Journal of palliative medicine
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Comparative Study
A preliminary study comparing attitudes toward hospice referral between African American and white American primary care physicians.
End-of-life (EOL) decision making is an integral component of high-quality health care. Factors influencing individual primary care physicians (PCPs) can affect their perspectives and referral preferences for EOL care. Numerous barriers have been cited, including patient and family readiness, physicians' comfort with discussing death, and the pursuit of a cure. This study explores another barrier by examining physician ethnicity and comparing the attitudes toward hospice referral between African American and white American primary care providers (PCPs). Training PCPs to efficiently transition from a curative model of care to a palliative model of care has the potential to increase the level of appropriate EOL care, increase hospice referral, and enhance patient and provider satisfaction; it is also fiscally prudent. This preliminary study aims to compare attitudes toward hospice referral and physicians' personal experiences with hospice between African American and white American PCPs. ⋯ The results of our preliminary study suggest that certain attitudes toward hospice referral may differ between African American and white American PCPs. If validated, further insight into this issue could lead to educational programs for PCPs that correct misperceptions.
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Comparative Study
Assessment of quality of life in patients receiving palliative care: comparison of measurement tools and single item on subjective well-being.
Many quality-of-life assessment tools are not feasible in palliative care settings because of the severe impairment of the physical, cognitive, and psychological status of patients. This study investigated whether comprehensive instruments can be replaced by a single item concerning the well-being of patients. ⋯ The single item is unable to completely replace comprehensive questionnaires, but it is useful to initiate communication on QoL and can be recommended as a substitute for physical-functional aspects of QoL assessment in the palliative care setting.
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Sleep disruption is a common complaint in breast cancer patients receiving chemotherapy. We describe the sleep aid prescribing practices of oncologists treating women receiving adjuvant or neoadjuvant chemotherapy for breast cancer at a single institution. ⋯ Sleep disturbances during AC chemotherapy for early-stage breast cancer are common and are frequently treated with sleep aid medications. We show that women with prior sleep aid use and concurrent psychiatric medication use were more likely to need sleep aids during chemotherapy, suggesting these are high-risk populations that could be targeted for intervention prospectively.
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To characterize the level of formal training and perceived educational needs in palliative care of emergency medicine (EM) residents. ⋯ New York City EM residents reported palliative care as an important competency for emergency medicine physicians, yet also reported low levels of formal training in palliative care. The majority of residents surveyed favored additional training.
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Communication is an ongoing challenge for clinicians working with people facing life-threatening illnesses and end of life. Family conferences offer patient-focused, family-oriented care that brings together patients, family members, and health care providers. ⋯ Physicians and other health care professionals can use the model as a guide for conducting family conferences and strengthening communication with patients, families and colleagues.