Abstract
Letter to the Editor
Appropriate vocational education should focus on making nurses and physicians aware of the need to change the priorities of their actions when facing a patient's death. (page 126)
Brief Report
Does receiving individualized feedback about the findings of a research study that the hospice participated in affect clinical practice? (page 147)
Fast Facts and Concepts
#178 The National POLST Paradigm Initiative, 2nd Edition
#234 Prognosis of Anoxic-Aschemic Encephalopathy
(page 241)
Personal Reflection
“I am actually surprised to find that I am afraid of death. It is like being a flight instructor yet being afraid to fly.” (page 245)
Case Discussions in Palliative Medicine
A case of malignant ascites managed by insertion of a Tenckhoff catheter, resulting in successful symptomatic control and improvement in quality of life. (page 251)
Book and Media Reviews
(page 255)
Recent Literature
(page 257)
African Americans and Hospice Care
African Americans have enrolled in hospice care at lower rates than whites. A brochure describing hospice care using stories portraying African Americans' experiences with hospice, including their initial attitudes and beliefs about hospice, factors influencing their enrollment in the program, and outcomes following enrollment, was tested for its effects on attitudes, knowledge, and intent to use. Mean knowledge increased 20%; average attitude toward hospice improved 12.5%. Intention to enroll a family member in hospice increased from 84.5% to 92.9% (p = 0.002) and intentions to seek hospice care for themselves increased from 83% to 96% (p < 0.001). (page 161)
Video Education about Dementia
Improved means of education are needed for people with low health literacy. Seventy-six subjects were randomized to a verbal description or a video about advanced dementia. Among subjects receiving the verbal description, 72% preferred comfort; 12% chose limited care; and 16% desired life-prolonging measures. In the video group, 91% preferred comfort only; 9% chose limited care; and none desired life-prolonging. Factors associated with greater likelihood of opting for comfort included greater health literacy and randomization to the video. (page 169)
Proxy Accuracy
Proxy decision-makers play a critical role when a patient lacks decision-making capacity. When compared to patient preferences, adult children demonstrated the lowest elder-proxy accuracy and spousal proxies the highest accuracy. Accuracy was associated with family conflict. Proxies reporting higher family conflict had lower accuracy. No interaction between family conflict and relationship type was revealed. (page 179)
Hospitalization of Home Hospice Patients
Seventeen percent of home hospice patients were hospitalized. Of those hospitalized, 42% percent died in the hospital. Almost half were admitted through the emergency department. Common reasons for admission included delirium, pain, and falls. Most patients (52%) received care of a moderate level of intensity, with 18% receiving the most intensive level of care. Receiving care of high intensity was associated with emergency department admission. Charges to patient accounts averaged over $9,000 per stay. Concordance of care in the hospital to preexisting patient goals was high, but could not be determined in 39% of cases due to lack of documentation of patient goals. (page 185)
Barriers to Pain and Fatigue Management
Barriers to pain and fatigue relief have been identified at three levels: patient, professional, and system. In a controlled trial, there were significant immediate and sustained effects of the intervention on pain and fatigue barriers as well as knowledge. Measurable improvements in quality of life were found in physical and psychological well-being only. It appears that this clinical intervention was effective in reducing patient barriers to pain and fatigue management, increasing patient knowledge regarding pain and fatigue, and is feasible and acceptable to patients. (page 197)