Our death denying culture continues to send the message to mourners that the healthiness of an individual’s grief is to be measured by how quickly and proficiently the mourner “gets over” the loss and moves into a productive life. I remember a co-worker who was supported by our employer while her husband went through months of chemotherapy to fight cancer. Once her husband died and weeks passed, she was fired because of a lack of productivity.
Navigating these new mandates may pose administrative and technical challenges for covered entities and for business associates. The Department of Health and Human Services has estimated that the cost of implementation ranges from $114 million to $225 million in the first year and approximately $14.5 million each year thereafter.1 Many companies, however, maintain that the amount reported by the Department of Health and Human Services significantly underestimates the actual compliance costs.4 This conundrum is particularly true for mobile health companies in a rapidly expanding HIT industry.
Conclusions: Problems in implementation of ACPs are multifactorial and not necessarily due to deliberate nonadherence by health professionals. Potential solutions to improve the clinical impact of ACP are discussed.
Predictable deaths from diseases like cancer account for approximately 83% of deaths in China. Despite the growing numbers of terminally ill people from all diseases, palliative care is in its infancy. Factors that have slowed the development of palliative care include cultural values that encourage efforts to cure (even when such treatment is likely to be futile) over the alleviation of suffering, limited public policies and funding for palliative care, and poor education of healthcare professionals about end-of-life care.
Although use of hospice services continues to increase across the United States, with more than 1.5 million Americans receiving services in 2010, only 9% of hospice recipients are African American. In her article in the August 2013 issue of the Clinical Journal of Oncology Nursing, Drisdom explored the barriers African Americans experience when using hospice care, including cultural and knowledge issues.
The decision to stop a medication by an individual is influenced by multiple competing barriers and enablers. Knowledge of these will aid in the development of a deprescribing process, particularly in approaching the topic of cessation with the patient and what process should be utilised. However, further research is required to determine if the proposed patient-centred deprescribing process will result in improved patient outcomes.
As the hospice care setting becomes more racially and ethnically diverse, attending to the different conditions and needs of various groups is essential to providing optimal care. African Americans make up only a small percentage of hospice users in the United States. This article highlights barriers associated with the underenrollment of African Americans into hospice and palliative care programs. A thorough analysis of the literature was conducted to define hospice and palliative care and assess circumstances that impact the use of hospice services by African Americans. Many African Americans are not choosing hospice care because of cultural issues or knowledge deficits, whether through lack of communication or low literacy. Healthcare providers can begin by familiarizing themselves with hospice organizations and developing and putting into practice strategies to communicate with and educate patients and families about hospice care in a culturally sensitive manner.
These findings may support health care professionals to tailor the provision of support and information and remove communication barriers accordingly. Additionally, they provide input for interventions to support patients in effective communication.
A better understanding of potentially high therapeutic failure rates in pain management may be a first step toward doing better with currently available treatments. Clinically, this means expecting analgesic failure, assessing pain, and considering options for stopping and switching therapies. This also requires casting aside a reliance on what works for “average” patients, and asking what works best, for whom, in what circumstances.
Challenges of accrual in supportive care trials in pediatric oncology.