Journal of pain and symptom management
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The remarkable growth of palliative care in the United States in the last 25 years has been fueled by the expansion of Medicare to include a hospice benefit. Medicare provides health insurance for qualified elderly individuals and Medicaid covers the poor. Hospice benefits are the same for both Medicare and Medicaid. ⋯ U. S. hospice care is predominantly care delivered in the place the patient calls home (95.6%). Although the hospice benefit has provided palliative care for more patients and families than any other country, the requirements for use have been found to be self-limiting.
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End-of-life decisions for children can be complicated by disagreements between families and health care teams. These conflicts can lead to moral distress in providers. In addition, difficulties in prognostication aggravate the problem. ⋯ Through a case study of a child with a severe life-limiting syndrome, an analysis of both the ethical and legal implications of parental and team conflict are discussed. An ethics team can help provide guidance for teams and help mediate goals of care discussions with families. Palliative care consultation can also be useful, especially in providing support for both the parent and the child.
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J Pain Symptom Manage · Jul 2009
Optimizing decision making and resource allocation in palliative care.
Optimizing resource allocation in end-of-life care is one of the most difficult issues currently being addressed within the U. K. National Health Service. ⋯ Arguably, the value placed on improving quantity and quality of life is dependent on the context in which they are derived. In such circumstances, we can either adjust cost-effectiveness thresholds to ensure that end-of-life interventions have a less stringent cost-effectiveness hurdle to overcome or we can derive an entirely new evaluative framework that better captures the true value of interventions focusing primarily on care rather than cure. Irrespective of the approach taken, optimizing resource allocation in palliative care is crucial in ensuring that overall therapeutic objectives both for individual patients and for this patient group as a whole are achieved to the greatest degree possible.