Laurie J. Lyckholm

Ethics of rural health care

One quarter of the US population live in areas designated as rural. Delivery of rural health care can be difficult with unique challenges including limited access to specialists such as oncologists. The Rural Cancer Outreach Program is an alliance between an academic medical center and five rural hospitals. Due to the presence of this program, the appropriate use of narcotics for chronic pain has increased, the number of breast conserving surgeries has more than doubled and accrual to clinical trials has gone from zero to nine over the survey period. An increase in adjuvant chemotherapy has been noted. The rural hospitals and the academic center have seen a positive financial impact. The most prominent ethical issues focus on justice, especially access to health care, privacy, confidentiality, medical competency, and the blurring of personal and profession boundaries in small communities. As medical care has become more complex with an increasing number of ethical issues intertwined, the rural hospitals have begun to develop mechanisms to provide help in difficult situations. The academic center has provided expertise and continued education for staff, both individually and within groups, regarding ethical dilemmas.

Clinical and financial impact of a palliative care program at a small rural hospital.

BACKGROUND Palliative care (PC) programs attempt to improve communication and symptom management, and a consequence has been lower cost of in-hospital death. To date, most research has focused on urban large hospitals. This study reports the clinical and financial impact of a new palliative care service at a 76-bed nonprofit hospital located in rural Virginia, Rappahannock General Hospital (RGH). METHODS The RGH PC program started in 2006 with a part-time physician on grant support. We collected the number of consults, physician billing and receipts, and calculated the impact on the hospitals charges for patients treated with concurrent palliative care. RESULTS The program was well accepted clinically with referrals from most of the palliative care physicians colleagues. After the first year of operation, she has about 10 new consults and a total of 45 visits per month. Billings for this year are projected to be

Barriers to Effective Palliative Care for Low-Income Patients in Late Stages of Cancer: Report of a Study and Strategies for Defining and Conquering the Barriers

59,070 and her collections are projected to be

Will patients want hospice or palliative care if they do not know what it is

29,604 (50%). Hospital charges per patient are reduced about

Seasonal Hemolysis Due to Cold-Agglutinin Syndrome

400 per day, or 25%, after a palliative care consultation, which sums to

A principle-based approach to ethical issues in predictive genetic testing for breast cancer

80,000 to

Managing Pain with Algorithms: An Opportunity for Improvement? Or: The Development and Utilization of Algorithms to Manage Acute Pain

130,000 yearly. Referrals to home hospice increased. CONCLUSIONS Palliative care by a dedicated practitioner can work in rural areas. The income will be small, but the operational and financial benefits to the hospital can be significant. This is better care at a cost that rural hospitals and practitioners can afford.

The "PSOST": Providers' Signout for Scope of Treatment.

The discipline of palliative care is growing rapidly in the United States but, as in many other areas of medical care, multiple barriers exist to providing such care to low-income patients with end-stage cancer and other diseases. Reports vary with regard to definition and scope of these and other barriers. This article briefly reports a pilot study of perceived barriers to palliative care and related issues in an urban cancer clinic, reviews the current literature, and suggest ways to identify and overcome such barriers in low-income patients with cancer.

Maximal medical therapy and palliative care can work together: When are advanced care measures appropriate?

Approximately half the patients receiving hospice and palliative care services are those with cancer diagnoses. Both hospice and palliative care are underutilized by African Americans. Awareness of service availability is a prerequisite to accessing services. This study assessed awareness of hospice and palliative care among African American and non-Hispanic white patients at a cancer center. A cross-sectional survey was conducted at an urban, university-affiliated oncology clinic (N = 133). Participants were non-Hispanic white (58%) and African American (42%). Descriptive analyses were conducted to examine demographics and hospice and palliative care awareness. &khgr;2 Tests were used for bivariate comparisons. Knowledge of hospice care was lower among African Americans than whites and among those with limited education. Knowledge of palliative care followed the same pattern, but even fewer people were aware of or could define those services. This lack of awareness may explain the disproportionately low use of hospice and palliative care by African Americans. Improved awareness of hospice and palliative care is a first step toward reducing disparities in utilization of important and useful services for persons with life-limiting illnesses. Lack of awareness may limit access by cancer patients to needed hospice and palliative care.

Ovarian Suppression in the Management of Premenopausal Breast Cancer: Methods and Efficacy in Adjuvant and Metastatic Settings

Figure 1. A 61-year-old roads inspector from Illinois presented in 1992 with hemolytic anemia and acrocyanosis and was found to have cold-agglutinin syndrome. He was treated with plasmapheresis, prednisone, and chlorambucil and then followed without therapy for two years. He continued to work, which involved spending the majority of time outdoors. The patients cold-agglutinin titer exceeded 1:524,288, with a thermal maximum (the temperature at which agglutination occurs in vitro) of 37°C. The severity of the hemolysis, reflected by the lactate dehydrogenase concentration, was related to the ambient temperature, as illustrated. He is currently well and asymptomatic.