Hospices in California have undergone significant and complicated ownership changes in recent years. Little is known about the impact of these ownership changes on hospices. The purpose of our longitudinal, retrospective descriptive study was to describe the ownership changes impacting hospices 2018 to 2021 in California. Using descriptive statistics, we measured characteristics of hospices with and without ownership changes employing public data from the California Home Health Agencies and Hospice Annual Utilization Report. Ownership change characteristics were measured via publicly available hospice provider and facility data. Spatial characteristics were additionally measured via latitude and longitude publicly available data. Our findings showed that ownership changes were significant and complicated. An influx of for-profit organizations into the California market was primarily responsible for these changes. Additionally, lack of corporate financial public disclosure and voluntary hospice accreditation, certification, and reporting result in a lack of free, publicly available, definitive comprehensive data on for-profit hospice ownership. This hinders information gathering on and provider/familial choice-making regarding hospices. Our study provides critical insight into the impact of ownership changes and lack of definitive, free, publicly available information on adult hospices in California caring for children and has important clinical, research, and policy implications.

This case report explores the challenges and complexities associated with opioid management of cancer pain, emphasizing the importance of early involvement of a hospice consultation team and the adoption of a multidisciplinary approach to care. A 56-year-old man with advanced pancreatic cancer experienced escalating pain and inappropriate opioid prescriptions, highlighting the shortcomings of traditional pain management approaches. Despite procedural intervention by the attending physician and increased opioid dosages, the patient\'s condition deteriorated. Subsequently, the involvement of a hospice consultation team, in conjunction with collaborative psychiatric care, led to an overall improvement. The case underscores the necessity of early hospice engagement, psychosocial assessments, and collaborative approaches in the optimization of patient-centered palliative care.

Despite the growing prevalence of human immunodeficiency virus (HIV) and acquired immunodefiency syndrome (AIDS) in the Philippines and the psychosocial challenges it engenders, there remains a dearth of research on the intersection of HIV and hospice care. Stigma and discrimination further compound the challenges of providing inclusive hospice care to HIV patients in the country. Drawing upon the results of a recently published article centered on a Veteran assigned male at birth who expressed a desire for gender reassignment while receiving end-of-life care, this paper highlights the importance of sensitivity, understanding, and affirmation in hospice settings for HIV patients in the Philippines.

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Happiness is central in spirituality but has hardly been explored in palliative care. The objective of this study is to explore happiness in hospice care in the Netherlands. A case study design consisting of participatory observations and semi-structured interviews was used. Happiness was associated with all dimensions of health. Patients spoke about a growing receptivity and a deepening of connections with themselves and others. Hospice staff related their happiness to feeling a true connection and their work supported them in appreciating their own lives in new ways. This study suggests that happiness can be found in settings that are frequently associated with suffering.

UNASSIGNED: The goal of palliative care is to preserve the quality of life or patient \"comfort\" in patients with serious diseases. Palliative care providers serve a wide range of patients: from those who seek curative treatment to those who are actively dying. Given this range, palliative care must mirror the dynamic goals of the patient at different stages of life and treatment. Throughout these stages, a goal of the palliative care provider would be to avoid hastening death; however, this often leads to clinical decisions that directly pit the patient\'s comfort against the patient\'s life span. This is most salient with clinical decisions of withdrawing treatments that prolong life even at the expense of comfort. An example of this dichotomy can be seen when providers use enteral nutrition to treat head and neck cancer patients.
UNASSIGNED: We describe a patient with stage IV pancreatic cancer with metastases to her head and neck. The patient was experiencing increased morbidity related to her percutaneous endoscopic gastrostomy (PEG) tube feeding. These complications included tube-related concerns such as infection, leakage, and diarrhea but also decreased intended benefits as she lost weight and functionality while maintaining enteral feeding. Despite the patient experiencing a common and expected disease course, she remained unsure and was fearful about considering discontinuation of her enteral feeding. However, the care team who understood the risks, benefits, and harms related to withdrawal provided a foundation of discussion and mitigated patient fears, allowing for the successful removal of her PEG tube and increased quality of life at the end of life.
UNASSIGNED: To care for a patient in their entirety is also to care for them at all stages of disease. Care is not limited to those who might be cured of disease, but should also consider those who continue to live with disease and the downstream effects of medical interventions used to support them. Discontinuing treatments whose harms outweigh the benefits to patients is a moral imperative to providers; yet, how providers approach discontinuing life-prolonging treatment is seen as morally distressing. Our patient did not see the discussion as morally distressing and continued to benefit from active discussions even at the end of her life.

BACKGROUND: Under the background of the increasing aging population and cancer burden in China, the role of hospice care has become increasingly prominent. The government has paid more attention to the development of hospice care and set up pilot hospitals to promote hospice care. Moreover, healthcare providers play a leading role in hospice care services. To improve the quality of hospice care, the National Health Commission of the People\'s Republic of China proposed to set up hospice care training bases in municipal or above-level hospitals with hospice care or relevant work foundations, and train healthcare providers on hospice care. This study aimed to investigate the current situation of cognition and attitudes about hospice care among healthcare providers and provide a theoretical basis for hospital training.
METHODS: We used a quantitative design. A questionnaire survey was conducted among 1591 healthcare providers from August 2022 to November 2022. SPSS 22.0 software was used to analyze the data.
RESULTS: As a significant way of continuing education for healthcare providers, hospital training hasn\'t been effectively exploited in hospice care education. The average score of hospice care knowledge among participants was (7.74 ± 2.242) and the average score of hospice care attitudes among participants was (4.55 ± 1.503). According to multivariate linear regression analysis, sex (p < 0.001), education levels (p < 0.001), and professional titles (p = 0.018) of participants had significant difference on the score of hospice care knowledge; education levels (p = 0.009) and professional titles (p = 0.016) of participants had significant difference on the score of hospice care attitudes.
CONCLUSIONS: There were some misunderstandings about hospice care among healthcare providers and their attitudes towards hospice care were inactive. It\'s suggested that hospitals should carry out professional and systematic education courses to help healthcare providers understand hospice care correctly, and participate in hospice care services actively.

UNASSIGNED: The study explored the meaning of experiences within a family art therapy process among terminal cancer patients and their families.
UNASSIGNED: Ten participants, including four terminal cancer patients currently admitted to the hospice ward at an inpatient hospice facility in S City and four caregiving family members, engaged in four cycles of family art therapy sessions. The sessions were conducted weekly or bi-weekly, and each lasted approximately 50 minutes.
UNASSIGNED: Nine cross-case themes emerged \"feeling unfamiliar and intimidated by the idea of expressing my thoughts through art,\" \"trying to accept the present and positively overcome sadness,\" \"expressing hope through emotional bonds during the process of parting,\" \"conveying and preserving personal and family beliefs,\" \"feeling upset about family imbalances caused by deteriorating health,\" \"valuing togetherness and striving for stability amidst the current challenges,\" \"art as a medium of empowerment for patients and facilitator of family conversations, even amidst difficulties,\" \"sharing a range of emotions-not just joy, but concerns and sorrow-through art,\" and \"gratitude for art\'s role in improving family communication and connection through artwork.
UNASSIGNED: The findings of this study lead to several conclusions. First, patients and their families faced psychological challenges when confronted with impending death, yet they strove to remain optimistic by seeking meaning in their struggles. Second, families practiced open and expressive communication, sharing a spectrum of complex emotions with one another. Third, even as the patient\'s condition worsened, resulting in family fatigue, their support and cohesion strengthened.

Introduction: Palliative care (PC) pharmacists are an integral member of the PC team. Essential roles have been defined and entrustable professional activities (EPAs) have been recently developed for hospice and PC pharmacists. Case Description: We review four different complex patient cases where the specialist PC pharmacist worked with the interdisciplinary team to address whole patient suffering. Through the case series, we highlight the various components of HAPC pharmacist EPAs across the continuum of care. Case Management, Outcome, and Conclusion: Through the case series discussion, we brought to light PC pharmacists\' EPAs in pharmacotherapy consultation, assessing and optimizing medication therapy, symptom management, deprescribing, participating in goals-of-care discussions, managing medication therapy in the withdrawal of life-sustaining therapy in collaboration with interdisciplinary team in alignment with patient and family values, prognosis, and plan of care. We also emphasized the importance of PC pharmacists contributing to the advancement of science.

Background: The development of major depressive disorder in patients at end of life often goes undiagnosed, as it is difficult to distinguish from preparatory grief and/or hypoactive delirium in this unique patient population. If this preliminary barrier of appropriate diagnosis is overcome, it can be quite difficult to properly select and adjust pharmacological therapy. Many well-established antidepressants take four to five weeks for maximal effectiveness (which may be far too long of a titration period for patients at end of life), have various contraindications to patients\' comorbid chronic conditions (particularly patients with cardiovascular disease), or may simply be ineffective. Case: We present a case report of severe treatment-resistant depression in an end-stage heart failure patient enrolled in hospice care. Discussion: We discuss the potential use of a single low-dose intravenous racemic ketamine infusion to reduce end-of-life suffering related to depression, despite the theoretical contraindication of ketamine use in such patients, in part, due to its sympathomimetic secondary effect.