Journal of palliative medicine
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Hospice brings substantial clinical benefits to dying patients and families but is underutilized by patients dying of hematologic malignancies (HM); nationwide, only 2% of HM patients use hospice. There are 70,000 deaths among U.S. patients with hematologic malignancies yearly. ⋯ HM patients are referred late or never for hospice services. Studies evaluating earlier integration of palliative and hospice care with usual HM care are warranted. We present a one-page negotiation form that we have found useful in negotiations among HM physicians, hospice medical directors, and payers.
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Palliative medicine providers are often consulted to provide guidance for pain relief for a diverse population. End-of-life care is often challenging, balancing optimum pain relief with minimal side effects. Patients with both renal and hepatic dysfunction are particularly challenging when considering appropriate treatments. ⋯ This case discussion highlights an end-of-life pain symptom management challenge, and the associated pharmacological background. Ultimately, with no ideal pharmaceutical option, individualization of therapy will be crucial. Collaboration of palliative medicine providers and pharmacists may concurrently provide the best possible care at the best possible time and in the optimal location.
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Although hospices need to be able to anticipate patient acuity, there are currently no published models that predict the frequency of visits that a new hospice patient is likely to receive. ⋯ An acuity index based on these variables could help hospices to better anticipate patient needs and staff workload, and could be used to guide strategic planning as hospices take part in accountable care organizations (ACOs).