Improving End-of-Life Outcomes in Nursing Homes by Targeting Residents at High Risk of Mortality for Palliative Care: Program Description and Evaluation

2008 ◽  
Vol 11 (2) ◽  
pp. 217-225 ◽  
Author(s):  
Cari Levy ◽  
Monica Morris ◽  
Andrew Kramer
Keyword(s):  
Palliative Care ◽  
High Risk ◽  
Nursing Homes ◽  
End Of Life ◽  
Care Program ◽  
Palliative Care Program ◽  
Life Outcomes ◽  
Risk Of Mortality ◽  
Program Description

Pain Management

2019 ◽  
pp. 116-131
Author(s):  
Judith A. Paice
Keyword(s):  
Palliative Care ◽  
Pain Management ◽  
End Of Life ◽  
Family Communication ◽  
Pain Control ◽  
Care Program ◽  
Palliative Care Program ◽  
Institutional Policies ◽  
Team Members ◽  
Serious Illness

Pain is one of the most common and most feared symptoms experienced by those with serious illness. The nurse’s role begins with assessment and continues through the development of a plan of care and its implementation. During this process, the nurse provides education and counseling to the patient, family, and other team members. Nurses also are critical for developing institutional policies and monitoring outcomes that ensure good pain management for all patients within their palliative care program. To provide optimal pain control, all healthcare professionals must understand the frequency of pain at the end of life, the barriers that prevent good management, the comprehensive assessment of this syndrome, and the treatments used to provide relief. Effective pain control and alleviation of suffering is highly dependent upon the strength of clinician, patient, and family communication and relationship. These are key strengths of nursing, at all phases of palliative care.

End-of-Life Care for Children Enrolled in a Community-Based Pediatric Palliative Care Program

2014 ◽  
Vol 17 (5) ◽  
pp. 589-591 ◽  
Author(s):  
Lisa M. Niswander ◽  
Philene Cromwell ◽  
Jeanne Chirico ◽  
Alyssa Gupton ◽  
David N. Korones
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Care Program ◽  
Pediatric Palliative Care ◽  
Life Care ◽  
Palliative Care Program ◽  
Community Based

Effectiveness of a Home-Based Palliative Care Program for End-of-Life

2003 ◽  
Vol 6 (5) ◽  
pp. 715-724 ◽  
Author(s):  
Richard D. Brumley ◽  
Susan Enguidanos ◽  
David A. Cherin
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Care Program ◽  
Palliative Care Program ◽  
Home Based

Fostering patients and families during end-of-life care.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 150-150
Author(s):  
Michelle Tufaro ◽  
Jim Devries
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Medical Center ◽  
Care Program ◽  
Care Plan ◽  
Additional Patient ◽  
Palliative Care Program ◽  
Spiritual Assessment ◽  
Care Plans ◽  
Interdisciplinary Process

150 Background: Hunterdon Palliative Care Program is a service owned and run by Hunterdon Medical Center, a non-profit, Magnet-recognized, community hospital of 178 beds for the residents of Hunterdon County in New Jersey. The program strives to provide the highest quality patient and family-centered care for seriously ill and terminal patients. Our goals include respect for patient autonomy, values and personal decisions, as well as minimizing of symptom distress, optimizing supportive interventions and services for patients and their families. The individual need of each patient is determined by an interdisciplinary process that includes the ongoing clarification of goals of care. In order to achieve this we have developed several tools to capture the unique needs of each patient and encourage a daily interdisciplinary process. Methods: Three tools were developed to incorporate and utilize the expertise of each individual team member which includes physicians, nurse practitioner, social worker, chaplain and a reiki master. Results: The tools are currently being used by all in-patient palliative care patients. The psych-social-spiritual assessment and care plan sheets are completed within 24 hours of the initial consultation. The documents are placed on the chart next to the written consult. Daily rounding sheets are placed in the progress notes section of the chart. All members of the patient’s treatment team are encouraged to utilize the forms. Both the care plan note and the daily rounding sheet include a section for input from other disciplines. A hot pink strip is located at the bottom of each sheet to make it easy for others to identify forms for integration into additional patient care plans. Conclusions: The Palliative Care Program was awarded Certification by The Joint Commission, with no recommendations for improvement! The interdisciplinary approach to a patient’s end of life needs was sited as "superior" for clinical documentation with special attention to the psycho-social spiritual assessment as a “best practice” standard.

scholarly journals No difference in effects of ‘PACE steps to success’ palliative care program for nursing home residents with and without dementia: a pre-planned subgroup analysis of the seven-country PACE trial

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Rose Miranda ◽  
◽  
Tinne Smets ◽  
Nele Van Den Noortgate ◽  
Jenny T. van der Steen ◽  
...  
Keyword(s):  
Palliative Care ◽  
Nursing Home ◽  
Quality Of Care ◽  
Nursing Homes ◽  
Care Program ◽  
Improve Quality ◽  
Palliative Care Program ◽  
Advanced Dementia ◽  
Disease Specific

Abstract Background ‘PACE Steps to Success’ is a multicomponent training program aiming to integrate generalist and non-disease-specific palliative care in nursing homes. This program did not improve residents’ comfort in the last week of life, but it appeared to improve quality of care and dying in their last month of life. Because this program included only three dementia-specific elements, its effects might differ depending on the presence or stage of dementia. We aimed to investigate whether the program effects differ between residents with advanced, non-advanced, and no dementia. Methods Pre-planned subgroup analysis of the PACE cluster-randomized controlled trial in 78 nursing homes in seven European countries. Participants included residents who died in the previous 4 months. The nursing home staff or general practitioner assessed the presence of dementia; severity was determined using two highly-discriminatory staff-reported instruments. Using after-death questionnaires, staff assessed comfort in the last week of life (Comfort Assessment in Dying–End-of-Life in Dementia-scale; primary outcome) and quality of care and dying in the last month of life (Quality of Dying in Long-Term Care scale; secondary outcome). Results At baseline, we included 177 residents with advanced dementia, 126 with non-advanced dementia and 156 without dementia. Post-intervention, respectively in the control and the intervention group, we included 136 and 104 residents with advanced dementia, 167 and 110 with non-advanced dementia and 157 and 137 without dementia. We found no subgroup differences on comfort in the last week of life, comparing advanced versus without dementia (baseline-adjusted mean sub-group difference 2.1; p-value = 0.177), non-advanced versus without dementia (2.7; p = 0.092), and advanced versus non-advanced dementia (− 0.6; p = 0.698); or on quality of care and dying in the last month of life, comparing advanced and without dementia (− 0.6; p = 0.741), non-advanced and without dementia (− 1.5; p = 0.428), and advanced and non-advanced dementia (0.9; p = 0.632). Conclusions The lack of subgroup difference suggests that while the program did not improve comfort in dying residents with or without dementia, it appeared to equally improve quality of care and dying in the last month of life for residents with dementia (regardless of the stage) and those without dementia. A generalist and non-disease-specific palliative care program, such as PACE Steps to Success, is a useful starting point for future palliative care improvement in nursing homes, but to effectively improve residents’ comfort, this program needs further development. Trial registration ISRCTN, ISRCTN14741671. Registered 8 July 2015 – Retrospectively registered.

scholarly journals First referral to an Integrated Onco-Palliative Care program: a retrospective analysis of its timing

2020 ◽  
Author(s):  
Claire Barth ◽  
Isabelle Colombet ◽  
Vincent Montheil ◽  
Olivier Huillard ◽  
Pascaline Boudou-Rouquette ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Performance Status ◽  
Care Program ◽  
Albumin Level ◽  
Palliative Care Program ◽  
Incurable Cancer ◽  
Early Integration ◽  
Effective Organization ◽  
Trajectory Of Care

Abstract Background: Palliative care (PC) referral is recommended early in the course of advanced cancer. This study aims to describe, in an integrated onco-palliative care program (IOPC), patient’s profile when first referred to this program, timing of this referral and its impact on the trajectory of care at end-of-life. Patients and Methods: The IOPC combined the weekly onco-palliative meeting (OPM) dedicated to patients with incurable cancer, and/or the clinical evaluation by the PC team. Oncologists can refer to the multidisciplinary board of the OPM the patients for whom goals and organization of care need to be discussed. We analyzed all patients first referred at OPM in 2011-2013. We defined the index of precocity (IP), as the ratio of the time from first referral to death by the time from diagnosis of incurability to death, ranging from 0 (late referral) to 1 (early referral). Results: Of the 416 patients included, 57% presented with lung, urothelial cancers, or sarcoma. At first referral to IOPC, 76% were receiving antitumoral treatment, 63% were outpatients, 56% had a performance status ≤2 and 46% had a serum albumin level >35g/l. The median [1st-3rd quartile] IP was 0.39 [0.16-0.72], ranging between 0.53 [0.20-0.79] (earliest referral, i.e. close to diagnosis of incurability, for lung cancer) to 0.16 [0.07-0.56] (latest referral, i.e. close to death relatively to length of metastatic disease, for prostate cancer). Among 367 decedents, 42 (13%) received antitumoral treatment within 14 days before death, and 157 (43%) died in PC units.Conclusions: The IOPC is an effective organization to enable early integration of PC and decrease aggressiveness of care near the end-of life. The IP is a useful tool to model the timing of referral to IOPC, while taking into account each cancer types and therapeutic advances.

scholarly journals First referral to an Integrated Onco-Palliative Care program: a retrospective analysis of its timing

2019 ◽  
Author(s):  
Claire Barth ◽  
Isabelle Colombet ◽  
Vincent Montheil ◽  
Olivier Huillard ◽  
Pascaline Boudou-Rouquette ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Performance Status ◽  
Care Program ◽  
Albumin Level ◽  
Palliative Care Program ◽  
Incurable Cancer ◽  
Early Integration ◽  
Effective Organization ◽  
Trajectory Of Care

Abstract Background : Palliative care (PC) referral is recommended early in the course of advanced cancer. This study aims to describe, in an integrated onco-palliative care program (IOPC), patient’s profile when first referred to this program, timing of this referral and its impact on the trajectory of care at end-of-life. Patients and Methods : The IOPC combined the weekly onco-palliative meeting (OPM) dedicated to patients with incurable cancer, and/or the clinical evaluation by the PC team. Oncologists can refer to the multidisciplinary board of the OPM the patients for whom goals and organization of care need to be discussed. We analyzed all patients first referred at OPM in 2011-2013. We defined the index of precocity (IP), as the ratio of the time from first referral to death by the time from diagnosis of incurability to death, ranging from 0 (late referral) to 1 (early referral). Results: Of the 416 patients included, 57% presented with lung, urothelial cancers, or sarcoma. At first referral to IOPC, 76% were receiving antitumoral treatment, 63% were outpatients, 56% had a performance status ≤2 and 46% had a serum albumin level >35g/l. The median [1 st -3 rd quartile] IP was 0.39 [0.16-0.72], ranging between 0.53 [0.20-0.79] (earliest, for lung cancer) to 0.16 [0.07-0.56] (latest, for prostate cancer). Among 367 decedents, 42 (13%) received antitumoral treatment within 14 days before death, and 157 (43%) died in PC units. Conclusions : The IOPC is an effective organization to enable early integration of PC and decrease aggressiveness of care near the end-of life. The IP is a useful tool to model the trajectory of care while taking into account each cancer types and therapeutic advances.

scholarly journals First referral to an Integrated Onco-Palliative Care program: a retrospective analysis of its timing

2020 ◽  
Author(s):  
Claire Barth ◽  
Isabelle Colombet ◽  
Vincent Montheil ◽  
Olivier Huillard ◽  
Pascaline Boudou-Rouquette ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Performance Status ◽  
Care Program ◽  
Albumin Level ◽  
Palliative Care Program ◽  
Incurable Cancer ◽  
Early Integration ◽  
Effective Organization ◽  
Trajectory Of Care

Abstract Background: Palliative care (PC) referral is recommended early in the course of advanced cancer. This study aims to describe, in an integrated onco-palliative care program (IOPC), patient’s profile when first referred to this program, timing of this referral and its impact on the trajectory of care at end-of-life. Patients and Methods: The IOPC combined the weekly onco-palliative meeting (OPM) dedicated to patients with incurable cancer, and/or the clinical evaluation by the PC team. Oncologists can refer to the multidisciplinary board of the OPM the patients for whom goals and organization of care need to be discussed. We analyzed all patients first referred at OPM in 2011-2013. We defined the index of precocity (IP), as the ratio of the time from first referral to death by the time from diagnosis of incurability to death, ranging from 0 (late referral) to 1 (early referral). Results: Of the 416 patients included, 57% presented with lung, urothelial cancers, or sarcoma. At first referral to IOPC, 76% were receiving antitumoral treatment, 63% were outpatients, 56% had a performance status ≤2 and 46% had a serum albumin level >35g/l. The median [1st-3rd quartile] IP was 0.39 [0.16-0.72], ranging between 0.53 [0.20-0.79] (earliest referral, i.e. close to diagnosis of incurability, for lung cancer) to 0.16 [0.07-0.56] (latest referral, i.e. close to death relatively to length of metastatic disease, for prostate cancer). Among 367 decedents, 42 (13%) received antitumoral treatment within 14 days before death, and 157 (43%) died in PC units.Conclusions: The IOPC is an effective organization to enable early integration of PC and decrease aggressiveness of care near the end-of life. The IP is a useful tool to model the timing of referral to IOPC, while taking into account each cancer types and therapeutic advances.

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