Improving Palliative Care

Abstract

six suggestions for changing policy. These include advocating for regional and federal health care report cards; pushing for service arrangements that ensure genuine choices at end of life; expanding content of advance directives; funding public forums newsletters and hearings; working with local end-of-life agencies; and talking to the media about improvement efforts that are underway in the community. Additionally, authors discuss strategies for changing organizational culture. Part IV becomes more prescriptive than previous chapters, with fewer collaboratives described. Authors offer strategies for the unique challenges of improving care in specific populations: patients with dementia, Alzheimer’s, cancer, depression, delirium, congestive heart failure, and chronic obstructive pulmonary disease. Authors note the need for more studies in these populations. Chapter 14 addresses the difficult symptoms of depression and delirium. Several tools and approaches are offered to clinicians, including the recommendation by psychiatrist Harvey Chochinov that doctors just ask patients: ‘‘Are you depressed?’’ In his study of 197 patients receiving palliative care for advanced cancer, this single item was as valid as other brief screening tools, such as the Beck Depression Inventory-Short Form. The authors support using evidence-based practice at the bedside by using single-item tools such as this one and by suggesting goals for best practice: Set an aim to treat at least 80% of patients with depression, once identified. The Appendices contain 50 pages of instruments appropriate for use in quality improvement studies, including checklists, guidelines, multidimensional instruments, and tools to assess spirituality and grief. In summary, clinicians and others wanting to improve their end-of-life care should have this sourcebook at arm’s reach. It’s organized and formatted for the busy practitioner needing to ‘‘see oneddo onedteach one.’’ This makes for easy reading and clinicians will have all they need to get started by Tuesday morning. The studies and resources can only be viewed as relevant to those joining the field or refining their practice in endof-life care.