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Now more than ever, it is essential for hospice and palliative care nurse leaders to be front and center in the quality improvement (QI) arena. Because nurses are integral to the delivery of hospice and palliative care, they are pivotal in efforts to improve quality. This article sought to provide an in-depth understanding of the leadership role that nurses can play in QI activities from project inception and team formation, to the planning stage. The analysis revealed that hospice and palliative care nurses have a leadership role at the onset of the QI project that includes active team membership as a QI team leader, team member, and/or champion. Nurses also have a leadership role in formulating the project aims and choosing the appropriate project model within their organizations. Finally, hospice and palliative care nurses use their planning skills to develop QI project measures, data collection plan, data analysis plan, and communication/implementation/evaluation plan. The QI project provides opportunities for hospice and palliative care nurse leaders to use their clinical, technical, and administrative knowledge to improve the care of patients and families at the end of life. [ABSTRACT FROM AUTHOR]

Much of what is known about delay in seeking medical care has been from patients with acute coronary syndromes. Less is known about why patients living with chronic cardiopulmonary illnesses delay seeking care for worsening symptoms. The aim of this study was to describe the perspectives of patients with end-stage heart failure or chronic obstructive pulmonary disease about their timing in seeking medical care for worsening symptoms. Two semistructured interviews were conducted with 20 participants and were audio recorded and transcribed verbatim. Avoiding the hospital was the central theme among participants in this study. Returning to the hospital invoked an underlying fear, symbolizing negative things. These included a perceived hassle and setback associated with hospitalization and a fear of not returning home following another admission, either from loss of independence or death. This study sheds light on findings from previous research that delay results from the inability to recognize worsening symptoms. Participants in this study clearly recognized worsening symptoms, yet waited to seek care until it was unbearable in effort to avoid the hospital. The incorporation of palliative alongside disease-driven care within this population would alleviate symptoms, which could decrease the need for emergent care and subsequent hospitalization. [ABSTRACT FROM AUTHOR]

Experts in both heart failure and palliative care recommend collaboration between the two disciplines as a mechanism to improve late-stage heart failure care. However, referral rates of heart failure patients to palliative care services remain low. The purpose of this study was to describe the perspectives of heart failure patients and their family members regarding the barriers to palliative care in late-stage heart failure care. We used qualitative content analysis to identify themes from 40 semistructured interviews with 24 hospitalized late-stage heart failure patients and 16 designated family members. Results indicated that participants often refused or deferred palliative care services if they viewed hospice and palliative care as synonymous. They perceived that a set of hospice ‘‘rules'' existed and that they were ‘‘deal breakers'' for heart failure patients as they impeded the goals of aggressively managing troubling symptoms and/or providing comfort at end of life. The findings from this study underscore the need to examine the current hospice guidelines and for clinicians to view palliative care as a philosophy of care that allows for the unpredictable trajectory of heart failure. [ABSTRACT FROM AUTHOR]

Background and Objectives: To assess the current structures, knowledge, and readiness to integrate palliative care (PC) into Parkinson disease (PD) care at Parkinson's Foundation Centers of Excellence (COE) in the United States., Methods: Three unique surveys were administered to health care professionals/staff at COEs to assess PC (1) resources, (2) knowledge and comfort, (3) clinical experience and processes, (4) barriers, and (5) readiness for implementation., Results: Response rates for the 3 surveys were 97%, 98%, and 56%. In total, 41% of COEs have access to outpatient PC specialists, 71% have mental health counseling, 82% have support groups, and 9% had very limited PC resources. Overall, 74% of providers believed persons with advanced PD should receive PC, and knowledge of PC fundamentals was good across providers. For high-needs persons with PD (PWP), only 16% of physicians and 24% of advanced practice providers made referrals to PC specialists ≥75% of the time, while 9% and 16% never made such referrals. Limited time, space, financing, and staffing were seen as major barriers to PC implementation. In total, 37% of providers were satisfied with their COE's ability to provide PC services. Most COEs report a culture open to change and appear well-positioned to implement PC in a more comprehensive fashion., Discussion: These results demonstrate the emergence of structures and processes to provide PC to persons with PD at COEs. They also identify concrete opportunities to strengthen integration of PC through educational, quality improvement, and advocacy efforts., Competing Interests: The authors report no relevant disclosures. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp. TAKE-HOME POINTS → Growing literature supports the use of palliative care in management of people with Parkinson disease, but the extent and scope of current practice is unknown.→ Survey of PD Centers of Excellence showed that many structural elements of PC—including social workers, chaplains, and nurses—are available at most COEs or the institutions.→ Perceived barriers to PC included staffing, time, space, finances, scheduling, and billing.→ In general, respondents reported a positive culture for improvement and change demonstrating a fertile substrate for implementation of PC at COEs., (© 2024 American Academy of Neurology.)

Background and Objectives: People with Parkinson disease (PWP) and their care partners have high palliative care needs resulting from disabling motor and nonmotor symptoms. There is growing support for palliative care (PC) approaches to Parkinson disease. However, little is known regarding the extent to which the palliative needs of PWP and care partners are currently being met. This study's primary objective is to describe PWP's and care partners' perceptions of the extent to which their PC needs are being met. Secondary objectives are to describe their perceptions of the quality of clinical communication and their knowledge of PC., Methods: PWPs and care partners (n = 12,995) who had consented to receiving surveys from the Parkinson's Foundation were emailed an electronic survey. PC was operationalized as comprising 5 key components: systematic assessment and management of (1) nonmotor symptoms, (2) PWPs' emotional and spiritual needs, (3) care partners' needs, (4) the completion of annual advance care planning, and (5) timely referrals to specialist palliative care and hospice when appropriate., Results: A total 1,882 individuals (1,266 PWP and 616 care partners) responded to the survey (response rate 14.5%). Few PWP (22%) reported that their neurologists never asked regarding bothersome nonmotor symptoms or did so or only if they brought it up. Fifty percent of PWP reported that pain as a specific nonmotor symptom was never managed or managed only if they brought it up. Similarly, PWPs' emotional and spiritual needs (55%), care partners' well-being (57%), and completion of advance care planning documentation (79%) were never addressed or only addressed if PWP brought it up. The quality of clinical communication was generally rated as open and honest (64% PWP). Fewer PWP (30%) reported that doctors helped them deal with the uncertainties of Parkinson disease. Most PWP (85%) reported being knowledgeable regarding PC, and 68% reported that the goal of PC was to help friends and family cope with the illness., Discussion: Although some elements of PC are currently being addressed in routine care for PWP, there are many gaps and opportunities for improvement. These data may facilitate focused attention and development of resources to improve the quality and availability of PC for Parkinson disease., Competing Interests: B. M. Kluger received funding related to this work from the National Institute of Aging (K02AG062). All other authors report no disclosures relevant to the manuscript. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp., (© 2023 American Academy of Neurology.)

Kumpfer's resilience framework (KRF) was initially developed from evidence on resilience and its predictors among at-risk youth. This framework has been expanded to guide resilience research in diverse populations facing a variety of stressors. However, KRF's strengths and weaknesses have not been evaluated since its publication. Guided by Walker and Avant's method, an analysis of KRF was conducted drawn from 41 publications. A revised KRF diagram was proposed on the basis of the analysis to improve clarity, consistency, logical structure, and parsimony in the diagram of KRF. Overall, KRF provides a useful, generalizable, and testable theoretical framework for future resilience research., Competing Interests: There is no conflict of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: The purpose of this study was to examine the effect of proactive palliative care consultation on length of stay for high-risk patients in the medical intensive care unit (MICU)., Design: A prospective pre/post nonequivalent control group design was used for this performance improvement study., Setting: Seventeen-bed adult MICU., Patients: Of admissions to the MICU, 191 patients were identified as having a serious illness and at high risk of dying: 65 patients in the usual care phase and 126 patients in the proactive palliative care phase. To be included in the sample, a patient had to meet one of the following criteria: a) intensive care admission following a current hospital stay of >or=10 days; b) age >80 yrs in the presence of two or more life-threatening comorbidities (e.g., end-stage renal disease, severe congestive heart failure); c) diagnosis of an active stage IV malignancy; d) status post cardiac arrest; or e) diagnosis of an intracerebral hemorrhage requiring mechanical ventilation., Interventions: Palliative care consultations., Measurements and Main Results: Primary measures were patient lengths of stay a) for the entire hospitalization; b) in the MICU; and c) from MICU admission to hospital discharge. Secondary measures included mortality rates and discharge disposition. There were no significant differences between the usual care and proactive palliative care intervention groups in respect to age, gender, race, screening criteria, discharge disposition, or mortality. Patients in the proactive palliative care group had significantly shorter lengths of stay in the MICU (8.96 vs. 16.28 days, p = .0001). There were no differences between the two groups on total length of stay in the hospital or length of stay from MICU admission to hospital discharge., Conclusions: Proactive palliative care consultation was associated with a significantly shorter MICU length of stay in this high-risk group without any significant differences in mortality rates or discharge disposition.