Abstract
Varilek BM, Isaacson MJ: Female veteran use of palliative and hospice care: A scoping review. Military Med 2021 [e-pub ahead of time]; DOI: 10.1093/milmed/usab005.
The number of female veterans in the United States in the age range of 55–64 years increased sevenfold from 2000 to 2015. Female veterans are more likely to suffer from certain mental health disorders, respiratory diseases, neurological diseases, and some forms of cancer when compared with their male counterparts. Veterans affairs (VA) health care providers need to be prepared to care for this growth of female veterans with serious illness. These serious illnesses require appropriate medical management, which often includes palliative care. It is imperative to determine how VA health care providers integrate palliative and hospice care for this population. The purpose of this scoping review was to explore the palliative and hospice care literature specific to female veterans to learn (1) what evidence is available regarding female veterans' use of palliative and hospice care? (2) To meet the needs of this growing population, what gaps exist specific to female veterans' use of palliative and hospice care?
Results of the review demonstrated that 19 articles met the inclusion criteria. Fourteen quantitative articles were included, which comprised 10 retrospective chart reviews, 1 randomized controlled trial, 1 correlation, 1 quality improvement, and 1 cross-sectional. The remaining five were qualitative studies. The sample populations within the articles were overwhelmingly male and white. Content analysis of the articles revealed three themes: quality of end-of-life care, distress, and palliative care consult. The authors conclude that the female veteran population is increasing and becoming more ethnically diverse. Female veterans are not well represented in the literature. The authors found that retrospective chart reviews dominated the palliative and hospice care literature specific to veterans. They suggest more prospective study designs are needed that explore the veteran and family experience while receiving end-of-life care. With the rising number of older female veterans and their risk for serious illness, it is imperative that research studies purposefully recruit, retain, analyze, and report female veteran statistics along with their male counterparts.
Orfali K. Getting to the truth: Ethics, trust, and triage in the United States versus Europe during the Covid-19 pandemic. Hastings Center Rep 2021 [e-pub ahead of time]; DOI: 10/1002/hast.1206.
Ethical issues around triage have been at the forefront of debates during the Covid-19 pandemic. This essay compares both discussion and guidelines around triage and the reality of what happened in the United States and in Europe, both in anticipation of and during the first wave of the pandemic. Why did the issue generate so many vivid debates in the United States and so few in most European countries, although the latter were also affected by the rationing of health care resources? Are countries with socialized health care systems better equipped to face the hard choices of triaging? Important lessons in transparency, trust, and accountability for policymakers can be drawn from this comparison, demonstrating that fostering public involvement and ethical debate remains a critical element for the sustained acceptance of any triage plan.
Bruce L, Tallman R. Promoting racial equity in COVID-19 resource allocation. J Med Ethics 2020 [e-pub ahead of time]; DOI: 10.1136/medethics-2020-106794.
Owing to COVID-19's strain on health systems across the globe, triage protocols determine how to allocate scarce medical resources with the worthy goal of maximizing the number of lives saved. However, due to racial biases and long-standing health inequities, the common method of ranking patients based on impersonal numeric representations of their morbidity is associated with disproportionately pronounced racial disparities. In response, policymakers have issued statements of solidarity. However, translating support into responsive COVID-19 policy is rife with complexity. Triage does not easily lend itself to race-based exceptions. Reordering triage queues based on an individual patient's racial affiliation has been considered but may be divisive and difficult to implement. And although COVID-19 hospital policies may be presented as rigidly focused on saving the most lives, many make exceptions for those deemed worthy by policymakers such as frontline health care workers, older physicians, pregnant women, and patients with disabilities. These exceptions demonstrate creativity and ingenuity—hallmarks of policymakers' abilities to flexibly respond to urgent societal concerns—which should also be extended to patients of color. This article dismantles common arguments against the confrontation of racial inequity within COVID-19 triage protocols, highlights concerns related to existing proposals and proposes a new paradigm to increase equity when allocating scarce COVID-19 resources.
Cithambarm K, Duffy M, Courtney E. What constitutes good quality end-of-life care? Perspectives of people with intellectual disabilities and their families. J Policy Pract Intellect Disabilities 2021 [e-pub ahead of time]; DOI: 10.1111/jppi.12376.
Owing to increased life expectancy, just as with the general population, people with intellectual disabilities are experiencing, and dying from, chronic and life-limiting conditions. This has led to an increase in the need for end-of-life care for people with intellectual disabilities. However, there is limited evidence as to what constitutes good end-of-life care from the perspectives of people with intellectual disabilities and their family members. This study aimed to discover the care needs of people with intellectual disabilities at the end of life in Ireland. A grounded theory approach was employed to explore the perspectives of the participants. After obtaining appropriate ethical approval, 19 semistructured individual interviews were carried out with 11 people with mild and moderate intellectual disabilities and eight family members to collect data that were subsequently analyzed through constant comparative analysis. Results demonstrated that the views of the participants suggested that providing personal care while vulnerable and dying, being with and communicating with the dying person, and meeting their spiritual needs were considered as being essential at the end of life for people with intellectual disabilities. The authors conclude that the findings from this study have shown that people with intellectual disabilities can engage with those around them and demonstrate how they would like to be cared for, and discuss what would be considered as being good care at the end of life.