Journal of palliative medicine
-
Pain is a common symptom for patients with advanced illness. Palliative care (PC) clinicians are experts in pharmacologic and nonpharmacologic treatment of pain and other symptoms for these patients. ⋯ This article, written by clinicians with expertise in interventional pain and PC, outlines and explains many of the adjunctive and interventional therapies that can be considered for patients with pain in the setting of serious illness. Only by understanding and considering all available options can we ensure that our patients are receiving optimal care.
-
Background: Fetal malformations are diagnosed prenatally in nearly 3% of pregnancies, and ∼1.2% are major malformations. After prenatal diagnosis, it is imperative to consider families' values and to support their decision-making process. Prenatal palliative care is a growing field mainly based on family conferences. ⋯ Five main themes and 18 categories emerged from the charts and are described in detail. A model of follow-up in prenatal palliative care is proposed based on the themes and categories identified. Conclusions: This analysis may guide health professionals who seek to better identify family needs and values and organize follow-up during prenatal palliative care.
-
Objective: To describe trends in hospice social work visits in the last week of life before and after the introduction of the service intensity add-on (SIA) payment reform in 2016. Background: SIA was introduced to compensate hospices for the intensity of caring for individuals at the end of life; it is an hourly rate paid for registered nurse and social worker visits occurring during the last week of a beneficiary's life. Little is known about how hospices responded to this payment incentive. ⋯ This modest increase masks significant variation based on organizational characteristics, such as size, facility type, and participation in payment demonstrations. Discussion: Our findings underscore the importance of examining both the overall impact of this type of policy and the change in distribution to identify whether change is being realized uniformly or is associated with certain types of organizations. A number of potential barriers exist to responding to policy incentives that may not be evenly felt across the hospice community.
-
Objective: The aim of this study was to describe the patterns of discharge and re-enrollment to a community palliative care service, and to identify factors associated with re-enrollment. Background: Community-based palliative care is a limited resource. The evidence base to guide discharge practices from community palliative care services is limited. Methods: A retrospective audit of the electronic medical records for all patients discharged from the Sacred Heart Community Palliative Care Service (SHCPCS), Sydney, from July 2010 to July 2016 was conducted. Patients were excluded if they were discharged due to death, transferred out of catchment area, declined the service, transferred to another hospital, or were referred inappropriately. ⋯ Patients living in residential care facilities (odds ratio [OR] 3.45; 95% confidence interval [CI] 1.28-9.28; p = 0.01) and those with malignant diagnoses (OR 2.22; 95% CI 1.00-4.93; p = 0.04) had higher rates of re-enrollment. Discussion: The proportion of patients re-enrolled to the service was low. Both patient factors and disease factors were associated with re-enrollment. Future prospective studies evaluating prognostic factors to assist with effective discharge processes and guidelines are warranted.