Development of Hospice and Palliative Care in the United States

2008 ◽  
Vol 56 (1) ◽  
pp. 89-99 ◽  
Author(s):  
Stephen R. Connor
Keyword(s):  
United States ◽  
Palliative Care ◽  
Health Care Industry ◽  
The United States ◽  
Regulatory Change ◽  
Care Providers ◽  
Care Industry ◽  
History Of ◽  
Hospice And Palliative Care

More than 30 years have passed since palliative care was introduced in the United States, and what began as a small rebellion has evolved into a fairly large health care industry. Although the palliative care movement has considerably improved the care given to those at the end of life, many challenges remain for palliative care providers in the United States. This article discusses the history of hospice and palliative care in the United States, the Medicare Hospice Benefit, the growth of hospice and palliative care, and challenges such as the need for regulatory change, workforce issues, improving access to care, and improving the quality of palliative care.

BRCA1/2 Genetic Testing in the Community Setting

2002 ◽  
Vol 20 (22) ◽  
pp. 4485-4492 ◽  
Author(s):  
Wendy Y. Chen ◽  
Judy E. Garber ◽  
Suzanne Higham ◽  
Katherine A. Schneider ◽  
Katie B. Davis ◽  
...  
Keyword(s):  
United States ◽  
Ovarian Cancer ◽  
Genetic Testing ◽  
Cancer Prevention ◽  
Community Setting ◽  
The United States ◽  
Care Providers ◽  
Prevention Strategies ◽  
History Of ◽  
Genetic Results

PURPOSE: BRCA1/2 genetic testing has been commercially available in the United States since 1996. Most published reports described BRCA1/2 testing as research studies at large academic centers, but less is known about testing in the community. This study evaluates the process and early outcomes of BRCA1/2 genetic testing as a clinical service in the community setting. METHODS: Surveys were mailed to women in the United States whose health care providers ordered BRCA1/2 genetic testing from Myriad Genetic Laboratories from August 1998 through July 2000. Women tested at 149 large academic centers were excluded. Main outcome measures were demographic characteristics, recall of and satisfaction with the genetic testing process, and likelihood of pursuing cancer prevention strategies. RESULTS: Among the 646 respondents, 414 (64%) had a personal history of cancer and 505 (78%) had at least one first-degree relative with breast and/or ovarian cancer. Most subjects (82%) recalled discussions of informed consent before testing (median time, 30 minutes). Genetic results were conveyed during an office visit (57%), by telephone (39%), or by mail (3%). More than 75% of respondents were “very satisfied with the counseling received.” Cancer-free subjects with a germline mutation were more likely to consider prevention strategies after receiving the genetic results. CONCLUSION: Virtually all respondents had a personal and/or family history of breast/ovarian cancer. Although pretest and posttest communications were not standardized, overall satisfaction with clinical breast cancer genetic testing was high. Additional follow-up will provide data on future cancer prevention practices and cancer incidence.

Improving the Quality of Care across All Settings

2019 ◽  
pp. 573-605
Author(s):  
Marilyn Bookbinder ◽  
Romina Arceo ◽  
James T. McDaniel
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
The United States ◽  
Healthcare Settings ◽  
National Priority ◽  
Hospice And Palliative Care ◽  
Eol Care ◽  
Clinician Assessment ◽  
Care Path

This chapter provides perspectives on quality-based initiatives in the United States across healthcare settings and populations and describes their impact on patient, professional, and system outcomes. The authors discuss the need for quality improvement (QI) at end of life, QI principles, and the models, methods, and tools most frequently used. Also described are areas of national priority for improving end-of-life (EOL) care. A care-path for the end of life is used to illustrate a QI effort and the FOCUS_PDSA method and to encourage use of specific tools for improving EOL care, including respiratory distress, and a clinician assessment of EOL care using The Joint Commission (TJC) tracer methodology. The authors review the linkages between QI and practice changes in hospitals and hospices that ultimately lead to improved EOL care and close with examples of how nurses are providing leadership in the field of quality hospice and palliative care.

Complementary and Integrative Therapies in Palliative Care

2019 ◽  
pp. 361-370
Author(s):  
Mary-Anne Meyer ◽  
Melinda Ring
Keyword(s):  
United States ◽  
Palliative Care ◽  
Integrative Medicine ◽  
Critical Factor ◽  
The United States ◽  
Integrative Care ◽  
Complementary And Integrative Medicine ◽  
Integrative Therapies ◽  
Hospice And Palliative Care

A large portion of adults in the United States use some form of complementary and integrative medicine, but while these therapies are offered in many hospice and palliative care programs, few patients end up accessing the therapies. Studies show that patients who receive these services are more satisfied with their care. Additionally, surveys show that nurses are often the critical factor is assessing a patient’s appropriateness for integrative care and making the referrals. This chapter reviews therapies and supplements that can be used for specific conditions, and it ends with a list of resources to help put ideas into practice.

High–Tech, Aggressive Palliative Care: In the Service of Quality of Life

1993 ◽  
Vol 9 (1) ◽  
pp. 37-41 ◽  
Author(s):  
David M. Dush
Keyword(s):  
Quality Of Life ◽  
United States ◽  
Health Care ◽  
Palliative Care ◽  
Hospice Care ◽  
High Technology ◽  
The United States ◽  
High Tech ◽  
Hospice Movement

The hospice movement grew in part as a reaction to the perception that modern medical care had become too technological at the expense of being impersonal and insensitive to human psychological and spiritual concerns. In the United States, the institutionalization of hospice care under Medicare and other reimbursement systems has further established hospice as an alternative to high-technology, high-cost care. The present paper examines the question: What if hospice care becomes itself high-technology, aggressive, costly health care in order to remain true to its goal of maximizing quality of life? Implications for the goals and philosophical underpinnings of palliative care are discussed.

Principal Currents in the Economic Historiography of Latin America

1971 ◽  
Vol 31 (1) ◽  
pp. 222-253 ◽  
Author(s):  
Stanley J. Stein ◽  
Shane J. Hunt
Keyword(s):  
United States ◽  
Latin America ◽  
Economic History ◽  
The United States ◽  
Economic Systems ◽  
Economic Activities ◽  
French School ◽  
History Of ◽  
And Function

It will perhaps clarify the remarks that follow if we observe at the outset that the economic history of Latin America is in its infancy. This is not to say that the development of economic institutions, the operation of economic systems, the formation and growth of economic activities and attitudes, and the formulation and execution of economic policy have gone unnoticed in the history of Latin America. It is only to state that the formal discipline of economic history, even the use of economic history as part of a title, are of recent date. As in the historiography of most areas of the world, political developments and personalities in Latin America have constituted the core of historiography, and even today the “new” interdisciplinary history of half a century ago in the United States or the more recent French school of “total” history have drawn few adherents to Latin America. Many factors may be adduced to explain the delayed interest in economic history, but one may hazard the guess that there is a positive correlation between the degree of criticism of the nature and function of an economy and both the quantity and quality of economic historiography. At least in the United States, economic history owes no small debt to a muck-raking tradition. In Latin America, on the contrary, the nature of the literate elite and the limits on education have tended to stifle until recently the development of a body of economic literature of protest and, by extension, of economic history.

A cross-sectional pilot study of compassion fatigue, burnout, and compassion satisfaction in pediatric palliative care providers in the United States

2018 ◽  
Vol 17 (03) ◽  
pp. 269-275 ◽  
Author(s):  
Samuel M. Kase ◽  
Elisha D. Waldman ◽  
Andrea S. Weintraub
Keyword(s):  
United States ◽  
Palliative Care ◽  
Pilot Study ◽  
Compassion Fatigue ◽  
Compassion Satisfaction ◽  
Clinical Situation ◽  
The United States ◽  
Pediatric Palliative Care ◽  
Care Providers ◽  
Cross Sectional

AbstractObjectiveCompassion fatigue (CF) is secondary traumatic distress experienced by providers from contact with patients' suffering. Burnout (BO) is job-related distress resulting from uncontrollable workplace factors that manifest in career dissatisfaction. Compassion satisfaction (CS) is emotional fulfillment derived from caring for others. The literature on BO in healthcare providers is extensive, whereas CF and CS have not been comprehensively studied. Because of ongoing exposure to patient and family distress, pediatric palliative care (PPC) providers may be at particular risk for CF. We conducted a cross-sectional pilot study of CF, BO, and CS among PPC providers across the United States.MethodThe Compassion Fatigue and Satisfaction Self-Test for Helpers and a questionnaire of professional and personal characteristics were distributed electronically and anonymously to PPC physicians and nurses. Logistic and linear regression models for CF, BO, and CS as a function of potential risk factors were constructed.ResultsThe survey response rate was 39%, primarily consisting of female, Caucasian providers. The prevalence of CF, BO, and CS was 18%, 12%, and 25%, respectively. Distress about a “clinical situation,” physical exhaustion, and personal loss were identified as significant determinants of CF. Distress about “coworkers,” emotional depletion, social isolation, and “recent involvement in a clinical situation in which life-prolonging activities were not introduced” were significant determinants of BO. Physical exhaustion, personal history of trauma, “recent involvement in a clinical situation in which life-prolonging activities were not introduced,” and not discussing distressing issues were significant predictors of lower CS scores.Significance of resultsCF and BO directly influence the well-being and professional performance of PPC providers. To provide effective compassionate care to patients, PPC providers must be attentive to predictors of these phenomena. Further work is needed to explore additional causes of CF, BO, and CS in PPC providers as well as potential interventions.

Volunteering in the United States of America

2018 ◽  
Author(s):  
Greg Schneider
Keyword(s):  
United States ◽  
Palliative Care ◽  
Patient Care ◽  
United States Of America ◽  
The United States ◽  
Care Quality ◽  
Direct Patient Care ◽  
Hospice Movement ◽  
The Usa ◽  
Hospice And Palliative Care

Hospice and palliative care volunteering in the United States of America (USA) has changed dramatically since its inception in the late 1960s. Inspired by physician Dame Cicely Saunders, the modern hospice movement officially began in the USA in 1971 with Florence Wald founding the first hospice, Hospice, Inc., a non-profit in New Haven, Connecticut. Then in 1983, the US Congress established the Medicare Hospice Benefit, whose Conditions of Participation (CoPs) mandated that volunteers must provide administrative or direct patient care in an amount that, at a minimum, equals 5 per cent of the total patient care hours expended by all paid hospice employees and contract staff. Hence, every hospice programme must have a volunteer programme in order to receive reimbursement for services rendered. The primary forces currently shaping hospice and palliative care volunteering have been regulations, care quality, skill requirements, liability concerns, and changing business objectives in a highly competitive environment.

Benchmarking: A Tool for Excellence in Palliative Care

1992 ◽  
Vol 8 (4) ◽  
pp. 41-45 ◽  
Author(s):  
J. Alex Murray ◽  
Mary H. Murray
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Total Quality Management ◽  
Continuous Improvement ◽  
Well Being ◽  
The United States ◽  
Palliative Care Team ◽  
Care Providers ◽  
Total Quality

Quietly and without fanfare, total quality management (TQM) is being implemented in a branch of health care where quality of care has particular impact on the patient's comfort and well-being. Some palliative care providers, dedicated to improving the quality of life for the dying, have fulfilled all the criteria to be contenders for prestigious quality honors like the Baldrige Award in the United States and the Canada Award for Excellence. Their secret is simple: the patient defines quality, and the palliative care team acts on that definition. Benchmarking, a TQM tool, allows institutions and organizations to benefit from sharing their best processes, and keeps the TQM continuous improvement cycle on track.

Sign in / Sign up

Export Citation Format

Share Document