Articles: palliative-care.
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Objective: The aim of this study was to evaluate an adult home palliative care (HPC) program for multiple insurance product lines using multiple vendors to determine if the annual costs of health care decreased for those enrolled in HPC. Study Design: Of the 506 members who were referred to and qualified for palliative care in 2019, a retroactive review was done comparing annual health care costs between the 396 members in the enrolled group and the 110 members in the group receiving usual care. Methods: The total health care costs for the calendar year 2019 were compared between the group enrolled in HPC and those who received usual care. ⋯ Conclusions: Adult home-based palliative care delivered by multiple vendors (consisting of multiple insurance product lines) to a population is effective in decreasing total medical costs by 16.7% during a calendar year compared with a control group. The gross savings for those enrolled for 6-12 months (17.9%) were greater than the gross savings for those enrolled for 1-5 months (15.8%). The savings were most prominent for the commercial insurance product, while an increase in cost was seen for the Medicaid product.
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Background: People with life-limiting illnesses experience a range of distressing symptoms. Appetite-related symptoms are common, but studies have found varied prevalence and the distress caused has had limited quantification. Objectives: To examine the clinicodemographic factors and trajectory of appetite-related distress in the last 60 days of life. ⋯ There was a sharp decline in mean distress for all diagnostic groups around 7-10 days before death. Moderate to severe distress was associated with nausea-, bowel-, pain-, and breathing-related distress, controlling for key baseline factors. Conclusion: Appetite-related distress is prevalent and burdensome in the 60 days before death and is strongly associated with distress from other cardinal symptoms.
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Palliative medicine · Apr 2022
"I think that she would have wanted. . .": Qualitative interviews with bereaved caregivers reveal complexity in measuring goal-concordant care at the end of life.
Experts consider goal-concordant care an important healthcare outcome for individuals with serious illness. Despite their relationship to the patient and knowledge about the patient's wishes and values, little is known about bereaved family caregivers' perceptions of how end-of-life care aligns with patient goals and preferences. ⋯ Bereaved caregivers commonly rated care as goal-concordant while also identifying areas of disappointing and low-quality care. Communication, relationships and humanistic care, and care transitions are modifiable quality improvement targets for patients with advanced cancer.
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J Pain Symptom Manage · Apr 2022
Disparities in Supportive Care Needs Over Time between Racial and Ethnic Minority and Non-Minority Patients with Advanced Lung Cancer.
Little is known about inequities in supportive care needs among diverse patients with advanced lung cancer. ⋯ Minority patients with advanced lung cancer are more likely to have higher baseline and persistent supportive care needs relatives to non-minority patients. Clinicians caring for minority patients with lung cancer should provide targeted supportive care evaluation and treatment to ensure health equity.
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Palliative medicine · Apr 2022
An examination and proposed definitions of family members' grief prior to the death of individuals with a life-limiting illness: A systematic review.
Research has extensively examined family members' grief prior to the death of an individual with a life-limiting illness but several inconsistencies in its conceptualization of related constructs, yet significant conceptualization issues exist. ⋯ We found grief occurring before the death of a person with a life-limiting illness, which we termed pre-death grief, is comprised of two distinct constructs: anticipatory grief and illness-related grief. Anticipatory grief is future-oriented and is characterized by separation distress and worry about a future without the person with the life-limiting illness being physically present. Illness-related grief is present-oriented and is characterized by grief over current and ongoing losses experienced during the illness trajectory. These definitions provide the field with uniform constructs to advance the study of grief before the death of an individual with a life-limiting illness.