Journal of palliative medicine
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Background: Investigators have tested interventions delivered by specialty palliative care (SPC) clinicians, or by clinicians without palliative care specialization (primary palliative care, PPC). Objective: To compare the characteristics and outcomes of randomized clinical trials (RCTs) of SPC and PPC interventions. Design: Systematic review secondary analysis. ⋯ Improvements were demonstrated on quality of life by SPC and PPC trials and on physical symptoms by SPC trials. Conclusions: Compared to PPC, SPC interventions were more comprehensive, were more often delivered in clinical settings, and demonstrated stronger evidence for improving physical symptoms. In the face of SPC workforce limitations, PPC interventions should be tested in more trials with low risk of bias, and may effectively meet some palliative care needs.
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Introduction: In 2013, the Vermont legislature passed Act 39: The Patient Choice and Control at End-of-Life Act, which legalized medical aid in dying (MAID) under specific circumstances for terminally ill Vermont residents. In the five years since the law was passed, 52 patients in Vermont have been prescribed medications to hasten death; however, important information regarding the experiences of the patient, caregiver, or physician involved in this process is lacking. Objective: To survey the subspecialty physicians with the greatest contact with these patient populations, to better understand the physicians' attitudes and experiences with Act 39, and to gather more data about the utilization of Act 39 in Vermont. Design: Physicians practicing Hematology/Oncology, Neurology, and/or Palliative Care at the University of Vermont Medical Group and affiliated hospitals in the state of Vermont were invited to participate. ⋯ Seventy-one percent of the participants supported MAID via Act 39; however, many felt that they could use more information and resources to counsel a patient (51.4%) and complete the paperwork and prescription for life-ending medication (37.4%). Conclusion: This is the first study to collect information regarding physicians' attitudes and experiences regarding Act 39 in Vermont. Most respondents supported Act 39, but there is a need and desire for more physician education and resources regarding patient counseling and paperwork.