedback to specialty palliative care clinicians. Such input from providers could be used to elucidate those services provided by the team which are most appreciated and those which require further development in order to be truly effective. Furthermore, such input may also serve to identify completely new areas for inpatient palliative care needs.

The Death Debate: Penumbra Conundrum, Robert F. Johnson

Peer Reviewed Articles

Determination and declaration of death by neurologic criteria, brain death, is an established and legally accepted clinical practice with profound implications. Concerns regarding the accuracy of this diagnosis raise important clinical, ethical, and legal issues. A recent magazine article highlights these concerns by describing a poignant example of a patient meeting accepted clinical and ancillary testing criteria for brain death in the setting of post cardiac arrest hypoxic ischemic encephalopathy (CA-HIE). With continuation of ventilatory and nutritional support, this patient not only survived but over time demonstrated findings that were no longer consistent with brain death. Offered here is a …

It’S Not About You—It’S About Me, Robert F. Johnson

Peer Reviewed Articles

Hold Me, a film written and directed by Teace Snyder (2016) was distributed by email to palliative care clinicians and educators. The viewpoint presented here is not a review of this movie as a drama for entertainment. Rather it reviews the film to address the suggestion by its producers that it could serve as an adjunct to palliative care professional education.

We Are The Medicine, Madalynn Wendland, Toni Speed

Interprofessional Education

We are all healers— to ourselves, each other and the world around us. Whether you are on the path of becoming a health professional, or have been in practice for a long time, this half-day workshop will help you to view healing from a holistic perspective that draws from the ancient traditions while respecting contemporary science.

Taking Care Of Palliative Care, Jolene Baker, Kristina Larsen, Amanda Schumacher

Master of Social Work Student Policy Advocacy Briefs

Minnesota has done well with the amount of palliative care services provided across the state. However, rural communities in Minnesota have far less access to palliative care programs than those living in urban settings. This is in part due to the lack of availability of health care professionals in rural communities, and the lower reimbursement rates provided for palliative care programs in rural settings. Although the majority of large hospitals in Minnesota offer palliative care programs, most hospitals with fifty beds or less do not. Palliative care has been shown to improve the quality of life of individuals living with …

Factors Associated With End-Of-Life Planning In Huntington Disease., Nancy R Downing, Siera Goodnight, Sena Chae, Joel S Perlmutter, Michael Mccormack, Elizabeth Hahn, Stacey K Barton, Noelle Carlozzi

Rowan-Virtua School of Osteopathic Medicine Departmental Research

OBJECTIVE: Knowledge of one's gene status for adult onset conditions provides opportunity to make advance end-of-life (EOL) plans. The purposes of these analyses were to (1) determine the prevalence of EOL plans, including advance directives (ADs) among persons across 3 stages of Huntington disease (HD) and (2) examine factors associated with having ADs in this sample.

METHODS: Data are from 503 participants in the HD Quality of Life study. Participants completed an online health-related quality-of-life survey that included questions regarding EOL planning and self-reported HD symptoms. Frequencies were calculated for EOL planning by the HD stage. Bivariate analysis and logistic …

Pain Management: Time To Minimize Variations In Practice., Parag Bharadwaj, Brynn E Sheehan, Sunita Dodani, Charles F Von Gunten

Ambulatory and Primary Care Articles

There continue to be great variations in the management of pain in palliative care. Efforts need to be made within the field develop strategies to address this to avoid undue distress in patients.

Going Beyond ‘Do No Harm’: A Critical Annotation, Robert F. Johnson

Peer Reviewed Articles

The Op-Ed article in the New York Times (November 4th, 2016), “On Assisted Suicide, Going Beyond Do No Harm” by Haider Javed Warraich provided an articulate and timely plea for more widespread availability and application of physician-assisted dying, or “suicide”, as part of end-of-life medical care. While this profound intervention should be considered by physicians and others as an option for those able to express their wishes at the end-of-life, it must be considered in the context of the ethical principles appropriate for all health care interventions and recognized for its limited role in the overall approach to compassionate care …

End-Of-Life Care And Opioid Use In India: Challenges And Opportunities, Aasems Jacob, Aju Mathew

Markey Cancer Center Faculty Publications

No abstract provided.

Reducing Symptom Distress In Patients With Advanced Cancer Using An E-Alert System For Caregivers: Pooled Analysis Of Two Randomized Clinical Trials, David H. Gustafson, Lori L. Dubenske, Amy K. Atwood, Ming-Yuan Chih, Roberta A. Johnson, Fiona Mctavish, Andrew Quanbeck, Roger L. Brown, James F. Cleary, Dhavan Shah

Health and Clinical Sciences Faculty Publications

Background: Symptom distress in patients toward the end of life can change rapidly. Family caregivers have the potential to help patients manage those symptoms, as well as their own stress, if they are equipped with the proper resources. Electronic health (eHealth) systems may be able to provide those resources. Very sick patients may not be able to use such systems themselves to report their symptoms but family caregivers could.

Objective: The aim of this paper was to assess the effects on cancer patient symptom distress of an eHealth system that alerts clinicians to significant changes in the patient’s symptoms, as …

Palliative Players: Project Development And Initial Implementation, Eliza Eager

Muskie School Capstones and Dissertations

The Palliative Players are screened and trained hospice volunteers who provide a low-cost, sustainable, role-playing resource for use teaching communication skills to healthcare workers who discuss serious illness with patients and their families. The Palliative Players project was conceived and developed in early 2017 by Dr. Lauren Michalakes, Medical Director of Palliative Care at Coastal Healthcare Alliance (CHA); Sarah Dwelley, RN; Flic Shooter, Director of Hospice Volunteers of Waldo County (HVOWC); and Eliza Eager, Project Coordinator; to provide believable, emotive simulated patients (SPs) for role-play in workshops teaching healthcare workers communication tools and skills for use in conversations with patients …

Development And Implementation Of A Nurse Driven Protocol To Increase Palliative Care Consults In Patients With Advanced Heart Failure, Amber Calendar

Doctor of Nursing Practice Projects

Heart failure creates a significant economic burden for the United States (Ambrosy et al., 2014). In an effort to better coordinate care for patients with advanced heart failure, the American College of Cardiology and American Heart Association developed guidelines for the management of heart failure and suggest integration of palliative care services (Yancy et al., 2013). Palliative care is defined as specialized medical care for patients with serious illness to improve quality of life by focusing on symptom control (Hospice and Palliative Care Association, 2017). The aim of this scholarly project was to translate research into practice by developing a …

Implementation Of A Screening Tool Protocol To Identify Patients With Unmet Palliative Care Needs And Improve Access To Palliative Care In The Icu, Katie Roach

DNP Projects

PURPOSE: The purpose of this study is to evaluate the use of a screening protocol for identifying patients with unmet palliative care needs, and improve access to these services in the intensive care units at Norton Hospital.

METHODS: This study was a single-site retrospective report of the impact of a palliative care screening protocol on palliative care use and quality metrics that correlated to access to palliative care services in the intensive care units at Norton Hospital. The sample consisted of 135 medical records of patients admitted during the study period, which spanned the timeframe between January 1, 2017 and …

Avoiding Overtreatment At The End Of Life: Physician-Patient Communication And Truly Informed Consent, Barbara A. Noah, Neal R. Feigenson

Pace Law Review

This paper’s primary focus will be on considering how best to ensure that patients have the tools to make both informed and authentic choices about their care at the end of life. We will argue that truly informed decision making can help to reduce excessive end-of-life care by any measure. Most importantly for dying patients, better informed decisions can help reduce unnecessary suffering and result in care that aligns with their well-considered values and preferences.

In the first part of this paper, we will explain that, by any of these measures, many dying patients are receiving too much therapy and …

Soothing Relaxation Journeys: Designing Evidence Based Music And Imagery Opportunities, Amy Clements-Cortés

Music Faculty Publications

This paper provides information on the creation of an original collection of music and imagery journeys based on the literature in oncology and palliative care. Background evidence is shared about music and relaxation, music relaxation in medical settings, and music and relaxation in oncology/hospice treatment. The development of the resource is illuminated with respect to principles that guided the design. The Journeys collection is a tool that can be used independently by persons experiencing a variety of issues including: anxiety, pain, stress, low self-esteem, and low mood, etcetera; as well as with groups when implemented by a healthcare professional. While …