Cannabis and End-of-Life Care: A Snapshot of Hospice Planning and Experiences Among Illinois Medical Cannabis Patients With A Terminal Diagnosis

2021 ◽  
pp. 104990912110186
Author(s):  
James Alton Croker ◽  
Julie Bobitt ◽  
Sara Sanders ◽  
Kanika Arora ◽  
Keith Mueller ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Fast Track ◽  
Hospice Care ◽  
Cannabis Use ◽  
Care Plan ◽  
Medical Cannabis ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Eol Care

Introduction: Between 2013 and 2019, Illinois limited cannabis access to certified patients enrolled in the Illinois Medical Cannabis Program (IMCP). In 2016, the state instituted a fast-track pathway for terminal patients. The benefits of medicinal cannabis (MC) have clear implications for patients near end-of-life (EOL). However, little is known about how terminal patients engage medical cannabis relative to supportive care. Methods: Anonymous cross-sectional survey data were collected from 342 terminal patients who were already enrolled in ( n = 19) or planning to enroll ( n = 323) in hospice for EOL care. Logistic regression models compare patients in the sample on hospice planning vs. hospice enrollment, use of palliative care vs. hospice care, and use standard care vs non-hospice palliative care. Results: In our sample, cancer patients ( OR = 0.21 (0.11), p < .01), and those who used the fast-track application into the IMCP ( OR = 0.11 (0.06), p < .001) were less likely to be enrolled in hospice. Compared to patients in palliative care, hospice patients were less likely to report cancer as their qualifying condition ( OR = 0.16 (0.11), p < .01), or entered the IMCP via the fast-track ( OR = 0.23 (0.15), p < .05). Discussion: Given low hospice enrollment in a fairly large EOL sample, cannabis use may operate as an alternative to supportive forms of care like hospice and palliation. Clinicians should initiate conversations about cannabis use with their patients while also engaging EOL Care planning discussions as an essential part of the general care plan.

Graduating nurses' knowledge of palliative and end-of-life care

2020 ◽  
Vol 26 (1) ◽  
pp. 5-12
Author(s):  
Ann Selena Cleary
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Baccalaureate Nursing ◽  
Survey Design ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Convenience Sample ◽  
Eol Care ◽  
Care Course ◽  
Nurses Knowledge

Background: Generalist nurses frequently care for people who have advanced chronic diseases in decline, or who are dying. Few studies have measured graduating nurses' knowledge about end-of-life (EoL) care. Aims: To measure and compare knowledge about EoL care using the palliative care quiz for nurses among two cohorts of graduating nurses in a baccalaureate nursing programme. Methods: A quantitative cross-sectional survey design using a convenience sample of two cohorts of students. Findings: Total mean scores were low at 44.5% and 46.5% for the cohorts, respectively; this was not statistically significant. Misconceptions related to presentation and symptom management of the dying patient and integration of palliative with acute care. Palliative care knowledge was higher among the cohort who completed the dedicated EoL care course. Conclusion: Significant misconceptions about EoL care exist among these graduating nurses; this information provides direction for curriculum revision.

The Promise of Palliative Care

Pained ◽  
2020 ◽  
pp. 203-206
Author(s):  
Michael D. Stein ◽  
Sandro Galea
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
End Of Life ◽  
Social Workers ◽  
Hospice Care ◽  
Care Plan ◽  
Life Care ◽  
High Quality ◽  
Life Threatening

This chapter assesses palliative care. Palliative care focuses on improving the quality of life for people with life-threatening illnesses by involving a team of nurses, doctors, social workers, and clergy in a care plan. Hospice care—administered in dedicated units and in services delivered at home—has been slowly expanding over the past two decades, but the increasing percentage of patients who use hospice for less than 7 days suggests that the full benefits of end-of-life palliative care are not being realized. Meanwhile, the use of unwanted, aggressive end-of-life care, often inconsistent with patient preferences, remains pervasive. For palliative care to be effective, it must be supported by government policies and insurer incentives; it must also be owned by communities, which must continue to ask for help in designing and paying for high-quality palliative care for patients and their caregiving families.

scholarly journals ASSESSING HEALTH-RELATED OUTCOMES OF MEDICAL CANNABIS USE AMONG OLDER PERSONS IN COLORADO AND ILLINOIS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S204-S204 ◽  
Author(s):  
J Alton Croker ◽  
Julie Bobitt ◽  
Kanika Arora ◽  
Brian Kaskie
Keyword(s):  
Older Persons ◽  
Sleep Disturbances ◽  
Cannabis Use ◽  
Medical Cannabis ◽  
Treatment Needs ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Specific Patient ◽  
Patient Reported ◽  
Health Related

Abstract The use of cannabis is increasing among older Americans. A growing body of evidence shows cannabis and cannabinoids effective for treating chronic pain, spasticity, nausea, and sleep disturbances. States seeking to respond to the treatment needs of specific patient populations have legalized the use of cannabis for medical purposes. Few instruments offer standard outcomes for understanding the use of medial cannabis from the patient perspective, particularly focusing on older persons. Using cross-sectional survey data from a sample of older persons in Colorado and Illinois, we validate two scales to consistently measure patient-reported health related outcomes of medical cannabis use. We confirmed the validity of two separate, reliable outcome scales: a three-factor scale for measuring global health outcomes and a single-factor scale for capturing adverse health events. The COPS questionnaire revealed strong construct validity and internal consistency, and a lack of meaningful factor variance.

scholarly journals Medical cannabis use in the Australian community following introduction of legal access: The 2018-2019 Online Cross-Sectional Cannabis as Medicine Survey (CAMS-18)

2020 ◽  
Author(s):  
Nicholas Lintzeris ◽  
Llewellyn Mills ◽  
Anastasia Suraev ◽  
Maria Bravo ◽  
Thomas Arkell ◽  
...  
Keyword(s):  
Mental Health ◽  
Chronic Pain ◽  
Online Survey ◽  
Medical Profession ◽  
Cannabis Use ◽  
Medical Cannabis ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Convenience Sample ◽  
Plant Matter

Abstract Background: In 2016 the Australian federal government passed legislation enabling a range of cannabis-based products to be prescribed to patients by registered healthcare professionals. An online survey conducted immediately prior to these legislative changes found that the vast majority of respondents at the time were illicitly sourcing cannabis plant matter, smoking was the preferred route of administration, and mental health, chronic pain, and sleep conditions were the most frequently cited reasons for medical cannabis use. This manuscript reports the results of a follow-up survey conducted in 2018-2019, the Cannabis As Medicine Survey (CAMS-18). The goal of this second questionnaire was to examine patterns of use and consumer perspectives regarding medical cannabis use in Australia, two years after the introduction of legal access pathways. Methods: Anonymous online cross-sectional survey with convenience sample, recruited mainly through online media between September 2018 and March 2019. Participants were adults (18 years or over) residing in Australia who reported using a cannabis product for self-identified therapeutic reasons during the preceding 12 months. The survey measured consumer characteristics; indications and patterns of medical cannabis use; routes and frequency of administration; perceived benefits and harms; experiences and preferred models of access to medical cannabis. Results: Data were available for 1388 respondents. The main categories of condition being treated with medical cannabis were pain (36.4%), mental health (32.8%), sleep (9.2%), neurological (5.2%) and cancer (3.8%). Respondents reported using medical cannabis on 15.8 (11.2) days in the past 28, by inhaled (71.4%) or oral (26.5%) routes and spending AUD$82.27 ($101.27) per week. There were high levels of self-reported effectiveness, but also high rates of side effects. There was uncertainty regarding the composition of illicit cannabinoid products and concerns regarding their possible contamination. Few respondents (2.7%) had accessed legally prescribed medical cannabis, with the main perceived barriers being cost, disinterest from the medical profession, and stigma regarding cannabis use. Conclusions: Chronic pain, mental health and sleep remain the main clinical conditions for which consumers report using medical cannabis. Despite two years of legal availability, most consumers in Australia reported accessing illicit cannabis products, with uncertainty regarding the quality or composition of cannabis products.

The relationship between caregivers’ perceptions of end-of-life care in long-term care and a good resident death

2020 ◽  
Vol 18 (6) ◽  
pp. 683-690
Author(s):  
Eunyoung Lee ◽  
Tamara Sussman ◽  
Sharon Kaasalainen ◽  
Pamela Durepos ◽  
Lynn McCleary ◽  
...  
Keyword(s):  
End Of Life ◽  
Long Term Care ◽  
Critical Role ◽  
Good Death ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Term Care ◽  
Spiritual Issues ◽  
Eol Care

AbstractObjectiveQuality end-of-life (EOL) care is critical for dying residents and their family/friend caregivers. While best practices to support resident comfort at EOL in long-term care (LTC) homes are emerging, research rarely explores if and how the type of care received at EOL may contribute to caregivers’ perceptions of a good death. To address this gap, this study explored how care practices at EOL contributed to caregivers’ perceptions of a good resident death.MethodThis study used a retrospective cross-sectional survey design. Seventy-eight participants whose relative or friend died in one of five LTC homes in Canada completed self-administered questionnaires on their perceptions of EOL care and perceptions of a good resident death.ResultsOverall, caregivers reported positive experiences with EOL care and perceived residents to have died a good death. However, communication regarding what to expect in the final days of life and attention to spiritual issues were often missing components of care. Further, when explored alongside direct resident care, family support, and rooming conditions, staff communication was the only aspect of EOL care significantly associated with caregivers’ perceptions of a good resident death.Significance of resultsThe findings of this study suggest that the critical role staff in LTC play in supporting caregivers’ perceptions of a good resident death. By keeping caregivers informed about expectations at the very end of life, staff can enhance caregivers’ perceptions of a good resident death. Further, by addressing spiritual issues staff may improve caregivers’ perceptions that residents were at peace when they died.

Attitudes and Perceptions of End-of-Life Dreams and Visions and Their Implication to the Bereaved Family Caregiver Experience

2020 ◽  
pp. 104990912095231
Author(s):  
Pei C. Grant ◽  
Kathryn Levy ◽  
Tahleen A. Lattimer ◽  
Rachel M. Depner ◽  
Christopher W. Kerr
Keyword(s):  
Focus Group ◽  
End Of Life ◽  
Ad Hoc ◽  
Hospice Care ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Positive Attitudes ◽  
Dreams And Visions ◽  
Bereaved Family ◽  
The Impact

Background: While the majority of research assesses the impact of end-of-life dreams and visions (ELDVs) on patients, more recent research has begun to explore their impact on family caregivers (FCG). Objective: This study evaluates the relationship between general attitudes about dreams, perspectives of ELDV and their role the bereaved FCG experience. Design: Mixed-methods using a cross-sectional survey and five focus groups. Settings/Subjects: A total of 500 FCGs of patients who died under hospice care were recruited for the survey. Focus group members were self-selected through identified interest from the survey. Measurements: In addition to demographics and ELDV prevalence, general attitude toward dreams, ELDV perspectives, and impact on grief were assessed using ad hoc surveys. Results: Participants reporting ELDVs were significantly more validating of everyday dreams ( p < .001). Positive attitudes toward dreams strongly correlated with comfort from ELDVs for both patients and FCGs. Openness correlated positively with comfort from the ELDV for both the patient ( r = .149, p = .038) and FCG ( r = .217, p = 0.002) and negatively with fear/anxiety ( r = −.141, p = 0.050). Negative ELDV perceptions (ex. ELDVs were caused by medications) affected grief in areas such as accepting the loss ( r = −.235, p = .010) or maintaining connection ( r = −.255, p = .010) with the deceased. Focus group discussions were thematically analyzed resulting in 4 themes: ELDV narrative, Connection, Reflection, and Other Experiences. Conclusions: Positive general attitudes toward dreams and positive ELDV perceptions are correlated with better bereavement outcomes. Therefore, patient and family education on ELDVs that focuses on awareness and understanding of ELDVs may enhance clinical outcomes for both family and patients.

scholarly journals Knowledge of palliative care and preference of end of life care: a cross-sectional survey of residents in the Chinese socio-cultural background of Macao

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Kuai In Tam ◽  
Sok Leng Che ◽  
Mingxia Zhu ◽  
Sok Man Leong
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Associated Factors ◽  
Tertiary Education ◽  
Life Care ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Comfort Care ◽  
Study Results

Abstract Background Since the establishment of a hospice in the year 2000 and the development of a palliative care ward in 2019, there is no study examining public’s knowledge of palliative care, nor preference of end of life care in Macao. Aim Targeting Chinese residents of Macao, the current study has 3 goals: i) to understand the level of knowledge of palliative care, ii) to explore the preference of end of life treatments, and iii) to identify the associated factors of the preference of end of life treatments. Methods A cross-sectional questionnaire survey was conducted using a structured questionnaire. The study employed non-probability quota sampling through which Macao residents aged 18 and above were recruited between July and September 2020. Results A total of 737 responses were valid. The average correct rate of palliative care knowledge ranged from 40.4% to 85.5%. Pertaining to end of life treatments, 62.0% of the respondents chose comfort care. However, almost half of the respondents agreed that life-sustaining treatments should not be stopped under any circumstances. Respondents who scored higher in palliative care knowledge and those with secondary and tertiary education were associated factors of choosing comfort care rather than life-sustaining treatments. In addition, respondents who agreed that futile life-sustaining treatments should be stopped were also associated with preference for comfort care. Conclusion The understanding of palliative care amongst Macao residents is inadequate. Despite the public’s inclination towards comfort care, it is generally believed that life-sustaining treatments should not be stopped at the end of life. The study results suggest that not only the knowledge of palliative care should be enhanced amongst the general public in Macao, but information about life-sustaining treatments should also be offered to patients and families by healthcare professionals, in aiding end of life treatment decision making.

Development and Implementation of an End-of-Life Curriculum for Pediatric Residents

2018 ◽  
Vol 35 (11) ◽  
pp. 1439-1445 ◽  
Author(s):  
Paria M. Wilson ◽  
Lori A. Herbst ◽  
Javier Gonzalez-del-Rey
Keyword(s):  
End Of Life ◽  
Curriculum Design ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Pediatric Residents ◽  
Resident Physicians ◽  
Life Curriculum ◽  
Stressful Experience ◽  
Eol Care ◽  
Dying Patient

Background: Caring for a child near the end of life (EOL) can be a stressful experience. Resident physicians are often the frontline providers responsible for managing symptoms, communicating difficult information, and pronouncing death, yet they often receive minimal education on EOL care. Objective: To develop and implement an EOL curriculum and to study its impact on resident comfort and attitudes surrounding EOL care. Design: Kern’s 6-step approach to curriculum development was used as a framework for curriculum design and implementation. Setting/Participants: Categorical and combined pediatric residents at a large quaternary care children’s hospital were exposed to the curriculum. Measurements: A cross-sectional survey was distributed pre- and postimplementation of the curriculum to evaluate its impact on resident comfort and attitudes surrounding EOL care. Results: One-hundred twenty-six (49%) of 258 residents completed the preimplementation survey, and 65 (32%) of 201 residents completed the postimplementation survey. Over 80% of residents reported caring for a dying patient, yet less than half the residents reported receiving prior education on EOL care. Following curriculum implementation, the percentage of residents dissatisfied with their EOL education fell from 36% to 14%, while the percentage of residents satisfied with their education increased from 14% to 29%. The postimplementation survey identified that resident comfort with communication-based topics improved, and they sought additional training in symptom management. Conclusions: The implementation of a longitudinal targeted multimodal EOL curriculum improved resident satisfaction with EOL education and highlighted the need for additional EOL education.

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