Journal of palliative medicine
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In the Medicare population, end-of-life care is fragmented and hospice is underutilized. Evidence suggests that hospice care is associated with increased patient/family satisfaction and reductions in overall health care costs. Advanced Illness Management (AIM) is a home-based program established to ease the transition between curative and comfort care for seriously ill patients who lack coordinated hospital, home health, and hospice care. ⋯ The AIM program was successful at increasing hospice utilization through a targeted intervention focused on palliative and end-of-life care, increased patient education and decision making, and a dynamic treatment approach. The finding of increased utilization by African Americans, a population traditionally reluctant to use hospice, was particularly noteworthy.
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This study was conducted to gain an understanding of bereaved hospice family caregivers' perceptions of the communication process from initial discussion of the need for end-of-life care and hospice through the decision to choose hospice and the transition home. ⋯ Although many health care professionals play a role in the communication and transition to hospice care, physicians and social workers were found to be pivotal participants in this process. A coordinated team approach to end-of-life communication and decision-making may facilitate the process and possibly lead to increased and earlier referral to hospice.
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Evidence suggests that racial and ethnic disparities exist in access to effective pain treatment. ⋯ The majority of studies reveal racial and ethnic disparities in access to effective pain treatment akin to disparities found in other medical services. Quality improvement initiatives that improve treatment of pain for all patients according to established guidelines should decrease disparities by race or ethnicity. Educational interventions should aim to improve patient-provider communication regarding pain and its treatment and should provide support around substance abuse issues. Further research is needed to examine pain treatment outcomes and to determine whether health care system factors lead to these disparities.
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Although in-depth interviewing is well suited to studying the sensitive topic of end-of-life decision making, no reports have been published assessing the effects on parents of participating in interviews regarding end-of-life decision making for critically ill children. ⋯ This study demonstrates the willingness of many parents of critically ill children to participate in study interviews regarding end-of-life decision making, a topic that most parents felt was important and warranted more research.