Approaching Death: Improving Care at the End of Life

Stepp, Lisa

doi:10.7326/0003-4819-128-11-199806010-00034

Cited by 4 publications

(2 citation statements)

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“…Palliative Medicine's role as defined by the Institute of Medicine is to "prevent, relieve, reduce, or soothe the symptoms of disease or disorder without effecting a cure" so they are a specialty that assists with this transition. 2 Traditionally, Palliative medicine has been met with hesitation and reluctance as it is deemed as "giving up". However multiple studies have shown improved symptom management, quality of life, and in some, decreased mortality.…”

Section: Introductionmentioning

confidence: 99%

Early Versus Usual Palliative Care Consultation in the Intensive Care Unit

Helgeson

Burnside

Robinson

et al. 2022

Am J Hosp Palliat Care

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Objectives Palliative Medicine involvement in MICU patients have improved length of stay and mortality, but with varying effects on specific patient decision outcomes, such as, advance care planning. These studies have utilized Palliative Medicine later in the hospital or ICU course, with some evidence showing that earlier involvement resulted in better results. The purpose of this study was to evaluate the benefits of early (within 24 hours) palliative care consultation in medical ICU (MICU) patients to clinical and satisfaction outcomes. Methods An unblinded randomized study performed in the MICU in one academic hospital in the USA. Ninety-one adult patients admitted to MICU received a Palliative care medicine consultation within 24 hours as the intervention. Measurements and results Ninety-one patients admitted to the MICU underwent randomization with 50 patients randomly assigned to receive Palliative Medicine consultation and 41 patients randomly assigned to receive standard-of-care based on predefined criteria. The median satisfaction score was 23 points higher for the patients in the intervention group (P < .001). The median length of MICU stay was 5 days shorter in the intervention group compared to the control group (95% CI; 1 day to 18 days, P = .018). Advance care planning was completed in the hospital for 34% of patients in the intervention arm and 12% of patients in the controls arm (absolute risk difference 22%, 95% CI 4% to 37%, P = .016). Conclusion Early Palliative Medicine consultation within 24 hours of MICU admission showed significant benefits to patients by improving satisfaction and decreasing length of stay. This study provides evidence that Palliative Medicine involvement earlier in the course of severe disease is important. Further studies in other types of intensive care units (neurological and Cardiovascular) are necessary to determine their impact.

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Section: Introductionmentioning

confidence: 99%

Early Versus Usual Palliative Care Consultation in the Intensive Care Unit

Helgeson

Burnside

Robinson

et al. 2022

Am J Hosp Palliat Care

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“…As utilization has increased over the last two decades, enhancing EOL care has become a national priority with a number of organizations calling for improvements in the quality of care and the use of multiple broad therapies to treat the distinct emotional, spiritual, and physical needs of hospice patients and families. [3][4][5] In the expert report, Dying in America, the Institute of Medicine 5 emphasized the need for comprehensive hospice care that is focused on socially supportive, comforting alternatives to medically centered interventions that typically rely on elaborate technological treatments.…”

Section: Introductionmentioning

confidence: 99%

Implementation and outcomes of complementary therapies in hospice care: an integrative review

et al. 2021

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Complementary therapies are increasingly integrated into hospice care, emphasizing the need to examine the evidence regarding implementation and effects on end-of-life outcomes. This review synthesizes the evidence regarding the implementation of complementary therapies and effects on end-of-life outcomes in hospice care. Whittemore and Knafl’s five-step integrative review process was applied. Using predefined search terms, research-based articles between 2006 and 2020 were reviewed. Twenty-three quantitative/mixed method studies conducted across eight countries met the final review criteria. Most commonly used complementary therapies were music, biofield therapies (reiki, therapeutic touch), and massage therapy. Most studies reported significant findings on physical symptoms (pain, dyspnea, fatigue, gastrointestinal symptoms, agitation) and/or psychosocial/spiritual symptoms (anxiety, depression, spirituality, well-being, quality of life); 40% of studies had both significant and nonsignificant findings. Methodological limitations included study design (few randomized controlled trials), small sample size, high attrition rate, lack of racial/ethnic diversity, unstandardized intervention implementation, and multiple outcome measurement instruments. Complementary therapies are promising components of hospice care; however, rigorous studies are needed to validate the effect on end-of-life outcomes and determine the most efficacious implementation. Complementary therapy studies face challenges consistent with end-of-life research; however, efforts to design rigorous trials and address methodological issues are required to enhance the state of the science.

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