Journal of palliative medicine
-
To explore how staff recognize that a resident is dying and to present a typology of comfort measures. ⋯ The terms comfort measures and comfort care are widely used in nursing homes but definitions and modes of delivery vary. In-depth exploration can be utilized to compare of current and existing practices and contribute knowledge about whether palliative care is provided in nursing homes and if so, how. Ultimately program comparisons can lead to improvements in nursing home-based end-of-life care and standards for the delivery of palliative care in this setting.
-
The small proportion of cancers diagnosed at the local disease stage, resectable at the time diagnosis, and responsive to chemotherapy contribute to poor survival making pancreatic cancer the fourth leading cause of cancer death among Americans. This emphasizes the importance of receiving appropriate palliative care. Racial/ethnic cancer treatment disparities have been observed for many cancer sites. We examine patterns of care in a population-based sample of African American, Hispanic and non-Hispanic white patients diagnosed with pancreatic cancer. ⋯ Differences in primary tumor size, stage and insurance status contributed to racial/ethnic differences in the receipt of cancer-directed surgery but did not explain differences in the receipt of chemotherapy for African American or radiation for Hispanic patients. More population-based research is needed to examine race/ethnicity, insurance status and receipt of treatment and palliative care for pancreatic cancer.
-
Pediatric end-of-life care involves multiple decision-makers including the patient, the family, and the health care provider. Although some information exists on the role of patient and family values on decision making, little is known about what influences the health care provider's decisions and performance. ⋯ Age and experience create confidence in managing pediatric end-of-life care issues. Other provider variables including gender and religious beliefs may also influence confidence on some issues. Although formal education helps providers feel better prepared to care for children with terminal conditions, the majority of providers still feel no more than adequately prepared by their training. More emphasis on experience-driven education delivered by seasoned educators may improve confidence in delivering pediatric end-of-life care.