Journal of palliative medicine
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Introduction: There is limited understanding of critical care (CC) and specialist palliative care (SPC) professionals' perceptions regarding the role and utility of SPC for patients on extracorporeal membrane oxygenation (ECMO). Methods: An 18-item survey was distributed via convenience sampling and snowballing strategies to CC and SPC attendings working with veno-venous ECMO patients. Results: A total of 75 surveys were completed. ⋯ Responses varied on the appropriateness of discussing SPC with patients/families prognosis (81% SPC vs. 47% CC, p < 0.05), end-of-life preferences (100% vs. 62%, p < 0.05), goals of care (95% vs. 58%, p < 0.05), and code status (76% vs. 43%, p < 0.05). Conclusion: Most respondents indicated that psychosocial support and multidisciplinary team collaborations were within the SPC scope. CC professionals were less likely to indicate that discussion of the care trajectory with patients/families was within SPC scope.
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Background: Formal assessment of What Matters in end-of-life care is often done in medical settings through legal forms. Past research indicates that Native Hawaiians are less likely to complete these forms than Whites. The purpose of this study was to explore health care preferences among Native Hawaiian elders and to identify cultural themes that may impact quality care at end of life. ⋯ Results: Themes suggest the criticality of: (1) incorporating cultural traditions into health care routines; (2) involving family in health and end-of-life decisions; (3) supporting home-based care at the end of life; and (4) building strong patient-provider relationships. Conclusion: Although findings parallel preferences expressed in other populations, the data provide additional insights into the preferences of Native Hawaiian elders anticipating end-of-life care. Recommendations for culturally competent care include: (1) develop relationships with Native Hawaiian patients well before end-of-life care is needed to facilitate discussions of care preferences; (2) work collaboratively with the patient and the patient's defined family; (3) ask about cultural practices and engage traditional healers as directed by the patient; and (4) provide services in patients' homes and communities.
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The field of Hospice and Palliative Medicine (HPM) has its roots in the principles, promulgated by Dame Cicely Saunders, that patient and family are the unit of care and that comprehensive integration of physical, psychological, social, and spiritual care is necessary to address suffering in all its dimensions. Although we aspire to provide comprehensive care for our patients, most hospice and palliative care (HPM) physicians lack basic competencies for identifying and managing patients with psychological distress and mental health distress and disorders, a growing segment of our clinical population. ⋯ The history of our field, the nature of our clinical workforce, the culture of PC, and our educational programs all contribute to our current practice model, which is not adequate to meet the mental health needs of our patients. I propose strategies to address these challenges focused on enhancing integration between psychiatry/psychology and HPM, changes in fellowship education and faculty development, addressing the stigma against people with mental health diagnoses, and addressing system and cultural challenges that limit our ability to provide the kind of comprehensive, integrative care that our field aspires to.