The American journal of hospice & palliative care
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Am J Hosp Palliat Care · Sep 2010
Comparative StudyThe triad that matters: palliative medicine, code status, and health care costs.
Delayed discussion of a patient's code status can lead to shortsighted care plans that increase hospital length of stay (LOS) and costs. ⋯ The amount of time that expires until the issue of code status was settled to clearly related to utilization of hospital resources.
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Am J Hosp Palliat Care · Sep 2010
Implementing evidence-based practices: considerations for the hospice setting.
With increased regulation and scrutiny of outcomes, hospice programs are being challenged to consider the implementation of evidence-based practices (EBPs). This study reports findings from hospice director interviews and staff focus groups, which occurred following the completion of a multifaceted translating research into practice (TRIP) intervention designed to promote evidence-based pain management practices. ⋯ Three areas for evaluation prior to implementing an EBP initiative in hospices were identified: community, agency, and staff cultures. Recommendations for implementation of EBPs in hospices are provided.
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Am J Hosp Palliat Care · Sep 2010
Case ReportsUse of sustained release oral morphine as a bridge in withdrawal of morphine in patients on high doses of oral immediate release morphine for cancer pain.
According to World Health Organization (WHO), cancer pain can be controlled effectively with oral morphine in up to 90% of patients. Due to advancement in anticancer therapy and early presentation of cancer patients, the likelihood of cure is on an increasing trend. Awareness and education in the use of oral morphine, and easier regulations in procurement of oral morphine for use in cancer pain has lead to prescription of oral morphine to more patients earlier in pain therapy. ⋯ Guidance for starting medications is fairly easily obtained, but it is difficult to find information about switching or discontinuing opioids. The initial decrease in dose is well tolerated by the patient but the last few steps of complete withdrawal are difficult. We present 2 cases where the sustained release oral morphine was used as a bridge to withdraw immediate release oral morphine successfully in 2 patients after resolution of disease.
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Am J Hosp Palliat Care · Sep 2010
Personality characteristics of hospice palliative care volunteers: the ''big five'' and empathy.
The goal of this study was to examine the personality characteristics of hospice palliative care volunteers by measuring the so-called big five personality traits and 4 separate aspects of empathy. A total of 99 hospice palliative care volunteers completed the NEO Five-Factor Inventory (NEO-FFI) of Costa Jr and McCrae and the Interpersonal Reactivity Index (IRI) of Davis. ⋯ On the empathy measure, female hospice palliative care volunteers scored significantly higher on the empathic concern and perspective taking subscales compared to the female norms, and significantly lower on the personal distress and fantasy subscales. The results of this study may have implications for the recruitment and retention of hospice palliative care volunteers.
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Families and their dying members have notably unmet needs. This is in large part due to health professionals being unprepared to be authentic (emotionally appropriate, purposive, and responsible) in end-of-life encounters. ⋯ Patterns emerged in a presence of authentic being-with dying, which assisted persons in their transitions toward a peaceful death. Patterns are explicated in a 5-point framework, which paralleled Heidegger's structures of authentic being-toward-death.