The American journal of hospice & palliative care
-
Am J Hosp Palliat Care · May 2014
The role of analgesic adjustment strategies in achieving analgesic efficacy in opioid-tolerant hospice patients in China.
Diverse strategies of analgesic adjustment are often, respectively, used to sustain analgesic efficiency for opioid-tolerant patients with different refractory factors of pain. In order to select effective analgesic adjustment strategy for hospice patient without knowing explicit causes of diminishing analgesic efficiency, a retrospective data of 743 patients among 3760 hospice patients were analyzed. ⋯ For opioid-tolerant hospice patients, the analgesic adjustment strategy can be selected for individual patient. After repeated analgesic adjustments, opioid tapering may also occur.
-
Am J Hosp Palliat Care · May 2014
Completion of advance directives among low-income older adults: does race/ethnicity matter?
This study examined the prevalence of completion of advance directives (ADs) and the effects of race/ethnicity on AD completion using a cross-sectional design. Low-income older adults (n = 256) who were residents of supportive housing facilities or members of a senior center were interviewed in person. ⋯ Those with higher levels of knowledge, positive attitudes, or those with higher incomes were more likely to complete ADs than their counterparts. Findings suggest that as a proxy for multiple socioeconomic, social and cultural factors, race, and ethnicity need to be considered in planning end-of-life care.
-
Am J Hosp Palliat Care · May 2014
Improved resident physician confidence with advance care planning after an ambulatory clinic intervention.
Many primary care providers feel uncomfortable discussing end-of-life care. The aim of this intervention was to assess internal medicine residents' advance care planning (ACP) practices and improve residents' ACP confidence. Residents participated in a facilitated ACP quality improvement workshop, which included an interactive presentation and chart audit of their own patients. ⋯ Patients requiring an interpreter were less likely to have participated in ACP. Residents reported significantly improved confidence with ACP and identified important training gaps. Future studies examining the impact on ACP quality are needed.
-
Am J Hosp Palliat Care · May 2014
Factors affecting the place of death among hospice home care cancer patients in Taiwan.
Some patients who receive hospice home care still end up dying in hospital. The significance of the variables possibly affecting the place of death in patients with terminal cancer who received hospice home care was examined. ⋯ For a better hospice care service, it is essential to inquire patients or their relatives on preferred place of death while concerning the influences of other factors.
-
Am J Hosp Palliat Care · May 2014
Hospice patient evacuation: a case for using a checklist for safe disaster response.
This study was conducted to provide lessons learned from the experience of a small, rural hospice care organization to an actual crisis that required evacuation of the facility. A process improvement framework using the emergency response certification guidelines was used to first provide details of the incident, second analyze the effectiveness of disaster planning and response in response to an actual crisis, and third discuss the post-event review, lessons learned, and process improvement. This case study revealed 5 emerging themes-disaster can happen at the most inopportune times, facilities should focus on the most likely hazards, written agreements are needed even in small tight-knit communities, redundancy of resources is needed, and disaster planning and response is a process that should be continually improved.