scholarly journals INNOVATIVE STRATEGIES TO SUPPORT OLDER ADULTS AND THEIR FAMILIES IN HOSPICE AND PALLIATIVE CARE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S199-S199
Author(s):  
George Demiris ◽  
Karen Hirschman
Keyword(s):  
Older Adults ◽  
Palliative Care ◽  
Hospice Care ◽  
Geographic Distance ◽  
Smart Phone ◽  
Evidence Base ◽  
Lessons Learned ◽  
Ethical Challenges ◽  
Rural Settings ◽  
Hospice And Palliative Care

Abstract In order to better support older adults with life-limiting illness and their families, many initiatives utilize information technology and other innovative platforms to increase access to supportive services and bridge geographic distance. Such technologies cover a broad range of systems ranging from smart phone applications to wearables and traditional telehealth platforms. There is a growing evidence base for such interventions but technical, clinical and ethical challenges remain when utilizing technology in the context of hospice and palliative care especially for older adults, including the concerns for caregiver burden, privacy, security, confidentiality, obtrusiveness and accessibility. In this symposium we provide an overview of innovative tools available for interventions in palliative and hospice care designed for patients and/or family caregivers in urban and rural settings. We provide lessons learned from three NIH funded studies testing different technology-based interventions in various settings including home hospice and outpatient palliative care. Discussion will follow focused on the clinical, ethical and practical challenges of innovation and the unique considerations for technology-mediated intervention design in a variety of palliative and hospice care settings. This symposium aims to provide: 1. an overview of existing technology-based interventions for older adults and their families in palliative care and hospice 2. evidence-based recommendations resulting from clinical trials in urban and rural settings for the design and implementation of innovative tools in hospice and palliative care 3. a discussion of challenges and opportunities for the use of technology to support older adults and their families

Changes in the Quantity and Level of Evidence of Palliative and Hospice Care Literature: The Last Century

2008 ◽  
Vol 26 (35) ◽  
pp. 5679-5683 ◽  
Author(s):  
Jennifer Tieman ◽  
Ruth Sladek ◽  
David Currow
Keyword(s):  
Palliative Care ◽  
Clinical Trials ◽  
Hospice Care ◽  
Medical Literature ◽  
Evidence Base ◽  
Level Of Evidence ◽  
Ovid Medline ◽  
Trial Basis ◽  
Hospice And Palliative Care ◽  
Specific Search

Purpose To objectively quantify the literature and the clinical trial basis for palliative and hospice practice given a perception that its evidence base is not well developed. Methods Using Ovid Medline, the study looked at cumulative and absolute numbers of articles in the general medical literature and the palliative and hospice care literature. The same comparisons were made exploring clinical trials from 1902 to 2005. Data were collated in five year groups from 1970 onward using a highly specific search phrase. Results The proportion of all Ovid Medline publications relating to palliative and hospice care rose from 0.08% in 1970 to 0.38% of the literature in 2005. In the same time, clinical trials increased from 0.96% to 7.22% of the palliative care literature published. By 2005, one in every 122 clinical trials published in the literature as a whole was in palliative or hospice care. The rate of growth in palliative care clinical trials as a proportion of all palliative and hospice publications was on average 1.4 times greater than in the corresponding general literature. More than one half of these studies were reported in just 43 journals, most of which were not specialist palliative and hospice care journals. Discussion Given the diversity of journals in which clinical studies related to hospice and palliative care appear, there is a key challenge for clinicians in finding ways that will allow currency of practice in a broad and rapidly changing field.

scholarly journals TECHNOLOGICALLY MEDIATED INTERVENTIONS IN HOSPICE AND PALLIATIVE CARE: CONSIDERATIONS FOR RURAL ELDERS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S199-S200
Author(s):  
Karla T Washington
Keyword(s):  
Older Adults ◽  
Palliative Care ◽  
Rural Communities ◽  
Rural Areas ◽  
Healthcare Providers ◽  
Lessons Learned ◽  
Spiritual Support ◽  
Technological Infrastructure ◽  
Hospice And Palliative Care ◽  
Rural Elders

Abstract Rural communities are home to a disproportionate number of older adults, many of whom are living with a serious illness or providing care to a seriously ill family member or friend. For these individuals, hospice and palliative care services can provide much-needed biopsychosocial and spiritual support, leading to an enhanced quality of life. Technologically-mediated interventions hold promise as a strategy to bridge geographic distances between healthcare providers and rural elders; however, the effect of such interventions may be greater when they are designed in a manner congruent with rural culture and compatible with the technological infrastructure common in rural areas. Informed by lessons learned during a pilot study of a telehealth intervention in one Midwestern state (R21CA191165), this presentation includes a discussion of strategies to more effectively recruit, engage, and retain rural older adults into studies testing technologically-mediated interventions for hospice and palliative care patients and their families.

scholarly journals Implementation of Remote Interventions in Older Adults: Lessons Learned During COVID-19 Isolation

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 950-950
Author(s):  
Jamie Rincker ◽  
Jessica Wallis ◽  
Angela Fruik ◽  
Alyssa King ◽  
Kenlyn Young ◽  
...  
Keyword(s):  
Older Adults ◽  
Weight Loss ◽  
Nutrition Education ◽  
Underserved Populations ◽  
Smart Phone ◽  
Dropout Rate ◽  
Lessons Learned ◽  
Drop Out ◽  
Electronic Submission ◽  
Weight Loss Interventions

Abstract Recommendations for older adults to socially isolate during the COVID-19 pandemic will have lasting impacts on body weight and physical activity. Due to the pandemic, two in-person RCT weight-loss interventions in obese older adults with prediabetes, Veterans Achieving Weight Loss and Optimizing Resilience-Using Protein (VALOR-UP, n=12) and the Egg-Supplemented Pre-Diabetes Intervention Trial (EGGSPDITE, n=7), were converted to remote formats and weekly nutrition (EGGSPDITE and VALOR-UP) and exercise (VALOR-UP only) classes were delivered using synchronous videoconference technology (Webex); classes were accessed via tablet/desktop/laptop or smart phone. Steps taken to transition participants to remote formats included technology training, implementation of staff tech-support, and delivery of nutrition education, tablets, scales, and exercise bands. The time to successfully transition participants was 1 week for early adopters (n=10) and up to 4 weeks for those with significant technology barriers (n=9); their difficulties included internet access, camera and microphone access and use, and electronic submission of weight and food records. Even with these challenges, in the first 3 months of remote delivery, participant dropout rate was low (10.5%, n=2), attendance was high (87.6% nutrition class (n=19); 76.4% exercise class (VALOR-UP, n=12)), and weight loss was successful (>2.5% loss (n=13); >5% loss (n=8)), showing that lifestyle interventions can be successfully adapted for remote delivery. Remote interventions also have potential for use in non-pandemic times to reach underserved populations who often have high drop-out rates due to caretaker roles, transportation limitations, and work schedules. These barriers were significantly reduced using a virtual intervention platform.

scholarly journals 523. COVID-19 Preparedness in Hospice and Palliative Care

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S328-S328
Author(s):  
Monika Pogorzelska-Maziarz ◽  
Jeannette Kates ◽  
Jingjing Shang ◽  
Angela M Gerolamo
Keyword(s):  
Palliative Care ◽  
Hospice Care ◽  
Group Discussion ◽  
Discussion Board ◽  
Community Group ◽  
Care Community ◽  
Care Services ◽  
Do It Yourself ◽  
Hospice And Palliative Care ◽  
The Impact

Abstract Background Due to the emergence of COVID-19 and resulting pandemic, there is an increased demand for palliative care and hospice care services. However, the impact of COVID-19 on the hospice and palliative agencies is unknown. Methods An electronic survey was disseminated via the Hospice & Palliative Nurses Association newsletter, posted to the Sigma Theta Tau Hospice and Palliative Care Community Group discussion board and advertised through social media from May 7–28, 2020. Summary statistics were computed. Results We collected 36 surveys representing all U.S. regions. Most respondents (78%) reported that their agency has cared for confirmed COVID-19 patients. Only half of agencies had access to laboratory facilities for surveillance and detection of the presence of outbreaks in both patients and staff (58%) and the ability to test patients and providers for COVID-19 (55%). Due to COVID-19, participants stated that the agency added new protocols regarding aerosol-generating procedures policies (58%), use of surface barriers (61%) and PPE usage (e.g. donning and doffing) in patient homes (56%). The majority (76%) reported that their agency required field clinicians to call ahead to ascertain COVID-19 exposure/symptoms before a home visit. More than half (58%) reported that their agency lacked supplies, including N95 respirators (45%), cleaning/disinfectant product (23%), alcohol based sanitizer (18%), eye protection (18%), gowns (18%), and surgical masks (14%). Overall, participants shared that field clinicians had to reuse (76%), extend (73%) or ration (30%) PPE supplies. Respondents reported that their agency accessed supplemental PPE through state/local resources (67%), private/community donations (67%), and do-it-yourself efforts (55%). One third (31%) reported that their agency was experiencing staffing shortages due to COVID-19; of these, 60% reported that shortages were due to staff infected with/quarantined due to COVID-19. Conclusion Our findings suggest that COVID-19 has presented significant challenges for palliative care and hospice agencies as they provide care to patients and families at an unprecedented rate. Disclosures All Authors: No reported disclosures

Palliative and Hospice Care: Educational Needs of Inpatient Registered Nurses

2016 ◽  
Vol 22 (2) ◽  
pp. 114-120 ◽  
Author(s):  
Jennifer L. Ashley ◽  
Tracy K. Fasolino
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Acute Care ◽  
Formal Education ◽  
Care Setting ◽  
Hospice Care ◽  
Acute Care Setting ◽  
Life Threatening ◽  
Hospice And Palliative Care

Hospice and palliative care aim to improve the quality of life for patients and families impacted by chronic, serious, and life-threatening illnesses. Patients and families benefit from earlier integration of palliative care and seamless transitions to hospice care. Nurses are an integral part of the care team, and their understanding of these services is critical. However, many nurses do not receive formal education in hospice and palliative care. This leads to lack of skills that nurses need to provide and discuss hospice and palliative care across care settings. Nurses in an acute care setting of a large health system were invited to participate in a survey, Attitudes Towards Care at the End-of-Life. The results of this survey revealed that nurses believe that patients and families need to be communicated with honestly regarding their disease, but nurses lack the knowledge of how to facilitate these discussions. Another key finding is that nurses feel less confident with non-pharmacologic interventions to relieve patients’ suffering. Education is urgently needed in these areas.

Oncologists’ perceptions of rounding alongside palliative care physicians: Results of a post-intervention survey study.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e20674-e20674 ◽  
Author(s):  
Thomas William LeBlanc ◽  
James A Tulsky ◽  
Amy Pickar Abernethy ◽  
Christopher A Jones ◽  
Anthony N Galanos ◽  
...  
Keyword(s):  
Palliative Care ◽  
Solid Tumor ◽  
Hospice Care ◽  
Care Physician ◽  
Lessons Learned ◽  
Survey Study ◽  
Post Intervention ◽  
New Model ◽  
Oncology Service ◽  
Palliative Care Physician

e20674 Background: In August 2011, a new rounding model was instituted on the inpatient solid tumor oncology service at Duke. This model incorporated a palliative care physician as a second attending on service, alongside the rounding solid tumor oncologist. We sought to assess the oncologists’ perceptions of this model, and of palliative care, 1 year later. Methods: We developed a 15-item survey assessing 3 domains: (1) perceptions about palliative care in general, (2) lessons learned from palliative care colleagues, if any, and (3) changes in the experience of rounding on the solid tumor oncology service. Faculty were invited to participate by e-mail, via an anonymous web link. All oncology faculty who rounded at least 2 weeks since August 2011 were included. Results: Response rate was 73% (8 of 11). 75% (N=6) of respondents had rounded both before and after the new model was instituted. 75% reported a more positive perception of palliative care (N=6), 88% (N=7) reported learning new ways to manage cancer patients’ symptoms, and 100% agreed that the palliative care physician brings a valuable skill set to the team. Only 1 respondent felt that palliative care physicians detract from oncologic issues, and none thought the palliative care physicians discuss hospice too early. 88% (N=7) reported greater willingness to round on the service under the new model, and 100% agreed that rounding was more enjoyable since the addition of the palliative care attending to the team. 100% agreed that palliative care is a necessary component of comprehensive cancer care, and that palliative care should have a presence in the outpatient cancer clinics; 88% (N=7) reported feeling comfortable doing palliative care in their own clinical practice. All agreed that “palliative care” is different from “hospice care.” Conclusions: Rounding alongside palliative care physicians on an inpatient oncology service may improve oncologists’ perceptions of palliative care, teach them new symptom management skills, and improve their willingness to do inpatient rounding. Fears about palliative care physicians inappropriately introducing hospice too early for patients with solid tumors may be unfounded.

Perceptions and Attitudes About Hospice and Palliative Care Among Community-Dwelling Older Adults

2012 ◽  
Vol 30 (2) ◽  
pp. 153-161 ◽  
Author(s):  
Erika Manu ◽  
Terri L. Mack-Biggs ◽  
Caroline A. Vitale ◽  
Andrej Galecki ◽  
Tisha Moore ◽  
...  
Keyword(s):  
Older Adults ◽  
Palliative Care ◽  
Community Dwelling ◽  
Perceptions And Attitudes ◽  
Hospice And Palliative Care ◽  
Community Dwelling Older Adults

The economic challenges of palliative medicine

2015 ◽  
Author(s):  
Thomas J. Smith ◽  
J. Brian Cassel
Keyword(s):  
Palliative Care ◽  
Lower Cost ◽  
Hospice Care ◽  
Cost Minimization ◽  
Cost Benefit ◽  
Cost Utility ◽  
Utility Analysis ◽  
New Directions ◽  
Hospice And Palliative Care ◽  
Benefit Cost

The compelling reasons for palliative care continue to be better symptom management, better advanced care planning and medically appropriate goal setting, and transitions to hospice care. Other new-found compelling reasons include better survival with hospice care, better survival with concurrent palliative care, and lower cost to hospitals and government and insurance funders. In studies to date, hospice and palliative care have been associated with equal or better survival and equal or lower cost. This chapter defines the various types of cost and clinical studies (including cost minimization, cost-effectiveness, cost utility analysis, cost-benefit, cost avoidance) and discusses the available data about the economic challenges of palliative care, how to apply the available data, how to collect and present some useful and useable data, and new directions for research.

Volunteering in hospice and palliative care in Germany

2018 ◽  
Author(s):  
Michaela Hesse ◽  
Lukas Radbruch
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
Health Care Providers ◽  
Hospice Care ◽  
Care Service ◽  
Health Care Service ◽  
Care Providers ◽  
Specialist Services ◽  
Patient Groups ◽  
Hospice And Palliative Care

German hospice care developed as a civil society movement in which volunteers were essential from the beginning. Palliative care was, however, led by a few pioneer physicians and started independently from hospices. This separate development is still visible with a clear distinction between palliative care units and inpatient hospices. Over the last two decades these two areas of care have moved more into the regular health care service. As a result volunteer services are increasingly subject to regulations. This also means that there is an increasing amount of competition and economic pressure. Developing trust and high transparency in the local and regional palliative care networks, and open and bilateral collaboration of specialist services with general practitioners (GPs) and other health care providers on the basic palliative care level are prerequisites of integrated palliative care. Ongoing development leads to changes in the patient groups that receive palliative care.

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