Background: The Palliative Care and Rapid Emergency Screening (P-CaRES) tool has been validated to identify patients in the emergency department (ED) with unmet palliative care needs, but no prognostic data have been published. The Palliative Performance Scale (PPS) has been validated to predict survival based on performance status and separately has been shown to predict survival among adults admitted to the hospital from the ED. Objective: To concurrently validate the 6-month prognostic utility of P-CaRES with a replication of prior studies that demonstrated the prognostic utility of the PPS among adults admitted to the hospital from the ED. Design: Prospective cohort study. Setting/Subjects: Adults >55 years admitted to the hospital from the ED at an urban academic hospital in South Carolina. Measurement: Baseline PPS score and P-CaRES status were evaluated within 51 hours of admission. Vital status at 6 months was evaluated by phone or chart review. Results: 131 of 145 participants completed the study. Six-month survival was 79.2% of those with a PPS of 60-100 (22/106 died) and 48% of those with a PPS of 10-50 (13/25 died) (p = 0.0004). Six-month survival was 85.2% for P-CaRES negative (13/88 died) and 48.8% for P-CaRES positive (22/43 died) (p < 0.0001). The inferred hazard ratio (HR) for PPS 10-50, as compared to PPS 60-100 was 3.003 (95%CI (1.475, 6.112) p = 0.0024) and the HR for P-CaRES positive, as compared to P-CaRES negative was 4.186 (95%CI (2.052, 8.536) p < 0.0001). Conclusion: The P-CaRES tool and PPS can predict 6-month survival of older adults admitted from the ED.
Care of the dementia patient continues to be challenging. It is a terminal condition that many times goes undiagnosed leading to improper evidence-based interventions. Healthcare professionals (HCPs) should initiate goals of care conversations early with patients and their families in order to align treatment preferences. Early integration of palliative medicine is an important intervention that can lead to better manage symptoms and lessen the strain on loved ones. Additionally, early enrollment into hospice should be encouraged with loved ones to promote quality of life as defined by the patient.
Countries participated, Response rate 63%. Median age 47(SD+/-12), 75% were women. 40% were Catholic. 58% were physicians, 19% nurses, 12% psychology, and other12%. The median time of working in PC was 9 years (+/-7). LAPC considered themselves spiritual (median: 8/10, range 0-10) and religious (5, 0-10). LAPC considered S/R very important in their lives (9/10, 0-10 and 6/10, 0-10), respectively. LAPC reported that S/R was a source of strength and comfort (9/10, SD+/-2), helped them to cope with their problems (8/10, SD+/-3), and helped them to keep their quality of life in a stressful work environment (8/10, SD+/-4), significant in those belonging to a church community (p¼0.000), time working in PC (p¼0.01), age (p¼0.03). 190/ 221(86%) reported strongly/somewhat agreed with the statement: ''I feel called to take care of patients who are dying''. 31/221(14%) reported being Burned out. No significant difference among gender, profession, age, years in profession or in PC, or importance of spirituality and religion. Objectives 1. Describe resident perceptions of direct observation of goals-of-care communication. 2. Describe barriers to direct observation of goalsof-care communication.
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