1
|
Mercadante S, Zimmermann C, Lau J, Walsh D. Should an Acute Palliative Care Unit be Mandatory for Cancer Centers and Tertiary Care Hospitals? J Pain Symptom Manage 2025; 69:e70-e77. [PMID: 39426555 DOI: 10.1016/j.jpainsymman.2024.10.010] [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: 08/26/2024] [Revised: 10/07/2024] [Accepted: 10/08/2024] [Indexed: 10/21/2024]
Abstract
Acute palliative care units have been developing in the last years and their clinical activity and characteristics have been described, despite large differences in different countries. One controversial topic is whether such units should be mandatory as standard in comprehensive cancer centers or even in tertiary hospitals. In this "Controversies in Palliative Care" article, three expert clinicians independently answer this question. Specifically, each group provides a synopsis of the key studies that inform their thought processes, share practical advice on their clinical approach, and highlight the opportunities for future research. Interestingly, all three experts arrived at similar conclusions. They underscored the importance of an acute palliative care unit, which provides a different pattern of activities in comparison with typical inpatient hospices, generally caring for patients who have a limited expected survival.
Collapse
Affiliation(s)
- Sebastiano Mercadante
- Main Regional Center for Pain Relief and Supportive/Palliative Care, La Maddalena Cancer Center, Palermo, IT, USA.
| | - Camilla Zimmermann
- Division of Palliative Medicine, Department of Medicine, University of Toronto and Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Canada
| | - Jenny Lau
- Department of Supportive Care, Princess Margaret Cancer Centre, Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Declan Walsh
- Department of Supportive Oncology, Atrium Health Levine Cancer, Charlotte, USA; Atrium Health Wake Forest Baptist Comprehensive Cancer Center, The Hemby Family Chair in Supportive Oncology, Winston-Salem, USA
| |
Collapse
|
2
|
Viftrup DT, Voetmann SS. Caring Existentially and Spiritually for Young Children and Close Grandchildren of Life-Threatened Cancer Patients in Secularized Denmark. Semin Oncol Nurs 2023; 39:151484. [PMID: 37543470 DOI: 10.1016/j.soncn.2023.151484] [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] [Received: 06/07/2023] [Revised: 07/07/2023] [Accepted: 07/10/2023] [Indexed: 08/07/2023]
Abstract
PURPOSE When children are given opportunities to talk about their existential and spiritual concerns and needs, different health risks related to parents' illness and death may be reduced. The existential and spiritual care and conversations provided during parents' and close grandparents' cancer illness are insufficient. This article presents a practical and theoretical perspective on how to care for the existential and spiritual needs of children at three different age stages. DATA SOURCES Data from a research project guided the process of synthesizing the theoretical aspects with the practical. The theoretical perspective comprises Majbrit Guldin's theory of children's age-related grief reactions and James Fowler's three stages about children's spiritual and cognitive development. The empirical study is based on qualitative interviews with 16 children or close grandchildren of cancer patients at hospice. CONCLUSION The theoretical and practical perspective function as a guide for existential and spiritual care and conversation with children at three different ages. The preschool child needs adults to support their growing spirituality and help them show, express, and understand their feelings. The school-aged child needs adults who listen to and acknowledge the child's understandings, experiences, and feelings as well as challenge their rigid thinking. The young adult needs adults who are willing to be there for them physically, mentally, socially, and spiritually in a genuine relationship. IMPLICATIONS FOR NURSING PRACTICE The perspective might function well for nurses and other health professionals as it is generic and addresses barriers for communication with children found in different healthcare contexts.
Collapse
Affiliation(s)
- Dorte Toudal Viftrup
- Associate Professor, Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.
| | - Sara Stage Voetmann
- PhD Student, Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
3
|
Rantanen P, Chochinov HM, Emanuel LL, Handzo G, Wilkie DJ, Yao Y, Fitchett G. Existential Quality of Life and Associated Factors in Cancer Patients Receiving Palliative Care. J Pain Symptom Manage 2022; 63:61-70. [PMID: 34332045 PMCID: PMC8766863 DOI: 10.1016/j.jpainsymman.2021.07.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 07/19/2021] [Accepted: 07/21/2021] [Indexed: 01/03/2023]
Abstract
CONTEXT Enhancing quality of life (QoL) is a goal of palliative care. Existential QoL is an important aspect of this. OBJECTIVES This study sought to advance our understanding of existential QoL at the end of life through examining levels of Preparation and Completion, subscales of the QUAL-E, and their associated factors. METHODS We used data from a multi-site study of 331 older cancer patients receiving palliative care. We examined levels of Preparation and Completion and their association with demographic, religious, and medical factors, and with the Patient Dignity Inventory. RESULTS Preparation and Completion scores were moderately high. In adjusted models, being 10 years older was associated with an increase of 0.77 in Preparation (P = 0.002). Non-white patients had higher Preparation (1.03, P = 0.01) and Completion (1.56, P = 0.02). Single patients reported Completion score 1.75 point lower than those married (P = 0.01). One-point increase in intrinsic religiousness was associated with a 0.86-point increase in Completion (P = 0.03). One-point increase in terminal illness awareness was associated with 0.75-point decrease in Preparation (P = 0.001). A 10-point increase in symptom burden was associated with a decrease of 0.55 in Preparation (P < 0.001) and a decrease of 1.0 in Completion (P < 0.001). The total Patient Dignity Inventory score and all of its subscales were negatively correlated with Preparation (r from -.26 to -.52, all P < 0.001) and Completion (r from -.18 to -.31, all P < 0.001). CONCLUSION While most patients reported moderate to high levels of existential QoL, a subgroup reported low existential QoL. Terminal illness awareness and symptom burden may be associated with lower existential QoL.
Collapse
Affiliation(s)
- Petra Rantanen
- University of Rochester School of Medicine and Dentistry (P.R.) Rochester, New York, USA
| | - Harvey Max Chochinov
- Research Institute of Oncology and Hematology (H.M.C.), Cancer Care Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada, USA
| | - Linda L Emanuel
- Buehler Center on Aging (L.L.E.), Heatlh and Society, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
| | - George Handzo
- Health Services Research & Quality (G.H.), HealthCare Chaplaincy Network, Caring for the Human Spirit TM, New York, New York, USA
| | - Diana J Wilkie
- Center for Palliative Care Research and Education (D.J.W., Y.Y.), College of Nursing, University of Florida, Gainesville, Florida, USA
| | - Yingwei Yao
- Center for Palliative Care Research and Education (D.J.W., Y.Y.), College of Nursing, University of Florida, Gainesville, Florida, USA
| | - George Fitchett
- Department of Religion (G.F.), Health and Human Values, Rush University Medical Center, Chicago, Illinois, USA.
| |
Collapse
|
4
|
Viftrup DT, Nissen R, Søndergaard J, Hvidt NC. Four aspects of spiritual care: a phenomenological action research study on practicing and improving spiritual care at two Danish hospices. Palliat Care Soc Pract 2021; 15:26323524211050646. [PMID: 34708208 PMCID: PMC8543636 DOI: 10.1177/26323524211050646] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/16/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In Denmark and internationally, there has been an increased focus on strengthening palliative care by enhancing spiritual care. Dying patients, however, do not experience their spiritual needs being adequately met. METHODS Through an action research study design with four consecutive stages, namely, observation in practice, reflection-on-praxis, action-in-praxis, and evaluation of the action research process involving patients and hospice staff from two hospices in Denmark, two research questions were explored: (1) How do patients and staff perceive, feel, live, practice, and understand spiritual care at hospice? and (2) How can spiritual care be improved in hospice practice? The data material presented comprised 12 individual interviews with patients and nine focus group interviews with the staff. RESULTS We found four aspects of spiritual care through which patients and staff seemed to perceive, feel, live, practice, and understand spiritual care at hospice, and from where spiritual care may be improved in hospice practice. These aspects constituted four themes: (1) relational, (2) individualistic, (3) embodied, and (4) verbal aspects of spiritual care. CONCLUSION Staff realized immanent limitations of individual aspects of spiritual care but learned to trust that their relational abilities could improve spiritual care. Embodied aspects seemed to open for verbal aspects of spiritual care, but staff were reluctant to initiative verbal dialogue. They would bodily sense values about preserving patients' boundaries in ways that seemed to hinder verbal aspects of spiritual care. During action-in-praxis, however, staff realized that they might have to initiate spiritual conversation in order to care for patients' spiritual needs.
Collapse
Affiliation(s)
- Dorte Toudal Viftrup
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, 5000 Odense C, Denmark
| | - Ricko Nissen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Niels Christian Hvidt
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| |
Collapse
|
5
|
Developing an Educational Course in Spiritual Care: An Action Research Study at Two Danish Hospices. RELIGIONS 2021. [DOI: 10.3390/rel12100827] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Further improvement of spiritual care in palliative care is warranted. Particularly reducing barriers and enhancing spiritual care competencies among the healthcare professionals is needed. The aim was to develop a training course in spiritual care in close collaboration with patients and staff from two Danish hospices. We applied an action research design to ensure that the training course was rooted in everyday practice of patients and staff. The methodology applied was based on philosophical hermeneutics and existential phenomenology. The action research process enabled the division into three topics on how a training course can reduce barriers towards spiritual care among the healthcare professionals. These three topics functioned as a theoretical framework for educating staff at a hospice in spiritual care. The three topics were: (1) the vulnerable encounter; (2) self-reflection concerning spiritual needs, thoughts, beliefs, and values; and (3) shared professional language for spiritual care. We operationalized the three topics into a flexible course design that could be adaptable to the practical possibilities and limitations of the individual hospice. The curriculum includes theoretical teaching, reflection exercises, and an improvisation theater workshop with professional actors. Educating staff led to the improvement of spiritual care at the hospices involved in the study.
Collapse
|
6
|
Viftrup DT, Prinds C, Nissen RD, Steenfeldt VØ, Søndergaard J, Hvidt NC. Older Adults' Experience of Meaning at the End of Life in Two Danish Hospices: A Qualitative Interview Study. Front Psychol 2021; 12:700285. [PMID: 34603128 PMCID: PMC8484531 DOI: 10.3389/fpsyg.2021.700285] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 08/23/2021] [Indexed: 11/13/2022] Open
Abstract
The aim of this study was to explore how older adults (aged > 65) confronted with imminent death express their thoughts and feelings about death and dying and verbalize meaning. Furthermore, the aim was to investigate how health professionals could better address the needs of this patient group to experience meaning at the end of life. The study applied a qualitative method, involving semi-structured interviews with 10 participants at two hospices. The method of analysis was interpretative phenomenological analysis. We found three chronological time-based themes: (1) Approaching Death, (2) The time before dying, and (3) The afterlife. The participants displayed scarce existential vernacular for pursuing meaning with approaching death. They primarily applied understanding and vocabulary from a medical paradigm. The participants' descriptions of how they experienced and pursued meaning in the time before dying were also predominantly characterized by medical vernacular, but these descriptions did include a few existential words and understandings. When expressing thoughts and meaning about the afterlife, participants initiated a two-way dialogue with the interviewer and primarily used existential vernacular. This indicates that the participants' scarce existential vernacular to talk about meaning might be because people are not used to talking with healthcare professionals about meaning or their thoughts and feelings about death. They are mostly "trained" in medical vernacular. We found that participants' use of, respectively, medical or existential vernacular affected how they experienced meaning and hope at the end of life. We encourage healthcare professionals to enter into existential dialogues with people to support and strengthen their experiences of meaning and hope at the end of life.
Collapse
Affiliation(s)
- Dorte Toudal Viftrup
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Christina Prinds
- Research Unit of Gynecology and Obstetrics, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department for Research and Development, University College South Denmark, Haderslev, Denmark
| | - Ricko Damberg Nissen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | | | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Niels Christian Hvidt
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Odense, Denmark
| |
Collapse
|
7
|
Chahrour WH, Hvidt NC, Hvidt EA, Viftrup DT. Learning to care for the spirit of dying patients: the impact of spiritual care training in a hospice-setting. BMC Palliat Care 2021; 20:115. [PMID: 34273974 PMCID: PMC8286591 DOI: 10.1186/s12904-021-00804-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 05/17/2021] [Indexed: 11/21/2022] Open
Abstract
Background Patients approaching the end of their life do not experience their existential and spiritual needs being sufficiently met by the healthcare professionals responsible for their care. Research suggest that this is partly due to a lack of insight about spiritual care among healthcare professionals. By developing, implementing, and evaluating a research-based educational course on spiritual care targeting hospice staff, we aimed to explore the perceived barriers for providing spiritual care within a hospice setting and to evaluate the post-course impact among staff members. Methods Course development and evaluation was based on primary exploratory action research and followed the UK Medical Research Council’s framework for complex intervention research. The course was implemented at two Danish hospices and comprised thematic days that included lectures, reflective exercises and improvised participatory theatre. We investigated the course impact using a questionnaire and focus group interviews. The questionnaire data were summarized in bar charts and analysis of the transcribed interviews was performed based on Interpretative Phenomenological Analysis. Results 85 staff members participated in the course. Of these, 57 answered the evaluative questionnaire and 15 participated in 5 focus group interviews. The course elements that the participants reported to be the most relevant were improvised theatre unfolding existential themes and reflexive group activities. 98% of participants found the course relevant, answering either “relevant” or “very relevant”. 73,1% of participants answered “to a considerable extent” or “to a great extent” when asked to what extent they assessed the content of the course to influence their work in hospice. The focus group data resulted in 3 overall themes regarding perceived barriers for providing spiritual care: 1. Diverse approaches is beneficial for spiritual care, but the lack of a shared and adequate spiritual language is a communicative barrier, 2. Existential conversation is complicated by patients’ overlapping physical and existential needs, as well as miscommunication, and 3. Providing spiritual care requires spiritual self-reflection, self-awareness, introspection, and vulnerability. Conclusions This study provides insights into the barriers facing spiritual care in a hospice setting. Furthermore, the course evaluations demonstrate the valuable impact of spiritual care training for health care professionals. Further course work development is warranted to enhance the “science” of spiritual care for the dying. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00804-4.
Collapse
Affiliation(s)
- Wafie Hussein Chahrour
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense J. B. Winsløwsvej 9A, 5000, Odense C, Denmark.
| | - Niels Christian Hvidt
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense J. B. Winsløwsvej 9A, 5000, Odense C, Denmark
| | - Elisabeth Assing Hvidt
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense J. B. Winsløwsvej 9A, 5000, Odense C, Denmark
| | - Dorte Toudal Viftrup
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense J. B. Winsløwsvej 9A, 5000, Odense C, Denmark
| |
Collapse
|
8
|
Boureanu M, Brahim LO, Apedaile D, Wasserman S, Magalhaes M, Belzile E, Frati FYE, Lambert S. Evaluation of online, publicly available cancer-related educational and self-management resources for symptom management. Psychooncology 2021; 30:1884-1893. [PMID: 34165858 DOI: 10.1002/pon.5756] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/09/2021] [Accepted: 06/15/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The aims of this study were to evaluate the readability, suitability, and quality of publicly available online self-management (SM) resources for people with cancer. METHODS Resources were identified using two strategies: (1) a targeted search of 20 Canadian organizations and (2) a Google search. These were evaluated using the Suitability Assessment of Materials (SAM), the DISCERN tool for quality, and readability indices. The SM skills (e.g., problem-solving) and symptom management strategies addressed by each resource were also assessed. Descriptive and hierarchical cluster analyses were performed to identify resources of the highest suitability and quality as well as resource characteristics associated with higher quality and suitability. RESULTS A total of 92 resources were evaluated. The mean reading grade level for English resources was 10.29 (SD = 1.64, range of 7.05 to 15.09) and 12.62 for French resources (SD = 2.27, range of 10.12 to 15.65). The mean SAM score across the sample was 50.4% (SD = 10.6%), or 'adequate', and the mean DISCERN score was 61.1% (SD = 11.8%), or 'fair'. The cluster analysis indicated that 10 resources scored highly on both the SAM and the DISCERN. In total, 91 symptom management strategies were identified. On average, resources addressed 2.73 SM skills (SD = 1.58). CONCLUSIONS There is a need for plain language resources for people with lower reading ability and resources that incorporate more SM skills. Study findings will help healthcare professionals, patients, and their families identify optimal resources to address cancer-related symptoms.
Collapse
Affiliation(s)
- Mara Boureanu
- Ingram School of Nursing, McGill University, Montreal, Quebec, Canada
| | - Lydia Ould Brahim
- Ingram School of Nursing, McGill University, Montreal, Quebec, Canada
| | - Dorothy Apedaile
- St. Mary's Research Centre, Centre intégré universitaire de santé et de services sociaux de l'Ouest-de-l'Île-de-Montréal, Montreal, Quebec, Canada
| | - Sydney Wasserman
- Ingram School of Nursing, McGill University, Montreal, Quebec, Canada
| | - Mona Magalhaes
- St. Mary's Research Centre, Centre intégré universitaire de santé et de services sociaux de l'Ouest-de-l'Île-de-Montréal, Montreal, Quebec, Canada
| | - Eric Belzile
- St. Mary's Research Centre, Centre intégré universitaire de santé et de services sociaux de l'Ouest-de-l'Île-de-Montréal, Montreal, Quebec, Canada
| | - Francesca Y E Frati
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montreal, Quebec, Canada
| | - Sylvie Lambert
- Ingram School of Nursing, McGill University, Montreal, Quebec, Canada.,St. Mary's Research Centre, Centre intégré universitaire de santé et de services sociaux de l'Ouest-de-l'Île-de-Montréal, Montreal, Quebec, Canada
| |
Collapse
|
9
|
Hvidt NC, Nielsen KT, Kørup AK, Prinds C, Hansen DG, Viftrup DT, Assing Hvidt E, Hammer ER, Falkø E, Locher F, Boelsbjerg HB, Wallin JA, Thomsen KF, Schrøder K, Moestrup L, Nissen RD, Stewart-Ferrer S, Stripp TK, Steenfeldt VØ, Søndergaard J, Wæhrens EE. What is spiritual care? Professional perspectives on the concept of spiritual care identified through group concept mapping. BMJ Open 2020; 10:e042142. [PMID: 33372078 PMCID: PMC7772306 DOI: 10.1136/bmjopen-2020-042142] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES The overall study aim was to synthesise understandings and experiences regarding the concept of spiritual care (SC). More specifically, to identify, organise and prioritise experiences with the way SC is conceived and practised by professionals in research and the clinic. DESIGN Group concept mapping (GCM). SETTING The study was conducted within a university setting in Denmark. PARTICIPANTS Researchers, students and clinicians working with SC on a daily basis in the clinic and/or through research participated in brainstorming (n=15), sorting (n=15), rating and validation (n=13). RESULTS Applying GCM, ideas were identified, organised and prioritised online. A total of 192 unique ideas of SC were identified and organised into six clusters. The results were discussed and interpreted at a validation meeting. Based on input from the validation meeting a conceptual model was developed. The model highlights three overall themes: (1) 'SC as an integral but overlooked aspect of healthcare' containing the two clusters SC as a part of healthcare and perceived significance; (2) 'delivering SC' containing the three clusters quality in attitude and action, relationship and help and support, and finally (3) 'the role of spirituality' containing a single cluster. CONCLUSION Because spirituality is predominantly seen as a fundamental aspect of each individual human being, particularly important during suffering, SC should be an integral aspect of healthcare, although it is challenging to handle. SC involves paying attention to patients' values and beliefs, requires adequate skills and is realised in a relationship between healthcare professional and patient founded on trust and confidence.
Collapse
Affiliation(s)
- Niels Christian Hvidt
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
- Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Odense, Denmark
| | - Kristina Tomra Nielsen
- Department of Occupational Therapy, University College of Northern Denmark (UCN), Aalborg, Denmark
- The ADL Unit, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| | - Alex K Kørup
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
- Department of Mental Health Service Kolding-Vejle, Region of Southern Denmark, Vejle, Denmark
| | - Christina Prinds
- Clinical Institute, Syddansk Universitet Det Sundhedsvidenskabelige Fakultet, Odense, Denmark
- Research, University College South - Campus Haderslev, Haderslev, Denmark
| | - Dorte Gilså Hansen
- IRS, Center for Shared Decision Making, Lillebaelt Hospital, University of Southern Denmark, Vejle, Denmark
| | - Dorte Toudal Viftrup
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Elisabeth Assing Hvidt
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | | | - Erik Falkø
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Flemming Locher
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, JELLING, Denmark
| | - Hanne Bess Boelsbjerg
- Interacting Minds Centre, Department of Clinical Medicine, Aarhus Universitet, Aarhus, Denmark
- Elective Surgery Center, Silkeborg Regional Hospital, Silkeborg, Midtjylland, Denmark
| | - Johan Albert Wallin
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Karsten Flemming Thomsen
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Katja Schrøder
- Department of Public Health, Syddansk Universitet, Odense, Denmark
| | - Lene Moestrup
- Health Science Research Center, University College Lillebaelt - Campus Odense, Odense, Denmark
| | - Ricko Damberg Nissen
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Sif Stewart-Ferrer
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Tobias Kvist Stripp
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | | | - Jens Søndergaard
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Eva Ejlersen Wæhrens
- The Research Initiative for Activity studies and Occupational Therapy, Research Unit of User Perspectives, Institute of Public Health, University of Southern Denmark, Odense, Denmark
- The ADL unit, Frederiksberg Hospital Parker Institute, Frederiksberg, Hovedstaden, Denmark
| |
Collapse
|
10
|
Mah K, Swami N, Le LW, Chow R, Hannon BL, Rodin G, Zimmermann C. Validation of the 7-item Functional Assessment of Cancer Therapy-General (FACT-G7) as a short measure of quality of life in patients with advanced cancer. Cancer 2020; 126:3750-3757. [PMID: 32459377 DOI: 10.1002/cncr.32981] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/17/2020] [Accepted: 03/28/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Assessing quality of life is essential for individuals with advanced cancer, but lengthy assessments can be burdensome. The authors investigated the psychometric characteristics of the FACT-G7, a 7-item quality-of-life measure derived from the Functional Assessment of Cancer Therapy-General (FACT-G) scale, in advanced cancer. METHODS Data were obtained from outpatients with advanced cancer who were enrolled in a randomized controlled trial of early palliative care. At baseline, 228 intervention participants and 233 control participants (N = 461) completed the FACT-G and measures of symptom severity, quality of life near the end of life, problematic medical communication, and satisfaction with care. Follow-up measures were administered monthly for 4 months. RESULTS The FACT-G7 showed good internal consistency (Cronbach α = .72-.80), and its single-factor structure was supported. It correlated strongly with the FACT-G total, physical, and functional indices and with symptom severity (absolute r = 0.73-0.92); more moderately with the FACT-G emotional index and with symptom impact and preparation for the end of life (r = .40-.71); and least with the FACT-G social/family index and with relationship with health care provider, life completion, problematic medical communication, and care satisfaction measures (absolute r = .26-.44). Eastern Cooperative Oncology Group performance status groups differed on FACT-G7 scores, as expected (all P < .001). Improvements in FACT-G7 scores in the intervention group compared with the control group at 3-month (P = .049) and 4-month (P = .034) follow-up supported responsiveness to change and somewhat greater sensitivity than the FACT-G scores. CONCLUSIONS The FACT-G7 is a valid, brief measure particularly of the physical and functional facets of quality of life. It may enable rapid quality-of-life assessments in patients with advanced cancer.
Collapse
Affiliation(s)
- Kenneth Mah
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Nadia Swami
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Lisa W Le
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Ronald Chow
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Breffni L Hannon
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Division of Palliative Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Princess Margaret Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Division of Palliative Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Princess Margaret Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
11
|
Kwon S, Kim M, Choi S. Nurses' experiences of providing "sensitive nursing care" for terminally-ill individuals with cancer: A qualitative study. Eur J Oncol Nurs 2020; 46:101773. [PMID: 32504877 DOI: 10.1016/j.ejon.2020.101773] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 04/30/2020] [Accepted: 05/08/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To explore the sensitive nursing care provided by nurses who care for terminally-ill individuals with cancer. METHODS In-depth interviews were conducted using Colaizzi's phenomenological approach. Participants were 16 hospice specialists and four non-specialist nurses with experience in caring for terminal cancer patients in hospice specialized institutions in South Korea. RESULTS Eight theme clusters were drawn from the data and these clusters had two dimensions consisting of sensitive attitudes and sensitive nursing behaviors. The sensitive attitudes included reflecting on past experiences, developing an accepting attitude toward death, using intuition to address critical situations, and having an open mind regarding collaborating with colleagues. The sensitive nursing behaviors contained listening to patients' needs, responding to patients in a manner suitable to their conditions, quickly responding to patients' problem, and providing a moment saying farewell. CONCLUSIONS Teamwork and role models can help hospice specialists and non-specialist nurses caring for terminally-ill individuals with cancer to improve the sensitive nursing care. The sensitive attitudes and behaviors can be used as basic data for training programs designed to enhance nurses' sensitivity.
Collapse
Affiliation(s)
- Sinyoung Kwon
- Hospice & Palliative Care Center, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Science, Seoul, South Korea.
| | - Miyoung Kim
- College of Nursing, Ewha Womans University, Seoul, South Korea.
| | - Sujin Choi
- College of Nursing, Woosuk University, Jeonju, South Korea.
| |
Collapse
|
12
|
Gill A, Chakraborty A, Selby D. What is Symptom Burden: A Qualitative exploration of Patient Definitions. J Palliat Care 2018. [DOI: 10.1177/082585971202800204] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Current definitions of “symptom burden” are largely derived from clinicians, and there are many variations in the way the term is used, defined, and operationalized. The aim of this study was to explore patient perceptions of symptom burden in the context of advanced and incurable disease. A group of 58 cancer patients followed by a palliative care team answered a single open-ended question: “Please define ‘symptom burden.”’ Three authors independently coded and analyzed patient responses using a grounded theory approach. They identified six themes, the most frequently coded of which were: “can't do usual activities,” “psychological suffering,” and “specific severe symptoms.” Our findings indicate that the concept of symptom burden is complex and extends beyond numerical symptom-scoring systems. In addition to inquiring about specific symptoms, it may be important to directly ask patients about their overall burden or experience of symptoms.
Collapse
Affiliation(s)
- Ashlinder Gill
- D Selby (corresponding author): Division of Palliative Care, Sunnybrook Health Sciences Centre, Room H354, 2075 Bayview Avenue, Toronto, Ontario, Canada
| | - Anita Chakraborty
- A Gill, A Chakraborty: Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Debbie Selby
- A Gill, A Chakraborty: Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| |
Collapse
|
13
|
Abstract
Survivorship has become a significant topic within oncologic care. The tools and means by which the provision of survivorship care can be implemented and delivered are in development and are the focus of significant research oncology-wide. These tools and methods include innovations of survivorship care delivery, survivorship care plans, and improving communication among all stakeholders in an individual patient's care as the means to elevate health-related quality of life. The merits of these survivorship care provisions in the field of neuro-oncology and its patients' exigent need for more patient-centric care focused on living with their illness are discussed. Since 2014 there has been a mandate within the United States for adult cancer patients treated with curative intent to receive survivorship care plans, comprising a treatment summary and a follow-up plan, intended to facilitate patients' care after initial diagnosis and upfront treatment. Several cancer-specific survivorship care plans have been developed and endorsed by health care professional organizations and patient advocacy groups. A survivorship care plan specific for neuro-oncology has been collaboratively developed by a multidisciplinary and interprofessional committee; it is endorsed by the Society for Neuro-Oncology Guidelines Committee. It is available as open access for download from the Society for Neuro-Oncology website under "Resources": https://www.soc-neuro-onc.org/SNO/Resources/Survivorship_Care_Plan.aspx. Survivorship care offers an opportunity to begin directly addressing the range of issues patients navigate throughout their illness trajectory, an oncology initiative to which neuro-oncology patients both need and deserve equitable access.
Collapse
Affiliation(s)
- Heather Leeper
- Department of Neurology, NorthShore University Health System, Evanston, Illinois
| | - Kathrin Milbury
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| |
Collapse
|
14
|
Nakamura ZM, Deal AM, Nyrop KA, Choi SK, Wood WA, Muss HB. Associations of functional, psychosocial, medical, and socio-demographic factors with cognitive screening in chemotherapy naïve patients with breast cancer. Psychooncology 2018; 28:167-173. [DOI: 10.1002/pon.4928] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 10/06/2018] [Accepted: 10/17/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Zev M. Nakamura
- Department of Psychiatry; University of North Carolina at Chapel Hill; Chapel Hill NC USA
| | - Allison M. Deal
- Lineberger Comprehensive Cancer Center; University of North Carolina at Chapel Hill; Chapel Hill NC USA
| | - Kirsten A. Nyrop
- Lineberger Comprehensive Cancer Center; University of North Carolina at Chapel Hill; Chapel Hill NC USA
- Department of Medicine, Division of Hematology/Oncology; University of North Carolina at Chapel Hill; Chapel Hill NC USA
| | - Seul Ki Choi
- Department of Health Behavior, Gillings School of Global Public Health; University of North Carolina at Chapel Hill; Chapel Hill NC USA
| | - William A. Wood
- Lineberger Comprehensive Cancer Center; University of North Carolina at Chapel Hill; Chapel Hill NC USA
- Department of Medicine, Division of Hematology/Oncology; University of North Carolina at Chapel Hill; Chapel Hill NC USA
| | - Hyman B. Muss
- Lineberger Comprehensive Cancer Center; University of North Carolina at Chapel Hill; Chapel Hill NC USA
- Department of Medicine, Division of Hematology/Oncology; University of North Carolina at Chapel Hill; Chapel Hill NC USA
| |
Collapse
|
15
|
Wen FH, Chen JS, Chou WC, Hsieh CH, Chang WC, Shen WC, Tang ST. Quality of life and psychological distress are differentially associated with distinct symptom-functional states in terminally ill cancer patients' last year of life. Psychooncology 2018; 27:2111-2118. [DOI: 10.1002/pon.4775] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 05/15/2018] [Accepted: 05/17/2018] [Indexed: 01/27/2023]
Affiliation(s)
- Fur-Hsing Wen
- Department of International Business; Soochow University; Taipei Taiwan
| | - Jen-Shi Chen
- Division of Hematology-Oncology; Chang Gung Memorial Hospital at Linkou; Taoyuan City Taiwan
- Chang Gung University College of Medicine; Taoyuan City Taiwan
| | - Wen-Chi Chou
- Division of Hematology-Oncology; Chang Gung Memorial Hospital at Linkou; Taoyuan City Taiwan
- Chang Gung University College of Medicine; Taoyuan City Taiwan
| | - Chia-Hsun Hsieh
- Division of Hematology-Oncology; Chang Gung Memorial Hospital at Linkou; Taoyuan City Taiwan
- Chang Gung University College of Medicine; Taoyuan City Taiwan
| | - Wen-Cheng Chang
- Division of Hematology-Oncology; Chang Gung Memorial Hospital at Linkou; Taoyuan City Taiwan
- Chang Gung University College of Medicine; Taoyuan City Taiwan
| | - Wen Chi Shen
- Division of Hematology-Oncology; Chang Gung Memorial Hospital at Linkou; Taoyuan City Taiwan
- Chang Gung University College of Medicine; Taoyuan City Taiwan
| | - Siew Tzuh Tang
- Division of Hematology-Oncology; Chang Gung Memorial Hospital at Linkou; Taoyuan City Taiwan
- Department of Nursing; Chang Gung Memorial Hospital at Kaohsiung; Taoyuan City Taiwan
| |
Collapse
|
16
|
Moestrup L, Hvidt NC. Where is God in my dying? A qualitative investigation of faith reflections among hospice patients in a secularized society. DEATH STUDIES 2016; 40:618-629. [PMID: 27560705 DOI: 10.1080/07481187.2016.1200160] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Despite increased focus on the role of spiritual care in palliative care, there is limited knowledge about spirituality/religiosity among dying patients in secularized cultures such as Denmark. This study aims through semi-structured interviews with Danish hospice patients and participant observation to elucidate how hospice patients reflect and act upon their potential faith. The results demonstrate three dimensions of faith: (1) "Knowing" (cognition), (2) "doing" (praxis) and (3) "being" (meaning). The article concludes that most patients had a hesitant, but according to their situation, important faith although it was not something they knew much about, let alone discussed or practiced much.
Collapse
Affiliation(s)
- Lene Moestrup
- a Research Unit of General Practice, Faculty of Health Sciences , University of Southern Denmark , Odense C , Denmark
- b Health Science Research Center , University College Lillebaelt , Odense SØ , Denmark
| | - Niels Christian Hvidt
- a Research Unit of General Practice, Faculty of Health Sciences , University of Southern Denmark , Odense C , Denmark
| |
Collapse
|
17
|
Sutherland N, Ward-Griffin C, McWilliam C, Stajduhar K. Gendered Processes in Hospice Palliative Home Care for Seniors With Cancer and Their Family Caregivers. QUALITATIVE HEALTH RESEARCH 2016; 26:907-920. [PMID: 26489710 DOI: 10.1177/1049732315609571] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
There has been limited investigation into the processes that shape gender (in)equities in hospice palliative home care. As part of a larger critical ethnographic study, we examined how and why gender relations occur in this context. Using a critical feminist lens, we conducted in-depth interviews with clients living with terminal cancer, their family caregivers and primary nurses; observations of agency home visits; and review of institutional documents. A gender-based analysis revealed that gender enactments of Regulating Gender Relations were legitimized through ideological processes of Normalizing Gender Relations and Equalizing Gender Relations (Re)produced through institutional discourses of individualism and egalitarianism, these gendered processes both advantaged and disadvantaged men and women in hospice palliative home care. Findings suggest that to promote equity, health care providers and policy makers must attend to gender as a prevalent social determinant of health and health care. Implications for policy, practice, education, and research are discussed.
Collapse
|
18
|
Death wishes and explicit requests for euthanasia in a palliative care hospital: an analysis of patients files. BMC Palliat Care 2014; 13:53. [PMID: 25484624 PMCID: PMC4256797 DOI: 10.1186/1472-684x-13-53] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 11/13/2014] [Indexed: 11/20/2022] Open
Abstract
Background In the current public debate in France about end-of-life and legalization of euthanasia, palliative care is considered as a suitable answer or an alternative or even a supplement to euthanasia. The debate is based on opinion surveys, partly because there is a lack of objective data about the incidence of euthanasia requests (ER) in palliative care settings. The aim of this study was to collect, classify and quantify the expressions of wishes to die (WD), based on computerized files for patients admitted to an 81-bed palliative care hospital (PCH) in Paris during 2010–2011. Methods Two researchers analyzed the carers’ notes extracted on the basis of containing the words “wish to die”, “euthanasia” or any expressions relating to death. Notes related to WD and the corresponding patients were then classified in the order: ER, suicidal thought (ST) and other wish to die (OWD). Repeated ER were qualitatively analyzed according to a grid. Results We found that 195 of the 2157 patients (9%) expressed a WD: 61 (3%) expressed an ER; 15 (1%) described ST and 119 (6%) expressed an OWD without requiring acting. The WD group was predominantly female, stayed longer in the hospital (median 24 vs. 13 days), and consumed more anxiolytics and antidepressants. None of age, disease or marital status was associated with ER. More women and widows expressed an OWD. Twenty-six ER patients also expressed an OWD and two a ST. Six patients repeated their ER: all had poorly controlled symptoms with repercussions for their mental state. Conclusion Our data show the existence of various expressions of WD with a low incidence of ER in a French PCH. The observation of WD including ER is suggestive of good communication between the patients and the care teams. Independent of the changeability of expressions of WD, their very existence should lead to a consideration of the dynamic changes in these WD, and to care staff paying additional attention to the individual, their suffering and the context.
Collapse
|
19
|
Hu L, Li J, Wang X, Payne S, Chen Y, Mei Q. Prior Study of Cross-Cultural Validation of McGill Quality-of-Life Questionnaire in Mainland Mandarin Chinese Patients With Cancer. Am J Hosp Palliat Care 2014; 32:709-14. [PMID: 24939208 DOI: 10.1177/1049909114537400] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The validation of McGill quality-of-life questionnaire (MQOLQ) in mainland China, which had already been used in multicultural palliative care background including Hong Kong and Taiwan, remained unknown. Eligible patients completed the translated Chinese version of McGill questionnaires (MQOL-C), which had been examined before the study. Construct validity was preliminarily assessed through exploratory factor analysis extracting 4 factors that construct a new hypothesis model and then the original model was proved to be better confirmed by confirmatory factor analysis. Internal consistency of all the subscales was within 0.582 to 0.917. Furthermore, test-retest reliability ranged from 0.509 to 0.859, which was determined by Spearman rank correlation coefficient. Face validation and feasibility also confirm the good validity of MQOL-C. The MQOL-C has satisfied validation in mainland Chinese patients with cancer, although cultural difference should be considered while using it.
Collapse
Affiliation(s)
- Liya Hu
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jingwen Li
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xu Wang
- Faculty of Health & Social Sciences, Psychology, Leeds Metropolitan University, Leeds, United Kingdom
| | - Sheila Payne
- Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Yuan Chen
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qi Mei
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
20
|
Shin SH, Hui D, Chisholm GB, Kwon JH, San-Miguel MT, Allo JA, Yennurajalingam S, Frisbee-Hume SE, Bruera E. Characteristics and outcomes of patients admitted to the acute palliative care unit from the emergency center. J Pain Symptom Manage 2014; 47:1028-34. [PMID: 24246788 DOI: 10.1016/j.jpainsymman.2013.07.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 07/16/2013] [Accepted: 07/23/2013] [Indexed: 02/03/2023]
Abstract
CONTEXT Most patients admitted to acute palliative care units (APCUs) are transferred from inpatient oncology units. We hypothesized that patients admitted to APCUs from emergency centers (ECs) have symptom burdens and outcomes that differ from those of transferred inpatients. OBJECTIVES The purpose of this retrospective cohort study was to compare the symptom burdens and survival rate of patients admitted to an APCU from an EC with those of inpatients transferred to the APCU. METHODS Among the 2568 patients admitted to our APCU between September 1, 2003 and August 31, 2008, 312 (12%) were EC patients. We randomly selected 300 inpatients transferred to the APCU as controls (The outcome data were unavailable for two patients). We retrieved data on patient demographics, cancer diagnosis, Edmonton Symptom Assessment System scores, discharge outcomes, and overall survival from time of admission to the APCU. RESULTS The EC patients had higher rates of pain, fatigue, nausea, and insomnia and were less likely to be delirious. They were more than twice as likely to be discharged alive than transferred inpatients. Kaplan-Meier plot tests for product-limit survival estimate from admission to APCU for EC patients and inpatients were statistically significant (median survival 34 vs. 31 days, P<0.0001). In multivariate analysis, EC admission (odds ratio [OR]=1.8593, 95% confidence interval [CI] 1.1532-2.9961), dyspnea (OR=0.8533, 95% CI 0.7892-0.9211), well-being (OR=1.1192, 95% CI 1.0234-1.2257), and delirium (OR=0.3942, 95% CI 0.2443-0.6351) were independently associated with being discharged alive. CONCLUSION The EC patients have a higher acute symptom burden and are more likely to be discharged alive than transferred inpatients. The APCU was successful at managing symptoms and facilitating the discharge of both inpatients and EC patients to the community although the patients had severe symptoms on admission.
Collapse
Affiliation(s)
- Seong Hoon Shin
- Department of Palliative Care and Rehabilitation Medicine, University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA; Department of Internal Medicine, College of Medicine, Kosin University, Busan, Republic of Korea
| | - David Hui
- Department of Palliative Care and Rehabilitation Medicine, University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Gary B Chisholm
- Department of Biostatistics, University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Jung Hye Kwon
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University, Chuncheon, Republic of Korea
| | | | - Julio A Allo
- Department of Palliative Care and Rehabilitation Medicine, University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Sriram Yennurajalingam
- Department of Palliative Care and Rehabilitation Medicine, University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Susan E Frisbee-Hume
- Department of Palliative Care and Rehabilitation Medicine, University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative Care and Rehabilitation Medicine, University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
| |
Collapse
|
21
|
Tang ST, Chang WC, Chen JS, Su PJ, Hsieh CH, Chou WC. Trajectory and predictors of quality of life during the dying process: roles of perceived sense of burden to others and posttraumatic growth. Support Care Cancer 2014; 22:2957-64. [DOI: 10.1007/s00520-014-2288-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 05/12/2014] [Indexed: 11/29/2022]
|
22
|
Cheng HWB, Chan KY, Sham MKM, Li CW. Symptom Burden, Depression, and Suicidality in Chinese Elderly Patients Suffering from Advanced Cancer. J Palliat Med 2014; 17:10. [DOI: 10.1089/jpm.2013.0422] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
23
|
Utilizing participation in meaningful occupation as an intervention approach to support the acute model of inpatient palliative care. Palliat Support Care 2013; 12:409-12. [DOI: 10.1017/s1478951513000734] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractPalliative care is a model of care that aims to improve quality of life (QOL) for patients and their families/carers who are facing the challenges associated with a life limiting illness (WHO, 2012). Until recently, palliative care has been seen to be largely focused on the medical management of specific symptoms, with little or no consideration given to the patient's occupational identity and goals.Occupational therapy is a profession whose core philosophy is grounded in occupational participation. Occupational therapists have the skills and expertise to incorporate an individual's occupational performance goals into their treatment plan, thereby helping people to participate in personally meaningful occupations, within the limitations of their illness and physical capacity.The present article aims to illustrate (using case-study examples) how personally meaningful occupational participation can better support an acute model of palliative care practice, resulting in better patient outcomes and improved quality of life for both patients and their carers.
Collapse
|
24
|
Ozcelik H, Fadiloglu C, Karabulut B, Uyar M. Examining the Effect of the Case Management Model on Patient Results in the Palliative Care of Patients With Cancer. Am J Hosp Palliat Care 2013; 31:655-64. [DOI: 10.1177/1049909113506980] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose: We aimed to investigate the improvement in symptoms, quality of life, patient and family satisfaction with care, and direct costs resulting from a palliative care program based case management model. Methods: The research was implemented at the Medical Oncology Clinic hospital of a University between September 2009 and September 2011. The research sample consisted of a total of 44 patients (22 control and 22 intervention group). The research tools were the Edmonton Symptom Diagnosis System, the Karnofsky Performance Scale, the EORTCQLQ-C30 Quality of Life Scale, a patient and family satisfaction form, and a patient cost record form. Results: The difference between total symptom mean scores and the sub-dimension symptoms of pain, fatigue, nausea, depression, anxiety, lack of appetite, lethargy, well-being, dyspnea, and constipation post-hospitalization and post-discharge of patients in the control and experimental groups were found to be statistically significant (p < 0.05). The level of decrease in symptom severity in the experimental group patients was more than in the control group (p < 0.000). The satisfaction level of patients and family in the palliative care based case management service was higher than that for conventional service in the control group (p < 0.05). No statistical difference was detected between the experimental and control groups regarding health costs and duration of hospitalization (p > 0.05). Conclusion: We provided a better symptom control, improved the patient s quality of life (excluding physical and congnitive functions), and patient and family satisfaction levels were higher in the palliative care based case management intervention group, but direct health costs were not affected.
Collapse
Affiliation(s)
- Hanife Ozcelik
- Zubeyde Hanim School of Health, Nigde University, Nigde, Turkey
| | | | - Bulent Karabulut
- Department of Medical Oncology, Faculty of Medicine Hospital, Ege University, Izmir, Turkey
| | - Meltem Uyar
- Department of Algology, Faculty of Medicine Hospital, Ege University, Izmir, Turkey
| |
Collapse
|
25
|
Lowery AE, Krebs P, Coups EJ, Feinstein MB, Burkhalter JE, Park BJ, Ostroff JS. Impact of symptom burden in post-surgical non-small cell lung cancer survivors. Support Care Cancer 2013; 22:173-80. [PMID: 24018910 DOI: 10.1007/s00520-013-1968-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 08/27/2013] [Indexed: 12/20/2022]
Abstract
PURPOSE Pain, fatigue, dyspnea, and distress are commonly reported cancer-related symptoms, but few studies have examined the effects of multiple concurrent symptoms in longer-term cancer survivors. We examined the impact of varying degrees of symptom burden on health-related quality of life (HRQOL) and performance status in surgically treated non-small cell lung cancer (NSCLC) survivors. METHODS A sample of 183 NSCLC survivors 1-6 years post-surgical treatment completed questionnaires assessing five specific symptoms (pain, fatigue, dyspnea, depression, and anxiety), HRQOL, and performance status. The number of concurrent clinically significant symptoms was calculated as an indicator of symptom burden. RESULTS Most survivors (79.8 %) had some degree of symptom burden, with 30.6 % reporting one clinically significant symptom, 27.9 % reporting two symptoms, and 21.3 % reporting three or more symptoms. Physical HRQOL significantly decreased as the degree of symptom burden increased, but mental HRQOL was only significantly decreased in those with three or more symptoms. Receiver-operating characteristic (ROC) curves showed that having multiple concurrent symptoms (two or more) was most likely associated with limitations in functioning (area under a ROC curve = 0.75, sensitivity = 0.81, specificity = 0.54). CONCLUSIONS Two or more clinically significant symptoms are identified as the "tipping point" for showing adverse effects on HRQOL and functioning. This highlights the need for incorporating multiple-symptom assessment into routine clinical practice. Comprehensive symptom management remains an important target of intervention for improved post-treatment HRQOL and functioning among lung cancer survivors.
Collapse
Affiliation(s)
- Amy E Lowery
- School of Medicine, University of Pittsburgh, 5115 Centre Ave, Suite 140, Pittsburgh, PA, USA,
| | | | | | | | | | | | | |
Collapse
|
26
|
Rodríguez AM, Mayo NE, Gagnon B. Independent contributors to overall quality of life in people with advanced cancer. Br J Cancer 2013; 108:1790-800. [PMID: 23591199 PMCID: PMC3663579 DOI: 10.1038/bjc.2013.146] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: The definition of health for people with cancer is not focused solely on the physiology
of illness and the length of life remaining, but is also concerned with improving the
well-being and the quality of the life (QOL) remaining to be lived. This study aimed to
identify the constructs most associated with QOL in people with advanced cancer. Methods: Two hundred three persons with recent diagnoses of different advanced cancers were
evaluated with 65 variables representing individual and environmental factors,
biological factors, symptoms, function, general health perceptions and overall QOL at
diagnosis. Three independent stepwise multiple linear regressions identified the most
important contributors to overall QOL. R2 ranking and
effect sizes were estimated and averaged by construct. Results: The most important contributor of overall QOL for people recently diagnosed with
advanced cancer was social support. It was followed by general health perceptions,
energy, social function, psychological function and physical function. Conclusions: We used effect sizes to summarise multiple multivariate linear regressions for a more
manageable and clinically interpretable picture. The findings emphasise the importance
of incorporating the assessment and treatment of relevant symptoms, functions and social
support in people recently diagnosed with advanced cancer as part of their clinical
care.
Collapse
Affiliation(s)
- A M Rodríguez
- Faculty of Medicine, School of Rehabilitation Sciences, McGill University, 3654 Prom Sir William Osler, Montreal, Quebec, Canada H3G 1Y5.
| | | | | |
Collapse
|
27
|
Young J, Waugh L, McPhillips G, Levack P, Thompson A. Palliative care for patients with gastrointestinal cancer dying under surgical care: A case for acute palliative care units? Surgeon 2013; 11:72-5. [DOI: 10.1016/j.surge.2012.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2012] [Revised: 07/11/2012] [Accepted: 07/13/2012] [Indexed: 11/29/2022]
|
28
|
Current World Literature. Curr Opin Support Palliat Care 2012; 6:402-16. [DOI: 10.1097/spc.0b013e3283573126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
29
|
Jones JM, McPherson CJ, Zimmermann C, Rodin G, Le LW, Cohen SR. Assessing agreement between terminally ill cancer patients' reports of their quality of life and family caregiver and palliative care physician proxy ratings. J Pain Symptom Manage 2011; 42:354-65. [PMID: 21454041 DOI: 10.1016/j.jpainsymman.2010.11.018] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Revised: 11/22/2010] [Accepted: 11/23/2010] [Indexed: 11/19/2022]
Abstract
CONTEXT Proxy ratings, if valid, may provide an alternative approach to evaluating patient quality of life (QoL) at the end of life. OBJECTIVES To examine agreement between terminally ill cancer patients' self-reported QoL and proxy assessment of patient QoL by their family caregiver (FCG) and palliative care physicians (PCPs) at two time points. METHODS Patients admitted to an acute palliative care unit and their FCGs and PCPs completed the McGill Quality of Life Questionnaire (MQOL) at Days 3 and 6 after admission. Response bias and response precision were examined at the individual and group levels. Furthermore, we examined patient factors affecting agreement and responsiveness of proxy MQOL scores to changes in patients' QoL between Days 3 and 6. RESULTS Statistically and clinically significant mean differences were detected between the patient and both proxy groups' reports of QoL on Day 3, with the magnitude of the differences decreasing somewhat by Day 6. Proxies underestimated patients' QoL compared with patients' self-report. Response precision based on intraclass correlation values and proportion of approximate agreement was poor to fair at both time points. Agreement was better for patients with greater physical burden and more cognitive difficulties. Proxies' responsiveness to change from Day 3 to Day 6 was low, and proxies were not able to detect minimally important changes in QoL. CONCLUSION The findings suggest that moderate agreement between patient and proxy ratings of QoL develops over time but that precision at the individual level, which is more clinically relevant, is less reliable. New strategies for improving proxy reliability are needed.
Collapse
Affiliation(s)
- Jennifer M Jones
- Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, Toronto, Ontario, Canada.
| | | | | | | | | | | |
Collapse
|
30
|
Boston P, Bruce A, Schreiber R. Existential suffering in the palliative care setting: an integrated literature review. J Pain Symptom Manage 2011; 41:604-18. [PMID: 21145202 DOI: 10.1016/j.jpainsymman.2010.05.010] [Citation(s) in RCA: 229] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2010] [Revised: 05/26/2010] [Accepted: 05/28/2010] [Indexed: 11/29/2022]
Abstract
CONTEXT Existential and spiritual concerns in relation to palliative end-of-life care have received increasing attention over the past decade. OBJECTIVES To review the literature specifically related to existential suffering in palliative care in terms of the significance of existential suffering in end-of-life care, definitions, conceptual frameworks, and interventions. METHODS A systematic approach was undertaken with the aim of identifying emerging themes in the literature. Databases using CINAHL (1980-2009), MEDLINE (1970-2009), and PsychINFO (1980-2009) and the search engine of Google Scholar were searched under the key words existential suffering, existential distress, existential pain, palliative and end of life care. RESULTS The search yielded a total of 156 articles; 32% were peer-reviewed empirical research articles, 28% were peer-reviewed theoretical articles, and 14% were reviews or opinion-based articles. After manually searching bibliographies and related reference lists, 64 articles were considered relevant and are discussed in this review. Overall analysis identifies knowledge of the following: 1) emerging themes related to existential suffering, 2) critical review of those identified themes, 3) current gaps in the research literature, and 4) recommendations for future research. Findings from this comprehensive review reveal that existential suffering and deep personal anguish at the end of life are some of the most debilitating conditions that occur in patients who are dying, and yet the way such suffering is treated in the last days is not well understood. CONCLUSION Given the broad range of definitions attributed to existential suffering, palliative care clinicians may need to be mindful of their own choices and consider treatment options from a critical perspective.
Collapse
Affiliation(s)
- Patricia Boston
- Division of Palliative Care, Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada.
| | | | | |
Collapse
|