Journal of palliative medicine
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Randomized Controlled Trial
Nurse education program on meaninglessness in terminally ill cancer patients: a randomized controlled study of a novel two-day workshop.
Fostering patients' sense of meaning is an essential task for palliative care clinicians. Few studies have reported the effects on nurses of a short-term training program aimed at improving skills to relieve feelings of meaninglessness in terminally ill cancer patients. ⋯ This short-term educational intervention had a significant beneficial effect on nurses' confidence and modest effects on attitudes.
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The majority of young people in need of palliative care live in low- and middle-income countries, where curative treatment is less available. ⋯ Comprehensive pediatric palliative care provision is possible even in markedly impoverished settings. Improved national health system support, specialized training and opioid access are key targets for research and advocacy. Application of a checklist methodology can promote awareness of gaps to guide program evaluation, reporting, and strengthening.
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Observational Study
Factors associated with in-hospital death by site of consultation among elderly inpatients receiving pain and palliative care consultations.
Despite palliative care implementation, most deaths still occur in hospitals. ⋯ Among elderly non-ICU medical patients receiving palliative care consultations, the need for a consultation to assist with plan of care was associated with in-hospital death, while length of stay prior to consultation was important among both elderly ICU and non-ICU medical patients. Elderly hospitalized patients may benefit from earlier identification and palliative care consultation for assistance with plan of care to avoid in-hospital death.
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The right to self-determination is fundamental in clinical ethics. End-of-life conversations and advance directives (ADs), in addition to preserving this right, have been shown to decrease the likelihood of in-hospital death, improve the quality of care, and lower health costs in the final week of life. Despite these benefits, the rates of AD documentation are poor. ⋯ EMR-based reminders are effective in improving documentation rates of ADs. Further research is needed to establish whether improved documentation impacts inpatient management and costs of care.