National Hospice Foundation

African Americans have low engagement in advance care planning (ACP). This has been attributed to healthcare distrust and skepticism about ACP. A better understanding of these attitudes is needed to address health disparities related to end-of-life care. To explore the ACP-related values and beliefs of diverse African American communities across the USA and then the perceived value of an inexpensive end-of-life conversational game. Prospective, convergent, mixed methods cohort study involving fifteen underserved, African American communities across the USA. Of the 428 who attended events at purposively sampled sites, 90% consented to the research; 37% participated in one of 15 focus groups (n = 141). An end-of-life conversation game, played in groups of 4-6. The validated, 7-item ACP values and beliefs questionnaire (scaled 7 = least skeptical, 49 = most skeptical) was administered pre-game. Post-game focus groups explored perceptions about ACP and the intervention. Participants had positive attitudes (low skepticism) about ACP with a median score of 12.00 (7.00, 20.00). Values and beliefs did not significantly differ by geographical region; however, rural areas were observed to be slightly more skeptical than urban areas (median score 14.00 vs. 11.00, p = 0.002). Themes from focus groups converged with survey data showing participants valued the ACP process and consider further engagement in ACP to be worthwhile. Subthemes emphasized the need for and value of ACP. Skepticism about ACP may contribute to low rates of ACP engagement in underserved African American communities. The positive attitudes uncovered in our study either negate previous findings or suggest reduced skepticism. This study has been registered at clinicaltrials.gov ( NCT03456921 ).

Narrative Matters Health AffairsVol. 30, No. 8: New Perspectives On Substance Abuse Hospice And The ‘End Game’Eleanor Clift Affiliations Eleanor Clift ( [email protected] ) is a contributor to Newsweek and Daily Beast ; a panelist on the public affairs show, The McLaughlin Group ; and the author of Two Weeks of Life: A Memoir of Love, Death, and Politics (Basic Books, 2008). She joined the National Hospice Foundation board as an advocate in 2006. PUBLISHED:August 2011No Accesshttps://doi.org/10.1377/hlthaff.2011.0197AboutSectionsView articleView Full TextView PDFPermissions ShareShare onFacebookTwitterLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions View articleAbstractAfter her husband’s death from cancer, a veteran reporter concludes that hospice “should be front and center in the debate over the kind of health care future that we want.”TOPICSHospiceCancerPalliative careDiseasesSurgeryCancer patientsMedicare savings programsMedicareClinicsNurses Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article MetricsCitations: Crossref 1 History Published online 1 August 2011 Information Project HOPE—The People-to-People Health Foundation, Inc. PDF downloadCited byA Literature Review on Care at the End-of-Life in the Emergency DepartmentEmergency Medicine International, Vol. 2012

This feature is based on actual questions and answers received and responded to by the Hospice Foundation of America (HFA). This is a service provided for families and support group members of patients with advanced disease by William M. Lamers, MD, HFA Medical Consultant a member of this Journal's Editorial Board. Effective ways to communicate with families and support groups of patients with advanced disease are presented. In this issue, queries and responses are presented addressing the definition of palliative care, cancer without pain, when to contact a hospice, when to treat multiple myeloma, pneumonia at end-of-life.

In the controlled trial of Kameyama et al., methyl-B12, a neurotropic vitamin of the B-complex proved to be safe and effective for diabetic neuropathy. There are several open trials upon the diseases of cranial nerve in otolaryngology, such as hearing loss and facial palsy. We determined the effectiveness of this drug in 40 patients with peripheral vertigo in an open trial.Concerning vestibular symptoms, i. e. vertigo and dizziness, 84% of the patients experienced relief while on 6tab/day (3000μg/day) for 4-6 weeks.The most significant results as determined by the equilibrium function test were as follows; (1) the caloric tests showed a restoration of the disequilibrium in labyrinthine excitability on the level of 1% of significance. (2) the vertical writing tests yielded a significant (p<0.005) improvement in deviation toward the affected ear which corresponds to the restoration in the caloric tests.One patient complained slight anorexia and alimentally discomfort (2.5%).