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Khayal IS, Barnato AE. What is in the palliative care 'syringe'? A systems perspective. Soc Sci Med 2022; 305:115069. [PMID: 35691210 DOI: 10.1016/j.socscimed.2022.115069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 05/20/2022] [Accepted: 05/21/2022] [Indexed: 11/18/2022]
Abstract
The diffusion of palliative care has been rapid, yet uncertainty remains regarding palliative care's "active ingredients." The National Consensus Project Guidelines for Quality Palliative Care identified eight domains of palliative care. Despite these identified domains, when pressed to describe the specific maneuvers used in clinical encounters, palliative care providers acknowledge that "it's complex." The field of systems has been used to explain complexity across many different types of systems. Specifically, engineering systems develop a representation of a system that helps manage complexity to help humans better understand the system. Our goal was to develop a system model of what palliative care providers do such that the elements of the model can be described concretely and sequentially, aggregated to describe the high-level domains currently described by palliative care, and connected to the complexity described by providers and the literature. Our study design combined methodological elements from both qualitative research and systems engineering modeling. The model drew on participant observation and debriefing semi-structured interviews with interdisciplinary palliative care team members by a systems engineer. The setting was an interdisciplinary palliative care service in a US rural academic medical center. In the developed system model, we identified 59 functions provided to patients, families, non-palliative care provider(s), and palliative care provider(s). The high-level functions related to measurement, decision-making, and treatment address up to 8 states of an individual, including an overall holistic state, physical state, psychological state, spiritual state, cultural state, personal environment state, and clinical environment state. In contrast to previously described expert consensus domain-based descriptions of palliative care, this model more directly connects palliative care provider functions to emergent behaviors that may explain system-level mechanisms of action for palliative care. Thus, a systems modeling approach provides insights into the challenges surrounding the recurring question of what is in the palliative care "syringe."
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Affiliation(s)
- Inas S Khayal
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA; Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA; Department of Computer Science, Dartmouth College, Hanover, NH, USA.
| | - Amber E Barnato
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA; Section of Palliative Care, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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Pastrana T, De Lima L, Stoltenberg M, Peters H. Palliative Medicine Specialization in Latin America: A Comparative Analysis. J Pain Symptom Manage 2021; 62:960-967. [PMID: 33933625 DOI: 10.1016/j.jpainsymman.2021.04.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/16/2021] [Accepted: 04/21/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Formal recognition of palliative medicine as a specialty has been one of the main drivers in the development of palliative care. AIM To provide a comparative, comprehensive overview on the status of palliative medicine as medical specialty across Latin America. METHODS We conducted a comparative study of 19 Latin American countries. Key informants and persons in charge of the specialization training programs were identified and interviewed. We collected data on general recognition as specialty (title, process of certification) and on training program characteristics (title, start year, requirements, training length, and type full time or part time). RESULTS Eight of 19 countries (42%) Argentina, Brazil, Colombia, Costa Rica, Ecuador, Mexico, Paraguay and Venezuela reported palliative medicine as medical specialty. Thirty-five (sub)specialization training programs in palliative medicine were identified in the region (eight as a specialty and 27 as a subspecialty), the majority in Colombia (43.5%) and Brazil (33.7%). A total of 20% of the programs have yet to graduate their first cohort. Length of clinical training as specialty varied from two to four years, and from 520 hours to three years for a subspecialty. CONCLUSION Despite long-standing efforts to improve quality of care, and significant achievements to date, most Latin American countries have yet to develop palliative medicine as medical specialty. Specialty and sub-specialty training programs remain scarce in relation to regional needs, and the programs that do exist vary widely in duration, structure, and content.
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Affiliation(s)
- Tania Pastrana
- Department of Palliative Medicine (T.P.), RWTH University Aachen, Aachen, Germany.
| | - Liliana De Lima
- International Association for Hospice and Palliative Care (IAHPC) (L.D.L.), Houston, Texas, USA
| | - Mark Stoltenberg
- Division of Palliative Care and Geriatrics (M.S.), Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard Medical School (M.S.), Boston, Massachusetts, USA
| | - Harm Peters
- Dieter Scheffner Center for Medical Education and Educational Research (H.P.), Dean´s Office of Study Affairs, Charité - Universitätsmedizin Berlin, Berlin, Germany
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3
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Caponero R. Palliative Care in Colorectal Cancer. COLORECTAL CANCER 2021. [DOI: 10.5772/intechopen.93513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Approximately 25% of patients present with liver metastases at the time of the first diagnosis and up to 50% will further develop recurrence in the liver during their disease course. Traditionally approached surgically, by resection of the primitive tumor or stoma, the management to incurable stage IV colorectal cancer patients has significantly changed over the last three decades and is nowadays multidisciplinary, with a pivotal role played by chemotherapy. Most patients with stage IV colorectal cancer have a poor prognosis, but numerous palliative modalities are available today. When a cure is no longer possible, treatment is directed toward providing symptomatic relief. Good symptom management in oncology is associated with improved patient and family quality of life, greater treatment compliance, and may even offer survival advantages.
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Morrison LJ, Periyakoil VS, Arnold RM, Tucker R, Chittenden E, Sanchez-Reilly S, Carey EC. Launching the Next Steps to Improve Hospice and Palliative Medicine Fellow Performance Assessment: A Look Back to the Initial Toolkit of Assessment Methods. J Pain Symptom Manage 2021; 61:613-627. [PMID: 33091584 PMCID: PMC7569474 DOI: 10.1016/j.jpainsymman.2020.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/15/2020] [Accepted: 10/16/2020] [Indexed: 11/24/2022]
Abstract
Education leaders in hospice and palliative medicine (HPM) have long acknowledged the challenge of fellow performance assessment and the need for HPM-specific fellow assessment tools. In 2010, and in alignment with the Accreditation Council for Graduate Medical Education's (ACGME's) directive toward competency-based medical education, the national HPM Competencies Workgroup curated a set of assessment tools, the HPM Toolkit of Assessment Methods. The Toolkit has been a resource for HPM fellowship directors in evolving practical, multifaceted fellow assessment strategies. Now, as American Academy of Hospice and Palliative Medicine plans for a national workgroup in 2020 to define current HPM fellow assessment methods and to propose strategies to strengthen and standardize future assessment, the Toolkit provides a strong base from which to launch. However, the field learned important lessons from the 2010 Workgroup about the consensus process, gaps in areas of assessment, opportunities to address gaps with new or adapted tools, and limitations in implementing the Toolkit over time in terms of tracking, accessibility, and dissemination. This article describes the development of the Toolkit, including recommended tools and methods for assessment within each ACGME competency domain, and links the lessons learned to recommendations for the 2020 workgroup to consider in creating the next HPM assessment strategy and toolkit. Effective implementation will be crucial in supporting fellows to reach independent practice, which will further strengthen the field and workforce to provide the highest quality patient and family-centered care in serious illness. This will require an inspired, committed effort from the HPM community, which we enthusiastically anticipate.
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Affiliation(s)
- Laura J Morrison
- Yale Palliative Care Program, Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
| | | | - Robert M Arnold
- Section of Palliative Care and Medical Ethics, University of Pittsburgh Medical School, Pittsburgh, Pennsylvania, USA
| | - Rodney Tucker
- University of Alabama at Birmingham Center for Palliative and Supportive Care, Birmingham, Alabama, USA
| | - Eva Chittenden
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sandra Sanchez-Reilly
- Department of Medicine, University of Texas Health Science Center at San Antonio and South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - Elise C Carey
- Center for Palliative Medicine, Mayo Clinic, Rochester, Minnesota, USA
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5
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Zhang M, Li X. Focuses and trends of the studies on pediatric palliative care:A bibliometric analysis from 2004 to 2018. Int J Nurs Sci 2021; 8:5-14. [PMID: 33575439 PMCID: PMC7859508 DOI: 10.1016/j.ijnss.2020.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 11/10/2020] [Accepted: 11/26/2020] [Indexed: 10/25/2022] Open
Abstract
Objectives To investigate the focuses and trends of the studies on pediatric palliative care (PPC) and provide directions for future research. Methods Relevant papers about PPC published from 2004 to 2018 were analyzed using bibliometric analysis methods, including co-word analysis, biclustering analysis, and strategic diagram analysis. The included papers were divided into three groups based on the publication time, including 2004-2008, 2009-2013, and 2014-2018. Results A total of 1132 papers were published between 2004 and 2018, and there were 293 papers published between 2004 and 2008, 396 between 2009 and 2013, and 443 between 2014 and 2018. There were 42 high-frequency MeSH terms/MeSH subheadings in papers published between 2004 and 2018, including 12 between 2004 and 2008, 13 between 2009 and 2013, and 17 between 2014 and 2018. Conclusion Studies on PPC were making progress, with the increasing number, expanding scope, and uneven global distribution. Integration palliative care into pediatrics, cancer treatments in pediatric oncology, education methods on PPC, and establishment of professional teams were the major themes during 2004-2008, then the themes changed into establishing interventions to enhance the quality of life of the patients and parents, building professional-family relationship, and investigating attitude of health personnel in PPC during 2009-2013 and subsequently turned into communication skills, end-of-life decision making, and guidelines making on PPC during 2014-2018. Underdeveloped and protential themes including effective approaches to deal with the ethical dilemmas, training programs on communication skills, family support and guideline making are worth studying in the future.
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Affiliation(s)
- Miao Zhang
- School of Nursing, China Medical University, Shenyang, Liaoning, China
| | - Xiaohan Li
- School of Nursing, China Medical University, Shenyang, Liaoning, China
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6
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Fulton JJ, LeBlanc TW, Cutson TM, Porter Starr KN, Kamal A, Ramos K, Freiermuth CE, McDuffie JR, Kosinski A, Adam S, Nagi A, Williams JW. Integrated outpatient palliative care for patients with advanced cancer: A systematic review and meta-analysis. Palliat Med 2019; 33:123-134. [PMID: 30488781 PMCID: PMC7069657 DOI: 10.1177/0269216318812633] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND: Despite increasing emphasis on integration of palliative care with disease-directed care for advanced cancer, the nature of this integration and its effects on patient and caregiver outcomes are not well-understood. AIM: We evaluated the effects of integrated outpatient palliative and oncology care for advanced cancer on patient and caregiver outcomes. DESIGN: Following a standard protocol (PROSPERO: CRD42017057541), investigators independently screened reports to identify randomized controlled trials or quasi-experimental studies that evaluated the effect of integrated outpatient palliative and oncology care interventions on quality of life, survival, and healthcare utilization among adults with advanced cancer. Data were synthesized using random-effects meta-analyses, supplemented with qualitative methods when necessary. DATA SOURCES: English-language peer-reviewed publications in PubMed, CINAHL, and Cochrane Central through November 2016. We subsequently updated our PubMed search through July 2018. RESULTS: Eight randomized-controlled and two cluster-randomized trials were included. Most patients had multiple advanced cancers, with median time from diagnosis or recurrence to enrollment ranging from 8 to 12 weeks. All interventions included a multidisciplinary team, were classified as “moderately integrated,” and addressed physical and psychological symptoms. In a meta-analysis, short-term quality of life improved, symptom burden improved, and all-cause mortality decreased. Qualitative analyses revealed no association between integration elements, palliative care intervention elements, and intervention impact. Utilization and caregiver outcomes were often not reported. CONCLUSIONS: Moderately integrated palliative and oncology outpatient interventions had positive effects on short-term quality of life, symptom burden, and survival. Evidence for effects on healthcare utilization and caregiver outcomes remains sparse.
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Affiliation(s)
- Jessica J Fulton
- 1 Durham VA Health Care System, Durham, NC, USA.,2 Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA.,3 Center for the Study of Aging and Human Development, Duke University, Durham, NC, USA
| | - Thomas W LeBlanc
- 4 Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, NC, USA.,5 Duke Cancer Institute, Durham, NC, USA
| | - Toni M Cutson
- 1 Durham VA Health Care System, Durham, NC, USA.,6 Division of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Kathryn N Porter Starr
- 3 Center for the Study of Aging and Human Development, Duke University, Durham, NC, USA.,6 Division of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, NC, USA.,7 Geriatric Research, Education and Clinical Center (GRECC), Durham VA Health Care System, Durham, NC, USA
| | - Arif Kamal
- 5 Duke Cancer Institute, Durham, NC, USA.,8 Duke Fuqua School of Business, Duke University, Durham, NC, USA
| | - Katherine Ramos
- 1 Durham VA Health Care System, Durham, NC, USA.,3 Center for the Study of Aging and Human Development, Duke University, Durham, NC, USA.,7 Geriatric Research, Education and Clinical Center (GRECC), Durham VA Health Care System, Durham, NC, USA
| | | | - Jennifer R McDuffie
- 10 Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, USA.,11 Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Andrzej Kosinski
- 12 Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Soheir Adam
- 13 Division of Hematology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Avishek Nagi
- 10 Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, USA
| | - John W Williams
- 10 Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, USA.,11 Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, NC, USA
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Integration of oncology and palliative care: a Lancet Oncology Commission. Lancet Oncol 2018; 19:e588-e653. [DOI: 10.1016/s1470-2045(18)30415-7] [Citation(s) in RCA: 297] [Impact Index Per Article: 49.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 05/16/2018] [Accepted: 05/22/2018] [Indexed: 02/06/2023]
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Pilkey J, Downar J, Dudgeon D, Herx L, Oneschuk D, Schroder C, Schulz V. Palliative Medicine-Becoming a Subspecialty of the Royal College of Physicians and Surgeons of Canada. J Palliat Care 2017; 32:113-120. [PMID: 29129136 DOI: 10.1177/0825859717741027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The discipline of palliative medicine in Canada started in 1975 with the coining of the term "palliative care." Shortly thereafter, the provision of clinical palliative medicine services started, although the education of the discipline lagged behind. In 1993, the Canadian Society of Palliative Care Physicians (CSPCP) started to explore the option of creating an accredited training program in palliative medicine. This article outlines the process by which, over the course of 20 years, palliative medicine training in Canada went from a mission statement of the CSPCP, to a 1 year of added competence jointly accredited by both the Royal College of Physicians and Surgeons of Canada (Royal College) and the College of Family Physicians of Canada, to a 2-year subspecialty of the Royal College with access from multiple entry routes and a formalized accrediting examination.
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Affiliation(s)
- Jana Pilkey
- 1 Section of Palliative Medicine, Department of Family Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.,2 Palliative Care Program, Winnipeg Regional Health Authority, St Boniface General Hospital, Winnipeg, Manitoba, Canada
| | - James Downar
- 3 Interdepartmental Division of Critical Care Medicine, Division of Palliative Care, University of Toronto, Toronto, Ontario, Canada
| | - Deborah Dudgeon
- 4 Division of Palliative Medicine, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Leonie Herx
- 5 Department of Oncology, University of Calgary, Calgary, Alberta, Canada.,6 Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.,7 Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada.,8 Palliative and End of Life Care, Alberta Health Services, Calgary Zone, Calgary, Alberta, Canada
| | - Doreen Oneschuk
- 9 Division of Palliative Medicine, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Cori Schroder
- 10 Royal College of Physicians and Surgeons of Canada, Working Group in Palliative Medicine, Ottawa, Ontario, Canada
| | - Valerie Schulz
- 11 Department Anesthesia and Perioperative Medicine, University of Western Ontario, London, Ontario, Canada
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9
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Lee HJ, Lerner AD. POINT: Should Interventional Pulmonology Be Given American Board of Internal Medicine Subspecialty Status? Yes. Chest 2017; 153:16-18. [PMID: 28939360 DOI: 10.1016/j.chest.2017.08.1167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 08/23/2017] [Indexed: 11/18/2022] Open
Affiliation(s)
- Hans J Lee
- Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD.
| | - Andrew D Lerner
- Section of Interventional Pulmonology, Sibley Memorial Hospital/Johns Hopkins University, Washington, DC
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10
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Kang J, Park KO. Development of Evaluation Indicators for Hospice and Palliative Care Professionals Training Programs in Korea. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2017; 37:19-26. [PMID: 28125502 DOI: 10.1097/ceh.0000000000000142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION The importance of training for Hospice and Palliative Care (HPC) professionals has been increasing with the systemization of HPC in Korea. Hence, the need and importance of training quality for HPC professionals are growing. This study evaluated the construct validity and reliability of the Evaluation Indicators for standard Hospice and Palliative Care Training (EIHPCT) program. METHODS As a framework to develop evaluation indicators, an invented theoretical model combining Stufflebeam's CIPP (Context-Input-Process-Product) evaluation model with PRECEDE-PROCEED model was used. To verify the construct validity of the EIHPCT program, a structured survey was performed with 169 professionals who were the HPC training program administrators, trainers, and trainees. To examine the validity of the areas of the EIHPCT program, exploratory factor analysis and confirmatory factor analysis were conducted. RESULTS First, in the exploratory factor analysis, the indicators with factor loadings above 0.4 were chosen as desirable items, and some cross-loaded items that loaded at 0.4 or higher on two or more factors were adjusted as the higher factor. Second, the model fit of the modified EIHPCT program was quite good in the confirmatory factor analysis (Goodness-of-Fit Index > 0.70, Comparative Fit Index > 0.80, Normed Fit Index > 0.80, Root Mean square of Residuals < 0.05). The modified model of the EIHPCT comprised 4 areas, 13 subdomains, and 61 indicators. DISCUSSION The evaluation indicators of the modified model will be valuable references for improving the HPC professional training program.
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Affiliation(s)
- Jina Kang
- Dr. Kang: Invited Professor, Department of Health Convergence, Ewha Womans University, Seoul, Korea. Dr. Park: Associate Professor, Department of Health Convergence, Ewha Womans University, Seoul, Korea
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Lamba S, DeSandre PL, Quest TE. Opportunities and Challenges Facing the Integrated Physician Workforce of Emergency Medicine and Hospice and Palliative Medicine. J Emerg Med 2016; 51:658-667. [PMID: 27613448 DOI: 10.1016/j.jemermed.2016.06.056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 05/28/2016] [Accepted: 06/29/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The American Board of Emergency Medicine joined nine other American Board of Medical Specialties member boards to sponsor the subspecialty of Hospice and Palliative Medicine; the first subspecialty examination was administered in 2008. Since then an increasing number of emergency physicians has sought this certification and entered the workforce. There has been limited discussion regarding the experiences and challenges facing this new workforce. DISCUSSION We use excerpts from conversations with emergency physicians to highlight the challenges in hospice and palliative medicine training and practice that are commonly being identified by these physicians, at varying phases of their careers. The lessons learned from this initial dual-certified physician cohort in real practice fills a current literature gap. Practical guidance is offered for the increasing number of trainees and mid-career emergency physicians who may have an interest in the subspecialty pathway but are seeking answers to what a future integrated practice will look like in order to make informed career decisions. CONCLUSION The Emergency and Hospice and Palliative Medicine integrated workforce is facing novel challenges, opportunities, and growth. The first few years have seen a growing interest in the field among emergency medicine resident trainees. As the dual certified workforce matures, it is expected to impact the clinical practice, research, and education related to emergency palliative care.
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Affiliation(s)
- Sangeeta Lamba
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Paul L DeSandre
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia; Emory Palliative Care Center, Emory University School of Medicine, Atlanta, Georgia
| | - Tammie E Quest
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia; Emory Palliative Care Center, Emory University School of Medicine, Atlanta, Georgia
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Abstract
Over the past five decades, palliative care has evolved from serving patients at the end of life into a highly specialized discipline focused on delivering supportive care to patients with life-limiting illnesses throughout the disease trajectory. A growing body of evidence is now available to inform the key domains in the practice of palliative care, including symptom management, psychosocial care, communication, decision-making, and end-of-life care. Findings from multiple studies indicate that integrating palliative care early in the disease trajectory can result in improvements in quality of life, symptom control, patient and caregiver satisfaction, illness understanding, quality of end-of-life care, survival, and costs of care. In this narrative Review, we discuss various strategies to integrate oncology and palliative care by optimizing clinical infrastructures, processes, education, and research. The goal of integration is to maximize patient access to palliative care and, ultimately, to improve patient outcomes. We provide a conceptual model for the integration of supportive and/or palliative care with primary and oncological care. We also discuss how health-care systems and institutions need to tailor integration based on their resources, size, and the level of primary palliative care available.
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Affiliation(s)
- David Hui
- Department of Palliative Care &Rehabilitation Medicine, Unit 1414, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030, USA
| | - Eduardo Bruera
- Department of Palliative Care &Rehabilitation Medicine, Unit 1414, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030, USA
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World Workshop on Oral Medicine VI: an international validation study of clinical competencies for advanced training in oral medicine. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 120:143-51.e7. [DOI: 10.1016/j.oooo.2014.12.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 11/10/2014] [Accepted: 12/16/2014] [Indexed: 11/17/2022]
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Abstract
Palliative care psychiatry is an emerging subspecialty field at the intersection of Palliative Medicine and Psychiatry. The discipline brings expertise in understanding the psychosocial dimensions of human experience to the care of dying patients and support of their families. The goals of this review are (1) to briefly define palliative care and summarize the evidence for its benefits, (2) to describe the roles for psychiatry within palliative care, (3) to review recent advances in the research and practice of palliative care psychiatry, and (4) to delineate some steps ahead as this sub-field continues to develop, in terms of research, education, and systems-based practice.
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Affiliation(s)
- Nathan Fairman
- Department of Psychiatry and Behavioral Sciences, UC Davis School of Medicine, Sacramento, CA, USA.
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Weeks JC, Catalano PJ, Cronin A, Finkelman MD, Mack JW, Keating NL, Schrag D. Patients' expectations about effects of chemotherapy for advanced cancer. N Engl J Med 2012; 367:1616-25. [PMID: 23094723 PMCID: PMC3613151 DOI: 10.1056/nejmoa1204410] [Citation(s) in RCA: 796] [Impact Index Per Article: 66.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Chemotherapy for metastatic lung or colorectal cancer can prolong life by weeks or months and may provide palliation, but it is not curative. METHODS We studied 1193 patients participating in the Cancer Care Outcomes Research and Surveillance (CanCORS) study (a national, prospective, observational cohort study) who were alive 4 months after diagnosis and received chemotherapy for newly diagnosed metastatic (stage IV) lung or colorectal cancer. We sought to characterize the prevalence of the expectation that chemotherapy might be curative and to identify the clinical, sociodemographic, and health-system factors associated with this expectation. Data were obtained from a patient survey by professional interviewers in addition to a comprehensive review of medical records. RESULTS Overall, 69% of patients with lung cancer and 81% of those with colorectal cancer did not report understanding that chemotherapy was not at all likely to cure their cancer. In multivariable logistic regression, the risk of reporting inaccurate beliefs about chemotherapy was higher among patients with colorectal cancer, as compared with those with lung cancer (odds ratio, 1.75; 95% confidence interval [CI], 1.29 to 2.37); among nonwhite and Hispanic patients, as compared with non-Hispanic white patients (odds ratio for Hispanic patients, 2.82; 95% CI, 1.51 to 5.27; odds ratio for black patients, 2.93; 95% CI, 1.80 to 4.78); and among patients who rated their communication with their physician very favorably, as compared with less favorably (odds ratio for highest third vs. lowest third, 1.90; 95% CI, 1.33 to 2.72). Educational level, functional status, and the patient's role in decision making were not associated with such inaccurate beliefs about chemotherapy. CONCLUSIONS Many patients receiving chemotherapy for incurable cancers may not understand that chemotherapy is unlikely to be curative, which could compromise their ability to make informed treatment decisions that are consonant with their preferences. Physicians may be able to improve patients' understanding, but this may come at the cost of patients' satisfaction with them. (Funded by the National Cancer Institute and others.).
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Affiliation(s)
- Jane C Weeks
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA.
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16
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Concepts and definitions for "supportive care," "best supportive care," "palliative care," and "hospice care" in the published literature, dictionaries, and textbooks. Support Care Cancer 2012; 21:659-85. [PMID: 22936493 DOI: 10.1007/s00520-012-1564-y] [Citation(s) in RCA: 192] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 07/31/2012] [Indexed: 12/27/2022]
Abstract
PURPOSE Commonly used terms such as "supportive care," "best supportive care," "palliative care," and "hospice care" were rarely and inconsistently defined in the palliative oncology literature. We conducted a systematic review of the literature to further identify concepts and definitions for these terms. METHODS We searched MEDLINE, PsycInfo, EMBASE, and CINAHL for published peer-reviewed articles from 1948 to 2011 that conceptualized, defined, or examined these terms. Two researchers independently reviewed each citation for inclusion and then extracted the concepts/definitions when available. Dictionaries/textbooks were also searched. RESULTS Nine of 32 "SC/BSC," 25 of 182 "PC," and 12 of 42 "HC" articles focused on providing a conceptual framework/definition. Common concepts for all three terms were symptom control and quality-of-life for patients with life-limiting illness. "SC" focused more on patients on active treatment compared to other categories (9/9 vs. 8/37) and less often involved interdisciplinary care (4/9 vs. 31/37). In contrast, "HC" focused more on volunteers (6/12 vs. 6/34), bereavement care (9/12 vs. 7/34), and community care (9/12 vs. 6/34). Both "PC" and "SC/BSC" were applicable earlier in the disease trajectory (16/34 vs. 0/9). We found 13, 24, and 17 different definitions for "SC/BSC," "PC," and "HC," respectively. "SC/BSC" was the most variably defined, ranging from symptom management during cancer therapy to survivorship care. Dictionaries/textbooks showed similar findings. CONCLUSION We identified defining concepts for "SC/BSC," "PC," and "HC" and developed a preliminary conceptual framework unifying these terms along the continuum of care to help build consensus toward standardized definitions.
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Palliative care advocacy in the United States: are there lessons for geriatric psychiatry? Am J Geriatr Psychiatry 2012; 20:284-90. [PMID: 21989318 DOI: 10.1097/jgp.0b013e3182331732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Investment of palliative medicine in bridging the gap with academia: A call to action. Eur J Cancer 2011; 47:491-5. [DOI: 10.1016/j.ejca.2010.12.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Accepted: 12/14/2010] [Indexed: 11/19/2022]
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Quest TE, Marco CA, Derse AR. Hospice and Palliative Medicine: New Subspecialty, New Opportunities. Ann Emerg Med 2009; 54:94-102. [DOI: 10.1016/j.annemergmed.2008.11.019] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2007] [Revised: 11/17/2008] [Accepted: 11/25/2008] [Indexed: 10/21/2022]
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Palliative Emergency Medicine: Resuscitating Comfort Care? Ann Emerg Med 2009; 54:103-5. [DOI: 10.1016/j.annemergmed.2009.02.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2009] [Revised: 01/30/2009] [Accepted: 02/04/2009] [Indexed: 11/20/2022]
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Ferris FD, Bruera E, Cherny N, Cummings C, Currow D, Dudgeon D, JanJan N, Strasser F, von Gunten CF, Von Roenn JH. Palliative Cancer Care a Decade Later: Accomplishments, the Need, Next Steps—From the American Society of Clinical Oncology. J Clin Oncol 2009; 27:3052-8. [PMID: 19451437 DOI: 10.1200/jco.2008.20.1558] [Citation(s) in RCA: 263] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose In 1998, the American Society of Clinical Oncology (ASCO) published a special article regarding palliative care and companion recommendations. Herein we summarize the major accomplishments of ASCO regarding palliative cancer and highlight current needs and make recommendations to realize the Society's vision of comprehensive cancer care by 2020. Methods ASCO convened a task force of palliative care experts to assess the state of palliative cancer care in the Society's programs. We reviewed accomplishments, assessed current needs, and developed a definition of palliative cancer. Senior ASCO members and the Board of Directors reviewed and endorsed this article for submission to Journal of Clinical Oncology. Results Palliative cancer care is the integration into cancer care of therapies that address the multiple issues that cause suffering for patients and their families and impact their life quality. Effective provision of palliative cancer care requires an interdisciplinary team that can provide care in all patient settings, including outpatient clinics, acute and long-term care facilities, and private homes. Changes in current policy, drug availability, and education are necessary for the integration of palliative care throughout the experience of cancer, for the achievement of quality improvement initiatives, and for effective palliative cancer care research. Conclusion The need for palliative cancer care is greater than ever notwithstanding the strides made over the last decade. Further efforts are needed to realize the integration of palliative care in the model and vision of comprehensive cancer care by 2020.
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Affiliation(s)
- Frank D. Ferris
- From the San Diego Hospice and Palliative Care, San Diego, CA; M. D. Anderson Cancer Center, Houston, TX; Shaare Zedek Medical Center, Jerusalem, Israel; American Society of Clinical Oncology, Alexandria, VA; Flinders University, Adelaide, Australia; Queen's University, Kingston, Canada; Cantonal Hospital, St Gallen, Switzerland; and Northwestern University, Chicago, IL
| | - Eduardo Bruera
- From the San Diego Hospice and Palliative Care, San Diego, CA; M. D. Anderson Cancer Center, Houston, TX; Shaare Zedek Medical Center, Jerusalem, Israel; American Society of Clinical Oncology, Alexandria, VA; Flinders University, Adelaide, Australia; Queen's University, Kingston, Canada; Cantonal Hospital, St Gallen, Switzerland; and Northwestern University, Chicago, IL
| | - Nathan Cherny
- From the San Diego Hospice and Palliative Care, San Diego, CA; M. D. Anderson Cancer Center, Houston, TX; Shaare Zedek Medical Center, Jerusalem, Israel; American Society of Clinical Oncology, Alexandria, VA; Flinders University, Adelaide, Australia; Queen's University, Kingston, Canada; Cantonal Hospital, St Gallen, Switzerland; and Northwestern University, Chicago, IL
| | - Charmaine Cummings
- From the San Diego Hospice and Palliative Care, San Diego, CA; M. D. Anderson Cancer Center, Houston, TX; Shaare Zedek Medical Center, Jerusalem, Israel; American Society of Clinical Oncology, Alexandria, VA; Flinders University, Adelaide, Australia; Queen's University, Kingston, Canada; Cantonal Hospital, St Gallen, Switzerland; and Northwestern University, Chicago, IL
| | - David Currow
- From the San Diego Hospice and Palliative Care, San Diego, CA; M. D. Anderson Cancer Center, Houston, TX; Shaare Zedek Medical Center, Jerusalem, Israel; American Society of Clinical Oncology, Alexandria, VA; Flinders University, Adelaide, Australia; Queen's University, Kingston, Canada; Cantonal Hospital, St Gallen, Switzerland; and Northwestern University, Chicago, IL
| | - Deborah Dudgeon
- From the San Diego Hospice and Palliative Care, San Diego, CA; M. D. Anderson Cancer Center, Houston, TX; Shaare Zedek Medical Center, Jerusalem, Israel; American Society of Clinical Oncology, Alexandria, VA; Flinders University, Adelaide, Australia; Queen's University, Kingston, Canada; Cantonal Hospital, St Gallen, Switzerland; and Northwestern University, Chicago, IL
| | - Nora JanJan
- From the San Diego Hospice and Palliative Care, San Diego, CA; M. D. Anderson Cancer Center, Houston, TX; Shaare Zedek Medical Center, Jerusalem, Israel; American Society of Clinical Oncology, Alexandria, VA; Flinders University, Adelaide, Australia; Queen's University, Kingston, Canada; Cantonal Hospital, St Gallen, Switzerland; and Northwestern University, Chicago, IL
| | - Florian Strasser
- From the San Diego Hospice and Palliative Care, San Diego, CA; M. D. Anderson Cancer Center, Houston, TX; Shaare Zedek Medical Center, Jerusalem, Israel; American Society of Clinical Oncology, Alexandria, VA; Flinders University, Adelaide, Australia; Queen's University, Kingston, Canada; Cantonal Hospital, St Gallen, Switzerland; and Northwestern University, Chicago, IL
| | - Charles F. von Gunten
- From the San Diego Hospice and Palliative Care, San Diego, CA; M. D. Anderson Cancer Center, Houston, TX; Shaare Zedek Medical Center, Jerusalem, Israel; American Society of Clinical Oncology, Alexandria, VA; Flinders University, Adelaide, Australia; Queen's University, Kingston, Canada; Cantonal Hospital, St Gallen, Switzerland; and Northwestern University, Chicago, IL
| | - Jamie H. Von Roenn
- From the San Diego Hospice and Palliative Care, San Diego, CA; M. D. Anderson Cancer Center, Houston, TX; Shaare Zedek Medical Center, Jerusalem, Israel; American Society of Clinical Oncology, Alexandria, VA; Flinders University, Adelaide, Australia; Queen's University, Kingston, Canada; Cantonal Hospital, St Gallen, Switzerland; and Northwestern University, Chicago, IL
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Irwin SA, Ferris FD. The opportunity for psychiatry in palliative care. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2008; 53:713-24. [PMID: 19087465 DOI: 10.1177/070674370805301103] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The need for psychiatrists to work with patients and families living with chronic life-threatening illnesses has never been greater. Further, psychiatrists may find exciting work within the relatively new field of palliative care, which is devoted to the prevention and relief of all suffering. Increasingly, individuals are living longer with multiple issues that cause suffering, interfere with their lives, and often lead to psychosocial sequelae. To ensure state-of-the-art care for patients and families throughout an illness and any ensuing bereavement period, many experienced psychiatrists are needed as consultants to, and as members of, interdisciplinary palliative care teams. This need presents limitless opportunities for psychiatrists to care for patients, provide education, and engage in research. The potential to make a difference is great.
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Affiliation(s)
- Scott A Irwin
- Psychiatry Programs, The Institute for Palliative Medicine at San Diego Hospice, San Diego, California 92103, USA.
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Abstract
Paediatric palliative care is an emerging subspecialty that focuses on achieving the best possible quality of life for children with life-threatening conditions and their families. To achieve this goal, the individuals working in this field need to: clearly define the population served; better understand the needs of children with life-threatening conditions and their families; develop an approach that will be appropriate across different communities; provide care that responds adequately to suffering; advance strategies that support caregivers and health-care providers; and promote needed change by cultivating educational programmes. Despite these challenges, advances in paediatric palliative care have been achieved in a short period of time; we expect far greater progress as the field becomes more formalised and research networks are established.
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Affiliation(s)
- Stephen Liben
- The Montreal Children's Hospital of the McGill University Health Center, Montreal, Quebec, Canada
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Centeno C, Noguera A, Lynch T, Clark D. Official certification of doctors working in palliative medicine in Europe: data from an EAPC study in 52 European countries. Palliat Med 2007; 21:683-7. [PMID: 18073254 DOI: 10.1177/0269216307083600] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
There is an increasing move to recognize palliative medicine as an area of certificated specialization. Drawing on a survey of palliative care provision in the World Health Organization European region, an overview of palliative care specialization and accreditation practices was presented. Within an international survey to key experts in palliative care carried out in 2005, conducted in 52 countries, a question about the certification for palliative care professionals was included. Information was obtained for 43 of the 52 countries surveyed and all 43 countries (83%) provided data on certification. Palliative medicine has specialty status in just two European countries: Ireland and the UK. In five countries it is considered as a sub-specialty, for which a second certification is required: Poland, Romania, Slovakia and Germany and, recently, France. Some 10 other countries have started the process of certification for palliative medicine, in all cases opting for sub-specialty status that follows full recognition in an established specialty. Across countries there is disparity in the certification criteria followed and considerable variability in the demands that are made in order to achieve certification. Further studies are needed to focus in depth on palliative medicine certification and accreditation across Europe. Establishing uniform approaches to certification for palliative medicine in different European countries will contribute to wider take-up of specialty status and the improved recognition of palliative care as a discipline.
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Affiliation(s)
- Carlos Centeno
- European Association for Palliative Care Task Force on the Development of Palliative Care in Europe and Palliative Medicine Unit, Clínica Universitaria, University of Navarra, Pamplona, Spain.
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Griffin JP, Koch KA, Nelson JE, Cooley ME. Palliative Care Consultation, Quality-of-Life Measurements, and Bereavement for End-of-Life Care in Patients With Lung Cancer. Chest 2007; 132:404S-422S. [PMID: 17873182 DOI: 10.1378/chest.07-1392] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To develop clinical practice guidelines for application of palliative care consultation, quality-of-life measurements, and appropriate bereavement activities for patients with lung cancer. METHODS To review the pertinent medical literature on palliative care consultation, quality-of-life measurements, and bereavement for patients with lung cancer, developing multidisciplinary discussions with authorities in these areas, and evolving written guidelines for end-of-life care of these patients. RESULTS Palliative care consultation has developed into a new specialty with credentialing of experts in this field based on extensive experience with patients in end-of-life circumstances including those with lung cancer. Bereavement studies of the physical and emotional morbidity of family members and caregivers before, during, and after the death of a cancer patient have supported truthful communication, consideration of psychological problems, effective palliative care, understanding of the patient's spiritual and cultural background, and sufficient forewarning of impending death. CONCLUSION Multidisciplinary investigations and experiences, with emphasis on consultation and delivery of palliative care, timely use of quality-of-life measurements for morbidities of treatment modalities and prognosis, and an understanding of the multifaceted complexities of the bereavement process, have clarified additional responsibilities of the attending physician.
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Affiliation(s)
- John P Griffin
- University of Tennessee Health Science Center, 956 Court Ave, Room H314, Memphis, TN 38163, USA.
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Scott JO, Hughes L. A needs assessment: Fellowship Directors Forum of the American Academy of Hospice and Palliative Medicine. J Palliat Med 2006; 9:273-8. [PMID: 16629556 DOI: 10.1089/jpm.2006.9.273] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The Fellowship Directors Forum, a special interest group of the American Academy of Hospice and Palliative Medicine (AAHPM) initiated an assessment of the needs of directors of fellowship programs in the emerging specialty of hospice and palliative care. One major finding, which may contribute to understanding the needs of other new disciplines, is that directors come into this role with clinical and teaching experience, but lacking administrative, educational, and management skills perceived as necessary to success. A study team collected data from current and former fellowship directors across the United States using an online survey and telephone interviews. The survey was sent to 60 current and former directors, with a 60% response rate, and 16 randomly selected directors were interviewed. Results showed that directors believe development of an outcome-based standardized curriculum is vitally important to advancement of the field, and that this should be developed collaboratively through the Forum. Although directors were confident of their own clinical and teaching skills, directors identified a lack of adequate training and experience in several management and educational skill areas critical to running a successful fellowship program. The study team made several recommendations: develop models from parts of existing programs that can be incorporated into a standardized curriculum to meet Accreditation Council of Graduate Medical Education (ACGME) requirements; provide workshops and toolkits for new directors to address the lack of management and educational skills; and establish new communication methods through more or longer forum meetings, a dedicated website, and an online discussion group.
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Portenoy RK, Lupu DE, Arnold RM, Cordes A, Storey P. Formal ABMS and ACGME recognition of hospice and palliative medicine expected in 2006. J Palliat Med 2006; 9:21-3. [PMID: 16430340 DOI: 10.1089/jpm.2006.9.21] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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McClement SE. Acquiring an evidence base in palliative care: challenges and future directions. Expert Rev Pharmacoecon Outcomes Res 2006; 6:37-40. [DOI: 10.1586/14737167.6.1.37] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Morrison RS, Maroney-Galin C, Kralovec PD, Meier DE. The growth of palliative care programs in United States hospitals. J Palliat Med 2006; 8:1127-34. [PMID: 16351525 DOI: 10.1089/jpm.2005.8.1127] [Citation(s) in RCA: 170] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Palliative care programs are becoming increasingly common in U.S. hospitals. OBJECTIVE To quantify the growth of hospital based palliative care programs from 2000-2003 and identify hospital characteristics associated with the development of a palliative care program. DESIGN AND MEASUREMENTS Data were obtained from the 2001-2004 American Hospital Association Annual Surveys which covered calendar years 2000-2003. We identified all programs that self-reported the presence of a hospital-owned palliative care program and acute medical and surgical beds. Multivariate logistic regression was used to identify characteristics significantly associated with the presence of a palliative care program in the 2003 survey data. RESULTS Overall, the number of programs increased linearly from 632 (15% of hospitals) in 2000 to 1027 (25% of hospitals) in 2003. Significant predictors associated with an increased likelihood of having a palliative care program included greater numbers of hospital beds and critical care beds, geographic region, and being an academic medical center. Compared to notfor- profit hospitals, VA hospitals were significantly more likely to have a palliative care program and city, county or state and for-profit hospitals were significantly less likely to have a program. Hospitals operated by the Catholic Church, and hospitals that owned their own hospice program were significantly more likely to have a palliative care program than non- Catholic Church-operated hospitals and hospitals without hospice programs respectively. CONCLUSIONS Our data suggest that although growth in palliative care programs has occurred throughout the nation's hospitals, larger hospitals, academic medical centers, not-for-profit hospitals, and VA hospitals are significantly more likely to develop a program compared to other hospitals.
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Affiliation(s)
- R Sean Morrison
- Hertzberg Palliative Care Institute of the Brookdale Department of Geriatrics and Center to Advance Palliative Care, Mount Sinai School of Medicine New York, New York 10029, USA.
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Abstract
Palliative care defines itself as complementary to life-prolonging therapy. Consideration should be given instead to viewing palliative care as the gold standard for all patients with progressive, life-threatening illness. The dichotomy between cure on the one hand and palliation on the other reflects the oncologic roots of palliative medicine, as well as the widespread societal view of medical treatment as overwhelmingly focused on cure. Because the treatment of patients with serious and complex illness is seldom curative, it makes more sense to think of the care of such patients as inherently palliative. Patients must choose among various forms of potentially life-prolonging therapies, each with its own side-effect profile and likelihood of success, depending on how they prioritize their goals of care. From this perspective, palliative care, an interdisciplinary approach that attends to advance care planning, psychosocial issues, and management of symptoms, should be the standard of care for these patients. Palliative care physicians can either provide primary care to patients with serious illness or can serve as consultants in the care of particularly challenging cases.
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Liao S, Arnold RM. Series Introduction. J Palliat Med 2005. [DOI: 10.1089/jpm.2005.8.390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Solomon Liao
- UPMC-Montefiore Hospital, Univ of Pittsburgh, 200 Lothrop St; Ste 933 West, Pittsburgh PA 15213
| | - Robert M. Arnold
- University of California-Irvine, 101 The City Drive, ZC 4076H, Orange CA 92868
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Abstract
Hospice care in the United States has evolved from a movement and philosophy to a new medical specialty that addresses sources of suffering at many levels. Hospice interdisciplinary teams use Maslow's hierarchy of human need to integrate the multiple domains that influence patients' well-being and assists in the development of treatment plans to prevent or alleviate suffering. Contributing to the effectiveness of this care is the Medicare Hospice Benefit, which since 1983 has served as a model and a reimbursement mechanism that has encouraged proliferation of hospices to deliver care in homes, hospitals, and long-term care facilities. The whole-person approach of hospice care may benefit all patients and can be integrated into all medical management.
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Affiliation(s)
- Laurel Herbst
- San Diego Hospice & Palliative Care, 4311 Third Avenue, San Diego, CA 92130, USA.
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