Journal of palliative medicine
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Background: Population-based methods to identify patients with serious illness are necessary to provide equitable and efficient access to palliative care services. Aim: Create a validated algorithm embedded in the electronic medical record (EMR) to identify hospitalized patients with serious illness. Design: An initial algorithm, developed from literature review and clinical experience, was twice adjusted based on gaps identified from chart review. ⋯ Results: Compared with the gold standard of expert consensus, the final algorithm for identifying hospitalized patients with serious illness was found to have a sensitivity of 89%, specificity of 82%, positive predictive value of 80%, and negative predictive value of 90%. At our hospital, an average of 284 patients a day (54%) screened positive for at least one criterion, with an average of 38 patients newly screening positive daily. Conclusions: Data from the EMR can identify hospitalized patients with serious illness who may benefit from palliative care services, an important first step in moving to a system in which palliative care is provided proactively and systematically to all who could benefit.
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Patient sexuality and intimacy comprise important dimensions of quality of life (QOL), making them essential topics for palliative care (PC) clinicians to address. Created with interprofessional input from PC, urology, gynecology, sexual health, oncology, psychiatry, psychology, nursing, and social work, this article offers 10 high-yield, evidence-based tips to better equip PC clinicians to address sexuality and intimacy for patients with serious illness. These tips highlight skills such as opening discussions, assessing concerns through a biopsychosocial model, and thinking through appropriate interventions to improve QOL.
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Background: Patients with severe coronavirus disease 2019 (COVID-19) often rapidly deteriorate with severe dyspnea and should receive early specialist palliative care (SPC) as intensive symptom management may be required at the end of life. Currently, there is a paucity of data identifying triggers for early SPC involvement. Objective: To identify risk factors among nonventilated patients with severe COVID-19 who required high opioid and/or benzodiazepines (BZD) use for the control of dyspnea. ⋯ High users also required higher supplemental oxygen and had higher inpatient mortality rates. Conclusions: High dyspnea score is predictive of high opioid and/or BZD use for symptom control in nonventilated patients with severe COVID-19. Such patients with high mortality rates should be seen early by SPC.
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Purpose: This study was undertaken to determine the nature of the relationship between psychological resilience and spiritual well-being (SWB) among family caregivers (FCs) of patients with terminal cancer. Methods: This multicenter cross-sectional study included 173 FCs from nine inpatient hospice care units. SWB was assessed using the Functional Assessment of Chronic Illness Therapy-Spiritual well-being questionnaire, and various psychosocial variables, including psychological resilience, were also measured. ⋯ Results: Various factors were found to be associated with the SWB of FCs as determined by total FACIT-Sp-12 scores and the scores of its three domains. FC resilience was significantly associated with SWB as determined by total FACIT-Sp-12 scores and scores of the meaning and peace domains. Conclusion: Assessing FC psychological resilience would help palliative care providers improve their SWB.
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Randomized Controlled Trial
The Impact of Legalizing Medical Aid in Dying on Patient Trust: A Randomized Controlled Survey Study.
Background: Some commentators and several professional medical associations have expressed concern that legalizing medical aid in dying ("MAID") will undermine patient trust in the medical profession, particularly among historically disadvantaged patient populations. While this concern remains influential, it has been subject to limited empirical scrutiny. Objectives: This study aims to empirically assess whether MAID legalization undermines patient trust, with considerations of potential trust/demographic correlations in marginalized and minority patient populations. ⋯ Conclusions: Most of the participants not notified that MAID was legal in DC were not aware of this fact (92.5%). Patients who were notified that MAID was legal in DC were significantly more likely to report approval of MAID legalization (p = 0.0410), but showed no significant difference in AWFS score for trust in their physicians. The study did not substantiate concerns that legalizing medical aid in dying undermines patient trust in the medical profession.