Patients Receiving Hospice Care Research Articles

Peak Experiences: Lessons Learned from a Feasibility Study of Psilocybin-assisted Therapy for Demoralization in Patients Receiving Hospice Care

Peak Experiences: Lessons Learned from a Feasibility Study of Psilocybin-assisted Therapy for Demoralization in Patients Receiving Hospice Care

Changes in Diagnoses and Site of Care for Patients Receiving Hospice Care From Agencies Acquired by Private Equity Firms and Publicly Traded Companies

Private equity firms and publicly traded companies have been acquiring US hospice agencies; an estimated 16% of US hospice agencies are owned by private equity (PE) firms or publicly traded companies (PTC). To examine the association of PE and PTC acquisitions of hospices with Medicare patients' site of care and clinical diagnoses. This cohort study of US hospice agencies used a novel national database of acquisitions merged with the Medicare Post-Acute Care and Hospice Public Use File for 2013 to 2020. Changes in sites of care and patient characteristics for hospice agencies acquired by PE or PTCs were compared with changes for patients in nonacquired for-profit hospice agencies. Private equity and publicly traded company acquisitions. This study used a difference-in-differences approach within an event-study framework to examine the association of PE and PTC acquisitions of hospice agencies with changes in patient diagnoses and sites of care. Dependent variables were annual hospice-level measures of the Hierarchical Condition Category (HCC) score and proportion of patients diagnosed with cancer or dementia. Sites of care included the proportion of patients receiving hospice care in their personal home, nursing home, or assisted living facility. A total of 158 hospice agencies acquired by PEs, 250 acquired by PTCs, and 1559 other for-profit hospice agencies were included. Preacquisition, hospice agencies that would later be acquired by PE or PTC served a mean (IQR) 30.1% (12.0%-44.0%) and 29.4% (13.0%-43.0%) of their patients in nursing homes respectively, a greater proportion compared with the 27.1% (8.0%-43.8%) served by for-profit hospices that were never acquired. Agencies acquired by PE between 2014 and 2019 saw a significant relative increase of 5.98% in dementia patients (1.38 percentage points; 95% CI, 0.35-2.40 percentage points; P = .008). In PTC-owned hospices, the proportion of patients receiving care at home increased by 5.26% (2.98 percentage points; 95% CI, 1.46-4.51 percentage points; P < .001), the proportion of dementia patients rose by 13.49% (3.11 percentage points; 95% CI, 2.14-4.09 percentage points; P < .001), and the HCC score decreased by 1.37% (-3.19 percentage points; 95% CI, -5.92 to -0.47 percentage points; P = .02). These findings suggest that PE and PTCs select patients and sites of care to maximize profits.

Exploring Audio Recording in Terminally Ill Patients Receiving Hospice Care: "Stories for Life Charity" Model.

Stories for Life is a UK charity that provides a free and confidential service for terminally ill patients to audio record their "life story." Patients are given a copy of the recording and, if they wish, can then pass a copy on to their family/friends. This study explored how a group of terminally ill patients, receiving hospice care, experienced the process of making a voice recording of their biographies. Interviews were conducted with 5 terminally ill patients and 1 family member. Study participants found that talking to a trained volunteer provided a neutral, nonjudgmental interviewer. Patients reported a feeling of catharsis while telling their story as well as being able to reflect on significant life events. However, it was challenging to convey difficult emotions while also being mindful of protecting family who may listen to the recording. Although there was some uncertainty about how the recording would be perceived by listeners, leaving a voice-recorded life account was felt to be beneficial for immediate family members, as well as maintaining a meaningful connection with future generations. Overall, recording an audio biography in terminal illness can allow patients a space for reflection and a meaningful connection with their families.

Enhanced Communication through Virtual Interdisciplinary Team Rounds for Pediatric Patients Receiving Hospice Care in Outlying Communities

Enhanced Communication through Virtual Interdisciplinary Team Rounds for Pediatric Patients Receiving Hospice Care in Outlying Communities

Enhanced Communication through Virtual Interdisciplinary Team Rounds for Pediatric Patients Receiving Hospice Care in Outlying Communities (FR408B)

•List three ways that virtual palliative care rounds may benefit community-based providers.•List three areas in which virtual palliative care rounds may be applied in metropolitan and rural regions. Providing hospice/palliative care (HPM) for children in the community is challenging due to limited numbers of experienced clinicians outside of medical centers. In rural areas, pediatric HPM is almost non-existent, although adult providers attempt to care for children referred to them. Telehealth has been used effectively for patient follow up. Our goal is to extend the reach of existing pediatric HPM clinicians to provide team oversight and consultation to adult organizations providing pediatric HPM care in outlying locations. Virtual Pediatric Consultative Rounds (VPCR) were developed with a large community-based adult HPM partner with nine regional offices. Each regional office typically cares for 1-5 children. A rounding sheet was developed to collate clinical information to enhance efficiency of VPCR sessions. VPCR sessions utilizing Skype for Business (HIPPAA compliant) were scheduled every other week for two hours beginning in July 2018. The hospital-based pediatric HPM team and the community-based coordinators were on-line as each nurse presented medical/psychosocial issues, medication reconciliation, code status, hospital/ED visits, follow-ups and goals. 5-10 minutes per patient was allotted including a short dialog/Q&A. Patient records were updated for both institutions and changes noted. An online survey was developed to assess the nurses' experiences with the VPCR process ranging from 1(strongly disagree) to 5 (strongly agree). Nine pediatric nurses participated in the VPCR initiative and seven completed the survey. Most nurses used a corporate cellphone for reporting; whereas, two used laptops with televideo when able. After an initial learning curve for logins, participants found the technological interface acceptable with good-to-excellent audio and video quality. –VPCR participation: (Likert 1-5) –Allowed better patient care: 3.86 –Facilitated better care coordination: 4.0 –Improved communication w/ family: 3.86 –Reduced ER visits/hospitalization: 2.57 –Enhanced dialog with referring MD: 4.29 –Improved understanding of MD's plan: 3.71 VPCR improves communication between referring hospitals and community providers, facilitates problem solving and a sense of professionalism.

Effect of hospice care on health-care costs for Taiwanese patients with cancer during their last month of life in 2004-2011: A trend analysis.

Objective:End-of-life cancer care imposes a heavy financial burden on patients, their families, and their health insurers. The aim of this study was to explore the 8-year (2004–2011) trends in health-care costs for Taiwanese cancer decedents in their last month of life and, specifically, to assess the association of these trends with hospice care.Materials and Methods:We conducted a population-based longitudinal study and analyzed data from Taiwan's National Health Insurance Research Database. The data consisted of not only claims information – costs of hospitalization and outpatient department visits – but also the associated patient characteristics, catastrophic illness status, hospice patient designation, and insurance system exit date (the proxy for death).Results:A total of 11,104 cancer decedents were enrolled, and 2144 (19.3%) of these patients received hospice care. The rate of hospice service use increased from 14.9% to 21.5% over 8 years. From 2004 to 2011, the mean health-care cost per day in the last month of life increased 8.2% (from US$93 ± $108 in 2004 to US$101 ± $110 in 2011; P = 0001). We compared three groups of patients who received hospice care for more than 1 month (long-H group), received hospice care for 30 days or less (short-H group), and did not receive hospice care (non-H group). Compared to non-H group, long-H group had a significantly lower mean health-care cost per day during their last month of life (US$85.7 ± 57.3 vs. US$102.4 ± 120) (P < 0001). Furthermore, compared to short-H and non-H groups, patients in the long-H group had lower probabilities of receiving chemotherapy and visiting the emergency department more than once. They also incurred lower health-care costs (US$77.1 ± 58.1 vs. US$92.2 ± 56.0 for short-H group and US$102.4 ± 120 for non-H group) (P < 0001).Conclusion:Health-care costs in the last month of life are increasing over time in Taiwan. Nonetheless, health-care costs for patients receiving hospice can be as much as 16.3% lower than patients not receiving hospice care. Patients receiving hospice care for more than 30 days also had lower health-care costs than those receiving care for <30 days.

Evaluation of Medication-Related QTc Prolongation Risks in Patients Receiving Hospice Care (QI727)

1.Characterize the use of QTc prolonging medications in hospice patients.2.Recall the average QTc prolonging medication burden is hospice patients. Medications commonly used for symptom management in the hospice population are linked with QTc interval prolongation, which may lead to torsades de pointes. Safety risk of QTc-prolonging medications in this population may be underestimated. To develop a risk assessment scoring tool for QTc prolongation in hospice patients. A retrospective chart review of a national hospice pharmacy provider was completed. Decedents with a cardiac-related primary hospice diagnosis and medication claims profiled during between January 1, 2018 and March 31, 2018 were included. Age, sex, and medications profiled were also collected. Charts of decedent’s age ≥ 65 years were reviewed for medications with a known or possible risk of QTc interval prolongation. Independent patient risk factors and profiled medications, based on CredibleMeds.org categories of QTc interval prolongation risk, were scored using a modified RISQ-PATH tool. Independent patient risk factors were also scored. A total of 16,501 decedents were reviewed with an average age of 87 years. The population is 56.6% (n=9,343) female. This subset of patients scored 9 on RISQ-PATH based on independent risk facts alone. Percentage of patients with QTc-prolonging drugs was 28.8% with 10.3% of the population on a drug that CredibleMeds.org ranks as known risk of torsades. Additionally, 6.9% of patients were prescribed diuretics. After the initial review of population data, additional statistical analysis is in progress for final risk assessment tool development. Results of this analysis will be incorporated in final presentation. Our population review illustrates utilization of medications with QTc prolongation risk in a patients with several independent risk factors already present. Evaluating patient risk for QTc interval prolongation will help prioritize significance of drug-drug interactions and inform our discussions with interdisciplinary teams about the risk vs benefits of these medications for symptom management.

P123 Continuous Inotrope Therapy for Heart Failure Patients Receiving Hospice Care: A Case Series

P123 Continuous Inotrope Therapy for Heart Failure Patients Receiving Hospice Care: A Case Series

The Effects of a Single Session of Music Therapy on the Agitated Behaviors of Patients Receiving Hospice Care.

Research suggests that agitation is a common symptom for hospice patients, but while studies have examined the outcomes of music therapy on the agitated behaviors of patients in other settings, none have addressed this symptom in patients with terminal illnesses. The study objective was to determine whether a single session of music therapy provided by a board certified music therapist and using the entrainment principle would decrease agitation in hospice patients. This pilot study was a single-blind, pretest/posttest design. Music therapists used the principle of entrainment with live music during the treatment session. Subjects included in the study were 77 patients at a large hospice in south Florida with documented agitation. Agitation was measured using the Overt Agitation Severity Scale (OASS) for 5 minutes prior to and 5 minutes following a 20 minute music therapy intervention. Results from 73 participants were analyzed with a mean difference of -5.77 points from pretest to posttest. Results indicating a decrease in agitation were statistically significant (p < 0.001) for the entire sample. Age, gender, location, and diagnosis were found to have no significant effects on the results. Results indicate that a single session of music therapy using the entrainment principle may be an effective treatment for hospice patients experiencing agitation.

Music Therapy Is Associated With Family Perception of More Spiritual Support and Decreased Breathing Problems in Cancer Patients Receiving Hospice Care

ContextMusic therapy is a common discretionary service offered within hospice; however, there are critical gaps in understanding the effects of music therapy on hospice quality indicators, such as family satisfaction with care. ObjectivesThe purpose of this study was to examine whether music therapy affected family perception of patients' symptoms and family satisfaction with hospice care. MethodsThis was a retrospective, cross-sectional analysis of electronic medical records from 10,534 cancer patients cared for between 2006 and 2010 by a large national hospice. Logistic regression was used to estimate the effect of music therapy using propensity scores to adjust for non-random assignment. ResultsOverall, those receiving music therapy had higher odds of being female, having longer lengths of stay, and receiving more services other than music therapy, and lower odds of being married/partnered or receiving home care. Family satisfaction data were available for 1495 (14%) and were more likely available if the patient received music therapy (16% vs. 12%, P < 0.01). There were no differences in patient pain, anxiety, or overall satisfaction with care between those receiving music therapy vs. those not. Patients who received music therapy were more likely to report discussions about spirituality (odds ratio [OR] = 1.59, P = 0.01), had marginally less trouble breathing (OR = 0.77, P = 0.06), and were marginally more likely to receive the right amount of spiritual support (OR = 1.59, P = 0.06). ConclusionMusic therapy was associated with perceptions of meaningful spiritual support and less trouble breathing. The results provide preliminary data for a prospective trial to optimize music therapy interventions for integration into clinical practice.

Factors Associated with the Hospitalization of Patients Receiving Hospice Care (TH317-B)

Objectives Understand the prevalence of hospitalization, ED visits, and ICU stays of Medicare beneficiaries who use hospice. Understand the patient-level and hospice-level factors associated with hospitalization, ED visits, and ICU stays of Medicare beneficiaries who use hospice. Original Research Background: There is a growing body of evidence indicating that outcomes related to hospital utilization, including

Ketamine for the Treatment of Depression in Patients Receiving Hospice Care: A Retrospective Medical Record Review of Thirty-One Cases

Depression is prevalent in patients receiving hospice care. Standard antidepressant medications do not work rapidly enough in this setting. Evidence suggests that ketamine rapidly treats treatment refractory depression in the general population. Ketamine׳s role for treating depression in the hospice population warrants further study. A retrospective medical record review of 31 inpatients receiving hospice care who received ketamine for depression on a clinical basis was conducted. The primary outcome measure was the Clinical Global Impression Scale, which was used retrospectively to rate subjects׳ therapeutic improvement, global improvement, and side effects from ketamine over 21 days. Additionally, time to onset of therapeutic effect was analyzed. Using the Clinical Global Impression Scale, ketamine was found to be significantly therapeutically effective through the first week after ketamine dosing (p < 0.05), with 93% of patients showing positive results for days 0-3 and 80% for days 4-7 following ketamine dosing. Patients experienced global improvement during all 4 studied time periods following ketamine dosing (p < 0.05). Significantly more patients had either no side effects or side effects that did not significantly impair functioning at each of the 4 assessed time periods following ketamine dosing (p < 0.05). Additionally, significantly more patients experienced their first therapeutic response during days 0-1 following ketamine dosing (p < 0.001) than during any other time period. These data suggest that ketamine may be a safe, effective, and rapid treatment for clinical depression in patients receiving hospice care. Blinded, randomized, and controlled trials are required to substantiate these findings and support further clinical use of this medication in hospice settings.

A Retrospective Chart Review of the Efficacy of Ketamine for Depression in Patients Receiving Hospice Care (FR416-A)

1.Understand the importance of treating depression in patients receiving hospice care.2.Understand why standard antidepressants are not adequate for this patient population.3.Understand the efficacy and tolerability of ketamine for the treatment of depression in inpatients receiving hospice care. Depression is highly prevalent in patients receiving hospice care and untreated depression is associated with poor outcomes. Standard antidepressant medications often do not work rapidly enough for patients receiving hospice care. A growing body of literature suggests ketamine may rapidly treat “treatment refractory depression” in the general population. However, ketamine's role in treating depression in the hospice population is not well understood. A retrospective chart review of inpatients receiving hospice care who received ketamine for treatment of their depression was conducted to examine efficacy, time to efficacy, and tolerability of ketamine for treatment of depression. 31 patients' charts were reviewed and evaluated for severity of depression, global improvement, therapeutic effect, side effects, and efficacy of treatment based on the Clinical Global Impression Scale (CGI). Time to onset of therapeutic effect, maximal effect and side effects were also documented. CGI scores from days 1, 3, 7, and 14-21 days post-ketamine dosing were compared by Chi-squared analyses. Chi-squared analyses were also utilized to compare both time to first therapeutic effect and maximum effect between different time points post-ketamine dosing. Significantly more patients experienced their first therapeutic response (χ2 = 25.5, df = 4, p < 0.001) and maximal response (χ2 = 14.5, df = 7, p = 0.043) to ketamine day 1 post-ketamine dosing. Additionally, significantly more patients had a marked therapeutic response (p < .011), rather than unchanged, minimal, or moderate therapeutic response, to ketamine days 1 and 3 post-ketamine dosing. Significantly more patients were rated as having no side effects (p < .002) compared to those having minimal, moderate, marked, or severe side effects. This data suggests that for depressed patients receiving inpatient hospice care, ketamine is well tolerated and has a rapid onset of action and is safe and efficacious.

Undetected Cognitive Impairment and Decision-Making Capacity in Patients Receiving Hospice Care

: Cognitive dysfunction is common in patients with advanced, life-threatening illness and can be attributed to a variety of factors (e.g., advanced age, opiate medication). Such dysfunction likely affects decisional capacity, which is a crucial consideration as the end-of-life approaches and patients face multiple choices regarding treatment, family, and estate planning. This study examined the prevalence of cognitive impairment and its impact on decision-making abilities among hospice patients with neither a chart diagnosis of a cognitive disorder nor clinically apparent cognitive impairment (e.g., delirium, unresponsiveness). : A total of 110 participants receiving hospice services completed a 1-hour neuropsychological battery, a measure of decisional capacity, and accompanying interviews. : In general, participants were mildly impaired on measures of verbal learning, verbal memory, and verbal fluency; 54% of the sample was classified as having significant, previously undetected cognitive impairment. These individuals performed significantly worse than the other participants on all neuropsychological and decisional capacity measures, with effect sizes ranging from medium to very large (0.43-2.70). A number of verbal abilities as well as global cognitive functioning significantly predicted decision-making capacity. : Despite an absence of documented or clinically obvious impairment, more than half of the sample had significant cognitive impairments. Assessment of cognition in hospice patients is warranted, including assessment of verbal abilities that may interfere with understanding or reasoning related to treatment decisions. Identification of patients at risk for impaired cognition and decision making may lead to effective interventions to improve decision making and honor the wishes of patients and families.

Oral Conditions in Cancer Patients Receiving Hospice Care

Objectives. Cancer patients at the end of life are suffering with advanced disease, at which time the focus of care is on quality of life. Oral health plays an essential role by contributing to symptom management, social interaction, and nutritional intake. The purpose of this study was to characterize the presence, severity, and functional impact of oral health conditions in advanced cancer patients in hospice care.

Treatment of Resistant Depression in Patients with Cancer with Low Doses of Ketamine and Desipramine

Journal of Palliative MedicineVol. 13, No. 3 Letters to the EditorTreatment of Resistant Depression in Patients with Cancer with Low Doses of Ketamine and DesipramineDuraiyah Thangathurai, Jay Roby, and Peter RoffeyDuraiyah ThangathuraiSearch for more papers by this author, Jay RobySearch for more papers by this author, and Peter RoffeySearch for more papers by this authorPublished Online:23 Feb 2010https://doi.org/10.1089/jpm.2009.0312AboutSectionsView articleView Full TextPDF/EPUB ToolsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Treatment of Resistant Depression in Patients with Cancer with Low Doses of Ketamine and Desipramine." , 13(3), p. 235FiguresReferencesRelatedDetailsCited BySingle Subcutaneous Ketamine Dose Followed by Oral Ketamine for Depression Symptoms in Hospice Patients: A Case Series13 April 2021 | Journal of Pain & Palliative Care Pharmacotherapy, Vol. 35, No. 2Substance Use Disorders in Pregnancy and Lactation26 May 2021The Efficacy of Ketamine in the Palliative Care Setting: A Comprehensive Review of the Literature Nathaniel Goldman, Michael Frankenthaler, and Lidia Klepacz3 September 2019 | Journal of Palliative Medicine, Vol. 22, No. 9Psychiatric, behavioral, and cognitive disorders in patients with extracranial cancers23 July 2018 | CNS Spectrums, Vol. 23, No. 6A research study review of effectiveness of treatments for psychiatric conditions common to end-stage cancer patients: needs assessment for future research and an impassioned plea3 April 2018 | BMC Psychiatry, Vol. 18, No. 1Benzodiazepine use, misuse, and abuse: A reviewMental Health Clinician, Vol. 6, No. 3Dopamine D2/D3 but not dopamine D1 receptors are involved in the rapid antidepressant-like effects of ketamine in the forced swim testBehavioural Brain Research, Vol. 279The activation of adenosine monophosphate-activated protein kinase in rat hippocampus contributes to the rapid antidepressant effect of ketamineBehavioural Brain Research, Vol. 253Daily Oral Ketamine for the Treatment of Depression and Anxiety in Patients Receiving Hospice Care: A 28-Day Open-Label Proof-of-Concept Trial Scott A. Irwin, Alana Iglewicz, Richard A. Nelesen, Jessica Y. Lo, Connie H. Carr, Sheilani D. Romero, and Linda S. Lloyd22 July 2013 | Journal of Palliative Medicine, Vol. 16, No. 8Rapid-Acting Glutamatergic Antidepressants: The Path to Ketamine and BeyondBiological Psychiatry, Vol. 73, No. 12Glutamatergic antidepressants27 June 2012Be Prudent of Ketamine in Treating Resistant Depression in Patients with Cancer Chun Yang, Zhi-qiang Zhou, and Jian-jun Yang19 May 2011 | Journal of Palliative Medicine, Vol. 14, No. 5 Volume 13Issue 3Mar 2010 InformationCopyright 2010, Mary Ann Liebert, Inc.To cite this article:Duraiyah Thangathurai, Jay Roby, and Peter Roffey.Treatment of Resistant Depression in Patients with Cancer with Low Doses of Ketamine and Desipramine.Journal of Palliative Medicine.Mar 2010.235-235.http://doi.org/10.1089/jpm.2009.0312Published in Volume: 13 Issue 3: February 23, 2010PDF download

Portraits of Caregivers of End-Stage Dementia Patients Receiving Hospice Care

The purpose of this study was to investigate how caregivers respond to the end stages of dementia with the assistance from hospice. Data were collected from 27 family caregivers over the course of 10 months, with each caregiver being interviewed up to 4 times during the time that the patient received hospice care. Chart review data were also collected. Four distinct caregiver portraits emerged: (a) disengaged, (b) questioning, (c) all-consumed, and (d) reconciled. Caregivers in each portrait differed in how they responded to the impending death of the care recipient, the disease progression, and hospice care. Recognizing the differences in the ways that caregivers respond to the final stages of the disease will assist hospice and other providers in best meeting the needs of the caregivers.

Characteristics of Patients Receiving Hospice Care at Home Versus in Nursing Homes: Results From the National Home and Hospice Care Survey and the National Nursing Home Survey

This study examined 1170 deceased home hospice patients from the 1998 National Home and Hospice Care Survey and 617 deceased nursing home hospice patients from the 1997 and 1999 National Nursing Home Surveys. T tests and Bonferroni adjustments for multiple comparisons were performed to assess differences in characteristics of patients receiving hospice care at home versus in nursing homes. We found that the nursing home hospice population differs significantly from the home hospice population in the United States. Nursing home hospice patients were more likely to be older, have Medicaid as their primary payment source, have dementia and other noncancer primary diagnosis, and receive dietary/nutrition service, medication management, and physician services than home hospice patients.

Providing care at the end of life: do Medicare rules impede good care?

Providing care at the end of life: do Medicare rules impede good care?