Abstract:
OBJECTIVE:In advanced dementia, many difficult decisions may arise as the disease progresses, including whether to use feeding by tube. Several recent articles question the benefit of percutaneous endoscopic gastrostomy (PEG) tube placement in persons with advanced dementia. However, patients with advanced dementia are still referred for PEG tubes. This study attempts to understand more about physician decisions to recommend PEG tube placement in patients with advanced dementia. DESIGN:Mailed survey. SETTING:Random sample of 500 physicians from the American Medical Association Masterfile. PARTICIPANTS:Primary care physicians. MEASUREMENTS:Physician knowledge, beliefs, and self-reported practices of PEG tubes in advanced dementia. RESULTS:Of the 416 eligible participants, 195 completed surveys (response rate of 46.9%). A significant number of physicians believe PEG tubes have the following benefits in advanced dementia: reduce aspiration pneumonia (76.4%), and improve pressure ulcer healing (74.6%), survival (61.4%), nutritional status (93.7%), and functional status (27.1%). Most physicians underestimate 30-day mortality in patients who receive a PEG and more than half of physicians believe PEG tubes in advanced dementia are the standard of care. Also, a majority of physicians believe speech therapists, nurses, and nutritional support teams recommend feeding tubes, which influences their decision to recommend a PEG. Last, almost half of these respondents had a nursing home request PEG tube placement, leading physicians to recommend a PEG. CONCLUSIONS:We find a notable discord between physician opinion, reported practice, and the literature regarding PEG tubes in advanced dementia that reveals some of the barriers to decreasing the referral of these patients for PEG.
journal_name
J Palliat Medjournal_title
Journal of palliative medicineauthors
Shega JW,Hougham GW,Stocking CB,Cox-Hayley D,Sachs GAdoi
10.1089/109662103322654767subject
Has Abstractpub_date
2003-12-01 00:00:00pages
885-93issue
6eissn
1096-6218issn
1557-7740journal_volume
6pub_type
杂志文章abstract:BACKGROUND:In 2011 the Palliative Care Funding Review highlighted concerns about the funding, provision, and quality of care at the end of life. Two years on, an independent review of the Liverpool Care Pathway--prompted by a storm of negative media coverage--has raised concerns around a lack of funding, availability o...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2013.0464
更新日期:2013-12-01 00:00:00
abstract:BACKGROUND:Nurses and nursing care providers provide the most direct care to patients at end of life. Yet, evidence indicates that many feel ill-prepared for the complexity of palliative care. OBJECTIVE:To review the resources required to ensure adequate education, training, and mentorship for nurses and nursing care ...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2017.0395
更新日期:2018-01-01 00:00:00
abstract:: Background: Systematic measurement of conversational features in the natural clinical setting is essential to better understand, disseminate, and incentivize high quality serious illness communication. Advances in machine-learning (ML) classification of human speech offer ...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2018.0270
更新日期:2018-12-01 00:00:00
abstract::For most families, the preferred location of death for their child is home, yet most children still die in the hospital. Many children with life-threatening and life-limiting illness are medically dependent on technology, and palliative transport can serve as a bridge from the intensive care unit to the family's home ...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2018.0301
更新日期:2019-04-01 00:00:00
abstract:BACKGROUND:Many patients with cancer involving the respiratory system suffer from the frequent recurrence of significant, submassive hemoptysis, which may result in invasive procedures, hospital stays, and a reduction in quality of life. Currently, there are no widely accepted noninvasive therapeutic options. Few case ...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2015.0167
更新日期:2015-12-01 00:00:00
abstract:BACKGROUND:In 2017, the Ohio Pediatric Palliative Care and End-of-Life Network (OPPEN) published nine domains of high-quality care for pediatric home-based hospice and palliative care (HBHPC). Eight domains established by the National Consensus Project (NCP) were validated for pediatric HBHPC, and a ninth domain of "Co...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2018.0056
更新日期:2018-10-01 00:00:00
abstract:OBJECTIVE:To determine whether it is possible to predict, at the time of hospice enrollment, which patients will die within 6 months. DESIGN:Electronic health record-based retrospective cohort study. SETTING:Patients admitted to 10 hospices in the CHOICE network (Coalition of Hospices Organized to Investigate Compara...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2013.0631
更新日期:2014-08-01 00:00:00
abstract:BACKGROUND:The role of emergent palliative surgery in the setting of advanced malignancy remains a subject of controversy. OBJECTIVE:The purpose of this study was to identify clinical predictors of outcome in patients with cancer who undergo nonelective abdominal surgery. SETTING/SUBJECTS:Individuals who underwent ur...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2013.0235
更新日期:2014-01-01 00:00:00
abstract:: Background: Mobile health (mHealth) is a promising tool for improving health outcomes. However, the benefits of using mHealth in palliative care are under studied. Objective: As a first step to designing meaningful palliative c...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2019.0216
更新日期:2020-02-01 00:00:00
abstract:: Introduction: Ventricular-assist devices (VADs) offer end-stage heart failure patients a chance to live longer and better. VAD patient numbers are growing, as is the need for their hospice care, whether they die from cardiac or noncardiac causes. But many hospices do not a...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2018.0581
更新日期:2019-09-01 00:00:00
abstract:BACKGROUND:There is increasing recognition of the value of advance care planning for children with life-limiting conditions. It is important that we acknowledge and reflect on the challenges that this work presents in order to optimize practice. OBJECTIVE:Our aim was to review advance care planning for children with l...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2013.0374
更新日期:2014-09-01 00:00:00
abstract:BACKGROUND:Methadone is an attractive medication for treating children with advanced cancer with pain as it is the only long-acting opioid available as a liquid. However, it is not frequently used due to concerns about potential toxicities and side effects. OBJECTIVE:Evaluate the efficacy and safety of methadone as th...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2017.0712
更新日期:2018-09-01 00:00:00
abstract::It has frequently been claimed that palliative care (PC) consultation services reduce hospital length of stay (LOS). We review 12 published studies comparing patients receiving PC or similar intervention and patients receiving usual care with regard to average total hospital LOS. None of the six observational studies ...
journal_title:Journal of palliative medicine
pub_type: 杂志文章,评审
doi:10.1089/jpm.2009.0379
更新日期:2010-06-01 00:00:00
abstract:: Background: The number of hospital-based palliative care consultation teams (PCCTs) has increased in Japan, and quality improvement (QI) of PCCTs is an issue. The Japanese Society for Palliative Medicine is building a framework for continuous QI of PCCT activities. ...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2019.0236
更新日期:2020-03-01 00:00:00
abstract:BACKGROUND:Cancer pain continues to be undertreated, despite the availability of evidence-based guidelines. The Australian National Pain Strategy identified establishment of systems and guidelines to adequately manage cancer pain as a high priority. OBJECTIVES:This study aimed to identify barriers and facilitators to ...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2013.0245
更新日期:2013-11-01 00:00:00
abstract:: Background: Physical activity in palliative care patients is closely linked to independence, function, carer burden, prognosis, and quality of life. Changes in physical activity can also be related to service provision needs, including requirements for support and prognosi...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2018.0414
更新日期:2019-07-01 00:00:00
abstract:BACKGROUND:Entrustable professional activities (EPAs) are routine tasks considered essential to a professional practice. An EPA can serve as a performance-based outcome that a clinical supervisor would progressively entrust a learner to perform. OBJECTIVE:Our aim was to identify, develop, and validate a set of EPAs fo...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2014.0392
更新日期:2015-08-01 00:00:00
abstract:: Background: This study examines communication profiles and associated attitudes toward health care professionals in interviews with family caregivers of hospitalized patients with confirmed multidrug-resistant organisms (e.g., methicillin-resistant Staphylococcus aureus or...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2019.0027
更新日期:2019-12-01 00:00:00
abstract:: Background: Dyspnea is common in interstitial lung disease (ILD) patients and often refractory to conventional treatment. Little is known regarding the safety of systemic morphine in ILD patients. Objective: The objective of th...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2018.0272
更新日期:2018-12-01 00:00:00
abstract::Central pain syndromes are a complex, diverse group of clinical conditions that are poorly understood. We present a patient with progressive, debilitating central pain and co-existing mood disorders that was refractory to multimodal pharmacologic and nonpharmacologic therapies, but that ultimately responded to electro...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2017.0344
更新日期:2018-02-01 00:00:00
abstract:BACKGROUND:Critical care nurse communication training has largely been limited to didactic materials, interactive training for nurse supervisors, or brief participatory learning programs within the context of comprehensive end-of-life care educational seminars. Preliminary evidence suggests that an interactive approach...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2011.0225
更新日期:2011-12-01 00:00:00
abstract::Studies examining individuals' preferences reflect a broad consensus that the end of life is a period during which medical care should be different from that in other periods in patients' lives. More specifically, patients, families, and health care providers believe that medical care during this unique period should ...
journal_title:Journal of palliative medicine
pub_type: 杂志文章,评审
doi:10.1089/jpm.2005.8.s-12
更新日期:2005-01-01 00:00:00
abstract:BACKGROUND:Patients' and families' evaluations of health care, including palliative care, are widely used as performance measures. Survey scores may be affected by nonresponse bias, resulting in inaccurate performance evaluation. OBJECTIVES:Our aim was to examine nonresponse bias for the mailed version of the Departme...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2015.0050
更新日期:2015-10-01 00:00:00
abstract:BACKGROUND:After prenatal diagnosis of lethal fetal abnormality (LFA), some couples choose to continue the pregnancy rather than opt for termination of the pregnancy. This may result in the requirement for neonatal palliative care, which in France is prescribed by the Leonetti Law. These rare situations raise various q...
journal_title:Journal of palliative medicine
pub_type: 杂志文章,多中心研究
doi:10.1089/jpm.2014.0023
更新日期:2014-08-01 00:00:00
abstract:BACKGROUND:Over the last 20 years, multiple interventions to better integrate palliative care and intensive care unit (ICU) care have been evaluated. This systematic review summarizes these studies and their outcomes. METHODS:We searched MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL...
journal_title:Journal of palliative medicine
pub_type: 杂志文章,评审
doi:10.1089/jpm.2013.0409
更新日期:2014-02-01 00:00:00
abstract:BACKGROUND:Identifying people who are at risk of deteriorating and dying is essential to inform goals of care, appropriate treatment decisions, patient autonomy, and effective end-of-life care. Limited literature exists on predicting survival near the end of life for people with a hematological malignancy. OBJECTIVE:T...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2018.0033
更新日期:2018-12-01 00:00:00
abstract:OBJECTIVES:Many deaths occur among persons without insurance coverage for hospice care. We examined the patient and agency characteristics associated with receiving unreimbursed hospice care in a national survey. RESULTS:We examined the receipt of unreimbursed care using the 1998 National Home and Hospice Care Survey ...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/109662103768253696
更新日期:2003-08-01 00:00:00
abstract:BACKGROUND:Living at home is an important factor for maintaining high quality of life among patients. Many studies have discussed parameters associated with place of death, but no studies have yet clarified which factors influence the length of stay at home during the end of life. OBJECTIVE:The aim of this study was t...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2016.0455
更新日期:2017-08-01 00:00:00
abstract:OBJECTIVES:To determine the effects of thalidomide and placebo on anorexia-cachexia and its related symptoms, body composition, resting metabolic rate, and serum cytokines and their receptors in patients with advanced cancer. METHODS:Included in the study were patients with advanced cancer with weight loss greater tha...
journal_title:Journal of palliative medicine
pub_type: 杂志文章,随机对照试验
doi:10.1089/jpm.2012.0146
更新日期:2012-10-01 00:00:00
abstract:BACKGROUND:Psychiatric research in the 1950s and 1960s showed potential for psychedelic medications to markedly alleviate depression and suffering associated with terminal illness. More recent published studies have demonstrated the safety and efficacy of psilocybin, MDMA, and ketamine when administered in a medically ...
journal_title:Journal of palliative medicine
pub_type: 杂志文章,评审
doi:10.1089/jpm.2017.0684
更新日期:2018-04-01 00:00:00