Journal of palliative medicine
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Background: Summary statistics often hide individual patients' suffering, thereby impeding quality improvement efforts. Objectives: We aimed to show the experience of a population with health care toward the end of life while preserving the experience of the individual. Design: We developed a data display method called per-patient illness trajectory analysis. ⋯ The method fosters the assessment of unmet palliative care need and care quality for individuals, small high-need groups, and populations. Conclusion: In populations of up to 200 people, per-patient illness trajectory analysis is feasible and promising. Using random sampling, it could be extended to larger populations.
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Many seriously ill patients undergo surgical interventions. Palliative care clinicians may not be familiar with the nuances involved in perioperative care, however they can play a valuable role in enabling the delivery of patient-centered and goal-concordant perioperative care. ⋯ Palliative care clinicians may also be called upon to direct discussions around perioperative management of modified code status orders and to engage around the goal-concordance of proposed interventions. This article, written by a team of surgeons and anesthesiologists, many with subspecialty training in palliative medicine and/or ethics, offers ten tips to support palliative care clinicians and facilitate comprehensive discussion as they engage with patients and clinicians considering surgical interventions.
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Introduction: Voicing My CHOiCES (VMC) is an advance care planning (ACP) guide designed to assist adolescents and young adults (AYAs) with serious illness in communicating their care preferences to others. This study evaluated a revised version of VMC. Methods and Materials: A structured interview was used alongside two versions of VMC to solicit AYA preferences and feedback regarding content and layout changes. ⋯ Most AYAs (95.5%) found the guide helpful for thinking about their care. Conclusions: Study findings support updates to VMC that specifically reflect AYAs end-of-life (EoL) preferences and emphasize the value of engaging AYAs in ACP conversations directly related to their specific concerns, priorities, and preferences. Use of VMC has potential for enhancing overall quality of care and quality of life for AYAs at EoL.
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Introduction: Aggressive end-of-life (EOL) care for cancer patients can lead to increased hospitalizations and worse quality of death, while goals of care (GOC) discussions including EOL care conversations are associated with fewer hospitalizations and increased hospice use. During hematology-oncology training, fellows should develop communication skills that include eliciting and documenting patients' GOC to provide quality care during EOL. We aimed to determine the frequency of documentation of GOC discussions in fellow's clinics as well as characteristics of EOL care. ⋯ GOC discussions were associated with higher hospice enrollment and advance directive documentation and lower hospitalizations. Conclusions: All fellows had at least one patient who died in their patient panels, but less than half of patients had documented GOC discussions. Fellowship programs should consider incorporating quality improvement measures and communication skills training to ensure fellows have competence in GOC communication and EOL care delivery.