Improving End of Life Cancer Outcomes Through Development and Implementation of a Spiritual Care Advocate Program

Background: Explored whether increased support for spiritual concerns between the healthcare team and patients through the provision of a Spiritual Care Advocate (SCA) would improve end of life outcomes in a metastatic cancer population. Design: Newly diagnosed metastatic cancer patients were recruited at the University of Chicago Medical Center and received spiritual support from a Spiritual Care Advocate during chemotherapy treatments. The final sample consisted of 42 patients (58% of those approached) who completed the baseline survey and had known survival status. Measurement: Patients completed pre/post surveys measuring spiritual support and palliative quality of life. Baseline measurements of religious practice and externalizing religious health beliefs were also obtained. Receipt of aggressive EOL care was derived from the electronic medical record. Result: Median age was 61 years, with 48% Black, and predominantly male (62%). Of the 42 patients, 30 (70%) had died by the time of this analysis. Perceived spiritual support from the medical team increased in 47% of those who received non-aggressive EOL care and by 40% in those who received aggressive EOL care (p=0.012). Patient perceptions of spiritual support from the medical community increased from 27% at baseline to 63% (p=0.005) after the SCA intervention. Only 20% of recipients received aggressive treatments at end of life. Conclusion: The SCA model improved the perceived spiritual support between the healthcare team and patients. Although limited by a small sample size, the model was also associated with an improvement in EOL patients’ quality of life, spiritual wellbeing, and decreased aggressive EOL care.

Demographic Predictors of the Perceived Likelihood of Hiring a Health Care Advocate

Background and Significance: The field of health care advocacy developed in response to the growing complexity of the health care system. A Health Care Advocate (HCA) is a trained professional who can help patients navigate the health care system. In the present study we investigated the effects of social support, number of people with whom individuals reside, gender, age, income, and race on the perceived likelihood of hiring an HCA for oneself. Method: Nine hundred and eighty-seven adults (Mage = 45.48 years, SD = 17.33 years, 55.4% female) were randomly selected and asked to complete a questionnaire. To explore the relationships of the perceived likelihood of hiring an HCA, path-analytic models using full-information maximum likelihood (FIML) estimation were tested, using Stata 12.1. Results: The model fit well statistically, ? 2 (5, N = 987) = 8.50, p = 0.131, and descriptively, CFI = 0.999, RMSEA = 0.027, pclose = 0.891, CD = 0.205. Conclusion: Overall, the model accounted for 4.30% of the variance in Hire HCA. More research is needed to better understand the role of an HCA in our complex and everchanging health care system.

NEGLIGENCE AND ACCOMMODATION

ABSTRACTWhereas the Restatement of Torts and leading economic and justice-based approaches to explaining the standard of reasonable care advocate symmetric measurement of reasonable care across the defendant/plaintiff distinction, this article demonstrates that, in fact, the law applies this standard asymmetrically. Defendants are expected to discharge an objectively fixed amount of care, whereas plaintiffs are generally assessed using a subjective measurement of reasonable care. Normatively, I argue that an asymmetric assessment of care, because it combines an unfavorable assessment of defendant's negligence with a favorable assessment of plaintiff's negligence, means that the victim gets to fix the terms of the interaction. This argument resonates with the powerful egalitarian idea of accommodating, rather than overlooking, relevant differences; different treatment is necessary for the duty of reasonable care to give effect to the qualitative difference between the plaintiff's life and limb and the defendant's autonomy. Asymmetric assessment of due care, I argue, is the doctrinal metric by which the law determines what it is for the plaintiff and the defendant to relate as equals given that difference, or to relate as substantive equals.