Journal of palliative medicine
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Lack of evidence supporting the claim that palliative care can improve quality of life and promote good death in patients with terminal cancer. ⋯ Under comprehensive palliative care, patients with terminal cancer can have good quality of life and experience a good death even with short survival.
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Giving a Grand Rounds presentation provides the hospice and palliative medicine subspecialist with the occasion to participate in a time-honored and respected event. It remains an opportunity to promote the discipline, support institutional culture change, and favorably influence the attitudes, knowledge, skills, and performance of colleagues. For those pursuing academic careers, it also is a chance to establish academic currency and develop teaching and presentation skills. ⋯ To do this well, adult learning principles must be thoughtfully incorporated into a presentation style and method appropriate to the venue. The approach emphasizes learner-centeredness, interactive strategies, and evaluation. Room for creativity exists at every step and can add enjoyment and challenge along the way.
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In 2008, the Centers for Medicare & Medicaid Services (CMS) required U.S. hospices to implement comprehensive quality improvement programs. CMS contracted with the Quality Improvement Organization in North and South Carolina to develop quality measures and instruments to assess hospice and palliative care quality. ⋯ Specifications and data collection tools are available for 34 PEACE quality measures that were highly rated by experts in hospice and palliative care. Future research should assess the scientific soundness and responsiveness of these measures to quality improvement.
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Palliative medicine has made rapid progress in establishing its scientific and clinical legitimacy, yet the evidence base to support clinical practice remains deficient in both the quantity and quality of published studies. Historically, the conduct of research in palliative care populations has been impeded by multiple barriers including health care system fragmentation, small number and size of potential sites for recruitment, vulnerability of the population, perceptions of inappropriateness, ethical concerns, and gate-keeping. ⋯ The resulting Palliative Care Research Cooperative (PCRC) agreed on a set of core principles: active, interdisciplinary membership; commitment to shared research purposes; heterogeneity of participating sites; development of research capacity in participating sites; standardization of methodologies, such as consenting and data collection/management; agile response to research requests from government, industry, and investigators; focus on translation; education and training of future palliative care researchers; actionable results that can inform clinical practice and policy. Consensus was achieved on a first collaborative study, a randomized clinical trial of statin discontinuation versus continuation in patients with a prognosis of less than 6 months who are taking statins for primary or secondary prevention. This article describes the formation of the PCRC, highlighting processes and decisions taken to optimize the cooperative group's success.
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Recently, the discussion about medical errors and patient safety has gained scientific as well as public attention. Errors in medicine have been proven to be frequent and to carry enormous financial costs and moral consequences. We aimed to review the research on medical errors in palliative care and to screen relevant literature to appreciate the relevance of safety studies to the field. ⋯ Although patients in palliative care are more vulnerable to errors and their consequences, there is little theoretical or empirical research on the subject. We propose a specific definition for errors in palliative care and analyze the challenges of delineating, identifying and preventing errors in such key areas as prognostication, advance care planning and end-of-life decision-making.