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1.
Orv Hetil. 2018 Sep;159(35):1441-1449. doi: 10.1556/650.2018.31126.

[Validation of the Hungarian version of the Professional Quality of Life Scale].

[Article in Hungarian; Abstract available in Hungarian from the publisher]

Author information

1
Magatartástudományi Intézet, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest, Nagyvárad tér 4. XX. emelet, 1089.
2
Pszichológiai Intézet, Általános Lélektani és Módszertani Tanszék, Károli Gáspár Református Egyetem Budapest.
3
Pedagógiai és Pszichológiai Kar, Eötvös Loránd Tudományegyetem Budapest.

Abstract

INTRODUCTION:

The Professional Quality of Life Scale, measuring the quality of professional life, has been developed to examine the positive and negative changes in the work of those who have undergone extremely stressful experiences. The quality of life of the personnel of palliative-hospice teams may be influenced physically as well as emotionally by their every-day experiences of suffering, death, dying and the patients' traumas.

AIM:

The aim of the study was the examination of the psychometric features and factor structure of the Hungarian version of the Professional Quality of Life Scale questionnaire, which can measure compassion fatigue and satisfaction, secondary traumatisation and burnout. Our long-term objective is the development of formative and intervention strategies for hospice workers in order to increase their satisfaction, physical and mental well-being and their willingness to work in hospice.

METHOD:

The cross-sectional, questionnaire study was made with hospice workers. The questionnaires were available in an anonym, printed form. We used the Hungarian versions of the Shortened Maastricht Vital Exhaustion Questionnaire and of the Shortened Beck Depression Scale, of the CES-D Depression Scale and of the Shortened WHO General Well-Being Scale to validate.

STATISTICAL ANALYSIS:

IBM SPSS 23.0© software was used for the analysis. To explore the factor structure of the measurement scale, explorative factor analysis was made (analysis of the main component, Varimax rotation); subsequently, 4 scales were prepared the Cronbach-alpha values of which were suitable for further examination.

RESULTS:

188 questionnaires were sent back (female 86.2%, male 13.8%); the majority work as nurses and in home hospice care (94 people). The inner consistency of the created 4 scales is acceptable according to the Cronbach-alpha values. The inner consistency of the questions regarding burnout is low. The correlation of our measurement scales with the standardised scales for outer validity has sufficient strength and direction.

CONCLUSIONS:

Our questionnaire can measure the phenomena under examination according to the expected values, with suitable consistency on the basis of the inner and outer indicators. Orv Hetil. 2018; 159(35): 1441-1449.

KEYWORDS:

ProQOL; a szakmai élet minőségét mérő kérdőív; hospice; palliative care; palliatív ellátás; professional quality of life; validity hospice care; validálás

PMID:
30146907
DOI:
10.1556/650.2018.31126
[Indexed for MEDLINE]
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3.
JAMA. 2018 Jul 17;320(3):239-241. doi: 10.1001/jama.2018.10062.

The Status of End-of-Life Care in the United States: The Glass Is Half Full.

Author information

1
Perelman School of Medicine, Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia.
PMID:
30027232
DOI:
10.1001/jama.2018.10062
[Indexed for MEDLINE]
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4.
Medicine (Baltimore). 2018 Jul;97(28):e11319. doi: 10.1097/MD.0000000000011319.

Use of controlled negative pressure in management of phlegmon caused by fulminant complication of pressure wound: A case report.

Author information

1
Institute of Nursing and Health Sciences, Department of Medicine, University of Rzeszow, Rzeszow.
2
Specialist Hospital Podkarpackie Oncology Center in Brzozów, Brzozow.
3
Department of Clinical Nursing, Faculty of Health Sciences, Collegium Medicum, Jagiellonian University, Krakow, Poland.

Abstract

RATIONALE:

Effective wound healing depends on the adequate choice of the wound cleansing method, to enable rapid removal of necrotic tissue. Negative pressure wound therapy (NPWT) is an effective non-invasive technique for management of wounds of varied aetiology, including deep tissue injuries caused by pressure.

PATIENT CONCERNS:

This article discusses a case of an 82-year-old female receiving hospice care at home owing to progressing untreated thoracic spinal stenosis, bedridden for 4 years, incapable of self-care.

DIAGNOSES:

Three fulminant pressure wounds, 50 cm each, with signs of undermining, Stage II/IV according to National Pressure Ulcer Advisory Panel, were identified in the area of the sacrum and the right and left trochanter. Despite measures used to prevent pressure sores, and nutritional supplementation, two months later a fourth pressure ulcer involving subcutaneous tissue was identified in the area of the right sciatic tuber, accompanied with signs of systemic inflammatory response, as well as massive phlegmon and lesion in the ischial bone.

INTERVENTIONS:

As previously applied treatments (surgical necrectomy, biological therapy - Lucilia Sericata maggots, autolysis, pharmacological therapy) proved ineffective, NPWT was experimentally administered to evacuate exudate and to cleanse the wound.

OUTCOMES:

Application of negative pressure during a 42-day therapy allowed significantly faster cleansing of the wound. The pressure wounds was significantly reduced in size, and necrotic tissue was removed from the sciatic tuber, which ultimately was covered with granulation tissue.

LESSONS:

Controlled negative pressure can successfully be used in the process of cleansing an infected pressure wound to safely remove exudate and to minimise local inflammation. Administration of controlled negative pressure is an effective and safe method in the process of cleansing an infected pressure wound.

PMID:
29995766
PMCID:
PMC6076132
DOI:
10.1097/MD.0000000000011319
[Indexed for MEDLINE]
Free PMC Article
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5.
Emerg Med Pract. 2018 Jul 1;20(Suppl 7):1-2.

Points & Pearls: Emergency department management of dyspnea in the dying patient

Author information

1
Emergency Physician, Ochsner Medical Center, New Orleans, LA
2
Assistant Professor, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
3
Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY

Abstract

Dyspnea is one of the most distressing symptoms experienced by dying patients, and it is a common reason for such patients to seek care in the emergency department. Many underlying disease states and acute illnesses cause shortness of breath at the end of life, and management tends to be symptomatic rather than diagnostic, particularly in those for whom comfort is the most important goal. Opioids are the most effective and widely studied agents available for palliation of dyspnea in this population, while adjuvant therapies such as oxygen, noninvasive positive pressure ventilation, and hand-held fans may also be used. Benzodiazepines may also be helpful in select patients. The early involvement of palliative medicine specialists and/or hospice services for dying patients can facilitate optimal symptom management and transitions of care. [Points & Pearls is a digest of Emergency Medicine Practice.].

PMID:
29993207
[Indexed for MEDLINE]
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6.
J Music Ther. 2018 Sep 8;55(3):309-339. doi: 10.1093/jmt/thy011.

Music Therapy When Death Is Imminent: A Phenomenological Inquiry.

Author information

1
Starshine Hospice, Cincinnati Children's Hospital, Cincinnati, OH, Cincinnati, OH.

Abstract

Music therapists have described powerful case examples and personal experiences of providing music therapy for clients who are actively dying that suggest a complex experience that merits further exploration. This phenomenological study was conducted to gain a better understanding of the lived experience of music therapists working with clients who are actively dying. Four music therapists (2 female, 2 male), with an average of 10 years' hospice care experience, participated in semi-structured interviews. Data were analyzed using a phenomenological approach (Moustakas, 1994). Ten themes were distilled from the interviews and grouped into four categories: ongoing assessment, intuitive processes, countertransference, and the role of aesthetics and transformation. Participants described a flexible, dynamic clinical and personal process informed by ongoing assessment. These findings point to the importance of further discussion surrounding the clinical implications of the music therapist's internal experience and the role of assessment, intuition, and aesthetics in hospice music therapy.

PMID:
29992294
DOI:
10.1093/jmt/thy011
[Indexed for MEDLINE]
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7.
Emerg Med Pract. 2018 Jul;20(7):1-20. Epub 2018 Jul 1.

Emergency department management of dyspnea in the dying patient.

Author information

1
Emergency Physician, Ochsner Medical Center, New Orleans, LA.
2
Assistant Professor, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.

Abstract

Dyspnea is one of the most distressing symptoms experienced by dying patients, and it is a common reason for such patients to seek care in the emergency department. Many underlying disease states and acute illnesses cause shortness of breath at the end of life, and management tends to be symptomatic rather than diagnostic, particularly in those for whom comfort is the most important goal. Opioids are the most effective and widely studied agents available for palliation of dyspnea in this population, while adjuvant therapies such as oxygen, noninvasive positive pressure ventilation, and hand-held fans may also be used. Benzodiazepines may also be helpful in select patients. The early involvement of palliative medicine specialists and/or hospice services for dying patients can facilitate optimal symptom management and transitions of care.

PMID:
29949707
[Indexed for MEDLINE]
Icon for EB Medicine
8.
Jpn J Clin Oncol. 2018 Jul 1;48(7):695-698. doi: 10.1093/jjco/hyy080.

Comparison of the accuracy and characteristics of the prognostic prediction of survival of identical terminally ill cancer patients by oncologists and palliative care physicians.

Author information

1
Department of Palliative Medicine, Kyowa Marina Hospital, Hyogo, Japan.

Abstract

Most terminally ill cancer patients in our hospice ward are referred from hospitals for anticancer treatment. For identical terminally ill cancer patients referred from other hospitals, differences in the accuracy and characteristics of the prognostic prediction of survival by oncologists and palliative care physicians were examined. We investigated 101 patients and compared the prognostic value between the clinical prediction of survival with oncologists and prognostic tool-conducted prediction by palliative care physicians with the actual survival times; the results were then classified as accurate, pessimistic and optimistic. Prognostic prediction by palliative care physicians was closer to the actual survival time. The number of accurately predicted cases by palliative care physicians was more than that by oncologists, and the number of optimistically predicted cases by oncologists was more than that by palliative care physicians. The palliative care physicians' prediction was more accurate, while the oncologists' prediction was more optimistic.

PMID:
29850870
DOI:
10.1093/jjco/hyy080
[Indexed for MEDLINE]
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9.
Ann Palliat Med. 2018 Apr;7(Suppl 2):S109-S117. doi: 10.21037/apm.2018.03.15.

Solidarity and compassion-prisoners as hospice volunteers in Poland.

Author information

1
Department of Social Work, UMK University, Torun, Poland. pkrakow@umk.pl.
2
Department of Social Work, UMK University, Torun, Poland.
3
Department of Pedagogy, WSB University, Gdansk, Poland.

Abstract

Democracy in Eastern Europe arrived after a long fight with a communist regime, and the activities of medical volunteers have been developing in opposition to the existing then in Poland mentality called Homo Sovieticus. From 1981 onwards the Polish Hospice Movement there was inspired by practitioners and international experiences brought by visits of Dr. Cicely Saunders. The history of modern end-of-life care in Poland was connected to caring communities, which could be called compassionate, because of the volunteering of all hospice team members. When palliative medicine started to become a part of the national healthcare programme, the hospice movement was slowly losing its exceptional character of professionals working together with volunteers, accompanied by considerable involvement of church communities. The new way of talking about end-of-life care was proposed in XXI century, and promotion of volunteering was part of it. In Gdansk an innovative program to reintegrate prisoners into society through voluntary work with hospice patients began. Since 2008 the WHAT project was aimed at social reintegration of prisoners through voluntary activities in hospices and correctional institutions from around Poland. In June 2009 Poland was awarded a prestigious prize 'The Crystal Scales of Justice' by The Council of Europe for a project called Voluntary Service of the Convicted in Poland implementing an innovative form of cooperation among prisons, hospices and social welfare homes. The research involving prisoners performing hospice-palliative care volunteering indicates a diverse range of life goals from the inmates not involved in hospices. These innovative correctional programs truly help local communities and prisoners who are currently working in 40 hospices and 70 nursing homes, helping those in need. Adequately prepared inmates who proved to be effective volunteers could be an inspiration to all who want to make end-of-life care more social, more humane and a more universal duty of compassionate communities.

KEYWORDS:

Palliative care; Poland; community; hospices; prisoners; solidarity; volunteering

PMID:
29764177
DOI:
10.21037/apm.2018.03.15
[Indexed for MEDLINE]
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10.
Support Care Cancer. 2018 Oct;26(10):3619-3625. doi: 10.1007/s00520-018-4223-0. Epub 2018 May 4.

Advanced imaging and hospice use in end-of-life cancer care.

Author information

1
Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA. michaela.dinan@duke.edu.
2
Department of Population Health Sciences, Duke University School of Medicine, 2200 W Main St, Suite 720, Durham, NC, 27705, USA. michaela.dinan@duke.edu.
3
Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.
4
Department of Population Health Sciences, Duke University School of Medicine, 2200 W Main St, Suite 720, Durham, NC, 27705, USA.
5
Department of Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA.
6
Department of Oncology, University of Calgary, Calgary, Alberta, Canada.

Abstract

INTRODUCTION:

Advanced imaging can inform prognosis and may be a mechanism to de-escalate unnecessary end-of-life care in patients with cancer. Associations between greater use of advanced imaging and less-aggressive end-of-life care in real-world practice has not been examined.

METHODS:

We conducted a retrospective analysis of SEER-Medicare data on patients who died from breast, lung, colorectal, or prostate cancer between 2002 and 2007. Hospital referral region (HRR)-level use of computerized tomography (CT), magnetic resonance imaging, and positron emission tomography was categorized by tertile of imaging use and correlated with hospice enrollment overall and late hospice enrollment using multivariable logistic regression.

RESULTS:

A total of 55,058 patients met study criteria. Hospice use ranged from 50.8% (colorectal cancer) to 62.1% (prostate cancer). In multivariable analyses, hospital referral regions (HRRs) with high rates of CT imaging were associated with lower odds of hospice enrollment (odds ratio, 0.80; 95% CI, 0.70-0.90) and late enrollment among those who did enroll (odds ratio, 1.49; 95% CI, 1.26-1.76). HRRs with the highest rates of CT use were predominantly located in the Midwest and Northeast and associated with higher percentage population of black patients (14.5 vs 5.6%), greater comorbidity (28.4 vs 23.7%), metropolitan residence (93.9 vs 78.5%), and less than high school education (26.4 vs 19.3%).

CONCLUSION:

In this population-based retrospective study, we did not observe evidence that overall and timely hospice are associated with higher rates of imaging near the end of life. An observed association between higher rates of imaging, particularly CT, may be explained in part by HRR-level differences in practice patterns and patient demographic characteristics. Further research is warranted to explore the ability of oncologic imaging to appropriately de-escalate care.

KEYWORDS:

Breast neoplasms; Colorectal neoplasms; Diagnostic imaging; Hospice care; Lung neoplasms; Outcome assessment (health care); Prostatic neoplasms

PMID:
29728843
DOI:
10.1007/s00520-018-4223-0
[Indexed for MEDLINE]
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11.
Home Healthc Now. 2018 May/Jun;36(3):185-188. doi: 10.1097/NHH.0000000000000654.

Reach for the Stars.

Author information

1
Gina Panozzo, DNP, RN-BC, is an Assistant Professor, Department of Nursing and Health, Benedictine University, Lisle, Illinois.

Abstract

Star Ratings were implemented by the Centers for Medicare and Medicaid Services for home healthcare agencies with the first release of measures in 2015 and 2016. Hospital Compare also displays Star Ratings, and Hospice also will soon have the Hospice Information Set displayed on Hospice Compare. Star Ratings in home healthcare are determined by a specific methodology and are based on nine quality areas. One set of Stars designates the nine quality areas and a second set of Stars reflects consumer satisfaction. This article discusses quality of patient care Star Ratings but not those based on Consumer Assessment of Healthcare Provider and Systems outcomes. Few agencies reach above 3-Star Ratings; the majority fall within 3 and 3.5 with the national benchmark being 3.5. Agencies should strive for high Star Ratings as consumers, hospitals, and other referral sources may base their decisions on the number of stars received.

PMID:
29722709
DOI:
10.1097/NHH.0000000000000654
[Indexed for MEDLINE]
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12.
Oncology (Williston Park). 2018 Apr 15;32(4):180-4.

Effective Palliative Care: What Is Involved?

Abstract

It is important for oncologists who provide comprehensive cancer care to be familiar with the principles of primary palliative care and interdisciplinary team-based approaches to palliative care. Palliative care is a medical subspecialty that provides specialized care to individuals with serious illnesses, with a primary focus on providing symptom relief, pain management, and relief from psychosocial distress, regardless of diagnosis or prognosis. Ideally, palliative care is provided by a team of physicians, nurses, social workers, psychologists, and chaplains. The core of palliative care is addressing, in depth, the physical, emotional, and spiritual suffering that a patient can experience. Palliative care is a key component of oncologic care, and we highly recommend that it be integrated into the plan of care for patients with advanced cancer. Early integration of palliative care has been shown to provide improved outcomes in patients with advanced cancer. This article reviews the ways in which palliative care and oncology teams can collaborate to provide high-quality care to patients and their families; it also provides practical tips for oncologists who wish to initiate primary palliative care for their patients. Prior to referral to a specialized interdisciplinary palliative care team, oncologists may start advance-care planning discussions, provide basic pain and non-pain symptom relief, and utilize assessment tools. If a specialized palliative care team is not available, the oncologist will often address additional aspects of palliative care, with assistance from social work departments and other resources in the community.

PMID:
29684230
[Indexed for MEDLINE]
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13.
BMJ Case Rep. 2018 Apr 17;2018. pii: bcr-2018-224732. doi: 10.1136/bcr-2018-224732.

Solitary cardiac metastasis from primary oral squamous cell carcinoma presenting as ST-elevation MI.

Author information

1
Department of Cardiology, Albany Medical College, Albany, New York, USA.

Abstract

Cardiac metastases from oral squamous cell carcinoma (SCC) are rare, especially in the absence of systemic metastasis. We describe a case of a patient presenting with chest pain and ECG abnormalities concerning for ST-elevation myocardial infarction that eventually was found to have an incidental right ventricular mass on chest CT angiogram. Ultimately, she had an intracardiac echocardiography-assisted biopsy diagnosis of isolated cardiac metastasis from primary oral SCC. The extent of the disease precluded any surgical intervention, and the patient subsequently transitioned to hospice care. Most cardiac metastases remain clinically silent until widespread systemic disease leads to death. Thus, cardiac metastasis should be considered in a patient with SCC who develops new cardiovascular symptoms or conduction abnormalities.

KEYWORDS:

cancer - see oncology; cardiovascular medicine; clinical diagnostic tests; interventional cardiology; radiology (diagnostics)

PMID:
29666101
DOI:
10.1136/bcr-2018-224732
[Indexed for MEDLINE]
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14.
PLoS One. 2018 Mar 27;13(3):e0194649. doi: 10.1371/journal.pone.0194649. eCollection 2018.

Availability of patient-centered cancer support services: A statewide survey of cancer centers.

Author information

1
College of Nursing, Medical University of South Carolina, Charleston, SC, United States of America.
2
Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States of America.
3
Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States of America.
4
Arnold School of Public Health, University of South Carolina, Columbia, SC, United States of America.
5
Department of Surgery, Fox Chase Cancer Center, Philadelphia, PA, United States of America.

Abstract

The Institute of Medicine recommended in their landmark report "From Cancer Patient to Cancer Survivor: Lost in Transition" that services to meet the needs of cancer patients should extend beyond physical health issues to include functional and psychosocial consequences of cancer. However, no systems exist in the US to support state-level data collection on availability of support services for cancer patients. Developing a mechanism to systematically collect these data and document service availability is essential for guiding comprehensive cancer control planning efforts. This study was carried out to develop a protocol for implementing a statewide survey of all Commission on Cancer (CoC) accredited cancer centers in South Carolina and to implement the survey to examine availability of patient support services within the state. We conducted a cross-sectional survey of CoC-certified cancer centers in South Carolina. An administrator at each center completed a survey on availability of five services: 1) patient navigation; 2) distress screening; 3) genetic risk assessment and counseling, 4) survivorship care planning; and 5) palliative care. Completed surveys were received from 16 of 17 eligible centers (94%). Of the 16 centers, 44% reported providing patient navigation; 31% reported conducting distress screening; and 44% reported providing genetic risk assessment and counseling. Over 85% of centers reported having an active palliative care program, palliative care providers and a hospice program, but fewer had palliative outpatient services (27%), palliative inpatient beds (50%) or inpatient consultation teams (31%). This was a small, yet systematic survey in one state. This study demonstrated a practical method for successfully monitoring statewide availability of cancer patient support services, including identifying service gaps.

PMID:
29584744
PMCID:
PMC5870953
DOI:
10.1371/journal.pone.0194649
[Indexed for MEDLINE]
Free PMC Article
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15.
J Drugs Dermatol. 2018 Mar 1;17(3):358-362.

Locally Advanced Basal Cell Carcinoma: Two Severe Case Presentations and Review.

Abstract

Basal cell carcinoma (BCC) is a common skin malignancy comprising 80% of non-melanoma skin cancers.1 Over 2.8 million cases are estimated to be diagnosed in the United States alone each year. Advanced BCCs are comprised of BCCs that have metastasized to local or distant lymph nodes or organs, or locally invasive BCCs that are extensive and infiltrate vital structures such as eyes, nose, or brain. Advanced BCC tumors represent roughly 1-10% of BCCs today. Two severe case presentations and treatment options will be discussed in this case report series and review. <p><em>J Drugs Dermatol. 2018;17(3):358-362.</em></p>.

PMID:
29537455
[Indexed for MEDLINE]
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16.
Dig Dis Sci. 2018 May;63(5):1173-1181. doi: 10.1007/s10620-018-4989-4. Epub 2018 Mar 5.

Determinants and Outcomes of Hospice Utilization Among Patients with Advance-Staged Hepatocellular Carcinoma in a Veteran Affairs Population.

Author information

1
Center of Innovation, Effectiveness and Quality, The Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, 2002 Holcombe Blvd. (MS152), Houston, TX, 77030, USA.
2
Sections of Health Services Research and Gastroenterology and Hepatology, The Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX, USA.
3
South Central Mental Illness Research, Education and Clinical Centers, The Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX, USA.
4
Center of Innovation, Effectiveness and Quality, The Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, 2002 Holcombe Blvd. (MS152), Houston, TX, 77030, USA. jdavila@bcm.edu.
5
Sections of Health Services Research and Gastroenterology and Hepatology, The Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX, USA. jdavila@bcm.edu.

Abstract

BACKGROUND:

Hospice provides integrative palliative care for advance-staged hepatocellular carcinoma (HCC) patients, but hospice utilization in HCC patients in the USA is not clearly understood.

AIMS:

We examined hospice use and subsequent clinical course in advance-staged HCC patients.

METHODS:

We conducted a retrospective study on a national, Veterans Affairs cohort with stage C or D HCC. We evaluated demographics, clinical factors, treatment, and clinical course in relation to hospice use.

RESULTS:

We identified 814 patients with advanced HCC, of whom 597 (73.3%) used hospice. Oncologist management consistently predicted hospice use, irrespective of HCC treatment [no treatment: OR 2.25 (1.18-4.3), treatment: OR 1.80 (1.10-2.95)]. Among patients who received HCC treatment, hospice users were less likely to have insurance beyond VA benefits (47.2 vs. 60.0%, p = 0.01). Among patients without HCC treatment, hospice users were older (62.2 [17.2] vs. 60.2 [14.0] years, p = 0.05), white (62.1 vs. 52.9%, p = 0.01), resided in the Southern USA (39.5 vs. 31.8%, p = 0.05), and had a performance score ≥ 3 (41.9 vs. 31.8%, p = 0.01). The median time from hospice entry to death or end of study was 1.05 [2.96] months for stage C and 0.53 [1.18] months for stage D patients.

CONCLUSIONS:

26.7% advance-staged HCC patients never entered hospice, representing potential missed opportunities for improving end-of-life care. Age, race, location, performance, insurance, and managing specialty can predict hospice use. Differences in managing specialty and short-term hospice use suggest that interventions to optimize early palliative care are necessary.

KEYWORDS:

Hepatocellular carcinoma; Hospice; Palliative care; Veteran

PMID:
29508165
PMCID:
PMC6010049
[Available on 2019-05-01]
DOI:
10.1007/s10620-018-4989-4
[Indexed for MEDLINE]
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17.
J Soc Work End Life Palliat Care. 2018 Jan-Mar;14(1):28-43. doi: 10.1080/15524256.2018.1432008. Epub 2018 Mar 5.

Challenges of Dealing with Financial Concerns during Life-Threatening Illness: Perspectives of Health Care Practitioners.

Author information

1
a University of Maryland, Baltimore, School of Social Work , Baltimore , Maryland , USA.
2
b University of Maryland, Baltimore, School of Nursing , Baltimore , Maryland , USA.

Abstract

The costs of serious medical illness and end of life care are often a heavy burden for patients and families (Collins, Stepanczuk, Williams, & Rich, 2016 ; Kim, 2007 ; May et al., 2014 ; Zarit, 2004 ). Twenty-six practitioners, including social workers, managers/administrators, supervisors, and case managers from five health care settings, participated in qualitative semistructured interviews about financial challenges patients encountered. Seven practitioners took part in a focus group. Practitioners were recruited from hospice (n = 5), long-term care (n = 5), intensive care (n = 5), dialysis (n = 6), and oncology (n = 5). Interview and focus group questions focused on financial challenges patients encountered when facing life-threatening illness. Interview data were transcribed and thematically coded and trustworthiness of data was established with peer debriefing, member checking, and agreement on themes among the authors. Practitioners described interacting micro, meso, and macroinfluences on the financial well-being and challenges patients encountered. Microlevel influences involved patient characteristics, such as their demographic profile and/or health status that set them up for financial aptitude or challenges. Macrolevel influences involved the larger health care/safety net system, which provided valuable resources for some patients but not others. Practitioners also discussed the mesolevel of influence, the local setting where they worked to match available resources with patients' individual needs given the constraints emerging from the micro and macrolevels. Practitioners described how they navigated the interplay of these three areas to meet patients' needs and cope with financial challenges. Implications for practice point to directly addressing the kind of financial concerns that patients and families facing financial burden from serious medical illness have, and identifying ways to bridge knowledge and resource access gaps at the individual, organizational, and societal levels.

KEYWORDS:

Critical illness; financial concerns; financial strain; social workers; socioeconomic factors

PMID:
29505397
DOI:
10.1080/15524256.2018.1432008
[Indexed for MEDLINE]
18.
J Soc Work End Life Palliat Care. 2018 Jan-Mar;14(1):73-92. doi: 10.1080/15524256.2018.1433097. Epub 2018 Mar 1.

Physician-Assisted Suicide and Midwest Social Workers: Where Do They Stand?

Author information

1
a St. Croix Hospice , Oakdale , Minnesota , USA.
2
b University of Louisville, Kent School of Social Work , Louisville , Kentucky , USA.
3
c St. Catherine University - University of St. Thomas, School of Social Work, St. Paul , Minnesota , USA.

Abstract

Physician-assisted suicide (PAS) is explicitly legal in five states and by court decision in one. Legislative bills have been introduced in other states including Minnesota, Iowa, and Wisconsin. This quantitative study was designed to understand Midwest, hospice and palliative care at end-of-life social workers' attitudes toward PAS, preferred terminology, perception of preparedness for the implementation, and awareness of PAS legislation in their state. Sixty-two social workers from Minnesota, Iowa, and Wisconsin completed an anonymous online survey. The results indicated that over one-half of the participants supported PAS legislation and is consistent with previous research on social workers across the country. While there was a range of perceived preparedness for implementation, a majority felt moderately to very prepared. Professional and personal values as well as professional experience influenced their perceived preparedness. Few social workers had accurate awareness of PAS legislation in their state or had attended workshops/events for further education or as a policy advocate. To practice competently and advocate at all levels of practice, hospice and palliative care at end-of-life social workers' need to understand their own attitudes and values toward PAS and pursue additional education around this ethical issue.

KEYWORDS:

Attitudes; competency; death with dignity; physician-assisted suicide; social workers

PMID:
29494791
DOI:
10.1080/15524256.2018.1433097
[Indexed for MEDLINE]
19.
J Soc Work End Life Palliat Care. 2018 Jan-Mar;14(1):8-27. doi: 10.1080/15524256.2018.1437590. Epub 2018 Feb 28.

Social Workers' Perceptions of Job Satisfaction, Interdisciplinary Collaboration, and Organizational Leadership.

Author information

1
a Department of Social Work , Sacred Heart University , Fairfield , Connecticut , USA.
2
b Graduate School of Social Service , Fordham University , New York , New York , USA.

Abstract

To address job satisfaction, and therefore employment retention, of hospice social workers, this study examined how relationships with other members of the interdisciplinary hospice team and perceptions of hospice leadership may be associated with job satisfaction of hospice social workers. The sample of 203 hospice social workers was recruited by e-mailing invitations to hospice social workers identified by hospice directors in three states, use of online social media sites accessed by hospice social workers, and snowball sampling. Study measures included professional experience, hospice characteristics, interdisciplinary collaboration, perception of servant leadership, and intrinsic and extrinsic job satisfaction. Variables significant in the model for intrinsic satisfaction were perception of servant leadership, interdisciplinary collaboration, and feeling valued by the hospice physician. Variables significant in the model for extrinsic satisfaction were perception of servant leadership, interdisciplinary collaboration, feeling valued by the hospice physician, and number of social workers at the hospice. Interdisciplinary collaboration was more important for intrinsic job satisfaction and leadership style was more important for extrinsic job satisfaction. Profit status of the hospice, experience of the social worker, caseload size, and other variables were not significant in either model. These results support previous findings that leadership style of the hospice director and relationships with hospice colleagues are important for hospice social workers' job satisfaction. Such low-cost modifications to the hospice work environment, albeit not simple, may improve job satisfaction of hospice social workers.

KEYWORDS:

Hospice; interdisciplinary collaboration; job satisfaction; leadership style; profit status; social work

PMID:
29488858
DOI:
10.1080/15524256.2018.1437590
[Indexed for MEDLINE]
20.
J Soc Work End Life Palliat Care. 2018 Jan-Mar;14(1):93-109. doi: 10.1080/15524256.2018.1437589. Epub 2018 Feb 26.

Hispanic Hospice Patients' Experiences of End-Stage Restlessness.

Author information

1
a Jane Addams College of Social Work , University of Illinois at Chicago , Chicago , Illinois , USA.

Abstract

End-stage restlessness, or terminal agitation, is experienced by some patients during their final days and is characterized by physical, emotional, or spiritual distress, agitation or anxiety. End-stage restlessness negatively affects the patient's death experience and can be distressing to the family and care team. Using the 2007 National Home and Hospice Care survey, this study examined factors associated with experiencing end-stage restlessness among non-Hispanic white and Hispanic hospice patients deceased at time of discharge. Results showed that being Hispanic/Latino, experiencing dyspnea, pain, and receiving palliative sedation treatment were risk factors for experiencing end-stage restlessness. The association between pain and restlessness was stronger for Hispanics compared with non-Hispanic whites. The Hispanic population remains underrepresented and little is known about the patient-centered experiences of Hispanic hospice users. Findings indicated that dying Hispanic patients continue to experience pain and other negative symptoms, even when hospice care is in place. Thus, it is important that social workers provide education to interdisciplinary team members about culturally competent practices, and advocate for a patient-centered approach to care.

KEYWORDS:

Health disparities; Hispanics; hospice; palliative care; symptoms

PMID:
29482491
DOI:
10.1080/15524256.2018.1437589
[Indexed for MEDLINE]

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