Improving Palliative Care with Deep Learning

Improving the quality of end-of-life care for hospitalized patients is a priority for healthcare organizations. Studies have shown that physicians tend to over-estimate prognoses, which in combination with treatment inertia results in a mismatch between patients wishes and actual care at the end of life. We describe a method to address this problem using Deep Learning and Electronic Health Record (EHR) data, which is currently being piloted, with Institutional Review Board approval, at an academic medical center. The EHR data of admitted patients are automatically evaluated by an algorithm, which brings patients who are likely to benefit from palliative care services to the attention of the Palliative Care team. The algorithm is a Deep Neural Network trained on the EHR data from previous years, to predict all-cause 3-12 month mortality of patients as a proxy for patients that could benefit from palliative care. Our predictions enable the Palliative Care team to take a proactive approach in reaching out to such patients, rather than relying on referrals from treating physicians, or conduct time consuming chart reviews of all patients. We also present a novel interpretation technique which we use to provide explanations of the model's predictions.Comment: IEEE International Conference on Bioinformatics and Biomedicine 201

Improving Care at the End of Life

Reviews RWJF's investments in improving end-of-life care, impact on the field, and lessons learned, including the need to coordinate objectives, integrate strategies, tie strategies to policy changes and incentives, and link communications and evaluation

Widening Access to Palliative Care for People with Learning Disabilities

This publication represents an important step towards greater partnership by sharing some of the thinking, good practice and resources that have been developed throughout learning disability and end of life care services in a form that will be accessible to all practitioners but especially those in a hospice setting. It includes sections on the definition and incidence of learning disability, healthcare for people with learning disability, as well as a glossary and an extensive section on resources

Medical student confidence to care for a dying patient and their family: a systematic review

Background: The General Medical Council expects medical graduates to care for dying patients with skill, clinical judgement and compassion. UK surveys continually demonstrate low confidence and increasing distress amongst junior doctors when providing care to the dying. Aim: This systematic review aims to determine what has been evidenced within worldwide literature regarding medical undergraduate confidence to care for dying patients. Design: A systematic electronic search was undertaken. Data extraction included measurements of baseline confidence, associated assessment tools, and details of applied educational interventions. Pre/post-intervention confidence comparisons were made. Factors influencing confidence levels were explored. The review was prospectively registered via PROSPERO (CRD42019119057). Data sources: MEDLINE, CINAHL, EMBASE, ISI Web of Science, ERIC, PsychINFO, British Education Index and Cochrane Review databases were accessed, with no restrictions on publication year. Eligible studies included the terms ‘medical student’, ‘confidence’, and ‘dying’, alongside appropriate MeSH headings. Study quality was assessed using the Mixed Methods Appraisal Tool. Results: Fifteen eligible studies were included, demonstrating a diversity of assessment tools. Student confidence was low in provision of symptom management, family support, and psycho-spiritual support to dying patients. Eight interventional studies demonstrated increased post-interventional confidence. Lack of undergraduate exposure to dying patients and lack of structure within undergraduate palliative care curricula were cited as factors responsible for low confidence. Conclusion: This review clarifies the objective documentation of medical undergraduate confidence to care for the dying. Identifying where teaching fails to prepare graduates for realities in clinical practice will help inform future undergraduate palliative care curriculum planning

Interventions at the end of life – a taxonomy for ‘overlapping consensus’

Context: Around the world there is increasing interest in end of life issues. An unprecedented number of people dying in future decades will put new strains on families, communities, services and governments. It will also have implications for representations of death and dying within society and for the overall orientation of health and social care. What interventions are emerging in the face of these challenges? Methods: We conceptualize a comprehensive taxonomy of interventions, defined as ‘organized responses to end of life issues’. Findings: We classify the range of end of life interventions into 10 substantive categories: policy, advocacy, educational, ethico-legal, service, clinical, research, cultural, intangible, self-determined. We distinguish between two empirical aspects of any end of life intervention: the ‘locus’ refers to the space or spaces in which it is situated; the ‘focus’ captures its distinct character and purpose. We also contend that end of life interventions can be seen conceptually in two ways – as ‘frames’ (organized responses that primarily construct a shared understanding of an end of life issue) or as ‘instruments’ (organized responses that assume a shared understanding and then move to act in that context). Conclusions: Our taxonomy opens up the debate about end of life interventions in new ways to provide protagonists, activists, policy makers, clinicians, researchers and educators with a comprehensive framework in which to place their endeavours and more effectively to assess their efficacy. Following the inspiration of political philosopher John Rawls, we seek to foster an ‘overlapping consensus’ on how interventions at the end of life can be construed, understood and assessed

End-of-Life Heart Failure Education With Staff Nurses; A Quality Improvement Project

Presented to the Faculty of the University of Alaska Anchorage in Partial Fulfillment of the Requirements for the Degree of MASTER OF SCIENCEHeart failure (HF) is a serious diagnosis and a major public health concern. The symptoms can be exhausting and can vary from person to person with periods of acute exacerbations requiring hospital admission. It is important for hospital staff nurses to be able to speak with knowledge and comfort about end‐of‐life planning. The purpose of this quality improvement project was to increase nurses’ awareness of the functional classification systems of HF, options and timing for palliative care, and describe nurses’ intent to use the information in practice. Nurses reported planning on using the information to “Be more Sensitive and Listen.” The prevailing theme to barriers to implementing this into practice was “Not enough time and discomfort.” Nurses who were comfortable having end‐of‐life discussions did not feel they had enough time, and those who were not comfortable did not engage because of discomfort toward the topic. Furthermore, recommendations from this study were the addition of a supportive palliative care team to manage patients with HF.End-of-Life Heart Failure Education with Staff Nurses; A Quality Improvement Project / Abstract / Table of Contents / Project / Background and Significant / Project Purpose / Literature Review / Methods / Analysis and Findings / Dissemination / Discussion / Conclusion / Impact on Practice / References / Appendix A New York Heart Failure Classification System / Appendix B Plan-Do-Check-Act Cycle / Appendix C Consent Form / Appendix D IRB Approval Letter / Appendix E Permission Letter / Appendix F Pre-Education Survey / Appendix G Post-Education Survey / Appendix H Case Study #1 / Appendix I Case Study #2 / Appendix J 'Do' Phase Education Intervention Lesson Plan / Appendix K Themes from QI Projec

Global Innovations in Measurement and Evaluation

We researched the latest developments in theory and practice in measurement and evaluation. And we found that new thinking, techniques, and technology are influencing and improving practice. This report highlights 8 developments that we think have the greatest potential to improve evaluation and programme design, and the careful collection and use of data. In it, we seek to inform and inspire—to celebrate what is possible, and encourage wider application of these ideas

Outlook Magazine, Winter 2015

https://digitalcommons.wustl.edu/outlook/1197/thumbnail.jp

Breaking the Barriers to Specialty Care: Practical Ideas to Improve Health Equity and Reduce Cost - Striving for Equity in Specialty Care Full Report

Tremendous health outcome inequities remain in the U.S. across race and ethnicity, gender and sexual orientation, socio-economic status, and geography—particularly for those with serious conditions such as lung or skin cancer, HIV/AIDS, or cardiovascular disease.These inequities are driven by a complex set of factors—including distance to a specialist, insurance coverage, provider bias, and a patient's housing and healthy food access. These inequities not only harm patients, resulting in avoidable illness and death, they also drive unnecessary health systems costs.This 5-part series highlights the urgent need to address these issues, providing resources such as case studies, data, and recommendations to help the health care sector make meaningful strides toward achieving equity in specialty care.Top TakeawaysThere are vast inequalities in access to and outcomes from specialty health care in the U.S. These inequalities are worst for minority patients, low-income patients, patients with limited English language proficiency, and patients in rural areas.A number of solutions have emerged to improve health outcomes for minority and medically underserved patients. These solutions fall into three main categories: increasing specialty care availability, ensuring high-quality care, and helping patients engage in care.As these inequities are also significant drivers of health costs, payers, health care provider organizations, and policy makers have a strong incentive to invest in solutions that will both improve outcomes and reduce unnecessary costs. These actors play a critical role in ensuring that equity is embedded into core care delivery at scale.

History, culture and traditions: the silent spaces in the study of spirituality at the end of life

Recent increase in the number of studies on spirituality manifests growing recognition of the importance of spirituality, as well as mounting interest in studying spirituality in healthcare. Most studies on spirituality in end of life care focus on identifying specific features of spirituality and often represent an individualistic understanding of spirituality. They seldom engage in a historical–cultural exploration of the contextual meanings of those features of spirituality. This paper aims to demonstrate the absence of contextual factors in studying spirituality at the end of life and to highlight the growing recognition of the importance of history, culture and traditions as resources to enrich our understanding of spirituality. An exploration of the concept of spirituality, an overview of the trajectory of the study of spirituality and a review of existing methodological stances reveal the silent space in current approaches to understanding spirituality at the end of life. Recognition of the importance of these contextual factors in understanding spirituality is growing, which is yet to influence the conceptualization and the conduct of spirituality research. Contextual understandings of spirituality that incorporate insights from the history, culture and traditions of specific contexts can inform effective means for providing spiritual support in clinical practice