Journal of palliative medicine
-
Background: End-of-life dreams and visions (ELDVs) are a recognized phenomenon that can occur as part of the normal dying process. Data suggest that ELDVs can provide comfort, foster discussion of waking life concerns, and lessen the fear of death. Current literature on ELDVs focuses on the prevalence, content, and effects of ELDVs exclusively in adult populations. Methods: We present the case of a 15-year-old girl with terminal glioblastoma who was enrolled in a pediatric palliative care program and later in hospice care. ⋯ These ELDV experiences afforded comfort and meaning to the patient and her family through her end-of-life trajectory as well as provided relief for her grieving family. Conclusion: In the case presented, ELDVs appear to show similar characteristics and impact in the adolescent population as described in the previous literature examining adult ELDVs. In addition, this case demonstrates the potential benefits of ELDV awareness for the bereaved. Clinicians working with pediatric and adolescent end-of-life populations should take note of the potential for ELDVs and the impact they can have on both patients and families.
-
Objective: To describe museum-based education (MBE) as an emerging pedagogy in our four hospice and palliative medicine (HPM) training programs. Background: MBE is a pedagogy that uses art and the museum space to promote a variety of skills, including reflective practice, self-awareness, and interprofessional teamwork. While MBE has been extensively applied and studied in undergraduate medical education, it is not a common educational strategy in HPM education. ⋯ Evaluations from MBE have been overwhelmingly positive. Conclusion: MBE holds great promise as a pedagogic strategy to improve metacognition, tolerance of uncertainty, appreciation of multiple perspectives, and teamwork among hospice and palliative care professionals. Further research is needed to identify best practices for MBE across HPM training programs.
-
Background: Despite mounting evidence that specialty palliative care (PC) improves patients' symptoms, quality of life, and goal concordant care, these services are likely underutilized. Objective: To determine the rate of missed and delayed opportunities for specialty PC in patients with peri-hospital death. Design: A retrospective, cross-sectional analysis, using electronic medical records of a state-wide healthcare system in Colorado, was performed. Included were adults who died during admission or within seven days of discharge from January 2015 to October 2018 at an academic medical center and had prior encounters within the affiliated state-wide healthcare system in the last year of life. Excluded were patients with sudden or obstetrics-related deaths. ⋯ Only 33% of patients had PC consultation, which was higher for patients with cancer (42%) than for those without cancer (26%). Of patients with specialty PC consultation, the median time from first referral to death was eight days (interquartile range: 3.25-25 days). Conclusions: Patients with peri-hospital death have low rates of specialty PC consultation, which, when present, often occurs close to death. This suggests there is a high rate of missed opportunities for specialty PC in this population.