Article Figures & Data
Figures
- Figure 1.
The palliative care continuum.
Adapted with permission from Emanuel LL, von Gunten CF, Ferris FF, eds. “Plenary 3: Elements and Models of End of Life Care,” The Education for Physicians on End-of-Life Care (EPEC) Curriculum:© The EPEC Project, 1999, 2003.
Tables
Letter Model Element Elaboration T Timely Proactive rather than reactive approach to avoid prolonged unnecessary suffering Team oriented Nurses, social workers, trained laypersons, and others involved L Longitudinal Balance of palliative and curative measures evolves with time C Collaborative Patients, family members, and providers share decisions Comprehensive All empirically supported domains of palliative care are addressed Element Ascertainment and Measures Assessment part 1 Demographics Discussion with resident, caregiver; review of facility records Diseases / diagnoses Discussion with resident, caregiver; review of facility records; request records from primary care physician Medications Discussion with resident, caregiver; review of facility records; request records from primary care physician Health status SF-36 Physical Component and Mental Component summary scales54– 56 Symptoms Memorial Symptom Assessment Scale (MSAS)57 items and Global Distress Index (GDI) Hearing Hand-held audiometer (1,000 and 2,000 Hz at 40 dB)45 Vision Wall-mounted Snellen eye chart45 Mood Geriatric Depression Scale, 15-item58 Cognition Mini Mental State Exam59 Activities of daily living Self-report of mobility, toileting, transfers, eating60 Functional abilities Physical Performance Test, 7-item61 Balance Performance oriented assessment of balance62 Gait Performance oriented assessment of gait62 Assessment part 2 Social support Social Support Survey63 Advance directives, current Discussion with resident and caregiver; review of facility records Medical decision-making capacity Clinical vignettes64 Life values and goals for medical care Values History, modified65 Wishes regarding aggressive interventions Values History, modified65 Hospice eligibility Comparison of characteristics with National Hospice Organization guidelines66 - Table 3.
Palliative Care Improvement Recommendations for Elderly Residents of 2 Assisted Living Facilities (N = 50)
Recommendation Category No. Percent * Recommendations were often addressed to more than 1 person (eg, resident, family caregiver, physician) and could include more than 1 recommendation per category. For this analysis, a separate recommendation was recorded for each targeted person in such cases. Mobility problem, fall risk 65 26 Advance directive 43 17 Vision problem 30 12 Hearing problem 28 11 Symptoms (eg, pain) 21 8 Dementia, cognitive problem 17 7 Depression 14 6 Urinary incontinence 7 3 Miscellaneous 29 11 Total 254 100
