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Erel M, Marcus EL, DeKeyser Ganz F. Cognitive biases and moral characteristics of healthcare workers and their treatment approach for persons with advanced dementia in acute care settings. Front Med (Lausanne) 2023; 10:1145142. [PMID: 37425320 PMCID: PMC10325688 DOI: 10.3389/fmed.2023.1145142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 06/05/2023] [Indexed: 07/11/2023] Open
Abstract
Introduction Palliative care (PC) delivery for persons with advanced dementia (AD) remains low, particularly in acute-care settings. Studies have shown that cognitive biases and moral characteristics can influence patient care through their effect on the thinking patterns of healthcare workers (HCWs). This study aimed to determine whether cognitive biases, including representativeness, availability, and anchoring, are associated with treatment approaches, ranging from palliative to aggressive care in acute medical situations, for persons with AD. Methods Three hundred fifteen HCWs participated in this study: 159 physicians and 156 nurses from medical and surgical wards in two hospitals. The following questionnaires were administered: a socio-demographic questionnaire; the Moral Sensitivity Questionnaire; the Professional Moral Courage Scale; a case scenario of a person with AD presenting with pneumonia, with six possible interventions ranging from PC to aggressive care (referring to life-prolonging interventions), each given a score from (-1) (palliative) to 3 (aggressive), the sum of which is the "Treatment Approach Score;" and 12 items assessing perceptions regarding PC for dementia. Those items, the moral scores, and professional orientation (medical/surgical) were classified into the three cognitive biases. Results The following aspects of cognitive biases were associated with the Treatment Approach Score: representativeness-agreement with the definition of dementia as a terminal disease and appropriateness of PC for dementia; availability-perceived organizational support for PC decisions, apprehension regarding response to PC decisions by seniors or family, and apprehension regarding a lawsuit following PC; and anchoring-perceived PC appropriateness by colleagues, comfort with end-of-life conversations, guilt feelings following the death of a patient, stress, and avoidance accompanying care. No association was found between moral characteristics and the treatment approach. In a multivariate analysis, the predictors of the care approach were: guilt feelings about the death of a patient, apprehension regarding senior-level response, and PC appropriateness for dementia. Conclusion Cognitive biases were associated with the care decisions for persons with AD in acute medical conditions. These findings provide insight into the potential effects of cognitive biases on clinical decisions, which may explain the disparity between treatment guidelines and the deficiency in the implementation of palliation for this population.
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Affiliation(s)
- Meira Erel
- Henrietta Szold Hadassah-Hebrew University School of Nursing, Jerusalem, Israel
| | | | - Freda DeKeyser Ganz
- Henrietta Szold Hadassah-Hebrew University School of Nursing, Jerusalem, Israel
- Faculty of Health and Life Sciences, Jerusalem College of Technology, Jerusalem, Israel
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2
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Corcoran J, Huang AH, Miyasaki JM, Tarolli CG. Palliative care in Parkinson disease and related disorders. HANDBOOK OF CLINICAL NEUROLOGY 2023; 191:107-128. [PMID: 36599503 DOI: 10.1016/b978-0-12-824535-4.00017-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Although neuropalliative care is a relatively new field, there is increasing evidence for its use among the degenerative parkinsonian syndromes, including idiopathic Parkinson disease, progressive supranuclear palsy, multiple system atrophy, dementia with Lewy bodies, and corticobasal syndrome. This chapter outlines the current state of evidence for palliative care among individuals with the degenerative parkinsonian syndromes with discussion surrounding: (1) disease burden and needs across the conditions; (2) utility, timing, and methods for advance care planning; (3) novel care models for the provision of palliative care; and 4) end-of-life care issues. We also discuss currently unmet needs and unanswered questions in the field, proposing priorities for research and the assessment of implemented care models.
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Affiliation(s)
- Jennifer Corcoran
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, United States
| | - Andrew H Huang
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, United States
| | - Janis M Miyasaki
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Christopher G Tarolli
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, United States.
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3
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Erel M, Marcus EL, Heyman SN, DeKeyser Ganz F. Do Perceptions about Palliative Care Affect Emergency Decisions of Health Personnel for Patients with Advanced Dementia? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10236. [PMID: 36011871 PMCID: PMC9408797 DOI: 10.3390/ijerph191610236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/11/2022] [Accepted: 08/14/2022] [Indexed: 06/15/2023]
Abstract
Decision analysis regarding emergency medical treatment in patients with advanced dementia has seldom been investigated. We aimed to examine the preferred medical treatment in emergency situations for patients with advanced dementia and its association with perceptions of palliative care. We conducted a survey of 159 physicians and 156 nurses from medical and surgical wards in two tertiary hospitals. The questionnaire included two case scenarios of patients with advanced dementia presenting gastrointestinal bleeding (scenario I) or pneumonia (scenario II) with a list of possible interventions and 11 items probing perceptions towards palliative care. Low burden interventions such as laboratory tests and intravenous administration of antibiotics/blood were preferred. Palliative measures such as analgesia/sedation were chosen by about half of the participants and invasive intervention by 41.6% (gastroscopy in scenario I) and 37.1% (intubation/mechanical ventilation in scenario II). Medical ward staff had a more palliative approach than surgical ward staff in scenario I, and senior staff had a more palliative approach than junior staff in scenario II. Most participants (90.4%) agreed that palliative care was appropriate for patients with advanced dementia. Stress in caring for patients with advanced dementia was reported by 24.5% of participants; 33.1% admitted fear of lawsuit, 33.8% were concerned about senior-level responses, and 69.7% were apprehensive of family members' reaction to palliative care. Perceptions of health care workers towards palliative care were associated with preferred treatment choice for patients with advanced dementia, mainly in scenario II. Attitudes and apprehensions regarding palliative care in these situations may explain the gap between positive attitudes towards palliative care and the chosen treatment approach. Acquainting emergency care practitioners with the benefits of palliative care may impact their decisions when treating this population.
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Affiliation(s)
- Meira Erel
- Henrietta Szold School of Nursing, Hadassah Hebrew University, Jerusalem 9112102, Israel
| | - Esther-Lee Marcus
- Henrietta Szold School of Nursing, Hadassah Hebrew University, Jerusalem 9112102, Israel
- Herzog-Medical Center, Department of Geriatrics, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9103702, Israel
| | - Samuel N. Heyman
- Herzog-Medical Center, Department of Geriatrics, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9103702, Israel
- Department of Medicine, Hadassah Hebrew University Hospital, Mt. Scopus, Jerusalem 9765422, Israel
| | - Freda DeKeyser Ganz
- Henrietta Szold School of Nursing, Hadassah Hebrew University, Jerusalem 9112102, Israel
- Faculty of Health and Life Sciences, Jerusalem College of Technology, Jerusalem 9372115, Israel
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4
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Jensen I, Bretschneider A, Stiel S, Wegner F, Höglinger GU, Klietz M. Analysis of Parkinson's Disease Outpatient Counselling for Advance Directive Creation: A Cross-Sectional Questionnaire-Based Survey of German General Practitioners and Neurologists. Brain Sci 2022; 12:brainsci12060749. [PMID: 35741634 PMCID: PMC9221250 DOI: 10.3390/brainsci12060749] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/01/2022] [Accepted: 06/06/2022] [Indexed: 02/05/2023] Open
Abstract
A major proportion of people with Parkinson’s disease (PwP) in Germany has written an advance directive (AD). Unfortunately, these ADs are unclear for PD-specific endpoints. We previously established consensus-based recommendations for disease-specific content of an AD in PwP. However, the implementation of those recommendations and the consulting of AD creation and modification in PwP remains to be evaluated. This study aimed to investigate the practical use of PD-specific recommendations for ADs in outpatient settings. A total of 87 physicians (45 general practitioners (GPs) and 42 neurologists, 10% response rate) answered a self-constructed semiquantitative questionnaire. The participants were asked to evaluate the suggested PD-specific recommendations for ADs and the supply of palliative care in the outpatient setting. Overall, the vast majority of treating physicians agreed on the usefulness of the newly constructed PD-specific recommendations. Consultations to discuss information about PD-specific ADs were scarce with short durations. Only 24% of participating physicians implemented the PD-specific recommendations in their daily practice. GPs and neurologists agreed on the benefit of disease-specific recommendations for ADs. In future, a more general integration of these recommendations in routine care might improve specific AD creation of PwP and advanced care planning.
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Affiliation(s)
- Ida Jensen
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (A.B.); (F.W.); (G.U.H.); (M.K.)
- Correspondence:
| | - Almut Bretschneider
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (A.B.); (F.W.); (G.U.H.); (M.K.)
| | - Stephanie Stiel
- Institute for General Practice and Palliative Care, Hannover Medical School, 30625 Hannover, Germany;
| | - Florian Wegner
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (A.B.); (F.W.); (G.U.H.); (M.K.)
| | - Günter U. Höglinger
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (A.B.); (F.W.); (G.U.H.); (M.K.)
| | - Martin Klietz
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (A.B.); (F.W.); (G.U.H.); (M.K.)
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Kluger BM, Kramer NM, Katz M, Galifianakis NB, Pantilat S, Long J, Vaughan CL, Foster LA, Creutzfeldt CJ, Holloway RG, Sillau S, Hauser J. Development and Dissemination of a Neurology Palliative Care Curriculum: Education in Palliative and End-of-Life Care Neurology. Neurol Clin Pract 2022; 12:176-182. [PMID: 35747891 PMCID: PMC9208408 DOI: 10.1212/cpj.0000000000001146] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 08/09/2021] [Indexed: 11/15/2022]
Abstract
ABSTRACTDespite increasing awareness of the importance of a palliative care approach to meet the needs of persons living with neurologic illness, residency and fellowship programs report meeting this educational need due to a limited pool of neuropalliative care educators and a lack of adequate educational resources. To meet this need, a group of experts in neuropalliative care and palliative medicine leveraged resources from the Education in Palliative and End-of-life Care (EPEC) program and the National Institutes of Nursing Research (NINR) to create a library of modules addressing topics relevant for neurology trainees, palliative medicine fellows and clinicians in practice. In this manuscript, we describe the development and dissemination plan of the Education in Palliative and End-of-life Care Neurology (EPEC-N) program, initial evidence of efficacy, and opportunities for neurology educators and health services researchers to utilize these resources.
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Affiliation(s)
- Benzi M Kluger
- Departments of Neurology and Medicine (BMK, RGH), University of Rochester Medical Center, NY; Department of Internal Medicine (NMK), Rush University Medical College, Chicago, IL; Division of Palliative Medicine and Department of Medicine (MK, NBG, SP, JL), University of California, San Francisco; Department of Neurology (CLV, LAF, SS), University of Colorado Anschutz Medical Campus, Aurora; Department of Neurology (CJC), University of Washington, Seattle; and Departments of Palliative and Internal Medicine (JH), Northwestern University, Chicago, IL
| | - Neha M Kramer
- Departments of Neurology and Medicine (BMK, RGH), University of Rochester Medical Center, NY; Department of Internal Medicine (NMK), Rush University Medical College, Chicago, IL; Division of Palliative Medicine and Department of Medicine (MK, NBG, SP, JL), University of California, San Francisco; Department of Neurology (CLV, LAF, SS), University of Colorado Anschutz Medical Campus, Aurora; Department of Neurology (CJC), University of Washington, Seattle; and Departments of Palliative and Internal Medicine (JH), Northwestern University, Chicago, IL
| | - Maya Katz
- Departments of Neurology and Medicine (BMK, RGH), University of Rochester Medical Center, NY; Department of Internal Medicine (NMK), Rush University Medical College, Chicago, IL; Division of Palliative Medicine and Department of Medicine (MK, NBG, SP, JL), University of California, San Francisco; Department of Neurology (CLV, LAF, SS), University of Colorado Anschutz Medical Campus, Aurora; Department of Neurology (CJC), University of Washington, Seattle; and Departments of Palliative and Internal Medicine (JH), Northwestern University, Chicago, IL
| | - Nicholas B Galifianakis
- Departments of Neurology and Medicine (BMK, RGH), University of Rochester Medical Center, NY; Department of Internal Medicine (NMK), Rush University Medical College, Chicago, IL; Division of Palliative Medicine and Department of Medicine (MK, NBG, SP, JL), University of California, San Francisco; Department of Neurology (CLV, LAF, SS), University of Colorado Anschutz Medical Campus, Aurora; Department of Neurology (CJC), University of Washington, Seattle; and Departments of Palliative and Internal Medicine (JH), Northwestern University, Chicago, IL
| | - Steven Pantilat
- Departments of Neurology and Medicine (BMK, RGH), University of Rochester Medical Center, NY; Department of Internal Medicine (NMK), Rush University Medical College, Chicago, IL; Division of Palliative Medicine and Department of Medicine (MK, NBG, SP, JL), University of California, San Francisco; Department of Neurology (CLV, LAF, SS), University of Colorado Anschutz Medical Campus, Aurora; Department of Neurology (CJC), University of Washington, Seattle; and Departments of Palliative and Internal Medicine (JH), Northwestern University, Chicago, IL
| | - Judith Long
- Departments of Neurology and Medicine (BMK, RGH), University of Rochester Medical Center, NY; Department of Internal Medicine (NMK), Rush University Medical College, Chicago, IL; Division of Palliative Medicine and Department of Medicine (MK, NBG, SP, JL), University of California, San Francisco; Department of Neurology (CLV, LAF, SS), University of Colorado Anschutz Medical Campus, Aurora; Department of Neurology (CJC), University of Washington, Seattle; and Departments of Palliative and Internal Medicine (JH), Northwestern University, Chicago, IL
| | - Christina L Vaughan
- Departments of Neurology and Medicine (BMK, RGH), University of Rochester Medical Center, NY; Department of Internal Medicine (NMK), Rush University Medical College, Chicago, IL; Division of Palliative Medicine and Department of Medicine (MK, NBG, SP, JL), University of California, San Francisco; Department of Neurology (CLV, LAF, SS), University of Colorado Anschutz Medical Campus, Aurora; Department of Neurology (CJC), University of Washington, Seattle; and Departments of Palliative and Internal Medicine (JH), Northwestern University, Chicago, IL
| | - Laura A Foster
- Departments of Neurology and Medicine (BMK, RGH), University of Rochester Medical Center, NY; Department of Internal Medicine (NMK), Rush University Medical College, Chicago, IL; Division of Palliative Medicine and Department of Medicine (MK, NBG, SP, JL), University of California, San Francisco; Department of Neurology (CLV, LAF, SS), University of Colorado Anschutz Medical Campus, Aurora; Department of Neurology (CJC), University of Washington, Seattle; and Departments of Palliative and Internal Medicine (JH), Northwestern University, Chicago, IL
| | - Claire J Creutzfeldt
- Departments of Neurology and Medicine (BMK, RGH), University of Rochester Medical Center, NY; Department of Internal Medicine (NMK), Rush University Medical College, Chicago, IL; Division of Palliative Medicine and Department of Medicine (MK, NBG, SP, JL), University of California, San Francisco; Department of Neurology (CLV, LAF, SS), University of Colorado Anschutz Medical Campus, Aurora; Department of Neurology (CJC), University of Washington, Seattle; and Departments of Palliative and Internal Medicine (JH), Northwestern University, Chicago, IL
| | - Robert G Holloway
- Departments of Neurology and Medicine (BMK, RGH), University of Rochester Medical Center, NY; Department of Internal Medicine (NMK), Rush University Medical College, Chicago, IL; Division of Palliative Medicine and Department of Medicine (MK, NBG, SP, JL), University of California, San Francisco; Department of Neurology (CLV, LAF, SS), University of Colorado Anschutz Medical Campus, Aurora; Department of Neurology (CJC), University of Washington, Seattle; and Departments of Palliative and Internal Medicine (JH), Northwestern University, Chicago, IL
| | - Stefan Sillau
- Departments of Neurology and Medicine (BMK, RGH), University of Rochester Medical Center, NY; Department of Internal Medicine (NMK), Rush University Medical College, Chicago, IL; Division of Palliative Medicine and Department of Medicine (MK, NBG, SP, JL), University of California, San Francisco; Department of Neurology (CLV, LAF, SS), University of Colorado Anschutz Medical Campus, Aurora; Department of Neurology (CJC), University of Washington, Seattle; and Departments of Palliative and Internal Medicine (JH), Northwestern University, Chicago, IL
| | - Joshua Hauser
- Departments of Neurology and Medicine (BMK, RGH), University of Rochester Medical Center, NY; Department of Internal Medicine (NMK), Rush University Medical College, Chicago, IL; Division of Palliative Medicine and Department of Medicine (MK, NBG, SP, JL), University of California, San Francisco; Department of Neurology (CLV, LAF, SS), University of Colorado Anschutz Medical Campus, Aurora; Department of Neurology (CJC), University of Washington, Seattle; and Departments of Palliative and Internal Medicine (JH), Northwestern University, Chicago, IL
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Kluger BM, Miyasaki JM. Key concepts and opportunities. HANDBOOK OF CLINICAL NEUROLOGY 2022; 190:3-15. [PMID: 36055718 DOI: 10.1016/b978-0-323-85029-2.00014-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Neuropalliative care is an emerging field dedicated to applying palliative care approaches to meet the needs of persons living with neurologic illness and their families. The development of this field acknowledges the unique needs of this population, including in terms of neuropsychiatric symptoms, the impact of neurologic illness on personhood, and the logistics of managing neurologic disability. In defining the goals of this field, it is important to distinguish between neuropalliative care as an approach to care, as a skillset, as a medical subspecialty, and as a public health goal as each of these constructs offers their own contributions and opportunities. As a newly emerging field, there are nearly unlimited opportunities to improve care through research, clinical care, education, and advocacy.
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Affiliation(s)
- Benzi M Kluger
- Department of Neurology, University of Rochester, Rochester, NY, United States
| | - Janis M Miyasaki
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada.
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Kluger BM, Dolhun R, Sumrall M, Hall K, Okun MS. Palliative Care and Parkinson's Disease: Time to Move Beyond Cancer. Mov Disord 2021; 36:1325-1329. [PMID: 33786871 DOI: 10.1002/mds.28556] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/02/2021] [Accepted: 02/16/2021] [Indexed: 12/23/2022] Open
Affiliation(s)
- Benzi M Kluger
- Departments of Neurology and Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Rachel Dolhun
- The Michael J. Fox Foundation, New York, New York, USA
| | - Malenna Sumrall
- Parkinson Foundation Patient and Family Advisory Council, New York, New York, USA
| | - Kirk Hall
- Parkinson Foundation Patient and Family Advisory Council, New York, New York, USA
| | - Michael S Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, Florida, USA.,Parkinson's Foundation, Miami, Florida, USA
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Abstract
PURPOSE OF REVIEW This review summarizes the current state of evidence for palliative care (PC) in movement disorders, describes the application of PC to clinical practice, and suggests future research directions. RECENT FINDINGS PC needs are common in persons living with movement disorders and their families from the time of diagnosis through end-of-life and contribute to quality of life. Early advance care planning is preferred by patients, impacts outcomes and is promoted by PC frameworks. Systematic assessment of non-motor symptoms, psychosocial needs and spiritual/existential distress may address gaps in current models of care. Several complementary and emerging models of PC may be utilized to meet the needs of this population. A PC approach may identify and improve important patient and caregiver-centered outcomes. As a relatively new application of PC, there is a need for research to adapt, develop and implement approaches to meet the unique needs of this population.
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Affiliation(s)
- Zachary A Macchi
- Department of Neurology, University of Colorado, Aurora, CO Building 400, Mail Stop F429, 12469 E 17th Place, Aurora, CO, 80045, USA.
| | - Christopher G Tarolli
- Department of Neurology, University of Rochester, Rochester, NY, USA
- Center for Health + Technology, University of Rochester, Rochester, NY, USA
| | - Benzi M Kluger
- Department of Neurology, University of Rochester, Rochester, NY, USA
- Center for Health + Technology, University of Rochester, Rochester, NY, USA
- Department of Medicine, Palliative Care Division, University of Rochester, Rochester, NY, USA
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Manu ER, Fitzgerald JT, Mullan PB, Vitale CA. Eating Problems in Advanced Dementia: Navigating Difficult Conversations. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2020; 16:11025. [PMID: 33241119 PMCID: PMC7678029 DOI: 10.15766/mep_2374-8265.11025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 07/02/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION The majority of older adults with advanced dementia (AD) develop difficulties with eating and swallowing, often prompting concerns about nutrition and quality of life. Employing a palliative approach requires providers to attain skills in addressing symptoms and communicating with family caregivers about the trajectory of AD and associated dysphagia, as well as to elicit goals of care. Research suggests internal medicine (IM) residents often perceive minimal education during training addressing skills needed to care for patients with AD. METHODS We developed and piloted a small-group interactive seminar utilizing a trigger video depicting a family meeting addressing eating problems in a patient with AD. Case-based learning, small-group discussion, and learner reflection were employed. We assessed the impact on 82 of the 106 IM, medicine-pediatrics, and neurology residents who participated in the seminar. RESULTS Participant evaluation indicated residents showed high satisfaction and perceived the educational content of the seminar to be robust and clinically relevant. We found statistically significant (p < .001) improvements in self-reported confidence in dementia-specific skills postseminar. Effect size was large to very large (Cohen's d = 1.3-1.7). DISCUSSION An interactive, case-based seminar utilizing a video depicting a realistic family meeting improved residents' self-efficacy in skills needed to address nutritional issues, engage in goals-of-care discussions, and reflect on concerns among caregivers of patients with AD. The seminar teaches important geriatric and palliative concepts meant to improve residents' ability to care for older adults with AD in their future careers.
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Affiliation(s)
- Erika R. Manu
- Assistant Professor, Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School; Physician, VA Ann Arbor Geriatric Research, Education and Clinical Center (GRECC)
| | - James T. Fitzgerald
- Professor Emeritus, Department of Learning Health Sciences, University of Michigan Medical School
| | - Patricia B. Mullan
- Professor Emerita, Department of Learning Health Sciences, University of Michigan Medical School
| | - Caroline A. Vitale
- Professor, Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School; Associate Director of Education and Evaluation, VA Ann Arbor Geriatric Research, Education and Clinical Center (GRECC)
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Abstract
Palliative care is an approach to the care of patients, affected by serious illness, and their families that aims to reduce suffering through the management of medical symptoms, psychosocial issues, spiritual well-being, and setting goals of care. Patients and families affected by a neurodegenerative illness have significant palliative care needs beginning at the time of diagnosis and extending through end-of-life care and bereavement. We advocate an approach to addressing these needs where the patient's primary care provider or neurologist plays a central role. Key skills in providing effective palliative care to this population include providing the diagnosis with compassion, setting goals of care, anticipating safety concerns, caregiver assessment, advance care planning, addressing psychosocial concerns, and timely referral to a hospice. Managing distressing medical and psychiatric symptoms is critical to improving quality of life throughout the disease course as well as at end-of-life. Many symptoms are common across illnesses; however, there are issues that are specific to the most common classes of neurodegenerative illness, namely dementia, parkinsonism, and motor neuron disease. Incorporating a palliative approach to care, although challenging in many ways, empowers physicians to provide greater support and guidance to patients and families in making the difficult journey through a neurodegenerative illness.
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12
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Hagemeier NE, Ventricelli D, Sevak RJ. Situational communication self-confidence among community pharmacists: A descriptive analysis. Res Social Adm Pharm 2017; 13:1175-1180. [PMID: 28027861 PMCID: PMC6613189 DOI: 10.1016/j.sapharm.2016.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 12/16/2016] [Indexed: 11/21/2022]
Abstract
Objective: To compare community pharmacists’ self-perceived communication confidence in prescription drug abuse and addiction (PDAA)-related scenarios to their self-confidence in other scenarios. Methods: An 18-item survey instrument adapted from the Self-Perceived Communication Competence instrument was administered to 2000 licensed Tennessee community pharmacists. Items elicited communication confidence across common community pharmacy scenarios. Analysis of communication self-confidence scores across context, receiver, audience, and demographic variables was conducted. Results: Mean self-confidence ratings ranged from 54.2 to 92.6 (0–100 scale). Self-perceived communication confidence varied across context, receiver, audience, personal and practice setting characteristics. Scenarios that involved PDAA communication with patients were scored significantly lower than non-PDAA patient scenarios (mean = 84.2 vs. 90.4, p<0.001). Conclusion: Community pharmacists are less confident in their ability to communicate with patients about PDAA as compared to non-PDAA scenarios. Practice Implications: Engaging patients and prescribers in PDAA conversations is a critical component of preventing and treating PDAA. Research is warranted to further explore measures of situational communication self-confidence and interventions to optimize self-confidence beliefs across PDAA scenarios.
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Affiliation(s)
- Nicholas E Hagemeier
- Department of Pharmacy Practice, East Tennessee State University Gatton College of Pharmacy, Johnson City, TN, USA.
| | - Daniel Ventricelli
- Department of Pharmacy Practice and Administration, Philadelphia College of Pharmacy, University of the Sciences, Philadelphia, PA, USA
| | - Rajkumar J Sevak
- Pharmacy Health Services, Harrison School of Pharmacy, Auburn University, Auburn, AL, USA
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13
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Tarolli CG, Chesire AM, Biglan KM. Palliative Care in Huntington Disease: Personal Reflections and a Review of the Literature. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2017; 7:454. [PMID: 28428907 PMCID: PMC5395679 DOI: 10.7916/d88057c7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 03/20/2017] [Indexed: 01/03/2023]
Abstract
Background Huntington disease is a fatal, autosomal dominant, neurodegenerative disorder manifest by the triad of a movement disorder, behavioral disturbances, and dementia. At present, no curative or disease modifying therapies exist for the condition and current treatments are symptomatic. Palliative care is an approach to care that focuses on symptom relief, patient and caregiver support, and end of life care. There is increasing evidence of the benefit of palliative care throughout the course of neurodegenerative conditions including Parkinson disease and amyotrophic lateral sclerosis. However, beyond its application at the end of life, little is known about the role of palliative care in Huntington disease. Methods In this article, we discuss what is known about palliative care in Huntington disease, specifically related to early disease burden, caregiver burnout, advance care planning, and end of life care. Results We provide a review of the current literature and discuss our own care practices. Discussion We conclude by discussing questions that remain unanswered and positing ideas for future work in the field.
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Affiliation(s)
| | - Amy M Chesire
- Department of Neurology, University of Rochester, Rochester, NY, USA
| | - Kevin M Biglan
- Department of Neurology, University of Rochester, Rochester, NY, USA.,Early Phase Clinical Development, Neurosciences, Eli Lilly and Company, Indianapolis, IN, USA
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14
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Kluger BM, Fox S, Timmons S, Katz M, Galifianakis NB, Subramanian I, Carter JH, Johnson MJ, Richfield EW, Bekelman D, Kutner JS, Miyasaki J. Palliative care and Parkinson's disease: Meeting summary and recommendations for clinical research. Parkinsonism Relat Disord 2017; 37:19-26. [DOI: 10.1016/j.parkreldis.2017.01.008] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 12/01/2016] [Accepted: 01/10/2017] [Indexed: 12/25/2022]
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Liu Y, Kline D, Aerts S, Youngwerth JM, Kutner JS, Sillau S, Kluger BM. Inpatient Palliative Care for Neurological Disorders: Lessons from a Large Retrospective Series. J Palliat Med 2017; 20:59-64. [DOI: 10.1089/jpm.2016.0240] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ying Liu
- Department of Neurology, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - Danielle Kline
- Department of Internal Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - Shanae Aerts
- Department of Neurology, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - Jeanie M. Youngwerth
- Department of Internal Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - Jean S. Kutner
- Department of Internal Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - Stefan Sillau
- Department of Neurology, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - Benzi M. Kluger
- Department of Neurology, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado
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Hanson E, Hellström A, Sandvide Å, Jackson GA, MacRae R, Waugh A, Abreu W, Tolson D. The extended palliative phase of dementia – An integrative literature review. DEMENTIA 2016; 18:108-134. [PMID: 27460046 DOI: 10.1177/1471301216659797] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
This article presents an integrative literature review of the experience of dementia care associated with the extended palliative phase of dementia. The aim was to highlight how dementia is defined in the literature and describe what is known about the symptomatology and management of advanced dementia regarding the needs and preferences of the person with dementia and their family carer/s. There was no consistent definition of advanced dementia. The extended palliative phase was generally synonymous with end-of-life care. Advanced care planning is purported to enable professionals to work together with people with dementia and their families. A lack of understanding of palliative care among frontline practitioners was related to a dearth of educational opportunities in advanced dementia care. There are few robust concepts and theories that embrace living the best life possible during the later stages of dementia. These findings informed our subsequent work around the concept, ‘Dementia Palliare’.
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Affiliation(s)
- Elizabeth Hanson
- The Swedish Family Care Competence Centre, Linnaeus University, Sweden
| | - Amanda Hellström
- The Swedish Family Care Competence Centre, Linnaeus University, Sweden
| | - Åsa Sandvide
- The Swedish Family Care Competence Centre, Linnaeus University, Sweden
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Nguyen CM, Jansen BDW, Hughes CM, Rasmussen W, Weckmann MT. A qualitative exploration of perceived key knowledge and skills in end-of-life care in dementia patients among medical, nursing, and pharmacy students. J Palliat Med 2015; 18:56-61. [PMID: 24971747 DOI: 10.1089/jpm.2014.0029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The steady increase in the number of people living and dying with dementia, coupled with the recent focus on quality of care, has highlighted the importance of dementia training for health care professionals. This exploratory study aimed to discover which skills health care students felt were important in providing quality end-of-life care to dementia patients. METHODS Ninety-four medicine, nursing, and pharmacy students participated in a larger study using open-ended and closed questions to explore attitudes related to caring for dementia patients at the end of life. This study looks at the student responses to an open-ended question regarding the skills and knowledge they believe are needed to provide end-of-life care to dementia patients. Individual responses were reviewed by the researchers, coded into key issues, and tabulated for frequency of occurrences and group differences. RESULTS Several common issues emerged: knowledge, patience, empathy, understanding, family involvement, compassion, medication knowledge, respect/patient autonomy, communication, quality of life, and patient education. Significant differences were observed among the participant groups on the following issues: Patience and understanding (pharmacy students mentioned these issues less frequently than medical and nursing students), compassion (medical students mentioned this issue more frequently than pharmacy students), and medication knowledge (pharmacy students mentioned this issue more frequently than medical and nursing students). CONCLUSIONS Different health care disciplines (in-training) value different skill sets for the provision of dementia care at the end-of-life. As health care education for dementia patients at the end of life is expanded, it will be important to understand which skills both patients and health care students value.
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Affiliation(s)
- Christopher M Nguyen
- 1 Departments of Family Medicine and Psychiatry, University of Iowa Hospitals and Clinics , Iowa City, Iowa
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18
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Boersma I, Miyasaki J, Kutner J, Kluger B. Palliative care and neurology: time for a paradigm shift. Neurology 2014; 83:561-7. [PMID: 24991027 DOI: 10.1212/wnl.0000000000000674] [Citation(s) in RCA: 148] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Palliative care is an approach to the care of patients and families facing progressive and chronic illnesses that focuses on the relief of suffering due to physical symptoms, psychosocial issues, and spiritual distress. As neurologists care for patients with chronic, progressive, life-limiting, and disabling conditions, it is important that they understand and learn to apply the principles of palliative medicine. In this article, we aim to provide a practical starting point in palliative medicine for neurologists by answering the following questions: (1) What is palliative care and what is hospice care? (2) What are the palliative care needs of neurology patients? (3) Do neurology patients have unique palliative care needs? and (4) How can palliative care be integrated into neurology practice? We cover several fundamental palliative care skills relevant to neurologists, including communication of bad news, symptom assessment and management, advance care planning, caregiver assessment, and appropriate referral to hospice and other palliative care services. We conclude by suggesting areas for future educational efforts and research.
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Affiliation(s)
- Isabel Boersma
- From the Departments of Neurology and Psychiatry (I.B., B.K.) and Internal Medicine (J.K.), University of Colorado Anschutz Medical Campus, Aurora; and Department of Neurology (J.M.), University of Alberta, Edmonton, Canada
| | - Janis Miyasaki
- From the Departments of Neurology and Psychiatry (I.B., B.K.) and Internal Medicine (J.K.), University of Colorado Anschutz Medical Campus, Aurora; and Department of Neurology (J.M.), University of Alberta, Edmonton, Canada
| | - Jean Kutner
- From the Departments of Neurology and Psychiatry (I.B., B.K.) and Internal Medicine (J.K.), University of Colorado Anschutz Medical Campus, Aurora; and Department of Neurology (J.M.), University of Alberta, Edmonton, Canada
| | - Benzi Kluger
- From the Departments of Neurology and Psychiatry (I.B., B.K.) and Internal Medicine (J.K.), University of Colorado Anschutz Medical Campus, Aurora; and Department of Neurology (J.M.), University of Alberta, Edmonton, Canada.
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19
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Theoretical exploration of Tennessee community pharmacists' perceptions regarding opioid pain reliever abuse communication. Res Social Adm Pharm 2014; 10:562-75. [DOI: 10.1016/j.sapharm.2013.07.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 07/17/2013] [Accepted: 07/17/2013] [Indexed: 11/20/2022]
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20
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Hagemeier NE, Gray JA, Pack RP. Prescription drug abuse: a comparison of prescriber and pharmacist perspectives. Subst Use Misuse 2013; 48:761-8. [PMID: 23607672 DOI: 10.3109/10826084.2013.787101] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study compared perceptions of prescribers and pharmacists (N = 89) regarding multiple aspects of prescription drug abuse. Questionnaires were developed to assess perceptions regarding the prevalence of prescription drug abuse, self-perceived communication competence, and additional communication and prescription drug abuse domains. Pharmacists perceived a larger percentage of patients (41%) to be abusing opioid pain relievers as compared with their prescriber colleagues (17%). Both prescribers and pharmacists indicated improvements in prescriber-pharmacist communication would serve to deter prescription drug abuse. Self-efficacy beliefs for detecting and discussing prescription drug abuse with patients were low for both cohorts. Implications and limitations are noted. Year of data collection: 2012 SETTING: Rural Appalachia Data Collection Instruments: Prescriber- and pharmacist-specific survey instruments Data Analysis Techniques: Independent samples t-test; Mann-Whitney U test.
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Affiliation(s)
- Nicholas E Hagemeier
- Pharmacy Practice, Gatton College of Pharmacy, East Tennessee State University, Johnson City, Tennessee 37614, USA.
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