End of Life Care's Ongoing Evolution.

Publisher: Lippincott, Williams & Wilkins Country of Publication: United States NLM ID: 101291585 Publication Model: Print Cited Medium: Internet ISSN: 1932-8095 (Electronic) Linking ISSN: 19328087 NLM ISO Abbreviation: Prof Case Manag

Original Publication: Philadelphia, PA : Lippincott, Williams & Wilkins c2007-

Advance Directives* ; Right to Die*; Case Management/*organization & administration ; Case Managers/*education ; Education, Nursing, Continuing/*organization & administration ; Palliative Care/*organization & administration ; Terminal Care/*organization & administration; Adult ; Curriculum ; Female ; Humans ; Longitudinal Studies ; Male ; Middle Aged ; United States

Purpose/objectives: PRIMARY PRACTICE SETTINGS:: Applicable to all settings across the transitions of care where case management practice occurs.
Findings/conclusions: Continuing shifts in society's cultural landscape, ongoing emphasis on value versus volume, and other industry fiscal imperatives continue to evoke an evolution in end-of-life care. The attainment of successful outcomes by professional case managers with those populations will be dependent on awareness and comprehension of regulations, legislation, and reimbursement; the influences of ongoing industry trends; availability of emerging resources; and ongoing technological advances. Ethical excellence remains at the core of case management across the interprofessional workforce and the transitions of care.
Implications for Case Management Practice: The professional case management workforce is tasked to effectively intervene across diverse client populations, with their caregivers and support systems. This action spans every life stage and illness course. With end-of-life care treatment and processes continuing to receive prime industry attention, case managers must be knowledgeable of the moving parts of this arena. Awareness of the ethical edges of each professional's sandbox is essential to quality-driven case management practice.

Acquaviva K. D. (2017). Chapter 1, Self-awareness and communication. In LGBTQ-inclusive hospice and palliative care: A practical guide to transforming professional practice (1st ed., pp. 2–14). New York, NY and York, United Kingdom: Harrington Park Press.
American Medical Association. (2017). Code of medical ethics. Chicago, IL: Author.
American Nurses Association. (2015). Code of ethics. Silver Spring, MD: Author.
American Society of Transplantation. (2019). Key position statements. Retrieved November 13, 2019, from https://www.myast.org/public-policy/key-position-statements/key-position-statements.
Arcadia Health Solutions. (2016). The final year: Visualizing the end of life. Retrieved November 11, 2019, from https://www.arcadia.io/final-year-visualizing-end-life/.
Banach E. (2019, February 22). Congress: To better understand value-based care, look to hospice. Morning Consult. Retrieved November 9, 2019, from https://morningconsult.com/opinions/congress-better-understand-value-based-care-look-hospice/.
Bélanger E., Rodríguez C., Groleau D., Légaré F., MacDonald M. E., Marchand R. (2016). Patient participation in palliative care decisions: An ethnographic discourse analysis. International Journal of Qualitative Studies on Health and Well-Being, 11, 32438. doi:10.3402/qhw.v11.32438.
Bernstein R. H., Singh L. A. (2019). A value-based payment model for palliative care: An analysis of savings and return on investment. Journal of Ambulatory Care Management, 42(1), 66–73.
Center to Advance Palliative Care, National Palliative Care Research Center. (2019). America's care of serious illness 2019. Retrieved November 9, 2019, from https://reportcard.capc.org/.
Centers for Medicare & Medicaid Services. (2018, January 29). Medicare care choices model awards. Newsroom: FAQs. Retrieved November 8, 2019, from https://www.cms.gov/newsroom/fact-sheets/medicare-care-choices-model-awards.
Centers for Medicare & Medicaid Services. (2019a). Medicare advantage value-based insurance design model. Retrieved November 11, 2019, from https://innovation.cms.gov/initiatives/vbid.
Centers for Medicare & Medicaid Services. (2019b). Medicare care choices model. Retrieved November 8, 2019, from https://innovation.cms.gov/initiatives/Medicare-Care-Choices/.
Cheney C. (2019). Break hospital SNF cycle at end of life. HealthLeaders Media. Retrieved February 20, 2019, from https://www.healthleadersmedia.com/clinical-care/break-hospital-snf-hospital-cycle-end-life.
Colorado General Assembly. (2019). HB19-1044 advance behavioral health orders treatment. Retrieved November 12, 2019, from https://leg.colorado.gov/bills/hb19-1044.
Commission for Case Manager Certification. (2015). Code of professional conduct for case managers with standards, rules, procedures and penalties. Mount Laurel, NJ: Author.
Courtright K. R., Chivers C., Becker M. J., Regli S. H., Pepper L. C., Draugelis M. E., O'Connor N. O. (2019). Electronic health record mortality prediction model for targeted palliative care among hospitalized medical patients: A pilot quasi-experimental study. Journal of General Internal Medicine, 34(9), 1841–1847.
Death with Dignity. (2019a). California: Current states: The End of Life Option Act is in effect. Retrieved November 13, 2019, from https://www.deathwithdignity.org/states/california/.
Death with Dignity. (2019b). Take action in your state. Retrieved November 12, 2019, from https://www.deathwithdignity.org/take-action/.
Dictionary.com. (n.d.) Right to die. Retrieved November 10, 2019, from https://www.dictionary.com/browse/right-to-die.
Fink-Samnick E. (2016). The evolution of end of life care: Ethical implications for case management. Professional Case Management, 21(4), 180–192.
Fink-Samnick E. (2019a). Chapter 3: Population Health focused challenges. In The social determinants of health: Case management's next frontier. Middleton, MA: HCPro.
Fink-Samnick E. (2019b). Chapter 4: Care considerations to challenge ethical excellence. In The essential guide to interprofessional ethics in healthcare case management (pp. 67–95). Middleton, MA: HCPro.
Firger J. (2017, July 22). Can a child refuse to comply with cancer treatment? Newsweek Magazine, Tech & Science. Retrieved November 10, 2019, from https://www.newsweek.com/mature-minor-cancer-treatment-kids-640662.
French E. B., McCauley J., Aragon M., Bakx P., Chalkley M., Chen S. H., Kelly E. (2017).End of life medical spending the last 12 months of life is lower than previously reported. Health Affairs (Millwood), 36(7), 1211–1217. doi:10.1377/hlthaff.2017.0174.
George A., Grodin M. (2016). Hospital ethics committees, consultants, and courts. AMA Journal of Ethics, 18(5), 554–559. Retrieved November 10, 2019, from https://journalofethics.ama-assn.org/article/hospital-ethics-committees-consultants-and-courts/2016-05.
Gooch K. (2018, October 25). SDoH contributes to over ½ of readmissions. Beckers Hospital News. Retrieved November 10, 2019, from https://www.beckershospitalreview.com/population-health/social-determinants-of-health-contributed-to-half-of-hospital-readmissions-study-finds.html.
Heath S. (2019, October 29). Algorithm identifies patients for end-of-life care communication. Patient Engagement HIT. Retrieved November 9, 2019, from https://patientengagementhit.com/news/algorithm-identifies-patients-for-end-of-life-care-communication.
Hoffman J., Goodnough A. (2019, March 6). Good news: Opioid prescribing fell. The Bad? Pain patients suffer, doctors say. New York Times. Retrieved November 10, 2019, from https://www.nytimes.com/2019/03/06/health/opioids-pain-cdc-guidelines.html.
Human Resources and Services Administration. (2019). Organ donation statistics. Retrieved November 13, 2019, from https://www.organdonor.gov/statistics-stories/statistics.html.
Institute of Medicine. (2015). Dying in America: Improving quality and honoring individual preferences near the end of life. Washington, DC: The National Academies Press.
Jha A. K. (2018, July 13). End of life care, not end of life spending. JAMA Forum. Retrieved September 5, 2019, from https://newsatjama.jama.com/2018/07/13/jama-forum-end-of-life-care-not-end-of-life-spending/.
John A., Hartford Foundation. (2017). Improving advance care planning: Research results from the “conversation starters” focus groups and “conversation stopper” physician survey. Retrieved October 30, 2019, from https://www.johnahartford.org/dissemination-center/view/advance-care-planning-poll#.
Karlin-Smith S., Ehley B. (2019, May 8). 5 unintended consequences of addressing the opioid crisis. Politico. Retrieved November 10, 2019, from https://www.politico.com/story/2018/05/08/opioid-epidemic-consequences-502619.
Kyle M. A., Blendon R. J., Benson J. M., Abrams M. K., Schneider E. C. (2019). Financial hardships of Medicare beneficiaries with serious illness. Health Affairs (Millwood), 38(11), 1801–1806.
McCabe M. (2015). Reenergizing the hospital ethics committee: An opportunity for nursing. Journal of Hospice and Palliative Nursing, 17(6), 480–487.
McNary A. (2014). Consent to treatment of minors. Innovations in Clinical Neuroscience, 11(3–4), 43–45.
Merriam Webster. (2018a). Euthanasia. Retrieved November 24, 2018, from https://www.merriam-webster.com/dictionary/euthanasia.
Merriam-Webster. (2018b). Physician-assisted suicide. Retrieved November 9, 2019, from https://www.merriam-webster.com/dictionary/physician-assisted%20suicide/.
Mosby's Medical Dictionary. (n.d.). Death with Dignity (2009). Retrieved November 10, 2019, from https://medical-dictionary.thefreedictionary.com/death+with+dignity.
Muller L. (2019). Chapter 8, Legal considerations in case management practice. In Powell S. K., Tahan H. M (Eds.), Case management: A practical guide for education and practice (4th ed., pp. 247–285). Philadelphia, PA: Wolters Kluwer.
NAMI. (2019). Psychiatric advanced directives. Retrieved October 29, 2019, from https://www.nami.org/Learn-More/Mental-Health-Public-Policy/Psychiatric-Advance-Directives-(PAD).
National Association of Social Workers. (2017). Code of ethics. Washington, DC: Author.
National Hospice and Palliative Care Organization. (2018a). CaringInfo, advance directives. Retrieved November 12, 2019, from http://www.caringinfo.org/i4a/pages/index.cfm?pageid=3285.
National Hospice and Palliative Care Organization. (2018b). Hospice care. Retrieved November 10, 2019, from https://www.nhpco.org/about/hospice-care.
National Hospice and Palliative Care Organization. (2019). Facts and figures 2018 edition, revision 7/19. Retrieved November 13, 2019, from https://www.nhpco.org/research/.
National Resource Center on Psychiatric Advance Directives (n.d.). Getting started. Retrieved November 10, 2019, from https://www.nrc-pad.org.
N.J. Department of Human Services. (2019, June 27). Human services launches secure Internet registry for psychiatric advanced directives, health and wellness, SOMA neighborhood news online. Retrieved November 12, 2019, from https://www.tapinto.net/towns/soma/categories/press-releases/articles/human-services-launches-secure-internet-registry-for-psychiatric-advanced-directives-20.
Obermeyer Z., Makar M., Abujaber S., Dominici F., Block S., Cutler D. M. (2014). Association between the Medicare hospice benefit and healthcare utilization and costs for patients with poor-prognosis cancer. JAMA, 312(18), 1888–1896.
Parker J. (2019, March 22). Questions abound on the Medicare advantage hospice carve-in. Hospice News. Retrieved November 11, 2019, from https://hospicenews.com/2019/03/22/uncertainties-abound-on-ma-hospice-carve-in%EF%BB%BF/.
Payne E. (2018, October 12). How close is your death? New algorithm can tell patients how long they have to live. Ottawa Citizen. Retrieved November 11, 2019, from https://ottawacitizen.com/news/local-news/how-close-is-your-death-new-algorithm-can-tell-patients-how-long-they-have-to-live.
Peckman C. (2016, April 1). Medscape physician compensation report 2016. Medscape. Retrieved November 9, 2019, from https://www.medscape.com/features/slideshow/compensation/2016/public/overview?src=wnl_physrep_160401_mscpedit&uac=232148CZ&impID=1045700&faf=1.
POLST.org. (2018). POLST paradigm program. Retrieved November 12, 2019, from http://polst.org.
Premier. (2019). Ready, risk, reward: Improving care for patients with chronic conditions. Charlotte, NC: Author.
ProjectBigLife Canada. (2019). Elder life (RESPECT) calculator. Retrieved November 11, 2019, from https://www.projectbiglife.ca/elder-life-calculator.
Schulman L. (2019, November 1). The potential of value-based care in oncology. Interview American Journal of Managed Care. Retrieved November 10, 2019, from https://www.ajmc.com/interviews/dr-lawrence-shulman-outlines-the-potential-of-valuebased-care-in-oncology.
Sedig L. (2016). What's the role of autonomy in patient and family-centered care when patients and family members don't agree? American Medical Association Journal of Ethics, 18(1), 12–17.
Shakerdge K. (2016, December 26). A dying man's wish to donate his organs gets complicated. NPR Health Shots. Retrieved September 30, 2018, from https://www.npr.org/sections/health-shots/2016/12/26/499494248/a-dying-man-s-wish-to-donate-his-organs-gets-complicated.
Super N., Ahuja R., Proff K. (2019). Reducing the cost and risk of dementia. Santa Monica, CA: Milken Institute. Retrieved November 13, 2019, from https://milkeninstitute.org/reports/reducing-cost-and-risk-dementia.
Thomas K. S., Durfey S. N. M., Gadbois E. A., Meyers D. J., Brazer J. F., McCreedy E. M., Wetle T. (2019). Perspectives of Medicare advantage plan representatives on addressing social determinants of health in response to the CHRONIC Care Act. JAMA Open Network, 2(7):e196923.
University of Washington School of Medicine. (2013). Ethics committees, programs and consultation; ethics in medicine. Retrieved October 1, 2018, from https://depts.washington.edu/bioethx/topics/ethics.html.
Whitcomb W. (2016, August). Providing effective palliative care in the era of value. The Hospitalist. Retrieved November 9, 2019, from https://www.the-hospitalist.org/hospitalist/article/121554/hospice-palliative-medicine/providing-effective-palliative-care-era-value.
Worldwide Palliative Care Alliance and World Health Organization. (2014). World Health Organization global atlas of palliative care at the end of life. Retrieved November 12, 2010, from http://www.thewhpca.org/resources/global-atlas-on-end-of-life-care.

Date Created: 20200403 Date Completed: 20201214 Latest Revision: 20210213

20221213

10.1097/NCM.0000000000000417

32235194