Is Care for the Dying Improving in the United States?

Teno, Joan M.; Freedman, Vicki A.; Kasper, Judith D.; Gozalo, Pedro; Mor, Vincent

doi:10.1089/jpm.2015.0039

Cited by 87 publications

(88 citation statements)

References 18 publications

(8 reference statements)

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“…Due to a national shortage of palliative subspecialists, most seriously ill patients will receive care from their primary care doctors and hospitalists. Data [28][29][30] show that seriously ill patients suffer tremendously due to unmet bio-psycho-sociospiritual care needs during all stages of their illness trajectory. No patient moves from a state of ''zero suffering'' to ''intractable suffering'' overnight.…”

Section: Physician-assisted Death In California and Hawaiimentioning

confidence: 99%

Multi-Ethnic Attitudes Toward Physician-Assisted Death in California and Hawaii

Periyakoil

Kraemer

Neri

2016

Journal of Palliative Medicine

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Background: As aid-in-dying laws are gaining more public acceptance and support, it is important to understand diverse perceptions toward physician-assisted death (PAD). We compare attitudes of residents from California and Hawaii to identify variables that may predict attitudes toward PAD. Methods: A cross-sectional online survey of 1095 participants (a 75.8% survey completion rate) from California and 819 from Hawaii (a 78.4% survey completion rate). Data were collected between July through October 2015.Results: Majority of study participants in California (72.5%) and Hawaii (76.5%) were supportive of PAD. Only 36.8% of participants in Hawaii and 34.8% of participants in California reported completing advance directives. To better understand which subgroups were most in favor of PAD, data were analyzed using both recursive partitioning and stepwise logistic regression. Older participants were more supportive of PAD in both states. Also, all ethnic groups were equally supportive of PAD. Completion of advance directives was not a significant predictor of attitudes toward PAD. Persons who reported that faith/religion/spirituality was less important to them were more likely to support PAD in both states. Thus, the major influences on the attitudes to PAD were religious/spiritual views and age, not ethnicity and gender. Even in the subgroups least supportive of PAD, the majority supported PAD. Conclusions: This study shows that in the ethnically diverse states of California and Hawaii, faith/religion/ spirituality and age are major influencers of attitudes toward PAD and not ethnicity and gender. Even in the subgroups least supportive of PAD, the majority supports PAD.

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Section: Physician-assisted Death In California and Hawaiimentioning

confidence: 99%

Multi-Ethnic Attitudes Toward Physician-Assisted Death in California and Hawaii

Periyakoil

Kraemer

Neri

2016

Journal of Palliative Medicine

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“…[1][2][3][4][5][6] Measuring quality indicators related to these important processes may be a stimulus for improvement. However, few health care organizations routinely measure the quality of end-of-life care in general, and even fewer routinely evaluate the quality of communication and decisionmaking.…”

Section: Discussionmentioning

confidence: 99%

“…5,6 One of the major reasons for this limited progress may be the lack of quality indicators that are meaningful at a health system level to guide decision-makers as they introduce policies and practices to improve end-of-life care. 7,8 We recently published a study that used a modified Delphi consensus process to develop a set of quality indicators related to advance care planning, goals-of-care discussions and documentation of these plans and goals (Table 1).…”

mentioning

confidence: 99%

Validation of quality indicators for end-of-life communication: results of a multicentre survey

Heyland

Dodek

You

et al. 2017

CMAJ

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Despite numerous calls to improve end-of-life care, and communication and decision-making in particular, [1][2][3][4] over 2 decades there has been little progress in this arena. 5,6 One of the major reasons for this limited progress may be the lack of quality indicators that are meaningful at a health system level to guide decision-makers as they introduce policies and practices to improve end-of-life care. 7,8 We recently published a study that used a modified Delphi consensus process to develop a set of quality indicators related to advance care planning, goals-of-care discussions and documentation of these plans and goals (Table 1).9 Quality indicators should be evaluated based on their reliability, validity, responsiveness to change and ease of implementation.10 Because of the robust methodology used in developing these quality indicators, 9 we believe they are clinically sensible and have face and content validity. Here we describe implementation of these quality indicators in a multicentre study to evaluate their feasibility and construct validity. A secondary objective was to establish a method for ranking institutions with respect to their performance in end-of-liferelated communication and decision-making. MethodsThis work was guided by a conceptual model of communication and decision-making in seriously ill and older patients who had been admitted to hospital, and the impact of these processes on patient-centred outcomes (Figure 1). 9 To validate the aforementioned quality indicators, we conducted a multicentre, prospective audit of communication and decision-making related to the use or nonuse of life-sustaining treatments during serious illness, from the perspectives of patients and their family members; this was called the Audit of Communication, Care Planning, and The lack of validated quality indicators is a major barrier to improving end-of-life communication and decision-making. We sought to show the feasibility of and provide initial validation for a set of quality indicators related to end-of-life communication and decision-making.

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“…In spite of this, COPD patients are much less likely to receive palliative care than patients with lung cancer [9-14]. In fact, COPD patients have limited access to specialists in palliative care [15, 16] and very few palliative care intervention studies are available for this population [17, 18]. …”

Section: Introductionmentioning

confidence: 99%

Can Early Introduction of Palliative Care Limit Intensive Care, Emergency and Hospital Admissions in Patients with Severe Chronic Obstructive Pulmonary Disease? A Pilot Randomized Study

et al. 2019

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Background: Despite their poor prognosis, patients with severe chronic obstructive pulmonary disease (COPD) have little access to palliative care and tend to have a high rate of hospital and intensive care unit (ICU) admissions during their last year of life. Objectives: To determine the feasibility of a home palliative care intervention during 1 year versus usual care, and the possible impact of this intervention on emergency, hospital and ICU admissions, survival, mood, and health-related quality of life (HRQL). Methods: Prospective controlled study of patients with severe COPD (GOLD stage III or IV) and long-term oxygen therapy and/or home noninvasive ventilation and/or one or more hospital admissions in the previous year for acute exacerbation, randomized to usual care versus usual care with add-on monthly intervention by palliative care specialists at home for 12 months. Results: Of 315 patients screened, 49 (15.5%) were randomized (26 to early palliative care; 23 to the control group); aged (mean ± SD) 71 ± 8 years; FEV₁ was 37 ± 14% predicted; 88% with a COPD assessment test score > 10; 69% on long-term oxygen therapy or home noninvasive ventilation. The patients accepted the intervention and completed the assessment scales. After 1 year, there was no difference between groups in symptoms, HRQL and mood, and there was a nonsignificant trend for higher admission rates to hospital and emergency wards in the intervention group. Conclusion: Although this pilot study was underpowered to formally exclude a benefit from palliative care in severe COPD, it raises several questions as to patient selection, reluctance to palliative care in this group, and modalities of future trials.

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Is Care for the Dying Improving in the United States?

Cited by 87 publications

References 18 publications

Multi-Ethnic Attitudes Toward Physician-Assisted Death in California and Hawaii

Multi-Ethnic Attitudes Toward Physician-Assisted Death in California and Hawaii

Validation of quality indicators for end-of-life communication: results of a multicentre survey

Can Early Introduction of Palliative Care Limit Intensive Care, Emergency and Hospital Admissions in Patients with Severe Chronic Obstructive Pulmonary Disease? A Pilot Randomized Study

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