End of Life Resources Overview
End of Life Resources is a library of information meant to assist physicians, caregivers and patients find information they need to better carry out end-of-life care.
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End of Life Resources
Video: Diane E. Meier, MD, FACP and Geoffery P. Dunn, MD, FACS "How to Have the Hard Conversation"
This video is a short segment taken from the Cunniff-Dixon Foundation 2009 Symposium on the 'Art of Medicine at the End of Life' held at the New York Academy of Medicine. In this clip Diane Meier talks candidly about "having the hard conversation" when a Doctor has to inform a patient that he or she is nearing the end of life.
Churning: The Association between Health Care Transitions and Feeding Tube Insertion for Nursing Home Residents with Advanced Cognitive Impairment
Abstract: There is a tenfold variation across U.S. states in the prevalence of feeding tube use among elderly nursing home residents (NHR) with advanced cognitive impairment. The goal of this study was to examine whether regions with higher rates of health care transitions at the end of life are more likely to use feeding tubes in patients with severe cognitive impairment.
Methods
A retrospective cohort study of U.S. nursing home residents with advanced cognitive impairment. The incidence of feeding tube insertion was determined by Medicare Part A and B billing data. A count of the number of health care transition in the last 6 months of life was determined for nursing home residents. A multivariate model examined the association of residing in a geographic region with a higher rates of health care transition and the insertion of a feeding tube in nusing home resident with advance cognitive impairment.
Results
Hospital Referral Region (HRR) health care transitions varied from 192 (Salem, Oregon) to 509 per 100 decedents (Monroe, Louisiana) within the last 6 months of life. HRRs with higher transition rates had a higher incidence of feeding tube insertion (Spearman correlation = 0.58). Subjects residing in regions with the highest quintile of transitions rates were 2.5 times (95% confidence interval [CI] 1.9–3.2) more likely to have a feeding tube inserted compared to those that resided in the lowest quintile.
Conclusions
Regions with higher rates of care transitions among nursing home residents are also much more likely to have higher rates of feeding tube placement for patients with severe cognitive impairment, a population in whom benefit is unlikely.
The Use of Complementary and Alternative Medicine Therapies by Patients with Advanced Cancer and Pain in a Hospice Setting: A Multi-centered, Descriptive Study
Author Manuscript: Our group recently completed the largest randomized controlled trial to date of massage therapy, the Reducing End-of-life Symptoms with Touch (REST) study. We investigated the use of massage therapy versus simple touch to reduce pain in patients with advanced cancer. (1) As part of this study, we also collected data about the use of Complementary/Alternative Medicine (CAM) by this patient population. The 2002 National Health Survey of over 31,000 US adults found 40% of patients with a current or former cancer diagnosis affirmed CAM use within the last year. (2) However, little data exist about the use of CAM in the palliative care population, though cancer and pain are two of the most commonly cited reasons for CAM use and 60% of US hospices offer CAM therapies...
* See below for PDF of full manuscript
