Journal of palliative medicine
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Perinatal palliative care (PPC) programs are proliferating nationwide, but little is known about their structure, process, or desired outcomes, to inform future program development. ⋯ While PPC programs do not often measure quality, their goals are family centered, with a focus on parent satisfaction with decision making and psychosocial support. PPC programs coordinate interdisciplinary care by arranging meetings and advocating for families. More research is needed to understand parent perspectives on care provided.
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Red blood cell (RBC) transfusions are commonly prescribed for palliative care patients for symptoms. However, RBCs are a limited resource, transfusion is not without risk, and may be of variable benefit in people approaching the end of life. The aim of this study was to review RBC transfusions in our palliative care unit (PCU), examining evidence of benefit or harms, and preparing for a prospective multisite study. ⋯ For RBC transfusion in palliative care patients, the majority had subjective benefit. However, subjective improvement correlated poorly with objective scale-based measures. The sensitivity of assessment scales, high rates of placebo response, and the multifactorial nature of symptoms at the end of life make evaluation of RBC transfusions challenging.
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Rituals can increase a sense of connectedness, meaning, and support, especially after the death of those for whom we care. Hospice staff may benefit from the use of personal rituals as they cope with the frequent deaths of their patients, ultimately aiming to provide compassionate care while minimizing burnout. ⋯ Rituals may be an important way to increase compassion and decrease burnout among hospice staff and volunteers. Organizations may benefit from providing training and support for personalized rituals among team members, especially new staff who may be at greater risk for burnout.
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Intimacy is an important component of the palliative care (PC) assessment. Evaluation of patient concerns related to intimacy should be included in a comprehensive PC consultation. The concerns are rarely assessed for hospitalized PC patients, yet there is evidence to support that patients want to talk about intimacy. ⋯ Pilot data from this quality improvement (QI) project suggest a clear need for intimacy assessment in PC consultation. Intimacy is impacted by serious illness and patients/partners want to discuss issues with clinicians. PC clinicians can incorporate intimacy discussions as part of a routine assessment without adding significant amount of time.
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Family conferences are an essential component of high-quality ICU care and an important skill for physicians. For residents, intensive care unit (ICU) rotations represent an opportunity to learn to conduct family conferences, and residents are already familiar with an approach for learning ICU procedures with steps of increasing responsibility organized as a module. ⋯ This five-component module for teaching family conferences was rated as acceptable by most respondents, but significant barriers to successful implementation must be addressed before this is likely to be an effective teaching method.