Articles: palliative-care.
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Background: Pediatric patients often undergo surgery during terminal admissions. However, the involvement and timing of palliative care consults in caring for these patients has not been readily described. Objective: To describe the presence and timing of palliative care consults for pediatric patients who undergo surgical procedures during terminal admissions. ⋯ Children without a palliative care consult were more likely than children with a consult to die during surgery (19.1% vs. 2.7%, p = 0.02), have surgery within 24 hours of death (52.4% vs. 15.9%, p < 0.001), and undergo a full resuscitation attempt (47.6% vs. 12.4%, p = 0.002). Receipt of a palliative care consultation did not differ by patient sex, reported race and ethnicity, language, insurance, or income level. Conclusions and Relevance: Palliative care consults support high-quality end-of-life care for children and impact perioperative outcomes, including intensity of surgical care and resuscitation in the final hours of life.
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J Pain Symptom Manage · Aug 2023
Observational StudyFactors Associated with Distress Related to Posttraumatic Stress Disorder at the End of Life Among U.S. Veterans.
Posttraumatic stress disorder (PTSD) may emerge or re-emerge at end of life (EOL), increasing patient suffering. Understanding factors associated with PTSD at EOL may assist clinicians in identifying high risk veterans. ⋯ Trauma and PTSD screening, pain management, and providing palliative care and emotional support at EOL, particularly in at-risk groups such as veterans from racial/ethnic minority backgrounds and those with dementia, are critical to decreasing PTSD-related distress at EOL.
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J Pain Symptom Manage · Aug 2023
Attitudes of palliative care specialists toward assessing sexual dysfunction in patients with cancer.
The sexual health of patients is frequently neglected. ⋯ Palliative care providers infrequently address the presence of SD among patients with cancer. Additional training and routine screening for SD might help addressing this problem.
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J Pain Symptom Manage · Aug 2023
Using design thinking to promote goals of care conversations with seriously ill patients.
Goals of care (GOC) conversations can improve serious illness outcomes such as pain and symptom management and patient satisfaction. ⋯ We found that design thinking techniques offered a useful bridge between RE-AIM strategy and clinical.
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J Pain Symptom Manage · Aug 2023
Evolving Advance Care Planning in a Health Ecosystem: The Kaiser Permanente Experience.
Advance care planning is an integral part of supporting patients through serious illness and end-of-life care. ⋯ More than 6000 physicians, nurses, and social workers have been trained in LCP. Over one million patients have engaged in LCP since its inception, with over 52% of patients age 55+ having a surrogate designated. There is evidence of high treatment concordance with patients' desired wishes (88.9%), with high rates of advance directive completion as well (84.1%).