Journal of palliative medicine
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Background: There are racial/ethnic disparities in hospice use and end-of-life (EOL) care outcomes in the United States. Although the use of community health workers (CHWs) and patient navigators (PNs) has been suggested as a means of reducing them, CHW/PNs' attitudes toward a palliative care philosophy remain unknown. The purpose of this study was to examine how personal attributes affect a CHW/PN's attitude toward EOL care. ⋯ Eighty percent strongly agreed or agreed with being open to discussing death with a dying patient. Higher self-efficacy scores were associated with more favorable attitudes toward hospice (r = 0.306, p = 0.016). Conclusions: CHWs/PNs have an overall favorable attitude toward the palliative care philosophy and may be inclined to providing EOL care.
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Observational Study
Feasibility and Clinical Usefulness of a Novel Nonwearable Sheet-Type Monitor (Nemuri SCAN): Prognostic Value of Increased Respiratory Rate in Actively Dying Patients.
Objective: The objective of this study was to explore the feasibility of monitoring actively dying patients hospitalized in a palliative care unit using a nonwearable sheet-type monitor that measured the state of sleep and vital signs per minute. In addition, we aimed to clarify the incidence of increased respiratory rate and its relationship with survival time. Design and Measurement: This study was conducted at a 51-bed palliative care unit in Japan from April 2018 through October 2019. ⋯ The cumulative incidence of increased respiratory rate (defined as more than 30 respiratory rate per minute) was 63.16% during the observational period, and the mean time between appearance of increased respiratory rate and death was 4.17 ± 4.04 days. Conclusion: This study clearly shows that hospitalized actively dying patients can be monitored using a nonwearable sheet-type monitor that measures sleeping state and vital signs per minute. Further studies are needed to utilize these noninvasive continuous monitoring devices in daily clinical practice.
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Background: Despite availability of educational resources and documentation methods for advance care planning (ACP), few video tools exist. Animation relevant to Veteran experiences may enhance clinical conversations by illustrating relatable scenarios. Objective: To explore clinician perspectives on four novel video vignettes created by the study group. ⋯ Videos were relatable, relevant, and motivating with 90% respondents reporting ready intention to use in clinical practice. Conclusions: Veteran-specific animated video vignettes are received affirmatively by Veteran Affairs clinicians. These videos have potential to foster early engaged discussions about ACP.
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Background: The COVID-19 pandemic has spurred unprecedented need for specialty palliative care. The Palliative Care Quality Collaborative (PCQC) provides unique infrastructure for rapid data collection and analysis. Objectives: To capture and describe real-time, real-world experiences of specialty palliative care professionals caring for patients with COVID-19 through a rapid reporting tool and registry. ⋯ All pediatric patients were full code before and after palliative care consult. Qualitative themes were strained communication with patients, family visitation challenges, communication barriers between clinicians and families, rapid changes in palliative care medical management, community care options difficult to find, lack of testing in community-based settings, and guardianship and legal challenges. Conclusion: Preliminary data from the first 306 patients reported to the PCQC COVID-19 Registry describe palliative care use concentrated among older and higher risk patients and challenges to the provision of palliative care during this pandemic.
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As many hospitals scaled back integrative therapies during the COVID-19 pandemic, we instead turned to the multifaceted qualities of music to bridge physical and social divides. In this report, we describe palliative care music therapists as frontline providers utilizing evidence-based approaches to support healing and recovery for patients in the intensive care unit, patient and family care at end of life, and staff wellness. ⋯ Despite barriers brought on by the pandemic, the sensory and emotional immediacy of music bridged social distances at critical moments and addressed "suffering beyond words" among patients, families and health care workers. Our experience reinforced the need for MT as standard of interdisciplinary care during the pandemic and beyond.