Journal of palliative medicine
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Pediatric palliative care (PPC) aims to promote quality of life for children and their families through prevention and relief of physical and psychosocial symptoms. Little is known about how PPC/hospice services impact health care resource utilization in an uncertain financial landscape. ⋯ Enrollment in home-based PPC/hospice was associated with lower hospital and ER LOS and total hospital charges as compared with the period prior to enrollment for children with noncancer diagnoses.
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End-of-life care (EOLC) is a key component in care of older people. However, evidence suggests that the oldest old (>85 years) are less likely to access specialist EOLC. ⋯ Age-associated disparity exists in care provided in the last two days and the realization of preferences.
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Hospice brings substantial clinical benefits to dying patients and families but is underutilized by patients dying of hematologic malignancies (HM); nationwide, only 2% of HM patients use hospice. There are 70,000 deaths among U.S. patients with hematologic malignancies yearly. ⋯ HM patients are referred late or never for hospice services. Studies evaluating earlier integration of palliative and hospice care with usual HM care are warranted. We present a one-page negotiation form that we have found useful in negotiations among HM physicians, hospice medical directors, and payers.
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The communication skills of noticing emotional cues and responding empathically are necessary but insufficient for some conversations about redefining goals of care. For some patients, an empathic response by a clinician is insufficient to move the conversation forward. We describe an expert approach that links empathy to action. In this approach, we outline (1) how affect provides a spotlight that illuminates what is important, (2) how empathy affords a way to connect with patients and families that engages deep values, (3) how clinicians can infer deep values through an associative process with patients, and (4) how clinicians can then design actions with patients and families and nurture their commitment to the actions.