Journal of palliative medicine
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Background: Oncologists routinely have opportunities for goals-of-care (GoC) discussions with patients. GoC discussions increase the likelihood that patients receive care consistent with their values. However, oncologists often feel ill-equipped to discuss end-of-life care. ⋯ Assessing for understanding, offering "I wish" statements, and providing prognosis were the least utilized skills among all oncologists. Conclusion: Our real-time communication skills coaching INT resulted in a significant increase in oncologists' ability to elicit patient values during GoC discussions, suggesting that skill acquisition can occur in the face of less intensive training. Future studies can highlight gaps leading to the lack of differences in utilization of other skills.
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Objective: To examine the relationship between admission Karnofsky Performance Status (KPS) and discharge disposition. Background: Little is known about the relationship between functional status before hospitalization and discharge disposition. Methods: In a retrospective cohort study of patients seen by Mount Sinai Hospital Medicine Primary Palliative Care Program (HPPC), we used demographic and clinical data to compare discharge disposition by patients' functional status before admission into the hospital. ⋯ Key Message: This retrospective cohort study examined the relationship between KPS before hospital admission and discharge disposition in hospitalized seriously ill patients admitted to the hospital medicine service who received a HPPC consultation. The results suggest that those with a higher admission KPS (more functional) are more likely to be discharged home, whereas those with a lower KPS (less functional) are more likely to be discharged to a facility or hospice. KPS before hospital admission could guide palliative care resource allocation and discharge needs.
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Background: An often-stated concern is that dying persons receive too much aggressive medical care. Objective: Examine next-of-kin perceptions of the amount of medical care received in the last month of life. Design: Mixed-methods study with 623 survey responses and in-depth interviews with a subsample of 17 respondents. ⋯ Respondents who reported "too little" compared with those that stated the "right amount" reported higher unmet needs for symptom palliation, physician communication concerns, with other important opportunities to improve the quality of care. Among the 17 in-depth interviews of those indicating "too little" care on the structured survey, the predominant concern (n = 10) was inadequate symptom management. Conclusion: While the majority of respondents indicated their loved one received the right amount of medical care at the end of life, a notable minority (one in six) indicated that their loved one received too little care.
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Background: There is paucity of data on the potential value of early palliative home care for patients with hematologic malignancies. Objective: To compare costs, use of resources, and clinical outcomes between an early palliative home care program and standard hospital care for active-advanced or terminal phase patients. Patients and Methods: In this real-life, nonrandomized comparative study, the allocation of advanced/terminal phase patients to either home or hospital was based on pragmatic considerations. ⋯ Compared with hospital, domiciliary assistance produced a weekly saving of € 2314.9 for the health provider, with a charge of € 85.9 for the family, and was cost-effective by an ICER of € -7013.9 of prevented days of care for avoided infections. Conclusions: Current findings suggest that costs of early palliative home care for patients with hematologic malignancies are lower than standard hospital care costs. Domiciliary assistance may also be cost-effective by reducing the number of days to treat infections.
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Objective: To improve residents' knowledge, self-perceived skills, and attitudes about hospice. Methods: An online case-based curriculum in a flipped classroom design was provided to postgraduate year-one (PGY-1) residents. Residents completed a pre- and postassessment. ⋯ Satisfaction with training in hospice was significantly higher after receiving the curriculum. Conclusion: A flipped classroom curriculum increased knowledge, confidence in skills, and satisfaction with residency training in hospice care. This design offers curriculum solutions that address competing demands in the new era of social distancing and remote learning.