Journal of palliative medicine
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Multicenter Study
Predictors of intensive end-of-life and hospice care in Latino and white advanced cancer patients.
The role of end-of-life (EOL) care preferences and conversations in receipt of care near death for Latinos is unclear. ⋯ EOL discussions and DNR orders may prevent intensive EOL care among Latino cancer patients. Efforts should continue to engage Latino patients and caregivers in these activities.
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San Diego Hospice and the Institute for Palliative Medicine created one of the earliest perinatal palliative care programs in the country. Only four studies have reported outcomes for pregnant women referred to perinatal palliative care services for potentially lethal prenatal diagnoses. ⋯ One-third of women met with the palliative care team only once or twice prior to delivery, indicating a need for earlier referral to provide more comprehensive palliative care.
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Randomized Controlled Trial
Clinical effectiveness of online training in palliative care of primary care physicians.
Primary care physicians (PCPs) have a major responsibility in the management of palliative patients. Online palliative care (PC) education has not been shown to have a clinical impact on patients that is equal or different to traditional training. ⋯ Participation in an online PC education program by PCPs improved patient scores for some symptoms and family anxiety on the POS and also showed improved global QOL. Significant differences were found in physicians' knowledge at short and long term.
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Currently, more than half of all nursing home residents use hospice at some point. Studies have shown benefits to hospice enrollment for patients; however, the literature on ownership differences in hospice care in general has indicated that for-profit hospices offer a narrower scope of services and employ fewer professional staff. Although nursing home staffing patterns have been shown to be essential to quality of care, the literature has not explored differences in number of patients per staff member for hospice care within nursing homes. ⋯ Staffing is an important indicator of hospice quality, thus our findings may be useful for anticipating potential impacts of the growth in for-profit hospice on nursing home residents.
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Case Reports
Discussing goals of care for a delirious advanced cancer patient in the hospice setting.
In the United States, patient autonomy is generally considered the most important ethical principle; however, patients sometimes make decisions that are medically futile or in conflict with the principles of beneficence and nonmaleficence. Difficult issues are often compounded if the patient loses capacity and a surrogate must provide substituted judgments. Allowing autonomy free reign can sometimes be detrimental to patient care and contribute to family distress. Here, we describe the case of a terminally ill patient whose conflicting desires were to have "everything" done--including cardiopulmonary resuscitation--and to simultaneously avoid hospitalization and die peacefully at home.