Adaptation, dissemination, and evaluation of a cancer palliative care curriculum for the Indian health system.

In 2006, the Indian Health Service (IHS) and the National Cancer Institute (NCI) collaborated to develop an interdisciplinary palliative training program for health professionals in the Indian health system. Their goal was to improve clinician knowledge and skills in palliative care, to train future trainers, and to increase access to palliative care for American Indians and Alaska Natives. The combined program of participant self-study utilizing a multimedia CD-ROM and train-the-trainer seminars followed the curriculum entitled Education in Palliative and End-of-Life Care for Oncology (EPEC-O) with American Indian and Alaska Native Cultural Considerations.

Learning that leads to action: impact and characteristics of a professional education approach to improve the care of critically ill children and their families.

Objective: To determine the impact of an innovative professional educational approach on clinicians' confidence and ability to make institutional improvements in pediatric palliative care.

Design: Evaluation to assess impact of educational intervention on participants and participant institutions.

Setting: Retreats lasting 2.

Next of kin perspectives on the experience of end-of-life care in a community setting.

Background: Previous studies of end-of-life experience have been conducted primarily in urban medical centers and mostly focused on preferences for rather than experience of care.

Objective: To describe family end-of-life experience and perceptions of care across clinical settings from a semirural community perspective, identifying experiences associated with patient quality of life as rated by next of kin.

Design: Retrospective study using structured interviews with decedents' next of kin and medical chart reviews.

End-of-life treatment preferences of persons with serious mental illness.

Objective: The goal of this study was to ascertain preferences for end-of-life care among persons with serious mental illness.

Methods: The participants were 150 community-residing adults with serious mental illness. The Health Care Preferences Questionnaire was administered to obtain information about treatment preferences in response to hypothetical medical illness scenarios: use of pain medication in the case of incurable cancer and use of artificial life support in the case of irreversible coma.

Medical advance care planning for persons with serious mental illness.

Objective: This study examined preferences regarding medical advance care planning among persons with serious mental illness, specifically, experience, beliefs, values, and concerns about health care proxies and end-of-life issues.

Methods: A structured interview, the Health Care Preferences Questionnaire, was administered to a convenience sample of 150 adults with serious mental illness who were receiving community-based services from the Massachusetts Department of Mental Health. Clinical information and demographic data were also collected.

Evaluation of the Missoula-VITAS Quality of Life Index--revised: research tool or clinical tool?

Background: Quality of life (QOL) is a central outcome measure in caring for seriously ill patients. The Missoula-VITAS Quality of Life Index (MVQOLI) is a 25-item patient-centered index that weights each of five QOL dimensions (symptoms, function, interpersonal, wellbeing, transcendence) by its importance to the respondent. The measure has been used to assess QOL for hospice patients, and has been found to be somewhat complex to use and analyze.

Measuring patient treatment preferences in end-of-life care research: applications for advance care planning interventions and response shift research.

Understanding the dynamics of patient treatment preferences can be important for end-of life are research, and has particular salience not only to guide a process of advance care planning (ACP) but also as an outcome measure. Ascertaining the reliability and responsiveness of preferences for life-sustaining treatments within and between patients is a necessary foundation for utilizing patient-agent congruence as an outcome for ACP interventions. This study validated a modified version of the Emanuel and Emanuel Medical Directive for use in both research and clinical applications.

Establishing a culturally sensitive palliative care program in rural Alaska Native American communities.

End-of-life programs that provide an option for patients to die at home are available in most U.S. communities.