Articles: terminal-care.
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J Pain Symptom Manage · Dec 2024
Economic Value of Unpaid Family Caregiver Time Following Hospital Discharge and at End of Life.
Family caregivers (FCGs) play a crucial role in care for people with serious illness, yet unpaid care is often overlooked in estimates of care recipient (CR) care costs. ⋯ Of 282 FCGs, 94% were non-Hispanic White, 71% were female, 71% had a college degree, and 51% were in the workforce. FCGs of decedents (58%) compared to survivors reported significantly more caregiving hours per person-month (392 vs. 272), resulting in higher estimated economic value per person-month using opportunity ($12,653 vs. $8843), proxy ($5689 vs. $3955), and combined costing methods ($9490 vs. $6443) CONCLUSION: This study informs more complete economic evaluations of palliative care by estimating the economic value of unpaid caregiving. The high intensity of unpaid caregiving for people with serious illness, especially toward the end of life, should be considered when designing policies and interventions to support FCGs. Better methods for approximating economic value are needed to address potential inequities in current valuation approaches.
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Observational Study
Use of Hospice and End-of-Life Care Quality Among Medical Centers with High Versus Lower Specialist Palliative Care Reach Among People with Heart Failure: An Observational Study.
Background: Rates of specialist palliative care (SPC) vary among Veterans Affairs Medical Centers (VAMCs) for people with advanced heart failure (aHF). We evaluated the associations between facility rates of SPC reach and the quality of end of life (EOL) care received among this population. Methods: We conducted a retrospective cohort study among 3681 people with aHF who died in 83 VAMCs from 2018 to 2020. ⋯ There was a significant interaction between VAMC reach, receipt of SPC, and inpatient hospice (p < 0.001) but no interaction between VAMC reach, receipt of SPC, and EOL care quality (p = 0.049). Conclusion: Families of patients with aHF who die in VAMCs with higher SPC reach report better EOL care quality regardless of whether or not they receive SPC. Research is needed to investigate factors beyond receiving SPC associated with these EOL outcomes.
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J Pain Symptom Manage · Dec 2024
Machine learning for targeted advance care planning in cancer patients: a quality improvement study.
Prognostication challenges contribute to delays in advance care planning (ACP) for patients with cancer near the end of life (EOL). ⋯ Identifying patients with cancer and high mortality risk via machine learning elicited a substantial increase in documented ACP conversations but did not impact EOL care. Our intervention showed promise in changing clinician behavior. Further integration of this model in clinical practice is ongoing.
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Background: Nurses who provide person-centered care even after death must possess essential competencies to perform their duties effectively. Therefore, it is imperative to develop educational programs to enhance the capabilities of new nurses in care after death. Objective: To develop a care after-death mentoring program that includes an augmented reality (AR) end-of-life experience for new nurses and to describe its effectiveness. ⋯ Results: Significant improvements were observed in both comfort during bereavement/end-of-life care and compassion competency (t = -8.43, p < 0.001; t = -4.90, p < 0.001). Conclusions: This study demonstrated enhancements in participants' comfort levels regarding bereavement and end-of-life care, as well as their ability to exhibit compassion after participating in the program. Consequently, it was confirmed that simulation-based care after-death mentoring education utilizing an AR app helped enhance the capabilities of new nurses.
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J Pain Symptom Manage · Nov 2024
ReviewLimitations with California Medicaid Data for Palliative and End of Life Care Quality Measures.
In 2014 the California legislature passed Senate Bill 1004 (SB 1004) that was designed to expand access to specialty palliative care for individuals served by California's Medicaid (known as Medi-Cal) Managed Care Plans (MCPs). The California Department of Health Care Services (DHCS) operationalized the legislation by developing minimum requirements for palliative care programs that all MCPs must meet or exceed.7 Quality and utilization data specific to California's Medicaid population are needed for stakeholders to identify care deficiencies and disparities, describe the end of life experience and utilization patterns of MCP members, compare these patterns to Medicare beneficiaries or other populations, and set appropriate targets to help monitor progress. ⋯ Beyond the practical challenges of allowing time for data access and approvals, both projects revealed several limitations to using administrative data to assess quality of palliative and end of life care for a Medicaid population. We describe these challenges that undermined our confidence in analysis results and propose solutions to measuring the quality of palliative and end of life care for Medicaid patients and suggested next steps.