Journal of palliative medicine
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Objective: Medication management in home hospice is challenging for family caregivers (FCGs). We tested a patient-centered medication review and FCG support program delivered by hospice staff called "Shared Medication PLanning In (SiMPLIfy) Home Hospice." Methods: A pilot cluster-randomized trial at two U. S. home hospice agencies measured the primary outcome of reduction in Medication Regimen Complexity Index (MRCI) (range 0 [no medications]-no upper limit) and secondary outcome of Family Caregiver Medication Administration Hassle Scale (FCMAHS) (range 0 [no hassle-120 [greatest hassle]). ⋯ FCMAHS differed between spousal and nonspousal FCGs (p = 0.12). Conclusion: A clinician-FCG-patient communication program in home hospice is feasible and may reduce medication complexity. SiMPLIfy has the potential to reduce polypharmacy.
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Context: Social determinants of health (SDOH) impacted the quality of home hospice care provided during the COVID-19 pandemic. Perspectives from professionals who provided care identify challenges and lessons learned from their experience. Objective: To examine hospice professionals' perspectives of how SDOH affected the delivery of high-quality home hospice care in New York City (NYC) during the COVID-19 pandemic. ⋯ Conclusion: SDOH provide a context to understand disparity in the provision of hospice care. COVID-19 exacerbated these conditions. Addressing multidimensional barriers created by SDOH is key in creating high-quality and equitable hospice care, particularly during a crisis.
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Objectives: While epidural anesthesia is an established technique for labor and perioperative pain, its use in the hospice setting remains limited, resulting in a reliance on oral opioids. We describe patients with intractable pain who pursued hospice enrollment with tunneled epidural analgesia for pain management. Methods: All patients who received a tunneled epidural prior to hospice enrollment between January 1, 2017, and September 20, 2023, were included. ⋯ The average change in OME was -122.73 mg. Conclusions: Overall, tunneled epidural analgesia may be an underutilized method of pain management for patients at end-of-life with intractable pain. Further high-quality research on the subject is necessary to establish effectiveness, safety, and barriers to implementation.