External validation of a web-based prognostic tool for predicting survival for patients in hospice care.

Prognostat is an interactive Web-based prognostic tool for estimating hospice patient survival based on a patient's Palliative Performance Scale (PPS) score, age, gender, and cancer status. The tool was developed using data from 5,893 palliative care patients, which was collected at the Victoria Hospice in Victoria, British Columbia, Canada, beginning in 1994. This study externally validates Prognostat with a retrospective cohort of 590 hospice patients at LifePath Hospice and Palliative Care in Florida, USA.

A flexible alternative to the Cox proportional hazards model for assessing the prognostic accuracy of hospice patient survival.

Prognostic models are often used to estimate the length of patient survival. The Cox proportional hazards model has traditionally been applied to assess the accuracy of prognostic models. However, it may be suboptimal due to the inflexibility to model the baseline survival function and when the proportional hazards assumption is violated.

Etiology of falls among cognitively intact hospice patients.

Background: Falls can pose a serious threat to hospice patients receiving palliative care. Interventions to reduce falls have yielded minimal results among older patients. Falls among hospice patients provide a unique population from which a new approach to fall prevention may need to be established.

Predicting emergency room visits and hospitalizations among hospice patients with cardiac disease.

Background: One goal of quality palliative care in hospice is to limit emergency room visits and/or hospitalizations (ERVH).

Purpose: The purpose of this study was to determine predisposing factors that contribute to ERVH and devise a model to predict the probability of hospice cardiac disease patients having ERVH after hospice admission.

Methods: The study was a retrospective chart review of hospice cardiac patients comparing those with ERVH (n = 65) and those who died in their homes (n = 80).

Predictors of well-being in bereaved former hospice caregivers: the role of caregiving stressors, appraisals, and social resources.

Objective: The current literature on caregiving and bereavement indicates that the relationship between these two common life events is complex and needs to be further studied in order to gain a more comprehensive understanding of their interaction.

Methods: In the current project, 50 spouses of hospice patients with end-stage lung cancer or dementia were assessed while caregiving and at an average of 4 months after the death on a variety of measures, including caregiving stressors, appraisals, social resources, and well-being. A stress process model was utilized in order to examine which preloss factors were associated with postloss depression, life satisfaction, and grief.

Spirituality and job satisfaction among hospice interdisciplinary team members.

As a continuing effort to enhance the quality of palliative care for the dying, this study examined (1) the prevalence of spirituality among hospice interdisciplinary team (IDT) members; (2) whether spirituality is related to job satisfaction; and (3) the structural path relationships among four variables: spiritual belief, integration of spirituality at work, self actualization and job satisfaction. The study surveyed 215 hospice IDT members who completed the Jarel Spiritual Well-Being Scale, the Chamiec-Case Spirituality Integration and Job Satisfaction Scales. Multiple regression and structural path modeling methods were applied to explain the path relationships involving all four variables.

Quality of life and symptom control in hospice patients with cancer receiving chemotherapy.

The value of palliative chemotherapy for hospice patients is difficult to quantify and little is known about outcomes from these treatments. This study examined quality of life and symptom control in hospice patients with cancer receiving chemotherapy and in a control group of hospice patients with cancer who had not received chemotherapy for at least 3 months. Using a case-control study design matching patients by age, gender, race, and cancer diagnosis, patients receiving chemotherapy reported a similar number of symptoms as patients off chemotherapy.

Impact of coping skills intervention with family caregivers of hospice patients with cancer: a randomized clinical trial.

Background: Family caregivers for cancer patients experience high levels of stress and burden and diminished quality of life (QOL). Interventions to improve coping skills of caregivers have been shown to be effective with other populations, but their impact has not been assessed in the difficult context of hospice care. The purpose of this study was to determine whether hospice plus a coping skill training intervention improved family caregivers' QOL, burden, coping, and mastery, compared with hospice plus emotional support, and usual hospice care.

Advancing geriatrics education: evaluation of a new curricular initiative.

Background: This study describes the development of a required 1-week curricular program in geriatric medicine for 3rd-year medical students and presents 3 years of evaluation data.

Description: Successful aging, heterogeneity of the aging population, and comprehensive geriatric assessment were emphasized. In addition to didactic sessions, students participated in panel discussions and small group case conferences, and performed history and physical examinations on older patients.

Are older French patients as willing as older American patients to undertake chemotherapy?

Purpose: A view often held in Europe is that older Europeans are less willing than older Americans to undertake chemotherapy. This study assesses whether this view is valid.

Patients And Methods: Three-hundred twenty outpatients aged 70 years and older were interviewed via anonymous questionnaires: French patients with and without cancer and American patients with and without cancer.

Predictors of depression and life satisfaction among spousal caregivers in hospice: application of a stress process model.

Using a stress process model, risk factors (caregiving stressors, caregiver health, and negative social interactions) and protective factors (caregiving appraisals and social resources) were examined as predictors of family caregiver well-being (depression and life satisfaction). Eighty spousal caregivers of hospice patients with dementia or lung cancer completed structured interviews and self-report measures assessing components of the stress process model. Results suggest that objective measures of patient impairment or amount of care provided are not strong predictors of caregiver depression or life satisfaction.

Decisions for hospice care in patients with advanced cancer.

Objectives: To identify factors that may influence the decision of whether to enter a hospice program or to continue with a traditional hospital approach in patients with advanced cancer and to understand their decision-making process.

Design: Cross-sectional structured interview.

Setting: One community-based hospice and three university-based teaching hospitals.

Predictors of six-month survival among patients with dementia: an evaluation of hospice Medicare guidelines.

The goal of the present study was to assess the validity of the Medicare hospice eligibility guidelines for dementia patients, as well as identify predictors that could more accurately identify prognosis in dementia patients referred to hospice. A retrospective chart review was conducted, including initial assessment and longitudinal follow-up of patients until the time of death. In addition, a second validation cohort was also followed.

Initial voluntary program standards for fellowship training in palliative medicine.

Initial voluntary standards for fellowship programs in palliative medicine were developed through a collaborative process involving the directors of fellowship training programs, the American Academy of Hospice and Palliative Medicine (AAHPM), and the American Board of Hospice and Palliative Medicine (ABHPM). These groups worked with a consultant and representatives from the American Board of Medical Specialties (ABMS) and the Accreditation Council for Graduate Medical Education (ACGME) to create a training structure for the programs that will maximize the likelihood for recognition and accreditation of the subspecialty. An accreditation group modeled after an ACGME residency review committee will be formed to review and adopt the standards, then accredit programs voluntarily.