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Biomedical subjects

Linda L Emanuel

Publications and source records attributed to Linda L Emanuel.

6 recordsLinked to original sources
PubMed2002

Ensuring competency in end-of-life care: controlling symptoms.

BACKGROUND: Palliative medicine is assuming an increasingly important role in patient care. The Education for Physicians in End-of-life Care (EPEC) Project is an ambitious program to increase core palliative care skills for all physicians. It is not intended to transmit specialty level competencies in palliative care. METHOD: The EPEC Curriculum was developed to be a comprehensive syllabus including trainer notes, multiple approaches to teaching the material, slides, and videos of clinical encounters to trigger discussion are provided. The content was developed through a combination of expert opinion, participant feedback and selected literature review. Content development was guided by the goal of teaching core competencies not included in the training of generalist and non-palliative medicine specialist physicians. RESULTS: Whole patient assessment forms the basis for good symptom control. Approaches to the medical management of pain, depression, anxiety, breathlessness (dyspnea), nausea/vomiting, constipation, fatigue/weakness and the symptoms common during the last hours of life are described. CONCLUSION: While some physicians will have specialist palliative care services upon which to call, most in the world will need to provide the initial approaches to symptom control at the end-of-life.

Journal Article↗
PubMed2002

Managing end-of-life care: comparing the experiences of terminally Ill patients in managed care and fee for service.

There have been no published empirical studies comparing the experiences of terminally ill patients in managed care organizations (MCOs) and those in fee for service (FFS). This investigation represents the first empirical study to systematically compare substantive outcomes between populations of terminally ill patients enrolled in MCO and FFS healthcare delivery systems. The investigators interviewed 988 patients whose physicians judged them to be terminally ill and 893 of their caregivers. Outcomes assessments were made in six domains: patient-physician relationship; access to care and use of health care; prevalence of symptoms; and planning for end-of-life care, care needs, and economic burdens. Overall, the two populations of terminally ill patients were found to have comparable outcomes, but several significant differences were present. MCO patients were more likely than their FFS counterparts to use an inconvenient hospital (P =.02), spend more than 10% of their income on medical care (P =.02), and have been bedridden more than 50% of the time during the last 4 weeks of life (P =.03). Caregivers of MCO patients were as likely as the caregivers of FFS patients to report a substantial caregiving burden (P =.59). Despite concerns about the threats of MCOs to the physician-patient relationship, few differences in the quality of the relationship between the two cohorts were found. Finally, terminally ill patients in MCOs did not show better experiences than those in FFS on any outcome measure. Additional research is required to explore how MCOs may improve upon the care available to dying patients.

Adolescent↗
PubMed2002

Recommendations to improve end-of-life care through regulatory change in U.S. health care financing.

Palliative care has emerged as the interdisciplinary approach to relieving suffering and improving quality of life. Unfortunately, it is not yet available to all who need it. Although legislation may ultimately be needed, regulatory changes can quickly improve the current situation. While we see many regulatory changes that are possible, just three would quickly improve care: adjust hospital payment to include essential palliative care services for hospitalized patients in pertinent Diagnostic Related Groups (DRGs); clarify physician payment for providing palliative care by clarifying guidelines for carriers and paying for case management services; and clarify the Medicare Hospice Benefit by defining the 6 month prognosis in statistical terms.

Diagnosis-Related Groups↗