Palliative Hospice Research Articles

Case Report: Gastric Metastasis revealing a Disseminated Skin Melanoma: A Case Report and Literature Review

Abstract Background Melanoma, an aggressive malignant skin cancer, has the ability to spread both locoregionally and to distant sites. The risk of metastasis is correlated to invasion depth and the presence of ulceration. Although gastrointestinal (GI) metastases are uncommon, gastric involvement is particularly rare. Case presentation We report a case of a 62-year-old male who presented with abdominal pain, dyspepsia, anorexia, and weight loss. On physical examination abdominal masses and hepatomegaly were detected. Radiological imaging showed widespread masses in the abdominal and thoracic regions. Upper GI endoscopy identified an umbilicated protruded lesion with central dark pigmentation at the antro-fundic junction. Histopathological examination and immunohistochemical staining were consistent with melanoma. A subsequent rigorous skin examination uncovered a primary malignant skin melanoma. Due to worsening general condition, the patient received palliative hospice care. Conclusion This report highlights the critical need for vigilant skin examination when encountering gastric lesions with dark pigmentation, which led to the identification of initially undetected cutaneous melanoma.

The role of physical and occupational therapy in palliative and hospice medicine of neurodegenerative diseases

The aim of our research is to review modern literature regarding the relevance and frequency of physical and occupational therapy in palliative and hospice medicine of neurodegenerative diseases. Results. The role of physical therapy and occupational therapy in palliative-hospice medicine for such neurodegenerative diseases as Parkinson’s disease, cognitive impairment and/or dementia, Alzheimer’s disease, amyotrophic lateral sclerosis, multiple sclerosis has been studied. It has been found, a wide variety of physical and occupational therapy is widely used in palliative hospice medicine despite the disease’s severity. These methods significantly improve the quality of life of both palliative patients and their families ultimately. Physical and occupational therapist specialists are a very important link in the multidisciplinary team of palliative-hospice medicine. Conclusions. Physical and occupational therapy play a very important role in neurodegenerative diseases patients requiring palliative-hospice care in today’s world. Palliative physical and occupational therapy of patients with neurodegenerative diseases has many benefits that help maintain or improve various bodily functions. This contributes to the quality of life improving for not only patients but also for their family members who care for them.

Implementing Advance Care Planning for dialysis patients: HIGHway project

BackgroundPatients undergoing hemodialysis have a high mortality rate and yet underutilize palliative care and hospice resources. The Shared Decision Making-Renal Supportive Care (SDM-RSC) intervention focused on goals of care conversations between patients and family members with the nephrologist and social worker. The intervention targeted deficiencies in communication, estimating prognosis, and transition planning for seriously ill dialysis patients. The intervention showed capacity to increase substantially completion of advance care directives. The HIGHway Project, adapted from the previous SDM-RSC, scale up training social workers or nurses in dialysis center in advance care planning (ACP), and then support them for a subsequent 9-month action period, to engage in ACP conversations with patients at their dialysis center regarding their preferences for end-of-life care.MethodsWe will train between 50–60 dialysis teams, led by social workers or nurses, to engage in ACP conversations with patients at their dialysis center regarding their preferences for end-of-life care. This implementation project uses the Knowledge to Action (KTA) Framework within the Consolidated Framework for Implementation Research (CFIR) to increase adoption and sustainability in the participating dialysis centers. This includes a curriculum about how to hold ACP conversation and coaching with monthly teleconferences through case discussion and mentoring. An application software will guide on the process and provide resources for holding ACP conversations. Our project will focus on implementation outcomes. Success will be determined by adoption and effective use of the ACP approach. Patient and provider outcomes will be measured by the number of ACP conversations held and documented; the quality and fidelity of ACP conversations to the HIGHway process as taught during education sessions; impact on knowledge and skills; content, relevance, and significance of ACP intervention for patients, and Supportive Kidney Care (SKC) App usage. Currently HIGHway is in the recruitment stage.DiscussionEffective changes to advance care planning processes in dialysis centers can lead to institutional policy and protocol changes, providing a model for patients receiving dialysis treatment in the US. The result will be a widespread improvement in advance care planning, thereby remedying one of the current barriers to patient-centered, goal-concordant care for dialysis patients.Trial registrationThe George Washington University Protocol Record NCR213481, Honoring Individual Goals and Hopes: Implementing Advance Care Planning for Persons with Kidney Disease on Dialysis, is registered in ClinicalTrials.gov Identifier: NCT05324878 on April 11th, 2022.

Caring for patients near the end-of-life at Mayo Clinic: a narrative

I’m a palliative care and hospice doctor focusing my clinical care on families near the end of life. It has been a great privilege to be welcomed to the bedside of so many seriously ill and dying patients to care for them and their families. Pursuing geriatrics and palliative care were not always met with welcome sentiments from my peers. “You’re going to take care of sick and dying patients.” “It is so depressing.” My experience is that geriatrics and palliative care are a little like peeking through the old skeletal keyhole into a living room. You have to get up real close to peek inside and if you dare to go through and enter in, a whole new world opens. It is often a sacred space. A space for a team of professionals caring together.

Impact of an augmented intelligence-based tool upon the timeliness of referrals to palliative care and hospice in patients with advanced cancer in the real-world setting.

12127 Background: Timely integration of palliative care (PC) and hospice management for patients with advanced cancer requires informed clinical decision-making and expectation-setting to help patients realize their end-of-life (EOL) goals. Longer stay with hospice is a quality indicator in oncology care that requires earlier referral to PC and hospice. We have previously demonstrated that an augmented intelligence (AI) tool used to predict 30-day mortality can assist with an increase in referrals to PC and hospice. In this secondary analysis, we report on the impact of the AI tool on the timeliness of referral to PC and hospice prior to death. However, calculating days with hospice across multiple hospice providers and geographies can be challenging. Thus, we used a real-world (RW) measure of 14 to 90 days prior to death as a surrogate for timeliness for hospice and 90 to 180 days prior to death for a PC referral. Methods: Medical records of patients at a large community-based hematology/oncology practice in the Pacific Northwest who experienced a mortality event pre-deployment (January 2017 to April 2018) or post-deployment (May 2018 to June 2021) of the AI tool were electronically reviewed for evidence of a PC or hospice referral. Patients were included if the referral was between 14 to 90 days of the mortality event for hospice care or between 90 to 180 days prior to death for PC. Outcomes for additional timepoints (1-3 days and 4-13 days and >90 days) will be provided at the final presentation. Data were analyzed using a statistical process control chart. Results: Of the patients who experienced a mortality event, the following percentages had been referred pre- and post-deployment of the AI tool: PC 7.1% pre- and 15.0% post-deployment; hospice 11.5% pre- and 32.1% post-deployment. A system shift (≥6 points in a row steadily increasing or decreasing) occurred early after deployment, in June 2018. The overall improvements were 111.0% in PC referrals and 179.1% in hospice referrals within the respective timeframes. Conclusions: Deployment of an AI tool at a hematology/oncology practice substantially increased the proportions of patients referred to PC 90-180 days prior to death and hospice between 14 -90 days prior to death, suggesting a favorable impact on timeliness of referrals. If confirmed in additional studies, the AI-based tool can be utilized to integrate PC early in the management of patients with advanced cancer.[Table: see text]

End-of-life care in the cardiac intensive care unit: a contemporary view from the Critical Care Cardiology Trials Network (CCCTN) Registry.

Increases in life expectancy, comorbidities, and survival with complex cardiovascular conditions have changed the clinical profile of the patients in cardiac intensive care units (CICUs). In this environment, palliative care (PC) services are increasingly important. However, scarce information is available about the delivery of PC in CICUs. The Critical Care Cardiology Trials Network (CCCTN) Registry is a network of tertiary care CICUs in North America. Between 2017 and 2020, up to 26 centres contributed an annual 2-month snapshot of all consecutive medical CICU admissions. We captured code status at admission and the decision for comfort measures only (CMO) before all deaths in the CICU. Of 13422 patients, 10% died in the CICU and 2.6% were discharged to palliative hospice. Of patients who died in the CICU, 68% were CMO at death. In the CMO group, only 13% were do not resuscitate/do not intubate at admission. The median time from CICU admission to CMO decision was 3.4 days (25th-75th percentiles: 1.2-7.7) and ≥7 days in 27%. Time from CMO decision to death was <24 h in 88%, with a median of 3.8 h (25th-75th 1.0-10.3). Before a CMO decision, 78% received mechanical ventilation and 26% mechanical circulatory support. A PC provider team participated in the care of 41% of patients who died. In a contemporary CICU registry, comfort measures preceded death in two-thirds of cases, frequently without PC involvement. The high utilization of advanced intensive care unit therapies and lengthy times to a CMO decision highlight a potential opportunity for early engagement of PC teams in CICU.

A Qualitative Study of the Impact of COVID-19 on Hospice and Home-Based Palliative Care in Taiwan

COVID-19 has had a tremendous impact on individuals and health care, particularly among those with serious illnesses. Although Taiwan initially reported low rates of COVID-19 (20.7 cases per million in 2020), by early 2021 the Alpha variant began spreading in Taiwan, which went into a soft lockdown from May to July. This study aimed to investigate the impact of COVID-19 on Hospice and Home-Based Palliative Care (HBPC) patients, family, and medical team member in Taiwan during different COVID-related time points. From November 2020 to May 2021, we conducted semi-structured interviews with 2 patient, 5 caregivers, and 8 medical team members in the hospice and HBPC setting to elicit their views about the impact of COVID-19 on care. Content analysis was used to guide the analysis of themes. Two researchers independently coded transcripts and met to reconcile codes. Results showed varying impact across the time points. In 2020, patients, caregivers, medical team members felt little impact of COVID-19. However, in 2021, HBPC caregivers reduced the frequency of HBPC visits to lower the household COVID-19 infection risk. Hospice and HBPC team members reported that more caregivers selected HBPC over hospice. They also observed an increase in complicated grief among family survivors following the soft lockdown. The impact of the pandemic on homecare provision increased as prevalence of COVID-19 increased, impacting care and quality of hospice and HBPC. Further research is needed to better understand the impact of the pandemic on the quality of hospice /HBPC and grief experiences.

Social Workers in Primary Care Increase Access to Palliative Care

Clinical trials show that palliative care improves patient experiences and reduces costs, and use of palliative care and hospice care have been increasing over the past three decades. In the Veterans Administration health care system (VA), Veterans may receive palliative care concurrently with other treatments. However, many barriers exist to the use of palliative care, such as patients’ misperceptions. Social workers in primary care teams may increase use of this valuable service by establishing trust between patient and care team, educating patients and caregivers, and coordinating services. Leveraging a national social-work-staffing program as a natural experiment, we evaluated the effect of hiring one or more social workers to the primary-care team on use of palliative or hospice care among Veterans with a recent hospital stay. Our data included 91,675 episodes of care between 2016 and 2018. 1.45 percent of episodes were followed by use of palliative care or hospice within 30 days. The addition of one or more social workers through the staffing program was associated with an increase of 0.53 percentage points (p<0.001) in the probability of any palliative or hospice care, i.e., a more than 30% increase relative to the mean. Policy makers and health system leaders who seek to improve patient experience and reduce costs through increased access to palliative and hospice care could consider social work staffing as a policy tool to achieve those aims.

Missed Opportunities for Compassion: A Call to Action for Incarcerated Individuals Denied Compassionate Release

In 2016, a total of 4,117 state and federal prisoners died in publicly or privately operated prisons. Each year from 2001 to 2016, an average of 88% of deaths in state prisons were due to natural causes, with more than half of those due to cancer, heart disease or liver disease, conditions for which non-incarcerated citizens often benefit from palliative care and hospice. Prisoners age 55 and older are the fastest-growing segment of the population residing in prisons, as well as those with the highest mortality rate. Compassionate release of seriously ill prisoners became a matter of federal statute in 1984 and has currently been adopted by the majority of U.S. prison jurisdictions. The spirit of the mandate is based on the idea that catastrophic health conditions ie terminal illness affect the four principles of incarceration: retribution, rehabilitation, deterrence, and incapacitation. Concerned about an aging prison population, overcrowded facilities, and soaring costs, many policy makers are calling for a wider use of compassionate release for persons with terminal illness as well as broader prison reform. The prognosticating criteria of compassionate release guidelines are clinically flawed, and the application and procedural barriers are prohibitive. In this paper we review cases of patients who qualified for compassionate release but had their applications denied. We will discuss the urgent need for access to quality palliative medicine for incarcerated persons with advanced illness and call healthcare providers to action with the aim of reducing suffering and promoting social justice for those in need.

Full Code to Do-Not-Resuscitate: Culturally Adapted Palliative Care Consultations and Code Status Change Among Seriously Ill Hispanic Patients.

Palliative care and hospice services are disproportionately underutilized by ethnic minority patients. Addressing barriers to utilization of these services is critical to reducing disparities. The purpose of this study was to assess the impact of a culturally adapted palliative care consultation service for Hispanics on end-of-life decisions, specifically likelihood of changing from full code to do-not-resuscitate (DNR) status during index admission for serious illness. A cross-sectional study design was applied to data extracted from electronic health records (EHR) of patients seen by a Geriatric Palliative Care service during inpatient stays between 2018 and 2019. The majority of referrals came from critical care sites. Culturally adapted palliative care consultations using the SPIKES tool featured a Spanish-speaking team member leading discussions, involvement of multiple and key family members, and a chaplain who is a Catholic Priest. The analytic sample included 351 patients who were, on average, 72 years old. 54.42% were female, 59.54% were Hispanic, and of Hispanic patients, 47.37% spoke primarily Spanish. Culturally adapted consults resulted in higher rates of conversion to DNR status in palliative cases of the target population. Both primary language and ethnicity were associated with likelihood of change from full code to DNR status, such that Spanish speakers and those of Hispanic ethnicity were more likely to switch to DNR than non-Hispanics and English-Speakers. This study illustrates how culturally adapted palliative care consultations can help reduce barriers and improve end-of-life decision-making, and can be applied with similar populations of seriously ill Hispanic patients.

Exploring the status of and demand for palliative day-care clinics and day hospices in Germany: a protocol for a mixed-methods study

BackgroundTo date, the establishment and development of palliative day-care clinics and day hospices in Germany have been completely unsystematic. Research is needed to gain insight into these services and to ensure their accessibility and quality. Accordingly, the ABPATITE research project aims at: (1) identifying the characteristics of palliative day-care clinics and day hospices in Germany, (2) determining demand and preferences for these services, and (3) proposing recommendations (with expert agreement) for the needs-based establishment and development of these services.MethodsThe research is a multi-perspective, prospective, observational study following a mixed-methods approach across three study phases. In phase 1a, qualitative expert interviews will be conducted to capture the facility-related characteristics of palliative day-care clinics and day hospices in Germany; the results will feed into a questionnaire sent to all such institutions identified nationwide. In phase 1b, a questionnaire will be sent to local statutory health insurance providers, to gain insight into their contracts and accounting and remuneration models. In phase 2a, a service preference survey will be conducted with patients and family caregivers. In phase 2b, semi-structured interviews with management staff will explore the factors that promote and hinder the provision of service. In phase 2c, the external perspective will be surveyed via focus groups with local actors involved in hospice and palliative care. In phase 3a, focus groups with representatives from relevant areas will be conducted to develop recommendations. Finally, in phase 3b, recommendations will be agreed upon through a Delphi survey.DiscussionThe empirically developed recommendations should enable the establishment and development of day hospices and palliative day-care clinics in Germany to be better managed, more oriented to actual demand, and more effectively integrated into wider health care services. Importantly, the findings are expected to optimize the overall development of hospice and palliative care services.Trial registration:The study was prospectively registered in the German Clinical Trials Register (Deutsches Register Klinischer Studien) (Registration N° DRKS00021446; date of registration: April 20, 2020). The study is searchable under the International Clinical Trials Registry Platform Search Portal of the World Health Organization, under the German Clinical Trials Register number.

Increasing Awareness of Palliative Medicine With the Emergency Department: A Quality Improvement Project.

Palliative medicine can be essential in helping to align patients' goals of care with their treatment team. Referrals for palliative medicine are more advantageous when initiated in the emergency department as this is the first point of contact for seriously ill patients being admitted to the hospital. This paper highlights a quality improvement project initiated to address knowledge gaps in palliative medicine with emergency department (ED) staff and to increase referrals for palliative medicine from the ED. The palliative medicine staff held an in-service training with the ED staff which focused on defining palliative medicine and the importance of early consults when the patient presents in the ED. Palliative medicine staff also highlighted the differences between palliative medicine and hospice care, when and how to initiate a consult for palliative medicine, as well as how to contact the palliative medicine division. The results showed that after this educational intervention the number of palliative medicine consults increased three-fold. Before the educational intervention, monthly averages for palliative medicine were 6 and after rose to 18.9 per month.

Intensity of end-of-life health care and mortality after systemic anti-cancer treatment in patients with advanced lung cancer

BackgroundWe aimed to study the mortality and intensity of health care in patients with advanced lung cancer who received systemic anti-cancer treatment (SACT) compared with patients who were not eligible for SACT (no-SACT).MethodsA retrospective cohort of patients with lung cancer, who were treated at the North Estonia Medical Centre from 2015 to 2017, was linked to population-based health care data from the Estonian Health Insurance Fund. We calculated 14- and 30-day mortality after SACT and used a composite measure of intensity of care, comprised from the following: emergency department visit, admission to hospital, admission to intensive care unit, receipt of radiotherapy or systemic treatment.ResultsThe median overall survival (OS) of patients who received at least one cycle of SACT (n = 489) was 9.1 months and in patients with no-SACT (n = 289) 1.3 months (hazard ratio [HR] = 4.23, 95% CI = 3.60–5.00). During the final 30 days of life, intensive EOL care was received by 69.9% of the SACT patients and 43.7% of the no-SACT patients. Intensive EOL care in the last 30 days of life is more probable among patients in the SACT group (odds ratio [OR] = 3.58, 95% CI = 2.54–5.04, p < 0.001), especially in those with a stage IV disease (OR = 1.89, 95% CI = 1.31–2.71, p = 0.001). In the SACT group 6.7 and 14.7% of patients died within 14 days and 30 days after the last cycle, respectively.ConclusionsSignificant proportion of patients with advanced lung cancer continue to receive intensive care near death. Our results reflect current patterns of EOL care for patients with lung cancer in Estonia. Availability of palliative care and hospice services must be increased to improve resource use and patient-oriented care.

Chaplaincy Care in the MICU: Examining the Association Between Spiritual Care and End-of-Life Outcomes.

Seriously ill patients admitted to the Intensive Care Unit (ICU) experience severe spiritual and existential distress. Patients' surrogate decision makers face the burden of making complex decisions about their loved ones' care. Experienced chaplains may play a role in assisting with decision-making, possibly by aligning patients' values and wishes with treatment plans and avoiding non-beneficial aggressive measures. To identify associations between chaplaincy care and length of stay (LOS) in the medical ICU (MICU). This was a retrospective observational study of usual spiritual care in the adult MICUs of 4 medical centers in the United States over a 3-month period. Inclusion criteria were death in the MICU or discharge to palliative care or hospice. Measures included medical, treatment, and spiritual care information. Through bivariate and multivariable analyses associations between spiritual care and LOS were examined. In multivariable analysis of the 254 patients, receiving spiritual care was associated with an increased likelihood of being in a higher LOS tertile (adjusted odds ratio = 2.94, p < .001). In post hoc bivariate analysis, cases receiving spiritual care within the first 48 hours of MICU admission revealed a trend toward lower LOS (p = .181). Spiritual care in the MICU was associated with longer LOS. Early intervention by chaplains who are well-integrated in the ICU may assist patients and their loved ones in coming to terms with grave illness and making difficult treatment decisions. Further well-designed studies of spiritual care interventions that may affect outcomes are needed.

Protecting Patient Goals in Palliative Care and Hospice

Palliative care and hospice, while distinct programs, are quite often given to the same individuals. The complexities of achieving goal-oriented care often lead to utilitarian ethics in health care, particularly as societal respect for human life and dignity weakens. This article examines these complexities with a particular emphasis on ensuring personalized care from physicians who know the goals of the patient.

Educating Internal Medicine Residents on Palliative Medicine and Hospice Care at a Community Teaching Hospital.

The Accreditation Council of Graduate Medical Education (ACGME) currently requires Internal Medicine (IM) GME programs to incorporate educational opportunities for training and structured experiences in Palliative and Hospice Medicine. Miscomprehension of the differences between palliative medicine and hospice care is a barrier for IM residents ordering palliative consults as many residents may underutilize palliative medicine if a patient is not appropriate for hospice. This educational performance improvement (PI) project assessed 3 domains, including Medical Knowledge (MK) of palliative versus hospice medicine at baseline and following a single didactic session. Additionally, the number of palliative consults ordered was used as a surrogate for interpersonal and communication skills (ICS) and patient care (PC) domains. An 8-question survey and 30-minute didactic session were created based upon experientially-determined issues most confusing to IM residents. Participants included 33 IM residents (PGY-1s-3 s) from July 2018 (first cohort) and 32 (PGY-1 s and any PGY-2s-3 s who did not participate in the first cohort) from July 2019 (second cohort). 65 of a possible 73 residents participated (89% response rate) Pre-test Questions 5, 6, and 8 correct responses were <50% in both cohorts with average scores, respectively, of 43.1%, 35.4%, and 40%. Residents improved on the post-test for Q5, 6, 8 to, respectively, 80%, 86.7%, and 48.3% (t = 7.68, df = 59, p < 001). Correct Q1 responses declined in the first cohort, but clarification for the second cohort improved from pre-test (36.4%) to post-test (65.5%). The total number of palliative consults placed by IM residents increased as well. Baseline MK of palliative versus hospice medicine was <50% on 4/8 questions. A brief educational session significantly improved residents' short-term comprehension and increased the number of palliative consults.

Health care coach support in reducing acute care use in patients with cancer.

4 Background: Lay health workers (LHWs) who are trained to proactively discuss goals of care and assess patient symptoms have improved value-based cancer care among Veterans and a Medicare Advantage population. Little data exists regarding the effect of integrating LHWs into community oncology care among commercially insured populations. In this study, we implemented an LHW intervention to assist with goals of care and symptom management in collaboration with a private community oncology practice among patients with advanced cancer. This randomized controlled trial evaluates the effect of the intervention on acute care use and secondarily on goals of care documentation and patient satisfaction. Methods: Newly diagnosed patients with advanced stages of solid and hematologic malignancies were randomized from 8/11/2016 through 6/5/2019 into the intervention and control groups. All patients were followed for 12 months or death, whichever was first. Patients reported satisfaction with care using the Consumer Assessment of Healthcare Providers and Systems survey at time of enrollment and 9 months follow-up. We compared risk of death using Cox Models and compared rates of acute care, palliative care and hospice use using generalized models adjusted for length of follow-up. Results: A total of 104 patients were randomized with 52 in the intervention and 52 in the control. In both groups, the mean age was 67 years; 70% were non-Hispanic white, 25% Asian Pacific Islander, 1% Native Hawaiian, 1% American Indian/Alaskan Native, 3% multiple races/ethnicities. There were no differences in cancer diagnoses or stages. There were no differences in rates of survival between the two groups. Intervention patients as compared to the control had lower mean emergency department visits (0.80 +/- 0.17 versus 1.9 +/- 0.46, p = 0.02) and hospitalizations (0.67 +/- 0.19 versus 1.49 +/- 0.37, p = 0.04), greater rates of goals of care documentation (92% versus 33% p = 0.002) and no differences in palliative care (88% versus 77% p = 0.16) or hospice use (27% versus 21% p = 0.45). At 9 months follow-up as compared to baseline, patients in the intervention experienced greater improvements in satisfaction with their care (difference-in-difference: 0.41, 95% CI 0.22-0.60, p &lt; 0.001). Conclusions: An LHW intervention significantly reduced acute care use and improved patient experiences with cancer care as compared to a control group. This intervention may be a solution to improve care delivery and experiences for patients after a diagnosis of cancer in community oncology settings. Clinical trial information: NCT03154190 .

Abstract WP364: Utilization of End-of-Life Care Services in Stroke Patients Across a Large Health System

Background: Patients presenting to hospitals with devastating strokes have high mortality rates (a national quality metric) and significant needs for end-of-life (EOL) care including palliative care (PC) and hospice services. Appropriate utilization of PC/hospice services across a health system can improve timeliness of care delivery and inpatient mortality rates. Our hospital system consists of 11 hospitals; 1 tertiary academic center (TAC)/comprehensive stroke center (CSC) and 10 community hospitals of which 3 are CSCs and 5 are primary stroke centers. In-house hospice is based in a community CSC and not the TAC. We investigated mortality, early death, and PC/hospice utilization to understand whether EOL services are effectively used across our system. Methods: Stroke patients (by DRG) and EOL utilization (defined by PC/hospice ICD 10 codes or MD specialty) were identified from January-December 2018. The TAC data were compared to the combined data of the other 10 system hospitals. Outcomes include EOL utilization, PC/Hospice utilization rates, and early deaths (deaths within 48 hours of admission). Chi-square was used to analyze categorical variables. Significance level was set at p&lt;0.05. Analyses were performed using SAS 9.4 Results: Total stroke volume was 4,062: 1228 presented to the TAC and 2,834 to the 10 other system hospitals. The TAC and system mortality is 12% and 6% respectively. The EOL utilization rate at the TAC (19%) is significantly higher (p&lt;0.0001) than across the system (8%). PC utilization (TAC 18% vs system 6%, p&lt;0.0001) and hospice utilization (TAC 7% vs system 4%, p=0.0009) are significantly higher at the TAC. At the EOL, the TAC (37%) had significantly fewer (p=0.0004) patients with hospice involvement compared to the system (53%). Early deaths occurred significantly more (p&lt;0.0001) at the TAC (7%) than across the system (2%). Conclusions: Stroke mortality and EOL needs are concentrated at our TAC while hospice care is based at and more utilized in the community hospitals. Our data supports implementing a hospice service at the TAC to enhance PC delivery for high mortality stroke volume and developing an EOL Stroke Pathway to standardize care delivery.

A Guide to Palliative Care and Hospice

Palliative care and hospice can be confusing subjects. Many people misunderstand the meaning of both and often consider the two terms synonymous. There are, however, important differences between palliative care and hospice. Palliative care is designed to anticipate, prevent, and manage physical, psychological, social, and spiritual suffering. It is primarily concerned with the symptoms that result from an illness or from the interventions used to treat said illness. It includes both the terminally ill and those with chronic, life-limiting conditions. Hospice is a type of palliative care provided to individuals with a life expectancy of six months or less. Patients are generally admitted to hospice when their condition no longer responds to aggressive interventions or they have chosen to discontinue medical intervention for ethically appropriate reasons. It is necessary to approach enrolling in hospice with caution, and important questions must be considered before doing so.

Palliative Care, Hospice, and Physical Therapy: Where Have We Been? Where Are We Now? Where Are We Going?

Palliative Care, Hospice, and Physical Therapy: Where Have We Been? Where Are We Now? Where Are We Going?