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Stadnyk A, Casimiro HJ, Reis-Pina P. Mindfulness on Symptom Control and Quality of Life in Patients in Palliative Care: A Systematic Review. Am J Hosp Palliat Care 2024; 41:706-714. [PMID: 37468131 PMCID: PMC11032623 DOI: 10.1177/10499091231190879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023] Open
Abstract
INTRODUCTION Palliative care is a medical and humanitarian approach that improves the quality of life of patients, and their families, who are facing problems associated with chronic and life-threatening illnesses. Few studies have evaluated the effectiveness of mindfulness-based interventions for terminally ill or incurable patients. The aim of this study was to systematically review the literature on the effect of mindfulness-based interventions on symptom control and quality of life in patients in palliative care. METHODS PubMed, Web of Science and Cochrane databases were searched for articles, published between January 2017 and December 2022, in English, including randomized controlled and clinical trials. Participants: terminally ill or incurable patients. Interventions: any mindfulness-based intervention. Comparators: any. Outcomes: symptom control and quality of life. The risk of bias was analysed through Cochrane's ROB-2 tool. RESULTS Eight studies were included involving 609 patients and 75 dyads patients-spousal caregivers. The overall risk of bias was low to moderate. Mindfulness-based interventions are helpful in managing suffering, anxiety and depressive symptoms, fatigue, insomnia, drowsiness, appetite, and spiritual well-being. CONCLUSION Mindfulness-based interventions control several symptoms and improve spiritual quality of life in patients in palliative care. Additionally, their informal caregivers also benefit from these interventions. Future trials are crucial to investigate other effects of mindfulness-based interventions, and their long-term benefits, in patients in palliative care.
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Affiliation(s)
| | - Hugo Jorge Casimiro
- Faculty of Medicine, University of Lisbon, Lisbon, Portugal
- Hospital Palliative Care Team, Setúbal Hospital Centre, Setúbal, Portugal
| | - Paulo Reis-Pina
- Faculty of Medicine, University of Lisbon, Lisbon, Portugal
- Bento Menni’s Palliative Care Unit, Casa de Saúde da Idanha, Sintra, Portugal
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Bergman J, Filippou P, Suskind AM, Johnson K, Calvert E, Fero K, Lorenz KA, Giannitrapani K, Hugar L, Koo K, Leppert J, Scales CD, Terris M, Nielsen M, Gore JL. Primary Palliative Care in Urology: Quality Improvement Summit 2021-2022. Urol Pract 2024; 11:529-536. [PMID: 38451199 DOI: 10.1097/upj.0000000000000538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 01/19/2024] [Indexed: 03/08/2024]
Abstract
INTRODUCTION The AUA convened a 2021-2022 Quality Improvement Summit to bring together interdisciplinary providers to inform the current state and to discuss potential strategies for integrating primary palliative care into urology practice. We hypothesized that the Summit findings would inform a scalable primary palliative care model for urology. METHODS The 3-part summit reached a total of 160 interdisciplinary health care professionals. Webinar 1, "Building a Primary Palliative Care Model for Urology," focused on a urologist's role in palliative care. Webinar 2, "Perspectives on Increasing the Use of Palliative Care in Advanced Urologic Disease," addressed barriers to possible implementation of a primary palliative care model. The in-person Summit, "Laying the Foundation for Primary Palliative Care in Urology," focused on operationalization of primary palliative care, clinical innovations needed, and relevant metrics. RESULTS Participants agreed that palliative care is needed early in the disease course for patients with advanced disease, including those with benign and malignant conditions. The group agreed about the important domains that should be addressed as well as the interdisciplinary providers who are best suited to address each domain. There was consensus that a primary "quarterback" was needed, encapsulated in a conceptual model-UroPal-with a urologist at the hub of care. CONCLUSIONS The Summit provides the field of urology with a framework and specific steps that can be taken to move urology-palliative care integration forward. Urologists are uniquely positioned to provide primary palliative care for their many patients with serious illness, both in the surgical and chronic care contexts.
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Affiliation(s)
- Jonathan Bergman
- The David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
- Los Angeles County Department of Health Services, Los Angeles, California
- Veterans Health Administration, Los Angeles, California
| | - Pauline Filippou
- Kaiser Permanente Northern California, Santa Clara Medical Center, Santa Clara, California
| | - Anne M Suskind
- University of California, San Francisco, San Francisco, California
| | - Karen Johnson
- American Urological Association, Linthicum, Maryland
| | - Emily Calvert
- American Urological Association, Linthicum, Maryland
| | - Katherine Fero
- The David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Karl A Lorenz
- Veterans Health Administration, Los Angeles, California
- Stanford University, Stanford, California
| | - Karleen Giannitrapani
- Veterans Health Administration, Los Angeles, California
- Stanford University, Stanford, California
| | - Lee Hugar
- Lexington Medical Center, West Columbia, South Carolina
| | | | - John Leppert
- Veterans Health Administration, Los Angeles, California
- Stanford University, Stanford, California
| | | | | | - Matthew Nielsen
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - John L Gore
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Pinto S, Lopes S, de Sousa AB, Delalibera M, Gomes B. Patient and Family Preferences About Place of End-of-Life Care and Death: An Umbrella Review. J Pain Symptom Manage 2024; 67:e439-e452. [PMID: 38237790 DOI: 10.1016/j.jpainsymman.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/22/2023] [Accepted: 01/03/2024] [Indexed: 02/05/2024]
Abstract
CONTEXT The place where people are cared towards the end of their life and die is a complex phenomenon, requiring a deeper understanding. Honoring preferences is critical for the delivery of high-quality care. OBJECTIVES In this umbrella review we examine and synthesize the evidence regarding preferences about place of end-of-life care and death of patients with life-threatening illnesses and their families. METHODS Following the Joanna Briggs Institute methodology, we conducted a comprehensive search for systematic reviews in PsycINFO, MEDLINE, EMBASE, CINAHL, Epistemonikos, and PROSPERO without language restrictions. RESULTS The search identified 15 reviews (10 high-quality, three with meta-analysis), covering 229 nonoverlapping primary studies. Home is the most preferred place of end-of-life care for both patients (11%-89%) and family members (23%-84%). It is also the most preferred place of death (patient estimates from two meta-analyses: 51%-55%). Hospitals and hospice/palliative care facilities are preferred by substantial minorities. Reasons and factors affecting preferences include illness-related, individual, and environmental. Differences between preferred places of care and death are underexplored and the evidence remains inconclusive about changes over time. Congruence between preferred and actual place of death ranges 21%-100%, is higher in studies since 2004 and a meta-analysis shows noncancer patients are at higher risk of incongruence than cancer patients (OR 1.23, 95% CI: 1.01-1.49, I2 = 62%). CONCLUSION These findings are a crucial starting point to address gaps and enhance strategies to align care with patient and family preferences. To accurately identify patient and family preferences is an important opportunity to change their lives positively.
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Affiliation(s)
- Sara Pinto
- Faculty of Medicine (S.P., S.L., A.B.S., M.D., B.G.), University of Coimbra, Azinhaga de Santa Comba, Coimbra, Portugal; Nursing School of Porto (S.P.), Rua Dr. António Bernardino de Almeida, Porto, Portugal; Cintesis@RISE, NursID (S.P.), Rua Dr. Plácido da Costa, Porto, Portugal
| | - Sílvia Lopes
- Faculty of Medicine (S.P., S.L., A.B.S., M.D., B.G.), University of Coimbra, Azinhaga de Santa Comba, Coimbra, Portugal; NOVA National School of Public Health, Public Health Research Center (S.L.), Universidade NOVA de Lisboa, Lisboa, Portugal; Comprehensive Health Research Center (S.L.), Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Andrea Bruno de Sousa
- Faculty of Medicine (S.P., S.L., A.B.S., M.D., B.G.), University of Coimbra, Azinhaga de Santa Comba, Coimbra, Portugal
| | - Mayra Delalibera
- Faculty of Medicine (S.P., S.L., A.B.S., M.D., B.G.), University of Coimbra, Azinhaga de Santa Comba, Coimbra, Portugal
| | - Barbara Gomes
- Faculty of Medicine (S.P., S.L., A.B.S., M.D., B.G.), University of Coimbra, Azinhaga de Santa Comba, Coimbra, Portugal; Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation (B.G.), King's College London, London, United Kingdom, Bessemer Road, SE5 9PJ, London, United Kingdom.
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O'Connor T, Liu WM, Samara J, Lewis J, Paterson C. 'How long do you think?' Unresponsive dying patients in a specialist palliative care service: A consecutive cohort study. Palliat Med 2024:2692163241238903. [PMID: 38654605 DOI: 10.1177/02692163241238903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
BACKGROUND Predicting length of time to death once the person is unresponsive and deemed to be dying remains uncertain. Knowing approximately how many hours or days dying loved ones have left is crucial for families and clinicians to guide decision-making and plan end-of-life care. AIM To determine the length of time between becoming unresponsive and death, and whether age, gender, diagnosis or location-of-care predicted length of time to death. DESIGN Retrospective cohort study. Time from allocation of an Australia-modified Karnofsky Performance Status (AKPS) 10 to death was analysed using descriptive narrative. Interval-censored survival analysis was used to determine the duration of patient's final phase of life, taking into account variation across age, gender, diagnosis and location of death. SETTING/PARTICIPANTS A total of 786 patients, 18 years of age or over, who received specialist palliative care: as hospice in-patients, in the community and in aged care homes, between January 1st and October 31st, 2022. RESULTS The time to death after a change to AKPS 10 is 2 days (n = 382; mean = 2.1; median = 1). Having adjusted for age, cancer, gender, the standard deviation of AKPS for the 7-day period prior to death, the likelihood of death within 2 days is 47%, with 84% of patients dying within 4 days. CONCLUSION This study provides valuable new knowledge to support clinicians' confidence when responding to the 'how long' question and can inform decision-making at end-of-life. Further research using the AKPS could provide greater certainty for answering 'how long' questions across the illness trajectory.
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Affiliation(s)
- Tricia O'Connor
- Clare Holland House, Canberra Health Services, North Canberra Hospital, Canberra, ACT, Australia
- Caring Futures Institute, Flinders University, Bedford Park, SA, Australia
| | - Wai-Man Liu
- Research School of Finance, Actuarial Studies and Statistics, Australian National University, Canberra, ACT, Australia
| | - Juliane Samara
- Clare Holland House, Canberra Health Services, North Canberra Hospital, Canberra, ACT, Australia
| | - Joanne Lewis
- School of Nursing and Health, Avondale University, Wahroonga, NSW, Australia
| | - Catherine Paterson
- Caring Futures Institute, Flinders University, Bedford Park, SA, Australia
- Central Adelaide Local Health Network, Adelaide, SA, Australia
- School of Nursing, Midwifery and Public Health, University of Canberra, Bruce, ACT, Australia
- Robert Gordon University, Aberdeen, Scotland, UK
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Heckel M, Peters J, Schweighart S, Habermann M, Ostgathe C. Knowledge and Public Perception of Palliative Care in Germany. J Palliat Med 2024. [PMID: 38625024 DOI: 10.1089/jpm.2023.0630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024] Open
Abstract
Background: Literature reviews reveal poor knowledge and awareness of palliative care in the public. Health literacy deficits impact access to palliative care. Objectives: The aim of this manuscript is to explore the public perception of palliative care in Germany. Design: Triangulated qualitative research design: a snowball-spread online survey and a random pedestrian survey. Setting/Subjects: Citizens in Germany. Results: The pedestrian survey (n = 100) revealed 34% of the participants being not familiar with palliative care. The online survey (n = 994) 5.7% of participants reported to not know what palliative care was. The public's perception of palliative care is mainly medicine oriented, referring to inpatient care for the immediately dying; however, further significant misperceptions were scarce. Conclusions: The public perception shows an indistinct picture of palliative care, and some misconceptions about the objectives and areas of responsibility of the subject, meanwhile, palliative care is known to a majority of people. Understanding partly incomplete pictures of patients and relatives may help to react appropriately in staff-patient interactions and improve public relations.
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Affiliation(s)
- Maria Heckel
- Department of Palliative Medicine, CCC Erlangen-EMN, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Joachim Peters
- Department of German Linguistics, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Susanna Schweighart
- Department of Palliative Medicine, CCC Erlangen-EMN, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Mechthild Habermann
- Department of German Linguistics, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Christoph Ostgathe
- Department of Palliative Medicine, CCC Erlangen-EMN, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
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Chambergo-Michilot D, Becerra-Gonzales VG, Kittipibul V, Colombo R, Bravo-Jaimes K. Racial Differences in Hospice Care Outcomes in Patients With Advanced Heart Failure: Systematic Review and Meta-analysis. Am J Cardiol 2024; 217:5-9. [PMID: 38382703 DOI: 10.1016/j.amjcard.2024.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 01/08/2024] [Accepted: 01/28/2024] [Indexed: 02/23/2024]
Abstract
There remains a paucity of investigational data about disparities in hospice services in people with non-cancer diagnoses, specifically in heart failure (HF). Black patients with advanced HF have been disproportionally affected by health care services inequities but their outcomes after hospice enrollment are not well studied. We aimed to describe race-specific outcomes in patients with advanced HF who were enrolled in hospice services. We obtained the data from PubMed, Scopus, and Embase for all investigations published until January 11, 2023. All studies that reported race-specific outcomes after hospice enrollment in patients with advanced HF were included. Of the 1,151 articles identified, 5 studies (n = 24,899) were considered for analysis involving a sample size ranging from 179 to 11,754 patients. Black patients had an increased risk of readmission (odds ratio 1.55, 95% confidence interval [CI] 1.34 to 1.79, I2 0%) and discharge (odds ratio 1.75, 95% CI 1.53 to 1.99, I2 0%) compared with White patients. Moreover, Black patients have a nonsignificant lower risk of mortality compared with White patients (relative risk 0.67, 95% CI 0.43 to 1.05, I2 90%). In conclusion, this study showed that Black patients with advanced HF receiving hospice care have a higher risk of readmission and discharge compared with White patients.
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Affiliation(s)
| | - Victor G Becerra-Gonzales
- Division of Cardiology, Department of Medicine, University of Miami/Jackson Memorial Hospital, Miami, Florida
| | | | - Rosario Colombo
- Division of Cardiology, Department of Medicine, University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - Katia Bravo-Jaimes
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida.
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Kim A, O'Callaghan A, Hemmaway C, Johney L, Ho J. Quality outcomes for end-of-life care among people with haematological malignancies at a New Zealand cancer centre. Intern Med J 2024; 54:588-595. [PMID: 37718574 DOI: 10.1111/imj.16235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 08/31/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Little is known about the end-of-life (EOL) experience and specialist palliative care use patterns of patients with haematological malignancies (HMs) in New Zealand. AIMS This retrospective analysis sought to examine the quality of EOL care received by people with HMs under the care of Auckland District Health Board Cancer Centre's haematology service and compare it to international data where available. METHODS One hundred consecutive adult patients with HMs who died on or before 31 December 2019 were identified. We collected information on EOL care quality indicators, including anticancer treatment use and acute healthcare utilisation in the last 30 days of life, place of death and rate and timing of specialist palliative care input. RESULTS During the final 14 and 30 days of life, 15% and 27% of the patients received anticancer therapy respectively. Within 30 days of death, 22% had multiple hospitalisations and 25% had an intensive care unit admission. Death occurred in an acute setting for 42% of the patients. Prior contact with hospital and/or community (hospice) specialist palliative care service was noted in 80% of the patients, and 67% had a history of hospice enrolment. Among them, 15% and 28% started their enrolment in their last 3 and 7 days of life respectively. CONCLUSIONS The findings highlight the intensity of acute healthcare utilisation at the EOL and high rates of death in the acute setting in this population. The rate of specialist palliative care access was relatively high when compared with international experiences, with relatively fewer late referrals.
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Affiliation(s)
- Ann Kim
- Adult Hospital Palliative Care Service, Auckland City Hospital, Auckland, New Zealand
| | - Anne O'Callaghan
- Adult Hospital Palliative Care Service, Auckland City Hospital, Auckland, New Zealand
| | - Claire Hemmaway
- Clinical Haematology, Auckland City Hospital, Auckland, New Zealand
| | - Leslie Johney
- Adult Hospital Palliative Care Service, Auckland City Hospital, Auckland, New Zealand
| | - Jess Ho
- School of Medicine, The University of Auckland, Auckland, New Zealand
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Gomes SA, Silva DNM, Sorice F, Arantes A, Peixoto R, Ferrari R, Martins M, Jácome A, Bergerot C, de Melo AC, Ferrari B. Outpatient Palliative Care Program: Impact on Home Death Rate in Brazil. Cancers (Basel) 2024; 16:1380. [PMID: 38611059 PMCID: PMC11010934 DOI: 10.3390/cancers16071380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/27/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
While the positive impact of early palliative care on the quality of life of cancer patients is well established, there is a noticeable research gap in developing countries. This study sought to determine the impact of an outpatient palliative care (OPC) program on the location of death among patients in Brazil. This was a retrospective study including patients with cancer who died between January 2022 and December 2022 in 32 private cancer centers in Brazil. Data were collected from medical records, encompassing demographics, cancer characteristics, and participation in the OPC program. The study involved 1980 patients, of which 32.3% were in the OPC program. OPC patients were predominantly younger (average age at death of 66.8 vs. 68.0 years old, p = 0.039) and composed of women (59.4% vs. 51.3%, p = 0.019) compared to the no-OPC patients. OPC patients had more home/hospice deaths (19.6% vs. 10.4%, p < 0.001), and participation in the outpatient palliative care program strongly predicted home death (OR: 2.02, 95% CI: 1.54-2.64). Our findings suggest a significant impact of the OPC program on increasing home and hospice deaths among patients with cancer in our sample. These findings emphasize the potential of specialized OPC programs to enhance end-of-life care, particularly in low-resource countries facing challenges related to social and cultural dimensions of care and healthcare access.
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Affiliation(s)
- Sarah Ananda Gomes
- Oncoclinicas&Co – Medica Scientia Innovation Research (MEDSIR) /MedSir, Sao Paulo 04543-906, SP, Brazil; (D.N.M.S.); (F.S.); (A.A.); (R.P.); (R.F.); (M.M.); (A.J.); (C.B.); (A.C.d.M.)
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Consolo L, Rusconi D, Colombo S, Basile I, Campa T, Pezzera D, Benenati S, Caraceni A, Lusignani M. Implementation of the e-IPOS in Home Palliative Cancer Care: A Quasiexperimental Pilot Study. Am J Hosp Palliat Care 2024:10499091241240667. [PMID: 38504550 DOI: 10.1177/10499091241240667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024] Open
Abstract
INTRODUCTION Electronic patient-reported outcome measures (e-PROMs) offer advantages in palliative cancer care, including rapid completion, improved data quality and direct storage, improving clinical decision-making. The electronic Integrated Palliative Care Outcome Scale (e-IPOS) in this context enables thorough self-assessment by patients, enhancing symptom management and self-reflection of their current situation. AIM To evaluate the feasibility of implementing the e-IPOS in home palliative cancer care. OUTCOMES The primary outcomes included the enrollment consent rate, study retention rate, e-IPOS completion rate and response completeness, and the number of clinical assessments and interventions performed during home visits. The secondary outcomes were the number of unscheduled visits and patients' perceived quality of life. DESIGN A two-group quasiexperimental clinical pilot study. The control group received standard palliative care, the intervention group received standard care along with weekly e-IPOS completion during home visits. Both groups were enrolled for 4 weeks. SETTING/PARTICIPANTS Adults with advanced cancer from the home palliative care unit of the Istituto Nazionale dei Tumori of Milan. RESULTS Twenty-three patients were enrolled (74.19%), and 20 completed the study (drop-out: 13.04%). 82.5% of the expected e-IPOS responses were received, of which 96.9% were fully complete. In the intervention group, the Wilcoxon test showed an increase in identified needs and documented interventions (P < .05) and a decrease in unscheduled visits (P < .05). CONCLUSION It is feasible to recruit people via home palliative care for an e-IPOS implementation study. Future fully powered studies should investigate the feasibility and assess patients' perceptions of its use to better understand its clinical benefits.
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Affiliation(s)
- Letteria Consolo
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
- Bachelor School of Nursing, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan Italy
| | - Daniele Rusconi
- Urologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Stella Colombo
- Intensive Care Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Ilaria Basile
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
- High-Complexity Unit of Palliative Care, Pain Therapy and Rehabilitation, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan Italy
| | - Tiziana Campa
- High-Complexity Unit of Palliative Care, Pain Therapy and Rehabilitation, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan Italy
| | - Daniele Pezzera
- High-Complexity Unit of Palliative Care, Pain Therapy and Rehabilitation, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan Italy
| | - Salvatore Benenati
- High-Complexity Unit of Palliative Care, Pain Therapy and Rehabilitation, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan Italy
| | - Augusto Caraceni
- High-Complexity Unit of Palliative Care, Pain Therapy and Rehabilitation, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Maura Lusignani
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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Caulfield RMH, Selman LE, Gibbins J, Forbes K, Chamberlain C. Enhanced supportive care in cancer centres: national cross-sectional survey. BMJ Support Palliat Care 2024:spcare-2023-004326. [PMID: 38471788 DOI: 10.1136/spcare-2023-004326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 01/25/2024] [Indexed: 03/14/2024]
Abstract
OBJECTIVES 'Early' specialist palliative care (SPC) has been shown to improve outcomes for patients with advanced cancer, yet patients are often referred late. 'Enhanced supportive care' (ESC) aims to facilitate earlier integrated supportive care for those with incurable cancer. This study aimed to explore clinicians' understanding of ESC/SPC delivery through description of current service provision. METHODS This national cross-sectional survey of 53 cancer centres had two parts. Part 1: Service details, was directed to lead ESC/SPC nurses or consultants about service configuration, and Part 2: Clinician understanding, targeting conceptual understanding of service aims including ESC/SPC teams and oncology consultants (n=262 surveys). Multiple-choice questions explored service provision, referral triggers and evidence of integration with oncology, with free-text responses. Quantitative results were analysed with Fischer's exact test. Qualitative free text was line-by-line coded by two authors independently to derive themes. RESULTS 56% (30/53) of SPC and ESC teams and 14% (14/100) of oncologists responded. Those involved in ESC self-reported greater integration with oncology compared with non-ESC teams, for example, joint case discussions (64.3%, 9/14 vs 23.1%, 3/13, p=0.05), and timelier patient referral ((>6 months before death vs <6 months) (10/14 vs 4/13, p=0.06)). Qualitative themes described ambiguity in definitions of supportive and palliative terms and a perception of timelier identification of patients when ESC was involved. CONCLUSION Providers of ESC perceive greater integration with oncology and potentially timelier referral for patients compared with teams not delivering ESC. Terminology around SPC and ESC remains uncertain across England.
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Affiliation(s)
- Rachel Moya Helen Caulfield
- Population Health Sciences, Bristol Medical School, Bristol, UK
- Basingstoke and North Hampshire Hospital-Foundation School, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - Lucy E Selman
- Population Health Sciences, Palliative and End of Life Care Research Group, Bristol Medical School, Bristol, UK
| | | | - Karen Forbes
- Population Health Sciences, Palliative and End of Life Care Research Group, Bristol Medical School, Bristol, UK
- Supportive and Palliative Care, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Charlotte Chamberlain
- Population Health Sciences, Palliative and End of Life Care Research Group, Bristol Medical School, Bristol, UK
- Supportive and Palliative Care, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
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Pedrosa AJ, Feldmann S, Klippel J, Volberg C, Weck C, Stefan L, Pedrosa DJ. Factors Associated with Preferred Place of Care and Death in Patients with Parkinson's Disease: A Cross-Sectional Study. J Parkinsons Dis 2024:JPD230311. [PMID: 38457148 DOI: 10.3233/jpd-230311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
Background A significant proportion of people with Parkinson's disease (PwPD) die in hospital settings. Although one could presume that most PwPD would favor being cared for and die at home, there is currently no evidence to support this assumption. Objective We aimed at exploring PwPD's preferences for place of end-of-life care and place of death, along with associated factors. Methods A cross-sectional study was conducted to investigate PwPD's end-of life wishes regarding their preferred place of care and preferred place of death. Using different approaches within a generalized linear model framework, we additionally explored factors possibly associated with preferences for home care and home death. Results Although most PwPD wished to be cared for and die at home, about one-third reported feeling indifferent about their place of death. Preferred home care was associated with the preference for home death. Furthermore, a preference for dying at home was more likely among PwPD's with informal care support and spiritual/religious affiliation, but less likely if they preferred institutional care towards the end of life. Conclusions The variation in responses regarding the preferred place of care and place of death highlights the need to distinguish between the concepts when discussing end-of-life care. However, it is worth noting that the majority of PwPD preferred care and death at home. The factors identified in relation to preferred place of care and death provide an initial understanding of PwPD decision-making, but call for further research to confirm our findings, explore causality and identify additional influencing factors.
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Affiliation(s)
- Anna J Pedrosa
- Department of Neurology, Philipps University Marburg, Marburg, Germany
| | - Sarah Feldmann
- Department of Neurology, Philipps University Marburg, Marburg, Germany
| | - Jan Klippel
- Department of Neurology, Philipps University Marburg, Marburg, Germany
| | - Christian Volberg
- Department of Anaesthesiology and Intensive Care Medicine, Philipps University Marburg, University Hospital Giessen and Marburg, Marburg, Germany
- Research Group Medical Ethics, Philipps University Marburg, Marburg, Germany
| | - Christiane Weck
- Department of Neurology, Hospital Agatharied, Agatharied, Germany
- Institute of Palliative Care, Paracelsus Medical University, Salzburg, Austria
| | - Lorenzl Stefan
- Department of Neurology, Hospital Agatharied, Agatharied, Germany
- Institute of Palliative Care, Paracelsus Medical University, Salzburg, Austria
| | - David J Pedrosa
- Department of Neurology, Philipps University Marburg, Marburg, Germany
- Centre for Mind, Brain and Behaviour, Philipps University Marburg, Marburg, Germany
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12
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Arantzamendi M, Sapeta P, Belar A, Centeno C. How palliative care professionals develop coping competence through their career: A grounded theory. Palliat Med 2024; 38:284-296. [PMID: 38380528 PMCID: PMC10955801 DOI: 10.1177/02692163241229961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
BACKGROUND Palliative care professionals face emotional challenges when caring for patients with serious advanced diseases. Coping skills are essential for working in palliative care. Several types of coping strategies are mentioned in the literature as protective. However, little is known about how coping skills are developed throughout a professional career. AIM To develop an explanatory model of coping for palliative care professionals throughout their professional career. DESIGN A grounded theory study. Two researchers conducted constant comparative analysis of interviews. SETTING/PARTICIPANTS Palliative care nurses and physicians across nine services from Spain and Portugal (n = 21). Theoretical sampling included professionals who had not continued working in palliative care. RESULTS Professionals develop their coping mechanisms in an iterative five-stage process. Although these are successive stages, each one can be revisited later. First: commencing with a very positive outlook and emotion, characterized by contention. Second: recognizing one's own vulnerability and experiencing the need to disconnect. Third: proactively managing emotions with the support of workmates. Fourth: cultivating an integrative approach to care and understanding one's own limitations. Fifth: grounding care on inner balance and a transcendent perspective. This is a transformative process in which clinical cases, teamwork, and selfcare are key factors. Through this process, the sensations of feeling overwhelmed sometimes can be reversed because the professional has come to understand how to care for themselves. CONCLUSIONS The explicative model presents a pathway for personal and professional growth, by accumulating strategies that modulate emotional responses and encourage an ongoing passion for work.
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Affiliation(s)
- Maria Arantzamendi
- Universidad de Navarra, Institute for Culture and Society-ATLANTES Global Observatory of Palliative Care, Pamplona, Navarra, Spain
- IdISNA-Instituto de Investigación Sanitaria de Navarra. Medicina Paliativa
| | - Paula Sapeta
- Dr. Lopes Dias High School of Health—Castelo Branco Polytechnic Institute, Castelo Branco, Portugal
| | - Alazne Belar
- Universidad de Navarra, Institute for Culture and Society-ATLANTES Global Observatory of Palliative Care, Pamplona, Navarra, Spain
- IdISNA-Instituto de Investigación Sanitaria de Navarra. Medicina Paliativa
| | - Carlos Centeno
- Universidad de Navarra, Institute for Culture and Society-ATLANTES Global Observatory of Palliative Care, Pamplona, Navarra, Spain
- IdISNA-Instituto de Investigación Sanitaria de Navarra. Medicina Paliativa
- Clínica Universidad de Navarra, Pamplona, Navarra, Spain
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13
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Pottash M, Rao A. The Complex Ethical and Moral Experience of Left Ventricular Assist Device Deactivation. J Pain Symptom Manage 2024; 67:274-278. [PMID: 37984719 DOI: 10.1016/j.jpainsymman.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 10/30/2023] [Accepted: 11/15/2023] [Indexed: 11/22/2023]
Abstract
The left ventricular assist device (LVAD) is a fully implantable cardiac replacement device that can complicate the process of dying. We present a case of a patient who attempted to deactivate the LVAD without the support of his medical team. This action was understood as a "suicide attempt" though when the patient was later felt to be dying, LVAD deactivation proceeded without reference to psychiatric illness. To understand this case, we discuss the ethics of LVAD deactivation in the dying process. We then explore the experience of clinicians and the public encountering this unique technology across clinical contexts. We herein present a novel and possibly controversial analysis of the moral complexities of LVAD deactivation and suggest that clinicians be transparent about these complexities with patients and families.
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Affiliation(s)
- Michael Pottash
- Division of Palliative Medicine, Department of Medicine (M.P., A.R.), MedStar Washington Hospital Center, Washington, DC, USA; Georgetown University School of Medicine (M.P., A.R.), Washington, DC, USA.
| | - Anirudh Rao
- Division of Palliative Medicine, Department of Medicine (M.P., A.R.), MedStar Washington Hospital Center, Washington, DC, USA; Georgetown University School of Medicine (M.P., A.R.), Washington, DC, USA
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14
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Sheehan MM, Zilberberg MD, Lindenauer PK, Higgins TL, Imrey PB, Guo N, Deshpande A, Haessler SD, Rothberg MB. Associations between Present-on-Admission Do-Not-Resuscitate Orders and Short-Term Outcomes in Patients with Pneumonia. South Med J 2024; 117:165-171. [PMID: 38428939 PMCID: PMC10914325 DOI: 10.14423/smj.0000000000001663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Abstract
OBJECTIVES Do-not-resuscitate (DNR) orders are used to express patient preferences for cardiopulmonary resuscitation. This study examined whether early DNR orders are associated with differences in treatments and outcomes among patients hospitalized with pneumonia. METHODS This is a retrospective cohort study of 768,015 adult patients hospitalized with pneumonia from 2010 to 2015 in 646 US hospitals. The exposure was DNR orders present on admission. Secondary analyses stratified patients by predicted in-hospital mortality. Main outcomes included in-hospital mortality, length of stay, cost, intensive care admission, invasive mechanical ventilation, noninvasive ventilation, vasopressors, and dialysis initiation. RESULTS Of 768,015 patients, 94,155 (12.3%) had an early DNR order. Compared with those without, patients with DNR orders were older (mean age 80.1 ± 10.6 years vs 67.8 ± 16.4 years), with higher comorbidity burden, intensive care use (31.6% vs 30.6%), and in-hospital mortality (28.2% vs 8.5%). After adjustment via propensity score weighting, these patients had higher mortality (odds ratio [OR] 2.39, 95% confidence interval [CI] 2.33-2.45) and lower use of intensive therapies such as vasopressors (OR 0.83, 95% CI 0.81-0.85) and invasive mechanical ventilation (OR 0.68, 95% CI 0.66-0.70). Although there was little relationship between predicted mortality and DNR orders, among those with highest predicted mortality, DNR orders were associated with lower intensive care use compared with those without (66.7% vs 80.8%). CONCLUSIONS Patients with early DNR orders have higher in-hospital mortality rates than those without, but often receive intensive care. These orders have the most impact on the care of patients with the highest mortality risk.
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Affiliation(s)
| | | | - Peter K. Lindenauer
- Departments of Healthcare Delivery and Population Sciences and Medicine, University of Massachusetts Chan Medical School-Baystate, Springfield
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester
| | - Thomas L. Higgins
- The Center for Case Management, Natick, Massachusetts
- Departments of Medicine and Anesthesiology, Division of Pulmonary and Critical Care Medicine, University of Massachusetts Chan Medical School-Baystate, Springfield
| | - Peter B. Imrey
- Department of Quantitative Health Sciences, Cleveland, Ohio
| | - Ning Guo
- Department of Quantitative Health Sciences, Cleveland, Ohio
| | | | - Sarah D. Haessler
- Department of Medicine, Division of Infectious Diseases, University of Massachusetts Chan Medical School-Baystate, Springfield, Massachusetts
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15
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Aparicio P, Alonso-Babarro A, Barba R, Moldenhauer F, Suárez C, de Asúa DR. Analysis of the circumstances associated with death and predictors of mortality in Spanish adults with Down syndrome, 1997-2014. J Appl Res Intellect Disabil 2024; 37:e13187. [PMID: 38369309 DOI: 10.1111/jar.13187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 10/03/2023] [Accepted: 12/08/2023] [Indexed: 02/20/2024]
Abstract
OBJECTIVES Characterise the circumstances associated with death during admission of adults with Down syndrome (DS) and to identify predictors of mortality. PATIENTS AND METHODS Observational study based on data on all emergent admissions of adults with DS to hospitals of the Spanish National Health System between 1997 and 2014. We analysed epidemiological and clinical variables. RESULTS We analysed admissions of 11,594 adults with DS, mean age 47 years. 1715 patients died (15%), being the highest mortality (35%) in individuals aged 50-59. A past medical history of cerebrovascular disease (aOR 2.95 [2.30-3.77]) or cancer (aOR 2.79 [2.07-3.75]), gross aspiration's admission (aOR 2.59 [2.20-3.04]), immobility (aOR 2.31 [1.46-3-62]), and readmission within 30 days (aOR 2.43 [2.06-2.86]) were identified as predictors of mortality. CONCLUSIONS Adults with DS have a high in-hospital mortality rate. The main predictors of death were cerebrovascular disease, cancer, early readmission, and conditions commonly associated with advanced dementia.
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Affiliation(s)
- Paloma Aparicio
- Palliative Care Department, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | | | - Raquel Barba
- Internal Medicine Department, Hospital Universitario Rey Juan Carlos, Madrid, Spain
| | - Fernando Moldenhauer
- Adult Down Syndrome Unit, Internal Medicine Department, Hospital Universitario de la Princesa, Madrid, Spain
| | - Carmen Suárez
- Adult Down Syndrome Unit, Internal Medicine Department, Hospital Universitario de la Princesa, Madrid, Spain
| | - Diego Real de Asúa
- Adult Down Syndrome Unit, Internal Medicine Department, Hospital Universitario de la Princesa, Madrid, Spain
- Down Syndrome Medical Interest Group-USA (DSMIG-USA), Orlando, Florida, USA
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16
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Saito T, Konta T, Kudo S, Ueno Y. Factors associated with community residents' preference for living at home at the end of life: The Yamagata Cohort Survey. Glob Health Med 2024; 6:70-76. [PMID: 38450115 PMCID: PMC10912798 DOI: 10.35772/ghm.2023.01072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 09/30/2023] [Accepted: 10/26/2023] [Indexed: 03/08/2024]
Abstract
Japan's rapidly aging and high-mortality society necessitates a wider awareness and implementation of advance care planning. This Yamagata Cohort study investigated local residents' preferences for where they would like to spend their final days, and the underlying factors associated with those preferences with a self-administered questionnaire survey of local residents aged 40 years and over . Logistic regression analyses were used to assess those factors and, specifically, the choice of "Home" as the preferred place for end-of-life residence. Among the 10,119 responders, 61% chose their home as the most desirable place to spend their final days. The multiple logistic regression analysis showed that the independent factors associated with the choice of "Home" were: male, older age, not living with someone who needs care, not discussing the end of life, currently happy, struggling to live on current income, not feeling anxious or depressed, and current place of residence the same as their grandparents' birthplace. This suggested that reducing the burden of home care and addressing frequent emotional issues such as happiness and anxiety could increase the number of people choosing "Home". Open-ended comments indicated the importance of getting information and options, and discussing the choice of place for terminal care in light of individual backgrounds including having reservations about family. Support and systems are needed to understand what community residents consider important when deciding where to spend their final days, and to bridge the gap between their desired location and their actual end of life.
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Affiliation(s)
- Tomoko Saito
- Department of Nursing, Yamagata University School of Medicine Hospital, Yamagata, Japan
| | - Tsuneo Konta
- Department of Public Health and Hygiene, Yamagata University Graduate School of Medical Science, Yamagata, Japan
| | - Sachiko Kudo
- Department of Nursing, Yamagata University School of Medicine Hospital, Yamagata, Japan
| | - Yoshiyuki Ueno
- Department of Gastroenterology, Yamagata University School of Medicine, Yamagata, Japan
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Cunningham C, Mayers P, Giddy J, De Swardt M, Hodkinson P. 'I am afraid the news is not good' - Breaking bad news in the time of COVID: Experiences from a field hospital. Afr J Prim Health Care Fam Med 2024; 16:e1-e10. [PMID: 38426776 PMCID: PMC10913135 DOI: 10.4102/phcfm.v16i1.4256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 11/23/2023] [Accepted: 11/25/2023] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND The COVID-19 Pandemic had profound effects on healthcare systems around the world. In South Africa, field hospitals, such as the Mitchell's Plain Field Hospital, managed many COVID patients and deaths, largely without family presence. Communicating with families, preparing them for death and breaking bad news was a challenge for all staff. AIM This study explores the experiences of healthcare professionals working in a COVID-19 field hospital, specifically around having to break the news of death remotely. SETTING A150-bed Mitchells Plain Field Hospital (MPFH) in Cape Town. METHODS A qualitative exploratory design was utilised using a semi-structured interview guide. RESULTS Four themes were identified: teamwork, breaking the news of death, communication and lessons learnt. The thread linking the themes was the importance of teamwork, the unpredictability of disease progression in breaking bad news and barriers to effective communication. Key lessons learnt included effective management and leadership. Many families had no access to digital technology and linguo-cultural barriers existed. CONCLUSION We found that in the Mitchell's Plain Field Hospital, communication challenges were exacerbated by the unpredictability of the illness and the impact of restrictions on families visiting in preparing them for bad news. We identified a need for training using different modalities, the importance of a multidisciplinary team approach and for palliative care guidelines to inform practice.Contribution: Breaking the news of death to the family is never easy for healthcare workers. This article unpacks some of the experiences in dealing with an extraordinary number of deaths by a newly formed team in the COVID era.
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Affiliation(s)
- Charmaine Cunningham
- Department of Family, Community and Emergency Care, Faculty of Health Sciences, University of Cape Town, Cape Town.
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18
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Nwosu AC, Mills M, Roughneen S, Stanley S, Chapman L, Mason SR. Virtual reality in specialist palliative care: a feasibility study to enable clinical practice adoption. BMJ Support Palliat Care 2024; 14:47-51. [PMID: 33597168 PMCID: PMC10894832 DOI: 10.1136/bmjspcare-2020-002327] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 02/03/2021] [Accepted: 02/04/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND The use of virtual reality (VR) is increasing in palliative care. However, despite increasing interest in VR, there is little evidence of how this technology can be implemented into practice. AIMS This paper aims to: (1) explore the feasibility of implementing VR therapy, for patients and caregivers, in a hospital specialist inpatient palliative care unit and a hospice, and (2) to identify questions for organisations, to support VR adoption in palliative care. METHODS The Samsung Gear VR system was used in a hospital specialist palliative inpatient unit and a hospice. Patients and caregivers received VR distraction therapy and provided feedback of their experience. Staff completed a feedback questionnaire to explore their opinion of the usefulness of VR in palliative care. A public engagement event was conducted, to identify questions to support implementation of VR in palliative care settings. RESULTS Fifteen individuals (12 (80%) patients and 3 (20%) caregivers) participated. All had a positive experience. No adverse effects were reported. Ten items were identified for organisations to consider ahead of adoption of VR in palliative care. These were questions about: the purpose of VR; intended population; supporting evidence; session duration; equipment choice; infection control issues; content choice; setting of VR; person(s) responsible for delivery and the maintenance plan. CONCLUSIONS It is feasible to use VR therapy in palliative care; however, further evidence about its efficacy and effectiveness is needed. Palliative care practitioners considering VR use should carefully consider several factors, to ensure that this technology can be used safely and effectively in clinical practice.
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Affiliation(s)
- Amara Callistus Nwosu
- International Observatory on End of Life Care, Lancaster University, Faculty of Health and Medicine, Lancaster, Lancashire, UK
- Marie Curie Hospice Liverpool, Liverpool, UK
| | - Mark Mills
- Marie Curie Hospice Liverpool, Liverpool, UK
| | - Simon Roughneen
- Academic Palliative and End of Life Care Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | | | | | - Stephen R Mason
- Palliative Care Unit, University of Liverpool, Liverpool, UK
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19
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Taubert M. Healthcare media interviews. BMJ Support Palliat Care 2024; 14:87-89. [PMID: 38176891 DOI: 10.1136/spcare-2023-004738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 12/13/2023] [Indexed: 01/06/2024]
Affiliation(s)
- Mark Taubert
- Palliative Medicine, Velindre NHS Trust, Cardiff, UK
- Cardiff University School of Medicine, Cardiff, UK
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Gonzalez-Jaramillo V, Arenas Ochoa LF, Saldarriaga C, Krikorian A, Vargas JJ, Gonzalez-Jaramillo N, Eychmüller S, Maessen M. The 'Surprise question' in heart failure: a prospective cohort study. BMJ Support Palliat Care 2024; 14:68-75. [PMID: 34404746 PMCID: PMC10894837 DOI: 10.1136/bmjspcare-2021-003143] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/24/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The Surprise Question (SQ) is a prognostic screening tool used to identify patients with limited life expectancy. We assessed the SQ's performance predicting 1-year mortality among patients in ambulatory heart failure (HF) clinics. We determined that the SQ's performance changes according to sex and other demographic (age) and clinical characteristics, mainly left ventricular ejection fraction (LVEF) and the New York Heart Association (NYHA) functional classifications. METHODS We conducted a prospective cohort study in two HF clinics. To assess the performance of the SQ in predicting 1-year mortality, we calculated the sensitivity, specificity, positive and negative likelihood ratios, and the positive and negative predictive values. To illustrate if the results of the SQ changes the probability that a patient dies within 1 year, we created Fagan's nomograms. We report the results from the overall sample and for subgroups according to sex, age, LVEF and NYHA functional class. RESULTS We observed that the SQ showed a sensitivity of 85% identifying ambulatory patients with HF who are in the last year of life. We determined that the SQ's performance predicting 1-year mortality was similar among women and men. The SQ performed better for patients aged under 70 years, for patients with reduced or mildly reduced ejection fraction, and for patients NYHA class III/IV. CONCLUSIONS We consider the tool an easy and fast first step to identify patients with HF who might benefit from an advance care planning discussion or a referral to palliative care due to limited life expectancy.
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Affiliation(s)
- Valentina Gonzalez-Jaramillo
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | | | - Clara Saldarriaga
- Cardiology, Clinica Cardio VID, Medellin, Colombia
- Cardiology, University of Antioquia, Medellin, Colombia
| | - Alicia Krikorian
- School of Health Sciences, Pontifical Bolivarian University, Medellin, Colombia
| | - John Jairo Vargas
- School of Health Sciences, Pontifical Bolivarian University, Medellin, Colombia
- Institute of Cancerology, Las Americas Clinic, Medellin, Colombia
| | - Nathalia Gonzalez-Jaramillo
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Steffen Eychmüller
- University Center for Palliative Care, Inselspital University Hospital Bern, University of Bern, Bern, Switzerland
| | - Maud Maessen
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- University Center for Palliative Care, Inselspital University Hospital Bern, University of Bern, Bern, Switzerland
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21
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Fast-track hospital end-of-life discharge pathway: is it actually fast? National clinical audit. BMJ Support Palliat Care 2024; 14:90-93. [PMID: 35022188 DOI: 10.1136/bmjspcare-2021-003183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 09/19/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To determine adherence to Department of Health and Social Care target of fast-track pathway discharge for end-of-life care within 48 hours. METHODS Multicentre audit in England using retrospective analysis of patient records for fast-track pathway tools submitted between 1 March 2019 and 31 March 2019. RESULTS Most patients (72%) were not discharged within the 48-hour target. There was significant variability in success between hospital sites. Delays in discharge were most frequently considered to be secondary to delays in sourcing packages of care and 24-hour care facility placements. Involvement of specialist discharge nurses in paperwork submission improved rates by Commissioning Care Groups. Patients who died in hospital had significantly longer admissions than those who were discharged (discharged 19 days (IQR 11-28) vs died 28 days (IQR 18-42); p=0.039). This was entirely accounted for by increased numbers of days between admission and first suggestion of fast-track pathway discharge in those who died in hospital (discharged 9 days (IQR 5-19), died 15 days (IQR 9-33); p=0.003). CONCLUSIONS We demonstrated a delay in the fast-track pathway discharge process with significant variation in success of the discharge process at different geographical locations.
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Boegelund Kristensen T, Kelstrup Hallas M, Høgsted R, Groenvold M, Sjøgren P, Marsaa K. Burnout in physicians: a survey of the Danish society for palliative medicine. BMJ Support Palliat Care 2024; 14:52-55. [PMID: 34187876 DOI: 10.1136/bmjspcare-2021-003237] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 06/16/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Burnout, which is a state of prolonged physical and psychological exhaustion, seems to be a prevalent and serious problem among healthcare workers. Our aim was to investigate the prevalence of burnout symptoms among members of Danish Society of Palliative Medicine (DSPaM). METHODS All 160 physician members of DSPaM were invited to a questionnaire survey. The Copenhagen Burnout Inventory (CBI) was used to evaluate and differentiate between personal, work-related and client-related burnout. RESULTS 76 members responded (47,5%). 51% regularly received supervision. Scores on personal burnout demonstrated that 25% had no symptoms and 55% had symptoms that required attention; however, no respondents needed immediate intervention. Regarding work-related burnout: 40% had no symptoms, 20% had symptoms that needed attention and 3% needed immediate help. Regarding client-related burnout: 65% had no symptoms, 32% had symptoms that needed attention and none needed immediate intervention. CONCLUSIONS This survey demonstrated a relatively low rate of burnout symptoms among members of the DSPaM. In particular, the client-related burnout score was low, while higher scores were observed in personal and work-related burnout. Despite the relatively low overall levels of burnout, it is notable that about half of the physicians reported personal burnout, which needs to be addressed.
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Affiliation(s)
| | - Mette Kelstrup Hallas
- Department of Oncology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Rikke Høgsted
- Institute of Mental High Risk Psychology, Copenhagen, Denmark
| | - Mogens Groenvold
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Geriatric and Palliative Medicine, Palliative Care Research Unit, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Per Sjøgren
- Section of Palliative Medicine, Department of Oncology, Centre for Cancer and Organ Diseases, Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - Kristoffer Marsaa
- The Danish Knowledge Centre for Rehabilitation and Palliative Care (REHPA), University of Southern Denmark, Nyborg, Denmark
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Namukwaya E, de Sousa AB, Lopes S, Touwen DP, van der Steen JT, Bélanger E, Brooks J, Yghemonos S, Sehmi K, Gomes B. EOLinPLACE: an international research project to reform the way dying places are classified and understood. Palliat Care Soc Pract 2024; 18:26323524231222498. [PMID: 38357678 PMCID: PMC10865961 DOI: 10.1177/26323524231222498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 12/07/2023] [Indexed: 02/16/2024] Open
Abstract
Background Whenever possible, a person should die where they feel it is the right place to be. There is substantial global variation in home death percentages but it is unclear whether these differences reflect preferences, and there are major limitations in how the place of death is classified and compared across countries. Objectives EOLinPLACE is an international interdisciplinary research project funded by the European Research Council aiming to create a solid base for a ground-breaking international classification tool that will enable the mapping of preferred and actual places towards death. Design Mixed-methods observational research. Methods and analysis We combine classic methods of developing health classifications with a bottom-up participatory research approach, working with international organizations representing patients and informal carers [International Alliance of Patients' Organizations (IAPO) and Eurocarers]. First, we will conduct an international comparative analysis of existing classification systems and routinely collected death certificate data on place of death. Secondly, we will conduct a mixed-methods study (ethnography followed by longitudinal quantitative study) in four countries (the Netherlands, Portugal, Uganda and the United States), to compare the preferences and experiences of patients with life-threatening conditions and their families. Thirdly, based on the generated evidence, we will build a contemporary classification of dying places; assess its content validity through focus groups with patients, carers and other stakeholders; and evaluate it in a psychometric study to examine construct validity, reliability, responsiveness, data quality and interpretability. Ethics Approved by the ethics committee of the University of Coimbra, Faculty of Medicine (CE-068-2022) and committees in each of the participating countries. Discussion The findings will provide a deeper understanding of the diversity in individual end-of-life pathways. They will enable key developments such as measurement of progress towards achievement of preferences when care can be planned. The project will open new directions in how to care for the dying. Trial registration Research Registry UIN 9213.
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Affiliation(s)
- Elizabeth Namukwaya
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Sílvia Lopes
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
| | - Dorothea Petra Touwen
- Department of Medical Ethics and Health Law, Leiden University Medical Center, Leiden, the Netherlands
| | - Jenny Theodora van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
- Department of Primary and Community Care and Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Emmanuelle Bélanger
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA
| | - Joanna Brooks
- Population Health and Palliative Medicine, Master of Health Services Administration, University of Kansas School of Medicine, Kansas City, KS, USA
| | | | - Kawaldip Sehmi
- International Alliance of Patients’ Organizations, London, UK
| | - Barbara Gomes
- Faculty of Medicine, University of Coimbra, Pólo III, Sub-Unidade 3, Azinhaga de Santa Comba, Coimbra 3000-548, Portugal Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London, UK
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Strang P, Schultz T, Ozanne A. Partly unequal receipt of healthcare in last month of life in amyotrophic lateral sclerosis: a retrospective cohort study of the Stockholm region. Ups J Med Sci 2024; 129:9856. [PMID: 38371486 PMCID: PMC10870957 DOI: 10.48101/ujms.v129.9856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 12/19/2023] [Accepted: 12/19/2023] [Indexed: 02/20/2024] Open
Abstract
Context In amyotrophic lateral sclerosis (ALS), equal care is important, given that the disease often has complex symptoms at the end of life. Objectives The aim was to study the possible associations between demographic and clinical factors, including age, sex, and frailty, with acute healthcare utilization in the last month of life, measured by emergency room (ER) visits, admissions to acute hospitals and, acute hospitals as place of death, among patients with ALS. A second aim was to study whether receipt of specialized palliative care (SPC) affects above-mentioned healthcare utilization. Methods Observational, retrospective study based on Region Stockholm's administrative data warehouse (VAL) in Sweden. Data were retrieved for 2015-2021 and analyzed with descriptive statistics and logistic regression models. Results All deceased patients (n = 448) ≥18 years with ALS were included. The mean age was 70.5 years, 46% were women and 58% had risk of frailty according to Hospital Frailty Risk Score (HFRS). Ninety-nine (22%) were nursing home residents and 49% received SPC. The receipt of SPC in patients with ALS was equal in relation to gender, socio-economic standing, frailty, and age <75 years. Patients ≥75 years, those with dementia and/or residing in nursing homes (NH) were less likely to receive SPC (P = 0.01, P = 0.03 and P = 0.002, respectively). Receipt of SPC reduced ER visits (29% vs. 48%, P < 0.001) and deaths at hospital (12% vs. 48%, P <0.001). Patients who were frail, had a higher risk of ER visits and were more likely to die at an acute hospital setting (P < 0.001 and P = 0.004). NH residents were less likely to have ER visits and to die in hospital (P = 0.002 and P = 0.005). Conclusions The results indicate partly unequal distribution of palliative care, however the actual, individual preferences cannot be deducted from registry studies. All patients with ALS should be offered SPC when needed. Key message This register study shows that receipt of SPC in patients with ALS is equal in relation to gender, socioeconomic standing, frailty, and age <75 years, while those ≥75 years, with dementia, or residing in NH were somewhat less likely to receive SPC. Receipt of SPC reduces ER visits and acute hospital admissions.
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Affiliation(s)
- Peter Strang
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Torbjörn Schultz
- Research and Development Department, Stockholm’s Sjukhem Foundation, Stockholm, Sweden
| | - Anneli Ozanne
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg Sweden
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Soeda R, Ishikawa A, Oyamada S, Mitsuhashi M, Okano S, Yokosawa A, Okutsu T, Tsuji T. Trajectories of Activities of Daily Living in the Last Eight Weeks of Life Among Patients With Terminal Cancer in a Palliative Care Unit: A Retrospective Study. Palliat Med Rep 2024; 5:63-69. [PMID: 38406210 PMCID: PMC10890944 DOI: 10.1089/pmr.2023.0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2023] [Indexed: 02/27/2024] Open
Abstract
Background Although cancer patients' activities of daily living (ADL) are reported to decline before death, ADL trajectories have not been sufficiently clarified due to limitations in the assessment and analysis methods. Objectives To clarify the multiple trajectories of ADL in patients with terminal cancer using a comprehensive assessment measure. Design This was a retrospective observational study. Setting/Study Subjects Cancer patients aged ≥18 years discharged at death from a single-center palliative care unit. Measurements Functional Independence Measure (FIM) total scores for eight weeks retrospectively. Results In total, 306 patients were analyzed. Group-based trajectory modeling analysis estimated four groups as the best model for the FIM trajectory over eight weeks using the following trajectories: (1) a No Decline group, in which ADL did not decline until just before death; (2) a Rapid Decline group, in which ADL declined rapidly two weeks before death from a trajectory similar to the No Decline group; (3) a Moderate Disability and Slow Decline group, in which the patient slowly declined from requiring mild-to-severe assistance; and (4) a Severe Disability group, in which the patient continuously required severe assistance. Conclusions Multiple ADL trajectories were identified in the last eight weeks of life of patients with terminal cancer. These findings suggest that palliative care needs to be tailored to the characteristics of each patient.
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Affiliation(s)
- Ryo Soeda
- Department of Rehabilitation, Tsurumaki-Onsen Hospital, Hadano, Kanagawa, Japan
- Department of Rehabilitation Medicine, Keio University Graduate School, Shinjuku, Tokyo, Japan
| | - Aiko Ishikawa
- Department of Rehabilitation Medicine, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Shunsuke Oyamada
- Department of Biostatistics, Japanese Organisation for Research and Treatment of Cancer, Arakawa, Tokyo, Japan
| | | | - Suzune Okano
- Department of Rehabilitation, Tsurumaki-Onsen Hospital, Hadano, Kanagawa, Japan
| | - Aiko Yokosawa
- Department of Rehabilitation, Tsurumaki-Onsen Hospital, Hadano, Kanagawa, Japan
| | | | - Tetsuya Tsuji
- Department of Rehabilitation Medicine, Keio University School of Medicine, Shinjuku, Tokyo, Japan
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Surges SM, Brunsch H, Jaspers B, Apostolidis K, Cardone A, Centeno C, Cherny N, Csikós À, Fainsinger R, Garralda E, Ling J, Menten J, Mercadante S, Mosoiu D, Payne S, Preston N, Van den Block L, Hasselaar J, Radbruch L. Revised European Association for Palliative Care (EAPC) recommended framework on palliative sedation: An international Delphi study. Palliat Med 2024; 38:213-228. [PMID: 38297460 PMCID: PMC10865771 DOI: 10.1177/02692163231220225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
BACKGROUND The European Association for Palliative Care (EAPC) acknowledges palliative sedation as an important, broadly accepted intervention for patients with life-limiting disease experiencing refractory symptoms. The EAPC therefore developed 2009 a framework on palliative sedation. A revision was needed due to new evidence from literature, ongoing debate and criticism of methodology, terminology and applicability. AIM To provide evidence- and consensus-based guidance on palliative sedation for healthcare professionals involved in end-of-life care, for medical associations and health policy decision-makers. DESIGN Revision between June 2020 and September 2022 of the 2009 framework using a literature update and a Delphi procedure. SETTING European. PARTICIPANTS International experts on palliative sedation (identified through literature search and nomination by national palliative care associations) and a European patient organisation. RESULTS A framework with 42 statements for which high or very high level of consensus was reached. Terminology is defined more precisely with the terms suffering used to encompass distressing physical and psychological symptoms as well as existential suffering and refractory to describe the untreatable (healthcare professionals) and intolerable (patient) nature of the suffering. The principle of proportionality is introduced in the definition of palliative sedation. No specific period of remaining life expectancy is defined, based on the principles of refractoriness of suffering, proportionality and independent decision-making for hydration. Patient autonomy is emphasised. A stepwise pharmacological approach and a guidance on hydration decision-making are provided. CONCLUSIONS This is the first framework on palliative sedation using a strict consensus methodology. It should serve as comprehensive and soundly developed information for healthcare professionals.
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Affiliation(s)
- Séverine M Surges
- Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany
| | - Holger Brunsch
- Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany
| | - Birgit Jaspers
- Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany
- Department of Palliative Medicine, University Medicine Goettingen, Goettingen, Germany
| | | | - Antonella Cardone
- Cancer Patients Europe, Brussels, Belgium
- Pancreatic Cancer Europe, Brussels, Belgium
| | - Carlos Centeno
- ATLANTES Global Observatory of Palliative Care, Institute for Culture and Society, University of Navarra, Pamplona, Spain
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Nathan Cherny
- Department of Medical Oncology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Àgnes Csikós
- Department of Primary Health Care, Department of Hospice-Palliative Care, University of Pecs Medical School, Pecs, Hungary
| | | | - Eduardo Garralda
- ATLANTES Global Observatory of Palliative Care, Institute for Culture and Society, University of Navarra, Pamplona, Spain
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Julie Ling
- European Association for Palliative Care, Vilvoorde, Belgium
| | - Johan Menten
- Laboratory of Experimental Radiotherapy, KU Leuven, Leuven, Belgium
| | - Sebastiano Mercadante
- Main Regional Centre for Pain Relief and Palliative/Supportive Care, La Maddalena Cancer Centre, Palermo, Italy
| | - Daniela Mosoiu
- Medical Faculty, Transilvania University, Brasov, Romania
- Education and National Development Department, Hospice Casa Sperantei, Brasov, Romania
| | - Sheila Payne
- International Observatory on End-of-Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Nancy Preston
- International Observatory on End-of-Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Lieve Van den Block
- VUB-UGhent End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Jeroen Hasselaar
- Department of Primary Care, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
- Task Force on Palliative Sedation of the European Association for Palliative Care, Brussels, Belgium
| | - Lukas Radbruch
- Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany
- Task Force on Palliative Sedation of the European Association for Palliative Care, Brussels, Belgium
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Sweeny AL, Alsaba N, Grealish L, May K, Huang YL, Ranse J, Denny KJ, Lukin B, Broadbent A, Burrows E, Ranse K, Sunny L, Khatri M, Crilly J. End-of-life care: A retrospective cohort study of older people who died within 48 hours of presentation to the emergency department. Emerg Med Australas 2024; 36:13-23. [PMID: 37914673 DOI: 10.1111/1742-6723.14331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 09/06/2023] [Accepted: 09/27/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVES To describe the characteristics of, and care provided to, older people who died within 48 h of ED presentation. METHODS A descriptive retrospective cohort study of people 65 years and older presenting to two EDs in Queensland, Australia, between April 2018 and March 2019. Data from electronic medical records were collected and analysed. RESULTS Two hundred and ninety-five older people who died within 48 h of ED presentation were included. Nearly all arrived by ambulance (92%, n = 272) and 36% (n = 106) were from aged care facilities. Three-quarters (75%, n = 222) were triaged into the most urgent triage categories (i.e. Australasian Triage Scale; ATS 1/2). Fewer than half were previously independent with mobility (38%, n = 111) and activities of daily living (43%, n = 128). Sixty-one per cent (n = 181) had a pre-existing healthcare directive. Twenty-two per cent (n = 66) died in ED, most commonly due to pneumonia, intracerebral haemorrhage, cardiac arrest and/or sepsis. Over half had one or more ED visits (52%, n = 154) and/or hospital admissions (52%, n = 152) 6 months prior. CONCLUSIONS Identification of patients at end-of-life (EoL) is not always straightforward; consider recent reduction in independence and recent ED visits/hospital admissions. System-based strategies that span pre-hospital, ED and in-patient care are recommended to facilitate EoL pathway implementation and care continuity.
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Affiliation(s)
- Amy L Sweeny
- Emergency Department, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Nemat Alsaba
- Emergency Department, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Laurie Grealish
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- Nursing and Midwifery Research Unit, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Katya May
- Emergency Department, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
| | - Ya-Ling Huang
- Emergency Department, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
- Faculty of Health (Nursing), Southern Cross University, Gold Coast, Queensland, Australia
| | - Jamie Ranse
- Emergency Department, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
| | - Kerina J Denny
- Department of Intensive Care Medicine, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Bill Lukin
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Royal Brisbane Residential Aged Care Assessment and Referral Service, Brisbane, Queensland, Australia
| | - Andrew Broadbent
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
- Supportive and Specialist Palliative Care, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Erin Burrows
- Emergency Department, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Kristen Ranse
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
| | - Linda Sunny
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
- Lyell McEwin and Modbury Hospitals, Northern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Meghna Khatri
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Julia Crilly
- Emergency Department, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
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Tsuji T, Sento Y, Kamimura Y, Kawasaki T, Sobue K. Rapid Response System and Limitations of Medical Treatment Among Children With Clinical Deterioration in Japan: A Multicenter Retrospective Cohort Study. J Palliat Med 2024; 27:241-245. [PMID: 37851992 DOI: 10.1089/jpm.2023.0377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023] Open
Abstract
Objective: We investigated the role of rapid response systems (RRSs) in limitations of medical treatment (LOMT) planning among children, their families, and health care providers. Methods: This multicenter retrospective cohort study examined children with clinical deterioration using the Japanese RRS registry between 2012 and 2021. Results: Children (n = 348) at 28 hospitals in Japan who required RRS calls were analyzed. Eleven (3%) of the 348 patients had LOMT before RRS calls and 11 (3%) had newly implemented LOMT after RRS calls. Patients with LOMT were significantly less likely to be admitted to an intensive care unit compared with those without (36% vs. 61%, p < 0.001) and were more likely to die within 30 days (45% vs. 11%, p < 0.001). Conclusions: LOMT issues existed in 6% of children who received RRS calls. RRS calls for clinically deteriorating children with LOMT were associated with less intensive care and higher mortality.
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Affiliation(s)
- Tatsuya Tsuji
- Department of Anesthesiology and Intensive Care Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
- Department of Anesthesiology, Okazaki City Hospital, Okazaki, Japan
| | - Yoshiki Sento
- Department of Anesthesiology and Intensive Care Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yuji Kamimura
- Department of Anesthesiology and Intensive Care Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Tatsuya Kawasaki
- Department of Pediatric Critical Care, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Kazuya Sobue
- Department of Anesthesiology and Intensive Care Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Austin PD, Siddall PJ, Lovell MR. Posttraumatic growth in palliative care settings: A scoping review of prevalence, characteristics and interventions. Palliat Med 2024; 38:200-212. [PMID: 38229018 DOI: 10.1177/02692163231222773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
BACKGROUND Posttraumatic growth refers to positive psychological change following trauma. However, there is a need to better understand the experience of posttraumatic growth in the palliative care setting as well as the availability and efficacy of interventions that target this phenomenon. AIMS To provide a review of the prevalence, characteristics and interventions involving posttraumatic growth in adults receiving palliative care and to collate recommendations for future development and utilisation of interventions promoting posttraumatic growth. DESIGN We performed a systematic scoping review of studies investigating posttraumatic growth in palliative care settings using the Arksey and O'Malley six-step scoping review criteria. We used the PRISMA guidelines for scoping reviews. DATA SOURCES Articles in all languages available on Ovid Medline [1946-2022], Embase [1947-2022], APA PsycINFO [1947-2022] and CINAHL [1981-2022] in November 2022. RESULTS Of 2167 articles located, 17 were included for review. These reported that most people report low to moderate levels of posttraumatic growth with a decline towards end-of-life as distress and symptom burden increase. Associations include a relationship between posttraumatic growth, acceptance and greater quality-of-life. A limited number of interventions have been evaluated and found to foster posttraumatic growth and promote significant psychological growth. CONCLUSION Posttraumatic growth is an emerging concept in palliative care where although the number of studies is small, early indications suggest that interventions fostering posttraumatic growth may contribute to improvements in psychological wellbeing in people receiving palliative care.
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Affiliation(s)
- Philip D Austin
- Department of Palliative Care, HammondCare, Greenwich Hospital, Sydney, NSW, Australia
| | - Philip J Siddall
- Department of Pain Management, HammondCare, Greenwich Hospital, Sydney, NSW, Australia
- Sydney Medical School-Northern, University of Sydney, Sydney, NSW, Australia
| | - Melanie R Lovell
- Department of Palliative Care, HammondCare, Greenwich Hospital, Sydney, NSW, Australia
- Sydney Medical School-Northern, University of Sydney, Sydney, NSW, Australia
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Hession A, Luckett T, Currow D, Barbato M. Nurses' encounters with patients having end-of-life dreams and visions in an acute care setting - A cross-sectional survey study. J Adv Nurs 2024. [PMID: 38297455 DOI: 10.1111/jan.16079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 12/16/2023] [Accepted: 01/15/2024] [Indexed: 02/02/2024]
Abstract
AIM This study aimed to estimate the proportion of acute care nurses witnessing end-of-life dreams and visions or having these reported by a patient or relative, and to canvass their related attitudes and beliefs. DESIGN A cross-sectional survey study was conducted from February 2023 to May 2023. SETTING/PARTICIPANTS Participants were medical and surgical nurses from a 200-bed acute care hospital in metropolitan Australia. RESULTS Fifty-seven nurses participated from a workforce of 169 (34% response rate), of whom 35 (61%) reported they had encountered end-of-life dreams and visions. The nature of end-of-life dreams and visions encountered was similar to those reported in previous studies by patients and clinicians. Nurses generally held positive attitudes towards end-of-life dreams and visions but identified an unmet need for education and training on this aspect of end-of-life care. CONCLUSION Our results suggest that nurses in acute care encounter end-of-life dreams and visions in a similar proportion to oncology and long-term care but lower than in palliative care settings. Education and training regarding end-of-life dreams and visions are needed to ensure the provision of comprehensive, patient-centred end-of-life care. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution. IMPACT Research in sub-acute and long-term care settings suggests that end-of-life dreams and visions are a common accompaniment to the dying process. No research has yet focused on the acute care setting, despite this being the place of death for the majority of people in most high-income countries. This study demonstrates that acute care nurses encounter end-of-life dreams and visions in similar proportions to oncology and long-term care nurses but lower than palliative care nurses. Acute care nurses would benefit from education and training regarding end-of-life dreams and visions to enable the provision of holistic person-centred end-of-life care. REPORTING METHOD This study was reported using the STROBE Checklist for cross-sectional studies.
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Affiliation(s)
- Alison Hession
- Supportive and Palliative Care Network, Northern Sydney Local Health District, Hornsby Kuringai Hospital, Hornsby, New South Wales, Australia
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology, Sydney, New South Wales, Australia
| | - Tim Luckett
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology, Sydney, New South Wales, Australia
| | - David Currow
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Michael Barbato
- Department of Palliative Care, Port Kembla Hospital, Port Kembla, New South Wales, Australia
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Alshammary S, Altamimi I, Alhuqbani M, Alhumimidi A, Baaboud A, Altamimi A. Palliative Care in Saudi Arabia: An Updated Assessment Following the National Vision 2030 Reforms. J Palliat Med 2024. [PMID: 38271547 DOI: 10.1089/jpm.2023.0519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024] Open
Abstract
Background: Palliative care (PC) plays a crucial role in improving the quality of life for terminally ill patients and their families. In Saudi Arabia, the Reform of Healthcare Vision 2030 has recognized the importance of PC and aimed to enhance its availability and quality. Objectives: This study evaluates the current state of PC in Saudi Arabia post-Vision 2030 reforms. Design: A cross-sectional survey-based research was conducted at a ministry of health health care facility to assess the accessibility and quality of PC services. Setting/Subjects: The survey collected quantitative and qualitative data from PC managers in Saudi Arabia. Retrospective analysis of annual death records determined the demand for PC. Results: The results indicate notable progress in developing PC services in Saudi Arabia, including increased number of PC units, community home care services, outpatient services, and consultations. However, challenges persist in terms of geographical distribution, resource allocation, and availability of pain medications, particularly opioids. The study highlights the substantial need for PC for both cancer and noncancer patients, emphasizing the importance of expanding these services. Conclusions: To further improve PC, policymakers and stakeholders should prioritize resource allocation, health care workforce, and access to pain medications. These efforts will address the growing demand for PC and benefit terminally ill patients and their families in Saudi Arabia.
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Affiliation(s)
- Sami Alshammary
- Palliative Care, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Ibraheem Altamimi
- College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed Alhuqbani
- College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | | | - Alawi Baaboud
- Pediatric Emergency, King Salman bin Abdulaziz Medical City, Al Madinah Al Manawarah, Kingdom of Saudi Arabia
| | - Abdullah Altamimi
- Pediatric Emergency and Medical Toxicology, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
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Ishak Tayoob M, Rayala S, Doherty M, Singh HB, Alimelu M, Lingaldinna S, Palat G. Palliative Care for Newborns in India: Patterns of Care in a Neonatal Palliative Care Program at a Tertiary Government Children's Hospital. Health Serv Insights 2024; 17:11786329231222858. [PMID: 38269395 PMCID: PMC10807304 DOI: 10.1177/11786329231222858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 12/08/2023] [Indexed: 01/26/2024] Open
Abstract
Neonatal palliative care is a specialized area within children's palliative care, which focusses on the needs of infants with life-limiting or life-threatening conditions. Nearly one quarter of global neonatal deaths occur in India, where neonatal palliative care evidence is limited. This study describes the development and implementation of a neonatal palliative care program within a neonatal intensive care unit (NICU) at a government hospital, describing the implementing an 8-month pilot palliative care program for neonates, including the patterns of care, and barriers and enablers of success. The hospital-based palliative care team included trained pediatric palliative care physicians, a nurse, and a counselor. There was a steady increase in monthly referrals. There were 110 referrals in total, including 89 (81%) deaths and 18 (16%) babies were alive at the time of final follow-up, 10 months after the pilot program was completed. The program addressed physical symptoms, including providing morphine, as well as psychosocial and spiritual concerns of families. A model of hospital-based palliative care for neonates can be implemented within NICUs in tertiary government hospitals in India. Neonatal palliative care programs should include partnerships with charitable organizations to support implementation costs and provide palliative care training, mentorship, and capacity-building support.
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Affiliation(s)
| | | | - Megan Doherty
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Two Worlds Cancer Collaboration Foundation, Kelowna, Canada
- Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada
| | | | | | | | - Gayatri Palat
- Pain Relief and Palliative Care Society, Hyderabad, India
- Mehdi Nawaj Jung Institute of Oncology and Regional Cancer Centre, Hyderabad, India
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Souza-Silva RD, Calixto-Lima L, Varea Maria Wiegert E, de Oliveira LC. Decision tree algorithm to predict mortality in incurable cancer: a new prognostic model. BMJ Support Palliat Care 2024:spcare-2023-004581. [PMID: 38242639 DOI: 10.1136/spcare-2023-004581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 01/08/2024] [Indexed: 01/21/2024]
Abstract
OBJECTIVES To develop and validate a new prognostic model to predict 90-day mortality in patients with incurable cancer. METHODS In this prospective cohort study, patients with incurable cancer receiving palliative care (n = 1322) were randomly divided into two groups: development (n = 926, 70%) and validation (n = 396, 30%). A decision tree algorithm was used to develop a prognostic model with clinical variables. The accuracy and applicability of the proposed model were assessed by the C-statistic, calibration and receiver operating characteristic (ROC) curve. RESULTS Albumin (75.2%), C reactive protein (CRP) (47.7%) and Karnofsky Performance Status (KPS) ≥50% (26.5%) were the variables that most contributed to the classification power of the prognostic model, named Simple decision Tree algorithm for predicting mortality in patients with Incurable Cancer (acromion STIC). This was used to identify three groups of increasing risk of 90-day mortality: STIC-1 - low risk (probability of death: 0.30): albumin ≥3.6 g/dL, CRP <7.8 mg/dL and KPS ≥50%; STIC-2 - medium risk (probability of death: 0.66 to 0.69): albumin ≥3.6 g/dL, CRP <7.8 mg/dL and KPS <50%, or albumin ≥3.6 g/dL and CRP ≥7.8 mg/dL; STIC-3 - high risk (probability of death: 0.79): albumin <3.6 g/dL. In the validation dataset, good accuracy (C-statistic ≥0.71), Hosmer-Lemeshow p=0.12 and area under the ROC curve=0.707 were found. CONCLUSIONS STIC is a valid, practical tool for stratifying patients with incurable cancer into three risk groups for 90-day mortality.
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Kegel A, Espinoza J, Rahrig A, Schade-Wills T, Rowan CM. Interventions Performed in Children With Immunocompromised Conditions in the Pediatric Intensive Care Unit Within 48 Hours of Death. J Palliat Med 2024. [PMID: 38232707 DOI: 10.1089/jpm.2023.0400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024] Open
Abstract
Background: Understanding interventions preceding death in children with immunocompromised conditions is important to ensure a peaceful and dignified perideath experience. The aim of this study was to describe the number of interventions performed in the pediatric intensive care unit (PICU) within the 48 hours before death in this population. Methods: This was a single-center, retrospective cohort study of all children with an underlying oncologic, hematologic, or immunologic diagnosis admitted to the PICU for at least 72 hours between 2014 and 2021. Medical records were reviewed for interventions within 48 hours preceding death and for palliative care involvement. Interventions were defined as new or escalations in respiratory support, cardiopulmonary resuscitation (CPR), vascular access, drains, and radiographic studies. Associations were evaluated using simple logistic regression. Results: A total of 55 patients were included in this study. The predominant PICU admission diagnoses were respiratory (51%), followed by shock (25%), and neurologic diagnoses (9%). These predominant diagnoses were similar perideath. At PICU admission, only 1 patient had a do-not-resuscitate (DNR) order. Forty-six percent had a DNR order 48 hours preceding death, and 91% had DNR orders in place at time of death. During the 48-hour period preceding death, 80% of children received at least one intervention. Radiographic studies were the most common, used in 78% of children, followed by respiratory (20%), vascular (16%), CPR (13%), and drain placement (7%). Palliative care was involved in 38% of cases and was associated with a decrease in the number of radiologic interventions (p = 0.028) and CPR (p = 0.026). Conclusions: Children in the PICU with underlying immunocompromised conditions frequently receive interventions within the 48-hour period preceding death. Palliative care involvement was associated with fewer radiographic studies and fewer occurrences of CPR. The impact of interventions on the dying experience warrants further investigation.
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Affiliation(s)
- Anna Kegel
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine and Riley Hospital for Children, Indianapolis, Indiana, USA
| | - Jason Espinoza
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine and Riley Hospital for Children, Indianapolis, Indiana, USA
| | - April Rahrig
- Division of Pediatric Hematology Oncology, Department of Pediatrics, Indiana University School of Medicine and Riley Hospital for Children, Indianapolis, Indiana, USA
| | - Tina Schade-Wills
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine and Riley Hospital for Children, Indianapolis, Indiana, USA
| | - Courtney M Rowan
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine and Riley Hospital for Children, Indianapolis, Indiana, USA
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Reid C, Laird B, Travers S, McNiff J, Young S, Maddicks J, Bentley A, Fenning S. Death from COVID-19: management of breathlessness: a retrospective multicentre study. BMJ Support Palliat Care 2024; 13:e786-e789. [PMID: 34711657 DOI: 10.1136/bmjspcare-2021-003150] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 10/11/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Breathlessness is the most significant symptom in those dying of COVID-19. Historically, though, it has often been palliated poorly at end of life. The aim of this work was to assess whether breathlessness in patients dying from COVID-19 was being managed appropriately. METHODS A multicentre, retrospective analysis of clinical data was undertaken. Patients who had died of COVID-19 across three acute hospitals over a 2-month period were included. Those already prescribed background opioids and those who died in intensive care were excluded. Data were collected from clinical notes, where available. RESULTS 71 patients from 18 wards (3 hospitals) were included. The median total dose of opioid and midazolam given in the last 24 hours of life (continuous subcutaneous infusion ± 'as required' medication) was 33 mg (14-55) and 15 mg (6-26), respectively. 37 patients (52%) were prescribed continuous subcutaneous infusions. There were 426 recorded respiratory rates of at least 25 breaths per minute, for which an opioid or benzodiazepine was given in 113 (27%) of instances. CONCLUSIONS Less than a third of episodes of breathlessness, as measured by respiratory rate, were palliated with anticipatory medicines. Specific palliative care guidelines for COVID-19 are necessary but may not always be followed.
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Affiliation(s)
- Colette Reid
- NHS Lothian Hospital Palliative Care Service, NHS Lothian, Edinburgh, UK
| | - Barry Laird
- NHS Lothian Hospital Palliative Care Service, NHS Lothian, Edinburgh, UK
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
- St Columba's Hospice Care, Edinburgh, UK
| | - Susan Travers
- NHS Lothian Hospital Palliative Care Service, NHS Lothian, Edinburgh, UK
| | - Jessica McNiff
- NHS Lothian Hospital Palliative Care Service, NHS Lothian, Edinburgh, UK
| | - Suzanne Young
- NHS Lothian Hospital Palliative Care Service, NHS Lothian, Edinburgh, UK
| | - Jack Maddicks
- NHS Lothian Hospital Palliative Care Service, NHS Lothian, Edinburgh, UK
| | - Angela Bentley
- NHS Lothian Hospital Palliative Care Service, NHS Lothian, Edinburgh, UK
| | - Stephen Fenning
- NHS Lothian Hospital Palliative Care Service, NHS Lothian, Edinburgh, UK
- NHS Fife Specialist Palliative Care Service, NHS Fife, Kirkcaldy, UK
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Hjorth NE, Hufthammer KO, Sigurdardottir K, Tripodoro VA, Goldraij G, Kvikstad A, Haugen DF. Hospital care for the dying patient with cancer: does an advance care planning invitation influence bereaved relatives' experiences? A two country survey. BMJ Support Palliat Care 2024; 13:e1038-e1047. [PMID: 34848559 PMCID: PMC10850660 DOI: 10.1136/bmjspcare-2021-003116] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 10/21/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Advance care planning (ACP) is not systematically performed in Argentina or Norway. We used the post-bereavement survey of the ERANet-LAC International Care Of the Dying Evaluation (CODE) project (2017-2020) to examine the proportion of relatives who were offered an ACP conversation, the proportion of those not offered it who would have wanted it and whether the outcomes differed between those offered a conversation and those not. METHODS Relatives after cancer deaths in hospitals answered the CODE questionnaire 6-8 weeks post bereavement, by post (Norway) or interview (Argentina). Two additional questions asked if the relative and patient had been invited to a conversation about wishes for the patient's remaining lifetime, and, if not invited, whether they would have wanted such a conversation. The data were analysed using mixed-effects ordinal regression models. RESULTS 276 participants (Argentina 98 and Norway 178) responded (56% spouses, 31% children, 68% women, age 18-80+). Fifty-six per cent had been invited, and they had significantly more positive perceptions about care and support than those not invited. Sixty-eight per cent of the participants not invited would have wanted an invitation, and they had less favourable perceptions about the care, especially concerning emotional and spiritual support. CONCLUSIONS Relatives who had been invited to a conversation about wishes for the patient's remaining lifetime had more positive perceptions about patient care and support for the relatives in the patient's final days of life. A majority of the relatives who had not been invited to an ACP conversation would have wanted it.
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Affiliation(s)
- Nina Elisabeth Hjorth
- Faculty of Medicine, Department of Clinical Medicine K1, University of Bergen, Bergen, Norway
- Specialist Palliative Care Team, Department of Anaesthesia and Surgical Services, Haukeland University Hospital, Bergen, Norway
| | | | - Katrin Sigurdardottir
- Specialist Palliative Care Team, Department of Anaesthesia and Surgical Services, Haukeland University Hospital, Bergen, Norway
- Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway
| | - Vilma Adriana Tripodoro
- Pallium Latinoamérica, Buenos Aires, Argentina
- Instituto de Investigaciones Medicas Alfredo Lanari, University of Buenos Aires, Buenos Aires, Argentina
| | - Gabriel Goldraij
- Internal Medicine/Palliative Care Program, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Anne Kvikstad
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Palliative Medicine Unit, Cancer Clinic, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Dagny Faksvåg Haugen
- Faculty of Medicine, Department of Clinical Medicine K1, University of Bergen, Bergen, Norway
- Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway
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Tan F, Li N, Wu Y, Zhang C. Palliative sedation determinants: systematic review and meta-analysis in palliative medicine. BMJ Support Palliat Care 2024; 13:e664-e675. [PMID: 37553203 PMCID: PMC10850834 DOI: 10.1136/spcare-2022-004085] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 07/25/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND The utilisation of palliative sedation is often favoured by patients approaching end of life due to the presence of multiple difficult-to-manage symptoms during the terminal stage. This study aimed to identify the determinants of the use of palliative sedation. METHODS To identify pertinent observational studies, a comprehensive search was performed in PubMed, Embase, Cochrane Library, and PsycINFO databases from their inception until March 2022. The methodological quality of the chosen prospective and retrospective cohort studies was assessed using the Newcastle Ottawa Scale, while the Agency for Healthcare Research and Quality was used to evaluate the methodological quality of the selected cross-sectional studies. For each potential determinant of interest, the collected data were synthesised and analysed, and in cases where data could not be combined, a narrative synthesis approach was adopted. RESULTS A total of 21 studies were analysed in this research, consisting of 4 prospective cohort studies, 7 retrospective cohort studies, and 10 cross-sectional studies. The findings indicated that several determinants were significantly associated with palliative sedation. These determinants included younger age, male gender, presence of tumours, dyspnoea, pain, delirium, making advanced medical end-of-life decisions, and dying in a hospital setting. CONCLUSIONS The findings of our review could help physicians identify patients who may need palliative sedation in advance and implement targeted interventions to reverse refractory symptoms, develop personalized palliative sedation programs, and ultimately improve the quality of palliative care services. TRIAL REGISTRATION PROSPERO registration number CRD42022324720.
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Affiliation(s)
- Fang Tan
- Department of Palliative Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
- Medicine Research Center, West China-PUMC C.C. Chen Institute of Health, West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Na Li
- Department of Palliative Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
- Medicine Research Center, West China-PUMC C.C. Chen Institute of Health, West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yan Wu
- Department of Palliative Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
- Medicine Research Center, West China-PUMC C.C. Chen Institute of Health, West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chuan Zhang
- Department of Palliative Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
- Medicine Research Center, West China-PUMC C.C. Chen Institute of Health, West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
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Thomas B, Barclay G, Barbato M. Dexmedetomidine for end of life sedation: retrospective cohort comparison study. BMJ Support Palliat Care 2024; 13:e898-e901. [PMID: 37402543 DOI: 10.1136/spcare-2023-004252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 06/12/2023] [Indexed: 07/06/2023]
Abstract
OBJECTIVES Infused sedatives are often utilised to alleviate distress at the end of life. Which sedative best achieves this is unknown. This study compares breakthrough medication requirements of patients treated with the novel agent dexmedetomidine compared with patients treated with standard-care sedatives. METHODS A retrospective cross-cohort comparison. Two studies of patients at the end of life under sedation at the same palliative care unit, one utilising novel sedatives, and the other standard care were compared. Breakthrough medication requirements were compared using paired t-tests, including opioids, benzodiazepines and anticholinergics. Changes in background infusions were compared. RESULTS The dexmedetomidine cohort required less breakthrough interventions per day compared with the standard care group, the reduction was significant (2.2 vs 3.9, p=0.003). There was a significant difference in benzodiazepine requirements, with the dexmedetomidine cohort requiring fewer doses per day than the standard care cohort (1.1 vs 0.6, p=0.03). Anticholinergics were more commonly utilised in the standard care cohort but there was no significant difference (p=0.22). Opioid requirements were similar across cohorts with comparable rates of breakthrough use and infusion increases. CONCLUSIONS This study demonstrates a reduction in breakthrough medication requirements, particularly benzodiazepines, for patients sedated with dexmedetomidine at end of life.
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Affiliation(s)
- Benjamin Thomas
- Palliative Medicine, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
- Graduate School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Gregory Barclay
- Palliative Medicine, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
- Graduate School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Michael Barbato
- Palliative Care Unit, Port Kembla Hospital, Port Kembla, New South Wales, Australia
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Ota H, Ueki Y, Yamazaki K, Shodo R, Takahashi T, Yokoyama Y, Horii A. Head and neck cancer fungating wounds: a novel odour transferrer. BMJ Support Palliat Care 2024; 13:e833-e835. [PMID: 36028291 DOI: 10.1136/spcare-2022-003824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 08/12/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The management for malodour of malignant fungating wounds (MFWs) in head and neck cancer (HNC) is unestablished. We evaluated the effects of a novel odour transferrer on malodour generated by MFWs in patients with HNC. METHODS A spray-type odour transferrer approved by the Japanese government for safe use in humans produces a good scent by binding to bad odour. The odour of MFWs in 13 patients with HNC was scored by 37 medical staff and the patients' families using an odour scale ranging from 0 to 4 before and 1 week after application of the odour transferrer. RESULTS The odour score marked by all investigators (n=37), nurses (n=21) and doctors (n=11) decreased significantly (p<0.01). The odour score decreased by more than 2 points for 73% of all investigators after odour transferrer application. CONCLUSION This novel odour transferrer functions as an effective deodorant for MFWs in patients with HNC. It can be used by non-medical staff and may benefit patients with bad odours arising from MFWs as well as their families and medical staff.
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Affiliation(s)
- Hisayuki Ota
- Otolaryngology Head and Neck Surgery, Niigata University Faculty of Medicine Graduate School of Medical and Dental Science, Niigata, Japan
| | - Yushi Ueki
- Otolaryngology Head and Neck Surgery, Niigata University Faculty of Medicine Graduate School of Medical and Dental Science, Niigata, Japan
| | - Keisuke Yamazaki
- Otolaryngology Head and Neck Surgery, Niigata University Faculty of Medicine Graduate School of Medical and Dental Science, Niigata, Japan
| | - Ryusuke Shodo
- Otolaryngology Head and Neck Surgery, Niigata University Faculty of Medicine Graduate School of Medical and Dental Science, Niigata, Japan
| | - Takeshi Takahashi
- Otolaryngology Head and Neck Surgery, Niigata University Faculty of Medicine Graduate School of Medical and Dental Science, Niigata, Japan
| | - Yusuke Yokoyama
- Otolaryngology Head and Neck Surgery, Niigata University Faculty of Medicine Graduate School of Medical and Dental Science, Niigata, Japan
| | - Arata Horii
- Otolaryngology Head and Neck Surgery, Niigata University Faculty of Medicine Graduate School of Medical and Dental Science, Niigata, Japan
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Okuda Y, Kuriyama T, Kawamata T. Efficacy of metyrapone for symptoms of adrenocortical carcinoma. BMJ Support Palliat Care 2024; 13:e971-e973. [PMID: 37130722 DOI: 10.1136/spcare-2023-004233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/20/2023] [Indexed: 05/04/2023]
Abstract
Elevated cortisol by adrenocortical carcinoma leads to a variety of symptoms. We report on the efficacy of metyrapone in treatment of a variety of distressing symptoms caused by elevated cortisol in a patient who refused advanced treatment for adrenocortical carcinoma.
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Affiliation(s)
- Yuka Okuda
- Department of Anesthesiology, Wakayama Medical University, Wakayama, Japan
| | - Toshiyuki Kuriyama
- Department of Anesthesiology, Wakayama Medical University, Wakayama, Japan
| | - Tomoyuki Kawamata
- Department of Anesthesiology, Wakayama Medical University, Wakayama, Japan
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Dewhurst F, Hanratty B, Frew K, Paes P, Walker R, Barnes C, Maddock H, Elverson J, Byrne-Davis L. Palliative medicine trainees be should learn about frailty: meta-synthesis and Delphi study to establish curriculum content. BMJ Support Palliat Care 2024; 13:e1008-e1018. [PMID: 34815248 DOI: 10.1136/bmjspcare-2021-003013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 10/02/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Frailty is common and highly associated with morbidity and mortality, a fact that has been highlighted by COVID-19. Understanding how to provide palliative care for frail individuals is an international priority, despite receiving limited mention in Palliative Medicine curricula or examinations worldwide. This study aimed to synthesise evidence and establish expert consensus on what should be included in a Palliative-Medicine Specialist Training Curriculum for frailty. METHODS Literature Meta-synthesis conducted by palliative medicine, frailty and education experts produced a draft curriculum with Bologna based Learning-Outcomes. A Delphi study asked experts to rate the importance of Learning-Outcomes for specialist-training completion and propose additional Learning-Outcomes. This process was repeated until 70% consensus was achieved for over 90% of Learning-Outcomes. Experts divided Learning-Outcomes into specific (for inclusion in a frailty subsection) or generic (applicable to other palliative conditions). The Delphi panel was Subject Matter Experts: Palliative-Medicine Consultants (n=14) and Trainees (n=10), representing hospital, community, hospice and care home services and including committee members of key national training organisations. A final reviewing panel of Geriatric Medicine Specialists including experts in research methodology, national training requirements and frailty were selected. RESULTS The meta-synthesis produced 114 Learning-Outcomes. The Delphi Study and Review by Geriatric Medicine experts resulted in 46 essential and 33 desirable Learning-Outcomes. CONCLUSIONS This frailty curriculum is applicable internationally and highlights the complex and unique palliative needs of frail patients. Future research is required to inform implementation, educational delivery and service provision.
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Affiliation(s)
- Felicity Dewhurst
- Population Health Sciences, Newcastle University, Newcastle upon Tyne, UK
- St Oswalds Hospice, Newcastle upon Tyne, UK
| | - Barbara Hanratty
- Population Health Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Katherine Frew
- Palliative Medicine, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Paul Paes
- Palliative Medicine, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
- School of Medical Education, Newcastle University, Newcastle upon Tyne, UK
| | - Richard Walker
- Population Health Sciences, Newcastle University, Newcastle upon Tyne, UK
- Geriatric Medicine, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Catherine Barnes
- Geriatric Medicine, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
| | - Helena Maddock
- Geriatic Medicine, Gateshead Health NHS Foundation Trust, Gateshead, UK
| | | | - Lucie Byrne-Davis
- Division of Medical Education, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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Velilla Echeverri DC, Gómez Díaz M, Beltrán Pachón P, Lasso Valenzuela D, Poveda Carreño S, Erazo-Muñoz M. Lidocaine infusion for malignant visceral pain: case report. BMJ Support Palliat Care 2024; 13:e974-e976. [PMID: 37400161 PMCID: PMC10850713 DOI: 10.1136/spcare-2023-004350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 05/25/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Visceral pain accounts for nearly 28% of cancer-related pain, and its effective management poses significant challenges. The diverse pathways of neurotransmission, neurotransmitters, channels, and receptors suggest the need for individualized analgesic therapy. Our objective is to explore a therapeutic alternative for managing malignant visceral pain in advanced cancer. CASES In this report, we present two patients with malignant bowel obstruction and severe visceral pain, despite receiving opioid treatment, necessitating an alternative approach. Surgical interventions were considered but promptly ruled out. Paracentesis was performed as necessary. Pain management was initiated using a combination of opioids and co-analgesics. However, both patients required opioid dose escalation without achieving adequate pain control or tolerating the associated side effects. Consequently, a lidocaine infusion was administered to alleviate pain. OUTCOME Following 24-48 hours of lidocaine infusion, both patients achieved satisfactory symptom control, enabling a reduction in opioid doses and improvement in intestinal transit. No side effects were reported during the treatment. DISCUSSION Lidocaine infusions may be beneficial for pain management in patients with malignant bowel obstruction and visceral pain. The extent of pain control achieved in comparison to other therapeutics remains challenging to ascertain. We posit that lidocaine infusions, with their potential impact on visceral hypersensitivity, can enhance pain control and facilitate the recovery of bowel transit. Further studies are warranted to validate these findings.
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Shinada K, Kohno T, Fukuda K, Higashitani M, Kawamatsu N, Kitai T, Shibata T, Takei M, Nochioka K, Nakazawa G, Shiomi H, Miyashita M, Mizuno A. Depression and complicated grief in bereaved caregivers in cardiovascular diseases: prevalence and determinants. BMJ Support Palliat Care 2024; 13:e990-e1000. [PMID: 34686525 DOI: 10.1136/bmjspcare-2021-002998] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 09/28/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Despite the recommendation that patients with cardiovascular disease (CVD) receive bereavement care, few studies have examined the psychological disturbances in bereaved caregivers. We examined the prevalence and determinants of depression and complicated grief among bereaved caregivers of patients with CVD. METHODS We conducted a cross-sectional survey using a self-administered questionnaire for bereaved caregivers of patients with CVD who had died in the cardiology departments of nine Japanese tertiary care centres. We assessed caregiver depression and grief using the Patient Health Questionnaire-9 (PHQ-9) and Brief Grief Questionnaire (BGQ), respectively. The questionnaire also covered caregivers' perspectives toward end-of-life care and the quality of the deceased patient's death. RESULTS A total of 269 bereaved caregivers (mean age: 66 (57-73) years; 37.5% male) of patients with CVD were enrolled. Overall, 13.4% of the bereaved caregivers had depression (PHQ-9 ≥10) and 14.1% had complicated grief (BGQ ≥8). Depression and complicated grief's determinants were similar (ie, spousal relationship, unpreparedness for the death, financial and decision-making burden and poor communication among medical staff). Patients and caregivers' positive attitudes toward life-prolonging treatment were associated with complicated grief. Notably, in caregivers with complicated grief, there was less discussion with physicians about end-of-life care. Caregivers who felt that the patients did not receive sufficient treatment suffered more frequently from depression and complicated grief. CONCLUSIONS Approximately 15% of bereaved caregivers of patients with CVD suffered from depression and complicated grief. Cardiologists should pay particular attention to caregivers with high-risk factors to identify those likely to develop depression or complicated grief.
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Affiliation(s)
- Keitaro Shinada
- Division of Cardiology, School of Medicine, Keio University, Tokyo, Japan
| | - Takashi Kohno
- Division of Cardiology, School of Medicine, Keio University, Tokyo, Japan
- Department of Cardiovascular Medicine, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Keiichi Fukuda
- Division of Cardiology, School of Medicine, Keio University, Tokyo, Japan
| | - Michiaki Higashitani
- Department of Cardiology, Tokyo Medical University Ibaraki Medical Center, Ibaraki, Japan
| | - Naoto Kawamatsu
- Department of Cardiology, Mito Saiseikai General Hospital, Ibaraki, Japan
| | - Takeshi Kitai
- Departments of Cardiovascular Medicine and Clinical Research Support, Kobe City Medical Center General Hospital, Hyogo, Japan
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Tatsuhiro Shibata
- Division of Cardiovascular Medicine, Department Internal Medicine, Kurume University School of Medicine, Fukuoka, Japan
| | - Makoto Takei
- Department of Cardiology, Saiseikai Central Hospital, Tokyo, Japan
| | - Kotaro Nochioka
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Gaku Nakazawa
- Department of Cardiology, School of Medicine, Tokai University, Kanagawa, Japan
- Department of Cardiology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Hiroki Shiomi
- Department of Cardiology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Atsushi Mizuno
- Penn Medicine Nudge Unit, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Cardiovascular Medicine, St Luke's International University, Chuo-ku, Japan
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Bowers B, Antunes BCP, Etkind S, Hopkins SA, Winterburn I, Kuhn I, Pollock K, Barclay S. Anticipatory prescribing in community end-of-life care: systematic review and narrative synthesis of the evidence since 2017. BMJ Support Palliat Care 2024; 13:e612-e623. [PMID: 37236648 PMCID: PMC10850730 DOI: 10.1136/spcare-2022-004080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 04/15/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND The anticipatory prescribing of injectable medications is recommended practice in controlling distressing symptoms in the last days of life. A 2017 systematic review found practice and guidance was based on inadequate evidence. Since then, there has been considerable additional research, warranting a new review. AIM To review the evidence published since 2017 concerning anticipatory prescribing of injectable medications for adults at the end-of-life in the community, to inform practice and guidance. DESIGN Systematic review and narrative synthesis. METHODS Nine literature databases were searched from May 2017 to March 2022, alongside reference, citation and journal hand-searches. Gough's Weight of Evidence framework was used to appraise included studies. RESULTS Twenty-eight papers were included in the synthesis. Evidence published since 2017 shows that standardised prescribing of four medications for anticipated symptoms is commonplace in the UK; evidence of practices in other countries is limited. There is limited data on how often medications are administered in the community. Prescriptions are 'accepted' by family caregivers despite inadequate explanations and they generally appreciate having access to medications. Robust evidence of the clinical and cost-effectiveness of anticipatory prescribing remains absent. CONCLUSION The evidence underpinning anticipatory prescribing practice and policy remains based primarily on healthcare professionals' perceptions that the intervention is reassuring, provides effective, timely symptom relief in the community and prevents crisis hospital admissions. There is still inadequate evidence regarding optimal medications and dose ranges, and the effectiveness of these prescriptions. Patient and family caregiver experiences of anticipatory prescriptions warrant urgent investigation. PROSPERO REGISTRATION CRD42016052108.
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Affiliation(s)
- Ben Bowers
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
- Queen's Nursing Institute, London, UK
| | | | - Simon Etkind
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Sarah A Hopkins
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Isaac Winterburn
- Department of Psychiatry, Cambridge University, Cambridge, Cambridgeshire, UK
| | - Isla Kuhn
- School of Clinical Medicine, Cambridge University, Cambridge, Cambridgeshire, UK
| | - Kristian Pollock
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Stephen Barclay
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
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Lynøe N, Engström I, Juth N. Rawlsian reasoning about fairness at the end of life. BMJ Support Palliat Care 2024; 13:e1398-e1404. [PMID: 35768205 DOI: 10.1136/spcare-2021-003500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 06/13/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES The aim of this study was to discuss end-of-life care in the context of Rawls' and Daniels' philosophy of justice. The study is based on an empirical survey of Swedish physicians who were asked whether they would want the option of physician-assisted suicide (PAS) for themselves (hereafter called own preferences), what are their attitudes towards PAS in general and whether they were prepared to prescribe PAS drugs to eligible patients. The question is to what extent the physicians' answers are impartial and consistent in a Rawlsian sense. METHODS The underlying indicator was the physicians' own preferences. Kappa score inter-rater agreement was measured between that response and that same physician's general attitude towards allowing PAS and preparedness to prescribe PAS drugs. The coherence of provided comments and arguments were analysed using content analysis. RESULTS Palliative care physicians are the least willing to offer PAS, and surgeons and psychiatrist the most willing. There is a discrepancy between physicians' general attitudes about allowing PAS, their own wishes to be offered PAS at the end of life and the concrete action of prescribing PAS drugs. Arguments given for not prescribing PAS by those in favour of PAS are seemingly but not truly inconsistent. CONCLUSIONS Those supporting PAS provided impartial and consistent arguments for their stances in a Rawlsian sense, while those against PAS provided partial arguments. Two specialties, psychiatrists and palliative care physicians, were coherent in their reasoning about PAS for themselves and their willingness to prescribe the needed drugs.
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Affiliation(s)
- Niels Lynøe
- Stockholm Centre for Healthcare Ethics (CHE), Karolinska Institutet, Stockholm, Sweden
| | - Ingemar Engström
- Clinical Science/Psychiatry, Örebro universitet, Orebro, Örebro, Sweden
| | - Niklas Juth
- Stockholm Centre for Healthcare Ethics (CHE), Karolinska Institutet, Stockholm, Sweden
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46
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Roydhouse J, Connolly A, Daveson B, de Graaff B, Blanchard M, Currow DC. Palliative care symptoms and problems in a culturally and linguistically diverse population: large retrospective cohort study. BMJ Support Palliat Care 2024; 13:e1228-e1237. [PMID: 36720586 DOI: 10.1136/spcare-2022-004111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/09/2023] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Migrant Australians with cancer have higher unmet needs and poorer health-related quality of life. Less is known about their palliative care experience. We aimed to assess comparative symptom distress and problem severity for culturally and linguistically diverse Australians with cancer in palliative care. METHODS This was a retrospective, consecutive cohort study using data from the Palliative Care Outcomes Collaboration, which routinely collects standardised symptom assessments nationally at point-of-care. Adults with a cancer diagnosis who died 01/01/2016-31/12/2019 were included. The presence/absence of patient-reported symptom distress and clinician-rated problem severity were compared between people who preferred English and people who preferred another language using logistic regression models. We also compared people who preferred English and the four most common non-English languages in the dataset: Chinese, Greek, Italian and Slavic. RESULTS A total of 53 964 people with cancer died within the study period, allowing analysis of 104 064 assessments. People preferring non-English languages were less likely to report symptoms (pain: OR=0.89 (0.84 to 0.94); all other symptoms except fatigue OR<1 and CIs did not contain 1). Except for family/carer problems (OR=1.24 (1.12 to 1.31)), linguistically diverse people were less likely to report problems. Variation was seen between non-English language groups. CONCLUSIONS We did not find evidence of comparatively worse symptom distress or problem severity for nearly all scores for culturally and linguistically diverse Australians. Better symptom management or differential reporting may explain this. It is important to examine this further, including assessing differences within cultural and linguistic groups to ensure the delivery of high-quality palliative care.
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Affiliation(s)
- Jessica Roydhouse
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Alanna Connolly
- Palliative Care Outcomes Collaboration, Australian Health Services Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Barbara Daveson
- Palliative Care Outcomes Collaboration, Australian Health Services Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Barbara de Graaff
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Megan Blanchard
- Palliative Care Outcomes Collaboration, Australian Health Services Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - David C Currow
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
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van der Steen JT, Scheeres‐Feitsma TM, Schaafsma P. Commentary to: "Timely dying in dementia: Use patients' judgments and broaden the concept of suffering." Timely dying, suffering in dementia, and a role for family and professional caregivers in preventing it. Alzheimers Dement (Amst) 2024; 16:e12536. [PMID: 38496722 PMCID: PMC10941495 DOI: 10.1002/dad2.12536] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 01/14/2023] [Indexed: 03/19/2024]
Abstract
Broadening the concept of suffering in dementia to five types of suffering including suffering of family caregivers as proposed by Terman et al., may help raise awareness on a need to relieve suffering when living with dementia and adopt a holistic approach. However, as objective criteria in advance care plans for severe enough suffering to stop assisted feeding or other life-sustaining treatment in people with advanced dementia, these still need interpretation in the context of, for example, available treatment, and change in coping. New is the proposal to broaden severe enough suffering to suffering of family, including "bi-directional empathic suffering." We believe this creates new dilemmas regarding responsibility and may increase feelings of guilt. Quantifying suffering by adding up moderate suffering could further complicate matters. Therefore, we argue that a health care professional should guide the process and assume responsibility over current decisions to follow a person's previous wishes.
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Affiliation(s)
- Jenny T. van der Steen
- Department of Public Health and Primary CareLeiden University Medical CenterLeidenThe Netherlands
- Department of Primary and Community CareRadboud university medical centerNijmegenThe Netherlands
- Radboudumc Alzheimer CenterNijmegenThe Netherlands
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48
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Rodrigues AC, David F, Guedes R, Rocha C, Oliveira HM. Dying with end stage kidney disease: factors associated with place of death on a palliative care program. J Bras Nefrol 2024; 46:93-97. [PMID: 37870397 PMCID: PMC10962416 DOI: 10.1590/2175-8239-jbn-2023-0015en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 07/25/2023] [Indexed: 10/24/2023] Open
Abstract
INTRODUCTION End of life care of patients with end-stage kidney disease (ESKD) may be particularly challenging and requires the intervention of a specialized palliative care team (PCT). OBJECTIVE To characterize the population of ESKD patients referred to a PCT and evaluate the determinants of planned dying at home. METHODS We performed a retrospective observational cohort study of all patients with ESKD referred to our PCT between January 2014 and December 2021 (n = 60) and further characterized those with previously known ESKD regarding place of death (n = 53). RESULTS The majority of the patients were female and the median age was 84 years. Half of the patients were on conservative treatment, 43% were on chronic hemodialysis, and the remainder underwent hemodialysis on a trial basis and were subsequently suspended. Of those with previously known ESKD, 18% died at home and neither gender, age, cognition, performance status, comorbidities, CKD etiology, or treatment modality were associated with place of death. Anuria was significantly associated with dying at the hospital as was shorter time from dialysis suspension and death. Although not reaching statistical significance, we found a tendency towards a longer duration of palliative care follow-up in those dying at home. CONCLUSION Dying at home is possible in a palliative domiciliary program regardless of age, gender, etiology of CKD, major comorbidities, and treatment modality. Anuria and shorter survival from RRT withdrawal may be limiting factors for planned dying at home. A longer follow-up by palliative care may favor dying at home.
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Affiliation(s)
| | | | - Rita Guedes
- Hospital Pedro Hispano, Equipa de Cuidados Paliativos, Matosinhos,
Portugal
| | - Céu Rocha
- Hospital Pedro Hispano, Equipa de Cuidados Paliativos, Matosinhos,
Portugal
| | - Hugo M. Oliveira
- Hospital Pedro Hispano, Equipa de Cuidados Paliativos, Matosinhos,
Portugal
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49
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Lamfre LS, Hasdeu S, Coller MAG, Tripodoro VA. Economic impact of informal care of cancer patients at the end of life. Ann Palliat Med 2024; 13:73-85. [PMID: 38316399 DOI: 10.21037/apm-23-240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 12/05/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Economic analysis of the incorporation of palliative care (PC) programs allows for assessment of the potential financial impact of shifting activity from secondary care to primary, community and social care sectors. Only 14% of patients in need of PC in Argentina have access to PC services, similar to the world average, as estimated by World Health Organization (WHO). The economic impact of family care, which falls mainly on women, needs to be assessed at the public policy and research levels. We aimed to estimate and make visible the economic impact of unpaid care tasks developing a cost-effectiveness analytic model of a home-based PC program for cancer patients at the end of life from a social perspective (SP) in the province of Río Negro, Argentina. METHODS A Markov model was developed from a SP to assess the cost-effectiveness of palliative home care compared to the usual care (UC) of cancer patients. The model compares the provision of PC through a home-based program with the UC that patients receive at the end of life. The average cost per patient, percentage of home deaths, days at home in the last year of life and the economic impact of formal and informal care were estimated using the human capital approach for 2019. RESULTS palliative home care was cost-saving, leading to a 10.32% increase in home deaths, a decrease of 9 days of hospitalisation and an annual saving for society of USD 750 per patient. From a societal perspective, the largest cost-driver corresponds to informal care provided mainly by families, which accounted for 82% and 88% of the total daily cost of PC and UC strategy, respectively. CONCLUSIONS The incorporation of PC can improve the allocation of resources between the different levels of care. The visualisation of care tasks becomes particularly relevant when considering public policies and outcomes. Incorporating palliative home care strategies could alleviate the enormous costs faced by patients' families, especially women, in this stage of care.
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Affiliation(s)
- Laura S Lamfre
- University Center for Studies in Health, Economy and Well-being (CUESEB), National University of Comahue, Neuquén, Argentina
| | - Santiago Hasdeu
- University Center for Studies in Health, Economy and Well-being (CUESEB), National University of Comahue, Neuquén, Argentina; Provincial Committee for Biotechnologies, Ministry of Health of Neuquén, Neuquén, Argentina
| | - María A G Coller
- Cancer Control Program, Advanced Chronicity and Palliative Care, Ministry of Health of Rio Negro, Rio Negro, Argentina
| | - Vilma A Tripodoro
- Pallium Latin America Institute - Alfredo Lanari Medical Research Institute, University of Buenos Aires, Buenos Aires, Argentina; ATLANTES Global Observatory of Palliative Care, University of Navarre, Navarre, Spain
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50
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Chou PL, Lin PC, Lin CC, Lee HC, Huang YT. Trends and Changes in Intensive Care Use for Patients With Heart Failure in the Last Month of Life. Inquiry 2024; 61:469580241239143. [PMID: 38506439 PMCID: PMC10956157 DOI: 10.1177/00469580241239143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 02/22/2024] [Accepted: 02/26/2024] [Indexed: 03/21/2024]
Abstract
A good death is a human right. Unfortunately, patients with chronic heart failure (CHF) in the terminal stage still receive inappropriate life-sustaining treatment before death. There is limited understanding of the status of intensive care unit (ICU) admission, mechanical ventilation (MV), cardiopulmonary resuscitation (CPR), and even extracorporeal membrane oxygenation (ECMO) for patients with CHF before death, as well as their use of hospice-related services. This study investigated the trends and trend changes in intensive procedures and hospice-related services for patients with CHF in the last month of life. This population-based retrospective observational study included 25 375 patients with CHF from the National Health Insurance research database in Taiwan and collected information on their intensive treatments during the last month of life. We computed intensive treatment utilization rates and analyzed the trends and trend changes via joinpoint regression. The average percentage of patients with CHF admitted to ICUs was 53.27% (n = 13 516). A total of 327 (1.29%) patients with CHF received ECMO. The percentages of patients receiving MV (54.3%'41.5%) and CPR (41.5%'17%) decreased over time. Conversely, the percentage of ECMO use (0.52%'1.78%) increased. However, only 222 (0.87%) patients with CHF received hospice care in the last month of life between 2001 and 2013. The rates of ICU admission and life-sustaining treatment among patients with CHF in the month before death remain high, and hospice-related services remain inadequate. This study highlights the need for research and training in providing palliative and hospice care for patients with CHF.
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Affiliation(s)
- Pi-Ling Chou
- School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Pei-Chao Lin
- School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | | | - Hsiang-Chun Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan
| | - Yu-Tung Huang
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan; Department of Health Care Management, College of Management, Chang Gung University, Taoyuan, Taiwan
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