Journal of palliative medicine
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Background: Patients with cancer employ medicinal cannabis for poly-symptom management and as cancer-directed therapy. Little is known about their perspectives on the medicinal cannabis "high." Methods: Qualitative interviews across eight states with medicinal cannabis users with physician-verified cancer diagnoses (n = 24). ⋯ Conclusions: The "high" is central to the manner with which patients with cancer experience medicinal cannabis. Clinicians should be aware that patients may struggle to fine-tune medicinal cannabis dosing in the setting of the "high," and this challenge should be included in clinical discussions regarding oncological medicinal cannabis use.
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Objective: To determine whether families would make use of a pediatric-specific inpatient hospice facility for end-of-life care for children. Background: Location of end-of-life care and death are important considerations when treating children with life-limiting conditions. There is very limited research on utilization of an inpatient hospice facility for end-of-life care if a pediatric-specific facility is available. ⋯ The percent of patients who died in an inpatient hospice unit also increased significantly with the opening of the pediatric facility. Discussion: Results of this study show that providers are more likely to refer, and families are more likely to use inpatient hospice services when pediatric facilities are available. These results are important for establishing an evidence base in support for increasing access to PHFs.
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Observational Study
Impact of Early Referral to Palliative Care in Patients with Interstitial Lung Disease.
Background: Interstitial lung diseases (ILDs) have a major impact on survival and quality of life but only a small percentage of patients are referred for palliative care (PC). Objective: To assess the impact of early PC referral on hospital admissions, emergency department visits, and place of death in the last year of life. Design: This is a single-center retrospective observational study. ⋯ Results: Of the 51 included patients, 45% received early PC referral. Logistic regression indicated that early PC referral was independently associated with a lower risk of hospital admissions in the last year of life (OR = 0.16; 95% CI 0.03-0.75; p = 0.02) and a lower risk of dying in hospital (OR = 0.11; 95% CI 0.02-0.5; p = 0.009). Conclusion: Early PC referral reduces the need for hospitalization and enables domiciliary death.
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Medical interpreters are the primary facilitators of effective communication between clinical providers and patients with limited English proficiency. They can assist in managing complex meetings in which patients, families, and clinicians decide on next steps in care. ⋯ Rather than using an interpreter as a language tool, this article encourages PC clinicians to cultivate a partnership with the interpreter as a team member. We describe 10 tips for effective partnering with interpreters: the importance of including the interpreters in preencounter huddles and post-encounter debriefs, agreeing on strategies for interpreting "untranslatable" words and managing the encounters, using the "teach back" method to ensure understanding, acknowledging interpreters as cultural mediators, understanding the potential emotional impact of family meetings on interpreters, and enhancing follow-up with the PC team by providing contact information for PC staff to patients.