Hospice Professionals Research Articles

The Status of Institutions for End-of-Life Care in Jeju and the Role of Jeju Regional Cancer Center

Death has not been avoided then human will die. Improved sanitation, concerted efforts by public health, new science andtechnology, and the development if medical interventions have increased life expectancy. Also, needs to improve the quality oflife for patients with end-of-life has been increased. As care for patients with terminal illnesses has shifted form home toinstitutions, lack of familiarity with dying process and death has appeared. Hospice and palliative care is the part of medicine totake care patients with progressive , far-advanced diseases and short life expectancy, less than 6 months, for whom the focusof care is relief of suffering and the quality of life. Subsequent decades have seen a marked growth in the number ofinstitutions operating in Korea. But, hospice and palliative care still take a care for only a small group for dying patients. Therehave been no data for hospice and palliative care institutions in Jeju. This study is to summary the status of institution for endoflife care in Jeju and role of Jeju regional cancer center. Most hospice professionals dont't have experience of hospicepalliative care. and has not received proper amount of hospice education in Jeju. There are only 3 institutions and 2 volunteergroups in Jeju. In order to take a care patient with terminal illness, the general consensus that end-of-life care must improve,the public still maintains an adequate attitude toward end-of-life and the role of health workers. Jeju regional cancer centerneed to improve education programs of hospice palliative care according to the role of it and offer it for hospice care.

Barriers to employment of African American professionals in hospice: a qualitative study with African American social work students.

A major barrier to African American hospice utilization is the lack of African American hospice professionals. This qualitative study with 10 female African American social work students in a Midwestern university explored whether the participants were interested in hospice employment. Results provided information about reasons for the overall lack of diversity in hospice, reasons for the lack of African American staff in hospice, reasons for the lack of African American patients in hospice, and avenues toward knowledge about hospice by African American professionals. Barriers to African American employment included a lack of hospice content in social work education, differences between African American cultural and religious beliefs and hospice philosophy, and that the lack of African American hospice patients resulted in a lack of desire for employment in hospice. Strategies for recruiting and retaining African American hospice social workers are proposed.

‘Good’ and ‘bad’ deaths: Narratives and professional identities in interviews with hospice managers

This article explores the formal and functional characteristics of narratives of ‘good’ and ‘bad’ deaths as they were told by 13 UK-based hospice managers in the course of semi-structured interviews. The interviewees’ responses include a variety of remarkably consistent ‘narratives of successful/frustrated intervention’, which exhibit distinctive formal characteristics in terms of the starting point and core of the action, the choice of personal pronouns and metaphors, and the ways in which positive and negative evaluation is expressed. In functional terms, the hospice managers’ narratives play an important role in representing and constructing their professional views, challenges and identities. Overall, the narratives argue for the role of hospices and professional hospice staff in facilitating a ‘good’ death, and, by presenting a relatively unified view, may potentially preclude alternative perspectives.

Reducing the Need for Narcotics: The Role of the Neurointerventional Radiologist in Pain Management (TH333)

Hospice providers are experiencing a significant increase in the number of new regulations and their complexity. In addition, regulatory scrutiny of hospice services is at an all-time high and is not expected to diminish in the foreseeable future. Hospice professionals are asking, ‘‘Is this the new normal?’’ Regulatory changes include multiple diagnoses on the claim form, increased documentation for eligibility, physician narrative and face-toface encounter scrutiny, new quality reporting, hospice CAHPS survey development, patient level data collection, and hospice payment reform, as well as the increasing regulatory scrutiny from a variety of Centers for Medicare & Medicaid Services audit contractors. Content will include the latest information on hospice audits, actions, and reports from the Office of Inspector General and the Department of Justice that impact hospice care. This session will cover the latest regulatory requirements for hospice and their implementation in hospice programs, as well as suggestions for hospice eligibility issues and documentation. Furthermore, it will provide a forum for conference participants to ask questions and have a dialogue about compliance and regulatory issues commonly faced by hospice professionals and organizations.

Clinical Supervision: An Antidote to Personal and Team Compassion Fatigue (SA504)

1.To propose an expanded role of clinical supervision on the palliative care team utilizing a mental health professional's model.2.To share the University of California, San Diego Doris A. Howell Palliative Care Team experience utilizing clinical supervision.3.To suggest research to explore the correlation between compassion satisfaction and compassion fatigue with group clinical supervision on palliative care teams. Hospice and palliative care (HPM) professionals gravitate toward this field because we can provide patient- and family-centered, compassionate care. However, the intense nature of this field can frequently lead to compassion fatigue—irritability, fatigue, and lack of joy leading to a sense of helplessness, decreased compassion, and a preoccupation with perceived traumas. Compassion fatigue occurs when providers are exposed to repeated empathetic encounters, which may have a traumatic element, and experience an associated countertransference reaction. In contrast, burnout can manifest with similar behaviors, stems from workplace issues, and lacks the added element of countertransference. Clinicians who care for dying patients are at high risk for both compassion fatigue and burnout. For the purposes of this presentation, we will focus on compassion fatigue and propose a potential tool to combat it. Clinical supervision is an integral part of the mental health professional's training, which explores how one's personal past can impact one's ability to connect and affect patient care. This process is facilitated by an experienced mental health professional to explore countertransference and how it may contribute to poor or ineffectual patient care (by avoiding or blaming the “difficult patient”). Clinical supervision has been part of the University of California, San Diego Doris A. Howell Palliative Care Service since February 2011. We immediately observed increased team member self-awareness leading to increased job satisfaction, improved team dynamics, enhanced team member retention, and decreased compassion fatigue. We describe our experience and present this model as a potential tool to prophylact palliative care team compassion fatigue.

Similarities and Differences in Perspectives on Interdisciplinary Collaboration Among Hospice Team Members

This study surveyed 4 core hospice professionals (physicians, nurses, social workers, and chaplains) on their perceived level of interdisciplinary collaboration, the influences of interdisciplinary collaboration, and job satisfaction to determine potential similarities and differences based on profession and various demographic characteristics of the members or member hospices. Analysis found that there are overall no differences based on demographic characteristics. Differences between professions, while few, were largely in the area of perceptions on relationships between members of the hospice team. Specifically, social workers appear to perceive themselves as less connected to the other members of the interdisciplinary team, an area theorized to influence interdisciplinary collaboration. Difference between professions was also found in job satisfaction. Implications for hospice practice and interdisciplinary education are discussed.

Petroleum Jelly (Vaseline Balls) for the Treatment of Constipation

Constipation is a common symptom at end of life, impacting patient outcomes and healthcare costs. Hospice and palliative care professionals often use practices based on anecdotal evidence. One such intervention is an oral preparation of petroleum jelly (OPJ), referred to as "Vaseline balls." This survey was designed to collect information regarding healthcare practitioners' knowledge and attitudes toward the use of OPJ for the management of constipation in hospice and palliative care. An online survey was distributed to physicians, nurse practitioners, nurses, and pharmacists who work with hospice and palliative care patients. A total of 67% (n=237/353) of responders reported being familiar with the use of OPJ. Results indicate there is a need for further clinical research on the use of OPJ to guide practice.

Hospice Caregivers' Experiences With Pain Management: “I'm Not a Doctor, and I Don't Know if I Helped Her Go Faster or Slower”

ContextThose caring for their loved ones in hospice experience tremendous stress, being faced with numerous decisions as they work to manage the pain experienced by their loved one. Although hospice care teams create pain management strategies, it is the role of the caregiver to implement these plans. ObjectivesThe purpose of this study was to further understand the hospice caregiver experience relating to pain management. MethodsSemistructured interviews with 146 caregivers provided data for the study. Responses to seven questions asking for a ranking of end-of-life pain management indicated a less than ideal experience. Available narratives from 38 caregivers were analyzed for themes related to further understanding of the concerns. ResultsFive themes were identified in the data including difficulty with administration of pain medicines, concerns about side effects of medications, insecurity with pain assessment, frustrations with communication among health care team members, and memories of unrelieved pain. ConclusionThese findings should raise concern among hospice professionals, whose commitment is to the management of pain, including emotional pain, with a focus on both the patient and the family as a unit of care. These data clearly suggest that hospice providers have an opportunity to be sensitive to perceptions held by caregivers regarding pain management. Effective planning for pain control must incorporate the values and beliefs not only of each patient but also of the family caregiver.

Developing competencies for multidisciplinary hospice and palliative care professionals in Korea

Competency-based assessment helps to improve performance and to standardize education programs for hospice and palliative care professionals. This paper aims to report the process and results of developing the hospice and palliative care competencies by multidisciplinary experts in Korea. The competency development task force team of Korean hospice and palliative care professionals was comprised of seven physicians, four nurses, two social workers, and two clergy. To build consensus regarding competencies, the team performed a two-round Delphi survey. The importance of competency domains was assessed by using a 5-point Likert scale. After the completion of the Delphi survey, final competency domains were decided in a consensus meeting. The competencies were composed of knowledge, skills, and attitudes. The competency domains were identified as the following: 11 domains and 16 subdomains for physicians, 11 domains for nurses, 5 domains and 15 subdomains for social workers, as well as 3 domains and 5 subdomains for spiritual care providers. The high importance domains were different by specialties. Physical care and treatment for physicians, symptom management for nurses, bereavement care for social workers, and communication for spiritual care providers were ranked as highly important. For nurses and spiritual care providers, attitude-related domains were ranked the highest in importance. The competencies developed by multidisciplinary professionals are useful to identify the appropriate roles of each hospice and palliative care specialist involved in a team approach to patient care.

Pediatric Palliative Care Curriculum: Impact of "Pain Cards" on Pediatric Resident Education

sustain long-lasting hospice and palliative care programs. 2. Describe effective strategies to cultivate, engage, and sustain relationships with philanthropic individuals and organizations. 3. Outline a successful approach to enact immediately upon return from the conference to engage local funders, foundation, or development partners. Palliative care and hospice programs face increasingly stiff competition in the fundraising landscape, together with an ever-increasing dependence on outside funding to sustain growth of special programs such as pediatric services and fellowship training. Most hospice and palliative care professionals lack specific training in fundraising or philanthropic cultivation; in fact, we are usually trained that this is not our job or, more often, that we are crossing ethical boundaries if we are involved in fundraising. Yet our patients and families want to give to the people who have cared for them, and our programs will continue to depend on sources other than clinical revenue. This interactive session will explore myths and realities about funding through the lens of two programs that have successfully garnered large amounts of philanthropic support: San Diego Hospice, which receives $7.5 million annually in philanthropic support, including a $1.5 million endowment to support a fellow; and Akron Children’s Hospital, which has secured two endowments, one for the program and one to support the field’s first endowed chair in pediatric palliative care. Attendees will be exposed to role-plays demonstrating specific skills in solicitation of funds as well as specific ideas to raise money for program operations and for fellowship positions. Participants will also leave the session with a concrete plan to pursue and secure funding upon their return from the conference.

When Misbehavin’ Ain't Misbehavin’. Understanding and Responding to Behavioral Challenges in Palliative and Hospice Care (P12)

1.Discuss the common behavioral challenges encountered by hospice and palliative care professionals.2.Describe use of pharmacologic interventions for behavioral disturbances.3.Identify practical strategies for management of patient, patient family, and staff when coping with difficult behaviors. Families with DSM-diagnosed members frequently derail the process of discussion and care when someone in the family is approaching end of life. Patients with mental illnesses such as dementia, schizophrenia, bipolar disorders, and other types struggle in different ways at end of life. HPNA sponsored

Continuous Care: A Home Hospice Benefit

Hospice professionals are aware of the difficult transition that occurs when patients and their loved ones arrive at the end stages of metastatic cancer and desire to reach the end of life in their home. However, the actual practice of caring for someone who is dying at home requires specific skills and support from those trained in end-of-life care.

Family Decision-Making to Withdraw Life-Sustaining Treatment for Terminally-Ill Patients in an Unconscious State

Purpose: The purpose of this study is to understand family members’ experience of deciding to withdraw life-sustaining treatments for terminally-ill patients in an unconscious state. Methods: Data were collected by performing an in-depth interview with eight terminally-ill patients’ family members who decided to withdraw life-sustaining treatments. Colaizzi’s phenomenological method wa s used for data analysis. Results: Questions were classified into 12 groups and finally into five categories. The five categories were about family members ’ frustration with patient ’s condition, emotional preparation for the patient’s death upon medical professionals’ recommendation, patient’s wishes, exhaustion due to caring and past experiences related to life-sustaining treatment. Conclusion: Using the five categories, hospice and palliative professionals could better understand family members’ decision making experience of withdrawing life-sustaining treatments for terminally-ill patients. Based on that, the family members could be provided with appropriate counseling and care, which in turn could improve hospice and palliative care intervention. (Korean J Hosp Palliat Care 2012;15:147-154)Key Words: Terminally ill, Family, Withholding treatment, Qualitative rese arch서론

The Positive Impact of Individual Core Values

The role of values in organizations has been a highly researched topic (Collins in Good to Great, HarperCollins, New York, 2001; Collins and Porras in Built to Last: Successful Habits of Visionary Companies, HarperCollins, New York, 1997; Frederick and Weber 1990; Kouzes and Posner, The Leadership Challenge, 4th ed, Jossey-Bass, San Francisco, 2007; Pattison et al. Emerging Value in Health Care: The Challenges for Professionals, Jessica Kingsley Publishers, Philadelphia, 2010). However, little research has focused on values in health care settings. In addition, the research that has been done has focused on values from an organizational perspective, not from an individual perspective. Based on these two factors, in addition to the maturation and growth of the hospice industry and the researcher’s prior studies on hospice leadership and organizational practices, a research study was conducted to evaluate the core values of hospice professionals. Another key driver of the research was the expressed difference identified by leaders within the hospice industry that values of individuals new to hospice were different than those who have worked in the industry longer. A web-based survey was utilized to gather core values and demographic data from hospice professionals. Data were collected over a one-year period and involved 531 hospice professionals from 33 states. The demographic information collected was similar to comparative data from previous hospice studies. The top three core values identified in the study were family, faith, and love, and represented 76 % of all responses. No statistically significant identifiable differences, based on demographic variables, were found. Based on the findings, no support was found for the perceived differences noted by leaders working in the hospice industry. However, it identified that hospice professionals regardless of demographic characteristics appear to hold similar values as being important. Based on the findings, core values appear to be an area of commonality versus difference among hospice professionals and could serve as a focal point for building a positive organizational culture. Further research is suggested to evaluate the unique meaning of the key values identified by hospice professionals in the study. In addition, replication of the study in other health care settings would be encouraged.

The Role of Jeju Regional Cancer Center for Education of Hospice Palliative Care

Purpose: Education of hospice palliative care is essential for ensuring quality of end-of-life care. The purposes of this study is the role of Jeju regional cancer center's education about hospice palliative care.Methods: We analyzed the data of Questionnaire from hospice professionals, who received educations that had hold about hospice palliative care from 2007 to 2009 at Jeju cancer center.Results: 89 of 305 was included because complete response. The ratio of male verse female was 9:80. The predominant sequence was volunteer, nurse, social worker, officer, clergy, doctor. Although answer was different according to role of hospice palliative care, problems of hospice palliative institutions was deficiency of operating fund and knowledge of hospice palliative care of terminal patients. Motivation of concern with hospice were religious volunteer service and relation of duty at the institution. Carrier of hospice was about less than 1 year. The hope of regional cancer center were various hospice education program and promotion of regional cooperation.Conclusion: Most hospice professionals dont have experience of hospice palliative care and has not received proper amount of hospice education in Jeju. Jeju regional cancer center need to improve education programs of hospice palliative care according to the role of it.

The experiences of professional hospice workers attending creative arts workshops in Gauteng

Object: This article explores the experiences of professional hospice workers using a creative process for debriefing them in order to facilitate the expression and communication of complex thoughts and feelings. The creative arts workshops were developed with the understanding in mind that caring for terminally ill patients can be challenging and stressful and professional hospice workers are subsequently at risk of developing compassion fatigue. The workshops focussed on skills transfers as well as self-healing by experiencing and teaching a diverse range of creative arts like music, drama, art, touch therapy, storytelling and movement. Design: Case study design. Setting: Gauteng, South Africa. Methods: Data collection included individual interviews with 19 trainees at nine different hospices, focus group interviews, observations during the workshops as well as a researcher journal. Themes were generated through thematic analysis to describe the experiences of the caregivers. Results: We found that the expressive arts facilitated communication and self-care and improved the wellbeing of the professional hospice workers. Conclusion: These findings add to understanding of the healing effects of the creative arts and especially the benefits in the hospice setting.

Assessment of Hospice Health Professionals' Knowledge, Views, and Experience with Medical Marijuana

The medicinal and recreational use of cannabis has been controversial, especially in the United States. Marijuana for medicinal use is approved in 14 U.S. states and has recently been considered for legalization in several additional states. Given its demonstrated efficacy in symptom management, marijuana has a potential role in palliative care. This study utilized a 16-item questionnaire to assess the knowledge, experience, and views of hospice professionals regarding the use of marijuana in terminally ill patients. The study results revealed that, like the general public, hospice health care providers are generally in favor of legalization of marijuana and, if legalized, would support its use in symptom management for their terminally ill patients.

Breathing space: a flexible group programme for people with shortness of breath

IntroductionBreathlessness is a common symptom experienced by patients with advanced conditions which greatly impacts on wellbeing. The nature of patients' breathlessness often prevents them from being able to access support...

PC-FACS

PC-FACS (Fast Article Critical Summaries for Clinicians in Palliative Care), an electronic publication of the American Academy of Hospice and Palliative Medicine, provides palliative care clinicians with concise summaries of the most important findings from more than 50 medical and scientific journals. Each month, structured summaries and insightful commentaries on 6-10 articles help palliative care clinicians stay on top of the research that is critical to contemporary practice. PC-FACS is free to AAHPM members and members can earn up to 3 CME credits quarterly. Following are excerpts from recent issues, and comments from readers are welcomed at resources@aahpm.org.

Evaluating a protocol to train hospice staff in administering individualized music

The ongoing extension of the average human lifespan in most parts of the world forecasts an unprecedented number of aging adults developing Alzheimer's disease or related dementia. Behavioural and psychological symptoms of dementia, commonly referred to as agitated behaviours, are estimated to occur in over 80% of patients and are typically treated using antipsychotic medications, posing significant morbidity and mortality risks. An evidence-based protocol known as individualized music (IM) offers a non-pharmacological intervention to reduce agitation. This project, using a one-group pre-test-post-test design, was implemented by training a self-selected sample of 24 hospice professionals to use the IM protocol with dementia patients. The effectiveness of the training on increasing the participants' knowledge of and confidence in using IM was explored. Paired t-tests were employed to analyze the data and the results of the analysis were encouraging, suggesting that it is feasible to educate multidisciplinary hospice staff in implementing the IM protocol. Thus, there is potential for using IM in the palliative treatment of persons with advanced dementia.