Confronting myths: the Native American experience in an academic inpatient palliative care consultation program.

BACKGROUND: Recent end-of-life (EOL) care literature in non-Native American (NA) populations has demonstrated the benefits of EOL discussions. EOL discussions are associated with less aggressive care at EOL, better patient self-assessed quality of life, and less caregiver depression after the patient is deceased. There is no literature assessing these issues in NA populations. However, common myths that may affect care include: 1) NA patients will not discuss death and dying, 2) severely ill NA patients and families will not choose do not resuscitate (DNR) status, and 3) NA patients and families will not utilize hospice services if offered. METHODS: Our study explored these issues utilizing a consultation database from the Palliative Care Consultation Service at University of New Mexico Hospital (UNMH). Statistical analyses were conducted using nonparametric Wilcoxon tests for continuous variables and Fisher's exact test for categorical variables. RESULTS AND CONCLUSION: Study results demonstrate that health care providers can hold EOL care discussions with NA patients and NA patients' care preferences are affected by these discussions. The result do not support our hypothesis that there would be a lower rate of post-consult DNR status in NA patients (compared with non-NA). NA and non-NA patients and families participated in family meetings and their code status was affected to a similar degree. Furthermore, NA patients and their families choose hospice services at rates similar to non-NA patients seen by the palliative care consultation service.

Top ten list of long-term care facility preparations for the upcoming influenza season.

A novel influenza A partly of virus of swine origin (2009 H1N1) emerged this spring, resulting in an influenza pandemic. This pandemic is anticipated to continue into the next influenza season. Given that the 2009 H1N1 and seasonal influenza A appear to be somewhat different in the human populations affected and that two influenza vaccines will be recommended this fall, those who manage long-term care facilities and treat patients in them will be faced with many uncertainties as they approach the 2009/10 influenza season. Ten specific suggestions are offered to those responsible for the care of patients in long-term care facilities regarding the upcoming influenza season. These practical suggestions are the clinical opinions of the authors and do not represent official recommendations of the American Geriatrics Society or any agency.