Journal of palliative medicine
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Approximately 20% of deaths in the United States occur in nursing homes. Dying nursing home residents have unique care needs, which historically have been inadequately addressed. The goal of this study was to determine what factors influence nursing home administrators' choice of model for end-of-life care in their facilities. ⋯ For profit status, larger facility size, and shorter duration of administrator tenure were found to be associated with greater likelihood of considering implementation of a facility-based end-of-life care model. When asked about obstacles to providing quality end-of-life care, the majority of participants (n = 16) cited an educational deficit among physicians, staff, or the public as the most significant, while an additional seven cited staff shortages and turnover. These results suggest at least two potential avenues for change to improve end-of-life care in nursing homes: (1) educational efforts on the topics of end-of-life and palliative care among both practitioners, residents, and their families, and (2) creating incentives to improve staff recruitment and retention.
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Comparative Study
Physician- and nurse-reported effects of intravenous hydration therapy on symptoms of terminally ill patients with cancer.
To clarify physician- and nurse-reported effects of intravenous hydration therapy on symptoms of terminally ill patients with cancer. ⋯ The physicians and nurses in both oncology and palliative care settings frequently observed deterioration of fluid retention symptoms with limited benefits in alleviating dehydration symptoms by intravenous hydration therapy for terminally ill patients with cancer. It is suggested that routine use of artificial hydration therapy should not be recommended, and individualized treatment policy based on the comprehensive assessment of each patient's needs is strongly required.
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Although preference for location of death has been studied in the general population little is known about the experience of people from different ethnic backgrounds and nothing about the black Caribbean population living in the United Kingdom. Over 13 months we surveyed the family and friends of deceased first-generation black Caribbean and native-born white patients with advanced disease. Of the 106 black Caribbean and 110 white patients identified, 50 interviews per ethnic group were conducted, a response rate of 47% and 45%. ⋯ This was not related to restrictions in patients' activities of daily living or self-reported caregiver burden. Fewer respondents representing Caribbean than white patients stated that neither they (chi(2) = 8.9, p = 0.01) or the deceased patients (chi(2) = 8.6, p = 0.03) were given sufficient choice about the location of death. Our findings suggest: (1) a need to improve training in discussing care and treatment choices, including location of death, and (2) a deeper qualitative understanding of the cultural and other factors that may facilitate or prevent home deaths.
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Continuous parenteral hydromorphone is used to treat pain in palliative care. Case reports have suggested that neuroexcitatory symptoms, such as agitation, myoclonic activity, and even seizures may occur during administration. However, little information exists on the incidence of these side effects or their relationship to the dose or duration of parenteral hydromorphone. ⋯ Chart reviews were conducted searching for three neuroexcitatory symptoms: agitation, myoclonus, and seizures; the incidence and relationship of these symptoms were statistically compared to the maximal dose and number of days on continuous parenteral hydromorphone. We found that agitation, myoclonus, and seizures were not associated with the patients gender, age, or diagnosis but found that agitation was associated (p < 0.01) in patients with known metastatic disease. Agitation, myoclonus, and seizures were independently associated with the maximal dose (p < 0.05, p < 0.001, and p < 0.05) and with the duration (p < 0.01, p < 0.05, and p < 0.01) of continuous parenteral hydromorphone A possible mechanism for these findings is hydromorphone-3-glucoronide, a metabolic product of hydromorphone, which has been implicated in neuroexcitatory symptoms in laboratory investigations.