Evolving Advance Care Planning in a Health Ecosystem: The Kaiser Permanente Experience.

Background: Advance care planning is an integral part of supporting patients through serious illness and end-of-life care.

Problem: Several components of advance care planning may be too inflexible to account for patients' changing disease and evolving goals as serious illness progresses. Health systems are starting to implement processes to address these barriers, though implementation has varied.

Palliative Extubation: A Discussion of Practices and Considerations.

Palliative extubation (PE), also known as compassionate extubation, is a common event in the critical care setting and an important aspect of end-of-life care. In a PE, mechanical ventilation is discontinued. Its goal is to honor the patient's preferences, optimize comfort, and allow a natural death when medical interventions, including maintenance of ventilatory support, are not achieving desired outcomes.

Hospital utilisation in home palliative care: caregiver health, preparedness and burden associations.

Background: Prior studies show that family caregiver factors influence patient outcomes. The purpose of this analysis was to determine the association between family caregiver self-rated health, perception of preparedness and burden at the time of patient admission to home palliative care (HomePal) with downstream patient hospital utilisation and time to hospice enrolment and death.

Methods: Data for this cohort study (n=441) were drawn from a trial testing two models of HomePal.