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palliative care

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Looking at the effectiveness of outpatient palliative care

 

A JAMA article looks at the value of palliative care in the outpatient setting.

The authors summarized:

“The Institute for Clinical and Economic Review developed an evidence report on palliative care in the outpatient setting to support a public meeting of the New England Comparative Effectiveness Public Advisory Council (CEPAC) in March 2016.

“More than 90 million Americans live with at least 1 chronic illness, and 7 of 10 Americans die from chronic disease. As this population grows, unmet needs for symptom relief and comfort care have become more acute. Palliative care is a management approach focused on improving quality of life (QOL) through relief of pain, symptoms, and distress of serious illness. It can be administered in a number of settings; delivery in the outpatient setting has been identified as the next frontier in palliative care, potentially maximizing delivery and convenience of needed services.”

To read the article, please hit this link.


Big gaps seen in palliative care

hospice

The Joint Commission reports that only a quarter of U.S. hospitals have complete  palliative-care teams.

The Joint Commission  called on hospitals to deliver palliative care to Americans suffering from chronic and serious illnesses with  teams including a physician, a nurse, a social worker and a chaplain.

Regional variation in palliative care in the U.S. is  striking.  In New England, 88 percent of hospitals had palliative-care programs at last count, as did 77 percent of hospitals in the Pacific and Mid-Atlantic states. But in the south-central region, only about 40 percent of hospitals did.

For a Reuters overview on this topic, please hit this link.

 


Study: Palliative-care information, emotional-support sessions with kin of critically ill don’t help

hospice

This may surprise many people. An article in JAMA looks at the effect of informational and emotional-support meetings between palliative-care specialists and  families of critically ill patients.

The authors concluded:

“Among families of patients with chronic critical illness, the use of palliative care-led informational and emotional support meetings compared with usual care did not reduce anxiety or depression symptoms and may have increased post-traumatic stress disorder symptoms. These findings do not support routine or mandatory palliative care-led discussion of goals of care for all families of patients with chronic critical illness.”

To read the JAMA article, please hit this link.


Palliative care: Progress but still gaps

 

There has been considerable progress but gaps remain in the quality and quantity of palliative care, says this HealthAffairs report.

As the piece says “A growing body of research demonstrates that palliative care delivered through a broad range of models and care settings improves quality of life, quality of care, and in doing so, reduces hospital costs. Growing attention to best care of high-risk high-cost persons with complex and serious illness in the wake of the Affordable Care Act has resulted in considerable interest in improving access to palliative care for this population.”

“At the end of 2014, 67 percent of U.S. hospitals with more than 50 beds provide palliative care services, up from 15 percent in 1998 and 53 percent in 2006.”

“Gaps in access persist, however, associated with geography, hospital ownership, hospital size, and other hospital characteristics.”

 

 

 

 

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3 changes to improve palliative care

 

hospice

In London.

 

Yael Schenker, M.D., Robert Arnold, M.D.,  writing in JAMA about the future of palliative care, conclude:

“To improve palliative care for patients with serious illness, 3 changes must occur. First, palliative care specialists need to develop skills in clinician behavior change, system change, and quality improvement. Second, health systems need to expand their focus to develop programs that measure and improve the quality of palliative care that every patient receives. Third, federal funding must be aligned with a national goal of improving the experience of seriously ill patients and their loved ones. In short, the field of palliative care has expanded substantially over the past 20 years by demonstrating the value of involving palliative care specialists earlier and more routinely in the care of seriously ill patients. Moving forward, palliative care is likely to have the greatest benefit by teaching others clinicians to provide patient and family-centered care, designing systems, and advocating for policy changes that help make the involvement of specialists less necessary.”

 


Top 10 measures for palliative care

 

Top 10 measures  for palliative care  published online in the Journal of Pain and Symptom Management, courtesy of Hospitals & Health Systems:

1. Palliative care and hospice patients receive a comprehensive assessment (physical, psychological, social, spiritual and functional) soon after admission.

2. Seriously ill palliative care and hospice patients are screened for pain, shortness of breath, nausea and constipation during the admission visit.

3. Seriously ill palliative care and hospice patients who screen positive for at least moderate pain receive treatment (medication or other) within 24 hours.

4. Patients with advanced or life-threatening illness are screened for shortness of breath and, if positive to at least a moderate degree, have a plan to manage it.

5. Seriously ill palliative care and hospice patients have a documented discussion regarding emotional needs.

6. Hospice patients have a documented discussion of spiritual concerns or preference not to discuss them.

7. Seriously ill palliative care and hospice patients have documentation of the surrogate decision-maker’s name (such as the person who has healthcare power of attorney) and contact information, or absence of a surrogate.

8. Seriously ill palliative care and hospice patients have documentation of their preferences for life-sustaining treatments.

9. Vulnerable elders with documented preferences to withhold or withdraw life-sustaining treatments have their preferences followed.

10. Palliative care and hospice patients or their families are asked about their experience of care using a relevant survey.


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