Journal of palliative medicine
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Background and Objective: With the increase of visits among patients with end-of-life needs, palliative care (PC) interventions delivered in the emergency department (ED) have become increasingly important. The objective of this systematic review was to examine the effectiveness of ED-based PC interventions. Methods: A comprehensive search of the literature was conducted to identify any comparative studies assessing the effectiveness of ED-based PC interventions. Two independent reviewers completed study selection, quality assessment, and data extraction. ⋯ Two randomized trials reported no difference in mortality (RR = 0.89; 95% CI: 0.71-1.13; I2 = 0%), while one cohort study reported an increased mortality among patients referred to PC in the ED (RR = 1.89; 95% CI: 1.58-2.27). Overall, six out of eight studies reported a decrease in hospital length of stay (LOS) among patients undergoing an ED-based PC intervention compared with usual care. Conclusions: While there is compelling evidence to suggest that ED-based PC interventions can reduce hospital LOS, the evidence for the impact of these interventions on other outcomes is less robust. More high-quality comparative studies are needed to better understand the overall impact of ED-based PC interventions on improving patient outcomes as well as improving throughput and other quality of service-related outcomes.
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Background: Palliative care-related postdoctoral training opportunities are critical to increase the quantity and quality of palliative care research. Objective: To describe the history, activities, challenges, and future goals of the National Postdoctoral Palliative Care Research Training Collaborative. Design: National web-based survey of participating program leaders. ⋯ Key challenges relate to recruiting diverse trainees, fostering a shared identity, effectively advocating for trainees, and securing funding. Future goals include expanding efforts to engage clinician and nonclinician scientists, fostering the pipeline of palliative care researchers through expanded mentorship of predoctoral and clinical trainees, increasing the number of postdoctoral palliative care training programs, and expanding funding support for career development grants. Conclusion: The National Postdoctoral Palliative Care Research Training Collaborative fills an important role in creating a community for palliative care research trainees and developing strategies to address shared challenges.
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Background: Nephrologists commonly engage in decision making regarding the withholding or withdrawal of dialysis and palliative care in patients at end of life (EoL). However, these issues remain an unsolved dilemma for nephrologists. Objective: To explore nephrologists' perceptions on the decision-making process about withholding or withdrawing dialysis and palliative care in Korea. Design: A nationwide 25-item questionnaire online survey via e-mail. Setting/Subjects: A total of 369 Korean nephrologists completed the survey. Results: The proportions of respondents who stated that withholding or withdrawing dialysis at EoL is ethically appropriate were 87.3% and 86.2%, respectively. A total of 72.4% respondents thought that withdrawal of dialysis in a maintenance dialysis patient is ethically appropriate. ⋯ Fifty-eight percent of respondents stated that terminally ill dialysis patients should be allowed to use palliative care facilities. In addition, a number of nephrologists thought that adequate palliative care facilities, specific treatment guidelines, enough time to manage patients, financial support, and adequate medical experts are necessary. Conclusions: Korean nephrologists thought that withholding or withdrawing dialysis at EoL is ethically appropriate, even in maintenance dialysis patients. Therefore, consensus guidelines for palliative care after withholding or withdrawal of dialysis are needed.
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Objective: This report describes a pilot hospice inpatient unit dedicated to individuals experiencing distressing behaviors from dementia. Background: Patients with dementia who experience distressing symptoms cannot be well managed on typical inpatient units. Hospice of the Valley selected one unit to dedicate to dementia care. Methods: Data were analyzed from 237 patients admitted to the unit between May 2019 and April 2020. Behaviors were identified and rated for severity on admission, discharge, and postdischarge. ⋯ The most common behavior exhibited was agitation; the most common symptom leading to death was pain. Discussion: An inpatient hospice unit dedicated to patients with dementia can be successful. The hospice agency gains admissions that would otherwise be diverted to behavioral care settings. This successful pilot may be a model for other hospices.
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Observational Study
Feasibility of Delivering an Avatar-Facilitated Life Review Intervention for Patients with Cancer.
Background: Life review, a narrative-based intervention, helps individuals organize memories into a meaningful whole, providing a balanced view of the past, present, and future. Examining how the content of memories contributes to life's meaning improves some clinical outcomes for oncology patients. Combining life review with other modalities may enhance therapeutic efficacy. ⋯ Conclusion: An avatar-facilitated life review was feasible with a high rate of adherence, completion, and acceptability by patients. The findings support the need for a clinical trial to test the efficacy of this novel intervention. Clinical Trial Number NCT03996642.