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HEC Forum ; 24(2): 99-114, 2012 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-22302457


CONTEXT: Established in 1997, Summa Health System's Medical Ethics Committee (EC) serves as an educational, supportive, and consultative resource to patients/families and providers, and serves to analyze, clarify, and ameliorate dilemmas in clinical care. In 2009 the EC conducted its 100th consult. In 2002 a Palliative Care Consult Service (PCCS) was established to provide supportive services for patients/families facing advanced illness; enhance clinical decision-making during crisis; and improve pain/symptom management. How these services affect one another has thus far been unclear. OBJECTIVES: This study describes EC consults: types, reasons, recommendations and utilization, and investigates the impact the PCCS may have on EC consult requests or recommendations. METHODS: Retrospective reviews of 100 EC records explored trends and changes in types of consults, reasons for consults, and EC recommendations and utilization. RESULTS: There were 50 EC consults each in the 6 years pre- and post-PCCS. Differences found include: (1) a decrease in number of reasons for consult requests (133-62); (2) changes in top two reasons for EC consult requests from 'Family opposed to withdrawing life-sustaining treatment (LST)' and 'Patient capacity in question' to 'Futility' and 'Physician opposed to providing LST'; (3) changes in top two recommendations given by the EC from 'Emotional Support for Patient/Family' and 'Initiate DNR Order' to 'Comfort Care' and 'Withdraw Treatment.' Overall, 88% of recommendations were followed. CONCLUSION: PCCS availability and growth throughout the hospital may have influenced EC consult requests. EC consults regarding family opposition to withdrawing LST and EC recommendations for patient/family support declined.

Comités de Ética Clínica , Ética Médica , Derivación y Consulta/ética , Anciano , Comités de Ética Clínica/organización & administración , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cuidados Paliativos/ética , Derivación y Consulta/estadística & datos numéricos , Cuidado Terminal
Am J Hosp Palliat Care ; 28(8): 528-35, 2011 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-21518705


In order to graduate physicians prepared to effectively address clinical issues in palliative medicine and to comply with LCME requirements, the Northeastern Ohio Universities Colleges of Medicine and Pharmacy (NEOUCOM) integrated a coordinated four-year palliative care (PC) curriculum. This report describes the development of the longitudinal curriculum and provides helpful resources and strategies to guide clinicians and administrators undertaking similar efforts. This is a retrospective, descriptive report based on data collected throughout development of the new curriculum. A Palliative Care Advisory Committee initiated development of curricula in PC. An Office of Palliative Care was established to assess and coordinate offerings. Curriculum transformation was based on best practices. Two cornerstone pieces are highlighted: a mandatory hospice experience and a case based small group discussion prior to graduation.

Educación de Pregrado en Medicina/organización & administración , Cuidados Paliativos al Final de la Vida/métodos , Cuidados Paliativos/métodos , Aflicción , Curriculum/normas , Toma de Decisiones , Educación de Pregrado en Medicina/normas , Humanos , Comunicación Interdisciplinaria , Ohio , Relaciones Médico-Paciente , Relaciones Profesional-Familia , Desarrollo de Programa , Evaluación de Programas y Proyectos de Salud , Estudios Retrospectivos , Apoyo Social