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Strategies for whole system change in healthcare (HEARTS in HEALTHCARE)

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When Palliative Care Begins

Discussion: Sometime ago a New England newspaper, the Worcester Telegram & Gazette, carried a story entitled "Various Pathways Lead to a Good Death." in which a retired former chief of surgery, Dr. H. Brownell, spoke of his concern that too many patients die what he called ‘a bad death.’ In the article Brownell spoke about seeing patients, including his own, die in an intensive care unit with tubes poked into their chests, their bellies and just about every orifice of their bodies. He further commented about patients resuscitated with so much fluid that their faces were unrecognizable, arms black and blue from needles and blood sticks, in severe pain and unable to communicate—and with very little hope of survival. "No one," he commented, "should have to die like this." Janet L. Abrahm, M.D., F.A.C.P., at the University of Pennsylvania School of Medicine, Philadelphia, encourages physicians to broaden their concept of care for patients who are terminal...
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At End of Life, Family Often Too Optimistic on Survival Educating a family about a poor prognosis has always been difficult. Now a study appearing in the  Journal of the American Medical Association  reveals the extent of misunderstanding when patients and physicians both try predict the chance of a loved one's survival. In this 150-second analysis,  MedPage Today  clinical reviewer F. Perry Wilson MD, MSCE, breaks down the data.
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THE CHAPLAINS'​ NOTES IN PATIENT CHARTS -- BY RAYMOND J. LAWRENCE A very useful study was reported in the journal  Palliative and Supportive Care in May, 2016, entitled "Documenting presence: A descriptive study of chaplain notes in the intensive care unit." The research was completed in September, 2015. The authors of the report were Brittany M. Lee, B.S.; Farr A. Curlin, M.D.; and Philip J. Choi, M.D. The setting of the research was Duke University Hospital, Division of Pulmonary and Critical Care Medicine, in Durham, North Carolina. The study was done with input from the Director of Pastoral Services, Jim Rawlings. The researchers proposed that the recent emphasis on evidence-based practice may be leading chaplains to the use of a reduced, mechanical language insufficient for illuminating patients' individual stories. Whatever the cause may be, it is clear that the chaplains in this study are at sea on the matter of what should be appropriately...
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