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Article in press
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One Rain Does Not Make a Crop–Continuum of Care to Improve End-of-Life Care for Bariatric Patients
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Abstract [+]
Care of persons weighing over 500 lbs. poses additional challenges. For at least the past 20 years, training methods, resources, and equipment have been available to meet the demands of people weighing up to 500 pounds. However, this is not the case when exploring care options for the person weighing greater than 500 pounds. Hospital beds, magnetic resonance imaging (MRI) and computerized tomography (CT) scan beds, etc. are not usually designed to bear the weight of over 500 lbs. persons. According to Hale and others (2020), in 2017-2018 the age-adjusted prevalence of obesity in adults was 42.4%, and there were no significant differences between men and women among all adults or by age group. This case report illustrates the unique challenges and opportunities encountered by morbidly obese patients and healthcare professionals during end-of-life (EoL) care situations. It also categorically highlights the challenges, contextual discussions, and potential opportunities for healthcare delivery models to standardize and implement safe, effective, efficient, compassionate, person-centered, cost-effective care when serving bariatric persons.
Keywords
Bariatric patients; End-of-life; Compassionate care; Death with dignity; Palliative care physician.
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Current Issue
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The Middle East Cancer Consortium: A Model for Regional Conciliation and Compassion in the Middle East
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Regions in the Middle East are still experiencing political and military hostilities which negatively affect the health and health services of millions of people. Cancer is one of the major causes of high morbidity and mortality in the region. Palliative care for the cancer patient is one of the care options available for all those suffering from such a life-threatening disease. The Middle East Cancer Consortium (MECC) initiated a regional plan to implement palliative care approaches both in hospitals and the community. Moreover, the region lacks experienced professionals who could pave the way for establishing national palliative centers and guide primary care physicians and nurses to exercise this relatively new discipline in clinical practice. This report describes, in short, the endeavors, barriers and successes of this project, which are intended to bring medical professionals closer, thereby promoting understanding, respect and tolerance among individuals and communities in conflict.
Keywords
Cancer; Palliative care; Middle East; Conflicts.
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Using Datix Electronic Incident Reporting System to Develop a Palliative and End-of-Life Care Patient-Centered Auditing, Quality Assessment and Reporting System
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The need for specialist palliative care services has never been higher as the ongoing coronavirus disease (COVID) pandemic has highlighted. Yet even in the absence of the pandemic, specialist palliative care services in hospitals, hospices and within communities were already stretched beyond their capacity. The current fiscal climate within which most healthcare systems operate are undergoing global economic constraints making it a necessity that healthcare systems explore new ways of working to develop efficient high-quality services, maximising resources whilst maintaining good clinical governance. We describe how a hospital palliative and end-of-life care (PEoLC) specialist team, can harness an existing electronic incident reporting system Datix, adapting it to automatically track the longitudinal performance of the patient-centred, end-of-life care (EoLC) services that they deliver, along national standards in keeping with the Care Quality Commission (CQC) and the National Institute for Health and Excellence (NICE) guidelines for end-of-life care in the UK. Such automated systems can inform the quality of PEoLC services, improve the use of time and resource within specialist palliative care teams, support the delivery of evidence-based clinical governance standards, whilst supporting benchmarking across organisations, strategy development, insight into local/regional variations, and the establishment of standardisations of care.
Keywords
Palliative and end-of-life care (PEoLC); Performance indicator data; End-of-life-care audit; Clinical governance.
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Bioethics Training: Report on the Experience of a Medical Bioethics’ Scholar in a Tertiary Referral Hospital in a Low- and Middle-Income Country
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Abstract [+]
Skills in biomedical ethics are limited in the African health care systems. This significantly affects the bioethics discourse in the medical practice. The main reason for the paucity in knowledge and skills in bioethics is minimal or no training at all imparted to healthcare professionals. Where there is training, it is not well-structured like other courses in the training institutions. This report summarizes the status of bioethics training and outlines the implementation, processes, outcome and future outlook of a bioethics teaching project for masters in medicine residents (students) in a tertiary referral hospital in Africa. This project was part of postgraduate studies in biomedical ethics by a practicing physician. It entailed teaching bioethics to first year master’s in medicine residents (students). The teachings occurred in the author’s affiliated institution monthly for six-months. The topics covered were: general introduction to bioethics, ethical issues at end-of-life (EoL), informed consent, basics of research ethics, plagiarism and doctor-pharma interaction. These topics were selected due to their relevance to the residents in their practice and because they
needed to undertake research studies to graduate from the masters training program. In addition, these basic bioethics training provided the residents with the foundation to develop knowledge geared towards improving skills in analyzing diverse areas in the contemporary bioethics’ environment such as end-of-life care (EoLC), human research ethics, doctor-pharmaceutical relationships while looking at them within the context of political, cultural, socio-economic, and environmental determinants.
Keywords
Bioethics; Training; Kenya; Africa.
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Review of Melatonin and Results of Students Survey
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Abstract [+]
Purpose
The objective of the survey is to evaluate the knowledge and opinion of Howard University College of Pharmacy first-year professional pharmacy students regarding the use of the sleep medication melatonin.
Methods
A survey questionnaire comprising 20 questions on melatonin was developed and response obtained from 42 students. Demographic data and responses were gathered and evaluated. Descriptive statistics were used to analyze the responses.
Results
Most of the respondents had adequate knowledge about melatonin ranging from 54.8 to 92.6%. There was no statistical difference when responses were analyzed based on the gender of the survey participants. To specific questions whether melatonin is associated with weight gain, can help with signs and symptoms of cancer, recommend sleep hygiene instead of melatonin, and
whether melatonin is addictive, the majority (57.1%, 42.9%, 64.3% and 69.0%, respectively) provided the wrong responses.
Conclusion
More than half of the respondents had good levels of knowledge and opinion about melatonin, with the highest being 92.6% to a specific question on the use of melatonin. The students were only deficient in areas of melatonin being associated with weight gain, melatonin helping with signs and symptoms of cancer, recommending sleep hygiene, and melatonin causing addiction. There are significant differences between the age groups and whether those who worth healthcare area, or not in their response to some of the survey questions.
Keywords
Melatonin; Dietary supplement; Insomnia; Weight gain; Cancer; Light.
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The Psychosocial and Economic Effects of Caring for Terminally Ill Patients: The Case of Hospice Africa Uganda
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A Community Engagement Model to Drive Advance Directive Discussion and Completion
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Previous Issue
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Ethical Challenges to Respecting and Meeting Patients’ Requests: Lessons from Providing Palliative Care for Coronavirus Disease 2019 Patients
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The Psychosocial and Economic Effects of Caring for Terminally Ill Patients: The Case of Hospice Africa Uganda
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Abstract [+]
Introduction
Giving care to a patient at the end-of-life can be a challenging experience. The responsibilities of caregiving may include executing complex physical and mental tasks, financial planning, patient care, decision-making, emotional support and coordination of care.
This mixed-methods observational study aims to identify the psychosocial and economic effects of caregiving for terminally-ill patients by carers on the Hospice Africa Uganda Kampala program. It used both quantitative and qualitative data of caregivers caring for terminally-ill patients attending Hospice Africa Uganda Kampala. Simple random sampling was conducted to select caregivers who were invited to participate in the study.
Results
Results indicate that the majority of patients who were receiving palliative care (60.9%, 103) had been diagnosed with cancer. Most participants (62%, n=105) had spent less than one year caring for their patients, while (18%, n=31) were cared for between 1-5 years. Our results show that the responsibility of caregiving has significant effects on the psychosocial well-being of caretakers. In particular, it reduced the amount of time they spent attending social gatherings and caring for their children, their religious commitment (p<0.05), as well as their level of fatigue and exhaustion (p<0.05), and negatively impacted job finding activities.
Conclusion
Terminal caregiving has significant effects on the psychosocial well-being and incomes of caretakers, and their ability to find a job alongside caring for the patient. Based on these findings, it is therefore recommended that caregivers be given ongoing support to help them provide care to their own family members and patients with life limiting illnesses early in the disease trajectory.
Keywords
Psychosocial; Economic effects; Caregivers; Terminally-ill; Patients.
A Community Engagement Model to Drive Advance Directive Discussion and Completion
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Abstract [+]
Background
Advance directives (ADs) describe individuals’ preferences for life-sustaining treatments and/or surrogate decision-makers, to help avoid unwanted, burdensome treatments at the end-of-life. However, only 36.7% of adults have completed an AD. There is growing interest in adopting a public health approach to end-of-life care, including ADs. We describe the experience of Honoring Choices Tennessee (HCT) which developed a pilot program, Advance Directives at Work in Tennessee (AD@WorkTN), to enhance AD completion by the general public workforce.
Methods
The AD@WorkTN initiative targeted adults in the Tennessee workforce by engaging human resource (HR) leaders in educational presentations. Each workshop provided resources to employers to integrate ADs into the employee orientation and benefits enrollment process. Educational materials, web tools, podcasts, AD forms, and a demonstration of how to complete an AD were
included. Participants were directed to the HCT website which contains the state advance directive documents and with detailed instructions, as well as the co-branded MyDirectives app (MYD), to securely upload completed ADs. In April 2021 a HCT sponsored PBS documentary on advance care planning was produced with statewide distribution.
Results
Over a 2-year period, 58 workshops were conducted for 260 human resources leaders representing 958 businesses. As a result, 23 businesses have included ADs as part of the employee benefit process. Additionally, a 2-year multifaceted public outreach campaign between 2019-21 has reached 2,950 employees and 958 businesses. Approximately 81,500 Tennessee viewers have seen
the Public Broadcasting Service (PBS) documentary on advance care planning. There have been 2,954 visits to the HCT website and 411 visits to the co-branded MyDirectives site.
Conclusion
AD@WorkTN is a promising model to promote integration of ADs into the employee orientation and benefits enrollment processes. Enhanced discussion and completion of ADs among employed individuals and enhanced public discourse such as podcasts and television productions may encourage intergenerational conversations about end-of-life care and documentation in healthcare records.
Keywords
Palliative care; Advance directives; Community outreach.
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