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Venous thromboembolism (VTE) is a significant cause of death among palliatively treated patients. So far, numerous studies have been conducted on the general population. As a result, special scales were created to assess the risk of VTE or the probability of its occurrence. Among patients with terminal disease, there are much fewer publications discussing the problem of VTE. Hospice care patients constitute a special group due to their epidemiological structure and accompanying diagnoses. The most common are malignant tumors and heart failure. For this reason, they are particularly vulnerable to VTE events. This article reviews the literature on risk scales such as The Padua Risk Assessment Scale, Khoran score, Wells scale, PVFS scale and VTE-BLEED scale. W also present risk factors which contribute to the development of the VTE as well as to a more serious course of VTE. We discuss the epidemiological structure of patients, the impact of cancer as well as the chemotherapy used to treat it. We discuss the epidemiological structure of patients, the impact of cancer as well as the chemotherapy used in its treatment. We describe how the presence of a catheter and immobilization contribute to the development of VTE. We focus particularly on scales and risk factors to which a patient with a terminal disease is exposed. More research is needed in the future to better predict VTE in hospice patients. We hope that this work will increase awareness and encourage researchers to expand knowledge in this area. [ABSTRACT FROM AUTHOR]

Introduction: Patients with terminal‐stage cancer frequently experience multiple symptoms simultaneously. Little is known about how core symptom clusters differ in advanced‐cancer patients with different survival expectancies receiving hospice care. To identify the core symptom clusters of hospice‐care cancer patients with different survival expectancies and compare the features of their symptom networks. Methods: In this retrospective study, secondary data analysis was conducted. Records of 6946 patients with advanced cancer who received home‐based hospice care service in a hospice center from April 2001 to December 2020 were collected and analyzed using network analysis. Results: This analysis included 6946 patients with advanced cancer receiving hospice care. In patients with survival expectancies of 0–6 months, loss of appetite was identified as the core symptom (rs = 4.03, rb = 5.21, rc = 2.63), and five symptom clusters were identified. Malnutrition was the core symptom in patients with survival expectancies of 6–12 months (rs = 2.83, rb = 2.43, rc = 0.93), and nine symptom clusters were identified. Wasting syndrome was the core symptom cluster in two groups. The network density of symptoms in patients with < 6 months of survival expectancy (91.99) was higher than in patients with 6–12 months (28.39). Conclusions: Nutrition impact symptoms are the core symptoms for home‐hospice care cancer patients with a survival period of 1 year or below. Moreover, hospice cancer patients with short survival expectancies have greater inter‐symptom impact. [ABSTRACT FROM AUTHOR]

Background: Risk perception with respect to death is a prerequisite for patients with advanced cancer when the time comes to make medical decisions. However, the nature of death risk perception remains unclear. Method: In-depth interviews were conducted with 28 patients with advanced cancer who were recruited from two hospitals and one home-based hospice in Fujian, China. Interviews were transcribed and directed content analysis applied. The Tripartite Model of Risk Perception was used as a theoretical framework. Results: Patients with advanced cancer perceived their risk of death in different ways. Professional communication about death risk and data-driven risk perception were common in clinical settings. Affective influences, inherent cognition, and comparisons to others or oneself also contributed to the subjects' self-perceived death risk. Conclusion: This theory-informed qualitative study clarifies the nature of the perceived risk of death among patients with advanced cancer. The study findings offer healthcare providers a more nuanced understanding of the perceived risk of death among patients with advanced cancer. [ABSTRACT FROM AUTHOR]

Objective: The American College of Surgeons recommends structured family meetings (FM) for high-risk surgical patients. We hypothesized that goals of care discussions (GOCD) in the form of an FM, multidisciplinary family meeting (MDFM), or palliative care consult (PCC) would be underutilized in imminently dying thoracic surgery patients. Methods: A retrospective chart review at a tertiary academic medical center was performed on all inpatient mortalities and discharges to hospice after any thoracic surgery operation. The utilization of GOCDs was compared between the 2 groups. Secondary outcomes were length-of-stay, comatose status and ventilator dependence during initial GOCD, and timing of code status change. Results: In total, 56 patients met inclusion criteria: 44 of 56 (78.6%) died and 12 of 56 (21.4%) were discharged to hospice. Most patients had a FM (79.5% mortality vs 100% hospice, P =.29) and few had an MDFM (25.0% mortality vs 25.0% hospice, P = 1.00). Patients discharged to hospice were more likely to have a PCC (66.7% vs 31.2%, P =.03) and less likely to be comatose (16.7% vs 59.1%, P =.009) or ventilator dependent during initial GOCD (16.7% vs 70.5%, P =.001). Among patients who died and were DNR-CC (do not resuscitate—comfort care; 37 of 44), 75.7% died the same day of code status change and 67.6% died within 48 h of initial GOCD. Discussion: Although FMs were common, MDFMs were infrequent. Patients discharged to hospice were more likely to have a PCC. Most deaths occurred shortly after initial GOCD and most code status changes occurred on day-of-death. This data suggest an opportunity to improve GOCDs in critically ill thoracic surgery patients. [ABSTRACT FROM AUTHOR]

Introduction. Inadequate pain control may contribute to a desire to die. Early use of opioid analgesics could improve pain treatment. On the other hand, opioids are associated with risk of addiction. We aimed to compare the opinions on opioid analgesic use between palliative care patients and physicians. Material and methods. Data on the opinions of hospice and palliative care patients (n = 104) and physicians of different specialties (n = 216) were collected using a survey with closed-ended questions scored on a 5-point Likert scale. Results. The majority (87.5%) of cancer patients experienced pain during their illness (mean intensity: 7.01±2.44). More than half (53.3%) of physicians had concerns that patients overuse opioid drugs. Negative connotations associated with the word "morphine" were expressed in both study groups. Survey responses of both patients and physicians were consistent with the phenomenon of "opioidophobia". Conclusions. We found a high degree of consensus between cancer patients' and physicians' opinions on opioid analgesic use. However we also found some discrepancies in opinions and they were mostly related to medical knowledge, which may indicate poor patient education about opioid use and poor communication between patients and physicians. It is concerning to note these significant discrepancies concerning opioid use since patients considered opioids useful in ensuring pain relief and improving their quality of life. The majority (almost 90%) of patients surveyed struggled with pain over the course of their illness and treatment. [ABSTRACT FROM AUTHOR]

Family physicians often treat patients who require urinary management with the use of external urinary devices, clean intermittent catheterization, or indwelling urinary catheterization. External urinary devices are indicated for urinary incontinence (postvoid residual less than 300 mL), urine volume measurement for hospitalized patients, nonsterile urine diagnostic testing, improved comfort for patients in hospice or palliative care, and fall prevention for high-risk patients. Indwelling urinary catheterization is indicated for severe urinary retention or bladder outlet obstruction; wound healing in the sacrum, buttocks, or perineal area; prolonged immobilization; and as a palliative measure for patients who are terminally ill. Clean intermittent catheterization is an alternative to indwelling urinary catheterization for acute or chronic urinary retention (postvoid residual greater than 300 mL) without bladder outlet obstruction, sterile urine testing, postvoid residual volume assessment, and wound healing. Suprapubic catheter placement is considered when long-term catheterization is needed or urethral catheterization is not feasible. Urinary catheters should not be used solely for staff or caregiver convenience, incontinence-related dermatitis, urine culture procurement from a voiding patient, or initial incontinence management. Common complications of urinary catheter use include obstruction, bladder spasm, urine leakage, and skin breakdown of the sacrum, buttocks, or perineum. The risk of catheter-associated urinary tract infections increases with the duration of catheter use. Urologist referral is indicated for patients requiring urinary management who have recurrent urinary tract infections, acute infectious urinary retention, suspected urethral injury, or substantial urethral discomfort or if long-term catheterization is being considered. [ABSTRACT FROM AUTHOR]

In a group of palliative patients, venous thromboembolism (VTE) is a significant cause of death and reduction in quality of life. Current guidelines and scientific research on thromboprophylaxis most often refer to the population of oncology patients, who differ in many aspects from patients receiving palliative care. Thus, doctors working with patients undergoing palliative treatment have to face many problems related to safety and effectiveness of antithrombotic therapy in this type of care. In the case of chronically ill patients, diagnostic process may be somewhat difficult because the symptoms resulting from the underlying diseases can mask VTE symptoms. The aim of this article is to review the literature on symptoms and thromboprophylaxis in this group of patients. According to the latest guidelines of the American Society of Clinical Oncology (ASCO), it is not recommended to use VTE prophylaxis in outpatient oncology patients routinely, but it should be considered in high-risk patients who received a Khorana score of at least 2 before starting a new chemotherapy cycle. In patients diagnosed with VTE, in long-term prophylaxis lasting at least 6 months, due to greater effectiveness, it is recommended to use low-molecular-weight heparins, edoxaban, rivaroxaban or apixaban instead of vitamin K antagonists, which can be used if the previously mentioned drugs are unavailable. There are some studies which show that thromboprophylaxis may be beneficial for patients in palliative care. On the other hand, another studies’ results suggest that patients won’t gain any benefit from prevention. As our article shows it is very crucial to conduct scientific research on palliative patients and create clear guidelines for prophylaxis for this group of people. [ABSTRACT FROM AUTHOR]

Objective: To determine the budget impact of implementing multidisciplinary complex pain clinics (MCPCs) for Veterans Health Administration (VA) patients living with complex chronic pain and substance use disorder comorbidities who are on risky opioid regimens. Data Sources and Study Setting: We measured implementation costs for three MCPCs over 2 years using micro‐costing methods. Intervention and downstream costs were obtained from the VA Managerial Cost Accounting System from 2 years prior to 2 years after opening of MCPCs. Study Design: Staff at the three VA sites implementing MCPCs were supported by Implementation Facilitation. The intervention cohort was patients at MCPC sites who received treatment based on their history of chronic pain and risky opioid use. Intervention costs and downstream costs were estimated with a quasi‐experimental study design using a propensity score‐weighted difference‐in‐difference approach. The healthcare utilization costs of treated patients were compared with a control group having clinically similar characteristics and undergoing the standard route of care at neighboring VA medical centers. Cancer and hospice patients were excluded. Data Collection/Extraction Methods: Activity‐based costing data acquired from MCPC sites were used to estimate implementation costs. Intervention and downstream costs were extracted from VA administrative data. Principal Findings: Average Implementation Facilitation costs ranged from $380 to $640 per month for each site. Upon opening of three MCPCs, average intervention costs per patient were significantly higher than the control group at two intervention sites. Downstream costs were significantly higher at only one of three intervention sites. Site‐level differences were due to variation in inpatient costs, with some confounding likely due to the COVID‐19 pandemic. This evidence suggests that necessary start‐up investments are required to initiate MCPCs, with allocations of funds needed for implementation, intervention, and downstream costs. Conclusions: Incorporating implementation, intervention, and downstream costs in this evaluation provides a thorough budget impact analysis, which decision‐makers may use when considering whether to expand effective programming. [ABSTRACT FROM AUTHOR]

This study was conducted to determine the effect of Mindfulness-Based Compassionate Living (MBCL) training given to the informal caregivers of palliative patients on burnout and caregiving burden. A single-blind, randomized, controlled, experimental study was conducted with 54 caregivers of patients admitted to a hospital palliative care unit. The participants were randomly allocated to the experimental group (n  = 26) and control group (n  = 28). The experimental group received MBCL training twice a week for 4 weeks. Data were collected before and after the intervention using the Maslach Burnout Inventory, Caregiver Burden Scale and Self-Compassion Scale–Short Form. The data were analyzed using kurtosis and skewness coefficients, number, percentage, mean, standard deviation, chi-square test, independent samples t test, Wilcoxon signed ranks test and Mann-Whitney U test in SPSS version 22.0. The informal caregivers in the experimental group demonstrated a significant decrease in emotional exhaustion and depersonalization scores and an increase in personal accomplishment and self-compassion scores in posttest assessments after the MBCL intervention (P  < 0.05). All of these parameters differed significantly between the experimental and control groups after the intervention (P  < 0.05). MBCL training seems to be effective in reducing emotional exhaustion and depersonalization and increasing personal accomplishment and self-compassion among informal caregivers of palliative inpatients. The results of this study can be generalized to the caretakers of patients receiving palliative care in university hospitals. [ABSTRACT FROM AUTHOR]

Background: Hospice care frequently includes hands-on care from hospice aides, but the need for hospice aide care may vary in residential settings (e.g., assisted livings and nursing homes). Objectives: The objective of this study is to compare hospice aide use and factors associated with use across residential settings. Design: This longitudinal cohort study used data from Medicare beneficiaries in the United States enrolled in the Medicare Current Beneficiary Survey (MCBS) who died between 2010 and 2019 and had hospice claims and available residential setting data in MCBS (n = 1,915). Analysis: Decedent hospice aide use was compared by residential settings; multivariable models controlling for sociodemographic, clinical/functional, and hospice characteristics examined factors associated with hospice aide care in different residential settings. Results: Hospice aide visits were least common in the community setting (64.4% vs. 76.6% vs. 72.6% with any hospice aide visits in community, assisted living, and nursing home, respectively, p = 0.001). In adjusted models, factors associated with hospice aide visits did not significantly differ by residential settings. Conclusions: Despite staff providing hands-on support in assisted livings and nursing homes, hospice aide visits were more common in residential as opposed to community settings, and factors associated with hospice aide visits were similar among settings. To maximize the potentially positive impact of hospice aides on overall care, additional work is needed to understand when hospice aides are used and how hospice aides collaborate with families and care teams. This will help to ensure that hospice care is appropriately tailored to individual care needs in all residential settings. [ABSTRACT FROM AUTHOR]

Copyright of Nővér is the property of Chamber of Hungarian Health Care Professionals and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Patients' spiritual needs are often marginalized by medical staff, who identify them with religious practice, faith, and God. Illness and related human suffering are not just physical ailments alone. The loss of health entails several changes in a patient's life and requires reorganization of the family, professional, social, and spiritual aspects of it. The purpose of this article is to analyze the medical personnel's sense of readiness to provide spiritual care to patients of oncology units and hospice facilities. Methods: The study was carried out with the use of the Spiritual Supporter Scale whose psychometric values were determined on a high level of reliability with Cronbach's a = 0.88. Results: The results of the Spiritual Supporter Scale showed that oncology professionals got significantly lower scores [median (Me) = 5; mean (M) = 5.11; standard deviation (SD) = 1.89] in the overall scale score than those who work in hospices (Me = 7; M = 6.9; SD = 1.5). The analysis also showed that oncology unit employees (54%), declared that providing spiritual care to patients is an integral part of their work (p < 0.02) significantly less often than those employed in hospices (88%). They were also less likely to declare (77%) that spiritual support is necessary in their workplace than persons who provide care in hospices (95%; p < 0.01). Conclusions: The study showed the differences in the sense of preparedness as well as competencies to provide spiritual care among medical workers in hospices and oncology units. [ABSTRACT FROM AUTHOR]

Copyright of Environmental & Social Management Journal / Revista de Gestão Social e Ambiental is the property of Environmental & Social Management Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

PURPOSE: Hospice is underutilized by patients with hematologic malignancies (HM), and when patients are referred, they are typically more ill, hospitalized, and with shorter length of stay (LOS) than patients with solid tumors (ST), limiting research about home hospice care experiences of patients with HM. In this mixed-methods study, we examined the hospice experiences of patients with HM who died at residential care homes (RCHs), home-based settings in which volunteer caregivers and hospice staff provide end-of-life (EOL) care under the social hospice model. METHODS: We queried a registry of 535 hospice patients who died at RCHs between 2005 and 2020 that included quantitative medication administration data as well as qualitative data from hospice intake forms and written volunteer caregiver narratives. Qualitative data were analyzed by collective case study methodology. Quantitative comparisons of LOS and liquid morphine use were performed with matched patients with ST. RESULTS: The registry yielded 29 patients with HM, of whom qualitative data were available for 18 patients. Patients with HM exhibited common EOL symptoms (pain, dyspnea, and agitation). Instances of bleeding were low (22%), and notable HM-specific care concerns were described regarding bone fractures, skin integrity, and delirium. Most (78%) experienced good symptom management and peaceful or comfortable deaths. In only one case were symptoms described as severe and poorly managed. Patients with HM had comparable LOS on hospice and at the RCHs to patients with ST, with no group differences in liquid morphine use. CONCLUSION: In this registry cohort, most patients with HM achieved good symptom management in home care settings with volunteer caregivers and hospice support. Caregivers may require additional counseling and palliative medications for HM-specific EOL symptoms. Patients with blood cancers in a home care hospice setting have unique end-of-life experiences. [ABSTRACT FROM AUTHOR]

Background: Paediatric palliative care (PPC) has evolved in response to the increased prevalence of children who have been diagnosed with life-limiting conditions. Nursing care is a fundamental aspect of PPC and understanding nurses' experiences is imperative to the provision and development of quality holistic child-centred services. Aim: To review nurses' experiences of providing palliative care for children with life-limiting conditions. Method: A systematic database search of the Cumulative Index to Nursing and Allied Health Literature (CINAHL) Complete, Ovid Medline and Scopus was undertaken. Key words consisted of 'palliative care' or 'terminal care' or 'dying' or 'end-of-life care' and children* or paediatric* or pediatric* and 'nurs* experience*' or 'nurs* view*' or 'nurs* perspective*' or 'nurs* feeling*'. Inclusion criteria included peer-reviewed studies published between 2016–2023 in the English language. Findings: A thematic approach was adopted with the 11 papers selected for the review and each study critically analysed to identify three recurring themes. The themes included: 'a broken wreck', 'makes a life worth living' and 'challenges in doing 100%'. Findings point to mixed feelings among nurses in providing PPC and suggest that nurses experience emotional distress when caring for dying children. With appropriate supports and inspiration from their paediatric patients, nurses are determined to provide a 'good death' for the children in their care. Nevertheless, the perceived lack of knowledge and experience, communication struggles and personal dilemmas can be predisposing factors in triggering negative experiences among nurses when providing palliative care for children with life-limiting conditions. Recommendations: Education and policy development is required to meet the practice needs and support the emotional needs of nurses engaged in PPC. Further research is required to generate PPC evidence-based nursing interventions. In doing so, high quality PPC practice will be promoted, thereby ensuring high quality PPC for the children and their families. [ABSTRACT FROM AUTHOR]

A home is a preferred place of death by most people. Nurses play a key role in supporting end-of-life home care, yet less is known about the factors that determine home as a place of death. This scoping review describes the percentage of actual places of death and determines social factors related to home as the place of death among noncancer patients with end-stage chronic health conditions. Inclusion criteria included (1) noncancer chronic illness conditions, (2) outcomes of place of death, and (3) factors that determine home as a place of death. Sources of evidence included PubMed, CINAHL, and Web of Science databases, which were searched in May 2022, and additional searches from May 2022 to November 2023.The JBI scoping review guide (2020) and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Review extension were used. Twenty-eight studies were included in this analysis. The range of percentages is varied within the same place of death among the sample. Two major constructs that determine a home as a place of death were identified: preceding factors and social capital. The results suggest that the place of death among noncancer patients with end-stage chronic health conditions should be continued to be understood. Two constructs determined home as a place of death and are considered as a fundamental to increasing equal accessibility in the initiation of palliative care services to promote home death and meet end-of-life care goals. [ABSTRACT FROM AUTHOR]

Background: Opioid misuse and substance use disorders (SUDs) including opioid use disorder (OUD) are common and negatively impact quality of life. Hospice clinicians' experiences with these conditions have not been well described. Objectives: We sought to explore hospice clinicians' knowledge, practices, and comfort caring for patients with opioid misuse (e.g., a pattern of unsanctioned opioid use escalation, or concurrent illicit substance use) and SUDs. Design: We recruited hospice clinicians in the United States via national hospice and palliative care organizations to complete an online survey designed by the study authors and pilot tested with an interdisciplinary group of current/former hospice clinicians. Results: One hundred seventy-five clinicians (40% nurses, 40% physicians, 16% nurse practitioners) responded to the survey; most had cared for two or more hospice patients with opioid misuse or SUD in the past month. The majority felt confident identifying opioid misuse (94%) and taking SUD histories (79%). Most (62%) felt it is their role to treat hospice patients for SUD, though 56% lacked comfort in using buprenorphine for OUD treatment. While the majority felt it is their role to treat pain in hospice patients with SUDs (94%) and that hospice can help patients with SUDs (94%), many were not comfortable managing pain in patients taking buprenorphine (45%) or naltrexone (49%) for SUDs. Most felt comfortable managing pain in patients taking methadone for SUD (73%). Conclusions: Opioid misuse and SUD are common in hospice. Though clinicians are comfortable taking relevant histories, they feel less comfortable managing patients' opioid misuse or SUD, or these patients' pain. [ABSTRACT FROM AUTHOR]

Background: Terminally ill patients can benefit from hospice care, which specifically addresses the needs of patients and families affected by terminal illness. However, there is a lack of standardized evaluation criteria to assess the quality of hospice care for terminally ill patients in the ICU, and it is impossible to evaluate the service quality of hospice care. To use the Delphi method to construct a hospice care system for terminally ill patients in ICU that meets clinical needs, and to provide theoretical support for nursing decision-making of terminally ill patients in clinical ICU.Methods: Obtain relevant literatures by entering specific key words into the database, the hospice care nursing system for terminally ill patients in ICU was preliminarily drawn up by literature analysis, and 24 experts in this field were consulted for 3 rounds by Delphi method to discuss the development status of hospice care and finally establish the hospice care nursing system.Results: In the three rounds of letter inquiries, the positive coefficients of experts were all high, the expert authority coefficient (Cr) were 0.864, 0.849, 0.832, and the expert opinion coordination coefficient(W) were 0.186, 0.319, 0.224; The system includes 8 first-level indicators, 27 second-level indicators and 9 third-level indicators.Conclusion: In this study, three rounds of Delphi consultation methods were used to construct an evaluation index system for the nursing quality of hospice care for ICU patients. The evaluation indicators formulated closely focus on the physiological and psychological characteristics of ICU patients, which can provide a better reference for ICU patients with advanced life in the future. [ABSTRACT FROM AUTHOR]

Volunteers provide important social support for homeless people. While motivations of the volunteer population for homeless people have been studied, little is known about volunteers for a hospice targeting the homeless population. The purpose of this study is to describe volunteer experiences and motivation at a hospice for homeless people during the COVID-19 pandemic. This study was conducted at a hospice for homeless individuals in Fall 2021. Data were collected by six virtual focus groups in November and December 2021. There were 21 participants. The recordings of the focus groups were automatically transcribed via ZOOM. The data were analyzed based on themes. This study has highlighted three main findings. First, honoring a loved one and being engaged in the community were two main reasons individuals began volunteering at the hospice center. Second, volunteers faced many challenges during the COVID-19 pandemic, including a slow start, increased use of technology, and constant change in volunteers' responsibilities due to safety reasons. During this time however, volunteers felt much support from the program staff. Third, interactions with staff, other volunteers and residents were the main reasons driving volunteer motivation. This project examined the under-studied subject of volunteers' experiences at a hospice for homeless people and provided insight in this topic. While the COVID-19 pandemic affected volunteering at a hospice for homeless people, support from the program staff and leadership helped sustain volunteer motivation. [ABSTRACT FROM AUTHOR]

Hospice care is to improve the quality of life and help patients die comfortably, peacefully and dignified by controlling pain and discomfort symptoms and providing physical, psychological and spiritual care and humanistic care in the final stage of the patient's life. Hospice care clients were primarily cancer patients at first and then slowly extended to other critically patients. Hospice care can alleviate the physical, psychosocial and mental problems of patients with advanced cancer, meet the diversified and multi-level health service needs of patients, improve the quality of life of patients and their families, and also save medical expenditure and improve the efficiency of medical resources. At present, there were few studies on hospice care for Chinese patients with advanced cancer. In this study, the needs of hospice care for patients with advanced cancer were reviewed from physical comfort and pain reduction, dignity maintenance, social support, and help calm death, and specific screening and evaluation tools for hospice care for patients with advanced cancer. And this study was summarized to review the influencing factors of hospice care in order to provide a reference for clinical hospice care practice for patients with advanced cancer in China. [ABSTRACT FROM AUTHOR]

Background: Oral anticoagulants (OACs) are effective in reducing the risk of cardioembolic stroke due to atrial fibrillation. While most nursing home residents with atrial fibrillation qualify for anticoagulation based on clinical guidelines, the net clinical benefits of OACs may diminish as residents approach the end of life. Methods: We conducted a cross‐sectional study of 30,503 US nursing home residents with atrial fibrillation (based on Minimum Data Set 3.0 and Medicare Part A records) who used OACs in the year before enrolling in hospice care during 2012–2016. Whether residents discontinued OACs before hospice enrollment was determined using Part D claims and date of hospice enrollment. Modified Poisson models estimated adjusted prevalence ratios (aPR). Results: Almost half (45.7%) of residents who had recent OAC use discontinued prior to hospice enrollment. Residents who were underweight (aPR: 1.02; 95% confidence interval [CI]: 1.01–1.03), those with high bleeding risk (aPR: 1.04, 95% CI: 1.03–1.05), and those with moderate or severe cognitive impairment (aPR: 1.02, 95% CI: 1.02–1.03) had a higher prevalence of OAC discontinuation before entering hospice. Residents with venous thromboembolism (aPR: 0.94, 95% CI: 0.93–0.96), statin users (aPR: 0.88, 95% CI: 0.87–0.89), and those on polypharmacy (≥10 medications, aPR: 0.72; 95% CI: 0.71–0.73) were less likely to discontinue OACs before enrollment in hospice. Conclusion: Anticoagulants are often discontinued among older nursing home residents with atrial fibrillation before hospice enrollment; it is not clear that these decisions are driven solely by net clinical benefit considerations. Further research is needed on comparative outcomes to inform resident‐centered decisions regarding OAC use in older adults entering hospice. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study is to test the reliability and construct validity of a new instrument, the Caregiver-Centered Communication Questionnaire (CCCQ), designed to assess the extent to which family caregivers feel their perspectives and needs are appropriately acknowledged and addressed by the healthcare team. Methods: We administered the CCCQ to adult family caregivers of hospice patients. We calculated Cronbach's alpha and performed structural equation modeling. Following the estimation of the congeneric model, modification indices (MI) were examined to establish cross-loading. We used RMSEA, CFI and TLI, and SRMR to determine the quality of model fit. Results: A total of 525 caregivers completed the CCCQ instrument. The Cronbach's alpha was α = 0.98, indicating good reliability. Our final model demonstrated good fit to our data, χ2(354) = 711.653, RMSEA = 0.044(0.039, 0.049), CFI = 0.99, TLI = 0.99, SRMR = 0.029. Conclusion: Caregivers are asked to play an ever-increasing role in managing aspects of care. This role is not fully reflected in available toolkits to assess processes of care, and the CCCQ, designed to address this gap, was found to be reliable and valid. Assessing caregiver centered communication should and can be integrated into the evaluation of health care services delivered to patients and families. [ABSTRACT FROM AUTHOR]

Introduction. A handful of reports detail efforts to redesign traditional hospital gowns to address common concerns related to patient comfort and privacy for big bodied patients. Results suggest that improving gown design has the potential to improve both the patient and carer experience and satisfaction of care. Aim. This study aimed to ascertain the utility of gowns purposely designed for big bodied patients (named Xcellent Gowns) from a staff perspective. Methods. Qualitative semi-structured interviews were conducted in 2022 with 14 hospice staff members. Interview transcripts were uploaded to DedooseTM. Data were analysed utilising reflexive thematic analysis according to a six-phase process including data familiarisation, iterative data coding, and theme development and refinement. Results. The qualitative analysis of the interview data identified four main themes: (1) the gown experience, (2) fit-for-purpose, (3) love and dignity, (4) design principles. Each theme is presented and discussed with illustrative quotes from participants’ interview transcripts. Discussion. The perspectives of the staff participants in this study confirm research findings from other healthcare settings, that the patient and carer experience may be improved through focused redesign of this vital item of patient clothing. [ABSTRACT FROM AUTHOR]

Background: Racial and ethnic minoritized people with dementia (PWD) are at high risk of disenrollment from hospice, yet little is known about the relationship between hospice quality and racial disparities in disenrollment among PWD. Objective: To assess the association between race and disenrollment between and within hospice quality categories in PWD. Design/Setting/Subjects: Retrospective cohort study of 100% Medicare beneficiaries 65+ enrolled in hospice with a principal diagnosis of dementia, July 2012–December 2017. Race and ethnicity (White/Black/Hispanic/Asian and Pacific Islander [AAPI]) was assessed with the Research Triangle Institute (RTI) algorithm. Hospice quality was assessed with the publicly-available Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey item on overall hospice rating, including a category for hospices exempt from public reporting (unrated). Results: The sample included 673,102 PWD (mean age 86, 66% female, 85% White, 7.3% Black, 6.3% Hispanic, 1.6% AAPI) enrolled in 4371 hospices nationwide. Likelihood of disenrollment was higher in hospices in the lowest quartile of quality ratings (vs. highest quartile) for both White (adjusted odds ratio [AOR] 1.12 [95% confidence interval 1.06–1.19]) and minoritized PWD (AOR range 1.2–1.3) and was substantially higher in unrated hospices (AOR range 1.8–2.0). Within both low- and high-quality hospices, minoritized PWD were more likely to be disenrolled compared with White PWD (AOR range 1.18–1.45). Conclusions: Hospice quality predicts disenrollment, but does not fully explain disparities in disenrollment for minoritized PWD. Efforts to improve racial equity in hospice should focus both on increasing equity in access to high-quality hospices and improving care for racial minoritized PWD in all hospices. [ABSTRACT FROM AUTHOR]

Emergency medical services (EMS) systems are designed to provide care in the field and while transporting patients to a hospital; however, patients enrolled in hospice may not want invasive therapies nor benefit from hospitalization. For many reasons, encounters with hospice patients can be challenging for EMS systems, EMS clinicians, hospice clinicians, hospice patients, and their families. EMS clinicians should receive hospice-focused education that fosters a basic understanding of hospice, palliative therapies, and advance care planning documents (e.g., Physician Orders for Life Sustaining Treatment). This education should emphasize the ongoing development of end-of-life communication skills. EMS medical directors and local hospice organizations should collaborate to develop hospice patient-centered EMS protocols that address symptom management and delineate appropriate and goal concordant clinical interventions, and that are within the agency-level scope of practice for local EMS clinicians. Partnerships between EMS and hospice organizations can facilitate access to hospice teams who can provide clear guidance on whether to treat-in-place with follow-up care or to transport hospice patients to the hospital. EMS medical directors and local hospice organizations should collaborate to perform needs assessments of hospice patient EMS utilization. EMS medical directors should consider including a focus on EMS care of hospice patients as part of their overall quality management program(s). Ideally these efforts should be collaborative with local hospice agencies in order to facilitate meaningful process improvement strategies that include both EMS and hospice stakeholders. Reimbursement programs should reasonably compensate EMS agencies for scene treatment in place, as well as transport to alternative destinations such as in-patient hospice facilities. [ABSTRACT FROM AUTHOR]

Background: A growing number of persons living with dementia (PLwD) die at home with hospice care. However, there is limited information describing the needs of dying, community‐dwelling persons with dementia and their family care partners (FCPs). Understanding the range of challenges faced by these FCPs is requisite to developing resources and refining support infrastructure. The current study identifies caregiving challenges unique to this population and strategies FCPs use to address those challenges. Methods: Semi‐structured interviews were conducted with 40 current or recently bereaved FCPs of home hospice patients living with dementia, recruited from geriatrics clinics and a hospice agency in the New York metropolitan area. A thematic analysis guided by deductive and inductive approaches was used to code interview transcripts, identify broader conceptual categories, and search for themes. Results: Three themes were identified related to challenges faced by FCPs: (1) managing emotions and reacting to behaviors associated with advanced dementia; (2) lack of knowledge and adequate information related to dementia: disease progression and caregiving skills; and (3) maintaining FCP well‐being: self‐care and caregiver burden. Three themes were identified that describe strategies FCPs of PLwD employ to cope with end‐of‐life caregiving demands: (1) accepting help from professional caregivers and hospice support services; (2) getting knowledge and information about dementia; and (3) pragmatic approaches and acceptance of signs and symptoms of disease progression. Conclusions: FCPs of PLwD near the end of life (EOL) face caregiving challenges unique to dementia and dying. While FCPs are resourceful in identifying novel strategies for managing burden and caregiving responsibilities, our results point to gaps in the current support infrastructure for this population at the EOL. Findings also identify areas of need for care partners navigating end‐of‐life issues. [ABSTRACT FROM AUTHOR]

Most people wish to die at home yet significant barriers exist in accessing care in one's home, especially for individuals with caregiver and/or housing instability. Across the U.S., residential homes for the dying are opening to address gaps in end-of-life care by recruiting community members to serve as caregivers to hospice patients during their final days. This paper describes a blended-experiential training program, informed by both an evidence-based educational framework and transformative learning theory, that trains undergraduate students to serve as surrogate family members to hospice patients in residential care homes. This study analyzed data from a sample of undergraduate students (n = 35) who participated in an 8-week program. Applying Kirkpatrick's evaluation model, study results indicate the program provided essential knowledge and skills in end-of-life care, benefiting both student learning outcomes and resident care. [ABSTRACT FROM AUTHOR]

Background: Palliative care, a recognised component of care by the World Health Organization is poorly developed in low- and middle-income countries. Mobile phone technology, an effective way to increase access and sustainability of healthcare systems globally, has demonstrated benefits within palliative care service delivery, but is yet to be utilised in Ethiopia. Aim: To co-design, develop and evaluate a mobile phone based remote monitoring system for use by palliative care patients in Ethiopia Design: Two-phase co-design approach comprising multiple methods that is stakeholder interviews, focus groups, user-co-creation activities and healthcare worker prioritisation discussions 2019–2020. Phase-1 interviews (n = 40), Phase-2 focus groups (n = 3) and interviews (n = 10). Setting/Participants: Hospice Ethiopia and Yekatit 12 Medical College Hospital: healthcare workers, palliative care patients, family carers & software-developers. Results: Co-design activities lead to development of the prototype ' Ayzot ' application, which was well received and reported to be easy to use. Patients, and family caregivers saw provision of self-care information and symptom management as a key function of the App and expressed very positive attitudes towards such information being included. Healthcare workers found the App offered service benefits, in terms of time and cost-savings. Conclusion: This paper provides a detailed example of the development and design of a prototype remote monitoring system using mobile phone technology for palliative care use in Ethiopia. Further development and real-world testing are required, to not only understand how it acts within usual care to deliver anticipated benefits but also to explore its effectiveness and provide cost estimates for wider implementation. [ABSTRACT FROM AUTHOR]

Higher level of functional incapacity and invalidity is noted in palliative patients, as a result of disease progression, which is the reason for a significant decrease in the quality of life not only of these patients, but also of the family members who care for them. Physical therapy and occupational therapy are aimed at improving the patient's quality of life through rehabilitation measures to restore body function, ensure physical independence and activity, optimal physical condition and well-being, and patient adaptation in the environment. Aim: to review modern literary sources regarding the relevance of physical therapy and occupational therapy in palliative and hospice care. The search for literary sources was carried out in international scientometric databases: PubMed, Scopus, Web of Science, Google Scholar. The search depth is 13 years (from 2010 to 2022). The review indicates that physical therapy and occupational therapy in palliative and hospice medicine around the world are not used enough today. These two specialties of interdisciplinary treatment in palliative and hospice medicine play an important integral role, which is manifested in improving the quality of life of both patients and their family members who care for them through the use of a wide variety of methods. Hospice physical therapists not only help patients to support/keep functional abilities as long as possible, but also to reduce the burden on persons who care for terminally ill patients. Physical and occupational therapy have numerous benefits for patients with progressive life-threatening illnesses in palliative and hospice care. Physical therapy in palliative and hospice care can have a preventive, educational, and/or supportive function depending on the patient's situation. There is especially large deficiency in palliative physical therapy and occupational therapy among adolescents and young people, which requires wide implementation with high-quality training of relevant specialists. Physical therapy and occupational therapy play an important role in palliative and hospice care; all patients in palliative and hospice care, regardless of illness or severity, should have access to physical and occupational therapy based on individual needs. [ABSTRACT FROM AUTHOR]

Two-thirds of patients with advanced cancer have pain and, of these, approximately 10–20% do not respond to conventional pain management approaches. This case study concerns a hospice patient who received intrathecal drug delivery for intractable cancer pain at the end of life. This involved working in partnership with a hospital-based interventional pain team. Despite side-effects and complications associated with intrathecal drug delivery and the requirement for inpatient nursing care, intrathecal drug delivery was the best option for the patient. The case identifies the importance of a patient-centred approach to decision-making, effective partnerships between hospice and acute hospital teams, and nurse education as key factors contributing to the provision of safe and effective intrathecal drug delivery. [ABSTRACT FROM AUTHOR]

Background: The Medicare Hospice Benefit increasingly serves people dying with dementia. We sought to understand characteristics, hospice use patterns, and last-month-of-life care quality ratings among hospice enrollees with dementia coexisting with another terminal illness as compared to enrollees with a principal hospice diagnosis of dementia, and enrollees with no dementia. Methods: We conducted a pooled cross-sectional study among decedent Medicare beneficiaries age 70+ using longitudinal data from the National Health and Aging Trends Study (NHATS) (last interview before death; after-death proxy interview) linked to Medicare hospice claims (2011–2017). We used unadjusted and adjusted regression analyses to compare characteristics of hospice enrollees with coexisting dementia to two groups: (1) enrollees with a principal dementia diagnosis, and (2) enrollees with no dementia. Results: Among 1105 decedent hospice enrollees age 70+, 40% had coexisting dementia, 16% had a principal diagnosis of dementia, and 44% had no dementia. In adjusted analyses, enrollees with coexisting dementia had high rates of needing help with 3–6 activities of daily living, similar to enrollees with principal dementia (62% vs. 67%). Enrollees with coexisting dementia had high clinical needs, similar to those with no dementia, for example, 63% versus 61% had bothersome pain. Care quality was worse for enrollees with coexisting dementia versus principal dementia (e.g., 61% vs. 79% had anxiety/sadness managed) and similar to those with no dementia. Enrollees with coexisting dementia had similar hospice use patterns as those with principal diagnoses and higher rates of problematic use patterns compared to those with no dementia (e.g., 16% vs. 10% live disenrollment, p = 0.004). Conclusions: People with coexisting dementia have functional needs comparable to enrollees with principal diagnoses of dementia, and clinical needs comparable to enrollees with no dementia. Changes to hospice care models and policy may be needed to ensure appropriate dementia care. [ABSTRACT FROM AUTHOR]

Background: There is limited evidence regarding the challenges of providing hospice care to those dying at home during the COVID-19 pandemic. Objective: To describe the challenges of home hospice care and the specific types of disruptions in care processes experienced by patients and families. Design: Qualitative study of the electronic medical record notes of a large New York City (NYC) home-based primary care program. Setting/Subjects: Subjects were 58 patients referred to hospice who died during the initial NYC COVID-19 surge from March to June 2020. Results: We identified six domains of disruptions in home hospice care: delayed hospice enrollment, inability to conduct home visits, lack of needed supplies, communication failures, strained caregivers, and limitations of telehealth. Conclusions: This study provides a critical first analysis of disruptions in home hospice care that can feasibly be addressed and must be prioritized by hospices throughout the ongoing pandemic and in advance of future emergencies. [ABSTRACT FROM AUTHOR]

Dr. Ken Murray in his essay had suggested that doctors must discuss with patients, family members, end of life choices". Dr. Ken Murray had further written that medical care should not be administered which makes patient suffer in agony. When the patient is serious, Dr. Ken Murray opined, family members wish the doctors to "do anything that is reasonable" but the family members themselves do not know what is reasonable. [Extracted from the article]

Article 17 (1) 3 of The Act on Decisions on Life-sustaining Treatment for Patients in Hospice and Palliative Care or at the End of Life (hereinafter referred to as the ‘Life-sustaining Medical Determination Act’) was established based on the “patient’s presumptive intention” in the Supreme Court precedent for “the so-called grandmother Kim’s case or patient’s presumptive intention based on patient family statements” in the recommendation of the 3rd National Bioethics Committee. This is because it stipulates a method of confirming the patient’s intention on the premise that the patient’s prior autonomous intention exists. However, the content is quite far from guaranteeing the patient’s right to self-determination in terms of pure autonomy standards or legal principles. The above regulations stipulate that if there is a statement of agreement between two or more of the patient’s family members, it is regarded as the patient’s intention, but it does not have sufficient grounds to view it. Combining the text and clues of the above regulations, it is difficult to erase the impression that it is not just a procedure to estimate the patient’s intention, but to obtain consent from two or more family members. I am in a position that the above regulations should be improved into estimation regulations according to the pure autonomy standard. This is because the current law reflects the family’s values and positions, causing serious problems such as the risk of violating the patient’s right to self-determination and unfairly discriminating against unrelated patients. As a way to improve it, the estimated standards and methods of adult guardians under the German Civil Code are worth referring to. [ABSTRACT FROM AUTHOR]

The onco-functional balance in neuro-oncology requires maximizing tumor removal while rigorously preserving patients' neurological status. When postoperative worsening prevents the implementation of oncologic treatments, palliative care service offers an individualized path for symptom and psychosocial distress relief. Here, we report on a series of 25 patients operated on for malignant brain tumor who did not undergo adjuvant treatments after neurosurgery; they represented 3.9% of the whole institutional surgical series. These patients were significantly older and had a lower preoperative Karnofsky performance status than the whole cohort. Importantly, in 22 out of 25 (88%) cases, a surgical complication occurred, leading to clinical worsening in 21 patients. For the end of life, the majority of patients chose a hospice care facility (72%). While a careful selection of brain tumor patients candidate to neurosurgery is required, palliative care service provided invaluable help in coping with patients' and caregivers' needs. [ABSTRACT FROM AUTHOR]

The Beers criteria for potentially inappropriate medication use in older adults are currently managed by the American Geriatrics Society and have been updated seven times since their introduction in 1991. The criteria suggest medications that should be avoided in most older patients and in certain situations and combinations. These recommendations do not apply to patients in hospice or end-of-life care. [ABSTRACT FROM AUTHOR]

The article presents the discussion on the use of targeted oral therapy among home hospice patients in the hopes of improving symptom control. Topics include carcinogenicity, teratogenicity, reproductive toxicity, organ toxicity at low doses, genotoxicity, or a drug structure/toxicity profile; and opening the medicine bottle and placing the medication in the disposable medicine cup.