Journal of pain and symptom management
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J Pain Symptom Manage · Mar 2018
Oncologists' and patients' perceptions of initial, intermediate, and final goals of care conversations.
Although recommendations are for goals of care (GoC) conversations to happen early and often, their timing and content over the disease course remain unclear. ⋯ Although GoC conversations should follow individual patient preferences, our findings offer structure for their timing and content.
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J Pain Symptom Manage · Mar 2018
Bringing the Medical Home back Home in the Context of Population Health - Home-Based Primary Care and Home-Based Palliative Care.
With the growth of value-based care, payers and health systems have begun to appreciate the need to provide enhanced services to homebound adults. Recent studies have shown that home-based medical services for this high-cost, high-need population reduce costs and improve outcomes. ⋯ Given workforce constraints and growing demand, both HBPC and HBPalC will benefit from working together within a population health framework-where HBPC provides care to all patients who have trouble accessing traditional office practices and where HBPalC offers adjunctive care to patients with high symptom burden and those who need assistance with goals clarification. Policy changes that support provision of medical care in the home, population health strategies that tailor home-based medical care to the specific needs of the patients and their caregivers, and educational initiatives to assure basic palliative care competence for all home-based medical providers will improve access and reduce illness burden to this important and underrecognized population.
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J Pain Symptom Manage · Mar 2018
Changes in the Use of Intensive and Supportive Procedures for Patients With Stroke in Taiwan in the Last Month of Life Between 2000 and 2010.
Stroke is the second leading cause of death and the primary cause of disability worldwide. It is uncertain what care patients with stroke receive in their end of life and what trends in care are in recent years. ⋯ Over time, the use of supportive procedures increased, and the use of intensive procedures decreased in patients with stroke in the last month of life. This study highlights a need for research, guidelines, and training in how to provide palliative care for end-stage patients with stroke.