Peterssonmuir8525

Test-retest reliability showed a moderate level of consistency among SIC-Ex scores at months zero and three. Global rating at zero and three months showed fair to good/very good inter-evaluator correlation. Pearson correlation coefficients comparing total SIC-Ex and CCG scores were high for most evaluators. Self-scores by trainees did not correlate well with scores by evaluators. Conclusions SIC-Ex is the first assessment tool that provides evidence for incorporating the SIG guide framework for evaluation of resident competence. SIC-Ex is conceptually related to, but more specific than, CCG in evaluating serious illness conversation skills.Background Individuals experiencing homelessness face marginalization, dehumanization, and barriers to accessing quality palliative care. Inspired by the 3 Wishes Project, the Good Wishes Project (GWP) facilitates granting wishes to individuals experiencing homelessness and receiving palliative care with a goal of enhancing comfort and personalizing the end-of-life experience. Objective The main objective of this study was to elicit provider perspectives on the utility of the GWP in the delivery of end-of-life care to a population of homeless and vulnerably housed individuals. Design For this qualitative study, GWP client information and wish data were collected anonymously and analyzed quantitatively and descriptively. Semistructured interviews were conducted with health and social service professionals who cared for GWP clients. Interviews were recorded, transcribed, and analyzed through qualitative content analysis. Results At the time of evaluation, there were a total of 27 clients in the GWP. At 14 months after the project's launch, 40 wishes had been made, 24 of which had been granted. Wishes were classified into five categories basic necessities, end-of-life preparations, personal connections, paying-it-forward, and leisure. From the provider perspective (n = 7), the project was found to have utility in three main domains establishing and enhancing connection, satisfying basic needs, and promoting person-centered care. Conclusions The GWP is a promising psychosocial intervention in providing quality palliative care to individuals experiencing homelessness, whose lives have largely been burdened with hardship and marginalization.Background Urinary catheterization is often undertaken to relieve distressing bladder symptoms in palliative care. Objective The primary aim of this study was to determine the incidence of, and clinical indications that predispose patients admitted to palliative care units to, urinary catheterization. The secondary aims were to determine causal factors, including the type of malignancy, antecedent medications, and duration of admission in these patients. Methods This was a prospective observational dual site cohort study in palliative care inpatients. Univariate categorical chi-square analysis was performed to compare patients with and without urinary catheterization, and to identify risk factors associated with urinary catheter use. Results The incidence of catheterization in this cohort was 41% (43/104) and urinary retention (63%) was the most common cause. Agitation (47%) and urinary incontinence (70%) were common symptoms in those catheterized. Medications that were significantly associated with the need for urinary catheterization were benzodiazepines (p  less then  0.01) and antipsychotics (p = 0.01). All measures that define poor functional status were found to be significant (p  less then  0.01). Patients with prolonged hospitalization of greater than three weeks were catheterized more frequently (p = 0.017). Epigenetic inhibitor The majority of patients catheterized (79%) were admitted for terminal care. Conclusions The high incidence of urinary catheterization highlights the need for good bladder care for all patients in the palliative care setting. Patients with risk factors include the use of antipsychotics and benzodiazepines, declining functional status and prolonged hospital admission are more likely to be catheterized.Objective This report describes the experiences of a community-based palliative care (CBPC) program's efforts to understand the patterns of hospital utilization, specifically utilization reduction experienced by admitted patients. Efforts to quantify and describe an avoided hospitalization and opportunities to use these data to strengthen partnerships with local insurance payers to assure sustainability of the CBPC will be discussed. Background Patients with serious chronic illness experience emergency room care and hospitalizations with increasing frequency as their health deteriorates. CBPC programs are well positioned to decrease hospital utilization by early involvement and improved care management. Methods Arizona Palliative Home Care (AZPHC) program is a free standing CBPC in Maricopa County, Arizona, serving 3300 patients annually. An interdisciplinary team was formed within the CBPC to facilitate the identification of avoided hospital events and communicate these data to community partners in an effective and consistent manner. The processes developed by this team are described. Results AZPHC has enhanced its hospitalization avoidance strategies by communicating the rate of hospitalization avoidance events in a consistent and strategic manner. Providing instances of avoided hospitalizations with accompanying patient narratives to payers has enabled AZPHC to demonstrate the impact the CBPC has on improving quality of care and reducing overall costs. Discussion CBPC programs require payment for sustainability; therefore, partnerships with local insurance payers are essential. Presenting data that validate the impact of a program from a clinical and financial perspective will advance the growth of payer-CBPC provider relationships and secure a future for funded CBPC programs.Background Persons from a Christian tradition may have concerns that impede advance care planning for end of life. Sharing how Jesus practiced advance care planning may provide a pivot point to help ameliorate this problem. Objective To present a novel approach to advance care planning from a Christian tradition. Evolution of the Novel Approach Experiential learning that resulted in the novel approach is described using Kolb's learning cycle proceeding from concrete experience to reflective observation followed by abstract conceptualization and then active experimentation. Results The novel approach builds on events toward the end of Jesus' life to demonstrate how he practiced advance care planning telling those close to him that he was going to die even though they did not want to hear this, participating in a celebration of his life on Palm Sunday, sharing a Last Supper with those close to him, showing them how he wanted to be remembered, asking his friends to pray with him in the garden of Gethsemane, and saying to his mother that John would care for her. Questions related to these events are posed for use by health and spiritual care professionals to innovatively engage persons in advance care planning. Discussion This approach might be adapted for persons of other religious traditions by exploring their sacred teachings. It is proffered for others to explore, adapt, and evaluate for its utility in initiating and facilitating advance care planning.Palliative care teams and intensive care teams have experience providing goals-of-care guidance for critically ill patients and families. Critical coronavirus disease 2019 (COVID-19) infection is defined as infection requiring intensive care unit care, respiratory support, and often multiorgan involvement. This case presents a 53-year-old critically ill COVID-19 patient in multisystem organ failure who appeared hours from death despite best medical efforts. Comfort-focused care and compassionate extubation were offered after all medical teams felt near certain that death was imminent. Overnight, while options were being considered by the family, the patient began to markedly improve hemodynamically and was extubated several days later. Weeks later, the patient survived the hospital stay and was discharged to rehabilitation. After rehabilitation he returned home, able to walk, communicate freely, and independently perform all activities of daily living. Dialysis was no longer necessary and was stopped. The challenges of assisting in goals-of-care conversations for patients with serious COVID-19 infection are discussed.Background Despite the increasing use and acceptance of technology in health care, there is limited evidence on the usefulness and appropriate use of telehealth in home-based palliative care (HBPC). As part of the process evaluation of a pragmatic trial of video visits in HBPC, we assessed clinician experience with video visit implementation. Methods We assessed clinicians' experiences with and perception of the usefulness and appropriateness of video visits using anonymous surveys and brief qualitative interviews with a subset of survey participants. Qualitative analyses were guided by sociotechnical frameworks that emphasize technology's "value proposition" for its end users as being key to adoption. Results Clinicians (36 physicians and 48 registered nurses) generally had favorable attitudes toward video visits and telehealth. Respondents felt confident in the skills needed to make their role in video visits successful. Clinicians were neutral on whether video visits were useful for their practice or enhanced the patient-caregiver experience. Clinicians found video visits to be most appropriate for follow-up care (as opposed to start of care). The interviews yielded two themes that complemented the survey findings (1) factors enhancing the value proposition (positive responses from patients and families and convenience) and (2) factors diminishing the value proposition (issues related to the technology and scheduling). Discussion Our findings provide insights into clinicians' experiences with implementing remote video physician consultations, facilitated by a nurse in the patient's home in the pre-COVID-19 era. Clinician views about video visits may have shifted with the pandemic, which occurred after our data collection was complete. Clinical Trials Registration No. NCT#03694431.Assistance with discussing goals of care is one of the most common reasons clinicians seek out palliative care consultation. In practice though, the phrase "goals of care" is often utilized as a buzz phrase that lacks a shared understanding of its clinical relevance. We present a case example in which breakdowns in communication occurred between a patient and clinicians due to misunderstandings of the meaning of the phrase "goals of care." Subsequently, we review the literature to propose a unified definition of "goals of care" in hopes to minimize differences in what this phrase implies in clinical practice. We also seek to introduce a standardized process for establishing goals of care that may offer a more reliable and measurable method to promote goal-concordant care.Background Implementation of integrated oncology and palliative care improves patient outcomes but may represent a demanding task for health care providers (HCPs). Objective To explore physicians' and nurses' perceived challenges and learning needs in their care for patients with advanced cancer, and to analyze how these perceptions can provide insight on how to improve care for patients with advanced cancer in an integrated care model. Methods Residents in oncology, oncologists, nurses, and palliative care physicians were recruited to participate in focus group interviews. Six focus group interviews were conducted with 35 informants. Data were analyzed according to principles of thematic analysis. Results The discussions in the interviews concerned three broad themes an emphasis on patients' best interest, perceived as hindered by two sets of barriers; unsatisfactory organizational conditions such as time pressure, lack of referral routines, and few arenas for interdisciplinary collaboration, was perceived as one barrier.