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Gaughan S, Williams M. The holistic management of malignant bowel obstruction in women with advanced ovarian cancer at end of life. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:550-555. [PMID: 37344127 DOI: 10.12968/bjon.2023.32.12.550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
Bowel obstruction is commonly a pre-terminal event in women with advanced ovarian cancer. Management of symptoms will often be the focus rather than surgical intervention. Determining the patient's end-of-life wishes is paramount - because the prognosis for these patients can be short, advanced care planning is key. This case study will explore the management of nausea and vomiting associated with malignant bowel obstruction and demonstrate how a patient's psychological and social wellbeing is as important as managing the physical symptoms. It will discuss how skilled and effective communication is vital early in the disease trajectory in ensuring the patient's needs are met. Additionally, by undertaking a thorough holistic needs assessment, all aspects of end-of-life care can be discussed with the patient and family, which may enable the achievement of a preferred place of care and a peaceful, dignified death. Multidisciplinary working and co-ordination of care may allow for quick interventions, meeting individual needs and symptoms being managed more effectively.
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Affiliation(s)
- Sarah Gaughan
- Macmillan Lung and Rarer Clinical Nurse Specialist and Team Lead, Buckinghamshire Hospitals NHS Trust: Aylesbury
| | - Mary Williams
- Senior Lecturer in Cancer, Palliative and End of Life Care, Buckinghamshire New University, High Wycombe
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2
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Han HJ, Yeh JC, McNichol M, Buss MK. Delivering Palliative Care to Hospitalized Oncology Patients: A Scoping Review. J Pain Symptom Manage 2023; 65:e137-e153. [PMID: 36243248 DOI: 10.1016/j.jpainsymman.2022.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/26/2022] [Accepted: 09/30/2022] [Indexed: 11/06/2022]
Abstract
CONTEXT Early, longitudinal integration of palliative care (PC) is recommended for patients with advanced cancer, in both inpatient and outpatient settings. Despite the growth of specialty PC teams in the last decade, the majority of PC is still delivered in the inpatient setting using a traditional referral-based consult delivery model. However, traditional consultation can lead to significant variation or delay in inpatient PC utilization. New care delivery models and strategies are emerging to deliver PC to hospitalized oncology patients who would most benefit from their services and to better align with professional society recommendations. OBJECTIVES To identify different care models to deliver PC to ho`spitalized oncology patients and summarize their impact on patient and health system-related outcomes. METHODS We conducted a scoping review of peer-reviewed articles from 2006 to 2021 evaluating delivery of PC to oncology patients in acute inpatient care. We abstracted study characteristics, the study's intervention and comparison arms, and outcomes related to specialty PC intervention. RESULTS We identified four delivery models that have been reported to deliver PC: 1) traditional referral-based consultation, 2) criterion-based or "triggered" consultation, 3) co-rounding with primary inpatient team, and 4) PC clinicians serving as the primary team. We summarize the known outcomes data from each model, and compare the benefits and limitations of each model. CONCLUSION Our findings provide guidance to health systems about care delivery models to deploy and implement inpatient PC resources to best serve their unique populations.
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Affiliation(s)
- Harry J Han
- Section of Palliative Care, Division of General Medicine and Primary Care (H.J.H., J.C.Y.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
| | - Jonathan C Yeh
- Section of Palliative Care, Division of General Medicine and Primary Care (H.J.H., J.C.Y.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Megan McNichol
- Division of Knowledge Services, Department of Information Services (M.M.), Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Mary K Buss
- Division of Palliative Care, Department of Medicine (M.K.B.), Tufts University School of Medicine, Boston, Massachusetts, USA
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3
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Sobels E, Best M, Chadban S, Pais R. End Stage Kidney Disease Patient Experiences of Renal Supportive Care in an Australian Teaching Hospital - A Qualitative Study. J Pain Symptom Manage 2022; 63:737-746. [PMID: 34954064 DOI: 10.1016/j.jpainsymman.2021.12.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 11/26/2021] [Accepted: 12/17/2021] [Indexed: 11/17/2022]
Abstract
CONTEXT Renal Supportive Care Services (RSCS) were introduced in Australia to provide patient-centred care with a focus on better symptom management and improved quality of life in end stage kidney disease (ESKD) patients managed with or without dialysis. While RSCS have demonstrated clinical benefits with reduced length of hospital stay and symptom burden, there is a gap in understanding the experience of patients referred to RSCS. OBJECTIVES To identify patient attitudes, beliefs, and perspectives on the RSCS. METHODS Qualitative interviews were conducted with 20 participants from both dialysis and conservative treatment pathways. Transcripts were then thematically analysed and primary themes identified, which were reviewed with a stakeholder group that included doctors, nurses and allied health staff to provide triangulation. RESULTS Patients perceived the RSCS as a provider of multidisciplinary, holistic and patient-centred care that, in addition, helped to ensure prognostic awareness and timely end-of-life care planning. This contributed to an overall sense of patient empowerment with healthcare decisions. This study identified three major themes: (1) Expectations of care; (2) Experience of care; and (3) Understanding patient needs. CONCLUSION The study found that RSCS support patient-centred and family-orientated initiatives in decision making and control over healthcare management. This is empowering for patients. Additional patient values, needs and wants from the RSCS were also identified and these could be addressed to improve the patient experience. Our findings support the ongoing use of RSCS to improve the experience of ESKD patients.
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Affiliation(s)
- Eloise Sobels
- Central Clinical School (E.S.), University of Sydney, Sydney, Australia.
| | - Megan Best
- Department of Palliative Medicine (M.B., R.P.), Royal Prince Alfred Hospital, Sydney, Australia; Institute for Ethics and Society (M.B.), University of Notre Dame Australia, Sydney, Australia
| | - Steve Chadban
- Department of Renal Medicine (S.C., R.P.), Royal Prince Alfred Hospital, Sydney, Australia; Kidney Node, Charles Perkins Centre (S.C.), University of Sydney, Sydney, Australia
| | - Riona Pais
- Department of Palliative Medicine (M.B., R.P.), Royal Prince Alfred Hospital, Sydney, Australia; Department of Renal Medicine (S.C., R.P.), Royal Prince Alfred Hospital, Sydney, Australia
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Yeh JC, Urman AR, Besaw RJ, Dodge LE, Lee KA, Buss MK. Different Associations Between Inpatient or Outpatient Palliative Care and End-of-Life Outcomes for Hospitalized Patients With Cancer. JCO Oncol Pract 2022; 18:e516-e524. [PMID: 34914566 PMCID: PMC9810126 DOI: 10.1200/op.21.00546] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Palliative care (PC) improves outcomes in advanced cancer, and guidelines recommend early outpatient referral. However, many PC teams see more inpatient than outpatient consults. We conducted a retrospective study of hospitalized patients with cancer to quantify exposure to inpatient and outpatient PC and describe associations between PC and end-of-life (EOL) quality measures. METHODS We identified all decedents admitted to an inpatient oncology unit in 1 year (October 1, 2017-September 30, 2018) and abstracted hospitalization statistics, inpatient and outpatient PC visits, and EOL outcomes. Descriptive statistics, univariate tests, and multivariate analysis evaluated associations between PC and patient outcomes. RESULTS In total, 522 decedents were identified. 50% saw PC; only 21% had an outpatient PC visit. Decedents seen by PC were more likely to enroll in hospice (78% v 44%; P < .001), have do-not-resuscitate status (87% v 55%; P < .001), have advance care planning documents (53% v 31%; P < .001), and die at home or inpatient hospice instead of in hospital (67% v 40%; P < .01). Decedents seen by PC had longer hospital length-of-stay (LOS; 8.4 v 7.0 days; P = .03), but this association reversed for decedents seen by outpatient PC (6.3 v 8.3 days; P < .001), who also had longer hospice LOS (46.5 v 27.1 days; P < .01) and less EOL intensive care (6% v 15%; P < .05). CONCLUSION PC was associated with significantly more hospice utilization and advance care planning. Patients seen specifically by outpatient PC had shorter hospital LOS and longer hospice LOS. These findings suggest different effects of inpatient and outpatient PC, underscoring the importance of robust outpatient PC.
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Affiliation(s)
- Jonathan C. Yeh
- Section of Palliative Care, Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA,Jonathan C. Yeh, MD, 330 Brookline Ave, Yamins 100, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215; e-mail:
| | - Arielle R. Urman
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Robert J. Besaw
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Laura E. Dodge
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Kathleen A. Lee
- Section of Palliative Care, Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Mary K. Buss
- Section of Palliative Care, Division of General Medicine and Primary Care, Division of Medical Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Shimada S, Aoyanagi M, Sumi N. Components and Related Factors of Nursing Interventions for Improving Resilience in Cancer Patients Undergoing Chemotherapy. Healthcare (Basel) 2021; 9:healthcare9030300. [PMID: 33800524 PMCID: PMC7998617 DOI: 10.3390/healthcare9030300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/19/2021] [Accepted: 02/26/2021] [Indexed: 11/16/2022] Open
Abstract
Resilience is considered an effective concept for cancer patients, but nursing interventions for improving resilience have not been studied adequately yet. We aimed to explore the components and related factors of nursing interventions for promoting resilience among cancer patients receiving chemotherapy (NIPRPC). This cross-sectional study included 68 facilities from 396 cancer hospitals in Japan. Participants were 377 nurses who worked at the outpatient chemotherapy center or cancer ward. They completed self-administered questionnaires including the NIPRPC items and Resilience Scale for Nurses, etc. We conducted factor, correlational, and regression analysis. Based on the exploratory factor analysis, six-dimensional factor components: “Support for patients during the present situation and increasing their self-affirmation”, “Support for self-help”, “Support for utilizing the cancer medical team”, “Support for obtaining family cooperation”, “Support for maintaining regular lifestyle during chemotherapy”, and “Support for interacting with cancer patients and utilizing necessary information”. The strong related factors for all six factors were the resilience of the nurses and the number of collaborations with multiple occupations. Our findings will help nurses improve the psychosocial quality of life of cancer patients and address their needs related to cancer chemotherapy treatment.
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Affiliation(s)
- Shiena Shimada
- Department of Nursing, Hokkaido University Hospital, Sapporo 060-8648, Japan;
| | - Michiko Aoyanagi
- Faculty of Health Sciences, Hokkaido University, Sapporo 060-0812, Japan;
| | - Naomi Sumi
- Faculty of Health Sciences, Hokkaido University, Sapporo 060-0812, Japan;
- Correspondence:
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Janberidze E, Poláková K, Bankovská Motlová L, Loučka M. Impact of palliative care consult service in inpatient hospital setting: a systematic literature review. BMJ Support Palliat Care 2020; 11:351-360. [PMID: 32958505 DOI: 10.1136/bmjspcare-2020-002291] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 08/08/2020] [Accepted: 08/14/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Despite a number of studies on effectiveness of palliative care, there is a lack of complex updated review of the impact of in-hospital palliative care consult service. The objective is to update information on the impact of palliative care consult service in inpatient hospital setting. METHODS This study was a systematic literature review, following the standard protocols (Preferred Reporting Items for Systematic Reviews and Meta-Analyses, Joanna Briggs Institute tools) to ensure the transparent and robust review procedure. The effect of palliative care consult service was classified as being associated with improvement, no difference, deterioration or mixed results in specific outcomes. PubMed, Scopus, Academic Search Ultimate and SocINDEX were systematically searched up to February 2020. Studies were included if they focused on the impact of palliative care consult service caring for adult palliative care patients and their families in inpatient hospital setting. RESULTS After removing duplicates, 959 citations were screened of which 49 full-text articles were retained. A total of 28 different outcome variables were extracted. 18 of them showed positive effects within patient, family, staff and healthcare system domains. No difference was observed in patient survival and depression. Inconclusive results represented patient social support and staff satisfaction with care. CONCLUSIONS Palliative care consult service has a number of positive effects for patients, families, staff and healthcare system. More research is needed on factors such as patient spiritual well-being, social support, performance, family understanding of patient diagnosis or staff stress.
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Affiliation(s)
- Elene Janberidze
- Department of Psychiatry and Medical Psychology - Division of Medical Psychology, Charles University, Third Faculty of Medicine, Praha, Czech Republic .,Department of Gerontology and Palliative Medicine, Iv. Javakhishvili Tbilisi State University/Institute of Morphology, Tbilisi, Georgia.,Faculty of Medicine, School of Health Sciences and Public Health, University of Georgia, Tbilisi, Georgia
| | - Kristýna Poláková
- Department of Psychiatry and Medical Psychology - Division of Medical Psychology, Charles University, Third Faculty of Medicine, Praha, Czech Republic.,Center for Palliative Care, Praha, Czech Republic
| | - Lucie Bankovská Motlová
- Department of Psychiatry and Medical Psychology - Division of Medical Psychology, Charles University, Third Faculty of Medicine, Praha, Czech Republic
| | - Martin Loučka
- Department of Psychiatry and Medical Psychology - Division of Medical Psychology, Charles University, Third Faculty of Medicine, Praha, Czech Republic.,Center for Palliative Care, Praha, Czech Republic
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Taylor EJ, Li AH. Healthcare Chaplains' Perspectives on Nurse-Chaplain Collaboration: An Online Survey. JOURNAL OF RELIGION AND HEALTH 2020; 59:625-638. [PMID: 31912352 DOI: 10.1007/s10943-019-00974-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The collaboration between nurses and chaplains is essential to provide spiritual support in healthcare institutions. Given challenges in collaboration exist between these disciplines, this study sought to further understand the nature of the chaplain-nurse relationship. Data obtained from an online survey of members of the Association of Professional Chaplains (N = 266) provide a quantified and nuanced picture of how chaplains perceive nurse collaboration and provision of spiritual care. This study not only provides evidence that can inform chaplain and nurse practice, but also an instrument for measuring perceptions about collaboration to provide spiritual care.
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Affiliation(s)
| | - Angela H Li
- Loma Linda University School of Religion, Loma Linda, CA, USA
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8
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9
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Yang GM, Yoon S, Tan YY, Liaw K. Experience and Views of Oncology and Palliative Care Professionals on a Corounding Model of Care for Inpatients With Advanced Cancer. Am J Hosp Palliat Care 2018; 35:1433-1438. [PMID: 29843519 DOI: 10.1177/1049909118778863] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Palliative care is associated with better outcomes in advanced cancer, but there is limited research comparing different models of palliative care delivery alongside oncology care. For inpatients with cancer, palliative care is mostly delivered through a consult service, primarily relying on oncologist-initiated referrals to a separate specialist palliative care team. In our hospital setting, we piloted a palliative care and oncology corounding model of care. AIM To explore the views and experience of oncology and palliative care professionals on the corounding model compared to an inpatient consult service. DESIGN A qualitative study nested within a pre-post study of the corounding model of care, with semistructured interviews using thematic analysis. SETTING/PARTICIPANTS Eleven doctors and nurses involved in the pilot corounding model were interviewed. RESULTS Two main themes emerged: (1) the efficiency of care delivery and (2) quality of patient care. The theme on the efficiency of care delivery was related to access to palliative care input, team communications, and parallel workflow. The quality of patient care was described in terms of holistic approach to cancer care and rapport building with patients and their families. Most participants acknowledged positive aspects of the corounding model, yet some minor concerns were reported, such as disagreements between oncology and palliative care professionals. CONCLUSIONS This study provides insights into the benefits and drawbacks of a corounding model of care for inpatients. The views of health-care professionals can be incorporated into the development of integrated oncology and palliative care models to improve care for patients with advanced cancer.
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Affiliation(s)
- Grace Meijuan Yang
- 1 Division of Palliative Medicine, National Cancer Centre Singapore, Singapore, Singapore.,2 Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore
| | - Sungwon Yoon
- 3 Programme on Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Yung Ying Tan
- 1 Division of Palliative Medicine, National Cancer Centre Singapore, Singapore, Singapore
| | - Karen Liaw
- 4 St. Andrew's Community Hospital, Singapore, Singapore
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10
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Phongtankuel V, Meador L, Adelman RD, Roberts J, Henderson CR, Mehta SS, del Carmen T, Reid M. Multicomponent Palliative Care Interventions in Advanced Chronic Diseases: A Systematic Review. Am J Hosp Palliat Care 2018; 35:173-183. [PMID: 28273750 PMCID: PMC5879777 DOI: 10.1177/1049909116674669] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Many patients live with serious chronic or terminal illnesses. Multicomponent palliative care interventions have been increasingly utilized in patient care; however, it is unclear what is being implemented and who is delivering these interventions. OBJECTIVES To (1) describe the delivery of multicomponent palliative care interventions, (2) characterize the disciplines delivering care, (3) identify the components being implemented, and (4) analyze whether the number of disciplines or components being implemented are associated with positive outcomes. DESIGN Systematic review. STUDY SELECTION English-language articles analyzing multicomponent palliative care interventions. OUTCOMES MEASURED Delivery of palliative interventions by discipline, components of palliative care implemented, and number of positive outcomes (eg, pain, quality of life). RESULTS Our search strategy yielded 71 articles, which detailed 64 unique multicomponent palliative care interventions. Nurses (n = 64, 88%) were most often involved in delivering care, followed by physicians (n = 43, 67%), social workers (n = 33, 52%), and chaplains (n = 19, 30%). The most common palliative care components patients received were symptom management (n = 56, 88%), psychological support/counseling (n = 52, 81%), and disease education (n = 48, 75%). Statistical analysis did not uncover an association between number of disciplines or components and positive outcomes. CONCLUSIONS While there has been growth in multicomponent palliative care interventions over the past 3 decades, important aspects require additional study such as better inclusion of key groups (eg, chronic obstructive pulmonary disease, end-stage renal disease, minorities, older adults); incorporating core components of palliative care (eg, interdisciplinary team, integrating caregivers, providing spiritual support); and developing ways to evaluate the effectiveness of interventions that can be readily replicated and disseminated.
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Affiliation(s)
- Veerawat Phongtankuel
- Department of Medicine, Joan and Sanford I Weill Medical College of Cornell University, New York, NY, USA
| | - Lauren Meador
- Department of Medicine, Joan and Sanford I Weill Medical College of Cornell University, New York, NY, USA
| | - Ronald D. Adelman
- Department of Medicine, Joan and Sanford I Weill Medical College of Cornell University, New York, NY, USA
| | | | | | - Sonal S. Mehta
- Department of Medicine, Joan and Sanford I Weill Medical College of Cornell University, New York, NY, USA
| | - Tessa del Carmen
- Department of Medicine, Joan and Sanford I Weill Medical College of Cornell University, New York, NY, USA
| | - M.C. Reid
- Department of Medicine, Joan and Sanford I Weill Medical College of Cornell University, New York, NY, USA
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11
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Balboni TA, Fitchett G, Handzo GF, Johnson KS, Koenig HG, Pargament KI, Puchalski CM, Sinclair S, Taylor EJ, Steinhauser KE. State of the Science of Spirituality and Palliative Care Research Part II: Screening, Assessment, and Interventions. J Pain Symptom Manage 2017; 54:441-453. [PMID: 28734881 DOI: 10.1016/j.jpainsymman.2017.07.029] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2017] [Indexed: 01/12/2023]
Abstract
The State of the Science in Spirituality and Palliative Care was convened to address the current landscape of research at the intersection of spirituality and palliative care and to identify critical next steps to advance this field of inquiry. Part II of the SOS-SPC report addresses the state of extant research and identifies critical research priorities pertaining to the following questions: 1) How do we assess spirituality? 2) How do we intervene on spirituality in palliative care? And 3) How do we train health professionals to address spirituality in palliative care? Findings from this report point to the need for screening and assessment tools that are rigorously developed, clinically relevant, and adapted to a diversity of clinical and cultural settings. Chaplaincy research is needed to form professional spiritual care provision in a variety of settings, and outcomes assessed to ascertain impact on key patient, family, and clinical staff outcomes. Intervention research requires rigorous conceptualization and assessments. Intervention development must be attentive to clinical feasibility, incorporate perspectives and needs of patients, families, and clinicians, and be targeted to diverse populations with spiritual needs. Finally, spiritual care competencies for various clinical care team members should be refined. Reflecting those competencies, training curricula and evaluation tools should be developed, and the impact of education on patient, family, and clinician outcomes should be systematically assessed.
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Affiliation(s)
- Tracy A Balboni
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts; Department of Radiation Oncology, Dana Farber Cancer Institute, Boston, Massachusetts
| | - George Fitchett
- Harvard Medical Department of Religion, Health and Human Values, Rush University Medical Center, Chicago, Illinois
| | | | - Kimberly S Johnson
- Division of Geriatrics, Duke University School of Medicine, Durham, North Carolina; Department of Medicine, Duke University School of Medicine, Durham, North Carolina; Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, North Carolina; Geriatric Research, Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - Harold G Koenig
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina; Department of Psychiatry, Duke University School of Medicine, Durham, North Carolina; Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, North Carolina; Center for Spirituality, Theology and Health, Duke University School of Medicine, Durham, North Carolina; King Abdulaziz University, Jeddah, Saudi Arabia
| | - Kenneth I Pargament
- Department of Psychology, Bowling Green State University, Bowling Green, Ohio
| | - Christina M Puchalski
- George Washington Institute for Spirituality and Health, George Washington School of Medicine and Health Sciences, Washington, D.C
| | | | | | - Karen E Steinhauser
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina; Division of General Internal Medicine, Duke University School of Medicine, Durham, North Carolina; Department of Medicine, Duke University School of Medicine, Durham, North Carolina; Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, North Carolina; Center of Innovation in Health Services Research, Durham Veterans Affairs Medical Center, Durham, North Carolina.
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Abstract
OBJECTIVES To discuss the importance of cancer symptom clusters in clinical practice, review evidence for symptom cluster interventions, and make recommendations for symptom cluster identification, patient education, and management in clinical practice. DATA SOURCES Primary research and review articles identified through CINAHL, PubMed, and PsycINFO databases. CONCLUSION Several studies have investigated interventions for multi-symptom management or have evaluated the secondary effects of a single-symptom intervention on related symptoms. To date, only five studies have tested an intervention designed to manage a specific cancer symptom cluster. Those studies used nonpharmacologic approaches (psycho-education, cognitive-behavioral strategies, and acupressure) to address the pain, fatigue, and sleep disturbance symptom cluster, or the respiratory distress symptom cluster with some initial evidence of success. Further development and efficacy testing of symptom cluster interventions is needed. IMPLICATIONS FOR NURSING PRACTICE Clinical practice can be guided by knowledge of individual and multi-symptom management, and clinical judgment regarding possible etiologies of cancer symptom clusters. Clinicians should be aware of co-occurring symptoms in their patients, educate and involve patients in identifying symptom clusters and aggravating/alleviating factors, and coordinate treatment recommendations using strategies that are likely to be beneficial across symptoms.
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13
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Yang GM, Neo SHS, Lim SZZ, Krishna LKR. Effectiveness of Hospital Palliative Care Teams for Cancer Inpatients: A Systematic Review. J Palliat Med 2016; 19:1156-1165. [DOI: 10.1089/jpm.2016.0052] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Affiliation(s)
- Grace Meijuan Yang
- Department of Palliative Medicine, National Cancer Centre Singapore, Singapore, Singapore
| | - Shirlyn Hui-Shan Neo
- Department of Palliative Medicine, National Cancer Centre Singapore, Singapore, Singapore
| | - Shawn Zhi Zheng Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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14
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Shim HY, Chang YJ, Kawk KS, Mai TTX, Choi JY, Ahn EM, Jho HJ, Park SJ. Do Korean Doctors Think a Palliative Consultation Team Would Be Helpful to Their Terminal Cancer Patients? Cancer Res Treat 2016; 49:437-445. [PMID: 27506213 PMCID: PMC5398399 DOI: 10.4143/crt.2015.495] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 07/22/2016] [Indexed: 11/21/2022] Open
Abstract
PURPOSE Hospice and palliative care services (HPC) are not commonly utilized in Korea; however, palliative care teams (PCTs) have been found to be effective at addressing the shortcomings in HPC. In this study, we attempted to outline unmet palliative care needs of terminal cancer patients and the potential benefits of PCTs as perceived by doctors in Korea. MATERIALS AND METHODS We surveyed 474 doctors at 10 cancer-related academic conferences from June to November 2014 with a self-report questionnaire to assess their perceptions of end-of-life care needs and the expected effects of PCTs on caring for terminal cancer patients. Among those surveyed, 440 respondents who completed the entire questionnaire were analyzed. RESULTS In all domains, fewer participants reported satisfaction with palliative care services than those reporting needs (p < 0.001). The surveyed participants also reported difficulties with a shortage of time for treatment, psychological burden, lack of knowledge regarding hospice care, lengths of stay, and palliative ward availability. Multivariate logistic regression analysis revealed that female doctors (odds ratio [OR], 2.672; 95% confidence interval [CI], 1.035 to 6.892), doctors who agreed that referring my patients to a HPC means I must give up on my patient (OR, 3.075; 95% CI, 1.324 to 7.127), and doctors who had no experience with HPC education (OR, 3.337; 95% CI, 1.600 to 7.125) were associated with higher expected effectiveness of PCT activities. CONCLUSION The PCT activities were expected to fill the doctor's perceived unmet HPC needs of terminal cancer patients and difficulties in communications.
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Affiliation(s)
- Hye-Young Shim
- Department of Preventive Medicine, Eulji University School of Medicine, Daejeon, Korea
| | - Yoon Jung Chang
- Hospice & Palliative Care Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Kiu-Sang Kawk
- Hospice & Palliative Care Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Tran Thi Xuan Mai
- Hospice & Palliative Care Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Jin Young Choi
- Hospice & Palliative Care Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Eun Mi Ahn
- Hospice & Palliative Care Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Hyun Jung Jho
- Hospice & Palliative Care Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - So-Jung Park
- Hospice & Palliative Care Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea
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Tai SY, Lee CY, Wu CY, Hsieh HY, Huang JJ, Huang CT, Chien CY. Symptom severity of patients with advanced cancer in palliative care unit: longitudinal assessments of symptoms improvement. BMC Palliat Care 2016; 15:32. [PMID: 26968159 PMCID: PMC4787050 DOI: 10.1186/s12904-016-0105-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 03/07/2016] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND This study assessed the symptom severity of patients with advanced cancer in a palliative care unit and explored the factors associated with symptom improvement. METHODS This study was conducted in a palliative care unit in Taiwan between October 2004 and December 2009. Symptom intensity was measured by the "Symptom Reporting Form", and graded on a scale of 0 to 4 (0 = none, and 4 = extreme). These measures were assessed on the 1(st), 3(rd), 5(th), and 7(th) Day in the palliative care unit. The study data comprised routine clinical records and patients' demographic data. Generalized estimating equation (GEE) was used to assess the symptom improvement, and investigate the factors associated with the symptom reporting form scores. RESULTS Among the 824 recruited patients with advanced cancer, pain (78.4%), anorexia (64.4%) and constipation (63.5%) were the most common and severe symptom. After controlling for other factors in the multivariate GEE model, the day of palliative care administration was a significant factor associated with all of the scales, except Days 7 on the dyspnoea and oedema scales and Day 5 on the anxiety scale. In addition, patients aged ≥ 65 years exhibited significantly lower scores on the pain, sleep disturbance, depression, and anxiety scales than did those aged < 65 years. Moreover, female patients exhibited higher scores on the vomiting, anorexia, oedema, depression, and anxiety scales than did male patients. Furthermore, patients with gastrointestinal tract cancer exhibited higher scores on the constipation, vomiting, anorexia, oedema, depression, and anxiety scales and lower scores on the dyspnoea scale than did those with lung cancer. Patients with breast cancer exhibited higher scores on the oedema scale and lower scores on the anxiety scale. Patients with genitourinary cancer exhibited higher scores on the vomiting and oedema scales and lower scores on the dyspnoea scale. Patients with head, neck, and oral cancer exhibited lower scores on the oedema scale alone. CONCLUSION The symptom severity declined during the first week in the palliative care unit. In addition, differences in sex and primary cancer sites may contribute to varying degrees of symptom improvement.
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Affiliation(s)
- Shu-Yu Tai
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Family Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Family Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chung-Yin Lee
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chien-Yi Wu
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Hui-Ya Hsieh
- Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Joh-Jong Huang
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chia-Tsuan Huang
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
| | - Chen-Yu Chien
- Department of Otorhinolaryngology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Departments of Otorhinolaryngology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. .,Department of Otolaryngology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Fulcher CD, Kim HJ, Smith PR, Sherner TL. Putting evidence into practice: evidence-based interventions for depression. Clin J Oncol Nurs 2014; 18 Suppl:26-37. [PMID: 25427607 DOI: 10.1188/14.cjon.s3.26-37] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Depression is a distressing emotion that occurs during various times of the cancer trajectory. Depression often goes unrecognized and untreated, which can significantly affect cost, quality of life, and treatment adherence. The Oncology Nursing Society's Putting Evidence Into Practice depression project team reviewed current literature to identify evidence-based interventions to reduce depression in people with cancer. Pharmacologic and nonpharmacologic interventions were evaluated, and opportunities for nurses to integrate recommendations into practice are offered in this article.
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Affiliation(s)
| | - Hee-Ju Kim
- College of Nursing, Catholic University of Korea, Seoul
| | - Patsy R Smith
- College of Nursing, University of Oklahoma Health Sciences Center, Oklahoma City
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Epstein JB, Güneri P, Barasch A. Appropriate and necessary oral care for people with cancer: guidance to obtain the right oral and dental care at the right time. Support Care Cancer 2014; 22:1981-8. [PMID: 24676676 DOI: 10.1007/s00520-014-2228-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 03/21/2014] [Indexed: 02/07/2023]
Abstract
PURPOSE The identification of experienced and knowledgeable dental specialists to provide appropriate oral care for cancer patients, as well as the integration of this care within general oncology management, may be a challenge. This paper discusses the general and additional requirements for dental care providers to support the cancer patient and provide prevention and/or treatment for oral complications of cancer therapy. METHODS We performed a literature review of specific issues regarding the oral cavity and adjacent structures in the cancer patient, including detection and early diagnosis of oral malignancy. We incorporated the systemic effects of cancer and its therapy that affect oral disease and treatment. We present a summary of how to seek expert dental care for cancer patients and for referral from the dental and medical community. RESULTS Due to the complexity conferred by the disease and its treatment, cancer patients require educated, experienced dentists for treatment and/or prevention of oral-related morbidity. Correct diagnosis and evidence-based prophylactic and therapeutic oral care can significantly improve patient quality of life and reduce morbidity and healthcare costs. CONCLUSIONS The knowledge and expertise of dental professionals regarding prevention/treatment of complications and secondary malignant lesions in cancer patients are critical. Integration of oral care with the oncology care and in survivors requires effective communication between dental and medical providers beginning ideally at diagnosis. These clinicians may be identified at the cancer center, nearby hospital dental programs, and, less commonly, in the community.
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Affiliation(s)
- Joel B Epstein
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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