Journal of pain and symptom management
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J Pain Symptom Manage · Mar 2018
Relating to the experience of contingency in patients with advanced cancer; an interview study in American patients.
Being diagnosed with incurable cancer can be a life-changing experience, evoking different spiritual questions and needs. Confronting a serious life-threatening event occurs not only often unexpected but also can disrupt a person's self-image and ideals of their personhood. This confrontation makes it difficult for people to integrate it into their personal life story-otherwise referred to as an experience of contingency. ⋯ This study ensures a broader and deeper understanding of relating to the experience of contingency in having incurable cancer, which is crucial in developing accurate spiritual care in the palliative phase of patients.
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J Pain Symptom Manage · Mar 2018
Hospice Exposure Is Associated with Lower Healthcare Expenditures in Taiwanese Cancer Decedents' Last Year of Life: A Population-Based Retrospective Cohort Study.
Evidence for the association of hospice exposure with lower health care expenditures at end of life (EOL) remains inconclusive and neglects EOL care being concentrated in patients' last few months. ⋯ Hospice care was associated with lower health care expenditures when it could actively intervene in EOL care. Hospice philosophy should be applied not only shortly before death but also throughout the dying trajectory to achieve maximum cost savings.
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J Pain Symptom Manage · Mar 2018
Physician Decision-Making in the Setting of Advanced Illness: An Examination of Patient Disposition and Physician Religiousness.
Little is known about patient and physician factors that affect decisions to pursue more or less aggressive treatment courses for patients with advanced illness. ⋯ This study provides preliminary evidence that patient disposition toward more and less aggressive treatment in advanced illness does not substantially factor into physician recommendations. Non-religious physicians appear less likely to recommend disease-directed medical treatment in the setting of advanced illness, although this finding was not uniform and deserves further research.
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J Pain Symptom Manage · Mar 2018
Do Live Discharge Rates Increase as Hospices Approach Their Medicare Aggregate Payment Caps?
The rate of live discharge from hospice and the proportion of hospices exceeding their aggregate caps have both increased for the last 15 years, becoming a source of federal scrutiny. The cap restricts aggregate payments hospices receive from Medicare during a 12-month period. The risk of repayment and the manner in which the cap is calculated may incentivize hospices coming close to their cap ceilings to discharge existing patients before the end of the cap year. ⋯ Policymakers ought to consider the unintended consequences the aggregate cap may be having on patient outcomes of care.
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J Pain Symptom Manage · Mar 2018
Physicians' Opinions on Engaging Patients' Religious and Spiritual Concerns: A National Survey.
There has been a sustained debate in the medical literature over whether physicians should engage with patients' religious and spiritual concerns. ⋯ The majority of U.S. physicians endorse a limited role in the provision of spiritual care, although opinions varied based on physicians' religious characteristics.