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1.
J Palliat Med ; 2020 Feb 13.
Artículo en Inglés | MEDLINE | ID: mdl-32053034

RESUMEN

Thanks to the efforts of many individuals and organizations, the field of Hospice and Palliative Medicine (HPM) has undergone unprecedented growth over the last two decades. To meet the needs of seriously ill patients and families in inpatient, outpatient community setting in the future, the field of HPM must develop innovative strategies to expand the specialist workforce pipeline. With 148 programs participating in the National Residency Matching Program and 285 matched applicants in 2019, the specialty of HPM can barely replace those who are retiring or leaving the field. We call for a renewed and coordinated effort to increase the applicant pool for HPM fellowship positions, as well as greater access to specialist HPM training through expanded traditional fellowship programs and innovative specialist training pathways. Without such an expansion, our specialty will struggle to serve those patients and families who need us most.

2.
Artículo en Inglés | MEDLINE | ID: mdl-31988020

RESUMEN

Continuing the transition to competency-based education, Hospice and Palliative Medicine (HPM) fellowship programs began using context-free reporting milestones (RMs) for Internal Medicine subspecialties in 2014 but quickly recognized they did not reflect the nuanced practice of the field. This article describes the development of 20 subspecialty-specific RMs through consensus group process and vetting by HPM educators. A workgroup of content experts employed an iterative consensus building process between December 2017 and February 2019 to draft new RMs and to create a Supplemental Guide that outlines the intent of each RM, examples of each developmental trajectory, assessment methods, and resources to guide educators. Program directors, program coordinators, and designated institutional officers were contacted directly to solicit feedback. The majority of respondents agreed or strongly agreed that each RM represented a realistic progression of knowledge, skills, and behaviors, and that the set of milestones adequately discriminated between meaningful levels of competency. Similarly, respondents felt that the Supplemental Guide was a useful resource. The result is a set of carefully developed and broadly vetted RMs that represent a progression of development for HPM physicians over one year of clinical fellowship training.

3.
Acad Med ; 94(10): 1483-1488, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31135398

RESUMEN

PROBLEM: A disconnect exists between caregivers and health care providers, resulting in fragmented communication, which increases caregiver stress and compromises patient care. Although providers have a responsibility to recognize caregiver burden, they receive scant training on issues important to caregivers. APPROACH: From 2014 to 2017, as part of the Building Caregiver Partnerships Through Interprofessional Education project-a collaborative effort between Northeast Ohio Medical University and Summa Health-the authors developed curricula to foster effective partnerships between health care providers and caregivers by exposing medical students and residents to highly personal caregiving narratives. The curricula center on a short film featuring 4 families representing diverse caregiving experiences. The authors crafted several discussion guides, case-based learning exercises, structured clinical encounters, team-based simulations, and clinical cases as companion educational tools for the film. OUTCOMES: Medical students reported the educational tools piloted to be valuable in broadening their understanding of caregivers' needs, while residents reported the educational tools piloted to also be valuable in improving their communication and building partnerships with caregivers. Undergraduate and graduate faculty reported finding the pilots valuable. NEXT STEPS: Future goals include conducting an outcome evaluation, based on ACGME milestones, to identify and examine clinical outcomes to determine whether communication increases and quality of care improves as a result of the project. The authors would also like to include caregivers in the evaluation. Finally, because caregiving is best addressed from a team approach, the authors plan to pilot the project at other health professions programs.

4.
J Pain Symptom Manage ; 57(5): 1009-1017.e6, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-30790721

RESUMEN

CONTEXT: A physician workgroup of the American Academy of Hospice and Palliative Medicine sought to define curricular milestones (CMs) for hospice and palliative medicine (HPM) Fellowship Programs. The developed list of CMs would serve as components upon which to organize curriculum and standardize what to teach during training. These would complement entrustable professional activities previously developed by this group and new specialty-specific reporting milestones (RMs) for HPM developed through the Accreditation Council for Graduate Medical Education. OBJECTIVES: The objective of this study was to develop and vet CMs for HPM fellowships in the U.S. METHODS: A draft of CMs was developed through an iterative consensus group process with repeated cycles of drafting, analyzing, and revising by a broadly representative expert workgroup who then gained input from HPM educators at a national meeting workshop. The CM draft was subsequently revised and then vetted through a national survey to 203 fellowship educators. Respondents were asked to "keep," "revise," or "exclude" each proposed CM with space for comments. An agreement of 75% among respondents was set as the criteria a priori for keeping a CM. Eighty-four of the 203 potential respondents participated in the survey. All items met the minimum agreement level of 75% or greater recommending keeping the CM. Greater than 85% of the respondents agreed to keep 19 of the 22 CMs with no revisions. Comments for revisions on other CMs were primarily related to changes in language and formatting, not conceptual underpinnings. CONCLUSION: A group consensus method strengthened by inclusion of a national survey to HPM fellowship educators resulted in a CM document that is both carefully developed and broadly vetted. Along with entrustable professional activities and new specialty-specific RMs, these CMs offer educators and trainees tools to create more comprehensive curricula and behaviorally based assessment tools for HPM fellowships and their stakeholders.

5.
Soc Sci Med ; 220: 212-218, 2019 01.
Artículo en Inglés | MEDLINE | ID: mdl-30458430

RESUMEN

In 1965, Glaser and Strauss (1965) offered the concept of "awareness contexts" to explain what patients in hospitals do or don't know about their death trajectories. Awareness ranges from closed (where patients are completely unaware and family and providers protect "the secret") to open (where all parties communicate openly and honestly). While closed awareness was the norm in 1960s, open awareness is now considered standard practice in US, a reflection of mounting evidence that patients, families, and providers benefit from clear and honest communication at end of life (Seale et al., 1997; Wright et al., 2008). Despite the known benefits of open awareness, many terminal patients remain unaware or confused about their prognoses (Chen et al., 2017). This paper asks why, in an era of open awareness, are patients and families uncertain about dying? To answer this question, we focus on an aspect of Glaser and Strauss's theory that remains relatively understudied by researchers, namely the role of institutional and organizational realities in shaping awareness contexts. Based on interviews with 43 family members of deceased patients who died at General Hospital in the Midwestern US, we argue that two related conditions in hospitals-the increased specialization of medical professionals and the fragmentation of patient care-serve as important context for the death awareness of patients and families.

6.
J Pain Symptom Manage ; 54(4): 609-616.e1, 2017 10.
Artículo en Inglés | MEDLINE | ID: mdl-28729009

RESUMEN

CONTEXT: Entrustable Professional Activities (EPAs) represent the key physician tasks of a specialty. Once a trainee demonstrates competence in an activity, they can then be "entrusted" to practice without supervision. A physician workgroup of the American Academy of Hospice and Palliative Medicine sought to define Hospice and Palliative Medicine (HPM) EPAs. OBJECTIVE: The objective of this study was to describe the development of a set of consensus EPAs for HPM fellowship training in the United States. METHODS: A set of HPM EPAs was developed through an iterative consensus process involving an expert workgroup, vetting at a national meeting with HPM educators, and an electronic survey from a national registry of 3550 HPM physicians. Vetting feedback was reviewed, and survey data were statistically analyzed. Final EPA revisions followed from the multisource feedback. RESULTS: Through the iterative consensus process, a set of 17 HPM EPAs was created, detailed, and revised. In the national survey, 362 HPM specialists responded (10%), including 58 of 126 fellowship program directors (46%). Respondents indicated that the set of 17 EPAs well represented the core activities of HPM physician practice (mean 4.72 on a five-point Likert scale) and considered all EPAs to either be "essential" or "important" with none of the EPAs ranking "neither essential, nor important." CONCLUSIONS: A set of 17 EPAs was developed using national input of practicing physicians and program directors and an iterative expert workgroup consensus process. The workgroup anticipates that EPAs can assist fellowship directors with strengthening competency-based training curricula.


Asunto(s)
Educación de Postgrado en Medicina , Cuidados Paliativos al Final de la Vida , Cuidados Paliativos , Medicina Paliativa/educación , Adulto , Anciano , Técnica Delfos , Educación de Postgrado en Medicina/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Estados Unidos , Adulto Joven
7.
J Palliat Med ; 20(12): 1409, 2017 12.
Artículo en Inglés | MEDLINE | ID: mdl-28657824
9.
Popul Health Manag ; 17(2): 106-11, 2014 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-24156664

RESUMEN

The specific aim of the PEACE pilot study was to determine the feasibility of a fully powered study to test the effectiveness of an in-home geriatrics/palliative care interdisciplinary care management intervention for improving measures of utilization, quality of care, and quality of life in enrollees of Ohio's community-based long-term care Medicaid waiver program, PASSPORT. This was a randomized pilot study (n=40 intervention [IG], n=40 usual care) involving new enrollees into PASSPORT who were >60 years old. This was an in-home interdisciplinary chronic illness care management intervention by PASSPORT care managers collaborating with a hospital-based geriatrics/palliative care specialist team and the consumer's primary care physician. This pilot was not powered to test hypotheses; instead, it was hypothesis generating. Primary outcomes measured symptom control, mood, decision making, spirituality, and quality of life. Little difference was seen in primary outcomes; however, utilization favored the IG. At 12 months, the IG had fewer hospital visits (50% vs. 55%, P=0.65) and fewer nursing facility admissions (22.5% vs. 32.5%, P=0.32). Using hospital-based specialists interfacing with a community agency to provide a team-based approach to care of consumers with chronic illnesses was found to be feasible. Lack of change in symptom control or quality of life outcome measures may be related to the tools used, as these were validated in populations closer to the end of life. Data from this pilot study will be used to calculate the sample size needed for a fully powered trial.


Asunto(s)
Planificación Anticipada de Atención/organización & administración , Servicios de Atención de Salud a Domicilio/organización & administración , Cuidados a Largo Plazo/organización & administración , Calidad de Vida , Anciano , Anciano de 80 o más Años , Femenino , Anciano Frágil , Evaluación Geriátrica/métodos , Promoción de la Salud , Servicios de Salud para Ancianos/organización & administración , Humanos , Comunicación Interdisciplinaria , Masculino , Ohio , Cuidados Paliativos/organización & administración , Proyectos Piloto , Evaluación de Programas y Proyectos de Salud , Valores de Referencia , Resultado del Tratamiento
10.
J Palliat Med ; 16(3): 289-94, 2013 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-23343113

RESUMEN

BACKGROUND: Evidence suggests palliative care consult services yield cost improvements; few studies have examined the impact of an inpatient palliative care unit on hospital costs. OBJECTIVE: This study estimates the cost avoidance of a single hospital's acute palliative care unit (APCU), building upon previous studies (1) by limiting pre-APCU costs to two days pre-APCU transfer, thereby minimizing bias from higher-cost first days of admission, and (2) by not limiting the study to cancer patients or patients who died, thereby presenting more comprehensive APCU costs. DESIGN: This retrospective study compares direct costs of care on an APCU with costs pre-APCU transfer from general medical units, intensive care units (ICU), and the emergency department (ED), and compares the direct costs of APCU patients with those of control patients. The data were entered into an SPSS(®) 17.0 (SPSS Inc., Chicago, IL) statistical software database. Paired and independent samples t-tests were conducted to test cost differences. SETTING/SUBJECTS: Study patients were admitted or transferred to the APCU from October 2008 through January 2009. Control patients were inpatients during the same time period and met several matching criteria. MEASUREMENTS: The hospital's finance department provided direct costs, case mix index (CMI), and geometric mean length of stay, and the Department of Quality and Resource Management provided patients' demographic and administrative data. RESULTS: Of 209 patients transferred to the APCU, 50% transferred from a medical unit, 32% from an ICU, and 18% from the ED. Annualized, the total cost avoidance realized by transfers to the APCU was $848,556, over half of which came from ICU to APCU transfers. CONCLUSIONS: Cost avoidance is realized when patients transfer to an APCU even when conservative pre-APCU cost measures are used and when patients with varying diagnoses and discharge outcomes are included. This study demonstrates a replicable methodology for estimating the financial impact of an APCU.


Asunto(s)
Costos de Hospital , Unidades Hospitalarias/economía , Cuidados Paliativos/economía , Anciano , Femenino , Humanos , Pacientes Internos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Atención Terciaria de Salud/economía
11.
Am J Hosp Palliat Care ; 30(5): 419-24, 2013 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-22798634

RESUMEN

PURPOSE: To evaluate primary care physicians' understanding of and experience with advance care planning (ACP), palliative care, and hospice and how this might affect their utilization of these services. METHODS: Investigator-generated survey. RESULTS: Older age, more years in practice, and more personal and professional experience with ACP were correlated with an increase in the percentage of patients with progressive, chronic life-limiting diseases with whom physicians discussed advance directives. Overall, 97.5% of physician's expressed comfort in discussing ACP yet reported discussing advance directives with only 43% of appropriate patients. DISCUSSION: Often, discussions about ACP or referrals to palliative care or hospice do not occur until the patient is near the end of life. Our results indicate that primary care physician's personal and professional experience with ACP may be contributing to some of the barriers to these discussions.


Asunto(s)
Planificación Anticipada de Atención/estadística & datos numéricos , Conocimientos, Actitudes y Práctica en Salud , Cuidados Paliativos al Final de la Vida/estadística & datos numéricos , Cuidados Paliativos/estadística & datos numéricos , Médicos/estadística & datos numéricos , Adulto , Factores de Edad , Anciano , Actitud del Personal de Salud , Recolección de Datos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ohio/epidemiología , Relaciones Médico-Paciente , Pautas de la Práctica en Medicina/estadística & datos numéricos , Cuidado Terminal/estadística & datos numéricos
13.
HEC Forum ; 24(2): 99-114, 2012 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-22302457

RESUMEN

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.


Asunto(s)
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
14.
Clin Obstet Gynecol ; 55(1): 173-84, 2012 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-22343236

RESUMEN

Palliative care improves the quality of life of patients and their families through the prevention and treatment of distressing symptoms while addressing the psychological, social, and spiritual aspects of patient care. Emerging paradigms of delivery promote early involvement in the disease trajectory and specialty approaches to care. Interdisciplinary assessment and shared decision making are important components. Throughout the disease course, aggressive symptom management can improve patients' quality of life and their ability to tolerate and continue treatment. End-of-life care focuses on comfort, control, meaning, and support that become particularly intense when death is imminent.


Asunto(s)
Neoplasias Ováricas/complicaciones , Neoplasias Ováricas/psicología , Cuidados Paliativos , Antineoplásicos/efectos adversos , Ansiedad/etiología , Ansiedad/terapia , Ascitis/etiología , Ascitis/terapia , Aflicción , Comunicación , Estreñimiento/etiología , Estreñimiento/terapia , Toma de Decisiones , Depresión/etiología , Depresión/terapia , Disnea/etiología , Disnea/terapia , Fatiga/etiología , Fatiga/terapia , Femenino , Hospitales para Enfermos Terminales , Humanos , Hipercalcemia/etiología , Hipercalcemia/terapia , Obstrucción Intestinal/etiología , Obstrucción Intestinal/terapia , Linfedema/etiología , Linfedema/terapia , Mucositis/etiología , Mucositis/terapia , Náusea/prevención & control , Neoplasias Ováricas/terapia , Manejo del Dolor , Enfermedades del Sistema Nervioso Periférico/etiología , Enfermedades del Sistema Nervioso Periférico/terapia , Rol del Médico , Relaciones Médico-Paciente , Relaciones Profesional-Familia , Pronóstico , Calidad de Vida , Obstrucción Ureteral/etiología , Obstrucción Ureteral/terapia , Vómitos/prevención & control
15.
Popul Health Manag ; 15(2): 71-7, 2012 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-22088165

RESUMEN

Practice guidelines are available for hospice and palliative medicine specialists and geriatricians. However, these guidelines do not adequately address the needs of patients who straddle the 2 specialties: homebound chronically ill patients. The purpose of this article is to describe the theoretical basis for the Promoting Effective Advance Care for Elders (PEACE) randomized pilot study. PEACE is an ongoing 2-group randomized pilot study (n=80) to test an in-home interdisciplinary care management intervention that combines palliative care approaches to symptom management, psychosocial and emotional support, and advance care planning with geriatric medicine approaches to optimizing function and addressing polypharmacy. The population comprises new enrollees into PASSPORT, Ohio's community-based, long-term care Medicaid waiver program. All PASSPORT enrollees have geriatric/palliative care crossover needs because they are nursing home eligible. The intervention is based on Wagner's Chronic Care Model and includes comprehensive interdisciplinary care management for these low-income frail elders with chronic illnesses, uses evidence-based protocols, emphasizes patient activation, and integrates with community-based long-term care and other community agencies. Our model, with its standardized, evidence-based medical and psychosocial intervention protocols, will transport easily to other sites that are interested in optimizing outcomes for community-based, chronically ill older adults.


Asunto(s)
Enfermedad Crónica , Anciano Frágil , Promoción de la Salud/organización & administración , Servicios de Atención de Salud a Domicilio/organización & administración , Personas Imposibilitadas , Planificación de Atención al Paciente/organización & administración , Anciano , Anciano de 80 o más Años , Determinación de la Elegibilidad , Medicina Basada en la Evidencia , Femenino , Evaluación Geriátrica , Humanos , Masculino , Medicaid , Ohio , Cuidados Paliativos , Proyectos Piloto , Pobreza , Proyectos de Investigación , Apoyo Social , Estados Unidos
16.
J Pain Symptom Manage ; 43(3): 631-7, 2012 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-21925833

RESUMEN

CONTEXT: Low albumin levels have been associated with increased mortality, but few studies have looked at the mortality rates of patients with very low albumin levels. OBJECTIVES: The objective of this study was to determine the in-hospital mortality rates for patients older than 60 years with albumin levels <2.0 g/dL. METHODS: This was a retrospective study of 543 consecutive patients older than the age of 60 who had an albumin level <2.0 g/dL while admitted to Summa Akron City Hospital between July and November 2008. Data were obtained from hospital databases. Mortality rates were calculated for each albumin level and compared with the overall inpatient mortality for patients older than 60 years. Rates of discharge to home were calculated by albumin level. Cross-tabulations and correlations were conducted to determine the association between albumin level and mortality, and to assess the independent effects of total parenteral nutrition, dialysis, cancer, and end-stage renal disease. RESULTS: Patients with albumin levels between 1.0 and 1.4 had a 41% in-hospital mortality rate, with only 16% of the patients being discharged to home. Patients with albumin levels between 1.5 and 1.9 had a 21% mortality rate, with 33% of patients discharged to home. Overall hospital mortality for patients older than 60 years was 6% during the study period. Total parenteral nutrition, cancer, dialysis, and end-stage renal disease were not independent risk factors for mortality in this study. CONCLUSION: An albumin level is readily obtained across all areas of the hospital and provides a simple and useful aid in identifying patients at high risk of a poor hospital outcome.


Asunto(s)
Mortalidad Hospitalaria , Albúmina Sérica/deficiencia , Anciano , Anciano de 80 o más Años , Análisis por Conglomerados , Femenino , Humanos , Fallo Renal Crónico/mortalidad , Tiempo de Internación , Masculino , Persona de Mediana Edad , Alta del Paciente , Estudios Retrospectivos , Medición de Riesgo , Albúmina Sérica/análisis
17.
Am J Hosp Palliat Care ; 28(8): 528-35, 2011 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-21518705

RESUMEN

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.


Asunto(s)
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
18.
J Pain Symptom Manage ; 39(1): 76-87, 2010 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-19892511

RESUMEN

CONTEXT: Unlike primary care physicians in the U.S., it is only recently that Hungarian primary care physicians have had the educational resources for providing end-of-life care and the availability of hospice services as part of the Hungarian health care system. OBJECTIVES: The aim of this study was to assess, compare, and contrast beliefs and practices of end-of-life care held by primary care physicians practicing in selected regions of the United States and Hungary. METHODS: A 22-item questionnaire, written in English, translated to Hungarian, and pilot tested in both countries, was mailed to 339 Hungarian and 330 U.S. physicians, with response rates of 54% and 48%, respectively. Descriptive and bivariate analyses were conducted to compare the samples. RESULTS: Over half of U.S. physicians indicated they were quite knowledgeable about hospice care and rated currently available services for the terminally ill as exceptionally good, compared to less than 10% of Hungarian physicians. The physicians' differing beliefs that discussing a terminal prognosis fosters a sense of hopelessness is consistent with disclosure beliefs and practices. The majority of U.S. physicians believe it is the patients' right to know and always tell them when the diagnosis is terminal. Hungarian physicians (44%) believe that the patient's right to know is balanced by the physician's judgment of the patient's best interest, and an additional 40% disclose only if asked. CONCLUSION: These results illustrate some of the important differences in physicians' beliefs about the care of terminally ill patients between the two countries and can be used to guide medical education and practice.


Asunto(s)
Actitud del Personal de Salud , Actitud Frente a la Muerte , Cuidados Paliativos/psicología , Cuidado Terminal/psicología , Comparación Transcultural , Conocimientos, Actitudes y Práctica en Salud , Cuidados Paliativos al Final de la Vida , Hospitales para Enfermos Terminales , Humanos , Hungría , Relaciones Médico-Paciente , Médicos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Relaciones Profesional-Familia , Encuestas y Cuestionarios , Estados Unidos
19.
Am J Hosp Palliat Care ; 26(5): 376-83, 2009.
Artículo en Inglés | MEDLINE | ID: mdl-19571324

RESUMEN

BACKGROUND: Helping families make end-of-life care decisions can be challenging for health care providers in an intensive care unit (ICU). Family meetings facilitated by palliative care consult services (PCCS) have been recommended and found effective for improving support for families in these difficult situations. These services can be improved with a deeper understanding of factors associated with emotional burden in the aftermath of end-of-life decision making. OBJECTIVE: This qualitative study seeks to provide a better understanding of family experiences and emotional burden surrounding end-of-life decision making. PARTICIPANTS AND METHODS: We conducted in-depth, semistructured interviews with 23 family members following the death of a loved one in the ICU. All participants had been involved in a PCCS-led family meeting concerning end-of-life decisions about their loved one. Methodology from grounded theory was used to analyze the content of transcripts and to build a theoretical model. RESULTS: From the perspective of the family, decision making at the end of life is described within a theoretical model of salient experiences that are relevant to families' emotional burdens. Three temporal stages were evident: (1) the illness experience, (2) decision making in the family meeting, and (3) the dying process. However, emotional burden in the form of lingering questions and resentment was more common when families reported having negative experiences during the final hospital stay. CONCLUSIONS: Supportive responsiveness from the PCCS for families who have experienced critical incidents or who have unanswered questions or resentment about treatment may be an important consideration to alleviate later emotional burden.


Asunto(s)
Costo de Enfermedad , Familia/psicología , Cuidado Terminal/psicología , Muerte , Toma de Decisiones , Emociones , Humanos , Unidades de Cuidados Intensivos , Encuestas y Cuestionarios
20.
J Pain Symptom Manage ; 37(5): 873-83, 2009 May.
Artículo en Inglés | MEDLINE | ID: mdl-18804945

RESUMEN

The widespread need for palliative care has prompted the development of hospital-based palliative care consult services to provide a more interdisciplinary approach to managing advanced illness and end-of-life concerns. Establishing a successful consult service is a challenging task. This is a descriptive study of the development of a palliative care consult service (PCCS) within a non-profit, multi-hospital health system, and the five successful strategies used to optimize growth over the first five years. The PCCS is a mobile interdisciplinary team established to provide accessible, comprehensive end-of-life care and symptom management to patients with advanced illness within the health care system. Critical to its success, the team developed and maintained a database to document growth and ensure continuous quality improvement. A description of this database is provided, along with current performance outcomes. The program has prospered since its inception in 2002, with a 47% average annual growth over the first five years. The PCCS now averages 110 consults per month and has treated more than 3500 patients. This growth can be directly attributed to the five key strategies that have been used to plan, develop, and expand the program.


Asunto(s)
Eficiencia Organizacional , Cuidados Paliativos/organización & administración , Grupo de Atención al Paciente/organización & administración , Derivación y Consulta/organización & administración , Cuidado Terminal/organización & administración , Carga de Trabajo , Ohio
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