Journal of palliative medicine
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The importance of good clinician-patient communication to quality end-of-life care has been well documented yet there are no validated measures that allow patients to assess the quality of this communication. Using a sample of hospice patients (n = 83) and patients with chronic obstructive pulmonary disease (COPD) (n = 113), we evaluated the psychometric characteristics of a 13-item patient-centered, patient-report questionnaire about the quality of end-of-life communication (QOC). Our purpose was to explore the measurement structure of the QOC items to ascertain if the items represent unitary or multidimensional constructs and to describe the construct validity of the QOC score(s). ⋯ The scales' construct validity is supported by significant associations (p
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Although the widespread implementation of hospice in the United States has led to tremendous advances in the care of the dying, there has been no widely accepted psychological theory to drive needs assessment and intervention design for the patient and family. The humanistic psychology of Abraham Maslow, especially his theory of motivation and the hierarchy of needs, has been widely applied in business and social science, but only sparsely discussed in the palliative care literature. ⋯ The five levels of the hierarchy of needs as adapted to palliative care are: (1) distressing symptoms, such as pain or dyspnea; (2) fears for physical safety, of dying or abandonment; (3) affection, love and acceptance in the face of devastating illness; (4) esteem, respect, and appreciation for the person; (5) selfactualization and transcendence. Maslow's modified hierarchy of palliative care needs could be utilized to provide a comprehensive approach for the assessment of patients' needs and the design of interventions to achieve goals that start with comfort and potentially extend to the experience of transcendence.
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Despite disparities in health care access and quality, African Americans are underrepresented in many areas of clinical investigation, including research in end-of-life care. Because of the importance of surrogate reports in assessing the quality of end-of-life care, this study examined racial differences in next-of-kin participation in an ongoing study of satisfaction with end-of-life care. The parent study includes after-death interviews with next-of-kin of elderly African Americans and Caucasians who died at Duke Hospital. ⋯ The use of racially concordant interviewers, subject identification with the institution, and the absence of socioeconomic constraints may partly explain these findings. Given the growing diversity of the U. S. population, researchers in end-of-life care must use strategies aimed at recruiting racially and ethnically diverse samples.
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Family caregivers caring for a patient with terminal cancer may experience significant psychological distress. ⋯ Family caregivers of patients in the advanced stages of cancer experience a high level of psychological distress, which increases significantly as the patient loses autonomy. Health care policies and programs need to be revisited in order to take the reality of these patients and their families into account.
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Comparative Study
Cost and utilization outcomes of patients receiving hospital-based palliative care consultation.
To compare per diem total direct, ancillary (laboratory and radiology) and pharmacy costs of palliative care (PC) compared to usual care (UC) patients during a terminal hospitalization; to examine the association between PC and ICU admission. ⋯ PC was associated with significantly lower likelihood of ICU use and lower inpatient costs compared to UC. Our findings coupled with those indicating better patient and family outcomes with PC suggest both a cost and quality incentive for hospitals to develop PC programs.