Palliative Care Commons^™

Choices Related To Maximizing Quality Of Life At End Of Life, Theresa Lynn

Dissertations

Humans, including those residing in the United States, can live in denial of their own mortality. Because of this, futile care is sometimes provided, often at great monetary expense and for little or no return in terms of quality or length of life. At least two opportunities exist for making choices regarding care at the end of life in the U.S.: completing advance directives and choosing hospice care. This dissertation consists of three studies related to this topic. The first is a quantitative study about advance directives and attitude toward death. The advance directive completion rate among adults in the …

Hospice Home Immersion Project: Advancing Medical Education, Marilyn R. Gugliucci, Himanshu Malhotra, Andrea Gaul

Geriatric Medicine Faculty Publications

The University of New England College of Osteopathic Medicine (UNECOM) Hospice Immersion project was piloted in 2014 in southern Maine. It was designed and implemented as an experiential medical education learning model whereby medical students were “admitted” into the local Hospice Home to live there for 48 hours. Until this project, palliative and end of life care education at US Medical Schools and specifically UNECOM were accomplished through traditional medical education methods. The Hospice Immersion project utilizes qualitative ethnographic and autobiographic research designs, whereby a unique environment or “culture” (Hospice Home) is observed and life experiences of the medical student …

Integration Of Palliative Care In The Context Of Rapid Response A Report From The Improving Palliative Care In The Icu Advisory Board, J. E. Nelson, K. S. Mathews, D. E. Weissman, K. J. Brasel, M. Campbell, J. R. Curtis, J. A. Frontera, M. Gabriel, R. M. Hays, D. R. Lustbader, +7 Additional Authors

Journal Articles

Rapid response teams (RRTs) can effectively foster discussions about appropriate goals of care and address other emergent palliative care needs of patients and families facing life-threatening illness on hospital wards. In this article, The Improving Palliative Care in the ICU (IPAL-ICU) Project brings together interdisciplinary expertise and existing data to address the following: special challenges for providing palliative care in the rapid response setting, knowledge and skills needed by RRTs for delivery of high-quality palliative care, and strategies for improving the integration of palliative care with rapid response critical care. We discuss key components of communication with patients, families, and …

Integrating Palliative Care Into The Care Of Neurocritically Ill Patients: A Report From The Improving Palliative Care In The Icu Project Advisory Board And The Center To Advance Palliative Care, J. A. Frontera, J. R. Curtis, J. E. Nelson, M. Campbell, M. Gabriel, A. C. Mosenthal, D. R. Lustbader, K. J. Brasel, S. P. Weiss, D. E. Weissman, +5 Additional Authors

Journal Articles

OBJECTIVES: To describe unique features of neurocritical illness that are relevant to provision of high-quality palliative care; to discuss key prognostic aids and their limitations for neurocritical illnesses; to review challenges and strategies for establishing realistic goals of care for patients in the neuro-ICU; and to describe elements of best practice concerning symptom management, limitation of life support, and organ donation for the neurocritically ill. DATA SOURCES: A search of PubMed and MEDLINE was conducted from inception through January 2015 for all English-language articles using the term "palliative care," "supportive care," "end-of-life care," "withdrawal of life-sustaining therapy," "limitation of life …

Uncovering Meanings Of Death, Trauma, And Loss As Experienced By Hospice Bereavement Coordinators: A Phenomenological Study, Rochelle S. Clarke

Department of Family Therapy Dissertations and Applied Clinical Projects

This study examined the experiences of Hospice Bereavement Coordinators (HBCs) and Hospice Chaplains working with grief narratives from patient-family units exhibiting signs of anticipatory or complicated grief. While a significant amount of research has been conducted on Hospice employees, no qualitative studies have examined the interpretation of meaning from employees whose primary role focused on the psychosocial-spiritual aspects of clients exhibiting anticipatory or complicated grief. The researcher identified shared meaning of death, trauma, and loss from six participants in the context of a high stress and high loss environment. This study‘s findings revealed ten central themes: Death is an earthly …

Integrating Spirituality As A Key Component Of Patient Care, Suzette Bremault-Phillips, Joanne Olson, Pamela Brett-Maclean, Doreen Oneschuk, Shane Sinclair, Ralph Magnus, Jeanne Weis, Marjan Abbasi, Jasneet Parmar, Christina M. Puchalski

Medicine Faculty Publications

Patient care frequently focuses on physical aspects of disease management, with variable attention given to spiritual needs. And yet, patients indicate that spiritual suffering adds to distress associated with illness. Spirituality, broadly defined as that which gives meaning and purpose to a person’s life and connectedness to the significant or sacred, often becomes a central issue for patients. Growing evidence demonstrates that spirituality is important in patient care. Yet healthcare professionals (HCPs) do not always feel prepared to engage with patients about spiritual issues. In this project, HCPs attended an educational session focused on using the FICA Spiritual History Tool …

Existential Suffering And Cura Personalis: Dilemmas At The End-Of-Life, George P. Smith Ii

Scholarly Articles

Existential, or non-somatic suffering, is often associated with the management of refractory pain at the end-stage of life. Because of misleading sympathologies, this condition is often either mis-diagnosed or even ignored. When diagnosed as a part of a futile medical condition, this Paper argues that deep, palliative, or terminal sedation be offered to the distressed, dying patient as an efficacious and ethical response to preserving a semblance of human dignity in the dying process. Not only is this option of care humane and compassionate, it is consistent with the ideal of best patient care. The notion of care should not …

The Role Of Occupational Therapy In Primary Care, Priti Patel

Occupational Therapy Doctorate Capstone Projects

The Capstone Project is focused on communicating, influencing and educating other health care professionals regarding the role of occupational therapy in the future model of primary care delivery initiated by the adoption of the Affordable Care Act and the Triple Aim Initiative. Currently, primary care, the largest health care platform in United States, is not inclusive of occupational therapy services. Occupational therapists have the scope, knowledge and understanding to be part of the redesigned team model of primary care. Educating those currently working in primary care about adding occupational therapy services can have a significant impact on the profession of …

The Influence Of Positive And Negative Death Attitudes On Medical Students' Empathy And Attitudes Toward End-Of-Life Care, Elizabeth Palumbo

PCOM Psychology Dissertations

This quantitative study employed a cross-sectional survey research design in order to examine the relationships between medical students’ death attitudes, empathy, and attitudes toward end-of-life care. The participants were 206 medical students currently enrolled in the Doctor of Osteopathic Medicine program at the Philadelphia College of Osteopathic Medicine, Philadelphia campus. Results indicated that there were no significant differences in the level of empathy between medical students who held strong positive death attitudes and medical students with strong negative death attitudes. However, results indicated that significant differences existed in attitudes toward end-of-life care between medical students who held strong positive death …

Use Of Low-Dose Ketamine For Pain Management In An Emergency Department, Joseph Ladd, Winifred Pardo

All Publications

Background/Purpose: In the emergency department (ED), many barriers exist to pain management. Non-steroidal anti-inflammatory drugs and acetaminophen often cannot provide enough relief, while opioid analgesics are hindered by side effects, dependency, and tolerance. A non-competitive NMDA receptor antagonist, ketamine has historically been used for sedation and anesthesia in rural settings or in those with limited resources. Ketamine's unique safety profile and variety of dosage forms indicate its potential role in pain management. An evaluation was conducted of ketamine's use in low doses to treat pain in an emergency department with the third-greatest annual census in Miami-Dade county.

Methodology: A retroactive …

A Narrative Inquiry: Case Leaders' Perspectives On Resilience In Hospice Care, Gail Renee Ahern

Antioch University Dissertations & Theses

This study is a qualitative inquiry examining the perspective of team leaders within hospice organizations on resilience. The goal of this study was to examine how hospice leaders build resilience for themselves and within the interdisciplinary teams they lead. A framework of three key theories of leadership—servant, spiritual and authentic—was used to help in understanding the similarities and differences of the interviewed leaders and their key themes and practices. The eight leaders interviewed were from a range of hospices in diverse settings and all were directly responsible for leading interdisciplinary teams. In-depth phenomenological interviewing was undertaken until the study reached …

Palliative Care In Africa: A Global Challenge., Christian R Ntizimira, Jean Luc Nkurikiyimfura, Olive Mukeshimana, Scholastique Ngizwenayo, Diane Mukasahaha, Clare Clancy

Ambulatory and Primary Care Articles

We are often asked what challenges Rwanda has faced in the development of palliative care and its integration into the healthcare system. In the past, patients have been barred from accessing strong analgesics to treat moderate to severe pain, but thanks to health initiatives, this is slowly changing. Rwanda is an example of a country where only a few years ago, access to morphine was almost impossible. Albert Einsten said 'in the middle of difficulty lies opportunity' and this sentiment could not be more relevant to the development of palliative care programmes. Through advocacy, policy, and staunch commitment to compassion, …

The Efficacy Of Music As A Non-Analgesic Method Of Reducing Pain Perception During Cold Pressor Trials, Amanda Lynn Ziemba

Masters Theses

The purpose of this project was to investigate the impact of differentiated onset of self-selected music on pain perception and pain tolerance during a cold pressor test. Subjects participated in four trials during which music was presented at different points of time in relation to their exposure to the cold pressor test. Results indicated that listening to music prior to and concurrently with the onset of the pain resulted in lower self-reported pain (F(3, 66) :3.25, p < .05). Behavioral results indicated that subjects were able to tolerate an average of 25s longer (F(2.04,44.81): I.56,p > .05.) when music was presented after the onset of painful stimuli. Both results have positive implications for the clinical use of music as …

Palliative Care's Sacramental And Liturgical Foundations: Healthcare Formed By Faith, Hope, And Love, Darren M. Henson

Dissertations (1934 -)

Medical history identifies Dame Cicely Saunders as the founder of modern hospice and palliative care for the unique care she gave to the incurably and terminally ill. Less known is how her Christian faith, combined with her knowledge of medicine, influenced her vision. This work retrieves the Christian roots of palliative care and asserts that the practice of faith preserves the practice of medicine from succumbing to medicalized dying--a phenomenon that excessively relies on technology with the implied hope that it will ultimately conquer illnesses and even death. Efficiency and effectiveness ground modern medicine's epistemology. These concepts follow the philosophical …

Infectious Diseases, Bert Chapman

Libraries Faculty and Staff Scholarship and Research

Provides information about the role of infectious diseases in the early years of U.S. History, with particular emphasis on how they impacted injuries sustained in military conflict.

Improving The Spiritual Dimension Of Whole Person Care: Reaching National And International Consensus, Christina M. Puchalski, Robert Vitillo, Sharon K. Hull, Nancy Reller

Medicine Faculty Publications

Two conferences, Creating More Compassionate Systems of Care (November 2012) and On Improving the Spiritual Dimension of Whole Person Care: The Transformational Role of Compassion, Love and Forgiveness in Health Care (January 2013), were convened with the goals of reaching consensus on approaches to the integration of spirituality into health care structures at all levels and development of strategies to create more compassionate systems of care. The conferences built on the work of a 2009 consensus conference, Improving the Quality of Spiritual Care as a Dimension of Palliative Care. Conference organizers in 2012 and 2013 aimed to identify consensus-derived care …

Influence Of A Palliative Care Protocol On Nurses' Perceived Barriers To Palliative Care And Moral Distress, Christina Cavinder

Evidence-Based Practice Project Reports

The World Health Organization (2013) states palliative care for children should begin at diagnosis which may even occur prenatally. Neonatal palliative care is variable due to the high technological, curative environment in the newborn intensive care unit, and the uncertain prognoses of infants born at the edge of viability. The purpose of this EBP project was to determine the influence of establishing a neonatal palliative care protocol on nurses’ perceived barriers to palliative care and moral distress. Corley’s Moral Distress theory and Stetler’s Model were used as guides for the framework of the project. The protocol, based on guidelines supported …

Palliative Medicine Competency Education In Emergency Medicine Residency Training: A Preliminary Report, Chadd K. Kraus Do, Mph, Matthew Meyers Bs, Bryan G. Kane Md, Marna R. Greenberg Do, Mph, Facep

Department of Emergency Medicine

No abstract provided.

Understanding The Impact Of Values On Organizational Culture, Paul D. Longenecker

Health and Sport Sciences Faculty Scholarship

No abstract provided.

Prevalence And Risk Factors Of Depressive Symptoms In A Canadian Palliative Home Care Population: A Cross Sectional Study, Kathryn A. Fisher, Hsien Seow, Kevin Brazil, Shannon Freeman, Trevor Frise Smith, Dawn M. Guthrie

Kinesiology and Physical Education Faculty Publications

Background: Depression in palliative care patients is important because of its intrinsic burden and association with elevated physical symptoms, reduced immunity and increased mortality risk. Identifying risk factors associated with depression can enable clinicians to more readily diagnose it, which is important since depression is treatable. The purpose of this cross-sectional study was to determine the prevalence of depressive symptoms and risk factors associated with them in a large sample of palliative home care patients.

Methods: The data come from interRAI Palliative Care assessments completed between 2006 and 2012. The sample (n = 5144) consists of adults residing …

Spirituality And Health, Arndt Bussing, Klaus Baumann, Niels Christian Hvidt, Harold G. Koenig, Christina M. Puchalski, John Swinton

Medicine Faculty Publications

No abstract provided.

Integrating Palliative Care Into The Picu: A Report From The Improving Palliative Care In The Icu Advisory Board, R. Boss, J. Nelson, D. Weissman, M. Campbell, R. Curtis, J. Frontera, M. Gabriel, D. Lustbader, A. Mosenthal, R. Hays, +5 Additional Authors

Journal Articles

Objective: This review highlights benefits that patients, families and clinicians can expect to realize when palliative care is intentionally incorporated into the PICU. Data Sources: We searched the MEDLINE database from inception to January 2014 for English-language articles using the terms "palliative care" or "end of life care" or "supportive care" and "pediatric intensive care." We also hand-searched reference lists and author files and relevant tools on the Center to Advance Palliative Care website. Study Selection: Two authors (physicians with experience in pediatric intensive care and palliative care) made final selections. Data Extraction: We critically reviewed the existing data and …

Simulating Real Life Enhances Palliative Care For Patients In The Micu, Jennifer O'Neil Bsn, Rn, Leigh Jimmie Bsn, Rn

Posters

The objective of this project was to determine whether or not a palliative care education program would increase RN knowledge and comfort in caring for palliative care appropriate patients in the Medical Intensive Care Unit.

Immediate Return To Ambulation And Improved Functional Capacity For Rehabilition In Complex Regional Pain Syndrome Following Early Implantation Of A Spinal Cord Stimulation System, Brandon Jesse Goff, Jeremy Wingseng Naber, John Patrick Mccallin, Edward Michael Lopez, Kevin Brant Guthmiller, Karl Alan Lautenschlager, Tristan Toll Lai, Dean Harry Hommer, Gonzalez Raul Marin

PCOM Scholarly Works

Complex regional pain syndrome (CRPS) is a neuropathic pain condition that is characterized by vasomotor, sensory, sudomotor, and motor symptoms. Spinal cord stimulation (SCS) has been successfully utilized for the treatment of pain refractory to conventional therapies. We present a case of a previously highly functioning 54-year-old female who developed a rarely reported case of idiopathic CRPS of the right ankle which spontaneously occurred four months after an uncomplicated anterior cervical disc fusion. This condition resulted in severe pain and functional impairment that was unresponsive to pharmacological management. The patient's rehabilitation was severely stymied by her excruciating pain. However, with …

Assessing Prevalence Of Known Risk Factors In A Regional Central Kentucky Medical Center Heart Failure Population As An Approach To Assessment Of Needs For Development Of A Program To Provide Targeted Services To Reduce 30 Day Readmissions, Christeen Ivy Broaddus

DNP Projects

Abstract

Objectives:

1. Determine demographic, physiologic, and laboratory characteristics at time of admission of the heart failure (HF) population in a regional acute care facility in Central Kentucky through review of patient electronic medical records.
2. Determine which HF population characteristics are significantly associated with readmissions to the hospital.
3. Provide identification of the statistically significant common characteristics of the HF population to this facility so that they may work towards development of an electronic risk for readmission predictive instrument.

Design: Retrospective chart review.

Setting: Regional acute care facility in Central Kentucky.

Participants: All patients (n = 175) with a diagnosis or history …

Music At The End Of Life: Bringing Comfort And Saying Goodbye Through Song And Story, Amy Clements-Cortés

Music Faculty Publications

Music has been an important part of the human existence across all continents and cultures since the beginning of recorded time. It is used, for example, in the celebration of happy events, for religious rituals, and to acknowledge the death of loved ones, often as part of spiritual and symbolic rituals. Although the formal and structured use of music as a component of care for individuals in end-of-life palliative care and hospice systems is relatively new in the world of contemporary medicine, its use is growing rapidly and is appreciated by both those providing the music and those receiving the …

Learner-Based Teaching In Hospice And Palliative Care, Paul D. Longenecker

Health and Sport Sciences Faculty Scholarship

No abstract provided.

Palliative Care For The Medically Complex Child, Melanie Anspacher, Neha H. Shah

E-Learning Modules

**From the AAMC website: Contains time-sensitive information that will likely be inaccurate, obsolete, or irrelevant by August 12, 2016**

Children with special health care needs are increasingly prevalent in US hospitals. The pediatric hospitalist is often the primary provider of inpatient care for these patients. The Complex Care Curriculum was developed to provide a multi-modal educational curriculum for providers with the overall goal of improving inpatient care for this population. The curriculum is composed primarily of a series of topic-specific learning modules. This particular resource was created to provide pediatricians with educational materials related to palliative care for the medically …

Education And Referral Criteria: Impact On Oncology Referrals To Palliative Care., Barbara Reville, Joanne Reifsnyder, Deborah B Mcguire, Karen Kaiser, Abbie Santana

Department of Family & Community Medicine Faculty Papers

OBJECTIVE: To describe a quality improvement project involving education and referral criteria to influence oncology provider referrals to a palliative care service.

METHODS: A single group post-test only quasi-experimental design was used to evaluate palliative care service (PCS) referrals following an intervention consisting of a didactic presentation, education outreach visits (EOV) to key providers, and referral criteria. Data on patient demographics, cancer types, consult volume, reasons for referral, pre-consult length of stay, overall hospital stay, and discharge disposition were collected pre-intervention, then post-intervention for 7.5 months and compared.

SETTING AND SAMPLE: Attending oncologists, nurse practitioner, and house staff from the …

An Ehealth System Supporting Palliative Care For Patients With Non-Small Cell Lung Cancer: A Randomized Trial, David H. Gustafson, Lori L. Dubenske, Kang Namkoong, Robert Hawkins, Ming-Yuan Chih, Amy K. Atwood, Roberta Johnson, Abhik Bhattacharya, Cindy L. Carmack, Anne M. Traynor, Toby C. Campbell, Mary K. Buss, Ramaswamy Govindan, Joan H. Schiller, James F. Cleary

Community & Leadership Development Faculty Publications

BACKGROUND: In this study, the authors examined the effectiveness of an online support system (Comprehensive Health Enhancement Support System [CHESS]) versus the Internet in relieving physical symptom distress in patients with non-small cell lung cancer (NSCLC).

METHODS: In total, 285 informal caregiver-patient dyads were assigned randomly to receive, for up to 25 months, standard care plus training on and access to either use of the Internet and a list of Internet sites about lung cancer (the Internet arm) or CHESS (the CHESS arm). Caregivers agreed to use CHESS or the Internet and to complete bimonthly surveys; for patients, these tasks …