scholarly journals End of life care trajectories – hospital inpatient care in last two years of life

2017 ◽  
Vol 17 (5) ◽  
pp. 55
Author(s):  
Jorid Kalseth
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Inpatient Care ◽  
Hospital Inpatient ◽  
Life Care ◽  
Hospital Inpatient Care

scholarly journals Racial Disparities in End-of-Life Care Planning and Hospital Utilization: A Single Center Retrospective Study

Blood ◽  
2017 ◽  
Vol 130 (Suppl_1) ◽  
pp. 859-859
Author(s):  
Kedar Kirtane ◽  
Lois Downey ◽  
Stephanie J. Lee ◽  
Jared Randall Curtis ◽  
Ruth Engelberg
Keyword(s):  
End Of Life ◽  
Ethnic Minorities ◽  
Solid Tumor ◽  
End Of Life Care ◽  
Inpatient Care ◽  
Board Member ◽  
Hematologic Malignancies ◽  
Advisory Board ◽  
Life Care ◽  
Racial Ethnic

Abstract Introduction- Some prior studies suggest patients with hematologic malignancies receive more aggressive end-of-life care when compared to patients with solid tumor malignancies. Hematologic malignancies differ from solid tumors because of the continued potential for cure even in advanced disease, and potential difficulty identifying the terminal portion of a patient's illness. Racial/ethnic minorities are reported to have lower rates of hospice care, advanced directive use, and palliative care utilization. We studied differences in hospital utilization patterns and documentation of advance care planning between solid tumor and hematologic malignancy patients. In the subgroup of patients with hematologic malignancy, we also examined differences in these outcomes associated with racial/ethnic minority status. Methods- We conducted a retrospective cohort study of 9,469 patients with a diagnosis of cancer who received care at University of Washington (UW) Medicine and died between 2010 and 2015. Administrative data were available for the following events during the last 30 days of life: emergency department use, hospitalizations, and intensive care unit (ICU) utilization. We also examined death in a hospital and any documentation of advance directives (AD) in the electronic health record. We regressed each outcome on the binary predictor, adjusting for confounders (taken from a pool of potential confounders: age at death, patient gender, racial/ethnic minority status, level of education, insurance type, attributed facility, and number of Dartmouth Atlas chronic conditions). A variable was considered a confounder if its addition to the bivariate model changed the coefficient for the predictor by at least 10%. Binary outcomes were modeled with logistic regression. For count outcomes, we included only patients who had 1 or more days of the relevant type of care and modeled the remaining cases with negative binomial regression. All estimation was done with restricted maximum likelihood. Statistical significance was p <0.05. Results- In the last 30 days of life, decedents with hematologic cancer were significantly more likely to have aggressive hospital-based care, as measured by receipt of inpatient care, hospitalization for 14 or more days, multiple hospital admissions, and more days of hospital care, once admitted, than were those with solid tumor malignancies. They were also significantly more likely to have received ICU care, and to have spent more time in the ICU, once admitted, in the last 30 days of life. Finally, patients with hematologic malignancies were more likely to have died in a hospital rather than in other locations and more likely to have had documentation of AD in their electronic record. Among patients with hematologic malignancies, racial/ethnic minorities were less likely than white non-Hispanics to have documentation of AD and more likely to have 2+ emergency department visits or 14+ days of inpatient care, and had more days of inpatient care and ICU care, once admitted, in the last 30 days of life Conclusions- Patients with hematologic malignancies received more aggressive care at the end of life as measured by hospital utilization, despite having more documentation of AD than patients with solid tumor malignancy. Racial/ethnic minorities with hematologic malignancies had lower rates of AD documentation and received even more aggressive care than their white counterparts. Although these are administrative data, they suggest opportunities to improve end-of-life care of patients with hematologic malignancies, particularly racial/ethnic minorities. Disclosures Lee: Mallinckrodt: Honoraria; Amgen: Other: One-time advisory board member; Bristol-Myers-Squibb: Other: One-time advisory board member; Kadmon: Other: One-time advisory board member.

scholarly journals Bereaved family members’ perceptions of the quality of end-of-life care across four types of inpatient care settings

2017 ◽  
Vol 16 (1) ◽  
Author(s):  
Kelli Stajduhar ◽  
Richard Sawatzky ◽  
S. Robin Cohen ◽  
Daren K. Heyland ◽  
Diane Allan ◽  
...  
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Inpatient Care ◽  
Family Members ◽  
Life Care ◽  
Bereaved Family

scholarly journals 142 Advance Care Planning in Patients with Dementia: An Audit on End of Life Care in Hospital Deaths

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii1-iii16
Author(s):  
Rachel Sullivan ◽  
Clodagh Power ◽  
Elaine Greene ◽  
Roisin Purcell
Keyword(s):  
End Of Life ◽  
Advance Care Planning ◽  
End Of Life Care ◽  
Hospital Inpatient ◽  
Care Planning ◽  
Life Care ◽  
People With Dementia ◽  
Future Care ◽  
Advance Care ◽  
Resuscitation Status

Abstract Background End of life care (EOLC) planning is a difficult and often neglected area in dementia. Advanced care discussions play an important role in the planning of future care for patients with dementia. The NICE guidelines recommend that patients with dementia should be given every opportunity to discuss their wishes and preferences regarding their future care. The goal of our study was to explore the extent of EOLC planning in patients with dementia who died in hospital. Methods Patients with dementia who died in a large tertiary referral hospital in 2017 were identified via the Hospital Inpatient Enquiry (HIPE) database. A retrospective chart review was completed examining the documentation of Advance Care Planning (ACP) and discussions around end of life care. Charleston Comorbidity Index (CCI) was used to predict 1 year mortality. Results HIPE identified 49 patients with dementia who died in hospital. The average age was 84 and 53% were female. The commonest cause of death was respiratory (79.5%). Two thirds lived at home and 30% were nursing home residents. The mean CCI was 3.97 indicating 52% 1-year mortality, however only 34% were hospitalized in the last year. Only 14% had an ACP. Only 22% had resuscitation status recorded on admission. The majority had resuscitation status documented 15 days prior to death. In these cases 70% had clearly documented the discussion with family or patient and 84% documented ceilings of care 6 days prior to death. Palliative care were involved in 40% of cases. Two patients did not have resuscitation status documented prior to death and 3 received CPR. Conclusion Our study highlights the urgent need to facilitate conversations around end-of-life care with people with dementia. Advance care planning reduces the use of burdensome treatments, ensures dignity and comfort is prioritized enabling patients to live well until they die.

Palliative and End-of-Life Care Education Needs of Nurses Across Inpatient Care Settings

2017 ◽  
Vol 48 (7) ◽  
pp. 329-336 ◽  
Author(s):  
Deborah M. Price ◽  
Linda Strodtman ◽  
Marcos Montagnini ◽  
Heather M. Smith ◽  
Jillian Miller ◽  
...  
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Inpatient Care ◽  
Life Care ◽  
Care Education ◽  
Education Needs

Dysphagia in Hospice Care: The Roles of Social Work and Speech-Language Pathologists

2014 ◽  
Vol 23 (4) ◽  
pp. 173-186 ◽  
Author(s):  
Deborah Hinson ◽  
Aaron J. Goldsmith ◽  
Joseph Murray
Keyword(s):  
Social Work ◽  
End Of Life ◽  
Case Studies ◽  
End Of Life Care ◽  
Hospice Care ◽  
Patient Communication ◽  
Life Care ◽  
Speech Language Pathologists ◽  
Four Levels

This article addresses the unique roles of social work and speech-language pathologists (SLPs) in end-of-life and hospice care settings. The four levels of hospice care are explained. Suggested social work and SLP interventions for end-of-life nutrition and approaches to patient communication are offered. Case studies are used to illustrate the specialized roles that social work and SLP have in end-of-life care settings.

Die Entwicklung eines Instruments zur «Evaluation stationärer Hospize aus der Perspektive hinterbliebener Angehöriger» (EHPA)

Pflege ◽  
2011 ◽  
Vol 24 (3) ◽  
pp. 171-182
Author(s):  
Mandy Lohe ◽  
Manja Zimmermann ◽  
Christiane Luderer ◽  
Katharina Sadowski
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Life Care ◽  
Subjektive Bewertung ◽  
Ethische Probleme

Als Einrichtungen des Gesundheitswesens sind stationäre Hospize in Deutschland zur Qualitätssicherung und internen Qualitätsentwicklung verpflichtet. Die Bedeutung der Patientenzufriedenheit als einer der indirekten Indikatoren zur Beurteilung der Pflege- und Betreuungsqualität ist mittlerweile unumstritten. Eine subjektive Bewertung des Hospizes durch den Gast selbst birgt sowohl praktische als auch ethische Probleme. Eine Befragung der Angehörigen empfiehlt sich. Der vorliegende Artikel beschreibt die Entwicklung eines Instruments zur Evaluation stationärer Hospize aus der Sicht hinterbliebener Angehöriger. Mit dessen Hilfe soll die Frage, wie Angehörige die Begleitung und Pflege beurteilen, die ihnen sowie ihrem verstorbenen Familienmitglied durch das Hospiz zuteil wurde, beantwortet werden. Die Konstruktion der Fragen erfolgte auf Basis bestehender Konzepte zum Assessment der end-of-life care und einer Analyse aller identifizierten Instrumente zur Evaluation stationärer Hospize aus der Perspektive hinterbliebener Angehöriger. Die Fragebogenentwicklung umfasste neben der umfassenden Literaturrecherche die Bildung eines Itempools, die Itemauswahl, die kritische Diskussion der Fragen im Expertenkreis sowie einen standardisierten und kognitiven Pretest. Entstanden ist ein fünfdimensionaler Fragebogen, der physische, psychologische, soziale, spirituelle und versorgungsorganisatorische Aspekte der end-of-life care integriert. Das Instrument umfasst 53 Items in Form überwiegend geschlossener Fragen.

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