Browsing by Subject "Hospice"
Now showing 1 - 9 of 9
Results Per Page
Sort Options
Item Advance directives in home health and hospice agencies: United States, 2007(2011-11) Resnick, Helaine E.; Hickman, Susan E.; Foster, Gregory L.This report provides nationally representative data on policies, storage, and implementation of advance directives (ADs) in home health and hospice (HHH) agencies in the United States using the National Home and Hospice Care Survey. Federally mandated ADs policies were followed in >93% of all agencies. Nearly all agencies stored ADs in a file at the agency, but only half stored them at the patient's residence. Nearly all agencies informed staff about the AD, but only 77% and 72% of home health agencies informed the attending physician and next-of-kin, respectively. Home health and hospice agencies are nearly universally compliant with ADs policies that are required in order to receive Medicare and Medicaid payments, but have much lower rates of adoption of ADs policies beyond federally mandated minimums.Item COMPLETE (Communication Plan Early Through End of Life): Development of a Research Program to Diminish Suffering for Children at End of Life(Elsevier, 2021) Hendricks-Ferguson, Verna; Newman, Amy R.; Brock, Katharine E.; Haase, Joan E.; Raybin, Jennifer L.; Saini, Shermini; Moody, Karen M.; School of NursingWhile overall survival has improved significantly for children with cancer over the past 75 years, cancer remains the leading cause of death from disease among children and adolescents. Further, despite the many advances in medical and nursing care, children with cancer still experience significant physical and emotional suffering over the course of their illness, especially at the end of life (EOL). Children endure significant rates of high-intensity medical interventions (e.g., intubation, intensive care unit admission) at the EOL despite many parents, adolescents, and young adult patients identifying home as their preferred location of death. Hospice care has the potential to ease suffering at the EOL and facilitate home deaths, and yet, most children still die in acute care settings without hospice care. Numerous barriers prevent timely enrollment in hospice among children with cancer who are in the EOL period. This report describes the development and testing of a palliative care/EOL communication intervention designed to overcome some of these barriers and subsequently improve EOL outcomes (i.e., earlier hospice enrollment, less use of high-intensity medical interventions, reduced pain and suffering) among children with cancer and their parents (i.e., less emotional distress and uncertainty, improved hope and healthcare satisfaction).Item Hospice Care for End Stage Liver Disease in the United States(Taylor & Francis, 2021) Orman, Eric S.; Johnson, Amy W.; Ghabril, Marwan; Sachs, Greg A.; Medicine, School of MedicineIntroduction: Patients with end-stage liver disease (ESLD) have impaired physical, psychological, and social functions, which can diminish patient quality of life, burden family caregivers, and increase healthcare utilization. For those with a life expectancy of less than six months, these impairments and their downstream effects can be addressed effectively through high-quality hospice care, delivered by multidisciplinary teams and focused on the physical, emotional, social, and spiritual wellbeing of patients and caregivers, with a goal of improving quality of life. Areas Covered: In this review, we examine the evidence supporting hospice for ESLD, we compare this evidence to that supporting hospice more broadly, and we identify potential criteria that may be useful in determining hospice appropriateness. Expert Opinion: Despite the potential for hospice to improve care for those at the end of life, it is underutilized for patients with ESLD. Increasing the appropriate utilization of hospice for ESLD requires a better understanding of patient eligibility, which can be based on predictors of high short-term mortality and liver transplant ineligibility. Such hospice criteria should be data-driven and should accommodate the uncertainty faced by patients and physicians.Item Palliative Care and Hospice Referrals in Patients with Decompensated Cirrhosis: What Factors Are Important?(Mary Ann Liebert, Inc., 2020-08) Holden, John H.; Shamseddeen, Hani; Johnson, Amy W.; Byriel, Benjamin; Subramoney, Kavitha; Cheng, Yao-Wen; Saito, Akira; Ghabril, Marwan; Chalasani, Naga; Sachs, Greg A.; Orman, Eric S.; Medicine, School of MedicineBackground: Palliative care (PC) and hospice care are underutilized for patients with end-stage liver disease, but factors associated with these patterns of utilization are not well understood. Objective: We examined patient-level factors associated with both PC and hospice referrals in patients with decompensated cirrhosis (DC). Design: Retrospective cohort study. Setting/Subjects: Patients with DC hospitalized at a single tertiary center and followed for one year. Measurements: We assessed PC and hospice referrals during follow-up and examined patient-level factors associated with the receipt of PC and/or hospice, as well as associated clinical outcomes. We also examined late referrals (within one week of death). Results: Of 397 patients, 61 (15.4%) were referred to PC, 71 (17.9%) were referred to hospice, and 99 (24.9%) were referred to PC and/or hospice. Two hundred patients (50.4%) died during the one-year follow-up. In multivariable logistic regression, referral to PC was associated with increased comorbidity burden, ascites, increased MELD (Model for End-Stage Liver Disease)-Na score, lack of listing for liver transplant, and unmarried status. Hospice referral was associated with increased comorbidities, portal vein thrombosis, and hepatocellular carcinoma. PC referrals were late in 68.5% of cases, and hospice referrals were late in 62.7%. Late PC referrals were associated with younger age and married status. Late hospice referrals were associated with younger age and recent alcohol use. Conclusions: PC and hospice is underutilized in patients with DC, and most referrals are late. Patient-level factors associated with these referrals differ between PC and hospice.Item Quality of Hospice Care at Home Versus in an Assisted Living Facility or Nursing Home(Wiley, 2018-04) Unroe, Kathleen T.; Stump, Timothy E.; Effler, Shannon; Tu, Wanzhu; Callahan, Christopher M.; Medicine, School of MedicineOBJECTIVES: To describe differences in perceived quality of hospice care for individuals living at home or in a nursing home (NH) or assisted living facility (ALF) through analysis of after-death surveys of family members. DESIGN: Retrospective cohort study using hospice medical record data and Family Evaluation of Hospice Care (FEHC) survey data. SETTING: Large, national hospice provider. PARTICIPANTS: Individuals who died while receiving routine hospice care and family caregivers who completed after-death quality-of-care surveys. MEASUREMENTS: Survey results for 7,510 individuals were analyzed using analysis of variance and chi-square tests. Logistic regression was used to assess relationship between location of care and overall service quality. RESULTS: The overall survey response rate was 27%; 34.5% of families of individuals in ALFs in hospice, 27.4% of those at home, and 22.9% of those in NHs returned the survey (P < .001). Differences in return rate according to primary diagnosis were significant, although differences were not large. Most (84.3%) respondents reported that hospice referral had occurred at the right time, and 63.4% rated service quality as excellent. Hospice care in the NH was less likely to be perceived as excellent. CONCLUSION: There were significant differences in characteristics of individuals whose family members did and did not return surveys, which has implications for use of after-death surveys to evaluate hospice quality. Lower perceived quality of hospice care in NHs may be related to general dissatisfaction with receiving care in this setting. Survey results have the potential to set priorities for quality improvement, choice of provider, and potentially reimbursement. Underlying causes of differences of perceived quality in different settings of care should be examined.Item The Role of Art Therapy in Hospice: An Understanding of the Grief Process for Caregivers(2014-05) Hearn, Katherine; King, JulietThe responsibilities of caregiving create enormous pressures and risks for caregivers. Burnout, compromised health, depression, and depletion of financial resources are a reality of daily life for millions of Americans who are caregiving for a loved one (Family Caregiver Alliance, 2011). Family caregivers will increasingly provide care for aging parents or family members as the population of Americans over 65 rapidly increases (Family Caregiver Alliance, 2011). In addition to aging adults, other individuals in hospice care will require a caregiver for daily needs. In order to maintain the important role they play, caregivers’ experiences must be examined so that appropriate support for their quality of life can be provided (American Hospital Association, 2007). A systematic study of the existing literature on grief and art therapy in the hospice setting was undertaken over a nine month period. An 8 week program was developed from the resulting data that offers group art therapy to caregivers within the hospice setting. The program was designed to assist caregivers in their journey of grief and provide a group framework for learning self-care strategies for mental and physical well-being. It was hypothesized that art therapy can potentially benefit the caregiver allowing them to provide proper care to the patient and explore their own grief process after the patient has passed. Using art therapy interventions, the proposed group can be utilized or implemented by a trained art therapist to help explore the dynamics of grief through creative process and discussion. The support from art therapy groups for caregivers is intended to result in a positive reflection of self- expression and self-awareness so that the individual can continue to live meaningfully after their loved one has passed.Item The Impact of Specialty Palliative Care in Pediatric Oncology: A Systematic Review(Elsevier, 2021) Kaye, Erica C.; Weaver, Meaghann S.; DeWitt, Leila Hamzi; Leila Hamzi, Elizabeth; Stevens, Sarah E.; Lukowski, Joe; Shih, Brandon; Zalud, Kristina; Applegarth, Jacob; Wong, Hong-Nei; Baker, Justin N.; Ullrich, Christina K.; AAHPM Research Commttee; Medicine, School of MedicineContext: Children with cancer and their families have complex needs related to symptoms, decision-making, care planning, and psychosocial impact extending across the illness trajectory, which for some includes end of life. Whether specialty pediatric palliative care (SPPC) is associated with improved outcomes for children with cancer and their families is unknown. Objective: We conducted a systematic review following PRISMA guidelines to investigate outcomes associated with SPPC in pediatric oncology with a focus on intervention delivery, collaboration, and alignment with National Quality Forum domains. Methods: We searched PubMed, Embase, Scopus, Web of Science, and CINAHL databases from inception until April 2020 and reviewed references manually. Eligible articles were published in English, involved pediatric patients aged 0-18 years with cancer, and contained original data regarding patient and family illness and end-of-life experiences, including symptom management, communication, decision-making, quality of life, satisfaction, and healthcare utilization. Results: We screened 6682 article abstracts and 82 full-text articles; 32 studies met inclusion criteria, representing 15,635 unique children with cancer and 342 parents. Generally, children with cancer who received SPPC had improved symptom burden, pain control, and quality of life with decreased intensive procedures, increased completion of advance care planning and resuscitation status documentation, and fewer end-of-life intensive care stays with higher likelihood of dying at home. Family impact included satisfaction with SPPC and perception of improved communication. Conclusion: SPPC may improve illness experiences for children with cancer and their families. Multisite studies utilizing comparative effectiveness approaches and validated metrics may support further advancement of the field.Item Use of the Physician Orders for Life-Sustaining Treatment (POLST) Paradigm Program in the Hospice Setting(2009-02) Hickman, Susan E.; Nelson, Christine A.; Moss, Alvin H.; Hammes, Bernard J.; Terwilliger, Allison; Jackson, Ann; Tolle, Susan W.Background The Physician Orders for Life-Sustaining Treatment (POLST) Paradigm Program was designed to ensure the full range of patient treatment preferences are honored throughout the health care system. Data are lacking about the use of POLST in the hospice setting. Objective To assess use of the POLST by hospice programs, attitudes of hospice personnel toward POLST, the effect of POLST on the use of life-sustaining treatments, and the types of treatments options selected by hospice patients. Design A telephone survey was conducted of all hospice programs in three states (Oregon, Wisconsin, and West Virginia) to assess POLST use. Staff at hospices reporting POLST use (n = 71) were asked additional questions about their attitudes toward the POLST. Chart reviews were conducted at a subsample of POLST-using programs in Oregon (n = 8), West Virginia (n = 5), and Wisconsin (n = 2). Results The POLST is used widely in hospices in Oregon (100%) and West Virginia (85%) but only regionally in Wisconsin (6%). A majority of hospice staff interviewed believe the POLST is useful at preventing unwanted resuscitation (97%) and at initiating conversations about treatment preferences (96%). Preferences for treatment limitations were respected in 98% of cases and no one received unwanted cardiopulmonary resuscitation (CPR), intubation, intensive care, or feeding tubes. A majority of hospice patients (78%) with do-not-resuscitate (DNR) orders wanted more than the lowest level of treatment in at least one other category such as antibiotics or hospitalization. Conclusions The POLST is viewed by hospice personnel as useful, helpful, and reliable. It is effective at ensuring preferences for limitations are honored. When given a choice, most hospice patients want the option for more aggressive treatments in selected situations.Item Variation in Hospice Services by Location of Care: Nursing Home Versus Assisted Living Facility Versus Home(Wiley, 2017-07) Unroe, Kathleen T.; Bernard, Brittany; Stump, Timothy E.; Tu, Wanzhu; Callahan, Christopher M.; Medicine, School of MedicineOBJECTIVES: To describe differences in hospice services for patients living at home, in nursing homes or in assisted living facilities, including the overall number and duration of visits by different hospice care providers across varying lengths of stay. DESIGN: Retrospective cohort study using hospice patient electronic medical record data. SETTING: Large, national hospice provider. PARTICIPANTS: Data from 32,605 hospice patients who received routine hospice care from 2009 to 2014 were analyzed. MEASUREMENTS: Descriptive statistics were calculated for utilization measures for each type of provider and by location of care. Frequency and duration of service contacts were standardized to a 1 week period and pairwise comparisons were used to detect differences in care provided between the three settings. RESULTS: Minimal differences were found in overall intensity of service contacts across settings, however, the mix of services were different for patients living at home versus nursing home versus assisted living facility. Overall, more nurse care was provided at the beginning and end of the hospice episode; intensity of aide care services was higher in the middle portion of the hospice episode. Nearly 43% of the sample had hospice stays less than 2 weeks and up to 20% had stays greater than 6 months. CONCLUSION: There are significant differences between characteristics of hospice patients in different settings, as well as the mix of services they receive. Medicare hospice payment methodology was revised starting in 2016. While the new payment structure is in greater alignment with the U shape distribution of services, it will be important to evaluate the impact of the new payment methodology on length of stay and mix of services by different providers across settings of care.