Journal of palliative medicine
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Shared decision-making has become the standard of care for most medical treatments. However, little is known about physician communication practices in the decision making for unstable critically ill patients with known end-stage disease. ⋯ It is possible to analyze the decision making of physicians managing unstable critically ill patients with end-stage cancer using the framework of shared decision-making.
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Palliative care consultation teams in hospitals are becoming increasingly more common. Palliative care improves the quality of hospital care for patients with advanced disease. Less is known about its effects on hospital costs. ⋯ Palliative care for patients hospitalized with advanced disease results in lower costs of care and less utilization of intensive care compared to similar patients receiving usual care. Selection on unobserved characteristics plays an important role in the determination of costs of care.
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Outpatient palliative care, an evolving delivery model, seeks to improve continuity of care across settings and to increase access to services in hospice and palliative medicine (HPM). It can provide a critical bridge between inpatient palliative care and hospice, filling the gap in community-based supportive care for patients with advanced life-limiting illness. Low capacities for data collection and quantitative research in HPM have impeded assessment of the impact of outpatient palliative care. ⋯ A collaborative regional approach to HPM data can support evaluation and improvement of palliative care quality at the local, aggregated, and statewide levels.
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To identify characteristics of nursing homes and residents associated with particularly long or short hospice stays. ⋯ Few facility characteristics were associated with very long or very short hospice stays. However, high rates of discharge before death that may reflect a less predictable life trajectory of nursing home residents suggests that further evaluation of the hospice benefit for nursing home residents may be needed.
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An increased demand for palliative care services has been demonstrated, in part due to an aging population and an enhanced role of palliative care in nonmalignant illness. In particular, there is a demand for inpatient palliative care unit beds, with several services now creating waiting lists for admission. The aim of this study was to explore the development, implementation, and outcomes following the introduction of an inpatient palliative care admission triage tool. ⋯ This study represents the first reported attempt to define the priorities for a waiting list for admission to palliative care units, and demonstrates its utility in providing a transparent process for palliative care units to manage the competing needs of patients referred for care.