Approaching Death Improving Care at the End of Life (1997) / Chapter Skim
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Appendix C
Appendix C
Pages 327-357
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From page 327... ...
Alliance for Aging Research Health Care Costs of the Elderly, Terminally Ill Contact: Daniel Perry, Executive Director 2021 K Street, NW, Suite 305 Washington, DC 20006 202-293-2856 Research reveals that physician and hospital costs for people in their 80s and 90s are lower than for younger groups. Aggressive technological interventions are more likely to go to people with good functional status and prospects for recovery rather than to older terminally ill people.
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From page 328... ...
To improve the care of terminally ill patients, the Academy is developing a 20-hour curriculum entitled Physician Hospice/Palliative Care Training that promotes physician competence in end-of-life care. The curriculum consists of a series of integrated, clinically-oriented, self-contained, self-instructional modules called UNIPACs that apply adult learning theories and practices to end-of-life care.
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From page 329... ...
The ABHPM has developed a palliative care certification program that includes requirements for licensure, medical specialty certification, clinical and interdisciplinary care experience, and active care of at least 50 terminally ill patients in the last three years. The first certification examination was offered in November 1996.
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From page 330... ...
Over 30,000 copies of the resource documents have been distributed to training programs, hospices, and nursing homes and at national meetings of various medical organizations. Other products of the project include a set of educational objectives, slide packet, and collection of reprints all designed for use in educational programs.
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From page 331... ...
This program, along with parallel activities already under way at the AMA, will secure endorsement for end-of-life care skills among the leaders and role models in medicine. This program seeks to educate physicians throughout the country in the practicalities of discussion and completing advance care planning, and in the goals and interdisciplinary clinical skills of palliative care.
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From page 332... ...
The final objective of the anthropological findings of this project will be to suggest future policies and training guidelines for procurement professionals. Baystate Medical Center Dialysis Discontinuation: The Decision to Die and the Quality of Dying Contact: Lewis M
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From page 333... ...
It hopes to minimize poor communication, litigation, and media exposure that can drain and polarize parties. The pilot project offers two phases to supplement existing ethics committees: mediation and medical review panels.
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From page 334... ...
Associate Professor Community and Family Medicine Dartmouth College 7927 Strasenburgh Hanover, NH 03755 603-650-1 53 8 A multi-method, cross-disciplinary analysis will be developed to understand more about the dying experience of seriously ill adults through analyzing patient and family reports of severe pain and developing descriptive models of "good" and "bad" dying experiences from the viewpoints of the patient and family. Some of the uniquely detailed database and innovative methods to be used will be from an already successfully developed pain intervention database titled, "the Study to Understand Prognoses and Outcomes of Risks of Treatments" (SUPPORT)
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From page 335... ...
They believe that an adequate examination of the morality of assisted suicide and euthanasia requires exploring a whole set of moral and social questions about appropriate and compassionate care near the end of life." Science has brought tremendous force to bear on the lengthening of life by all possible means in the form of technological advancement. This sometimes leads to a lingering and painful death for loved ones, which has prompted forceful debate about the acceptability of assisted suicide and euthanasia.
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From page 336... ...
Invited experts and other panelists engage in a Socratic dialogue to "confront what they would do in complicated situations where the 'right' choice is not clear." In April 1997, Before I Die: Medical Care and Personal Choices, funded by the Robert Wood Johnson Foundation, was broadcast nationally. The program's pane!
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From page 337... ...
The George Washington University Center to Improve Care of the Dying Contact: Joanne Lynn, M.D., Director 1001 22n~ Street, NW, Suite 820 Washington, DC 20037 202-467-2222 www.gwu.edu/~cicd The Center to Improve Care of the Dying is an interdisciplinary organization engaging in research, advocacy, and education to improve the care of dying patients and those suffering with severely disabling diseases. Center staff encourage the development and realignment of health care funding to engender effective care.
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From page 338... ...
program that can be disseminated widely through home care agencies to improve care for terminally ill patients and families. Over two years, a curriculum will be developed to test in five home care agencies that represent various models of home care delivery and provide care to culturally diverse populations.
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From page 339... ...
Organizations will provide implementation teams and resource support as well as evaluation and sharing of details of change processes and results. Areas for improvement include using palliative/supportive care; improving pain management; meeting the needs of families; improving communication among family and health professionals; reducing transitions at the end of life; decisionmaking about treatments; making advance planning work; identifying non-beneficial care; overcoming administrative/legal barriers to optimal care; educating and supporting professionals; promoting multidisciplinary care; and increasing community support for end-of-life care.
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From page 340... ...
The qualitative research will include focus groups consisting of staff and administrators as well as interviews with the family members of recently deceased nursing home residents. Medicare Rights Center Initiative for the Terminally Ill on Medicare Contact: Mary Ann Etiebet, Education Director Diane Archer, Executive Director Medicare Beneficiaries Defense Fund 1460 Broadway, 8th Floor New York, NY 10036-7393 212-869-3850 Lack of information about financing options for end-of-life care is a substantial barrier to quality care at the end of life.
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From page 341... ...
for payment for terminal care services delivered to hospitalized patients and all palliative care. This new code will validate and legitimize the practice of palliative medicine by hospital professionals on behalf of their dying patients, since a reimbursed activity is much more likely to be viewed as an appropriate function for doctors and hospitals.
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From page 342... ...
The promotion effort includes the development of inmate-staffed hospice volunteer programs, development of national prison hospice guidelines, and the creation of a national network for the exchange of information between hospices and prisons. The Neurologic Institute at Columbia-Presbyterian Medical Center Palliative Care Decisionmaking and Outcomes in Amyotrophic Lateral Sclerosis Contact: Lewis P
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From page 343... ...
quality improvement plan with a learnercentered educational program for nursing home physicians that improves the quality of end-of-life nursing home care.
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From page 344... ...
Paul's Hospital, Vancouver, British Columbia Development of programs to enhance patient care and physician awareness, based on the results of a study of the emotional, psychological, and spiritual issues surrounding the suffering experienced by people with terminal illnesses. Marcia Levetown, M.D.
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From page 345... ...
Tilden, R.N., D.N.Sc. Oregon Health Sciences University 3181 SW Sam Jackson Park Rd., L101 Portland, OR 97201-3098 503-494-4466 This study compares end-of-life care in the three major settings where death occurs in Oregon: acute care hospital, nursing homes, and home hospice.
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From page 346... ...
provider identification of barriers to compassionate care. The Center is also a locus of continuing medical education activities for the State of Oregon and convened the statewide Task Force to Improve the Care of Terminally Ill Oregonians described later in this appendix.
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From page 347... ...
Box 2316 Princeton, NT 08543-2316 609-452-8701 www.lastacts.org Responding to distressing findings from SUPPORT, the largest clinical study ever conducted with dying patients, a coalition of 72 prominent organizations was initiated to improve the quality of care for dying patients in the United States. Former First Lady Rosalynn Carter is the Honorary Chair of Last Acts, a collaboration initially supported by a grant from the Robert Wood Johnson Foundation.
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From page 348... ...
Likewise, all must be aware of the financial burdens often borne by patients and families. Five goals are identified for acute care facilities: develop treatment options responsive to the needs of dying or irreversibly ill patients and their families; identify patients at risk of inappropriate or unwanted medical treatment; improve communication among patients, families, physicians, other health care team members and health care settings to foster informed, timely and mutually satisfactory treatment decisions; assure that the patient/surrogate is the primary decisionmaker in choosing among appropriate treatment options; and support effective processes for preventing and resolving conflicts regarding treatment decisions that respect patient values and the professional integrity of health care providers.
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From page 349... ...
Guidelines will be developed from the research findings. Supportive Care of the Dying: A Coalition for Compassionate Care Contact: Alicia Super, B.S.N., R.N.
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From page 350... ...
is developing comprehensive supportive care delivery models for adaptation to any and all communities in the United States. These models will, initially, be implemented in Catholic health care communities; thereafter, assistance will be offered for implementation within the broader community.
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From page 351... ...
Health Law Section, Oregon State Bar Kaiser Permanente, Northwest Legacy Health System National Association of Oncology Social Workers Oncology Nursing Society, Mt. Hood Chapter Oregon Alliance of Senior anci Health Services Oregon Association for Home Care Oregon Association of Hospitals anci Health Systems Oregon Board of Meclical Examiners Oregon Board of Pharmacy Oregon Health Care Association Oregon Health Division Oregon Hospice Association Oregon Meclical Association
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From page 352... ...
o r g / i n i t i a t / i n i t i a t . h t m The United Hospital Fund's Hospital Palliative Care Initiative is a multiyear, multimillion dollar, 12-hospital research and demonstration initiative with goals to analyze and improve the quality of hospital care for persons near the end of life and to develop new hospital-based palliative care services in New York City hospitals.
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From page 353... ...
University of California San Diego A Comparison of Treatments Provided to Terminally Ill Patients in Managed Care and Fee-for-Service Settings Contact: Lawrence T Schneiderman, M.D.
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From page 354... ...
University of Pittsburgh Medical Center Evaluating Health Providers' Communication with the Terminally Ill Contact: Gary Fischer, M.D. Assistant Professor of Medicine Division of General Internal Medicine Montefiore University Hospital, Suite W933 200 Lothrop Street Pittsburgh, PA 15213-2582 412-692-4857 Over the last ten years, medical educators have identified deficiencies in the care of the terminally ill and developed interventions to correct the problems, yet it is difficult to know if these interventions are improving physicians' interactions with dying patients.
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From page 355... ...
Programs should be developed as a result of this study to overcome barriers to receiving hospice care and increase access for terminally ill patients in need of such care. University of Washington Assessing Physician Performance in End-of-Life Care Contact: Paul G
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From page 356... ...
Vermont Ethics Network City Center 89 Main Street Drawer 20 Montpelier, VT 05620 802-828-2909 The Vermont Ethics Network is a private, nonprofit educational organization consisting of professional and laypeople throughout Vermont who are interested in medical ethics, and who participate as volunteers in YEN's educational work. The mission is to promote public and professional awareness and understanding of ethical issues in modern health care, and to enhance decisionmaking based on values and principles on both personal and social levels.
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From page 357... ...
The George Whitmore Foundation, in collaboration with the Jacob Periow Hospice, will create a program of hospice care for the deaf at the end of life. A key component of this pilot program will be the collection of data from the deaf community about their experiences with end-stage illness.
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