Journal of palliative medicine
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To test whether the presence of an informal or formal care network in the home leads to different hospice utilization patterns near death. To examine how the informal care relationship affects hospice use patterns. ⋯ Because formal care is associated with increased use of hospice, future work should examine whether patients without an in-home network faced access barriers. Caregiver relationships had large effects on length of hospice stays, yet we do not know whether changes moved a patient closer to or further away from their optimum use of the benefit.
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We evaluated the factors associated with life-supportive therapy withdrawal (LSTW) and length-of-stay (LOS) of adult patients with cancer who died while in the intensive care unit (ICU). We performed chart review of adult patients with cancer who died in a 53-bed ICU of a comprehensive cancer center and evaluated the relative impact of demographic and clinical factors by using logistic regression and linear regression. A total of 267 patients were included in the study. ⋯ Having a hematologic cancer, LSTW, or admission into the surgical oncologic ICU independently predicted increased LOS for those who died in the ICU (p < 0.001 p = 0.001, and p < 0.001, respectively). Cultural differences in dealing with the end-of-life process rooted in religious beliefs or language barriers and reflected in the utilization rates of LSTW by non-whites and whites may partially explain our findings. The difficult transition from curative to palliative care in the ICU is reflected by the increased LOS of patients who received LSTW, were diagnosed with hematologic cancers, or were admitted into the surgical unit.
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To explore how staff recognize that a resident is dying and to present a typology of comfort measures. ⋯ The terms comfort measures and comfort care are widely used in nursing homes but definitions and modes of delivery vary. In-depth exploration can be utilized to compare of current and existing practices and contribute knowledge about whether palliative care is provided in nursing homes and if so, how. Ultimately program comparisons can lead to improvements in nursing home-based end-of-life care and standards for the delivery of palliative care in this setting.
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Pediatric end-of-life care involves multiple decision-makers including the patient, the family, and the health care provider. Although some information exists on the role of patient and family values on decision making, little is known about what influences the health care provider's decisions and performance. ⋯ Age and experience create confidence in managing pediatric end-of-life care issues. Other provider variables including gender and religious beliefs may also influence confidence on some issues. Although formal education helps providers feel better prepared to care for children with terminal conditions, the majority of providers still feel no more than adequately prepared by their training. More emphasis on experience-driven education delivered by seasoned educators may improve confidence in delivering pediatric end-of-life care.