Life Care Planning Research Articles

Promoting end of life care across care homes: the role of the specialist palliative care nurse

In 2008 the NAO undertook a retrospective study for all deaths in Sheffield during October 2007. 58% of these deaths occurred in hospital despite 40% having no medical reason to...

Planning and choices towards the end of life – findings from a raising public awareness campaign

In response to the National End of Life Care Strategy, and the Dying Matters campaign, the authors ran a raising public awareness campaign from March 2010 to February 2011.Aim▶Gather public...

Self determination – not for everyone

The north coast area of NSW in Australia has a high aboriginal population. Unfortunately aboriginal people overall have a lower life expectancy and a high incidence of chronic disease. Advance...

Direct medical costs of pain specialist visits, the multi-morbidity burden, pain-related impairment, and the physical performance on subjects with poly-trauma history >two years and chronic non-malignant pain: impact on life care planning

Direct medical costs of pain specialist visits, the multi-morbidity burden, pain-related impairment, and the physical performance on subjects with poly-trauma history >two years and chronic non-malignant pain: impact on life care planning

Direct medical costs of opioid management and the functional status of subjects with poly-trauma history >two ears and chronic non-cancer pain: impact on health care utilization and life care planning

The study calculated the direct medical costs of opioid management (DMC) of subjects with Poly-Trauma >two years and determined the functional status due to pain-related impairment using the Pain Disability Questionnaire-Functional Status subscale (PDQ-FS), from the AMA Guides to Evaluation of Permanent Impairment, 6th Edition. The retrospective study computed DMC in Poly-Trauma subjects from outpatient rehabilitation clinic records; average retail charges (internet-based) were calculated for a 12-month period on 29 subjects (19 men, age 28-62).

A framework for the best end of life care planning

The National End of Life Care Programme has published its guide to improving the care of dying people in care homes. Here, we discuss how it can help optimize end of life care in your home.

Review of: Life Care Planning & Case Management Handbook, 3rd Edition

Review of: Life Care Planning & Case Management Handbook, 3rd Edition

748 End of Life Care Plans (ELCP) in Children with Life Limiting Conditions

Background and aim: Paediatricians face acute situations with children with life limiting illness, wherein resuscitative medical interventions should not be attempted. We aim to survey current prevailing practices on provision of ELCP in children who fulfil the criteria for life limiting illness in the London borough of Haringey, UK. Methods: Survey was conducted in the last quarter of 2009. A list was compiled of medical conditions deemed as life-limiting in children. Medical notes of all children on the list were reviewed, directing attention to the specific points that were noted as relevant in the audit proforma. Ethical issues were discussed with the clinical governance department at Great Ormond Street Hospital, London, UK. Results: 18 children with life limiting illness were resident in Haringey. 10 of the 18 (55.5%) children suffered from cerebral palsy. 13 of these children (72.2%) fulfilled criteria for the provision of an End of Life Care Plan (ELCP). 3 children of the 13 (23%) had an ELCP. Only one child had the ELCP documented and communicated to professionals appropriately. Conclusions: National standards for delivering end of life care for children are currently not being met, and children with complex neurodisabilities are not usually being appropriately considered for ELCP discussion. Professionals are uncomfortable with approaching and addressing the issue of ELCP in eligible candidates. A programme for training and support at all levels of service delivery - consultants, registrars and nursing staff should be developed and implemented.

'Palliative care': a contradiction in terms? A qualitative study of cancer patients with a Turkish or Moroccan background, their relatives and care providers

BackgroundPalliative cancer care aims to improve quality of life and ultimately quality of dying, while prolonging life is not an objective anymore when death nears. The question is, however, whether these perspectives on palliative care are congruent with the perspectives of immigrant families with a Turkish or Moroccan background.MethodsA qualitative design was used as we were looking for the personal views of 'very ill' cancer patients with a Turkish or Moroccan background, their family members and their Dutch care providers. We interviewed 83 people, involved in 33 cases to obtain information about their views, values and norms on 'good care'.ResultsThe main concerns about 'good care' expressed by Turkish and Moroccan families were: maximum treatment and curative care until the end of their lives, never having hope taken away, devoted care by their families, avoiding shameful situations, dying with a clear mind and being buried in their own country. Their views conflict, to some extent, with the dominant principles in palliative care, for example, the emphasis on quality of life and advanced care planning, which includes discussing diagnosis and prognosis with the patient.ConclusionsPatients and their families with a Turkish or Moroccan background often have different ideas about 'good care' than their Dutch care providers. As many of them are aiming at cure until the end of life, they find 'good palliative care' a contradiction in terms.

Case Management Roles and Functions Across Various Settings and Professional Disciplines

To describe the practice of case managers in diverse settings with special focus on the roles and functions that they engage in during an average work day. Results were also used to validate and revise as indicated in the blueprint of the certification examination of the credential Certified Case Manager (CCM). The study covered all of the various case management practice settings. This cross-sectional descriptive study applied the practice analysis method and survey research design. It also employed a purposive nonrandomized sampling procedure that resulted in 6,909 total participants. Data collection was completed between May and July 2009. The survey instrument used consisted of 209 items that addressed background and demographics, case management activities, and knowledge areas. The case management professionals who participated in this study had similar perceptions of the essential activities and knowledge aspects of their practice except for those who are vocational rehabilitation and work adjustment specialists and those who practice in the life care planning and disability management settings. The study also resulted in the identification of 6 essential activity and 6 knowledge area domains. This study described the current practice of case management in diverse settings and by different health care professionals who assume the case manager's role. It also forecasted what practice changes might occur in the next few years. In addition, it identified the essential activities and knowledge areas required for effective and competent performance of case managers. These findings provided the evidence of the CCM certification examination and demonstrated that the structure or blueprint of the examination was developed on the basis of rigorous research. In addition, findings of this study can be used for further research in case management and developing training and education curricula for the advancement of case managers.

Complex Regional Pain Syndrome Type-I: Social Aspect And Life Care Planning

Complex regional pain syndrome type I, also known as reflex sympathetic dystrophy, is a multisymptom syndrome usually affecting one or more extremities. Etiology is not being solved completely, but uncontrolled sympathetic activity and inflammatory response following soft tissue and nevre injury is thought to be the main cause of this disease. Common symptoms are pain and tenderness to palpation and evidence of autonomic nervous dysfunction in an extremity. There is not one single successfull treatment approach to complex regional pain syndrome and if the treatment of patient is not enough, major problems in patients social life may be occured. In this study, social aspect and life care planning of complex regional pain syndrome type I were discussed.

Advance Care Planning: An opportunity for person-centred care for people living with dementia

Many people want to be able to plan ahead, so that if in the future they cannot make decisions or do things, their wishes will be known. This is called Advance Care Planning (ACP). Although it is part of official NHS policy (NHS End of Life Care Planning), ACP is hardly ever done, and it may become more difficult once a person has memory problems. In the UK, there is very little research into ACP. By the time someone has signs of dementia, families often become involved. We are uncertain how this affects ACP and the views of the person with dementia, particularly with the new Mental Capacity Act which allow families to comment on health, as well as financial, issues. Our study will be exploring the area of ACP, especially in dementia, by • looking at the experience of other countries through a systematic review of the existing literature; • finding out what people who have carried out ACP in this country think through interviews and focus groups; • considering what factors might help professionals to encourage the process of ACP in practice; and • looking at how ACP might be done better for people with dementia. The ultimate aim of our study is to produce guidance on ACP for both people with dementia, their families and health care professionals.

Every dying patient deserves the best specialist care.

The End of Life Care Strategy is an important document, but end of life care planning is unfortunately much more complex than the Commons public accounts committee and your editorial (January 7) would suggest.

Assessing Economic Damages in Personal Injury and Wrongful Death Litigation: The State of Illinois

Forensic economics experts (FE) working with attorneys engaged in litigation, whether consulting, preparing a report, or testifying at deposition or trial, generally are expected to have some knowledge (1) of the state’s statutory and case law regarding allowable damages and methods; and (2) that certain topics (e.g., taxes, collateral sources) should not be mentioned or considered at certain times since a mistrial could result. This situation creates a tension: forensic economics experts are economics experts and are not attorneys, but nonetheless must have a reasonable understanding of the relevant state law. In this vein, the Journal of Forensic Economics (JFE) continues to publish a series of articles on the ways such damages are calculated in different state jurisdictions, one state at a time.2 The state of South Dakota is included in this issue and this paper adds Illinois to the list. Following the format of previous articles in this JFE series, Section II provides a listing of the controlling statutes, general case law, and court rules. Section III discusses the concept of earning capacity which appears throughout PI and WD case law in Illinois. Section IV discusses discounting to present value. Fringe benefits are discussed in Section V, while Section

The Plaintiff and Defense Attorney's Guide to Understanding Economic Damages

The Plaintiff and Defense Attorney's Guide to Understanding Economic Damages

Vocational outcomes after brain injury in a patient population evaluated for Life Care Plan reliability

This retrospective cohort study examined the vocational outcomes in forty-four traumatically brain injured patients. Patient files selected were limited to those who were seen for the development of an original Life Care Plan and were subsequently seen at least once for a complete update of that plan. Patients who were retired at the time of the brain injury were excluded. Each participant was actively involved in litigation at the time of the initial evaluation as well as at the time of his or her update evaluation. Traumatic brain injury resulted from various etiologies. Vocational outcomes were analyzed in relation to severity of injury, age at onset, gender and education. Vocational outcome was reported as a return to work, supported employment, return to school or training or permanent total disability. Twenty-one patients were classified as permanent-total disabilities. Twenty-three returned to work, supported employment, or were successfully in school and expected to return to work. This 52% rate of vocational or school participation is particularly noteworthy since all cases were actively in litigation. A significant trend was found for severity of injury, and level of education, but not for age at onset or gender. These factors are discussed in relation to the subjects' participation in third party civil litigation and implications for Life Care Planning.

Spinal Cord Injury Medicine. 6. Economic and Societal Issues in Spinal Cord Injury

Priebe MM, Chiodo AE, Scelza WM, Kirshblum SC, Wuermser LA, Ho CH. Spinal cord injury medicine. 6. Economic and societal issues in spinal cord injury. This self-directed learning module presents a variety of social and economic issues facing people with spinal cord injury (SCI). It is part of the study guide on SCI medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article focuses on the economic consequences of SCI, ethical issues in SCI, and the legislative efforts that have improved access and quality of life for people with disabilities. Costs of SCI include direct health care expenditures and lost earnings as a result of unemployment after SCI. Lifelong costs can be anticipated with the development of a comprehensive life care plan. Barriers to vocational reintegration continue to limit full participation for most people with SCI. Ethical issues central to SCI are related to the principles of autonomy and justice. As cure research becomes clinically applicable, the SCI community must work together to develop appropriate procedures to respect moral decision-making by all parties. Key legislation in the past century has resulted in important advances in the rights of people with disabilities. Overall Article Objectives (a) To review the economic consequences of spinal cord injury, including lifelong direct costs, life care planning, and factors affecting employment and (b) to identify current ethical issues facing the spinal cord injury community and review the advances made in the rights of people with disabilities in the United States through legislation.

Peaceful Awareness in Patients with Advanced Cancer

Previous studies have shown that prognostic awareness may be harmful to mental health yet beneficial for end of life care planning. The effects of prognostic awareness coupled with a sense of inner peace are unknown. In the multisite, longitudinal Coping with Cancer Study, 280 patients with advanced cancer were interviewed at baseline. Patients defining themselves as "terminally ill" and/or "at peace" most days were paired with others on sociodemographic, mental health and advance care planning. Primary caregivers of deceased patients were interviewed 6 months postloss and compared on their physical and mental health and their perceptions of patients' end-of-life care and death. Overall, 17.5% of patients reported being both peaceful and aware. Peacefully aware patients had lower rates of psychological distress and higher rates of advance care planning (e.g., completing do-not-resuscitate [DNR] orders, advance care planning discussions with physicians) than those who were not peacefully aware. Additionally, peacefully aware patients had the highest overall quality of death as reported by their caretakers in a postmortem evaluation. Surviving caregivers of peacefully aware patients were more physically and mentally healthy 6 months postloss than caregivers of patients who were "aware" but not peaceful. Patients with advanced cancer who are peacefully aware have better mental health and quality of death outcomes, and their surviving caregivers have better bereavement outcomes. Peaceful awareness is associated with modifiable aspects of medical care (e.g., discussions about terminal treatment preferences).

A patient with dementia and cancer: to feed via percutaneous endoscopic gastrostomy tube or not?

Despite the lack of clear benefits of feeding via gastrostomy tube in dementia patients, its use has been increasing. The views of health professionals, patients and their carers differ widely about the perceived benefits, which makes decision-making difficult and stressful. The palliative care approach of facilitating better communication and end-of life care planning can help avoid inappropriate gastrostomy tube placements. A case of an elderly male with dementia and two malignancies is described, and the place of the palliative care approach is explored.

Pediatric Life Care Planning and Case Management

Pediatric Life Care Planning and Case Management