Journal of palliative medicine
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Access to hospice is a growing public health matter given that quality care at the end of life should be provided to all individuals regardless of race, ethnicity, or socioeconomic status. Health care disparities, particularly among racial and ethnic groups, have been well documented in the scientific literature. However, little is known about the demographics of hospice users or the use of hospice services by specific racial and ethnic groups. ⋯ Racial variations in hospice use indicate minorities use services disproportionately less than white patients, even after researchers control for specific sociodemographic and clinical characteristics.
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To assess the reliability of quality indicators of end-of-life cancer care (QI-EOL) and evaluate the quality of end-of-life cancer care in general wards by using QI-EOL. ⋯ QI-EOL is generally a reliable quality measure instrument. We found the need for improvements of end-of-life cancer care in general wards using the QI-EOL.
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Studies of end-of-life care have shown that Latino patients want more aggressive care compared to white patients. While this has been attributed to aspects of ethnicity, national origin, and religion, it is possible that limited education might obscure the true relationship between Latino patients and their end-of-life care preferences. ⋯ Educational level was an independent predictor of end-of-life preferences after hearing a verbal description of advanced dementia. After viewing a video of a patient with advanced dementia there were no longer any differences in the distribution of preferences according to educational level. These findings suggest that educational level is an important variable to consider in research and in patient care when communicating about end-of-life care preferences. While attention to patients' culture is important, it is also important to avoid ascribing choices to culture that may actually reflect inadequate comprehension. Attention to communication barriers with techniques like the video used in the current study may help ensure optimal end-of-life care for Latino patients irrespective of educational level.
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Editorial Comment
Progress in measuring and improving palliative and end-of-life quality.
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ABSTRACT Carotid blowout is a devastating complication in patients with head and neck malignancy. The traditional surgical treatment for carotid blowout is often technically difficult and is associated with an unacceptably high morbidity and mortality. Recently, endovascular therapy has been proposed for head and neck surgical patients. ⋯ The use of such techniques in cases of impending or acute carotid blowout syndrome has been previously described to be beneficial for palliative head and neck cancer patients as well. We introduce a case of a head and neck cancer patient receiving palliative care, presenting with threatened carotid blowout, who was managed with endovascular placement of a covered stent under elective conditions in order to prevent an inevitable carotid rupture. In the present case endovascular carotid stenting allowed preservation of the vessel, prevented the dramatic situation of carotid rupture, and facilitated a rapid hospital discharge without any neurologic or stenting sequelae.