Examining the implementation of outpatient palliative care and its influence on quality of life in patients with a life-limiting condition
Bibliographic record
Abstract
Background: Incorporating home-based palliative care is a new frontier within health care. Many health systems do not have patient access to such services. The need for comprehensive palliative care is inevitable with the aging population. Benefit of initiating palliative medicine for patients with life-limiting illness is known within present literature. The practice gap that exists within palliative medicine is well supported by existing evidence, as is the need to improve access to this style of care. Purpose: The purpose of this study is to embed outpatient palliative care services within the visiting nurses association (VNA) within Wellspan Health. By embedding this service as a needs assessment project, the investigator attempts to demonstrate improved quality of life outcomes and overall improved symptom management. Methods: a pre-test and post-test survey method using a convenience sample within the VNA was conducted assessing symptom control, wellbeing and level of distress. Initial ratings of symptoms including pain, nausea, anxiety, depression, sleep wellbeing, and distress level was documented using the Edmonton Symptom Assessment System and the distress thermometer. Weekly surveys were provided to participants on week one through eight during home visits. Evaluation: Descriptive statistics was used to evaluate the data collected. A Wilcoxon Signed Rank test was used to compare pain, wellbeing and distress scores from initial home visit to the final visit at the end of three weeks. Results: A non-parametric Wilcox Signed Rank test was used to analyze symptom data. When comparing the mean rating from the ESAS from week one (M=35.20, SD= 20.85), to week three (M=30.30, SD= 17.84), overall improvement cannot be generalized with the implementation of palliative care within the home health model. No statistical significance was identified (z= -1.07,p= 0.284). The same was true for the NCCN Distress Thermometer at week one (M= 3.60, SD=2.80), as compared to the end of the study at week three (M= 2.69, SD= 2.69, z= -.049, p=0.623). Clinical Implications: Review of the results does demonstrate some improvement toward improved symptom management, but because of time constraints and limited participation, results were not supportive of the hypothesis of suggested improvement with implementation of outpatient palliative care services within the VNA. Results suggest increase support for completion of symptom management tools and increased study length to demonstrate a more generalizable finding.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.010 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".