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Concept: Cicely Saunders

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Palliative care, a medical field that has been practiced informally for centuries, was recently granted formal specialty status by the American Board of Medical Specialties. The demand for palliative care specialists is growing rapidly, since timely palliative care consultations have been shown to improve the quality of care, reduce overall costs, and sometimes even increase longevity.1,2 The field grew out of a hospice tradition in which palliative treatment was delivered only at the end of life, but its role has expanded so that palliative care specialists now also provide palliative treatment in the earlier stages of disease alongside disease-directed . . .

Concepts: Palliative medicine, Cancer, Cicely Saunders, Hospice, Palliative care, Medicine, Oncology

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In the United Kingdom hospice day care services are the fastest growing yet least researched of the palliative care services. Using photo-elicitation interviews with 11 day care patients attending a specialist hospice day care setting we explored their experiences of the hospice as a place and how these changed over time. Informed by concepts from existential and humanistic geography we propose three existential modes of being - Drifting, Sheltering and Venturing - which characterize the patients' lived experiences of the hospice. Our phenomenological analysis shows that the hospice is (re)constructed purposefully to achieve a sense of ‘home’ and ‘homelikeness’, creating an important therapeutic landscape for patients.

Concepts: Geography, Cicely Saunders, Hospice, United Kingdom, Palliative care

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Abstract Background: Families with young children often struggle to talk about and cope with a parent’s life-threatening illness and potential death. Adult interdisciplinary palliative medicine teams often feel unprepared to facilitate the open communication with these children that has been shown to reduce anxiety, depression, and other behavioral problems. In pediatric settings, child life specialists routinely provide this support to hospitalized children as well as their siblings and parents. Although these services are the standard of care in pediatrics, no research reports their use in the care of children of adults with serious illness. Objective: Our aim is to describe a pilot child life consultation service for the children of seriously ill adult inpatients. Design: We summarize the support needs of these children, their families, and the medical staff caring for them and report our experience with developing a child life consultation service to meet these needs. Setting/Subjects: Our service assists seriously ill adult inpatients and their families in a university medical center. Results: Informal feedback from families and staff was uniformly positive. During consultations, family and child coping mechanisms were assessed and supported. Interventions were chosen to enhance the children’s processing and self-expression and to facilitate family communication. Conclusion: All hospitals should consider providing broad-based in-service training enabling their staff to improve the support they offer to the children of seriously ill parents. Medical centers with access to child life services should consider developing a child life consultation service to further enhance this support. More research is needed to evaluate both the short- and long-term clinical impact of these interventions. AA was a 54-year-old man with severe liver damage caused by blunt trauma during a farming accident months earlier. His course was complicated by hemorrhage, multiple infections, and surgeries, and ultimately multi-organ system failure requiring extensive life-sustaining interventions. The palliative care service was consulted by the intensive care unit (ICU) team 3 days prior to AA’s death. A family meeting was held with his wife, sister, and sister-in-law, during which they chose not to further escalate medical interventions. It was clear to all involved that AA was dying. It was equally clear that it would be hard to let him go. Foremost among his family members' many concerns was how they would talk to his three children, ages 7 to 15 years old, during a planned visit to the hospital. Struggling with her own sense of impending loss, AA’s wife needed emotional support and the words to tell her children that their father was going to die. The children needed help to hear and process those words. A child life specialist was consulted.

Concepts: Suffering, Cicely Saunders, Hospice, Oncology, Palliative care, Medicine, Child life specialist, Family

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Palliative care research is relatively diverse and prioritizing research in this field is dependent on multiple factors such as complex ethical decisions in designing and conducting the research; access to participants who may be deemed “vulnerable” and an increasingly medically focused approach to care. The aim of this study was to inform organizational decision-making and policy development regarding future research priorities for a hospice service in New Zealand.

Concepts: Implementation, Cicely Saunders, Hospice, Palliative care

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Following a review of organisational culture in 2013, Schwartz Centre Rounds (SCR) were introduced to Marie Curie Hospice Hampstead (MCHH). Aiming to promote a ‘one hospice’ ethos, the SCR were chosen as an evidence-based tool to address psychological issues felt by staff managing the increasingly complex physical and emotional burden of palliative care delivery. Unlike in NHS hospitals in which SCR are usually conducted, which have large numbers of staff, MCHH is a hospice with a relatively small pool of staff. Consequently, there were reservations about the Rounds being effective in this setting, and initially trepidation from staff concerned about sharing and exposing their emotions.

Concepts: Emotion, Cicely Saunders, Palliative care, Marie Curie, Psychology, Cancer, Hospice

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Hospice palliative care volunteer work-being with dying persons and their often distraught family members-has the potential to take an emotional toll on volunteers. The aim of this review article is to examine the types of stressors hospice palliative care volunteers typically experience in their work and how they cope with them. The results of this literature review suggest that hospice palliative care volunteers do not generally perceive their volunteer work as highly stressful. Nonetheless, a number of potential stressors and challenges were identified in the literature, along with some strategies that volunteers commonly employ to cope with them. The implications for volunteers and volunteer training/management are discussed.

Concepts: Volunteer, Volunteering, Cicely Saunders, Hospice, Palliative care

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Despite the huge focus on reducing 30-day readmission rates, a majority of hospitals are still getting penalized. But, in many cases, the penalties may be too small to justify big expenditures for new programs and staff. Case management leaders should work with the hospital administration to redesign the way that care is delivered in order to succeed as the healthcare market changes. Hospitals need to have a handle on their own readmission data including number of patients readmitted within 7, 14, and 30 days, the top 10 conditions of readmitted patients, and where readmitted patients went after their initial discharge. Case managers should take the time to thoroughly assess patients for healthcare literacy, social issues, family support, and educate them on their conditions, their prognosis, and palliative and hospice care if appropriate.

Concepts: Patient, Cicely Saunders, Palliative care, Management, Hospice, Hospital

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Prior research indicates that hospice and palliative care delivered in outpatient settings are associated with reduced hospital readmissions for cancer patients. However, little is known about how inpatient palliative care affects readmissions in oncology.

Concepts: Cicely Saunders, Hospital, Chemotherapy, Cancer, Hospice, Palliative care, Oncology

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In 2014, 1.5 million people died of tuberculosis (TB) worldwide including 400,000 co-infected with HIV. TB remains a major cause of death and suffering globally, in spite of the fact that it is supposed to be a curable disease. Drug resistant forms of TB have developed as a result of poor treatment compliance including multi-drug and extreme drug resistant forms that take longer to treat and have higher likelihoods of treatment failure. In 2010, at the initiation of the TB community, a partnership was formed between the WHO Stop TB Program, the Worldwide Hospice Palliative Care Alliance, and the Open Society Foundation’s International Palliative Care Initiative (OSF/IPCI) to explore how to improve the ability of TB professionals to deliver palliative care to their patients. This article describes the progress made in the last six years and the barriers remaining. A training curriculum was developed, courses conducted at major TB conferences (Union Lung Health), several publications produced, model programs identified, and comprehensive clinical guidelines developed. There remain significant barriers including lack of awareness and a major need for resources to deliver palliative care education to the TB workforce and the palliative care community to realize WHO’s goal of zero suffering for TB patients.

Concepts: Cancer, Cicely Saunders, Oncology, Suffering, Antibiotic resistance, Hospice, Tuberculosis, Palliative care

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STUDY OBJECTIVE: We describe 11 clinical demonstrations of emergency department (ED) and palliative care integration to include traditional consultation services with hospital-based palliative care consultants through advanced integration demonstrations in which the ED provides subspecialty palliative care practice. METHODS: An interview guide was developed by the Improving Palliative Care in Emergency Medicine board that consists of emergency clinicians and palliative care practitioners. Structured interviews of 11 program leaders were conducted to describe the following key elements of the ED-palliative care integration, to include structure, function, and process of the programs, as well as strengths, areas of improvement, and any tools or outcome measures developed. RESULTS: In this limited number of programs, a variety of strategies are used to integrate palliative care in the ED, from traditional consultation to well-defined partnerships that include board-certified emergency clinicians in hospice and palliative medicine. CONCLUSION: A variety of methods to integrate palliative care in the emergency setting have emerged. Few programs collect outcomes-based metrics, and there is a lack of standardization about what metrics are tracked when tracking occurs.

Concepts: Suffering, Hospital, Improve, Palliative medicine, Oncology, Cicely Saunders, Palliative care, Hospice