Journal of palliative medicine
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Background: Children in rural geographies are not universally able to access pediatric-trained palliative or hospice providers. Objective: Determine whether telehealth inclusion of a familiar pediatric palliative care provider during the first two home-based hospice visits was acceptable to children, families, and adult-trained home hospice nurses in rural settings. Design: Case series. ⋯ Visit content was primarily caregiver support, quality of life, goals of care, symptom management, and medication review. Telehealth acceptability improved between time points and was higher in family caregivers (4.3-4.9 on 5-point scale; p = 0.001) than hospice nurses (3.2-3.8 on 5-point scale; p = 0.05). All children able to self-report stated a "like" for telehealth, citing six reasons such as "being remembered" and "medical knowledge and care planning." Conclusions: Pediatric palliative telehealth visits partnered with in-person hospice nurse offer acceptable access to services, while extending support.
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Since its creation, the Czech Republic has developed an advanced health system and social system. Life expectancy at birth has increased by an average of 7 years in only 20 years. However, polymorbidity and multicausality have now become topics of concern. ⋯ Focusing only on terminal illness care is insufficient. Beginning in 2005-2006, we have worked to create a system of education and clinical services in specialized palliative care in the health and social system. This article seeks to describe the leadership steps of this systemic change in the Czech Republic with the objective of helping others make the same journey.