Journal of palliative medicine
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Due to the aging population of China, the need for palliative care will increase. However, one of the barriers to utilization of palliative care is the traditional belief that talking about death and dying is taboo. ⋯ The majority of older patients were willing to answer the two questions about death and dying. About one-third of patients were not afraid of death, and older patients were less likely to be afraid of death. More than 50% of patients answered that they would not choose advanced life support when dying. More research in this area is needed to help advance palliative care in China.
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Hospice in-person visits in the last week of life are critical to ensure quality of care. In 2016, The Centers for Medicare & Medicaid Services (CMS) introduced a Service Intensity Add-on (SIA) payment for in-person routine home care (RHC) visits by a registered nurse or social worker in the last 7 days of life. ⋯ The relative size of the new SIA payment introduced by CMS has the potential to increase RN/SW visits and reduce disparities in visit patterns in the last week of life.
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Advance care planning (ACP) discussions often occur in the inpatient setting when patients are too ill to participate in decision making. Although the outpatient setting is the preferred time to begin these discussions, few physicians do so in practice. Many internal medicine (IM) residents report inadequate training as a barrier to having outpatient ACP discussions. ⋯ The GOCARE curriculum provides an alternative model of communication training that can be integrated into residency training and improve residents' skills in outpatient ACP discussions.
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Case Reports
Fosaprepitant for the Management of Refractory Pain in a Patient with Cancer-Related Dermatomyositis.
Optimal pain management often requires multiple pharmacological interventions with the goal of disrupting the pain-signaling pathway and targeting the underlying pathophysiology. Off label use of nonpain medications may have a role in treating refractory pain syndromes. ⋯ Fosaprepitant is a potentially novel adjuvant therapy for the treatment of refractory inflammatory pain syndromes in palliative care.
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Investigating complaints concerning end-of-life (EoL) care is a necessary step for improving the quality of life at its final stage. ⋯ The new model has the potential to clarify directions in research, quality assessment, and intervention regarding end-of-life care.