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The authors report on the implementation of a previously developed
clinical pathway for terminally ill patients, Palliative Care for Advanced
Disease (PCAD), on a Veterans Administration (VA) acute care oncology unit,
comparing processes of care and outcomes for patients on and off the pathway.
The PCAD pathway is designed to identify imminently dying patients, review
care goals, respect patients' wishes, assess and manage symptoms, address
spirituality, and support family members. Retrospective chart reviews from
15 patients who died on PCAD, 14 patients who died on general wards during
the same time, and 10 oncology unit patients who died prior to PCAD revealed
that PCAD patients were more likely to have documentation of care goals and
plans of comfort care (P=0.0001), fewer interventions, and more symptoms assessed
(P=0.004), and more symptoms managed according to PCAD guidelines (P=0.02).
Implementation of PCAD improved care of dying inpatients by increasing documentation
of goals and plans of care, improving symptom assessment and management, and
decreasing interventions at the end of life. Luhrs CA, Meghani S, Homel P,
Drayton M, O'toole E, Paccione M, Daratsos L, Wollner D, Bookbinder M. Reprinted
with permission from J Pain Symptom Manage. 2005 Jun;29(6):544-551.
PMID: 15963862
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15963862&query_hl=7
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