Palliative Care: A Concept Analysis Review

Empowering nurses to provide palliative care for COPD patients in a pulmonary department: participatory action research

BACKGROUND

Chronic obstructive pulmonary disease (COPD) affects the quality of life of patients and their caregivers. Although palliative care can improve quality of life, COPD patients and their caregivers have limited access to palliative care services. This study was conducted to empower nurses to provide palliative care to COPD patients in the pulmonary department.

METHODS

This participatory action research (PAR) was conducted in four steps: observation, reflection, planning, and action. Participants included all nurses (n = 18) who provided PC to COPD patients in the pulmonary department. The research team, physicians and managers, and a multiprofessional palliative care team formed the core PAR team. The data were collected via PCKT, FATCOD-B, and PCPS questionnaires about palliative care, interviews, focus groups, and observation. Qualitative content analysis and paired t-tests were used for data analysis.

RESULTS

Three major themes emerged: professional incompetence in palliative care, basic shortages in palliative care, and a lack of professional support. Three changes were made including enhancing palliative care knowledge, establishing a palliative care team, and increasing career motivation. There were significant increases in PCKT, FATCOD-B, and PCPS scores before and after PAR (p = 0.000).

CONCLUSION

Given the importance of providing palliative care, necessary measures, including PC training, and promoting inter professional collaboration and as well as motivating staff, should be taken by health managers.

Factors influencing the self-rationing of nursing care in palliative care settings

BACKGROUND

The rationing of nursing care is a significant concern in palliative care settings, where resource limitations can prevent nurses from providing comprehensive patient care. This study aims to examine the factors influencing the rationing of nursing care among palliative care nurses, focusing on the impact of psychological factors and workplace characteristics.

METHODS

A cross-sectional survey was conducted using the Perceived Implicit Rationing of Nursing Care (PIRNCA) questionnaire among 104 nurses working in palliative care. Data on anxiety and depression levels were collected using the HADS scale. Multivariate regression analysis was employed to identify key predictors of care rationing, including depression, anxiety, and type of care setting.

RESULTS

The average PIRNCA score was 0.82 (SD = 0.53), indicating that care rationing occurs "rarely." The most frequently rationed tasks were emotional and psychological support, patient education, and assistance with mobility. Nurses with higher depression (p = 0.002) and anxiety levels (p = 0.0012) were more likely to ration care. Working in a home-based hospice was associated with increased care rationing (p = 0.0012), while working in a palliative care ward reduced it (p = 0.0027).

CONCLUSIONS

Psychological distress, particularly depression and anxiety, significantly contributes to nursing care rationing in palliative care. Additionally, the type of care setting plays a critical role, with home-based hospice care being more prone to rationing. Interventions to support nurses' mental health and optimize resource allocation, particularly in home-based care, are essential to ensure comprehensive patient care in palliative settings.

CLINICAL TRIAL NUMBER

Not applicable.

Effect of travel distance on utilization of ancillary services among patients with pancreatic ductal adenocarcinoma: A single institution study

BACKGROUND

Fragmentation of care among patients with pancreatic cancer between specialized tertiary centers and community centers may be associated with increased patient burden and poorer outcomes. However, the impact of distance from a tertiary center on utilization of key ancillary services such as dietician consultation, and palliative or pain medicine consultation is unclear. We sought to examine how this travel distance influences the utilization of key ancillary services.

METHODS

This retrospective cohort study included 200 consecutive patients who were seen for a diagnosis of pancreatic ductal adenocarcinoma (PDAC) in 2021. Patients were grouped by travel distance: < 12.5, 12.5-49, and > 50 miles. Demographics, disease staging, and use of key ancillary services such as, dietician consultation, palliative, and pain medicine consultation were compared. Multiple logistic regression assessed associations between travel distance and ancillary service utilization.

RESULTS

Of the 200 patients, 14.5% traveled < 12.5 miles, 39.5% traveled 12.5-49 miles, and 46% traveled over 50 miles to our institution. Patients living over 50 miles away were significantly more likely to receive chemotherapy and radiation locally (81.8% vs 44.4%, p < 0.001). Importantly, they were less likely to utilize key ancillary services, including registered dietician consultation (Odds Ratio (OR) 0.34, p = 0.03), pancreatic enzyme prescriptions (OR 0.35, p = 0.03), pain medicine consultation (OR 0.20, p < 0.01), and palliative care consultation (OR 0.24, p < 0.01) compared to those living closer.

CONCLUSIONS

Patients living over 50 miles from our institution were significantly less likely to receive key supportive services. Despite similar clinical characteristics, these disparities show how initiatives are necessary to guarantee equitable access to comprehensive cancer care, regardless of geographic location.

Family Caregivers in Palliative Care Therapeutic Management: An Integrative Review

In palliative care, family caregivers are partners of multidisciplinary teams in the continuity of care at home. Effective therapeutic management provides optimal relief of distressing symptoms. It requires the acquisition of specific knowledge and care, but it also involves decision-making with ethical implications that increase the stress and burden on caregivers. The themes identified reflect the tangled dynamics of managing therapeutic regimens in the complexity of being a family caregiver. Therapeutic management relates to effective symptom management, which requires tasks and skills. This management is filled with uncertainties, fears, and emotions that arise from the complexity, responsibility, and weight represented by managing therapeutic regimens. Family caregivers are presented as coordinating elements within the healthcare system. The role of family caregivers is multidimensional, with numerous tasks and skills needed to support their relatives. Therapeutic management is more than just administering medications and needs to keep up with growing and fluctuating needs.

Identifying unmet palliative care needs of nursing home residents: A scoping review

INTRODUCTION

Many nursing home residents do not receive timely palliative care despite their need and eligibility for such care. Screening tools as well as other methods and guidelines can facilitate early identification of nursing home residents unmet palliative care needs.

AIM

To map and summarise the evidence on identifying unmet palliative care needs of nursing home residents.

METHODS

Any paper reporting on nursing home residents' unmet palliative care needs were eligible for inclusion. CINAHL, MEDLINE, Embase, Web of Science, APA PsycINFO, and APA PsycArticles and grey literature were systematically searched over two months, February and March 2024. Data were extracted using data extraction forms. Data were synthesised using descriptive analysis and basic content analysis.

RESULTS

Forty six records were included in this review. Nineteen methods, five screening tools, and four guidelines related to identifying residents unmet palliative care needs were identified. Most methods such as the Minimum Data Set and Palliative Care Needs Rounds were implemented as part of an intervention. Limited evidence was identified on what methods healthcare professionals use in daily practice. In total, 117 non-disease specific indicators for identifying residents unmet palliative care needs were identified, with physical indicators such as pain and weight loss being the most represented.

CONCLUSION

While developments have been made related to the concept of 'unmet palliative care needs', a clear definition is required. Evidence-based standardisation of methods for identifying unmet palliative care needs would ensure timely and equitable access to palliative care for nursing home residents worldwide. Achieving this goal requires incorporating screening for unmet palliative care needs into routine care.

Factors affecting the caregiver burden of family members to palliative care patients: A descriptive and cross-sectional study

OBJECTIVES

Many factors affect caregiver burden. Limited studies exist on the effect of social support and fatigue on family caregivers. This study aims to explore the impact of fatigue and social support on the burden experienced by family caregivers of palliative care patients.

METHODS

The study was conducted with 80 family caregivers. Data were collected using the Piper Fatigue Scale, the Burden Interview, and the Multidimensional Scale of Perceived Social Support. Regression analysis was used to evaluate the data.

RESULTS

The regression analysis revealed that higher scores on the MSPSS were significantly associated with lower Burden Interview scores (p < 0.05). Conversely, higher PFS scores were significantly correlated with increased Burden Interview scores (p < 0.05).

DISCUSSION

Both fatigue and social support play a critical role in shaping the caregiving burden experienced by family caregivers. Interventions aimed at reducing caregiver fatigue and enhancing social support may help alleviate this burden.

Artificially intelligent nursing homes: a scoping review of palliative care interventions

Introduction

The world's population is aging at a rapid rate. Nursing homes are needed to care for an increasing number of older adults. Palliative care can improve the quality of life of nursing home residents. Artificial Intelligence can be used to improve palliative care services. The aim of this scoping review is to synthesize research surrounding AI-based palliative care interventions in nursing homes.

Methods

A PRISMA-ScR scoping review was carried out using modified guidelines specifically designed for computer science research. A wide range of keywords are considered in searching six databases, including IEEE, ACM, and SpringerLink.

Results

We screened 3255 articles for inclusion after duplicate removal. 3175 articles were excluded during title and abstract screening. A further 61 articles were excluded during the full-text screening stage. We included 19 articles in our analysis. Studies either focus on intelligent physical systems or decision support systems. There is a clear divide between the two types of technologies. There are key issues to address in future research surrounding palliative definitions, data accessibility, and stakeholder involvement.

Discussion

This paper presents the first review to consolidate research on palliative care interventions in nursing homes. The findings of this review indicate that integrated intelligent physical systems and decision support systems have yet to be explored. A broad range of machine learning solutions remain unused within the context of nursing home palliative care. These findings are of relevance to both nurses and computer scientists, who may use this review to reflect on their own practices when developing such technology.

Navigating Alternative Medicine Preferences in Palliative Care: Challenges and Collaborative Solutions

Integrating alternative medicine into palliative care presents unique opportunities and challenges for healthcare providers. This article examines two clinical cases that illustrate the complexities of navigating patient preferences for alternative therapies within evidence-based palliative care. The first case involves a 50-year-old woman with metastatic breast cancer who prioritized the use of herbal poultices and natural remedies following her faith as a Seventh-day Adventist. Despite her initial resistance to conventional treatments, the collaborative efforts of the palliative care team facilitated compromises that improved her quality of life, including the use of radiotherapy to manage bleeding and opioids for pain relief in her final days. The second case highlights a 68-year-old man with advanced pulmonary fibrosis who preferred herbal infusions in his oxygen humidifier, homeopathic remedies, and Reiki while declining opioids due to concerns about side effects. The team addressed his symptom management needs through patient-centered communication and interdisciplinary collaboration, incorporating safer alternatives and supportive therapies without compromising his values. These cases underscore the importance of balancing respect for patient autonomy with the imperative to provide safe and effective care. Key strategies include interdisciplinary collaboration, empathetic communication, and incorporating complementary therapies that align with patient values while mitigating risks. By fostering trust and maintaining flexibility, palliative care teams can effectively address the diverse needs of patients who seek alternative medicine, ensuring holistic and patient-centered care. The discussion provides actionable recommendations for integrating alternative medicine preferences into palliative care practice, emphasizing the need for ongoing education, monitoring, and collaboration to navigate these complex situations effectively.

Palliative Care Services in Bhutan: Current Progress and Future Needs

Palliative care (PC) is a young concept in Bhutan. Since the establishment of home-based PC services at the national referral hospital of Bhutan for the residents of Thimphu City in 2018, many patients have benefitted. The need for PC in Bhutan is huge and urgent. The provision of quality PC is important to improve the quality of life of people facing life-limiting illnesses and end-of-life care, irrespective of their diagnosis. At present, efforts are being made to expand the services to the rest of the country by developing human resources. The plan is to train the existing manpower with the help of regional and international experts so that the PC services in Bhutan are sustainable.

Impact of Symptom Distress on the Quality of Life of Oncology Palliative Care Patients: A Portuguese Cross-Sectional Study

INTRODUCTION

Uncontrolled symptoms are widely recognized as one of the main challenges in oncology palliative care patients. The central aim of palliative care is to improve the patient's quality of life. In recent years, there has been a growing use of patient-reported outcome measures in palliative care, particularly to evaluate symptoms, quality of care, and well-being.

AIM

To evaluate the sociodemographic and clinical profile, symptom distress, and perceived quality of life in oncology palliative care patients admitted to a specialized palliative care unit in Portugal.

METHODS

This study was cross-sectional, descriptive, and correlational, carried out in the inpatient setting of the palliative care unit at a tertiary oncology hospital (at admission). The evaluated protocol included a sociodemographic and clinical questionnaire, as well as two measurement instruments: the Edmonton Symptom Assessment Scale (ESAS) and the Palliative Care Outcome Scale (POS), both filled out by the patients. Data analysis was conducted using IBM SPSS® Statistics version 25.0, with a significance level set at 5% (p < 0.05).

RESULTS

The majority of participants in this sample were male (61.7%), with a mean age of around 72 years. More than half of the patients admitted (n = 34; 56.7%) were being monitored in outpatient care. Digestive and head and neck cancers were the most commonly found in the sample (41.7% and 20%, respectively). A significant correlation was found between high symptom intensity and poorer quality of life and care (p < 0.01). This association was particularly pronounced for symptoms such as pain, weakness, depression, anxiety, and anorexia.

CONCLUSIONS

This study revealed a positive correlation between overall symptom severity and a perceived deterioration in quality of life, well-being, and quality of care. Future studies should consider utilizing alternative assessment tools for evaluating symptoms and quality of care. Additionally, including non-cancer palliative patients in similar studies may provide further valuable insights.

Current Status of and Barriers to Primary Palliative Care Recognized by Critical Care Specialist Nurses: A Nationwide Cross-Sectional Questionnaire Survey in Japan

Objectives: To investigate the current state of primary palliative care practice in Japanese critical care settings, identify care perceived as equivalent to primary palliative care, and explore the barriers. Methods: We employed a quantitative descriptive questionnaire survey with a nationwide cross-sectional design involving 740 critical care specialist nurses. Results: Questionnaires were received from 384 nurses, yielding a response rate of 51.9%. Nurses recognized typical palliative care provided to cancer patients, such as "relieving suffering at end-of-life" (95.3%), "pain management" (88.8%), and "caring for patients' psychological suffering" (88.3%), as primary palliative care in the critical care setting. They also recognized "monitoring and management of delirium" (68.5%), "caring for patients' social suffering" (63.5%), and "preventing post-intensive care syndromes" (61.7%) less frequently as aspects of primary palliative care in critical care settings. Additionally, the recognition was lower among emergency department nurses than intensive care unit nurses. The nurses recognized inadequate overall palliative care practices, especially regarding patients' social (72.1%) and spiritual (76.8%) suffering. They recognized "insufficient knowledge and skills among critical care medical staff" (70.6%) and "unable to confirm the patients' preferences to treatment goals" (54.4%) as barriers to providing primary palliative care. The barriers that nurses recognized less often were "uncertainty about palliative care in critical care settings" (6.8%) and "disagreements among nursing teams regarding providing palliative care" (8.3%). Conclusion: Specialist nurses understood palliative care but felt unprepared in primary palliative care due to limited knowledge. Improved education in primary palliative care and patient-family communication is needed in Japan's critical care settings.

Exploring patient awareness of palliative care - optimal timing and preferred approaches

OBJECTIVES

To explore patients' awareness levels of palliative care (PC) and how this awareness shapes their preferences regarding the timing and approach for discussing it.

METHODS

The study, conducted at a prominent institution specializing in oncology care, enrolled women aged 18-75 years who had been diagnosed with breast cancer. Patients completed guiding questions: Do you know what PC is?, When is the most appropriate time and the most appropriate way to discuss PC?. The interviews were conducted exclusively via video call and were recorded, transcribed, and then deleted.

RESULTS

The study involved 61 participants, averaging 49 years old. Almost half (47.5%) had completed high school. Qualitative data analysis revealed 9 thematic categories. Regarding the first question, 2 divergent categories emerged: care for life and threatening treatment. For the second question, opinions diverged into 4 categories: At an early stage, mid-course of the disease, as late as possible, and no time at all. For the third question, 3 categories emerged: communication and support, care setting and environment, and improving the PC experience.

SIGNIFICANCE OF RESULTS

This study reveals diverse perspectives on patients' awareness and preferences for discussing PC, challenging the misconception that it's only for end-of-life (EOL) situations. Comprehending PC influences when and how patients discuss it. If tied solely to EOL scenarios, discussions may be delayed. Conversely, understanding its role in enhancing advance support encourages earlier conversations. Limited awareness might delay talks, while informed patients actively contribute to shared decision-making. Some patients prefered early involvement, others find mid-treatment discussions stress-relieving. Community support, quiet environments, and accessible resources, underscoring the importance of a calm, empathetic approach, emphasizing the importance of understanding its role in advance support and providing valuable implications for enhancing patient care practices, theories, and policies.

Effectiveness of a palliative care education program for caregivers of cancer patients receiving chemotherapy in Port Said City: A pre-post quasi-experimental study

BACKGROUND

Emphasizing the pivotal role of caregivers in the cancer care continuum, a program designed to educate caregivers of cancer patients undergoing chemotherapy underscores their significance. The palliative care education initiative strives to cultivate a compassionate and effective care environment, benefiting both patients and caregivers. By imparting education, fostering positive attitudes, offering support, encouraging appropriate behaviors, and providing essential resources, the program aims to enhance the overall caregiving experience and contribute to the well-being of those navigating the challenges of cancer treatment.

OBJECTIVES

To evaluate the effectiveness of a palliative care education program for caregivers of cancer patients receiving chemotherapy.

METHODS

The research employed a purposive sample comprising 155 caregivers who were actively present with their cancer patients throughout the pre- and post-test phases within a quasi-experimental research design. The study took place at the outpatient oncology center of Al-Shifa Medical Complex in Port Said City, Egypt. To gather comprehensive data, 4 instruments were utilized: a demographic questionnaire, a nurse knowledge questionnaire, a scale measuring attitudes toward palliative care, and an assessment of reported practices in palliative care. This methodological approach allowed for a thorough exploration of caregiver perspectives, knowledge, attitudes, and practices within the context of a palliative care education program.

RESULTS

Before the palliative care education program, only 1.3% of caregivers had a good overall level of knowledge about cancer and palliative care; this increased to 40.6% after the program. Similarly, before the palliative care education program, 32.9% of caregivers had a positive overall attitude, which increased to 72.3% after the program. Similarly, 27.1% of caregivers had an overall appropriate palliative care practice during the pre-test phase, which increased to 93.5% after the palliative care education program.

SIGNIFICANCE OF THE RESULTS

The palliative care education program significantly improved caregivers' knowledge, attitudes, and practice scores. It is strongly recommended that caregivers of cancer patients receive continuing education in palliative care. In addition, it is crucial to conduct further research with a larger sample size in different situations in Egypt.

Question prompt list intervention for patients with advanced cancer: a systematic review and meta-analysis

BACKGROUND

Enhanced communication in end-of-life care (EOL) improves preparation and treatment decisions for patients with advanced cancer, affecting their quality of life at the end of life. Question prompt list (QPL) has been shown to enhance physician-patient communication in patients with cancer, but there is a lack of systematic review and meta-analysis for those with advanced cancer. Enhanced communication in end-of-life care improves preparation and treatment decisions for patients with advanced cancer, affecting their quality of life at the end of life.

OBJECTIVE

To review the effectiveness of QPL intervention on physician-patient communication and health outcomes during consultation in patients with advanced cancer.

METHODS

CINAHL, Embase, Scopus, and PsycINFO databases were undertaken using inclusion criteria for relevant articles up to August 2021. Pooled standardized mean difference (SMD) and 95% confidence intervals (CIs) were calculated using random-effects models. We used the Cochrane risk-of-bias assessment tool and modified Jadad scale to assess the quality of the studies.

RESULTS

Seven RCTs with 1059 participants were included, of which six studies were eligible for the meta-analysis. The pooled meta-analysis results indicated that QPL in patients with advanced cancer had a significant positive effect on the total number of questions asked (SMD, 0.73; 95% CI, 0.28 to 1.18; I2 = 83%) and on the patients' expectations for the future (SMD, 0.67; 95% CI, 0.08 to 1.25; I2 = 88%). There were no significant improvements in health-related outcomes such as end of life, anxiety, and quality of life.

CONCLUSIONS

Using QPL in advanced cancer consultations boosts patient questions which helps communication but not health-related indicators. Optimal results depend on full reading, but timing varies. Future research should examine the relationship between communication and health outcomes, including patient/physician behavior and social context.

Providers' Understanding of Cancer Aetiology and Supportive Features for Indigenous Palliative Cancer Care Service Provision in Kenya

Background

Palliative care is a fundamental component of providing people-centred health services to cancer patients. However, the primary pillars of indigenous palliative care such as provider understanding of cancer, its aetiology, and features are undocumented.

Objective

We sought to understand Traditional Health Providers (THPs) understanding of cancer aetiology, and the functional features that support indigenous palliative cancer care service provision in Kenya.

Method

The study used a mixed methods cross-sectional design. A semi-structured questionnaire was administered to 193 THPs, who self-reported to manage cancer patients. The findings were enriched and validated through member checking in 6 focus group discussions and five journey mapping in-depth interviews.

Results

Despite diversity in culture and experience among the indigenous providers in Kenya, their description of cancer etiology and their management practices and primary goal were similar. Cancer was consistently described as a deadly life-deforming disease by 61.1% of THPs (n = 118/193) and attributed to chemicals and toxins in the body 41.5% (n = 80). The indigenous palliative-care system was reported to be characterized by five tiered levels of care, diversity in expertise and experience, shared and consultative process (60%) and family involvement in medical decision (59.5%). Herbal regimen (60.1%) was found to be the cornerstone of informal palliative care blended with nutrition management 78.2% (n = 151), lifestyle changes 63.7% (n = 123) and counseling services 55.9% (n = 108). Payments for service were arbitrarily made in cash or in kind.

Conclusion

The features of indigenous palliative care services are informed by the providers' distinctive cultural terms and descriptions of cancer and cancer aetiology. Shared and consultative protocols, regimen exchange, referral to cascaded care, and caregiver involvement were all important palliative-care clues to saving and enhancing lives. The features provide context for development of indigenous palliative care framework, engagement of policy makers, and promotion of culturally-inclusive indigenous palliative care model for adoption.