Journal of palliative medicine
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Background: The relationship between nursing home (NH) stays before death and hospice use is understudied. Methods: A retrospective cohort study of Connecticut Medicaid decedents with common hospice diagnoses who died between 2017 and 2020. Medicaid/Medicare claims identified NH stays, hospice use, short length of stay (LOS) (≤7 days), demographics, and diagnoses. ⋯ Results: Among 26,261 decedents, 54.2% had NH stays (17.8% short-term, 36.4% long-term). Individuals with NH stays (vs. none) had reduced odds of hospice use (short-term odds ratio [OR]: 0.77 [95% confidence interval or CI: 0.71-0.82] and long-term OR: 0.47 [0.45-0.50]) and had higher odds of short hospice LOS (short-term OR: 2.67 [2.41-2.96] and long-term OR: 2.95 [2.69-3.22]). Conclusions: Further research is needed into why individuals with NH stays, especially long-term stays, are less likely to use hospice and more likely to have short LOS and how this difference relates to end-of-life care quality.
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Objective: To systematically review studies presenting quantitative data on the experiences of patients and providers engaged in VSED. Background: Voluntarily stopping eating and drinking (VSED) to purposefully accelerate the end of life is uncommon but likely accounts for thousands of deaths per year. A single systematic review of literature was published in 2014. ⋯ Little research to guide best practice is available, particularly in the United States. Caregivers and health care providers generally indicate support however, extensive preparation and caregiver assistance make the practice challenging. Practitioners express a need for training.
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Background: Altered cognitive function due to delirium changes the threshold or tolerance of symptoms. The impacts of delirium motor subtypes on symptoms remain unknown. Objectives: Determining whether delirium motor subtypes are associated with the severity of physical symptoms in a palliative care setting. ⋯ However, patients with hypoactive delirium did not have higher odds of developing severe symptoms. Patients without delirium at T1, who developed hyperactive or mixed delirium, had a higher severity of both pain and dyspnea than those who were delirium-free (OR, 95% CI; 1.60, 1.08-2.37, and 1.86, 1.27-2.72, respectively) at T2. Conclusion: Hyperactive delirium is associated with the intensity of pain and dyspnea in patients receiving palliative care.
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Background: Little is known about the aggressiveness of cancer care at the end of life (ACCEoL) for children with cancer in countries where palliative care (PC) is scarce. Objective: The aim of this study was to determine the frequency and time trends of ACCEoL in the pediatric population in a Western European country. Setting/Subjects: We conducted a retrospective cohort study analyzing children between 0 and 17 years who died of cancer in public hospitals in Portugal, from January 2010 to December 2015. ⋯ The prevalence of ACCEoL remained stable over the period. Conclusions: In our cohort about 9 out of 10 children with cancer experienced at least one indicator of ACCEoL, a rate higher than in countries with well-developed PC services. There is a need to improve the care in the last months of life for children with cancer.