Palliative Care

Rs, Morrison; De, Meier

doi:10.1056/nejmcp035232

Cited by 478 publications

(187 citation statements)

References 52 publications

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“…State-ofthe-art palliative medicine seldom utilizes ANH, stresses the avoidance of ANH, and has evolved other effective means of relieving the few symptoms attributable to dehydration or lack of nutrition. 38 Palliative strategies are based on the understanding that as the patient approaches the end of life, bodily functions slow. For many terminal patients, including those with advanced dementia, loss of appetite and thirst, often complicated by difficulty in swallowing, parallels the dying body's inability to utilize nutrients.…”

Section: Late 1990s: Empirical Datamentioning

confidence: 99%

Artificial Nutrition and Hydration: The Evolution of Ethics, Evidence, and Policy

Brody

Hermer

Scott³

et al. 2011

J GEN INTERN MED

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Section: Late 1990s: Empirical Datamentioning

confidence: 99%

Artificial Nutrition and Hydration: The Evolution of Ethics, Evidence, and Policy

Brody

Hermer

Scott³

et al. 2011

J GEN INTERN MED

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“…Palliative care is recognized as an important component of care for all patients with life-limiting illness (1,2); however, historically, palliative care has been focused on patients with malignant diseases (1,3,4) and has been underused in patients with chronic lung disease (1). Recently, interest has grown in providing palliative care for patients with chronic lung disease, including chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD) (1,5,6).…”

mentioning

confidence: 99%

Palliative Care for Patients Dying in the Intensive Care Unit with Chronic Lung Disease Compared with Metastatic Cancer

et al. 2016

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Rationale: Palliative care has been focused largely on patients with cancer, and yet patients with chronic lung diseases also have high morbidity and mortality. The majority of deaths in intensive care units (ICUs) follow decisions to withhold or withdraw life-sustaining treatments, suggesting that palliative care is critically important in this setting.Objectives: We explored differences in receipt of elements of palliative care among patients with interstitial lung disease (ILD) and chronic obstructive pulmonary disease (COPD) who die in ICUs compared with patients with cancer.Methods: We identified patients with COPD, ILD, or metastatic cancer who died in the ICUs of 15 Seattle-area hospitals between 2003 and 2008. We used robust multivariable logistic and linear regression to compare differences in receipt of elements of palliative care and length of stay. Measurements and Main Results:Compared with patients with cancer, patients with COPD were more likely to receive cardiopulmonary resuscitation before death and patients with ILD were less likely to have documentation of pain assessment in the last day of life. Patients with ILD and COPD were less likely to have a do-not-resuscitate order in place at the time of death and less likely to have documentation of discussions about prognosis than patients with cancer. Patients with COPD had longer hospital lengths of stay, and patients with COPD and ILD had longer ICU lengths of stay. Conclusions:Among patients who die in the ICU, patients with ILD and COPD receive fewer elements of palliative care and have longer lengths of stay than patients with cancer. These findings identify areas for improvement in caring for patients with chronic lung diseases.Clinical trial registered with www.clinicaltrials.gov (NCT00685893).

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“…103 It uses a teambased approach to relieve the pain, symptoms, and distress of a serious illness like CVD. 111 By determining patient and caregiver goals of care through skilled communication, treating distressing symptoms while coordinating care, providing practical support for patients and caregivers, and mobilizing community support and resources to ensure a secure and safe living environment, palliative care teams help meet patient and caregiver needs so that they can avoid unwanted and expensive crisis care. [112][113][114] Many large US hospitals now have palliative care services, but availability across settings is highly variable by region and by state.…”

Section: May 8 2018mentioning

confidence: 99%

Projected Costs of Informal Caregiving for Cardiovascular Disease: 2015 to 2035: A Policy Statement From the American Heart Association

Dunbar¹,

Khavjou²,

Bakas³

et al. 2018

Circulation

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199

102

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INTRODUCTION:In a recent report, the American Heart Association estimated that medical costs and productivity losses of cardiovascular disease (CVD) are expected to grow from $555 billion in 2015 to $1.1 trillion in 2035. Although the burden is significant, the estimate does not include the costs of family, informal, or unpaid caregiving provided to patients with CVD. In this analysis, we estimated projections of costs of informal caregiving attributable to CVD for 2015 to 2035. METHODS:We used data from the 2014 Health and Retirement Survey to estimate hours of informal caregiving for individuals with CVD by age/sex/race using a zero-inflated binomial model and controlling for sociodemographic factors and health conditions. Costs of informal caregiving were estimated separately for hypertension, coronary heart disease, heart failure, stroke, and other heart disease. We analyzed data from a nationally representative sample of 16 731 noninstitutionalized adults ≥54 years of age. The value of caregiving hours was monetized by the use of home health aide workers' wages. The per-person costs were multiplied by census population counts to estimate nation-level costs and to be consistent with other American Heart Association analyses of burden of CVD, and the costs were projected from 2015 through 2035, assuming that within each age/sex/racial group, CVD prevalence and caregiving hours remain constant. RESULTS:The costs of informal caregiving for patients with CVD were estimated to be $61 billion in 2015 and are projected to increase to $128 billion in 2035. Costs of informal caregiving of patients with stroke constitute more than half of the total costs of CVD informal caregiving ($31 billion in 2015 and $66 billion in 2035). By age, costs are the highest among those 65 to 79 years of age in 2015 but are expected to be surpassed by costs among those ≥80 years of age by 2035. Costs of informal caregiving for patients with CVD represent an additional 11% of medical and productivity costs attributable to CVD. CONCLUSIONS:The burden of informal caregiving for patients with CVD is significant; accounting for these costs increases total CVD costs to $616 billion in 2015 and $1.2 trillion in 2035. These estimates have important research and policy implications, and they may be used to guide policy development to reduce the burden of CVD on patients and their caregivers.

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Palliative Care

Cited by 478 publications

References 52 publications

Artificial Nutrition and Hydration: The Evolution of Ethics, Evidence, and Policy

Artificial Nutrition and Hydration: The Evolution of Ethics, Evidence, and Policy

Palliative Care for Patients Dying in the Intensive Care Unit with Chronic Lung Disease Compared with Metastatic Cancer

Projected Costs of Informal Caregiving for Cardiovascular Disease: 2015 to 2035: A Policy Statement From the American Heart Association

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