Background: Hospice agencies face unique challenges during times of widespread public health emergencies. The pandemic of novel coronavirus disease COVID-19 is widely affecting global healthcare systems. Aim: This study assesses effects of the COVID-19 pandemic on U.S. hospice agencies, staff, and patients as reported by hospice agency staff. Design: An anonymous electronic survey was developed. Free-text comments were assessed for impacts on hospice agencies, staff, and patients and their families. Setting/Participants: The target audience was members of the American Academy of Hospice and Palliative Medicine and the Hospice and Palliative Nurses Association who self-identified as being active with hospice agencies in the United States. Results: Reported impacts include inadequate supplies of personal protective equipment, changes in hospice services, and decreased access by hospice personnel to patients in long term care facilities. Flow of patients through hospice care settings was impeded. Agencies experienced changes in workforce availability and increased emotional support needs of staff. Patient and families experienced increased bereavement needs. Nearly one-third of respondents reported negative effects on patient outcomes, such as inadequate symptom management and negative psychosocial effects. Conclusion: Respondents indicate that the COVID-19 pandemic had negative effects on both hospice patient care and hospice agency functioning. Hospice agencies appear to face challenges unique among U.S. healthcare agencies due to their service delivery model and focus on interdisciplinary care. There is need for further exploration of the effects that the COVID-19 pandemic has on hospice agencies in order to improve care for their patient population during public health emergencies.
Introduction: Advance care planning (ACP) is an essential discussion between a health care provider and a patient about their future care during serious illness. In clinical practice, high-quality ACP may be addressed with an interprofessional approach. Role-playing is an ideal method to practice both ACP and shared decision-making before having these conversations with patients. Methods: This asynchronous role-playing workshop is prefaced with two prerecorded 25-minute videos for faculty and student preparation with one introducing ACP concepts, and one depicting a patient-physician ACP discussion. During the 2-hour workshop, students complete four role-play ACP scenarios with the following roles: patient, family member, nurse, nurse practitioner, and physician. Students rotate through different roles guided by scripts, and have a fact sheet for each scenario detailing prognostic information for disease processes. The role-play works optimally with three nursing students, three medical students, and one faculty facilitator per group. Facilitators are provided with a timeline, a guide for debriefing, and an evaluation rubric. Results: The survey data from 85 students spread over four course offerings were summarized. When asked both if learning objectives were met, and to reflect on the clinical relevance, teaching effectiveness, and the overall workshop experience, most participants reported a good to excellent rating. Discussion: This role-play activity allows students to practice ACP and shared decisionmaking, both with patient and family presence, and in premeeting rounds with the health care team. ACP exposure during student training helps trainees recognize the impact of high-quality interprofessional conversations on the care patients want and ultimately receive.
Nurse practitioners practicing in specialist palliative care roles in communities and hospitals have embraced the use of POST and followed through on complete and accurate completion of the forms. With this signatory authority, primary and specialist NPs have the potential to improve end-of-life care.
To determine whether a process of early palliative care intervention prompted by a patient-specific estimate of poor prognosis leads to improved patient outcomes in the medical intensive care unit (ICU). METHODS: We conducted a prospective two-phase study including usual care (UC) (N¼53) and usual care plus targeted proactive palliative care intervention (PC) (N¼51) (either by consulting supportive care services or shared decision making discussion by the intensivists), each lasting four months on consecutive patients admitted to the ICU who survived $48 hours. For both phases, patients predicted to be at high risk ($40% 6-month mortality) were identified using our validated integrated prognostic model1 [Surprise question "No" response-Would you be surprised if this patient died in the next six months?-, APACHE IV score, and Charlson Comorbidity Index (CCI) score]. RESULTS: Compared to UC, the pro-active PC intervention phase showed significant reduction in ICU readmissions (35.8% vs 16%, p¼0.022) and increased identification of the patient's legal decision maker (98% vs 83%, p¼0.009). There were no differences in means between groups (UC vs PC) for age (67.9 vs 68.1 years, p¼.938), CCI score (6.6 vs 6.1, p¼.489), and mortality prediction model score (51.6 vs 54.3, p¼.141). Intervention-arm patients had higher BMI (34.0 vs 28.3 kg/m2, p¼0.005) and APACHE IV scores (65.3 vs 55.8, p¼0.019), suggestive of a sicker critically ill patient population. There was no significant difference between groups (UC vs PC) in mean length of stay in ICU (5.5 vs 6.2 days, p¼.454) or in hospital (13.0 vs 14.7 days, p¼.466). There was no difference between groups (UC vs PC) in death at hospital discharge (60% vs 48%, p¼.208). CONCLUSIONS: This pilot study demonstrates feasibility and improved patient-specific outcomes of end-of-life care. CLINICAL IMPLICATIONS: Systematic identification of high-risk ICU patients using the integrated mortality prediction model and pro-active primary palliative care intervention improves shared-decision making with the appropriate legal decision-maker and ICU readmission rates. This study promotes the role of family engagement and empowerment which is in compliance with Society of Critical Care Medicine (SCCM) ICU liberation bundle (A-F). These findings provide support for a large, multisite trial to see if they can be confirmed and if this approach represents a way to improve ICU patient care.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
customersupport@researchsolutions.com
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.