The American journal of hospice & palliative care
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Am J Hosp Palliat Care · May 1999
Perceptions and decision-making on rehydration of terminally ill cancer patients and family members.
Although the appropriateness of forced rehydration for terminally ill cancer patients has been actively discussed, few studies have investigated its psychological aspects. To clarify patients' and family members' perceptions about rehydration and identify contributing factors for decision-making, a prospective structured survey was performed on 121 hospice inpatients with insufficient oral intake. Physicians did not recommend rehydration in 78 percent of patients, and 75 percent decided not to receive artificial fluid therapy. ⋯ Multiple regression analyses revealed patients' denial, physicians' recommendations determined by patients' performance status and fluid retention symptoms, and family members' belief that rehydration could worsen patients' distress as independent determinants for rehydration. In conclusion, hospice care receivers had various concerns about rehydration, related to patients' nutrition, survival, and distress. The main determinants for rehydration therapy were patients' performance status, fluid retention symptoms, denial, and care receivers' beliefs about the effect of hydration on the patients' distress.
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In order to develop standards of care that alleviate pain and other distressing symptoms among dying patients, the Providence Hospice of Yakima team has developed and utilized pain and nonpain symptom management algorithms. In use since late 1993, the system is a success, as demonstrated by positive satisfaction surveys among physicians, staff, and family members. This article offers an introduction to the algorithmic process, key components of its success, and guidelines for further improvement in the care provided to dying patients.
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Am J Hosp Palliat Care · May 1999
The Minimum Data Set 2.0: a functional assessment to predict mortality in nursing home residents.
Measures of functional assessment, such as the Karnofsky Scale, the Modified ADL Scale, and the Descriptive Scale, have been used to predict appropriateness for hospice care. A tool is needed to assess functional status across all treatment settings, including acute care, long-term care, and hospice. The objective of this paper is to determine whether the Minimum Data Set, when utilized in conjunction with physical assessment tools to determine prognosis, is accurate in predicting short-term mortality in nursing home residents. ⋯ The data were then analyzed to determine whether there existed a correlation between a significant change, as documented on the Minimum Data Set, and subsequent death of the patient. If there existed a correlation, the data were further studied to determine consistency in the categories of change that might demonstrate predictors of short-term mortality in nursing home residents. A decline in functional status, as documented on the Minimum Data Set 2.0 in the areas of cognitive functioning, communication, activities of daily living, incontinence, and nutrition, are strong predictors of short-term mortality in nursing home residents, independent of age, gender, and diagnosis.