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  1. Article: The role of geriatric palliative care in hospitalized older adults.

    Santivasi, Wil L / Partain, Daniel K / Whitford, Kevin J

    Hospital practice (1995)

    2019  Volume 48, Issue sup1, Page(s) 37–47

    Abstract: Take-Away Points:1. Geriatric palliative care requires integrating the disciplines of hospital medicine and palliative care in pursuit of delivering comprehensive, whole-person care to aging patients with serious illnesses.2. Older adults have unique ... ...

    Abstract Take-Away Points:1. Geriatric palliative care requires integrating the disciplines of hospital medicine and palliative care in pursuit of delivering comprehensive, whole-person care to aging patients with serious illnesses.2. Older adults have unique palliative care needs compared to the general population, different prevalence and intensity of symptoms, more frequent neuropsychiatric challenges, increased social needs, distinct spiritual, religious, and cultural considerations, and complex medicolegal and ethical issues.3. Hospital-based palliative care interdisciplinary teams can take many forms and provide high-quality, goal-concordant care to older adults and their families.
    MeSH term(s) Aged ; Aged, 80 and over ; Aging ; Cultural Characteristics ; Geriatric Assessment ; Health Services for the Aged/organization & administration ; Hospitalization ; Humans ; Interprofessional Relations ; Palliative Care/organization & administration ; Palliative Care/psychology ; Patient Care Team/organization & administration ; Religion
    Language English
    Publishing date 2019-12-22
    Publishing country England
    Document type Journal Article
    ZDB-ID 2570453-9
    ISSN 2377-1003 ; 2154-8331 ; 8750-2836
    ISSN (online) 2377-1003
    ISSN 2154-8331 ; 8750-2836
    DOI 10.1080/21548331.2019.1703707
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  2. Article ; Online: Music Therapy Intervention to Reduce Symptom Burden in Hospice Patients: A Descriptive Study.

    Estell, Madison H / Whitford, Kevin J / Ulrich, Angela M / Larsen, Brianna E / Wood, Christina / Bigelow, Maureen L / Dockter, Travis J / Schoonover, Kimberly L / Stelpflug, Amy J / Strand, Jacob J / Walton, Monica P / Lapid, Maria I

    The American journal of hospice & palliative care

    2024  , Page(s) 10499091241237991

    Abstract: Background: ...

    Abstract Background:
    Language English
    Publishing date 2024-03-19
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1074344-3
    ISSN 1938-2715 ; 1049-9091
    ISSN (online) 1938-2715
    ISSN 1049-9091
    DOI 10.1177/10499091241237991
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  3. Article ; Online: Ethical considerations of maternal-fetal surgery.

    Rousseau, Abigail C / Riggan, Kirsten A / Schenone, Mauro H / Whitford, Kevin J / Pittock, Siobhan T / Allyse, Megan A

    Journal of perinatal medicine

    2022  Volume 50, Issue 5, Page(s) 519–527

    Abstract: The practice of maternal-fetal surgery (MFS) has expanded from lethal fetal conditions to conditions which are significantly disabling but not a lethal fetal abnormality. The inclusion of myelomeningocele within the scope of MFS in the 1990s sparked a ... ...

    Abstract The practice of maternal-fetal surgery (MFS) has expanded from lethal fetal conditions to conditions which are significantly disabling but not a lethal fetal abnormality. The inclusion of myelomeningocele within the scope of MFS in the 1990s sparked a renewed debate over the ethics of MFS. While demonstrating increasing efficacy and range of application, MFS continues to be ethically fraught due to the inherent tension between maternal and fetal interests. Ethical issues central to MFS include the patienthood of the fetus; the balance of risks and benefits between the woman and fetus; informed consent for experimental procedures; and determination of conditions that meet ethical qualifications for MFS intervention. These concerns are likely to persist and evolve as perinatal medicine continues to advance. Here we summarize the current state of MFS ethics, highlighting the major positions in the literature thus far as well as examine future directions. It is essential robust discussions of these important issues continue both to ensure ethical medical practice and to provide support to clinicians, pregnant women, and their families.
    MeSH term(s) Ethics, Medical ; Female ; Fetal Diseases/surgery ; Fetal Therapies ; Fetus/surgery ; Humans ; Pregnancy ; Pregnant Women
    Language English
    Publishing date 2022-01-31
    Publishing country Germany
    Document type Journal Article ; Review
    ZDB-ID 123512-6
    ISSN 1619-3997 ; 0300-5577 ; 0936-174X
    ISSN (online) 1619-3997
    ISSN 0300-5577 ; 0936-174X
    DOI 10.1515/jpm-2021-0476
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  4. Article ; Online: Music Therapy Intervention to Reduce Caregiver Distress at End of Life: A Feasibility Study.

    Whitford, Kevin J / Ulrich, Angela M / Larsen, Brianna E / Phelps, Christina M / Siska, Martha J / Bigelow, Maureen L / Dockter, Travis J / Wood, Christina / Walton, Monica P / Stelpflug, Amy J / Lapid, Maria I

    Journal of pain and symptom management

    2023  Volume 65, Issue 5, Page(s) e417–e423

    Abstract: Background: Music therapy (MT) can relieve distressing end-of-life symptoms, but little is known regarding its effect on caregivers who are at risk for emotional distress as their loved ones approach death.: Measures: Quality of life (Linear Analogue ...

    Abstract Background: Music therapy (MT) can relieve distressing end-of-life symptoms, but little is known regarding its effect on caregivers who are at risk for emotional distress as their loved ones approach death.
    Measures: Quality of life (Linear Analogue Self-Assessment), depressive and anxiety symptoms (Patient Health Questionnaire for Depression and Anxiety), and stress (Role Overload Measure) pre-MT, post-MT and at 6-month follow-up, as well as a satisfaction survey post-MT.
    Intervention: Single MT session for 20-45 minutes OUTCOMES: 15/20 completed MT intervention, 14 also completed pre-MT and post-MT assessments, and 9 completed assessments at all 3 timepoints. Post-MT satisfaction survey (n=14) showed 100% of caregivers were very satisfied with MT and would recommend to others, and found MT very effective for emotional support (85.7%), stress relief (78.6%), spiritual support (71.4%), general feeling of wellness (71.4%), relaxation (69.2%), and pain relief (33.3%).
    Conclusions: Research on MT is feasible for caregivers of inpatient hospice patients.
    Trial registration: ClinicalTrials.gov Identifier: NCT03322228.
    MeSH term(s) Humans ; Caregivers/psychology ; Quality of Life/psychology ; Music Therapy ; Feasibility Studies ; Death
    Language English
    Publishing date 2023-01-19
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 639142-4
    ISSN 1873-6513 ; 0885-3924
    ISSN (online) 1873-6513
    ISSN 0885-3924
    DOI 10.1016/j.jpainsymman.2023.01.009
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  5. Article ; Online: Addressing the Needs of International Patients at End of Life in a Tertiary Care Medical Center.

    Whitford, Kevin J / Hines, Stephanie L / Bydon, Mohamad / Hayes, David L

    Mayo Clinic proceedings

    2018  Volume 93, Issue 12, Page(s) 1698–1699

    MeSH term(s) Hospice Care ; Humans ; Terminal Care ; Tertiary Care Centers ; Tertiary Healthcare
    Language English
    Publishing date 2018-12-06
    Publishing country England
    Document type Editorial ; Comment
    ZDB-ID 124027-4
    ISSN 1942-5546 ; 0025-6196
    ISSN (online) 1942-5546
    ISSN 0025-6196
    DOI 10.1016/j.mayocp.2018.10.015
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  6. Article ; Online: Ethical considerations of maternal-fetal intervention in a twin pregnancy discordant for anomalies.

    Riggan, Kirsten A / Collura, Christopher A / Pittock, Siobhan T / Ruano, Rodrigo / Whitford, Kevin J / Allyse, Megan

    The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians

    2019  Volume 34, Issue 8, Page(s) 1312–1317

    Abstract: Background: Recent evidence suggests prenatal fetoscopic tracheal occlusion (FETO) may improve the survival and long-term morbidity of neonates with congenital diaphragmatic hernia, yet little guidance exists in the medical literature as to the ethical ... ...

    Abstract Background: Recent evidence suggests prenatal fetoscopic tracheal occlusion (FETO) may improve the survival and long-term morbidity of neonates with congenital diaphragmatic hernia, yet little guidance exists in the medical literature as to the ethical permissibility of performing a maternal-fetal surgical intervention in a twin pregnancy discordant for a structural abnormality.
    Case: Here, we present a case of a twin pregnancy with an unaffected twin (Twin A) and a twin diagnosed with severe congenital diaphragmatic hernia (Twin B). A proposed fetoscopic tracheal occlusion (FETO) procedure may improve the likelihood of survival and postnatal outcome of Twin B; however, balloon placement may also initiate very preterm birth at 28 weeks of gestation. The Fetal Ethics Advisory Board was asked to provide guidance on the permissibility of FETO in this pregnancy.
    Discussion: A literature review identified one brief mention of FETO in a 34-week dichorionic twin pregnancy in the medical literature, which resulted in the rupture of fetal membranes in the sac of the nonsurgical twin. Only one paper specifically addressed the question of whether it would be ethically permissible to subject a healthy twin to the risks of maternal-fetal surgery for the benefit of a compromised twin, finding that any risk to the unaffected twin would be an ethical contraindication. We offer our own analysis of moral weight and risk/benefit considerations of this proposed intervention, and present our findings on the circumstances in which it may be ethically permissible to perform a maternal-fetal intervention in a twin pregnancy.
    Conclusion: While FETO was not ethically advisable in this pregnancy, we find that in limited circumstances, certain maternal-fetal surgical interventions may be ethically permissible in a twin pregnancy discordant for a structural abnormality if the risks to the unaffected twin are minimal and the procedure would improve the likelihood of survival and postnatal outcome of a critically compromised co-twin.
    MeSH term(s) Balloon Occlusion ; Female ; Fetoscopy ; Hernias, Diaphragmatic, Congenital/surgery ; Humans ; Infant, Newborn ; Morals ; Pregnancy ; Pregnancy, Twin ; Premature Birth ; Trachea
    Language English
    Publishing date 2019-06-20
    Publishing country England
    Document type Case Reports ; Journal Article
    ZDB-ID 2077261-0
    ISSN 1476-4954 ; 1057-0802 ; 1476-7058
    ISSN (online) 1476-4954
    ISSN 1057-0802 ; 1476-7058
    DOI 10.1080/14767058.2019.1631793
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  7. Article ; Online: Identifying patients at risk of inhospital death or hospice transfer for early goals of care discussions in a US referral center: the HELPS model derived from retrospective data.

    Romero-Brufau, Santiago / Whitford, Daniel / Whitford, Kevin J / Manning, Dennis M / Huddleston, Jeanne M

    BMJ open

    2018  Volume 8, Issue 1, Page(s) e015550

    Abstract: Objective: Create a score to identify patients at risk of death or hospice placement who may benefit from goals of care discussion earlier in the hospitalisation.: Design: Retrospective cohort study to develop a risk index using multivariable ... ...

    Abstract Objective: Create a score to identify patients at risk of death or hospice placement who may benefit from goals of care discussion earlier in the hospitalisation.
    Design: Retrospective cohort study to develop a risk index using multivariable logistic regression.
    Setting: Two tertiary care hospitals in Southeastern Minnesota.
    Participants: 92 879 adult general care admissions (50% male, average age 60 years).
    Primary and secondary outcome measures: Our outcome measure was an aggregate of inhospital death or discharge to hospice. Predictor variables for the model encompassed comorbidities, nutrition status, functional status, demographics, fall risk, mental status, Charlson Comorbidity Index and acuity of illness on admission. Resuscitation status, race, geographic area of residence and marital status were added as covariates to account for confounding.
    Results: Inhospital mortality and discharge to hospice were rare, with incidences of 1.2% and 0.8%, respectively. The Hospital End-of-Life Prognostic Score (HELPS) demonstrated good discrimination (C-statistic=0.866 in derivation set and 0.834 in validation set). The patients with the highest 5% of scores had an 8% risk of the outcome measure, relative risk 12.9 (10.9-15.4) when compared to the bottom 95%.
    Conclusions: HELPS is able to identify patients with a high risk of inhospital death or need for hospice at discharge. These patients may benefit from early goals of care discussions.
    MeSH term(s) Adolescent ; Adult ; Aged ; Aged, 80 and over ; Comorbidity ; Female ; Hospice Care ; Hospital Mortality ; Humans ; Logistic Models ; Male ; Middle Aged ; Minnesota ; Multivariate Analysis ; Patient Care Planning ; Patient Transfer/statistics & numerical data ; Retrospective Studies ; Risk Assessment ; Severity of Illness Index ; Young Adult
    Language English
    Publishing date 2018-01-21
    Publishing country England
    Document type Journal Article ; Multicenter Study
    ZDB-ID 2747269-3
    ISSN 2044-6055 ; 2044-6055 ; 2053-3624
    ISSN (online) 2044-6055
    ISSN 2044-6055 ; 2053-3624
    DOI 10.1136/bmjopen-2016-015550
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  8. Article ; Online: A feasibility study of virtual group therapy to improve quality of life of cancer caregivers.

    Lapid, Maria I / Atherton, Pamela J / Kung, Simon / Clark, Matthew M / Sloan, Jeff A / Whitford, Kevin J / Hubbard, Joleen M / Gentry, Melanie T / Miller, Janis J / Rummans, Teresa A

    Journal of psychosocial oncology

    2021  Volume 40, Issue 6, Page(s) 854–867

    Abstract: Background: Cancer caregiving can negatively impact the quality of life (QOL) of the caregiver. In-person interventions for improving coping skills have been shown to be effective in improving QOL for caregivers.: Objectives: This pilot project ... ...

    Abstract Background: Cancer caregiving can negatively impact the quality of life (QOL) of the caregiver. In-person interventions for improving coping skills have been shown to be effective in improving QOL for caregivers.
    Objectives: This pilot project explored the feasibility and acceptability of a virtual group therapy intervention to improve short-term cancer caregiver QOL.
    Methods: Caregivers of cancer patients were enrolled in a structured multidisciplinary intervention of eight virtual group therapy sessions provided over four weeks between September 9, 2013 and November 17, 2014. Group sessions were led by trained facilitators and included components of physical therapy, occupational therapy, psychosocial education, cognitive-behavioral intervention, supportive discussion, spiritual reflection, and mindfulness therapy. Feasibility was based on acceptable number of recruited participants per session; acceptability was defined using attendance and 80% QOL completion rates. QOL domains and symptom burden were assessed using validated single items.
    Results: The 20 cancer caregivers who enrolled were mostly older (80% were ≥ 65 years), female (76.5%), married to the patient (88.2%), Caucasian (100%), and highly educated (100%). 60% attended one to five sessions, 15% attended six to eight sessions, and 25% attended no sessions. Thirty percent completed pre- and post- intervention ratings of QOL items.
    Significance of results: Findings suggested that a virtual group therapy intervention is feasible for the cancer caregivers in this study. Although not statistically significant, the caregivers reported higher QOL and less symptom burden in multiple domains after participating in the virtual group therapy intervention.
    MeSH term(s) Humans ; Female ; Caregivers/psychology ; Quality of Life/psychology ; Feasibility Studies ; Pilot Projects ; Neoplasms/therapy ; Neoplasms/psychology ; Psychotherapy, Group
    Language English
    Publishing date 2021-11-29
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 605892-9
    ISSN 1540-7586 ; 0734-7332
    ISSN (online) 1540-7586
    ISSN 0734-7332
    DOI 10.1080/07347332.2021.2000550
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  9. Article ; Online: Impact of Massage Therapy on the Quality of Life of Hospice Patients and Their Caregivers: A Pilot Study.

    Havyer, Rachel D / Lapid, Maria I / Dockter, Travis J / McCue, Shaylene A / Stelpflug, Amy J / Bigelow, Maureen L / Robsahm, Mary Meg / Elwood, Theresa / Strand, Jacob J / Bauer, Brent A / Cutshall, Susanne M / Sloan, Jeff A / Walton, Monica P / Whitford, Kevin J

    Journal of palliative care

    2020  Volume 37, Issue 1, Page(s) 41–47

    Abstract: Evidence for massage therapy (MT) in hospice patients remains limited. We conducted a prospective pilot study on MTs impact on quality of life of hospice patients and caregivers. Patient-caregiver dyads were enrolled if patients scored ≥5 on pain, ... ...

    Abstract Evidence for massage therapy (MT) in hospice patients remains limited. We conducted a prospective pilot study on MTs impact on quality of life of hospice patients and caregivers. Patient-caregiver dyads were enrolled if patients scored ≥5 on pain, depression, anxiety, or well-being using the revised Edmonton Symptom Assessment System Revised (ESAS-r). The patient received MT weekly for up to 3 massages with assessments completed at baseline, after each massage, and 1 week after the final massage for patients and at baseline and 1 week after final massage for caregivers. A satisfaction survey was completed at study completion. A pro-rated area under the curve (AUC) was utilized to assess the primary endpoints of change in ESAS-r for patient ratings of pain, depression and anxiety as well as the Linear Analogue Self-Assessment (LASA). Median difference scores (end of study value)-(baseline value) for each participant and caregiver were calculated. Of 27 patients and caregivers enrolled, 25 patients received MT. Fifteen patients completed all 3 MT sessions and were given the final symptom assessment and satisfaction survey and their caregivers completed final assessments. The proportion of patients considered success (AUC > baseline) in the primary endpoints were the following: pain 40.9%, depression 40.9%, anxiety 54.5%, LASA 54.5%. Median difference scores were largely zero indicating no significant temporal change in symptoms. Patients were highly satisfied with MT. This pilot study indicated that MT was a feasible and well-received intervention in our population of patients with inadequately controlled symptoms.
    MeSH term(s) Caregivers ; Hospices ; Humans ; Massage ; Neoplasms ; Pilot Projects ; Prospective Studies ; Quality of Life
    Language English
    Publishing date 2020-11-19
    Publishing country United States
    Document type Journal Article
    ZDB-ID 639326-3
    ISSN 2369-5293 ; 0825-8597
    ISSN (online) 2369-5293
    ISSN 0825-8597
    DOI 10.1177/0825859720975991
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  10. Article ; Online: Safe use of opioids to manage pain in patients with cirrhosis.

    Swetz, Keith M / Carey, Elise C / Rho, Richard H / Mauck, William D / Whitford, Kevin J / Moynihan, Timothy J / Kaur, Judith S / Coyne, Patrick J / Smith, Thomas J

    Mayo Clinic proceedings

    2010  Volume 85, Issue 10, Page(s) 959; author reply 960

    MeSH term(s) Analgesics, Opioid/administration & dosage ; Analgesics, Opioid/therapeutic use ; Dose-Response Relationship, Drug ; Humans ; Liver Cirrhosis/complications ; Opioid-Related Disorders/prevention & control ; Pain/drug therapy ; Pain/etiology ; Pain Measurement ; Risk Factors
    Chemical Substances Analgesics, Opioid
    Language English
    Publishing date 2010-09-30
    Publishing country England
    Document type Comment ; Letter
    ZDB-ID 124027-4
    ISSN 1942-5546 ; 0025-6196
    ISSN (online) 1942-5546
    ISSN 0025-6196
    DOI 10.4065/mcp.2010.0294
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