Approaching end-of-life care in organ transplantation: the impact of transplant patients' death and dying.

Despite the success of transplantation, many transplant candidates and transplant recipients die each year. Some die awaiting transplants and some die months or years after receiving an organ. Quality end-of-life care can play a valuable role in easing the impact of death and dying in transplantation, as it focuses on enhancing patients' quality of life near death. Quality end-of-life care recognizes the values and preferences of patients and their families, and involves a process of shared decision making about patients' healthcare treatment in collaboration with healthcare practitioners. Advance care planning involves discussions with patients about their wishes and values about care, in the event that the patient becomes incapable of making such decisions. This article focuses on the application to transplantation of quality end-of-life care and advance care planning and identifies the effects that death and dying of transplant patients have on others. The information herein encourages healthcare practitioners to view and deliver quality end-of-life care as part of transplant patients' overall treatment management.

We've had training, now what? Qualitative analysis of barriers to domestic violence screening and referral in a health care setting.

The present study assesses barriers to identification and referral of domestic violence (DV) victims by staff at a health care institution following a 3-hr DV training program in which 752 health care providers participated. Focus groups are conducted with staff in hospital departments that serve a high volume of women. Responses to focus group questions identify system-wide and individual hospital department barriers. These barriers have implications for health care organizations trying to implement DV screening protocols through training alone to change staff behavior in diverse clinical settings. Limitations of this study and future research recommendations are also discussed.