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Vinches M, Neven A, Fenwarth L, Terada M, Rossi G, Kelly S, Peron J, Thomaso M, Grønvold M, De Rojas T. Clinical research in cancer palliative care: a metaresearch analysis. BMJ Support Palliat Care 2020; 10:249-258. [PMID: 32209567 DOI: 10.1136/bmjspcare-2019-002086] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/30/2020] [Accepted: 02/10/2020] [Indexed: 01/26/2023]
Abstract
OBJECTIVE This metaresearch of the clinicaltrials.gov database aims to evaluate how clinical research on palliative care is conducted within the setting of advanced cancer. METHODS Clinicaltrials.gov was searched to identify registered studies recruiting patients with cancer, and investigating issues relevant to palliative care. The European Organisation for Research and Treatment of Cancer QLQ-C15-PAL (Quality of Life in palliative cancer care patients) questionnaire was taken into account to define the research domains of interest. Studies investigating cancer-directed therapy, management of cancer treatment-related adverse events and diagnostic tests were excluded. Publication status was crosschecked using PubMed. RESULTS Of 3950 identified studies, 514 were included. The most frequent reason for exclusion was cancer-directed therapy (2491). In 2007-2012, 161 studies were registered versus 245 in 2013-2018. Included studies were interventional (84%) or observational (16%). Most studies were monocentric (60%), sponsored by academia (79%), and conducted in North America (57%) or Europe (25%). Seventy-nine per cent of studies evaluated a heterogeneous population (>1 tumour type). Interventional studies most frequently investigated systemic drugs (34%), behavioural interventions (29%) and procedures for pain (24%). Pain, quality of life and physical function were the most frequently studied research domains (188, 95 and 52 studies, respectively). The most applied primary outcome measures were efficacy/symptom control (61%), quality of life (14%) and feasibility (12%). Only 16% of the closed studies had published results in PubMed. CONCLUSIONS Our study describes the heterogeneous landscape of studies conducted to address the issues of patients with advanced cancer in palliative care. Albeit the observed increase in the number of studies over the last decade, the generalisation of the results brought by the existing trials is limited due to methodological issues and lack of reporting. A greater effort is needed to improve clinical research that supports evidence-based palliative cancer care.
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Affiliation(s)
- Marie Vinches
- Medical Department, EORTC Headquarters, Brussels, Belgium .,Medical Oncology Department, Institut Régional du Cancer de Montpellier (ICM), Montpellier, France
| | - Anouk Neven
- Statistics Department, EORTC Headquarters, Brussels, Belgium
| | | | - Mitsumi Terada
- International Trials Management Section, Clinical Research Support Office, National Cancer Center Hospital, Chuo-ku, Japan
| | - Giovanna Rossi
- Medical Department, EORTC Headquarters, Brussels, Belgium
| | - Sarah Kelly
- Fellowship Program, SIOP Europe, Brussels, Belgium.,Data Management Department, EORTC Headquarters, Brussels, Belgium
| | - Julien Peron
- Medical Oncology Department, Cancer Institute of the "Hospices Civils" of Lyon, Lyon, France
| | - Muriel Thomaso
- Supportive Care Department, Institut Régional du Cancer de Montpellier (ICM), Montpellier, France
| | - Mogens Grønvold
- Department of Palliative Medicine, Bispebjerg Hospital, Copenhagen University Hospital, Kobenhavn, Denmark
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Williams BR, Bailey FA, Goode PS, Kvale EA, Slay LA, Bakitas MA, Burgio KL. "Online Training Is Great but Human Interaction Is Better": Training Preferences of VA Interdisciplinary Palliative Care Consult Teams. Am J Hosp Palliat Care 2020; 37:800-808. [PMID: 32122166 DOI: 10.1177/1049909120907599] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A growing body of research has examined modalities for delivering palliative care education; however, we know little about education and training preferences of VA interdisciplinary Palliative Care Consult Teams (PCCT). In the BEACON II study, we explored training preferences of PCCTs from 46 Veterans Affairs Medical Centers (VAMCs) participating in either a multisite webinar or a small group, in-person workshop. We interviewed participants by telephone seven to eight month post-training. In all, 75.9% preferred in-person education and training, including 78.9% of workshop participants and 73.1% of webinar participants. Respondents described in-person training as fostering learning through the following processes: (1) active engagement and focus, (2) interaction and networking, (3) meaning-making and relevance, and (4) reciprocity and commitment. Although it is not possible for Web-based palliative care education programs to replicate all aspects of the in-person learning experience, building experiential, interactive, meaningful, and reciprocal components into Web-based education may help shift preferences and make interdisciplinary team-based palliative care education accessible to a larger audience.
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Affiliation(s)
- Beverly Rosa Williams
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Birmingham, AL and Atlanta, GA, USA.,Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - F Amos Bailey
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Birmingham, AL and Atlanta, GA, USA.,Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Medicine, Denver Health Medical Center, University of Colorado Denver, Denver, CO, USA
| | - Patricia S Goode
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Birmingham, AL and Atlanta, GA, USA.,Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Elizabeth A Kvale
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Birmingham, AL and Atlanta, GA, USA.,Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Medicine, University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Laurie A Slay
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Birmingham, AL and Atlanta, GA, USA.,Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Marie A Bakitas
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Birmingham, AL and Atlanta, GA, USA.,Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kathryn L Burgio
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Birmingham, AL and Atlanta, GA, USA.,Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Santivasi WL, Partain DK, Whitford KJ. The role of geriatric palliative care in hospitalized older adults. Hosp Pract (1995) 2020; 48:37-47. [PMID: 31825689 DOI: 10.1080/21548331.2019.1703707] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 12/10/2019] [Indexed: 06/10/2023]
Abstract
Take-Away Points:1. Geriatric palliative care requires integrating the disciplines of hospital medicine and palliative care in pursuit of delivering comprehensive, whole-person care to aging patients with serious illnesses.2. Older adults have unique palliative care needs compared to the general population, different prevalence and intensity of symptoms, more frequent neuropsychiatric challenges, increased social needs, distinct spiritual, religious, and cultural considerations, and complex medicolegal and ethical issues.3. Hospital-based palliative care interdisciplinary teams can take many forms and provide high-quality, goal-concordant care to older adults and their families.
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Affiliation(s)
- Wil L Santivasi
- Center for Palliative Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Daniel K Partain
- Center for Palliative Medicine & Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kevin J Whitford
- Center for Palliative Medicine & Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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Ryan S, Wong J, Chow R, Zimmermann C. Evolving Definitions of Palliative Care: Upstream Migration or Confusion? Curr Treat Options Oncol 2020; 21:20. [DOI: 10.1007/s11864-020-0716-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Abstract
Palliative care has evolved over the past five decades as an interprofessional specialty to improve quality of life and quality of care for patients with cancer and their families. Existing evidence supports that timely involvement of specialist palliative care teams can enhance the care delivered by oncology teams. This review provides a state-of-the-science synopsis of the literature that supports each of the five clinical models of specialist palliative care delivery, including outpatient clinics, inpatient consultation teams, acute palliative care units, community-based palliative care, and hospice care. The roles of embedded clinics, nurse-led models, telehealth interventions, and primary palliative care also will be discussed. Outpatient clinics represent the key point of entry for timely access to palliative care. In this setting, patient care can be enhanced longitudinally through impeccable symptom management, monitoring, education, and advance care planning. Inpatient consultation teams provide expert symptom management and facilitate discharge planning for acutely symptomatic hospitalized patients. Patients with the highest level of distress and complexity may benefit from an admission to acute palliative care units. In contrast, community-based palliative care and hospice care are more appropriate for patients with a poor performance status and low to moderate symptom burden. Each of these five models of specialist palliative care serve a different patient population along the disease continuum and complement one another to provide comprehensive supportive care. Additional research is needed to define the standards for palliative care interventions and to refine the models to further improve access to quality palliative care.
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Affiliation(s)
- David Hui
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Eduardo Bruera
- University of Texas MD Anderson Cancer Center, Houston, TX
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Song N, Choi JY. Comparison of the Characteristics Among Deceased Do-Not-Attempt-Resuscitation (DNAR) Cancer Patients in Hospice and Oncology Wards. ASIAN ONCOLOGY NURSING 2020. [DOI: 10.5388/aon.2020.20.1.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Nan Song
- Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Ja Yun Choi
- Department of Nursing, Chonnam National University, Gwangju, Korea
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Osman H, Shrestha S, Temin S, Ali ZV, Corvera RA, Ddungu HD, De Lima L, Del Pilar Estevez-Diz M, Ferris FD, Gafer N, Gupta HK, Horton S, Jacob G, Jia R, Lu FL, Mosoiu D, Puchalski C, Seigel C, Soyannwo O, Cleary JF. Palliative Care in the Global Setting: ASCO Resource-Stratified Practice Guideline. J Glob Oncol 2019; 4:1-24. [PMID: 30085844 PMCID: PMC6223509 DOI: 10.1200/jgo.18.00026] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Purpose The purpose of this new resource-stratified guideline is to provide expert guidance to clinicians and policymakers on implementing palliative care of patients with cancer and their caregivers in resource-constrained settings and is intended to complement the Integration of Palliative Care Into Standard Oncology Care: American Society of Clinical Oncology Clinical Practice Guideline Update of 2016. Methods ASCO convened a multidisciplinary, multinational panel of experts in medical oncology, family medicine, radiation oncology, hematology/oncology, palliative and/or hospice care, pain and/or symptom management, patient advocacy, public health, and health economics. Guideline development involved a systematic literature review, a modified ADAPTE process, and a formal consensus-based process with the Expert Panel and additional experts (consensus ratings group). Results The systematic review included 48 full-text publications regarding palliative care in resource-constrained settings, along with cost-effectiveness analyses; the evidence for many clinical questions was limited. These provided indirect evidence to inform the formal consensus process, which resulted in agreement of ≥ 75% (by consensus ratings group including Expert Panel). Recommendations The recommendations help define the models of care, staffing requirements, and roles and training needs of team members in a variety of resource settings for palliative care. Recommendations also outline the standards for provision of psychosocial support, spiritual care, and opioid analgesics, which can be particularly challenging and often overlooked in resource-constrained settings. Additional information is available at www.asco.org/resource-stratified-guidelines. It is the view of ASCO that health care providers and health care system decision makers should be guided by the recommendations for the highest stratum of resources available. The guideline is intended to complement but not replace local guidelines.
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Affiliation(s)
- Hibah Osman
- Hibah Osman, Balsam-Lebanese Center for Palliative Care, American University of Beirut Medical Center, Beirut, Lebanon; Sudip Shrestha, Nepal Cancer Hospital and Research Center, Lalitpur Submetropolis, Nepal; Sarah Temin, ASCO, Alexandria, VA; Zipporah V. Ali, Kenya Hospices and Palliative Care Association, Nairobi, Kenya; Rumalie A. Corvera, Asian Hospital and Medical Centre, Muntinlupa, Philippines; Henry D. Ddungu, Uganda Cancer Institute and Hutchinson Center Research Institute, Kampala, Uganda; Liliana De Lima, International Association for Hospice and Palliative Care, Houston, TX; Maria Del Pilar Estevez-Diz, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil; Frank D. Ferris, OhioHealth, Columbus, OH; Nahla Gafer, Radiation and Isotope Center, Khartoum, Sudan; Harmala K. Gupta, CanSupport, New Delhi, India; Susan Horton, University of Waterloo, Waterloo, Ontario, Canada; Graciela Jacob, Instituto Nacional de Cancerología, Buenos Aires, Argentina; Ruinuo Jia, Henan University of Science and Technology, Luoyang, People's Republic of China; Frank L. Lu, National Taiwan University Children's Hospital, Taipei, Republic of China; Daniela Mosoiu, Transylvania University Brasov, Brasov, Romania; Christina Puchalski, George Washington University, Washington, DC; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; Olaitan Soyannwo, University College Hospital Ibadan, Ibadan, Nigeria; and James F. Cleary, University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Sudip Shrestha
- Hibah Osman, Balsam-Lebanese Center for Palliative Care, American University of Beirut Medical Center, Beirut, Lebanon; Sudip Shrestha, Nepal Cancer Hospital and Research Center, Lalitpur Submetropolis, Nepal; Sarah Temin, ASCO, Alexandria, VA; Zipporah V. Ali, Kenya Hospices and Palliative Care Association, Nairobi, Kenya; Rumalie A. Corvera, Asian Hospital and Medical Centre, Muntinlupa, Philippines; Henry D. Ddungu, Uganda Cancer Institute and Hutchinson Center Research Institute, Kampala, Uganda; Liliana De Lima, International Association for Hospice and Palliative Care, Houston, TX; Maria Del Pilar Estevez-Diz, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil; Frank D. Ferris, OhioHealth, Columbus, OH; Nahla Gafer, Radiation and Isotope Center, Khartoum, Sudan; Harmala K. Gupta, CanSupport, New Delhi, India; Susan Horton, University of Waterloo, Waterloo, Ontario, Canada; Graciela Jacob, Instituto Nacional de Cancerología, Buenos Aires, Argentina; Ruinuo Jia, Henan University of Science and Technology, Luoyang, People's Republic of China; Frank L. Lu, National Taiwan University Children's Hospital, Taipei, Republic of China; Daniela Mosoiu, Transylvania University Brasov, Brasov, Romania; Christina Puchalski, George Washington University, Washington, DC; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; Olaitan Soyannwo, University College Hospital Ibadan, Ibadan, Nigeria; and James F. Cleary, University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Sarah Temin
- Hibah Osman, Balsam-Lebanese Center for Palliative Care, American University of Beirut Medical Center, Beirut, Lebanon; Sudip Shrestha, Nepal Cancer Hospital and Research Center, Lalitpur Submetropolis, Nepal; Sarah Temin, ASCO, Alexandria, VA; Zipporah V. Ali, Kenya Hospices and Palliative Care Association, Nairobi, Kenya; Rumalie A. Corvera, Asian Hospital and Medical Centre, Muntinlupa, Philippines; Henry D. Ddungu, Uganda Cancer Institute and Hutchinson Center Research Institute, Kampala, Uganda; Liliana De Lima, International Association for Hospice and Palliative Care, Houston, TX; Maria Del Pilar Estevez-Diz, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil; Frank D. Ferris, OhioHealth, Columbus, OH; Nahla Gafer, Radiation and Isotope Center, Khartoum, Sudan; Harmala K. Gupta, CanSupport, New Delhi, India; Susan Horton, University of Waterloo, Waterloo, Ontario, Canada; Graciela Jacob, Instituto Nacional de Cancerología, Buenos Aires, Argentina; Ruinuo Jia, Henan University of Science and Technology, Luoyang, People's Republic of China; Frank L. Lu, National Taiwan University Children's Hospital, Taipei, Republic of China; Daniela Mosoiu, Transylvania University Brasov, Brasov, Romania; Christina Puchalski, George Washington University, Washington, DC; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; Olaitan Soyannwo, University College Hospital Ibadan, Ibadan, Nigeria; and James F. Cleary, University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Zipporah V Ali
- Hibah Osman, Balsam-Lebanese Center for Palliative Care, American University of Beirut Medical Center, Beirut, Lebanon; Sudip Shrestha, Nepal Cancer Hospital and Research Center, Lalitpur Submetropolis, Nepal; Sarah Temin, ASCO, Alexandria, VA; Zipporah V. Ali, Kenya Hospices and Palliative Care Association, Nairobi, Kenya; Rumalie A. Corvera, Asian Hospital and Medical Centre, Muntinlupa, Philippines; Henry D. Ddungu, Uganda Cancer Institute and Hutchinson Center Research Institute, Kampala, Uganda; Liliana De Lima, International Association for Hospice and Palliative Care, Houston, TX; Maria Del Pilar Estevez-Diz, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil; Frank D. Ferris, OhioHealth, Columbus, OH; Nahla Gafer, Radiation and Isotope Center, Khartoum, Sudan; Harmala K. Gupta, CanSupport, New Delhi, India; Susan Horton, University of Waterloo, Waterloo, Ontario, Canada; Graciela Jacob, Instituto Nacional de Cancerología, Buenos Aires, Argentina; Ruinuo Jia, Henan University of Science and Technology, Luoyang, People's Republic of China; Frank L. Lu, National Taiwan University Children's Hospital, Taipei, Republic of China; Daniela Mosoiu, Transylvania University Brasov, Brasov, Romania; Christina Puchalski, George Washington University, Washington, DC; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; Olaitan Soyannwo, University College Hospital Ibadan, Ibadan, Nigeria; and James F. Cleary, University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Rumalie A Corvera
- Hibah Osman, Balsam-Lebanese Center for Palliative Care, American University of Beirut Medical Center, Beirut, Lebanon; Sudip Shrestha, Nepal Cancer Hospital and Research Center, Lalitpur Submetropolis, Nepal; Sarah Temin, ASCO, Alexandria, VA; Zipporah V. Ali, Kenya Hospices and Palliative Care Association, Nairobi, Kenya; Rumalie A. Corvera, Asian Hospital and Medical Centre, Muntinlupa, Philippines; Henry D. Ddungu, Uganda Cancer Institute and Hutchinson Center Research Institute, Kampala, Uganda; Liliana De Lima, International Association for Hospice and Palliative Care, Houston, TX; Maria Del Pilar Estevez-Diz, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil; Frank D. Ferris, OhioHealth, Columbus, OH; Nahla Gafer, Radiation and Isotope Center, Khartoum, Sudan; Harmala K. Gupta, CanSupport, New Delhi, India; Susan Horton, University of Waterloo, Waterloo, Ontario, Canada; Graciela Jacob, Instituto Nacional de Cancerología, Buenos Aires, Argentina; Ruinuo Jia, Henan University of Science and Technology, Luoyang, People's Republic of China; Frank L. Lu, National Taiwan University Children's Hospital, Taipei, Republic of China; Daniela Mosoiu, Transylvania University Brasov, Brasov, Romania; Christina Puchalski, George Washington University, Washington, DC; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; Olaitan Soyannwo, University College Hospital Ibadan, Ibadan, Nigeria; and James F. Cleary, University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Henry D Ddungu
- Hibah Osman, Balsam-Lebanese Center for Palliative Care, American University of Beirut Medical Center, Beirut, Lebanon; Sudip Shrestha, Nepal Cancer Hospital and Research Center, Lalitpur Submetropolis, Nepal; Sarah Temin, ASCO, Alexandria, VA; Zipporah V. Ali, Kenya Hospices and Palliative Care Association, Nairobi, Kenya; Rumalie A. Corvera, Asian Hospital and Medical Centre, Muntinlupa, Philippines; Henry D. Ddungu, Uganda Cancer Institute and Hutchinson Center Research Institute, Kampala, Uganda; Liliana De Lima, International Association for Hospice and Palliative Care, Houston, TX; Maria Del Pilar Estevez-Diz, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil; Frank D. Ferris, OhioHealth, Columbus, OH; Nahla Gafer, Radiation and Isotope Center, Khartoum, Sudan; Harmala K. Gupta, CanSupport, New Delhi, India; Susan Horton, University of Waterloo, Waterloo, Ontario, Canada; Graciela Jacob, Instituto Nacional de Cancerología, Buenos Aires, Argentina; Ruinuo Jia, Henan University of Science and Technology, Luoyang, People's Republic of China; Frank L. Lu, National Taiwan University Children's Hospital, Taipei, Republic of China; Daniela Mosoiu, Transylvania University Brasov, Brasov, Romania; Christina Puchalski, George Washington University, Washington, DC; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; Olaitan Soyannwo, University College Hospital Ibadan, Ibadan, Nigeria; and James F. Cleary, University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Liliana De Lima
- Hibah Osman, Balsam-Lebanese Center for Palliative Care, American University of Beirut Medical Center, Beirut, Lebanon; Sudip Shrestha, Nepal Cancer Hospital and Research Center, Lalitpur Submetropolis, Nepal; Sarah Temin, ASCO, Alexandria, VA; Zipporah V. Ali, Kenya Hospices and Palliative Care Association, Nairobi, Kenya; Rumalie A. Corvera, Asian Hospital and Medical Centre, Muntinlupa, Philippines; Henry D. Ddungu, Uganda Cancer Institute and Hutchinson Center Research Institute, Kampala, Uganda; Liliana De Lima, International Association for Hospice and Palliative Care, Houston, TX; Maria Del Pilar Estevez-Diz, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil; Frank D. Ferris, OhioHealth, Columbus, OH; Nahla Gafer, Radiation and Isotope Center, Khartoum, Sudan; Harmala K. Gupta, CanSupport, New Delhi, India; Susan Horton, University of Waterloo, Waterloo, Ontario, Canada; Graciela Jacob, Instituto Nacional de Cancerología, Buenos Aires, Argentina; Ruinuo Jia, Henan University of Science and Technology, Luoyang, People's Republic of China; Frank L. Lu, National Taiwan University Children's Hospital, Taipei, Republic of China; Daniela Mosoiu, Transylvania University Brasov, Brasov, Romania; Christina Puchalski, George Washington University, Washington, DC; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; Olaitan Soyannwo, University College Hospital Ibadan, Ibadan, Nigeria; and James F. Cleary, University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Maria Del Pilar Estevez-Diz
- Hibah Osman, Balsam-Lebanese Center for Palliative Care, American University of Beirut Medical Center, Beirut, Lebanon; Sudip Shrestha, Nepal Cancer Hospital and Research Center, Lalitpur Submetropolis, Nepal; Sarah Temin, ASCO, Alexandria, VA; Zipporah V. Ali, Kenya Hospices and Palliative Care Association, Nairobi, Kenya; Rumalie A. Corvera, Asian Hospital and Medical Centre, Muntinlupa, Philippines; Henry D. Ddungu, Uganda Cancer Institute and Hutchinson Center Research Institute, Kampala, Uganda; Liliana De Lima, International Association for Hospice and Palliative Care, Houston, TX; Maria Del Pilar Estevez-Diz, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil; Frank D. Ferris, OhioHealth, Columbus, OH; Nahla Gafer, Radiation and Isotope Center, Khartoum, Sudan; Harmala K. Gupta, CanSupport, New Delhi, India; Susan Horton, University of Waterloo, Waterloo, Ontario, Canada; Graciela Jacob, Instituto Nacional de Cancerología, Buenos Aires, Argentina; Ruinuo Jia, Henan University of Science and Technology, Luoyang, People's Republic of China; Frank L. Lu, National Taiwan University Children's Hospital, Taipei, Republic of China; Daniela Mosoiu, Transylvania University Brasov, Brasov, Romania; Christina Puchalski, George Washington University, Washington, DC; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; Olaitan Soyannwo, University College Hospital Ibadan, Ibadan, Nigeria; and James F. Cleary, University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Frank D Ferris
- Hibah Osman, Balsam-Lebanese Center for Palliative Care, American University of Beirut Medical Center, Beirut, Lebanon; Sudip Shrestha, Nepal Cancer Hospital and Research Center, Lalitpur Submetropolis, Nepal; Sarah Temin, ASCO, Alexandria, VA; Zipporah V. Ali, Kenya Hospices and Palliative Care Association, Nairobi, Kenya; Rumalie A. Corvera, Asian Hospital and Medical Centre, Muntinlupa, Philippines; Henry D. Ddungu, Uganda Cancer Institute and Hutchinson Center Research Institute, Kampala, Uganda; Liliana De Lima, International Association for Hospice and Palliative Care, Houston, TX; Maria Del Pilar Estevez-Diz, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil; Frank D. Ferris, OhioHealth, Columbus, OH; Nahla Gafer, Radiation and Isotope Center, Khartoum, Sudan; Harmala K. Gupta, CanSupport, New Delhi, India; Susan Horton, University of Waterloo, Waterloo, Ontario, Canada; Graciela Jacob, Instituto Nacional de Cancerología, Buenos Aires, Argentina; Ruinuo Jia, Henan University of Science and Technology, Luoyang, People's Republic of China; Frank L. Lu, National Taiwan University Children's Hospital, Taipei, Republic of China; Daniela Mosoiu, Transylvania University Brasov, Brasov, Romania; Christina Puchalski, George Washington University, Washington, DC; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; Olaitan Soyannwo, University College Hospital Ibadan, Ibadan, Nigeria; and James F. Cleary, University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Nahla Gafer
- Hibah Osman, Balsam-Lebanese Center for Palliative Care, American University of Beirut Medical Center, Beirut, Lebanon; Sudip Shrestha, Nepal Cancer Hospital and Research Center, Lalitpur Submetropolis, Nepal; Sarah Temin, ASCO, Alexandria, VA; Zipporah V. Ali, Kenya Hospices and Palliative Care Association, Nairobi, Kenya; Rumalie A. Corvera, Asian Hospital and Medical Centre, Muntinlupa, Philippines; Henry D. Ddungu, Uganda Cancer Institute and Hutchinson Center Research Institute, Kampala, Uganda; Liliana De Lima, International Association for Hospice and Palliative Care, Houston, TX; Maria Del Pilar Estevez-Diz, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil; Frank D. Ferris, OhioHealth, Columbus, OH; Nahla Gafer, Radiation and Isotope Center, Khartoum, Sudan; Harmala K. Gupta, CanSupport, New Delhi, India; Susan Horton, University of Waterloo, Waterloo, Ontario, Canada; Graciela Jacob, Instituto Nacional de Cancerología, Buenos Aires, Argentina; Ruinuo Jia, Henan University of Science and Technology, Luoyang, People's Republic of China; Frank L. Lu, National Taiwan University Children's Hospital, Taipei, Republic of China; Daniela Mosoiu, Transylvania University Brasov, Brasov, Romania; Christina Puchalski, George Washington University, Washington, DC; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; Olaitan Soyannwo, University College Hospital Ibadan, Ibadan, Nigeria; and James F. Cleary, University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Harmala K Gupta
- Hibah Osman, Balsam-Lebanese Center for Palliative Care, American University of Beirut Medical Center, Beirut, Lebanon; Sudip Shrestha, Nepal Cancer Hospital and Research Center, Lalitpur Submetropolis, Nepal; Sarah Temin, ASCO, Alexandria, VA; Zipporah V. Ali, Kenya Hospices and Palliative Care Association, Nairobi, Kenya; Rumalie A. Corvera, Asian Hospital and Medical Centre, Muntinlupa, Philippines; Henry D. Ddungu, Uganda Cancer Institute and Hutchinson Center Research Institute, Kampala, Uganda; Liliana De Lima, International Association for Hospice and Palliative Care, Houston, TX; Maria Del Pilar Estevez-Diz, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil; Frank D. Ferris, OhioHealth, Columbus, OH; Nahla Gafer, Radiation and Isotope Center, Khartoum, Sudan; Harmala K. Gupta, CanSupport, New Delhi, India; Susan Horton, University of Waterloo, Waterloo, Ontario, Canada; Graciela Jacob, Instituto Nacional de Cancerología, Buenos Aires, Argentina; Ruinuo Jia, Henan University of Science and Technology, Luoyang, People's Republic of China; Frank L. Lu, National Taiwan University Children's Hospital, Taipei, Republic of China; Daniela Mosoiu, Transylvania University Brasov, Brasov, Romania; Christina Puchalski, George Washington University, Washington, DC; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; Olaitan Soyannwo, University College Hospital Ibadan, Ibadan, Nigeria; and James F. Cleary, University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Susan Horton
- Hibah Osman, Balsam-Lebanese Center for Palliative Care, American University of Beirut Medical Center, Beirut, Lebanon; Sudip Shrestha, Nepal Cancer Hospital and Research Center, Lalitpur Submetropolis, Nepal; Sarah Temin, ASCO, Alexandria, VA; Zipporah V. Ali, Kenya Hospices and Palliative Care Association, Nairobi, Kenya; Rumalie A. Corvera, Asian Hospital and Medical Centre, Muntinlupa, Philippines; Henry D. Ddungu, Uganda Cancer Institute and Hutchinson Center Research Institute, Kampala, Uganda; Liliana De Lima, International Association for Hospice and Palliative Care, Houston, TX; Maria Del Pilar Estevez-Diz, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil; Frank D. Ferris, OhioHealth, Columbus, OH; Nahla Gafer, Radiation and Isotope Center, Khartoum, Sudan; Harmala K. Gupta, CanSupport, New Delhi, India; Susan Horton, University of Waterloo, Waterloo, Ontario, Canada; Graciela Jacob, Instituto Nacional de Cancerología, Buenos Aires, Argentina; Ruinuo Jia, Henan University of Science and Technology, Luoyang, People's Republic of China; Frank L. Lu, National Taiwan University Children's Hospital, Taipei, Republic of China; Daniela Mosoiu, Transylvania University Brasov, Brasov, Romania; Christina Puchalski, George Washington University, Washington, DC; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; Olaitan Soyannwo, University College Hospital Ibadan, Ibadan, Nigeria; and James F. Cleary, University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Graciela Jacob
- Hibah Osman, Balsam-Lebanese Center for Palliative Care, American University of Beirut Medical Center, Beirut, Lebanon; Sudip Shrestha, Nepal Cancer Hospital and Research Center, Lalitpur Submetropolis, Nepal; Sarah Temin, ASCO, Alexandria, VA; Zipporah V. Ali, Kenya Hospices and Palliative Care Association, Nairobi, Kenya; Rumalie A. Corvera, Asian Hospital and Medical Centre, Muntinlupa, Philippines; Henry D. Ddungu, Uganda Cancer Institute and Hutchinson Center Research Institute, Kampala, Uganda; Liliana De Lima, International Association for Hospice and Palliative Care, Houston, TX; Maria Del Pilar Estevez-Diz, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil; Frank D. Ferris, OhioHealth, Columbus, OH; Nahla Gafer, Radiation and Isotope Center, Khartoum, Sudan; Harmala K. Gupta, CanSupport, New Delhi, India; Susan Horton, University of Waterloo, Waterloo, Ontario, Canada; Graciela Jacob, Instituto Nacional de Cancerología, Buenos Aires, Argentina; Ruinuo Jia, Henan University of Science and Technology, Luoyang, People's Republic of China; Frank L. Lu, National Taiwan University Children's Hospital, Taipei, Republic of China; Daniela Mosoiu, Transylvania University Brasov, Brasov, Romania; Christina Puchalski, George Washington University, Washington, DC; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; Olaitan Soyannwo, University College Hospital Ibadan, Ibadan, Nigeria; and James F. Cleary, University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Ruinuo Jia
- Hibah Osman, Balsam-Lebanese Center for Palliative Care, American University of Beirut Medical Center, Beirut, Lebanon; Sudip Shrestha, Nepal Cancer Hospital and Research Center, Lalitpur Submetropolis, Nepal; Sarah Temin, ASCO, Alexandria, VA; Zipporah V. Ali, Kenya Hospices and Palliative Care Association, Nairobi, Kenya; Rumalie A. Corvera, Asian Hospital and Medical Centre, Muntinlupa, Philippines; Henry D. Ddungu, Uganda Cancer Institute and Hutchinson Center Research Institute, Kampala, Uganda; Liliana De Lima, International Association for Hospice and Palliative Care, Houston, TX; Maria Del Pilar Estevez-Diz, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil; Frank D. Ferris, OhioHealth, Columbus, OH; Nahla Gafer, Radiation and Isotope Center, Khartoum, Sudan; Harmala K. Gupta, CanSupport, New Delhi, India; Susan Horton, University of Waterloo, Waterloo, Ontario, Canada; Graciela Jacob, Instituto Nacional de Cancerología, Buenos Aires, Argentina; Ruinuo Jia, Henan University of Science and Technology, Luoyang, People's Republic of China; Frank L. Lu, National Taiwan University Children's Hospital, Taipei, Republic of China; Daniela Mosoiu, Transylvania University Brasov, Brasov, Romania; Christina Puchalski, George Washington University, Washington, DC; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; Olaitan Soyannwo, University College Hospital Ibadan, Ibadan, Nigeria; and James F. Cleary, University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Frank L Lu
- Hibah Osman, Balsam-Lebanese Center for Palliative Care, American University of Beirut Medical Center, Beirut, Lebanon; Sudip Shrestha, Nepal Cancer Hospital and Research Center, Lalitpur Submetropolis, Nepal; Sarah Temin, ASCO, Alexandria, VA; Zipporah V. Ali, Kenya Hospices and Palliative Care Association, Nairobi, Kenya; Rumalie A. Corvera, Asian Hospital and Medical Centre, Muntinlupa, Philippines; Henry D. Ddungu, Uganda Cancer Institute and Hutchinson Center Research Institute, Kampala, Uganda; Liliana De Lima, International Association for Hospice and Palliative Care, Houston, TX; Maria Del Pilar Estevez-Diz, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil; Frank D. Ferris, OhioHealth, Columbus, OH; Nahla Gafer, Radiation and Isotope Center, Khartoum, Sudan; Harmala K. Gupta, CanSupport, New Delhi, India; Susan Horton, University of Waterloo, Waterloo, Ontario, Canada; Graciela Jacob, Instituto Nacional de Cancerología, Buenos Aires, Argentina; Ruinuo Jia, Henan University of Science and Technology, Luoyang, People's Republic of China; Frank L. Lu, National Taiwan University Children's Hospital, Taipei, Republic of China; Daniela Mosoiu, Transylvania University Brasov, Brasov, Romania; Christina Puchalski, George Washington University, Washington, DC; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; Olaitan Soyannwo, University College Hospital Ibadan, Ibadan, Nigeria; and James F. Cleary, University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Daniela Mosoiu
- Hibah Osman, Balsam-Lebanese Center for Palliative Care, American University of Beirut Medical Center, Beirut, Lebanon; Sudip Shrestha, Nepal Cancer Hospital and Research Center, Lalitpur Submetropolis, Nepal; Sarah Temin, ASCO, Alexandria, VA; Zipporah V. Ali, Kenya Hospices and Palliative Care Association, Nairobi, Kenya; Rumalie A. Corvera, Asian Hospital and Medical Centre, Muntinlupa, Philippines; Henry D. Ddungu, Uganda Cancer Institute and Hutchinson Center Research Institute, Kampala, Uganda; Liliana De Lima, International Association for Hospice and Palliative Care, Houston, TX; Maria Del Pilar Estevez-Diz, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil; Frank D. Ferris, OhioHealth, Columbus, OH; Nahla Gafer, Radiation and Isotope Center, Khartoum, Sudan; Harmala K. Gupta, CanSupport, New Delhi, India; Susan Horton, University of Waterloo, Waterloo, Ontario, Canada; Graciela Jacob, Instituto Nacional de Cancerología, Buenos Aires, Argentina; Ruinuo Jia, Henan University of Science and Technology, Luoyang, People's Republic of China; Frank L. Lu, National Taiwan University Children's Hospital, Taipei, Republic of China; Daniela Mosoiu, Transylvania University Brasov, Brasov, Romania; Christina Puchalski, George Washington University, Washington, DC; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; Olaitan Soyannwo, University College Hospital Ibadan, Ibadan, Nigeria; and James F. Cleary, University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Christina Puchalski
- Hibah Osman, Balsam-Lebanese Center for Palliative Care, American University of Beirut Medical Center, Beirut, Lebanon; Sudip Shrestha, Nepal Cancer Hospital and Research Center, Lalitpur Submetropolis, Nepal; Sarah Temin, ASCO, Alexandria, VA; Zipporah V. Ali, Kenya Hospices and Palliative Care Association, Nairobi, Kenya; Rumalie A. Corvera, Asian Hospital and Medical Centre, Muntinlupa, Philippines; Henry D. Ddungu, Uganda Cancer Institute and Hutchinson Center Research Institute, Kampala, Uganda; Liliana De Lima, International Association for Hospice and Palliative Care, Houston, TX; Maria Del Pilar Estevez-Diz, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil; Frank D. Ferris, OhioHealth, Columbus, OH; Nahla Gafer, Radiation and Isotope Center, Khartoum, Sudan; Harmala K. Gupta, CanSupport, New Delhi, India; Susan Horton, University of Waterloo, Waterloo, Ontario, Canada; Graciela Jacob, Instituto Nacional de Cancerología, Buenos Aires, Argentina; Ruinuo Jia, Henan University of Science and Technology, Luoyang, People's Republic of China; Frank L. Lu, National Taiwan University Children's Hospital, Taipei, Republic of China; Daniela Mosoiu, Transylvania University Brasov, Brasov, Romania; Christina Puchalski, George Washington University, Washington, DC; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; Olaitan Soyannwo, University College Hospital Ibadan, Ibadan, Nigeria; and James F. Cleary, University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Carole Seigel
- Hibah Osman, Balsam-Lebanese Center for Palliative Care, American University of Beirut Medical Center, Beirut, Lebanon; Sudip Shrestha, Nepal Cancer Hospital and Research Center, Lalitpur Submetropolis, Nepal; Sarah Temin, ASCO, Alexandria, VA; Zipporah V. Ali, Kenya Hospices and Palliative Care Association, Nairobi, Kenya; Rumalie A. Corvera, Asian Hospital and Medical Centre, Muntinlupa, Philippines; Henry D. Ddungu, Uganda Cancer Institute and Hutchinson Center Research Institute, Kampala, Uganda; Liliana De Lima, International Association for Hospice and Palliative Care, Houston, TX; Maria Del Pilar Estevez-Diz, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil; Frank D. Ferris, OhioHealth, Columbus, OH; Nahla Gafer, Radiation and Isotope Center, Khartoum, Sudan; Harmala K. Gupta, CanSupport, New Delhi, India; Susan Horton, University of Waterloo, Waterloo, Ontario, Canada; Graciela Jacob, Instituto Nacional de Cancerología, Buenos Aires, Argentina; Ruinuo Jia, Henan University of Science and Technology, Luoyang, People's Republic of China; Frank L. Lu, National Taiwan University Children's Hospital, Taipei, Republic of China; Daniela Mosoiu, Transylvania University Brasov, Brasov, Romania; Christina Puchalski, George Washington University, Washington, DC; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; Olaitan Soyannwo, University College Hospital Ibadan, Ibadan, Nigeria; and James F. Cleary, University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Olaitan Soyannwo
- Hibah Osman, Balsam-Lebanese Center for Palliative Care, American University of Beirut Medical Center, Beirut, Lebanon; Sudip Shrestha, Nepal Cancer Hospital and Research Center, Lalitpur Submetropolis, Nepal; Sarah Temin, ASCO, Alexandria, VA; Zipporah V. Ali, Kenya Hospices and Palliative Care Association, Nairobi, Kenya; Rumalie A. Corvera, Asian Hospital and Medical Centre, Muntinlupa, Philippines; Henry D. Ddungu, Uganda Cancer Institute and Hutchinson Center Research Institute, Kampala, Uganda; Liliana De Lima, International Association for Hospice and Palliative Care, Houston, TX; Maria Del Pilar Estevez-Diz, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil; Frank D. Ferris, OhioHealth, Columbus, OH; Nahla Gafer, Radiation and Isotope Center, Khartoum, Sudan; Harmala K. Gupta, CanSupport, New Delhi, India; Susan Horton, University of Waterloo, Waterloo, Ontario, Canada; Graciela Jacob, Instituto Nacional de Cancerología, Buenos Aires, Argentina; Ruinuo Jia, Henan University of Science and Technology, Luoyang, People's Republic of China; Frank L. Lu, National Taiwan University Children's Hospital, Taipei, Republic of China; Daniela Mosoiu, Transylvania University Brasov, Brasov, Romania; Christina Puchalski, George Washington University, Washington, DC; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; Olaitan Soyannwo, University College Hospital Ibadan, Ibadan, Nigeria; and James F. Cleary, University of Wisconsin Carbone Cancer Center, Madison, WI
| | - James F Cleary
- Hibah Osman, Balsam-Lebanese Center for Palliative Care, American University of Beirut Medical Center, Beirut, Lebanon; Sudip Shrestha, Nepal Cancer Hospital and Research Center, Lalitpur Submetropolis, Nepal; Sarah Temin, ASCO, Alexandria, VA; Zipporah V. Ali, Kenya Hospices and Palliative Care Association, Nairobi, Kenya; Rumalie A. Corvera, Asian Hospital and Medical Centre, Muntinlupa, Philippines; Henry D. Ddungu, Uganda Cancer Institute and Hutchinson Center Research Institute, Kampala, Uganda; Liliana De Lima, International Association for Hospice and Palliative Care, Houston, TX; Maria Del Pilar Estevez-Diz, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil; Frank D. Ferris, OhioHealth, Columbus, OH; Nahla Gafer, Radiation and Isotope Center, Khartoum, Sudan; Harmala K. Gupta, CanSupport, New Delhi, India; Susan Horton, University of Waterloo, Waterloo, Ontario, Canada; Graciela Jacob, Instituto Nacional de Cancerología, Buenos Aires, Argentina; Ruinuo Jia, Henan University of Science and Technology, Luoyang, People's Republic of China; Frank L. Lu, National Taiwan University Children's Hospital, Taipei, Republic of China; Daniela Mosoiu, Transylvania University Brasov, Brasov, Romania; Christina Puchalski, George Washington University, Washington, DC; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; Olaitan Soyannwo, University College Hospital Ibadan, Ibadan, Nigeria; and James F. Cleary, University of Wisconsin Carbone Cancer Center, Madison, WI
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Hsieh CC, Huang HP, Tung TH, Chen IC, Beaton RD, Jane SW. The exploration of the knowledge, attitudes and practice behaviors of advanced care planning and its related predictors among Taiwanese nurses. BMC Palliat Care 2019; 18:99. [PMID: 31711482 PMCID: PMC6849307 DOI: 10.1186/s12904-019-0483-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 10/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the documented and well known patient benefits of ACP, the completion of ACP, only a minority of patients, during the advanced or EOL stage of their illnesses, receive such care. The misconceptions about ACP for healthcare providers, such as nurses, might become potential barriers to the effective implication of ACP. Also, from the transcultural perspective, it is evident essential to explore Taiwanese nurses' attitudes, knowledge, and actions of ACP. The purposes of this study were to explore the implication of ACP or hospice care for nurses caring for non-cancer chronic illness patients at a regional teaching hospital in Taiwan; and, to identify predictors of those nurses' knowledge, attitudes, and actions toward ACP. METHODS This cross-sectional study with a purposive sample of 218 nurses was conducted at a teaching hospital in southern Taiwan. Structured questionnaires were employed and data were analyzed with descriptive statistics, t-test, one-way ANOVAs, Pearson's correlation and multiple regressions. RESULTS 16.1% of Taiwanese physicians actively initiated ACP issues or conversations with patients or their family members. Nurses' attitudes toward ACP were fairly positive but their knowledge about ACP was insufficient and actions of ACP were not positively executed. The predictors of ACP-Knowledge (ACP-K) included position title, education hours and lacking of educational training. The predictors of ACP-Attitude (ACP-A) included ACP-K and "fear of patient or family member not accepting", whereas ACP-A, position title, "patients do not feel necessary" and "not sure physician's concern" were the predictors of ACP-Act. CONCLUSION Continuous education and training for nurses regarding ACP needs to be improved by taking those predictors found in this current study into account, and more studies on the nurse's role in ACP also should be further examined. TRIAL REGISTRATION KAFGH 106-012. Date of registration 1 May 2017.
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Affiliation(s)
- Chiu-Chu Hsieh
- Department of Nursing, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan, Republic of China
| | - Hsiang-Ping Huang
- Department of Nursing, Chang Gung University of Science and Technology, Tao-Yuan, Taiwan, Republic of China
| | - Tao-Hsin Tung
- Department of Medical Research and Education, Cheng Hsin General Hospital, Taipei, Taiwan, Republic of China
| | - I-Chien Chen
- Department of Nursing, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan, Republic of China
| | - Randal D Beaton
- Psychosocial & Community Health and Health Services, Schools of Nursing and Public Health, University of Washington, Seattle, USA
| | - Sui-Whi Jane
- Geriatric and Long-term Care Research Center, Graduate Institute of Nursing, Chang Gung University of Science and Technology, 261, Wen-Hua 1st Rd., Gui-Shan Dist, Tao-Yuan City, 33303, Taiwan, Republic of China. .,Division of Hematology/Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Lin-Ko, Taiwan, Republic of China.
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Shi H, Shan B, Zheng J, Peng W, Zhang Y, Zhou X, Miao X, Hu X. Knowledge and attitudes toward end-of-life care among community health care providers and its influencing factors in China: A cross-sectional study. Medicine (Baltimore) 2019; 98:e17683. [PMID: 31702621 PMCID: PMC6855584 DOI: 10.1097/md.0000000000017683] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
A majority of nurses struggled with a negative emotion of anger, doubt, fear, or anxious, uncomfortable in the face of death and dying. However, little was known about community health care providers' in China. Therefore, we conducted a study to investigate their knowledge and attitudes toward end-of-life care and analyze its influencing factors. To provide reference for developing effective strategies to promote end-of-life care in China.A total of 132 community health care providers of 10 community health care centers in Changzhi city were investigated by a Questionnaire of Knowledge and Attitudes toward Caring for the Dying from May, 2017 to December, 2017, and data was analyzed by SPSS 22.0 software.Of the 132 community health care providers who were under investigation, 70 knew about hospice care, but they rated their overall content on end-of-life care as inadequacy, especially in communication skills and knowledge of pain management. The average score of attitudes was 3.47 (SD = 0.44), the lowest score was in the subscale of nurse-patient communication, which was 2.91 (SD = 0.65). Health care providers who had worked for more than 11 years, who had experiences of the death of relatives or friends, and who had previous experiences of caring for terminal patients had more positive attitudes toward caring for the dying (P < .05 for all). There was a significant relationship between community health care providers' attitudes toward death and their attitudes toward end-of-life care (r = -0.282, P < .01). The significant predictors of attitudes toward end-of-life care were attitudes toward death (β = -0.342), experiences of the death of relatives (β=-0.207), experiences of caring for the dying (β = 0.185), and working experience (β = 0.171).Community health care providers had positive attitudes toward end-of-life care, but they lacked systematic and professional knowledge and skills of caring for the terminal patients. Education is the top priority. It is imperative to set up palliative care courses and life-death education courses, establish an indigenous end-of-life care model, and improve policies, systems, and laws to promote end-of-life care.
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Affiliation(s)
- Hongrui Shi
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu
| | | | | | - Wei Peng
- Department of Palliative Medicine, West China Fourth University Hospital of Sichuan University, Chengdu
| | | | - Xue Zhou
- Fenyang College of Shanxi Medical University, Fenyang
| | - Xiaohui Miao
- West China School of Nursing/West China Hospital
| | - Xiuying Hu
- Innovation Center of Nursing Research, West China School of Medicine/West China Hospital, Sichuan University, Chengdu, China
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Dover LL, Dulaney CR, Williams CP, Fiveash JB, Jackson BE, Warren PP, Kvale EA, Boggs DH, Rocque GB. Hospice care, cancer-directed therapy, and Medicare expenditures among older patients dying with malignant brain tumors. Neuro Oncol 2019; 20:986-993. [PMID: 29156054 DOI: 10.1093/neuonc/nox220] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background End-of-life care for older adults with malignant brain tumors is poorly understood. The purpose of this study is to quantify end-of-life utilization of hospice care, cancer-directed therapy, and associated Medicare expenditures among older adults with malignant brain tumors. Methods This retrospective cohort study included deceased Medicare beneficiaries age ≥65 with primary malignant brain tumor (PMBT) or secondary MBT (SMBT) receiving care within a southeastern cancer community network including academic and community hospitals from 2012-2015. Utilization of hospice and cancer-directed therapy and total Medicare expenditures in the last 30 days of life were calculated using generalized linear and mixed effect models, respectively. Results Late (1-3 days prior to death) or no hospice care was received by 24% of PMBT (n = 383) and 32% of SMBT (n = 940) patients. SMBT patients received late hospice care more frequently than PMBT patients (10% vs 5%, P = 0.002). Cancer-directed therapy was administered to 18% of patients with PMBT versus 25% with SMBT (P = 0.003). Nonwhite race, male sex, and receipt of any hospital-based care in the final 30 days of life were associated with increased risk of late or no hospice care. The average decrease in Medicare expenditures associated with hospice utilization for patients with PMBT was $-12,138 (95% CI: $-18,065 to $-6210) and with SMBT was $-1,508 (95% CI: $-3,613 to $598). Conclusions Receiving late or no hospice care was common among older patients with malignant brain tumors and was significantly associated with increased total Medicare expenditures for patients with PMBT.
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Affiliation(s)
- Laura L Dover
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Caleb R Dulaney
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Courtney P Williams
- Department of Medicine, Division of Hematology-Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| | - John B Fiveash
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Bradford E Jackson
- Center for Outcomes Research, John Peter Smith Hospital Health Network, Fort Worth, Texas
| | - Paula P Warren
- Department of Neurology, Division of Neuro-Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Elizabeth A Kvale
- Department of Medicine, Division of Palliative Medicine, University of Alabama at Birmingham, Birmingham, Alabama.,Birmingham VA Medical Center, Birmingham Alabama
| | - D Hunter Boggs
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Gabrielle B Rocque
- Department of Medicine, Division of Hematology-Oncology, University of Alabama at Birmingham, Birmingham, Alabama.,Department of Medicine, Division of Palliative Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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Ferrè F, Vinci B, Murante AM. Performance of care for end‐of‐life cancer patients in Tuscany: The interplay between place of care, aggressive treatments, opioids, and place of death. A retrospective cohort study. Int J Health Plann Manage 2019; 34:1251-1264. [DOI: 10.1002/hpm.2789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 03/19/2019] [Accepted: 03/20/2019] [Indexed: 11/10/2022] Open
Affiliation(s)
- Francesca Ferrè
- Scuola Superiore Sant'Anna Institute of Management and Department EMbeDS Pisa Italy
| | - Bruna Vinci
- Scuola Superiore Sant'Anna Institute of Management and Department EMbeDS Pisa Italy
| | - Anna Maria Murante
- Scuola Superiore Sant'Anna Institute of Management and Department EMbeDS Pisa Italy
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Carey ML, Zucca AC, Freund MA, Bryant J, Herrmann A, Roberts BJ. Systematic review of barriers and enablers to the delivery of palliative care by primary care practitioners. Palliat Med 2019; 33:1131-1145. [PMID: 31630630 DOI: 10.1177/0269216319865414] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND There is increasing demand for primary care practitioners to play a key role in palliative care delivery. Given this, it is important to understand their perceptions of the barriers and enablers to optimal palliative care, and how commonly these are experienced. AIM To explore the type and prevalence of barriers and enablers to palliative care provision reported by primary care practitioners. DESIGN A systematic review of quantitative data-based articles was conducted. DATA SOURCES Medline, Embase and PsychINFO databases were searched for articles published between January 2007 and March 2019. DATA SYNTHESIS Abstracts were assessed against the eligibility criteria by one reviewer and a random sample of 80 articles were blind coded by a second author. Data were extracted from eligible full-texts by one author and checked by a second. Given the heterogeneity in the included studies' methods and outcomes, a narrative synthesis was undertaken. RESULTS Twenty-one studies met the inclusion criteria. The most common barriers related to bureaucratic procedures, communication between healthcare professionals, primary care practitioners' personal commitments, and their skills or confidence. The most common enablers related to education, nurses and trained respite staff to assist with care delivery, better communication between professionals, and templates to facilitate referral to out-of-hours services. CONCLUSION A holistic approach addressing the range of barriers reported in this review is needed to support primary care providers to deliver palliative care. This includes better training and addressing barriers related to the interface between healthcare services.
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Affiliation(s)
- Mariko L Carey
- Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,Health Behaviour Research Collaborative, The University of Newcastle, Callaghan, NSW, Australia
| | - Alison C Zucca
- Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,Health Behaviour Research Collaborative, The University of Newcastle, Callaghan, NSW, Australia
| | - Megan Ag Freund
- Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,Health Behaviour Research Collaborative, The University of Newcastle, Callaghan, NSW, Australia
| | - Jamie Bryant
- Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,Health Behaviour Research Collaborative, The University of Newcastle, Callaghan, NSW, Australia
| | - Anne Herrmann
- Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,Health Behaviour Research Collaborative, The University of Newcastle, Callaghan, NSW, Australia
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Taber JM, Ellis EM, Reblin M, Ellington L, Ferrer RA. Knowledge of and beliefs about palliative care in a nationally-representative U.S. sample. PLoS One 2019; 14:e0219074. [PMID: 31415570 PMCID: PMC6695129 DOI: 10.1371/journal.pone.0219074] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 06/14/2019] [Indexed: 01/03/2023] Open
Abstract
Palliative care aims to improve quality of life for people with serious illness and their families. One potential barrier to palliative care uptake is inaccurate knowledge and/or negative beliefs among the general population, which may inhibit early interest in, communication about, and integration of palliative care following subsequent illness diagnosis. We explored knowledge and beliefs about palliative care among the general public using nationally-representative data collected in 2018 as part of the cross-sectional Health Information National Trends Survey. Only individuals who had heard of palliative care (n = 1,162, Mage = 51.8, 64% female) were queried on knowledge and beliefs. We examined whether self-assessed level of awareness of palliative care (i.e., knowing a little vs. enough to explain it) was associated with the relative likelihood of having accurate/positive beliefs, inaccurate/negative beliefs, or responding "don't know" to questions about palliative care. Respondents who indicated knowing a lot about palliative care had more accurate versus inaccurate knowledge than those who knew a little on only two of six items and more positive attitudes on only one of three items. In particular, respondents with greater awareness were equally likely to report that palliative care is the same as hospice and requires stopping other treatments, and equally likely to believe that palliative care means giving up and to associate palliative care with death. Those with higher awareness were less likely than those with lower awareness to respond "don't know," but greater awareness was not necessarily associated with having accurate or positive beliefs about palliative care as opposed to inaccurate or negative beliefs. Thus, even members of the general public who perceived themselves to know a lot about palliative care were often no less likely to report inaccurate knowledge or negative beliefs (versus accurate and positive, respectively). Findings suggest a need to improve awareness and attitudes about palliative care.
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Affiliation(s)
- Jennifer M Taber
- Department of Psychological Sciences, Kent State University, Kent, Ohio, United States of America
| | - Erin M Ellis
- Behavioral Research Program, National Cancer Institute, Bethesda, Maryland, United States of America
| | - Maija Reblin
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, United States of America
| | - Lee Ellington
- College of Nursing, University of Utah, Salt Lake City, Utah, United States of America
| | - Rebecca A Ferrer
- Behavioral Research Program, National Cancer Institute, Bethesda, Maryland, United States of America
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Burmann SN, Neukirchen M, Ostgathe C, Beckmann M, Schwartz J, Scheer K, Klco-Brosius S, Hense J, Teufel M, Tewes M. Knowledge and Self-Efficacy Assessment of Residents and Fellows Following Palliative Care Unit Rotation: A Pilot Study. Am J Hosp Palliat Care 2019; 36:492-499. [PMID: 30621437 DOI: 10.1177/1049909118823181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In Germany, some units of specialized palliative care (SPC) offer a 6- to 12-month rotation for resident physicians (RPs) and fellows from different specialties. OBJECTIVE This pilot study aimed to evaluate feasibility of assessing palliative care knowledge (PCK) and palliative care self-efficacy (PCSE) using a paper-based questionnaire. METHODS Palliative care knowledge and PCSE were assessed by introducing a score, followed by a descriptive analysis (determination of frequency, mean, median, and range) using nonparametric tests (χ2 test, Mann-Whitney U test). RESULTS We assessed 17 RPs following SPC rotation and 16 board-certified specialists (BCSs) who had no experience in SPC from 3 German comprehensive cancer centers. Resident physicians were predominantly enrolled in residency programs of hematology and oncology (n = 6), anesthesiology (n = 6), and psychosomatic medicine (n = 3). Resident physicians rotated between year 1 and 8 of residency. Fifteen RPs (88%) had elected this rotation and 72% preferred 12-month duration. The total PCK score of PCK was 27 (RPs) and 24 (BCSs; P = .002). Mean PCSE scores were 46 (RPs) and 39 (BCSs; P = .016). Of 71% of RPs, only 27% of BCSs knew how support of hospice service was initiated ( P = .004). Participants rated the items as comprehensible (n = 24; 73%), relevant (n = 25; 76%) and the questionnaire as adequately long (n = 23; 70%). CONCLUSION An improved PCK and PCSE were observed in physicians who rotated through an SPC unit; this resulted in an increased tangibility of local palliative care and hospice services. The questionnaire was comprehensible, relevant in terms of content, and adequate in length for a prospective multicenter survey.
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Affiliation(s)
- Sven Niklas Burmann
- 1 Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Martin Neukirchen
- 2 Department of Palliative Medicine, Medical Faculty, Heinrich-Heine-University, Duesseldorf University Hospital, Moorenstrasse, Duesseldorf, Germany
| | - Christoph Ostgathe
- 3 Department of Palliative Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Mingo Beckmann
- 4 Department of Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR-Klinikum Essen, Essen, Germany
| | - Jacqueline Schwartz
- 2 Department of Palliative Medicine, Medical Faculty, Heinrich-Heine-University, Duesseldorf University Hospital, Moorenstrasse, Duesseldorf, Germany
| | - Karin Scheer
- 5 Hospice Care, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Stephanie Klco-Brosius
- 6 West German Cancer Center, DAGGIST Consortium, University Hospital Essen, Essen, Germany
| | - Joerg Hense
- 1 Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Martin Teufel
- 4 Department of Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR-Klinikum Essen, Essen, Germany
| | - Mitra Tewes
- 1 Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
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Smith CEP, Kamal AH, Kluger M, Coke P, Kelley MJ. National Trends in End-of-Life Care for Veterans With Advanced Cancer in the Veterans Health Administration: 2009 to 2016. J Oncol Pract 2019; 15:e568-e575. [PMID: 31046573 DOI: 10.1200/jop.18.00559] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE It is imperative to provide quality end-of-life (EOL) care for patients with cancer. Although rates of hospice use within the Veterans Health Administration have improved, antineoplastic administration and intensive care unit (ICU) admission at the EOL, indicators of aggressive care, have not clearly declined over recent years. METHODS We identified 32,665 veterans diagnosed with stage IV lung, colorectal, or pancreatic cancer who died between 2009 and 2016 using a novel EOL Dashboard Tool created from Veterans Administration Cancer Registry data. This EOL tool reports the incidence of antineoplastic drug use in the last 14 days of life, ICU admission in the last 30 days of life, and hospice admission or consult. Change from 2009 to 2016 was assessed using a repeated measures one-way analysis of variance with post hoc test for linear trend of time for individual cancers and two-way analysis of variance for all cancers combined. RESULTS Antineoplastic use in the last 14 days of life declined from 6.8% in 2009 to 4.4% in 2016 (P = .03). ICU admission in the last 30 days did not change significantly, from 13.3% in 2009 to 14.7% in 2016. The exception was patients with stage IV lung cancer, in whom ICU admissions increased from 12.9% to 16.2% (P = .01). Patients using hospice services increased from 32.4% to 52.6% (P < .01). CONCLUSION Although antineoplastic administration at the EOL is declining for veterans with stage IV cancer, ICU admissions are unchanged and becoming more common in stage IV lung cancer despite increasing hospice use.
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Affiliation(s)
| | | | - Monica Kluger
- 2 Veterans Health Administration Support Service Center, Washington, DC
| | - Patty Coke
- 3 Central Arkansas Veterans Healthcare System, Little Rock, AR
| | - Michael J Kelley
- 1 Duke University Medical Center, Durham, NC.,4 Veterans Administration Medical Center and Veterans Administration National Oncology Program, Durham, NC
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68
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Fahy BN. Introduction: Role of palliative care for the surgical patient. J Surg Oncol 2019; 120:5-9. [PMID: 30919950 DOI: 10.1002/jso.25449] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 02/23/2019] [Indexed: 12/25/2022]
Abstract
Palliative care (PC) seeks to improve the quality of life for patients facing serious illness. Several oncology organizations have guidelines about PC, reflecting the need to integrate PC into standard oncology care. Many surgical patients do not receive PC despite the need for these services and established surgical PC competencies. Recent educational and research efforts reveal increased appreciation of the need and benefit of integrating PC services with cancer care in general, and surgical care, specifically.
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Affiliation(s)
- Bridget N Fahy
- Department of Surgery, Division of Surgical Oncology and Department of Internal Medicine, Division of Palliative Medicine, University of New Mexico, Albuquerque, New Mexico
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Steigleder T, Kollmar R, Ostgathe C. Palliative Care for Stroke Patients and Their Families: Barriers for Implementation. Front Neurol 2019; 10:164. [PMID: 30894836 PMCID: PMC6414790 DOI: 10.3389/fneur.2019.00164] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 02/07/2019] [Indexed: 11/17/2022] Open
Abstract
Stroke is a leading cause of death, disability and is a symptom burden worldwide. It impacts patients and their families in various ways, including physical, emotional, social, and spiritual aspects. As stroke is potentially lethal and causes severe symptom burden, a palliative care (PC) approach is indicated in accordance with the definition of PC published by the WHO in 2002. Stroke patients can benefit from a structured approach to palliative care needs (PCN) and the amelioration of symptom burden. Stroke outcome is uncertain and outlook may change rapidly. Regarding these challenges, core competencies of PC include the critical appraisal of various treatment options, and openly and respectfully discussing therapeutic goals with patients, families, and caregivers. Nevertheless, PC in stroke has to date mainly been restricted to short care periods for dying patients after life-limiting complications. There is currently no integrated concept for PC in stroke care addressing the appropriate moment to initiate PC for stroke patients, and the question of how to screen for symptoms remains unanswered. Therefore, PC for stroke patients is often perceived as a stopgap in cases of unfavorable prognosis and very short survival times. In contrast, PC can provide much more for stroke patients and support a holistic approach, improve quality of life and ensure treatment according to the patient's wishes and values. In this short review we identify key aspects of PC in stroke care and current barriers to implementation. Additionally, we provide insights into our approach to PC in stroke care.
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Affiliation(s)
- Tobias Steigleder
- Department of Palliative Care, University Hospital Erlangen-Nuremberg, Erlangen, Germany
- Department of Neurology, University Hospital Erlangen-Nuremberg, Erlangen, Germany
| | - Rainer Kollmar
- Department of Neurology and Neurointensive Care, Darmstadt Academic Hospital, Darmstadt, Germany
| | - Christoph Ostgathe
- Department of Palliative Care, University Hospital Erlangen-Nuremberg, Erlangen, Germany
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Gellis ZD, Kim E, Hadley D, Packel L, Poon C, Forciea MA, Bradway C, Streim J, Seman J, Hayden T, Johnson J. Evaluation of interprofessional health care team communication simulation in geriatric palliative care. GERONTOLOGY & GERIATRICS EDUCATION 2019; 40:30-42. [PMID: 30160623 DOI: 10.1080/02701960.2018.1505617] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
An interprofessional education (IPE) simulation-based geriatric palliative care training was developed to educate health professions students in team communication. In health care, interprofessional communication is critical to team collaboration and patient and family caregiver outcomes. Studies suggest that acquiring skills to work on health care teams and communicate with team members should occur during the early stage of professional education. The Interprofessional Education Collaborative (IPEC®) competency-based framework was used to inform the training. An evaluation examined attitudes toward health care teams, self-efficacy in communication skills, interprofessional collaboration, and participant satisfaction with the training experience. One-hundred and eleven participants completed pre- and post-training surveys. Overall, a majority of participants (97.3%) were satisfied with the training and reported more positive attitudes toward health care teams and greater self-efficacy in team communication skills. IPE participants had higher collaboration scores compared to observer learners. Further research is needed to explore long-term effects of IPE in clinical practice.
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Affiliation(s)
- Zvi D Gellis
- a Center for Mental Health & Aging Research, School of Social Policy & Practice , University of Pennsylvania , Philadelphia , PA , USA
| | - Eunhae Kim
- b School of Social Work , Texas State University , San Marcos , TX , USA
| | - Diane Hadley
- c Department of Pharmacy , University of the Sciences , Philadelphia , PA , USA
| | - Lora Packel
- d Department of Physical Therapy , University of the Sciences , Philadelphia , PA , USA
| | - Cathy Poon
- c Department of Pharmacy , University of the Sciences , Philadelphia , PA , USA
| | - Mary Ann Forciea
- e Division of Geriatrics , University of Pennsylvania , Philadelphia , PA , USA
| | - Christine Bradway
- f School of Nursing , University of Pennsylvania , Philadelphia , PA , USA
| | - Joel Streim
- g Department of Psychiatry , University of Pennsylvania , Philadelphia , PA , USA
| | - John Seman
- e Division of Geriatrics , University of Pennsylvania , Philadelphia , PA , USA
| | - Tara Hayden
- e Division of Geriatrics , University of Pennsylvania , Philadelphia , PA , USA
| | - Jerry Johnson
- e Division of Geriatrics , University of Pennsylvania , Philadelphia , PA , USA
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Abstract
Survivorship has become a significant topic within oncologic care. The tools and means by which the provision of survivorship care can be implemented and delivered are in development and are the focus of significant research oncology-wide. These tools and methods include innovations of survivorship care delivery, survivorship care plans, and improving communication among all stakeholders in an individual patient's care as the means to elevate health-related quality of life. The merits of these survivorship care provisions in the field of neuro-oncology and its patients' exigent need for more patient-centric care focused on living with their illness are discussed. Since 2014 there has been a mandate within the United States for adult cancer patients treated with curative intent to receive survivorship care plans, comprising a treatment summary and a follow-up plan, intended to facilitate patients' care after initial diagnosis and upfront treatment. Several cancer-specific survivorship care plans have been developed and endorsed by health care professional organizations and patient advocacy groups. A survivorship care plan specific for neuro-oncology has been collaboratively developed by a multidisciplinary and interprofessional committee; it is endorsed by the Society for Neuro-Oncology Guidelines Committee. It is available as open access for download from the Society for Neuro-Oncology website under "Resources": https://www.soc-neuro-onc.org/SNO/Resources/Survivorship_Care_Plan.aspx. Survivorship care offers an opportunity to begin directly addressing the range of issues patients navigate throughout their illness trajectory, an oncology initiative to which neuro-oncology patients both need and deserve equitable access.
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Affiliation(s)
- Heather Leeper
- Department of Neurology, NorthShore University Health System, Evanston, Illinois
| | - Kathrin Milbury
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Kang JH, Go SI, Bruera E. Compassion is a key quality for palliative care teams. Cancer Med 2018; 7:5325-5326. [PMID: 30306724 PMCID: PMC6246948 DOI: 10.1002/cam4.1804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 08/31/2018] [Accepted: 09/09/2018] [Indexed: 11/22/2022] Open
Abstract
Multidisciplinary team members including doctors, nurses, and chaplains, and social workers involve palliative. Therefore, it is not easy to define palliative care in a word. We are convinced that compassion is at the core of palliative care.
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Affiliation(s)
- Jung Hun Kang
- School of Medicine, Gyeongsang National University, Jinju, Korea.,Department of Internal Medicine, Gyeongsang University Hospital, Jinju, Korea
| | - Se Il Go
- Department of Internal Medicine, Gyeongsang National University Hospital, Changwon, Korea
| | - Eduardo Bruera
- Department of Palliative Care and Rehabilitation Medicine, University of Texas M.D. Anderson Cancer Center, Houston, Texas
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Integration of oncology and palliative care: a Lancet Oncology Commission. Lancet Oncol 2018; 19:e588-e653. [DOI: 10.1016/s1470-2045(18)30415-7] [Citation(s) in RCA: 297] [Impact Index Per Article: 49.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 05/16/2018] [Accepted: 05/22/2018] [Indexed: 02/06/2023]
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Abstract
Clinical research in neuro-oncology frequently classifies patients over 60-70 years of age as 'elderly', a designation intended to identify patients with the disease characteristics, psychosocial changes, and susceptibility to treatment toxicities associated with advancing age. The elderly account for a large proportion of patients diagnosed with glioblastoma (GBM), and this population is projected to increase. Their prognosis is inferior to that of GBM patients as a whole, and concerns over treatment toxicity may limit the aggressiveness with which they are treated. Recent clinical studies have assisted with therapeutic decision making in this cohort. Hypofractionated radiation with concurrent and adjuvant temozolomide has been shown to increase survival without worsened quality of life in elderly patients with good functional status. Single modality radiation therapy or temozolomide therapy are frequently used in this population, and while neither has demonstrated superiority, O6-methylguanine-DNA methyltransferase (MGMT) methylation status is predictive of improved survival with temozolomide over radiation therapy. Despite these advances, ambiguity as to how to best define, assess, and treat this population remains. The specific response of elderly patients to emerging therapies, such as immunotherapies, is unclear. Advancing outcomes for elderly patients with GBM requires persistent efforts to include them in translational and clinical research endeavors, and concurrent dedication to the preservation of function and quality of life in this population.
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Affiliation(s)
- Rebecca A Harrison
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 0431, Houston, TX, 77030, USA.
| | - John F de Groot
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 0431, Houston, TX, 77030, USA
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Chino F, Kamal AH, Leblanc TW, Zafar SY, Suneja G, Chino JP. Place of death for patients with cancer in the United States, 1999 through 2015: Racial, age, and geographic disparities. Cancer 2018; 124:4408-4419. [DOI: 10.1002/cncr.31737] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 07/18/2018] [Accepted: 08/02/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Fumiko Chino
- Department of Radiation Oncology; Duke University Medical Center; Durham North Carolina
| | - Arif H. Kamal
- Division of Medical Oncology and Palliative Care, Duke Cancer Institute; Durham North Carolina
| | - Thomas W. Leblanc
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute; Durham North Carolina
| | - S. Yousuf Zafar
- Division of Medical Oncology and Palliative Care, Duke Cancer Institute; Durham North Carolina
| | - Gita Suneja
- Department of Radiation Oncology; Duke University Medical Center; Durham North Carolina
| | - Junzo P. Chino
- Department of Radiation Oncology; Duke University Medical Center; Durham North Carolina
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Hui D, Kilgore K, Park M, Liu D, Kim YJ, Park JC, Fossella F, Bruera E. Pattern and Predictors of Outpatient Palliative Care Referral Among Thoracic Medical Oncologists. Oncologist 2018; 23:1230-1235. [PMID: 29895629 PMCID: PMC6263132 DOI: 10.1634/theoncologist.2018-0094] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 04/17/2018] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND There is significant variation in access to palliative care. We examined the pattern of outpatient palliative care referral among thoracic medical oncologists and identified oncologist characteristics associated with greater referral. MATERIALS AND METHODS We retrieved data on all patients who died of advanced thoracic malignancies at our institution between January 1, 2007, and December 31, 2012. Using median as a cutoff, we defined two groups (high-referring and low-referring oncologists) based on their frequency of referral. We examined various oncologist- and patient-related characteristics associated with outpatient referral. RESULTS Of 1,642 decedents, 444 (27%) had an outpatient palliative care referral. The median proportion of referral among 26 thoracic oncologists was 30% (range 9%-45%; median proportion of high-referring 37% vs. low-referring 24% when divided into two groups at median). High-referring oncologists were significantly younger (age 45 vs. 56) than low-referring oncologists; they were also significantly more likely to refer patients earlier (median interval between oncology consultation and palliative care consultation 90 days vs. 170 days) and to refer those without metastatic disease (7% vs. 2%). In multivariable mixed-effect logistic regression, younger oncologists (odds ratio [OR] = 0.97 per year increase, 95% confidence interval [CI] 0.95-0.995), younger patients (OR = 0.98 per year increase, 95% CI 0.97-0.99), and nonmetastatic disease status (OR = 0.48, 95% CI 0.29-0.78) were significantly associated with outpatient palliative care referral. CONCLUSION The pattern of referral to outpatient palliative care varied widely among thoracic oncologists. Younger oncologists were not only referring a higher proportion of patients, but also referring patients earlier in the disease trajectory. IMPLICATIONS FOR PRACTICE This retrospective cohort study found that younger thoracic medical oncologists were significantly more likely to refer patients to outpatient palliative care and to do so earlier in the disease trajectory compared with older oncologists, even after adjusting for other known predictors such as patient demographics. The findings highlight the role of education to standardize palliative care access and imply that outpatient palliative care referral is likely to continue to increase with a shifting oncology workforce.
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Affiliation(s)
- David Hui
- Department of Palliative Care, Rehabilitation and Integrative Medicine, Houston, Texas, USA
| | - Kelly Kilgore
- Department of Palliative Care, Rehabilitation and Integrative Medicine, Houston, Texas, USA
| | - Minjeong Park
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Diane Liu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Yu Jung Kim
- Department of Palliative Care, Rehabilitation and Integrative Medicine, Houston, Texas, USA
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ji Chan Park
- Department of Palliative Care, Rehabilitation and Integrative Medicine, Houston, Texas, USA
- Division of Hematology-Oncology, Department of Internal Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Republic of Korea
| | - Frank Fossella
- Thoracic and Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative Care, Rehabilitation and Integrative Medicine, Houston, Texas, USA
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Gustafson C, Lazenby M. Assessing the Unique Experiences and Needs of Muslim Oncology Patients Receiving Palliative and End-of-Life Care: An Integrative Review. J Palliat Care 2018; 34:52-61. [PMID: 30231835 DOI: 10.1177/0825859718800496] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objective of this review was to detail the experiences of Muslim oncology patients receiving palliative and end-of-life care and identify where gaps in the providing of culturally aware care occur. We also sought to examine ways in which providers could be better educated on the needs of Muslim patients at the end-of-life and identify barriers Muslims faced when being treated with hospice and palliative care models developed for non-Muslim populations. We conducted a search in April 2018 in the National Library of Medicine and CINAHL databases using the search terms "palliative care," "Muslim," and "cancer." Included were articles with focuses on adult Muslims with palliative and end-of-life care experiences. We then followed the PRISMA guidelines for an integrative review and used a data extraction matrix to identify 20 papers that met the inclusion criteria of the review. We identified four major themes patient experiences, patient care delivery suggestions, Muslim provider experiences, and definitions of death, present in all 20 papers of the review. Each of the included papers was categorized based on the dominant theme in the paper. This review ultimately found that the care provided to Muslim patients is subpar for the standard of culturally competent care and that the needs of Muslim patients at the end-of-life, as well as the needs of their families, are not being met. Moving forward further research on this topic is needed with a particular focus on examining the experiences of terminally ill Muslim patients receiving treatment in non-Muslim majority settings.
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Ferrer RA, Orehek E, Padgett LS. Goal conflict when making decisions for others. JOURNAL OF EXPERIMENTAL SOCIAL PSYCHOLOGY 2018. [DOI: 10.1016/j.jesp.2018.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Washington KT, Demiris G, Parker Oliver D, Albright DL, Craig KW, Tatum P. Delivering problem-solving therapy to family caregivers of people with cancer: A feasibility study in outpatient palliative care. Psychooncology 2018; 27:2494-2499. [PMID: 30107070 DOI: 10.1002/pon.4859] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 08/01/2018] [Accepted: 08/05/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVE In response to the well-documented need for evidence-based cancer caregiver support, we examined the feasibility of problem-solving therapy for family caregivers of cancer patients receiving outpatient palliative care and investigated the impact of problem-solving therapy on family caregivers' anxiety, depression, and quality of life. METHODS We conducted a feasibility study of a structured problem-solving therapy intervention delivered to family caregivers of cancer patients receiving outpatient palliative care from an academic health center in the Midwestern United States. Participants (N = 83) were randomly assigned to receive usual care or usual care plus a problem-solving therapy intervention, which was delivered over three sessions via web-based videoconferencing or telephone. Descriptive statistics were used to determine feasibility relative to recruitment, retention, and fidelity to core intervention components. Outcome data were analyzed using ordinary least squares multiple regression. RESULTS Problem-solving therapy for family caregivers of patients with cancer was found to be highly feasible in the outpatient palliative care setting. Caregivers who received problem-solving therapy reported less anxiety than those who received only usual care (P = 0.03). No statistically significant differences were observed for caregiver depression (P = 0.07) or quality of life (P = 0.06). CONCLUSIONS Problem-solving therapy is a feasible and promising approach to reducing cancer family caregivers' anxiety in the outpatient palliative care setting. Further testing in multiple sites is recommended.
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Affiliation(s)
- Karla T Washington
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri
| | - George Demiris
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Debra Parker Oliver
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri
| | - David L Albright
- School of Social Work, University of Alabama, Tuscaloosa, Alabama
| | - Kevin W Craig
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri
| | - Paul Tatum
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri
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Abstract
OBJECTIVE To describe palliative care integration into oncology, including several models that facilitate this integration, important considerations when initiating a program, special oncologic populations that would benefit from palliative care, and challenges to consider. DATA SOURCES Palliative care and oncology literature over the past decade. CONCLUSION Multiple models exist to facilitate the integration of palliative care based on the needs of the providers or payers. There are several special populations that would benefit from early integration of palliative care. IMPLICATIONS FOR NURSING PRACTICE Nurses play a critical role in identifying patients, providing early primary palliative care, and facilitating collaborative relationships with and referring to specialist palliative care.
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Ammari ABH, Hendriksen C, Rydahl-Hansen S. Results from the family and coping oriented palliative homecare intervention study (FamCope)-A randomized controlled trial. J Psychosoc Oncol 2018; 36:557-581. [PMID: 29995589 DOI: 10.1080/07347332.2018.1460003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
We tested if a family-and-coping-oriented basic palliative homecare intervention (six visits within 15 weeks) could improve quality-of-life and reduce anxiety and depression of advanced cancer patients and their closest relative, and reduce acute hospital admissions of patients. Fifty-seven families were randomized, but patient enrollment was terminated before reaching target sample due to a low recruitment rate. We found no evidence of effect of the FamCope-intervention, but further investigation of effective methods to support how families cope with advanced cancer at home is needed as levels of distress is as high in relatives as it is in patients. However, duration of interventions to support family-coping may need a considerable time-span to show effect on quality-of-life. We recommend that recruitment is undertaken in close collaboration with the hospital clinics, and that complexity of problems is used as inclusion criterion to decide when a family-coping intervention is needed based on the level of problems and distress in the family.
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Affiliation(s)
- Anne Birgitte Hjuler Ammari
- a Research Unit of Clinical Nursing, Palliative Medical Department , Bispebjerg and Frederiksberg University Hospital , Copenhagen , Denmark
| | - Carsten Hendriksen
- b Institute of Public Health, University of Copenhagen , Copenhagen , Denmark.,c Department of Integrated Health Care , Bispebjerg and Frederiksberg University Hospital , Copenhagen , Denmark
| | - Susan Rydahl-Hansen
- d Research Unit of Clinical Nursing, Bispebjerg and Frederiksberg University Hospital , Copenhagen , Denmark.,e Department of Nursing Science , University of Aarhus , Aarhus , Denmark
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82
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Osman H, Shrestha S, Temin S, Ali ZV, Cleary JF. Palliative Care in the Global Setting: ASCO Resource-Stratified Practice Guideline Summary. J Oncol Pract 2018; 14:431-436. [DOI: 10.1200/jop.18.00087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Hibah Osman
- Balsam-Lebanese Center for Palliative Care, American University of Beirut Medical Center, Beirut, Lebanon; Nepal Cancer Hospital and Research Center, Lalitpur, Nepal; ASCO, Alexandria, VA; Kenya Hospices and Palliative Care Association, Nairobi, Kenya; and University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Sudip Shrestha
- Balsam-Lebanese Center for Palliative Care, American University of Beirut Medical Center, Beirut, Lebanon; Nepal Cancer Hospital and Research Center, Lalitpur, Nepal; ASCO, Alexandria, VA; Kenya Hospices and Palliative Care Association, Nairobi, Kenya; and University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Sarah Temin
- Balsam-Lebanese Center for Palliative Care, American University of Beirut Medical Center, Beirut, Lebanon; Nepal Cancer Hospital and Research Center, Lalitpur, Nepal; ASCO, Alexandria, VA; Kenya Hospices and Palliative Care Association, Nairobi, Kenya; and University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Zipporah V. Ali
- Balsam-Lebanese Center for Palliative Care, American University of Beirut Medical Center, Beirut, Lebanon; Nepal Cancer Hospital and Research Center, Lalitpur, Nepal; ASCO, Alexandria, VA; Kenya Hospices and Palliative Care Association, Nairobi, Kenya; and University of Wisconsin Carbone Cancer Center, Madison, WI
| | - James F. Cleary
- Balsam-Lebanese Center for Palliative Care, American University of Beirut Medical Center, Beirut, Lebanon; Nepal Cancer Hospital and Research Center, Lalitpur, Nepal; ASCO, Alexandria, VA; Kenya Hospices and Palliative Care Association, Nairobi, Kenya; and University of Wisconsin Carbone Cancer Center, Madison, WI
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83
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Åvik Persson H, Sandgren A, Fürst CJ, Ahlström G, Behm L. Early and late signs that precede dying among older persons in nursing homes: the multidisciplinary team's perspective. BMC Geriatr 2018; 18:134. [PMID: 29898674 PMCID: PMC6000966 DOI: 10.1186/s12877-018-0825-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Accepted: 05/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nursing home residents in Sweden are old, frail and usually have multiple morbidities which often make dying a prolonged suffering. It has been found that older persons at nursing homes receive far less palliative care than younger persons, partly because it is difficult to identify when the final stage of life begins. The identification may help the staff to enable the older person and their families to participate in planning the care in accordance with their own preferences and values. With this in mind the aim was to explore the experiences of early and late signs preceding dying in older persons in nursing homes from the multidisciplinary team's perspective. METHODS The focus group method was used to interview 20 health-care professionals on the basis of semi-structured questions. Four focus groups were conducted at four nursing homes in two counties in southern Sweden. The groups included different professionals such as assistant nurses, registered nurses, occupational therapists, physiotherapists, social workers and unit managers. The analysis was conducted according to the focus group method developed by Kruger and Casey. RESULTS The analysis revealed one major theme, from unawareness to obviousness, which illustrates that the participants experienced dying as a happening, not a process, and found it difficult to identify early signs. Even though it was a new way of thinking, several suggestions of early signs were presented. The main category "Going into a bubble" illustrates early signs, which meant that the older person showed signs of wanting to withdraw from the outside world. The main category "The body begins to shut down" illustrates late signs, which meant that the older person showed signs that indicate that the body starts to prepare for death. CONCLUSIONS This study conveys new knowledge concerning the multidisciplinary team's collective experience of early and late signs that precede dying. This knowledge can increase the understanding of when a palliative care approach needs to be in place at nursing homes. The use of a palliative care approach in care planning requires consensus in the perception of the dying process of frail older persons.
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Affiliation(s)
- Helene Åvik Persson
- Department of Health Sciences, Faculty of Medicine, Lund University, P.O. Box 157, 221 00, Lund, Sweden.
| | - Anna Sandgren
- Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| | - Carl-Johan Fürst
- The Institute for Palliative Care, Lund University and Region Skåne, 221 00, Lund, Sweden
| | - Gerd Ahlström
- Department of Health Sciences, Faculty of Medicine, Lund University, P.O. Box 157, 221 00, Lund, Sweden
| | - Lina Behm
- Department of Health Sciences, Faculty of Medicine, Lund University, P.O. Box 157, 221 00, Lund, Sweden
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84
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Hui D, Cherny N, Latino N, Strasser F. The 'critical mass' survey of palliative care programme at ESMO designated centres of integrated oncology and palliative care. Ann Oncol 2018; 28:2057-2066. [PMID: 28911084 DOI: 10.1093/annonc/mdx280] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background The ESMO Designated Centres (ESMO-DCs) of Integrated Oncology and Palliative Care (PC) Incentive Programme has grown steadily. We aimed to characterise the level of PC clinical services, education and research at ESMO-DCs. Methods We sent all 184 ESMO-DCs an electronic survey consisting of 78 questions examining the DC characteristics, palliative care clinical programme (structure, processes, and outcomes), primary PC delivery by oncologists, education, research and attitudes and beliefs towards the ESMO-DC programme. Results The response rate was 83% (152/184). 115 (76%) ESMO-DCs were from Europe, 87 (57%) were tertiary care centres. 136 (90%) had inpatient consultation teams, 135 (89%) had outpatient PC clinics, 107 (71%) had dedicated acute care beds, and 75 (50%) offered community-based PC. An estimated 70% (interquartile range [IQR] 28-80%) of patients with advanced cancer had a PC consultation before death, occurring 90 days before death (median, IQR 40-150 days) for outpatients and 21 days (IQR 14-45 days) for inpatients. 59 (39%) offered PC fellowship programme; 47 (32%) had mandatory PC rotations for oncology fellows. Ninety-nine (65%) had double-boarded palliative oncologists. 118 (78%) of the ESMO-DCs reported that routine symptom screening was offered in the oncology clinic and 30% of patients had documented end-of-life discussions by their oncologists. Most centres (>80%) perceived the ESMO-DC programme to increase their status. Conclusions The ESMO-DCs had a high level of PC infrastructure and provided access to a large proportion of patients with advanced cancer. The survey supports that the 13 criteria required for ESMO designation set a robust framework for integration, stimulated investment of resources into some palliative care programmes prior to accreditation, and raised the interest about palliative care among clinicians, trainees and patients.
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Affiliation(s)
- D Hui
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - N Cherny
- Cancer Pain and Palliative Medicine Service, Department of Medical Oncology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - N Latino
- European Society for Medical Oncology Head Office, Viganello-Lugano
| | - F Strasser
- Oncological Palliative Medicine, Clinic Oncology/Hematology, Cantonal Hospital, St. Gallen, Switzerland
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85
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Chidiac C. The evidence of early specialist palliative care on patient and caregiver outcomes. Int J Palliat Nurs 2018; 24:230-237. [DOI: 10.12968/ijpn.2018.24.5.230] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Claude Chidiac
- Lecturer in Palliative Care, Saint Francis Hospice, Romford, UK and Course Director MSc Palliative and End of Life Care, School of Health and Social Care, London South Bank University, UK
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86
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Augustussen M, Pedersen M, Hounsgaard L, Timm H, Sjøgren P. Development of health-related quality of life and symptoms in patients with advanced cancer in Greenland. Eur J Cancer Care (Engl) 2018; 27:e12843. [PMID: 29578252 PMCID: PMC6001430 DOI: 10.1111/ecc.12843] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2018] [Indexed: 12/28/2022]
Abstract
A prospective national cohort study assessed the development of health-related quality of life (HRQoL) and symptoms in adult patients undergoing treatment and care for advanced cancer in Greenland. HRQol was examined by EORTC QLQ-C30 version 3.0 questionnaire monthly for 4 months. Changes over time and between-group comparisons were examined. Of 58 patients included in the study, 47% completed the questionnaire four times. Functioning was generally high, and improved social functioning was observed after 1 and 2 months. The highest symptom score was for fatigue followed by pain and nausea/vomiting. A high score for financial problems remained unchanged during the entire period. Patients with higher income had reduced pain intensity (p = .03) and diarrhoea (p = .05) than patients with income below the poverty line. After 1 month, reduction in pain intensity was observed for Nuuk citizens compared with non-Nuuk citizens (p = .05). After 2 months, non-Nuuk citizens reported improved social functioning compared with Nuuk citizens (p = .05). After 3 months, Global Health in Nuuk citizens was improved compared with non-Nuuk citizens (p = .05). An important clinical finding was that patients' needs for support are related to social status, and geographical factors should be taken into account when planning palliative care.
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Affiliation(s)
- M. Augustussen
- Institute of Nursing and Health ScienceIlisimatusarfikUniversity of GreenlandNuukGreenland
| | - M.L. Pedersen
- Greenland Center for Health ResearchInstitute of Nursing and Health ScienceUniversity of GreenlandNuukGreenland
| | - L. Hounsgaard
- Institute of Nursing and Health ScienceIlisimatusarfikUniversity of GreenlandNuukGreenland
- Greenland Center for Health ResearchInstitute of Nursing and Health ScienceUniversity of GreenlandNuukGreenland
- Department of Clinical ResearchOPENUniversity of Southern DenmarkOdenseDenmark
| | - H. Timm
- REHPA, Danish Knowledge Centre for Rehabilitation and Palliative CareNyborgDenmark
| | - P. Sjøgren
- Palliative Research GroupDepartment of OncologyRigshospitaletCopenhagenDenmark
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87
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Azhar A, Wong AN, Cerana AA, Balankari VR, Adabala M, Liu DD, Williams JL, Bruera E. Characteristics of Unscheduled and Scheduled Outpatient Palliative Care Clinic Patients at a Comprehensive Cancer Center. J Pain Symptom Manage 2018; 55:1327-1334. [PMID: 29410087 DOI: 10.1016/j.jpainsymman.2018.01.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 01/19/2018] [Accepted: 01/20/2018] [Indexed: 02/06/2023]
Abstract
CONTEXT There is limited literature regarding outpatient palliative care and factors associated with unscheduled clinic visits. OBJECTIVES To compare characteristics of patients with unscheduled vs. scheduled outpatient palliative care clinic visits. METHODS Medical records of 183 unscheduled cancer new outpatients and 104 unscheduled follow-up (FU) patients were compared with random samples of 361 and 314 scheduled new patients and FU patients, respectively. We gathered data on demographics, symptoms, daily opioid usage, and performance status. RESULTS Compared with scheduled new patients, unscheduled new patients had worse Edmonton Symptom Assessment Scale subscores for pain (P < 0.001), fatigue (P = 0.002), nausea (P = 0.016), depression (P = 0.003), anxiety (P = 0.038), drowsiness (P = 0.002), sleep (P < 0.001), and overall feeling of well-being (P = 0.001); had a higher morphine equivalent daily dose of opioids (median of 45 mg for unscheduled vs. 30 mg for scheduled; P < 0.001); and were more likely to be from outside the greater Houston area (P < 0.001). Most unscheduled and scheduled new and FU visits were for uncontrolled physical symptoms. Unscheduled FU patients, compared with scheduled FU patients, had worse Edmonton Symptom Assessment Scale subscores for pain (P < 0.001), fatigue (P < 0.001), depression (P = 0.002), anxiety (P = 0.004), drowsiness (P = 0.010), appetite (P = 0.023), sleep (P = 0.022), overall feeling of well-being (P < 0.001), and higher morphine equivalent daily dose of opioid (median of 58 mg for unscheduled FU visits vs. 40 mg for scheduled FU visits; P = 0.054). CONCLUSION Unscheduled new FU patients have higher levels of physical and psychosocial distress and higher opioid intake. Outpatient palliative care centers should consider providing opportunities for walk-in visits for timely management and close monitoring of such patients.
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Affiliation(s)
- Ahsan Azhar
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Angelique N Wong
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Agustina A Cerana
- Department of Internal Medicine, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Vishidha R Balankari
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Madhuri Adabala
- Diagnostic Group Integrated Healthcare System, Beaumont, Texas, USA
| | - Diane D Liu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Janet L Williams
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
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88
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Gani F, Enumah ZO, Conca-Cheng AM, Canner JK, Johnston FM. Palliative Care Utilization among Patients Admitted for Gastrointestinal and Thoracic Cancers. J Palliat Med 2018; 21:428-437. [PMID: 29100002 PMCID: PMC6016727 DOI: 10.1089/jpm.2017.0295] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Although a growing body of literature recommends the early initiation of palliative care (PC), the use of PC remains variable. OBJECTIVE The current study sought to describe the use of PC and to identify factors associated with the use of inpatient PC. DESIGN Retrospective, cross-sectional analysis of data from the National Inpatient Sample. SETTING AND SUBJECTS Patients admitted with a primary diagnosis of gastrointestinal and/or thoracic cancer from 2012 to 2013. MEASUREMENTS In-hospital length of stay (LOS), morbidity, mortality, and total charges. RESULTS A total of 282,899 patients were identified who met inclusion criteria of whom, 24,100 (8.5%) patients received a PC consultation during their inpatient admission. Patients who received PC were more likely to have a longer LOS (LOS >14 days: 5.4% vs. 9.4%) and were more likely to develop a postoperative complication (28.3% vs. 45.9%, both p < 0.001). Inpatient mortality was significantly higher among patients who had received PC than those who did not (5.4% vs. 44.1%, p < 0.001). On multivariable analysis, patient age (age ≥75 years: Odds Ratio [OR] = 2.54, 95% CI: 2.33-2.78), comorbidity (CCI >6: OR = 2.60, 95% CI: 2.48-2.74), and admission to larger hospitals (reference small: OR = 1.20, 95% CI: 1.14-1.25) were associated with greater odds of receiving PC (all p < 0.05). Patients who underwent a major operation during their inpatient admission demonstrated 79% lower odds of receiving PC (OR = 0.21, 95% CI: 0.20-0.22, p < 0.001). CONCLUSIONS Among patients admitted for cancer, PC services were used in 8.5% of patients during their inpatient admission with surgical patients being 79% less likely to receive a PC consultation. Further research is required to delineate the barriers to the use of PC so as to promote the use of PC among high-risk patients.
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Affiliation(s)
- Faiz Gani
- Department of Surgery, Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Zachary O Enumah
- Department of Surgery, Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Alison M Conca-Cheng
- Department of Surgery, Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Joseph K Canner
- Department of Surgery, Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Fabian M Johnston
- Department of Surgery, Johns Hopkins University School of Medicine , Baltimore, Maryland
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89
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Kaye EC, Gushue CA, DeMarsh S, Jerkins J, Sykes A, Lu Z, Snaman JM, Blazin L, Johnson LM, Levine DR, Morrison RR, Baker JN. Illness and end-of-life experiences of children with cancer who receive palliative care. Pediatr Blood Cancer 2018; 65:10.1002/pbc.26895. [PMID: 29218773 PMCID: PMC6159948 DOI: 10.1002/pbc.26895] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 10/19/2017] [Accepted: 10/24/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND The field of pediatric palliative oncology is newly emerging. Little is known about the characteristics and illness experiences of children with cancer who receive palliative care (PC). METHODS A retrospective cohort study of 321 pediatric oncology patients enrolled in PC who died between 2011 and 2015 was conducted at a large academic pediatric cancer center using a comprehensive standardized data extraction tool. RESULTS The majority of pediatric palliative oncology patients received experimental therapy (79.4%), with 40.5% enrolled on a phase I trial. Approximately one-third received cancer-directed therapy during the last month of life (35.5%). More than half had at least one intensive care unit hospitalization (51.4%), with this subset demonstrating considerable exposure to mechanical ventilation (44.8%), invasive procedures (20%), and cardiopulmonary resuscitation (12.1%). Of the 122 patients who died in the hospital, 44.3% died in the intensive care unit. Patients with late PC involvement occurring less than 30 days before death had higher odds of dying in the intensive care unit over the home/hospice setting compared to those with earlier PC involvement (OR: 4.7, 95% CI: 2.47-8.97, P < 0.0001). CONCLUSIONS Children with cancer who receive PC experience a high burden of intensive treatments and often die in inpatient intensive care settings. Delayed PC involvement is associated with increased odds of dying in the intensive care unit. Prospective investigation of early PC involvement in children with high-risk cancer is needed to better understand potential impacts on cost-effectiveness, quality of life, and delivery of goal concordant care.
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Affiliation(s)
| | - Courtney A. Gushue
- Le Bonheur Children’s Hospital, Memphis, TN
- University of Tennessee Health Science Center, Memphis, TN
| | - Samantha DeMarsh
- Ohio University Heritage College of Osteopathic Medicine, Cleveland, OH
| | - Jonathan Jerkins
- Le Bonheur Children’s Hospital, Memphis, TN
- University of Tennessee Health Science Center, Memphis, TN
| | - April Sykes
- St. Jude Children’s Research Hospital, Memphis, TN
| | - Zhaohua Lu
- St. Jude Children’s Research Hospital, Memphis, TN
| | - Jennifer M. Snaman
- Dana-Farber Cancer Institute, Boston, MA
- Boston Children’s Hospital, Boston, MA
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90
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Bähler C, Signorell A, Blozik E, Reich O. Intensity of treatment in Swiss cancer patients at the end-of-life. Cancer Manag Res 2018; 10:481-491. [PMID: 29588617 PMCID: PMC5858839 DOI: 10.2147/cmar.s156566] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Current evidence on the care-delivering process and the intensity of treatment at the end-of-life of cancer patients is limited and remains unclear. Our objective was to examine the care-delivering processes in health care during the last months of life with real-life data of Swiss cancer patients. Patients and methods The study population consisted of adult decedents in 2014 who were insured at Helsana Group. Data on the final cause of death were provided additionally by the Swiss Federal Statistical Office. Of the 10,275 decedents, 2,710 (26.4%) died of cancer. Intensity of treatment and health care utilization (including transitions) at their end-of-life were examined. Intensity measures included the following: last dose of chemotherapy within 14 days of death, a new chemotherapy regimen starting <30 days before death, more than one hospital admission or spending >14 days in hospital in the last month, death in an acute care hospital, more than one emergency visit and ≥1 intensive care unit admission in the last month of life. Results In the last 6 months of life, 89.5% of cancer patients had ≥1 transition, with 87.2% being hospitalized. Within 30 days before death, 64.2% of the decedents had ≥1 intensive treatment, whereby 8.9% started a new chemotherapy. In the multinomial logistic regression model, older age, higher density of nursing home beds and home care nurses were associated with a decrease, while living in the Italian- or French-speaking part of Switzerland was associated with an increase in intensive care. Conclusion Swiss cancer patients insured by Helsana Group experience a considerable number of transitions and intensive treatments at the end-of-life, whereby treatment intensity declines with increasing age. Among others, increased home care nursing might be helpful to reduce unwarranted treatments and transitions, therefore leading to better care at the end-of-life.
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Affiliation(s)
- Caroline Bähler
- Department of Health Sciences, Helsana Insurance Group, Zürich, Switzerland
| | - Andri Signorell
- Department of Health Sciences, Helsana Insurance Group, Zürich, Switzerland
| | - Eva Blozik
- Department of Health Sciences, Helsana Insurance Group, Zürich, Switzerland.,Department of Medicine, University Medical Centre Freiburg, Freiburg im Breisgau, Germany
| | - Oliver Reich
- Department of Health Sciences, Helsana Insurance Group, Zürich, Switzerland
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91
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Bischoff K, Yang E, Kojimoto G, Shepard Lopez N, Holland S, Calton B, Adkins SH, Cheng S, Miller BJ, Rabow MW. What We Do: Key Activities of an Outpatient Palliative Care Team at an Academic Cancer Center. J Palliat Med 2018; 21:999-1004. [PMID: 29431580 DOI: 10.1089/jpm.2017.0441] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Outpatient palliative care (PC) has been shown to positively impact quality of life and decrease healthcare utilization, but there are limited data describing what activities render these benefits. OBJECTIVE Describe the topics addressed by an outpatient PC team during scheduled visits. DESIGN Longitudinal cohort study. SETTING The Symptom Management Service, an ambulatory PC program at an academic comprehensive cancer center. MEASUREMENT Between March 23, 2015 and June 14, 2016, outpatient PC providers completed a checklist after each clinic visit, documenting topics covered during the visit. RESULTS During the study period, 1243 visits were conducted for 577 unique patients. Symptom management was the topic most commonly addressed during initial visits (in 92% of visits), followed by an introduction of PC (69%), support for family caregivers (47%), and communication with other clinicians (38%). Providers also supported patients to understand their prognosis (28%), treatment options (36%), and to make care decisions (22%). Formal advance care planning activities occurred infrequently, however, including designation of a Durable Power of Attorney for Healthcare (26%), completion of an advance directive or Provider Orders for Life-Sustaining Treatment form (10%), and discussing hospice (8%). Follow-up visits were dominated by symptom management (93%) and caregiver support (27%). CONCLUSIONS Symptom management, support for family and caregivers, and care coordination are the most common activities that occurred during scheduled outpatient PC visits. These findings can guide developing PC practices, as well as clinicians who provide primary PC.
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Affiliation(s)
- Kara Bischoff
- 1 Symptom Management Service, Department of Medicine, University of California , San Francisco, San Francisco, California
| | - Eleanor Yang
- 2 Department of Medicine, Northwestern University Feinberg School of Medicine , Chicago, Illinois
| | - Gayle Kojimoto
- 1 Symptom Management Service, Department of Medicine, University of California , San Francisco, San Francisco, California
| | - Nancy Shepard Lopez
- 1 Symptom Management Service, Department of Medicine, University of California , San Francisco, San Francisco, California
| | - Sarah Holland
- 1 Symptom Management Service, Department of Medicine, University of California , San Francisco, San Francisco, California
| | - Brook Calton
- 1 Symptom Management Service, Department of Medicine, University of California , San Francisco, San Francisco, California
| | - Sarah H Adkins
- 1 Symptom Management Service, Department of Medicine, University of California , San Francisco, San Francisco, California
| | - Stephanie Cheng
- 1 Symptom Management Service, Department of Medicine, University of California , San Francisco, San Francisco, California
| | - Bruce J Miller
- 1 Symptom Management Service, Department of Medicine, University of California , San Francisco, San Francisco, California
| | - Michael W Rabow
- 1 Symptom Management Service, Department of Medicine, University of California , San Francisco, San Francisco, California
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92
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Magarotto R, Lunardi G, Coati F, Cassandrini P, Picece V, Ferrighi S, Oliosi L, Venturini M. Reduced use of chemotherapy at the end of life in an integrated-care model of oncology and palliative care. TUMORI JOURNAL 2018; 97:573-7. [DOI: 10.1177/030089161109700506] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and Background When there is little hope of a clinical benefit, too delayed a withdrawal from chemotherapy might be detrimental for a patient's quality of life. We evaluated appropriately timed cessation of chemotherapy in our Oncology Department after integration of a Supportive and Palliative Care Unit. Methods We carried out a review of deceased patients in our department from January 2006 to December 2009. Activities of the Supportive and Palliative Care Unit started in late 2007. We analyzed the characteristics of patients near the end of life and chemotherapy use within 30 days of death as an aggressiveness of cure index. Results During the considered period, 361 hospitalized patients died: 69 in 2006, 77 in 2007, 97 in 2008 and 118 in 2009; 102 never received chemotherapy. Sixty-one of the remaining 259 patients died within 30 days of the last drug administration. The percentage of patients receiving chemotherapy in their last 30 days fell from 19% in 2006 and 20% in 2007, to 16% in 2008 and 14% in 2009. Conclusions Supportive and Palliative Care Unit integration decreased chemotherapy use in the last 30 days of life. A careful evaluation of prognostic factors of advanced cancer patients and provision of appropriate supportive and palliative cares can reduce the use of futile anticancer chemotherapy and preserve a patient's qualify of life.
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Affiliation(s)
- Roberto Magarotto
- Oncology Department, Ospedale Sacro Cuore-Don Calabria, Negrar (VR), Italy
| | - Gianluigi Lunardi
- Oncology Department, Ospedale Sacro Cuore-Don Calabria, Negrar (VR), Italy
| | - Francesca Coati
- Oncology Department, Ospedale Sacro Cuore-Don Calabria, Negrar (VR), Italy
| | - Paola Cassandrini
- Oncology Department, Ospedale Sacro Cuore-Don Calabria, Negrar (VR), Italy
| | - Vincenzo Picece
- Oncology Department, Ospedale Sacro Cuore-Don Calabria, Negrar (VR), Italy
| | - Silvia Ferrighi
- Oncology Department, Ospedale Sacro Cuore-Don Calabria, Negrar (VR), Italy
| | - Luciana Oliosi
- Oncology Department, Ospedale Sacro Cuore-Don Calabria, Negrar (VR), Italy
| | - Marco Venturini
- Oncology Department, Ospedale Sacro Cuore-Don Calabria, Negrar (VR), Italy
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93
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Integrating Oncology and Palliative Home Care in Italy: The Experience of the “L'Aquila per la Vita” Home Care Unit. TUMORI JOURNAL 2018; 99:225-8. [DOI: 10.1177/030089161309900217] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aim To evaluate the efficacy of a home care program, closely integrated with a medical oncology department. Patients and methods The charts, prospectively recorded, of all the patients treated at home by the “L'Aquila per la Vita” Home Care Unit from August 2006 to December 2011, were reviewed. The number of patients, home accesses, length of the home care, hospital admission, emergency calls, and the place of death were recorded. Data were analyzed considering the origin of the patients (medical oncology department or other). Results A total of 461 patients was followed at home for a total of 10,503 home accesses (median accesses/patient, 20; range, 1–159). The median length of home care was 76 days (range, 2–643 days). The median was 101 days for patients coming from the medical oncology department and 53 days for patients coming from other origins ( P <0.0005). There were 428 emergency calls (4.1% of all the home accesses). Emergency calls accounted for 253 of 7,364 home accesses (3.4%) among patients coming from the medical oncology department and for 175 of 3,139 home accesses (5.6%) among patients coming from other origins ( P = 0.00005). Eighty of 461 patients (17.3%) required one in-hospital admission and 19/461 patients (4.1%) more than one. Fifty-nine of 259 (17.8%) patients coming from the medical oncology department and 40 of 186 (26.9%) coming from other origins required in-hospital admissions ( P = 0.04). A total of 311 patients died (163 coming from the medical oncology department and 148 from other origins). Twenty-eight of 163 (17.1%) coming from the medical oncology department and 52 of 148 (35.1%) coming from other origins died in the hospital ( P = 0.0002). Conclusions A multidisciplinary and expert team, closely integrated with the hospital, can guarantee a long length of home care, avoiding hospitalization and closing the gap between the patients' preferences and the services offered regarding the place of death.
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Harford JB, Edwards BK, Nandakumar A, Ndom P, Capocaccia R, Coleman MP. Cancer control-planning and monitoring population-based systems. TUMORI JOURNAL 2018; 95:568-78. [DOI: 10.1177/030089160909500501] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Cancer is a growing global health issue, and many countries are ill-prepared to deal with their current cancer burden let alone the increased burden looming on the horizon. Growing and aging populations are projected to result in dramatic increases in cancer cases and cancer deaths particularly in low- and middle-income countries. It is imperative that planning begin now to deal not only with those cancers already occurring but also with the larger numbers expected in the future. Unfortunately, such planning is hampered, because the magnitude of the burden of cancer in many countries is poorly understood owing to lack of surveillance and monitoring systems for cancer risk factors and for the documentation of cancer incidence, survival and mortality. Moreover, the human resources needed to fight cancer effectively are often limited or lacking. Cancer diagnosis and cancer care services are also inadequate in low-and middle-income countries. Late-stage presentation of cancers is very common in these settings resulting in less potential for cure and more need for symptom management. Palliative care services are grossly inadequate in low- and middle-income countries, and many cancer patients die unnecessarily painful deaths. Many of the challenges faced by low- and middle-income countries have been at least partially addressed by higher income countries. Experiences from around the world are reviewed to highlight the issues and showcase some possible solutions.
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Affiliation(s)
| | | | | | - Paul Ndom
- Oncology Service, General Hospital of Yaounde, Yaounde, Camaroon
| | | | - Michel P Coleman
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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95
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Kolben T, Haberland B, Degenhardt T, Burgmann M, Koenig A, Kolben TM, Ulbach K, Mahner S, Bausewein C, Harbeck N, Wuerstlein R. Evaluation of an interdisciplinary palliative care inhouse training for professionals in gynecological oncology. Arch Gynecol Obstet 2018; 297:767-773. [PMID: 29362923 DOI: 10.1007/s00404-018-4681-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 01/17/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to evaluate the effect of a pilot interdisciplinary inhouse training in palliative care (PC) for gynecological oncologists. METHODS Competencies of participants from a gynecological university department were evaluated taking part in an interdisciplinary PC course in a pre and post design. The multiprofessional course covered basic principles of PC, symptom management and communication taught by PC specialists. Competencies were evaluated using self-designed questionnaires before (ISPG-1), right after (ISPG-2), and 6 months after the training (ISPG-3) (inhouse seminar palliative care in gynecology: ISPG). RESULTS 31 persons from the department of gynecology took part in the course, of which 27 answered the first questionnaire (seven nurses (26%), 19 doctors (71%), one profession not indicated (3%), median working experience in gynecological oncology: 5 years). Return rates were: ISPG-1 27/31 (87.1%), ISPG-2 20/31 (64.5%) and IPSG-3 14/31 (45.2%). A more positive attitude towards PC could be observed in the majority of participants after the course (ISPG-2 62%, ISPG-3 71%). They felt more competent in the care of palliative patients (46%). PC would be initiated earlier and the interaction with other disciplines was improved (ISPG-2 85%, ISPG-3 100%). The participants assessed a significant improvement of their skills in all palliative fields which were analyzed. CONCLUSION PC inhouse training improves the understanding of PC and the interdisciplinary approach in the management of patients with advanced disease. It is a feasible and useful instrument to improve the competencies in generalist PC of specialists in gynecological oncology.
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Affiliation(s)
- Thomas Kolben
- Department of Obstetrics and Gynecology, University Hospital Munich-Grosshadern, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - Birgit Haberland
- Department for Palliative Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Tom Degenhardt
- Department of Obstetrics and Gynecology, University Hospital Munich-Grosshadern, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Maximiliane Burgmann
- Department of Obstetrics and Gynecology, University Hospital Munich-Grosshadern, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Alexander Koenig
- Department of Obstetrics and Gynecology, University Hospital Munich-Grosshadern, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Theresa Maria Kolben
- Department of Obstetrics and Gynecology, University Hospital Munich-Grosshadern, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Kristina Ulbach
- Department of Obstetrics and Gynecology, University Hospital Munich-Grosshadern, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Sven Mahner
- Department of Obstetrics and Gynecology, University Hospital Munich-Grosshadern, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Claudia Bausewein
- Department for Palliative Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Nadia Harbeck
- Department of Obstetrics and Gynecology, University Hospital Munich-Grosshadern, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Rachel Wuerstlein
- Department of Obstetrics and Gynecology, University Hospital Munich-Grosshadern, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany
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96
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Characteristics and care pathways of advanced cancer patients in a palliative-supportive care unit and an oncological ward. Support Care Cancer 2018; 26:1961-1966. [DOI: 10.1007/s00520-017-4037-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 12/28/2017] [Indexed: 10/18/2022]
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The impact of early palliative care on the quality of care during the last days of life: what does the evidence say? Curr Opin Support Palliat Care 2018; 10:310-315. [PMID: 27635766 DOI: 10.1097/spc.0000000000000240] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW The aim of this review is to critically appraise the existing evidence on 'early palliative care' (EPC), discuss its relationship with advance care planning, and to reflect on the impact of EPC on the quality of care provided during the last days of life. RECENT FINDINGS There are indicators that EPC may help to avoid aggressive treatment, shorten hospital stay, improve overall quality of life, and to see more frequently dying and death at the preferred place of care. SUMMARY The evidence from randomized controlled trials supports the integration of palliative care early in the disease trajectory. However, in terms of outcomes and quality indicators for care in the last days of life, evidence is still lacking. Predominantly, when it comes to the outcomes which may be more difficult to assess, such as spiritual aspects, or the social network, for which more comprehensive information is needed. These outcomes should not be neglected in palliative care studies, particularly when they can provide meaningful information about patient and family adjustment, and focus on psychosocial aspects rather than physical symptom control.
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98
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Hahne P, Lundström S, Leveälahti H, Winnhed J, Öhlén J. Changes in professionals' beliefs following a palliative care implementation programme at a surgical department: a qualitative evaluation. BMC Palliat Care 2017; 16:77. [PMID: 29282050 PMCID: PMC5745985 DOI: 10.1186/s12904-017-0262-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 12/05/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND One ambition regarding palliative care is that it should be more accessible to patients and families regardless of care setting. Previous studies show many difficulties and shortcomings in the care of patients with palliative care needs in acute care facilities, but also challenges regarding efforts to implement palliative care. The aim of this study is to evaluate how the implementation of palliative care, using a combination of integration and consultation strategies, can change beliefs regarding palliative care among professionals in a surgical department. METHOD In order to explore professionals' experiential outcome of an educational implementation strategy, a before-after qualitative design was used. The study was based on three focus group discussions. Two discussions were conducted before introducing the implementation strategy and one was conducted after. The participants consisted of five nurses and two specialist surgeons from a surgical department in Sweden. The focus group discussions revealed a variety of different attitudes and beliefs, which were analysed using qualitative systematic text condensation. RESULTS Beliefs regarding palliative care were identified in seven areas; the importance of palliative care, working methods in palliative care, team collaboration in palliative care, collegial support, discussions about diagnosis, symptoms at the end of life, and families of patients in palliative care. Changes in beliefs were seen in all areas except one: team collaboration in palliative care. CONCLUSION It is possible to change the beliefs of health care professionals in a surgical department regarding palliative care through the implementation of palliative knowledge. Beliefs were changed from an individual to a collective development where the group initiated a shared palliative working method. The changes observed were palliative care being described as more complex and participants differentiating between surgical care and palliative care.
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Affiliation(s)
- Pia Hahne
- Stockholms Sjukhem Foundation, Mariebergsgatan 22, 112 35 Stockholm, Sweden
- Ersta Sköndal Bräcke University College, Box 111 89, -100 61 Stockholm, SE Sweden
| | - Staffan Lundström
- Stockholms Sjukhem Foundation, Mariebergsgatan 22, 112 35 Stockholm, Sweden
- Department of Oncology-Pathology Karolinska Institutet, Stockholm, Sweden
| | - Helena Leveälahti
- Stockholms Sjukhem Foundation, Mariebergsgatan 22, 112 35 Stockholm, Sweden
| | - Janet Winnhed
- Stockholms Sjukhem Foundation, Mariebergsgatan 22, 112 35 Stockholm, Sweden
- ASIH Praktikertjänst Västerort N.Ä.R.A, Vällingby, Sweden
| | - Joakim Öhlén
- Institute of Health and Care Sciences and University of Gothenburg Center for Person-Centered Care, Salgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
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Abstract
OBJECTIVE New, value-based regulations and reimbursement structures are creating historic care management challenges, thinning the margins and threatening the viability of hospitals and health systems. The Society of Critical Care Medicine convened a taskforce of Academic Leaders in Critical Care Medicine on February 22, 2016, during the 45th Critical Care Congress to develop a toolkit drawing on the experience of successful leaders of critical care organizations in North America for advancing critical care organizations (Appendix 1). The goal of this article was to provide a roadmap and call attention to key factors that adult critical care medicine leadership in both academic and nonacademic setting should consider when planning for value-based care. DESIGN Relevant medical literature was accessed through a literature search. Material published by federal health agencies and other specialty organizations was also reviewed. Collaboratively and iteratively, taskforce members corresponded by electronic mail and held monthly conference calls to finalize this report. SETTING The business and value/performance critical care organization building section comprised of leaders of critical care organizations with expertise in critical care administration, healthcare management, and clinical practice. MEASUREMENTS AND MAIN RESULTS Two phases of critical care organizations care integration are described: "horizontal," within the system and regionalization of care as an initial phase, and "vertical," with a post-ICU and postacute care continuum as a succeeding phase. The tools required for the clinical and financial transformation are provided, including the essential prerequisites of forming a critical care organization; the manner in which a critical care organization can help manage transformational domains is considered. Lastly, how to achieve organizational health system support for critical care organization implementation is discussed. CONCLUSIONS A critical care organization that incorporates functional clinical horizontal and vertical integration for ICU patients and survivors, aligns strategy and operations with those of the parent health system, and encompasses knowledge on finance and risk will be better positioned to succeed in the value-based world.
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Narsavage GL, Chen YJ, Korn B, Elk R. The potential of palliative care for patients with respiratory diseases. Breathe (Sheff) 2017; 13:278-289. [PMID: 29209422 PMCID: PMC5709801 DOI: 10.1183/20734735.014217] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Based on the demonstrated effectiveness of palliative care in the alleviation of symptoms and enhancement of life quality, it is important to incorporate palliative care early in the respiratory disease trajectory. Quality palliative care addresses eight domains that are all patient and family centred. Palliative care interventions in respiratory conditions include management of symptoms such as dyspnoea, cough, haemoptysis, sputum production, fatigue and respiratory secretion management, especially as the end-of-life nears. A practical checklist of activities based on the domains of palliative care can assist clinicians to integrate palliative care into their practice. Clinical management of patients receiving palliative care requires consideration of human factors and related organisational characteristics that involve cultural, educational and motivational aspects of the patient/family and clinicians. Early palliative care can relieve suffering and provide support for people with respiratory diseaseshttp://ow.ly/z0Hd30jpsb4
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Affiliation(s)
- Georgia L Narsavage
- Dept of Nursing, West Virginia University Health Sciences Center, Morgantown, WV, USA
| | - Yea-Jyh Chen
- Kent State University - College of Nursing, Kent, OH, USA
| | - Bettina Korn
- End-of-Life Care Programme, St. James's Hospital, Dublin, Ireland
| | - Ronit Elk
- University of South Carolina - College of Nursing, Columbia, SC, USA
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