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Wongkalasin K, Matchim Y, Kanhasing R, Pimvichai S. Uncertainty among patients with advanced-stage lung cancer. Int J Palliat Nurs 2024; 30:160-169. [PMID: 38630643 DOI: 10.12968/ijpn.2024.30.4.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
BACKGROUND Uncertainty is the inability to define the meaning of illness-related events, which may result in anxiety, depression, poor coping, the self-perception of being a burden and low quality of life. Uncertainty among Thai patients with advanced-stage lung cancer (ASLC) has not been well documented. AIMS To assess uncertainty in patients with ASLC. METHODS A cross-sectional survey design was adopted. Data were collected from 60 patients with ASLC at a university hospital. A demographic data form and the Mishel Uncertainty in Illness Scale (MUIS) were used to collect data. The data were analysed using descriptive statistics. RESULTS The patients had moderate levels of uncertainty in illness (83.73±15.25). Ambiguity about the illness and unpredictability of the prognosis scored at a moderate level for patients, while complexity of treatment and the system of care and inconsistency or lack of information, about the diagnosis or severity of the illness were at a low level. CONCLUSION The results of this study may help healthcare professionals better understand and manage uncertainty in patients with ASLC.
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Affiliation(s)
| | - Yaowarat Matchim
- Associate Professor, Faculty of Nursing, Thammasat University, Thailand
| | - Ruankwan Kanhasing
- Assistant Professor, Faculty of Medicine, Thammasat University, Thailand
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Thepsuwan A, Tontisirin N, Euasobhon P, Pannangpetch P, Leerapan B, Pattanaprateep O, Cohen SP. Cost-Effectiveness and Cost-Utility Analyses in Thailand of Continuous Intrathecal Morphine Infusion Compared with Conventional Therapy in Cancer Pain: A 10-year Multicenter Retrospective Study. Can J Pain 2023; 7:2225564. [PMID: 37533506 PMCID: PMC10392764 DOI: 10.1080/24740527.2023.2225564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 05/19/2023] [Accepted: 06/12/2023] [Indexed: 08/04/2023]
Abstract
Background Because of the high initial cost of intrathecal drug delivery (ITDD) therapy, this study investigated the cost-effectiveness and cost-utility of ITDD therapy in refractory cancer pain management in Thailand over the past 10 years. Methods The retrospective study was conducted in patients with cancer pain who underwent ITDD therapy from January 2011 to 2021 at three university hospitals. Clinical outcomes included the numerical rating scale (NRS), Palliative Performance Scale, and the EQ-5D. The direct medical and nonmedical as well as indirect costs were also recorded. Cost-effectiveness and cost-utility analyses were performed comparing ITDD therapy with conventional therapy (extrapolated from costs of the same patient before ITDD therapy) from a societally oriented economic evaluation. Results Twenty patients (F:M: 10:10) aged 60 ± 15 years who underwent implantation of an intrathecal percutaneous port (IT port; n = 15) or programmable intrathecal pump (IT pump; n = 5) were included. The median survival time was 78 (interquartile range = 121-54) days after ITDD therapy. At 2-month follow-up, the incremental cost-effectiveness ratio (ICER)/pain reduction of an IT port (US$2065.36 (CA$2829.54)/2-point NRS reduction/lifetime) was lower than for patients with an IT pump (US$5479.26 (CA$7506.58)/2-point NRS reduction/lifetime) compared with continued conventional therapy. The ICER/quality-adjusted life years (QALYs) gained for an IT port compared with conventional treatment was US$93,999.31(CA$128,799.06)/QALY gained, which is above the cost-effectiveness threshold for Thailand. Conclusion The cost-effectiveness and cost-utility of IT port therapy for cancer pain was high relative to the cost of living in Thailand, above the cost-effectiveness threshold. Prospective cost analysis studies enrolling more patients with diverse cancers that investigate the benefit of early ITDD therapy with devices over a range of prices are warranted.
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Affiliation(s)
- Arpawan Thepsuwan
- Department of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Nuj Tontisirin
- Department of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pramote Euasobhon
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Patt Pannangpetch
- Department of Anesthesiology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Borwornsom Leerapan
- Chakri Naruebodindra Medical Institute, Mahidol University, Samut Prakan, Thailand
| | - Oraluck Pattanaprateep
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Steven P. Cohen
- Department of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Departments of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Physical Medicine & Rehabilitation, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Departments of Anesthesiology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Department of Physical Medicine & Rehabilitation, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Pimvichai S, Matchim Y, Sinthusake T, Wongkalasin K. Quality of life and its correlates in pretreatment patients with locally advanced head and neck cancer: A cross-sectional study in Thailand. BELITUNG NURSING JOURNAL 2023; 9:244-252. [PMID: 37492758 PMCID: PMC10363966 DOI: 10.33546/bnj.2621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/22/2023] [Accepted: 06/06/2023] [Indexed: 07/27/2023] Open
Abstract
Background Locally advanced head and neck cancer (LAHNC) can significantly impact the quality of life of patients in various ways. However, several factors can contribute to the decrease in quality of life. In Thailand, there is limited knowledge about the factors that affect the quality of life of patients with LAHNC before they receive treatment. Objective This study aimed to examine the correlations between Palliative Performance Scale (PPS), family income, body mass index (BMI), age, comorbidity index, and the quality of life of patients with LAHNC before they undergo treatment. Methods A correlational cross-sectional study was conducted, and data were collected from 94 pretreatment patients with LAHNC who were admitted to a cancer center in central Thailand using purposive sampling. The data collection instruments included a demographic data form, a medical record form, the Charlson Comorbidity Index (CCI), the Palliative Performance Scale (PPS), and the Functional Assessment of Cancer Therapy-Head and Neck (FACT-H&N) version 4. Descriptive statistics, Pearson's correlation, and Spearman's rank correlation were used to analyze the data. Results All study participants completed the questionnaire. The results showed that the overall quality of life of the patients was moderate. PPS, family income, and body mass index were moderately positively correlated with quality of life (r = 0.494, p <0.01; r = 0.420, p <0.01; r = 0.339, p <0.01, respectively). Age had a moderate negative correlation with quality of life (r = -0.596, p <0.01), while comorbidity was not significantly associated with quality of life. Conclusion The quality of life of patients with LAHNC before treatment was associated with various factors, including PPS, family income, body mass index, and age. These findings highlight the importance of nutritional support before treatment and the need for social support, especially for older adult patients, to improve their quality of life. The results of this study can be valuable for nurses in developing care programs that enhance the quality of life for patients with LAHNC during the pretreatment phase.
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Affiliation(s)
| | - Yaowarat Matchim
- Faculty of Nursing, Thammasat University, Pathum Thani, Thailand
| | - Tanadej Sinthusake
- Maha Vajiralongkorn Thanyaburi Hospital, Department of Medical Services, Ministry of Public Health, Thailand
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Klankaew S, Temthup S, Nilmanat K, Fitch MI. The Effect of a Nurse-Led Family Involvement Program on Anxiety and Depression in Patients with Advanced-Stage Hepatocellular Carcinoma. Healthcare (Basel) 2023; 11:healthcare11040460. [PMID: 36832996 PMCID: PMC9956382 DOI: 10.3390/healthcare11040460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 02/02/2023] [Accepted: 02/03/2023] [Indexed: 02/08/2023] Open
Abstract
Psychological distress is commonly reported in patients with advanced cancer. Family is considered a psychological supporter for patients during their cancer journey. This study aimed to examine the effect of a nurse-led family involvement program on anxiety and depression in patients with advanced hepatocellular cancer. This is a quasi-experimental study with a two-group, pre-post-test design. Forty-eight participants were recruited at a male medical ward in a university hospital in Southern Thailand, and assigned to either the experimental or the control group. The experimental group received the nurse-led family involvement program, while the control group received only conventional care. Instruments included a demographic data form, clinical data form, and the Hospital Anxiety and Depression Scale. Data analyses were performed using descriptive statistics, chi-square, Fisher's exact test, and t-test. The results revealed that the mean scores of anxiety and depression in the experimental group at post-test were significantly lower than on the pretest and significantly lower than those of the control group. The results indicate that a nurse-led family involvement program has a short-term effect on the reduction of anxiety and depression in male patients with advanced HCC. The program can be useful for nurses to encourage family caregivers to engage in patient care during hospitalization.
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Affiliation(s)
- Sukhuma Klankaew
- Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Suthisa Temthup
- Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
- Correspondence:
| | - Kittikorn Nilmanat
- Faculty of Nursing, Prince of Songkla University, Songkhla 90110, Thailand
| | - Margaret I. Fitch
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON M4C 4V9, Canada
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Is aggressive care appropriate for patients with cancer complicated by pneumonia? A retrospective chart review in a tertiary hospital. BMC Palliat Care 2023; 22:3. [PMID: 36609364 PMCID: PMC9817238 DOI: 10.1186/s12904-023-01127-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 01/03/2023] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Pneumonia in cancer patients is often problematic in order to decide whether to admit and administer antibiotics or pursue a comfort care pathway that may avoid in-hospital death. We aimed to identify factors which are easily assessed at admission in Thailand's healthcare context that could serve as prognostic factors for in-hospital death. METHODS Regression analysis was utilized to identify the prognostic factors from clinical factors collected at admission. The primary outcome was in-hospital death. Data was collected from the electronic medical records of Chiang Mai University Hospital, Thailand, from 2016 to 2017. Data on adult cancer patients admitted due to pneumonia were reviewed. RESULTS In total, 245 patients were included, and 146 (59.6%) were male. The median age of the patients was 66 years (IQR: 57-75). A total of 72 (29.4%) patients died during admission. From multivariate logistic regression, prognostic factors for in-hospital death included: Palliative Performance Scale (PPS) ≤ 30 (OR: 8.47, 95% CI: 3.47-20.66), Palliative Performance Scale 40-50% (OR: 2.79, 95% CI: 1.34-5.81), percentage of lymphocytes ≤ 8.0% (OR: 2.10, 95% CI: 1.08-4.08), and pulse oximetry ≤ 90% (OR: 2.01, 95% CI: 1.04-3.87). CONCLUSION The in-hospital death rate of cancer patients admitted with pneumonia was approximately 30%. The PPS of 10-30%, PPS of 40-50%, percentage of lymphocytes ≤ 8%, and oxygen saturation < 90% could serve as prognostic factors for in-hospital death. Further prospective studies are needed to investigate the usefulness of these factors.
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Reliability and validity of the Arabic translation of the palliative performance scale. Palliat Support Care 2021; 18:575-579. [PMID: 31699174 DOI: 10.1017/s1478951519000889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The aim of this study was to translate the Palliative Performance Scale (PPSv2) into Arabic and to test the reliability and validity of the PPS Arabic translation (PPS-Arabic). METHOD The PPSv2 was translated into Modern Standard Arabic using a forward-backward method. Inter-rater and intra-rater reliabilities were tested in a pilot study that included 20 patients. The validation study included 150 cancer patients. Patients were divided according to their treatment plan into three groups (in-remission, palliative chemotherapy, and best supportive care) to perform hypothesis-testing construct validity. Validity was further evaluated by correlating PPS-Arabic with the Karnofsky Performance Scale (KPS), the Eastern Cooperative Oncology Group (ECOG) scale, and Physical Functioning (PF2) and Role Functioning (RF2) scales of the European Organization for Research and Treatment of Cancer quality of life questionnaire (EORTC QLQ-C30). RESULTS The intraclass correlation coefficients for the intra-rater and inter-rater reliability were 0.935 (95% CI: 0.88-0.965; p < 0.001) and 0.965 (95% CI: 0.934-0.981; p < 0.001), respectively. The PPS-Arabic internal consistency Cronbach's alpha was 0.986. The average PPS-Arabic score differed significantly (p < 0.001) between the three groups of patients being 89 for in-remission, 58 for palliative chemotherapy, and 38 for best supportive care. The PPS-Arabic score correlated significantly (p < 0.001) with the KPS, ECOG performance scale, and the EORTC QLQ-C30 PF2 and RF2 scales. CONCLUSION The PPS-Arabic is a reliable and valid tool for the assessment of performance status of cancer patients.
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Oğuz G, Şenel G, Koçak N, Karaca Ş. The Turkish Validity and Reliability Study of Palliative Performance Scale. Asia Pac J Oncol Nurs 2021; 8:413-418. [PMID: 34159234 PMCID: PMC8186388 DOI: 10.4103/apjon.apjon-2111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/31/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The Palliative Performance Scale version 2 (PPSv2) is a useful tool designed to assess the performance status of palliative care patients. The aim of this study was to translate the PPSv2 into Turkish and to test the validity and reliability of Turkish PPSv2 (PPS-TR) in cancer patients receiving palliative care. METHODS The translation of PPSv2 into Turkish was implemented using a forward-back forward procedure. The patients were allocated from inpatient palliative care unit, consultations from oncology services, palliative care polyclinic, and consultations from emergency unit. The inter-rater and intra-rater reliabilities were tested in a pilot study with 51 patients. The cross-sectional study consisted of 280 patients. The relationship between PPS-TR, Katz Index of Independence in Activities of Daily Living (Katz ADL), and Karnofsky Performance Scale (KPS) was also measured. Construct validity was assessed by observing the test capacity across patient groups based on the place of care. RESULTS Intraclass correlation coefficients (ICCs) at Time 1 and Time 2 were 0.982 (95% confidence interval [CI]: 0.972-0.989) and 0.991 (95% CI: 0.986-0.995). ICCs of intra-rater agreements were at least 0.956 (95% CI: 0.909-0.977) for three raters. KPS, Katz ADL, and PPS-TR scores of outpatients were significantly higher than those of inpatients and emergency. There was a perfect correlation between PPS-TR and KPS, while the correlation of PPS-TR with Katz ADL was almost perfect. CONCLUSIONS The PPS-TR is a reliable and valid tool for assessment of performance status of cancer patients receiving palliative care.
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Affiliation(s)
- Gonca Oğuz
- Department of Anesthesiology, Palliative Care Unit,University of Health Sciences, Dr AY Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Gülçin Şenel
- Department of Anesthesiology, Palliative Care Unit,University of Health Sciences, Dr AY Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Nesteren Koçak
- Department of Anesthesiology, Palliative Care Unit,University of Health Sciences, Dr AY Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Şerife Karaca
- Department of Anesthesiology, Palliative Care Unit,University of Health Sciences, Dr AY Ankara Oncology Training and Research Hospital, Ankara, Turkey
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Prompantakorn P, Angkurawaranon C, Pinyopornpanish K, Chutarattanakul L, Aramrat C, Pateekhum C, Dejkriengkraikul N. Palliative Performance Scale and survival in patients with cancer and non-cancer diagnoses needing a palliative care consultation: a retrospective cohort study. BMC Palliat Care 2021; 20:74. [PMID: 34039322 PMCID: PMC8157447 DOI: 10.1186/s12904-021-00773-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 05/13/2021] [Indexed: 11/12/2022] Open
Abstract
Background Palliative Performance Scale (PPS) has been frequently used to estimate the survival time of palliative care patients. The objective was to determine the associations between the PPS and survival time among cancer and non-cancer patients in Thailand. Methods This is a retrospective cohort study. All in-patient adults who received a palliative care consultation at Chiang Mai University Hospital between 1 July 2018 to 31 July 2019 were included in the study and were followed-up until 26 June 2020. The Palliative Performance Scale was assessed using the validated Thai-Palliative Performance Scale for Adults. Survival analysis was used to determine the association between the Palliative Performance Scale and survival time among cancer and non-cancer patients. Results Out of 407 patients, 220 were male (54.1%). There were 307 cancer patients (75.4%) and 100 non-cancer patients (24.6%). The PPS and survival time in cancer patients were significantly correlated. Cancer patients with PPS 10, 20, 30, 40–60, and 70–80% had a median survival time of 2, 6, 13, 39, and 95 days, respectively. Non-cancer patients with PPS 10, 20, and 30% had a median survival time of 8, 6, and 24 days, respectively. Conclusions While useful for estimating survival time for cancer patients, other factors should be taken into account in estimating the survival time for non-cancer patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00773-8.
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Affiliation(s)
| | - Chaisiri Angkurawaranon
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Lalita Chutarattanakul
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Chanchanok Aramrat
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Chanapat Pateekhum
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Buranupakorn T, Thangsuk P, Patumanond J, Phinyo P. Emulation of a Target Trial to Evaluate the Causal Effect of Palliative Care Consultation on the Survival Time of Patients with Hepatocellular Carcinoma. Cancers (Basel) 2021; 13:cancers13050992. [PMID: 33673534 PMCID: PMC7956840 DOI: 10.3390/cancers13050992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 02/22/2021] [Accepted: 02/24/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Hepatocellular carcinoma (HCC) is a common and aggressive liver cancer. As most patients are diagnosed during an incurable stage of the disease, they usually face great suffering during the end-of-life period. Palliative care can improve the patient’s quality of life and alleviate both physical and psychological symptoms. However, the discipline is underutilized due to a common misconception that it will accelerate the patient’s death. We emulated a hypothetical target trial to evaluate the causal effect of palliative care consultation on the survival time of patients diagnosed with HCC from retrospective observational data of a Thai tertiary care center. Although no clear survival benefit or harm was identified, palliative care consultation significantly reduced the use of unnecessary life-sustaining intervention, healthcare costs, and the risk of dying in the hospital among patients with HCC during their end-of-life period. Abstract Palliative care has the potential to improve the quality of life of patients with incurable diseases or cancer, such as hepatocellular carcinoma (HCC). A common misconception of palliative care with respect to the patient’s survival remains a significant barrier to the discipline. This study aimed to provide causal evidence for the effect of palliative care consultation on the survival time after diagnosis among HCC patients. An emulation of a target trial was conducted on a retrospective cohort of HCC patients from January 2017 to August 2019. The primary endpoint was the restricted mean survival time (RMST) at 12 months after HCC diagnosis. We used the clone–censor–weight approach to account for potential immortal time bias. In this study, 86 patients with palliative care consultation and 71 patients without palliative care consultation were included. The adjusted RMST difference was −29.7 (95% confidence interval (CI): −81.7, 22.3; p-value = 0.263) days in favor of no palliative care consultation. However, palliative care consultation was associated with an increase in the prescription of symptom control medications, as well as a reduction in life-sustaining interventions and healthcare costs. Our findings suggest that palliative care consultation was associated with neither additional survival benefit nor harm in HCC patients. The misconception that it significantly accelerates the dying process should be disregarded.
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Affiliation(s)
- Tassaya Buranupakorn
- Department of Family Medicine, Chiang Rai Prachanukroh Hospital, Chiang Rai 57000, Thailand; (T.B.); (P.T.)
| | - Phaviga Thangsuk
- Department of Family Medicine, Chiang Rai Prachanukroh Hospital, Chiang Rai 57000, Thailand; (T.B.); (P.T.)
| | - Jayanton Patumanond
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand;
| | - Phichayut Phinyo
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand;
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Musculoskeletal Science and Translational Research (MSTR) Cluster, Chiang Mai University, Chiang Mai 50200, Thailand
- Correspondence: ; Tel.: +66-53-935-180
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Sripaew S, Fumaneeshoat O, Ingviya T. Systematic adaptation of the Thai version of the supportive and palliative care indicators tool for low-income setting (SPICT-LIS). BMC Palliat Care 2021; 20:35. [PMID: 33607991 PMCID: PMC7896360 DOI: 10.1186/s12904-021-00729-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 02/12/2021] [Indexed: 11/25/2022] Open
Abstract
Background Identification of patients who might benefit from palliative care among countries with different socioeconomic and medical contexts is challenging. The Supportive and Palliative Care Indicators Tool for a Low-income Setting (SPICT-LIS) was designed to help physicians identify patients in low-income setting who might benefit from palliative care. We aimed to systematically adapt and refine the SPICT-LIS for Thai general palliative care providers. Methods We followed the WHO guidelines for translation, cross-cultural adaptation and validation of an instrument for the SPICT-LIS. Three expert panel members did the initial adaptation using forward and backward translations with pretested data. Two iterations of pretesting were conducted to test for applicability and reliability. The case vignettes which were used in the pretesting were modified hospital medical records. The pretesting was done with 30 respondents from various specialties in a community health center and 34 general palliative care providers from a regional referral hospital in the first and second iterations, respectively. To examine instrument reliability, interrater reliability and internal consistency were evaluated. Cognitive interviewing was conducted using semi-structured interviews with general practitioners (GPs) using the “think aloud strategy” and “probing questions”. Results The adapted Thai SPICT-LIS had a total of 34 indicators which included 6 general and 28 clinical indicators. The assessment of the adapted Thai SPICT-LIS found that it provided consistent responses with good agreement among the GPs, with a Fleiss kappa coefficient of 0.93 (0.76–1.00). The administration time was 2.3–4.3 min per case. Most respondents were female. The 8 interviewed GPs said they felt that the SPICT-LIS was appropriate for use in a general setting in Thailand. Conclusion The study found that the Thai SPICT-LIS could be an applicable, acceptable, and reliable tool for general palliative care providers in Thailand to identify patients who might benefit from palliative care.
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Affiliation(s)
- Supakorn Sripaew
- Department of Family and Preventive Medicine, Prince of Songkla University, Faculty of Medicine, Hat Yai, Songkhla, 90110, Thailand.
| | - Orapan Fumaneeshoat
- Department of Family and Preventive Medicine, Prince of Songkla University, Faculty of Medicine, Hat Yai, Songkhla, 90110, Thailand
| | - Thammasin Ingviya
- Department of Family and Preventive Medicine, Prince of Songkla University, Faculty of Medicine, Hat Yai, Songkhla, 90110, Thailand.,Research Center for Cancer Control, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand.,Medical Data Center for Research and Innovation, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
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Mosich V, Andersag M, Watzke H. Frau Doktor, wie lange noch? Die Palliative Performance Scale (PPS) als Hilfsmittel zur Einschätzung der Lebenszeit von PalliativpatientInnen – Validierung einer deutschen Version. Wien Med Wochenschr 2019; 169:387-393. [DOI: 10.1007/s10354-019-00714-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 10/21/2019] [Indexed: 11/25/2022]
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Pukrittayakamee P, Sapinum L, Suwan P, Harding R. Validity, Reliability, and Responsiveness of the Thai Palliative Care Outcome Scale Staff and Patient Versions Among Cancer Patients. J Pain Symptom Manage 2018; 56:414-420. [PMID: 29885457 DOI: 10.1016/j.jpainsymman.2018.05.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 05/23/2018] [Accepted: 05/30/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Palliative care is now part of Universal Health Coverage goals. Measurement of person-centered outcomes is central to determining quality and effectiveness. Guidance in psychometrics requires tools applied in new settings to have their properties tested. OBJECTIVES To translate staff and patient versions of the Palliative care Outcome Scale (POS, version 2) into Thai, and to determine its psychometric properties among cancer patients in a Thai public hospital. DESIGN The Thai POS was subjected to cross-cultural translation: forward translation, backward translation, review by experts, and content validity index measurement. The patient-rated and staff-rated versions were completed by 379 nurses. We tested internal consistency, known-group comparison, responsiveness, and agreement. SETTING/PARTICIPANTS About 379 Thai cancer patients were admitted to Maharaj Nakorn Chiang Mai Hospital. RESULTS We found good internal consistency (Cronbach's alpha 0.9), good discrimination between known groups (significant difference in scores between high and low performance status groups; Z ranged from -9.95 to -7.80; P < 0.001), good responsiveness (improvements in at Time 2; Z ranged from -14.01 to -6.31; P < 0.001), and acceptable to good patient-staff agreement on ratings (weighted kappa range 0.31-0.73). CONCLUSION The Thai POS is valid and reliable. These findings enable researchers and clinicians to apply the POS in primary research and routine clinical practice to both determine the effectiveness of interventions and improve care. This is the first validation in the region of a multidimensional person-centered outcome measure designed specifically for patients and families with advanced disease.
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Affiliation(s)
- Panate Pukrittayakamee
- Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ladarat Sapinum
- Maharaj Nakorn Chiang Mai Hospital, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Panadda Suwan
- Maharaj Nakorn Chiang Mai Hospital, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Richard Harding
- Department of Palliative Care, Policy & Rehabilitation, King's College London, Florence Nightingale School of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute, London, UK.
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Baik D, Russell D, Jordan L, Dooley F, Bowles KH, Masterson Creber RM. Using the Palliative Performance Scale to Estimate Survival for Patients at the End of Life: A Systematic Review of the Literature. J Palliat Med 2018; 21:1651-1661. [PMID: 30129809 DOI: 10.1089/jpm.2018.0141] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The Palliative Performance Scale (PPS) has been widely used for survival prediction among patients with cancer; however, few studies have reviewed PPS scores in heterogeneous palliative care populations across multiple care settings. OBJECTIVE The aim of this systematic review was to determine how the PPS tool has been used to estimate survival at the end of life. METHODS This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Embase, and the Cochrane Library were searched for the existing literature published from 2008 to 2017. We synthesized study characteristics, the PPS scores at baseline, and primary outcomes, and explored differences in survival estimates by diagnosis. The quality of the studies was assessed using the Good ReseArch for Comparative Effectiveness (GRACE) checklist. RESULTS Seventeen studies were included in this review (nine with cancer and eight with mixed diagnoses). All included studies reported that the PPS exhibited a significant association with survival. Survival estimates ranged from 1 to 3 days for patients with PPS scores of 10% compared with 5 to 36 days for those with scores of 30%. The categorical cut-points for the PPS scores were not consistently reported across studies. CONCLUSION This review provides a broad overview on the prognostic value of the PPS tool for survival among multiple patient populations across care settings. Consistent reporting of PPS scores would facilitate the comparison of survival estimates across end-of-life diagnoses.
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Affiliation(s)
- Dawon Baik
- 1 School of Nursing, Columbia University , New York, New York
| | - David Russell
- 2 Appalachian State University , Boone, North Carolina, Visiting Nurse Service of New York, New York, New York
| | - Lizeyka Jordan
- 3 Visiting Nurse Service of New York, New York, New York
| | - Frances Dooley
- 3 Visiting Nurse Service of New York, New York, New York
| | - Kathryn H Bowles
- 4 School of Nursing, University of Pennsylvania , Philadelphia, Pennsylvania, Visiting Nurse Service of New York, New York, New York
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Barallat E, Nabal M, Canal J, Trujillano J, Gea-Sánchez M, Larkin PJ, Downing MG. The Spanish Adaptation of the Palliative Performance Scale (Version 2) Among Cancer Patients at the End of Life: Psychometric Properties. J Pain Symptom Manage 2017; 54:570-577.e5. [PMID: 28712988 DOI: 10.1016/j.jpainsymman.2017.07.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 04/10/2017] [Accepted: 07/06/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Palliative Performance Scale (PPS) is a reliable tool to assess performance status in cancer patients receiving palliative care (PC). Spanish validated and culturally adapted tools are needed. OBJECTIVES The objectives are to develop PPS translation and cross-cultural adaptation into Spanish and to assess its psychometric properties. DESIGN Translation process with cross-cultural adaptation to produce Spanish Palliative Performance Scale (PPS-SPANISH). SETTINGS PC Team at one University hospital in Spain. PARTICIPANTS Fifteen advanced cancer patients (60 assessments) were included for PPS translation and validation and 250 patients for cross-sectional analysis. All participants were recruited at oncology ward, emergency area, and outpatient clinic by PC team professionals. Informed consent was given. Average age was 66.4 ± 13 years (60% men). METHODS The process is designed in three steps. In Step 1, PPS translation and reverse translation into Spanish (three bilingual speakers) and linguistic complexity measurement were performed. In Step 2, readability and intelligibility assessment was carried out. In Step 3, a pilot study was conducted to assess test-retest reliability followed by a cross-sectional study to measure internal consistency. Inclusion criteria were the same for two samples. Demographic data were also analyzed by descriptive statistics. RESULTS Following cultural, linguistic, and grammatical adaptation, PPS-SPANISH was readable and reliable. The analysis of the test-retest reliability after 48 hours showed intraclass correlations >0.60. Cronbach's alpha coefficient was 0.99 (0.988-0.992). There was high agreement with other functional assessment tools (Barthel Index and Karnofsky Performance Status Index). CONCLUSIONS PPS-SPANISH showed reliability and validity, and it is suitable to assess performance status in cancer patients receiving PC.
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Affiliation(s)
- Eva Barallat
- Faculty of Nursing and Physiotherapy, GESEC, University of Lleida, Lleida, Spain; Institute of Biomedical Research, IRB Lleida, Lleida, Spain.
| | - Maria Nabal
- Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Jaume Canal
- Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Javier Trujillano
- Institute of Biomedical Research, IRB Lleida, Lleida, Spain; Faculty of Medicine, University of Lleida, Lleida, Spain
| | - Montse Gea-Sánchez
- Faculty of Nursing and Physiotherapy, GESEC, University of Lleida, Lleida, Spain; Institute of Biomedical Research, IRB Lleida, Lleida, Spain
| | - Philip J Larkin
- University College Dublin School of Nursing, Midwifery and Health Systems Dublin, Ireland; Our Lady's Hospice & Care Services, University College Dublin College of Health Sciences, Dublin, Ireland
| | - Michael G Downing
- Faculty of Medicine, Palliative Consult Team, Primary & Community Health, South Caterbury District Health Board, Timaru, New Zealand
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Sathornviriyapong A, Nagaviroj K, Anothaisintawee T. The association between different opioid doses and the survival of advanced cancer patients receiving palliative care. BMC Palliat Care 2016; 15:95. [PMID: 27871265 PMCID: PMC5117570 DOI: 10.1186/s12904-016-0169-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 11/15/2016] [Indexed: 11/16/2022] Open
Abstract
Background Concerns that opioids may hasten death can be a cause of the physicians’ reluctance to prescribe opioids, leading to inadequate symptom palliation. Our aim was to find if there was an association between different opioid doses and the survival of the cancer patients that participated in our palliative care program. Methods A retrospective study was conducted at Ramathibodi Hospital, Bangkok between January 2013 and December 2015. All of the cancer patients that were referred to palliative care teams by their primary physicians were included in the study. The study data included the patients’ demographics, disease status, comorbidities, functional status, type of services, cancer treatments, date of consultation, and the date of the patient’s death or last follow-up. The information concerning opioid use was collected by reviewing the medical records and this was converted to an oral morphine equivalent (OME), following a standard ratio. The time-varying covariate in the Cox regression analysis was applied in order to determine the association between different doses of opioids and patient survival. Results A total of 317 cancer patients were included in the study. The median (IQR) of the OME among our patients was 6.43 mg/day (0.53, 27.36). The univariate Cox regression analysis did not show any association between different opioid doses (OME ≤ 30 mg/day and > 30 mg/day) and the patients’ survival (p = 0.52). The PPS levels (p < 0.01), palliative care clinic visits (HR 0.32, 95%CI 0.24–0.43), home visits (HR 0.75, 95%CI 0.57–0.99), chemotherapy (HR 0.32, 95%CI 0.22–0.46), and radiotherapy (HR 0.53, 95%CI 0.36–0.78) were identified as factors that increased the probability of survival. Conclusions Our study has demonstrated that different opioid doses in advanced cancer patients are not associated with shortened survival period.
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Affiliation(s)
- Anon Sathornviriyapong
- Department of Family Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Street, Rajthevi, Bangkok, 10400, Thailand
| | - Kittiphon Nagaviroj
- Department of Family Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Street, Rajthevi, Bangkok, 10400, Thailand.
| | - Thunyarat Anothaisintawee
- Department of Family Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Street, Rajthevi, Bangkok, 10400, Thailand
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Nagaviroj K, Anothaisintawee T. A Study of the Association Between Multidisciplinary Home Care and Home Death Among Thai Palliative Care Patients. Am J Hosp Palliat Care 2016; 34:397-403. [PMID: 26888885 DOI: 10.1177/1049909116631550] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Many terminally ill patients would prefer to stay and die in their own homes, but unfortunately, some may not be able to do so. Although there are many factors associated with successful home deaths, receiving palliative home visits from the multidisciplinary care teams is one of the key factors that enable patients to die at home. Our study was aimed to find whether there was any association between our palliative home care program and home death. METHODS A retrospective study was conducted in the Department of Family Medicine at Ramathibodi Hospital between January 2012 and May 2014. All of the patients who were referred to multidisciplinary palliative care teams were included. The data set comprised of patient's profile, disease status, functional status, patient's symptoms, preferred place of death, frequency of home visits, types of team interventions, and patient's actual place of death. Multiple logistic regression was applied in order to determine the association between the variables and the probability of dying at home. RESULTS A total of 142 patients were included into the study. At the end of the study, 50 (35.2%) patients died at home and 92 (64.8%) patients died in the hospital. The multivariate logistic regression analysis demonstrated a strong association between multidisciplinary home care and home death (odds ratio 6.57, 95% confidence interval [CI] 2.48-17.38). CONCLUSION Palliative home care was a significant factor enabling patients who want to die at home. We encourage health policy makers to promote the development of community-based palliative care programs in Thailand.
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Affiliation(s)
- Kittiphon Nagaviroj
- 1 Department of Family Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Thunyarat Anothaisintawee
- 1 Department of Family Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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