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Shin J, Hammer MJ, Paul SM, Conley YP, Harris C, Oppegaard K, Morse L, Cooper BA, Levine JD, Miaskowski C. Associations Between Preoperative Shortness of Breath and Potassium Channels Gene Variations in Women With Breast Cancer. Biol Res Nurs 2024:10998004241268088. [PMID: 39137431 DOI: 10.1177/10998004241268088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
OBJECTIVES Shortness of breath is a common symptom in patients with cancer. However, the mechanisms that underlie this troublesome symptom are poorly understood. Therefore, this study aimed to determine the prevalence of and associated risk factors for shortness of breath in women prior to breast cancer surgery and identify associations between shortness of breath and polymorphisms for potassium channel genes. METHODS Patients were recruited prior to breast cancer surgery and completed a self-report questionnaire on the occurrence of shortness of breath. Genotyping of single nucleotides polymorphism (SNPs) in potassium channel genes was performed using a custom array. Multiple logistic regression analyses were done to identify associations between the occurrence of shortness of breath and SNPs in ten candidate genes. RESULTS Of the 398 patients, 11.1% reported shortness of breath. These patients had a lower annual household income, a higher comorbidity burden, and a lower functional status. After controlling for functional status, comorbidity burden, genomic estimates of ancestry and self-reported race and ethnicity, the genetic associations that remained significant in the multiple regression analyses were for potassium voltage-gated channel subfamily D (KCND2) rs12673992, potassium voltage-gated channel modifier subfamily S (KCNS1) rs4499491, and potassium two pore channel subfamily K (KCNK2) rs4411107. CONCLUSIONS While these findings warrant replication, they suggest that alterations in potassium channel function may contribute to the occurrence of shortness of breath in women prior to breast cancer surgery.
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Affiliation(s)
- Joosun Shin
- Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Steven M Paul
- School of Nursing, University of California San Francisco, San Francisco, CA, USA
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Carolyn Harris
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Lisa Morse
- School of Nursing, University of California San Francisco, San Francisco, CA, USA
| | - Bruce A Cooper
- School of Nursing, University of California San Francisco, San Francisco, CA, USA
| | - Jon D Levine
- VA Portland Health Care System, Portland, OR, USA
| | - Christine Miaskowski
- School of Nursing, University of California San Francisco, San Francisco, CA, USA
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
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2
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Smirnova N, Lange AV, Glickman A, Desanto K, McDermott CL, Sullivan DR, Bekelman DB, Kavalieratos D. Criteria for Enrollment of Patients With COPD in Palliative Care Trials: A Systematic Review. J Pain Symptom Manage 2024; 67:e891-e905. [PMID: 38280439 PMCID: PMC11088983 DOI: 10.1016/j.jpainsymman.2024.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 01/11/2024] [Accepted: 01/13/2024] [Indexed: 01/29/2024]
Abstract
CONTEXT Use of palliative care interventions in chronic obstructive pulmonary disease (COPD) has increased in recent years and inclusion criteria used to identify patients with COPD appropriate for palliative care vary widely. We evaluated the inclusion criteria to identify ways to improve enrollment opportunities for patients with COPD. OBJECTIVES To determine inclusion criteria used to select patients with COPD for palliative care trials. METHODS A systematic review was conducted to determine criteria used to select patients with COPD for palliative care randomized controlled trials. A narrative synthesis was conducted for all trials. RESULTS Inclusion criteria were highly heterogeneous. Most studies (n = 11, 79%) used a combination of criteria to identify patients with COPD. Commonly used criteria included hospitalization for an acute exacerbation of COPD (n = 8, 57%), home supplemental oxygen use (n = 8, 57%), and spirometry values confirming COPD (n = 6, 43%). Three studies (21.4%) used Modified Medical Research Council score and two studies (21%) used physician prognosis or a performance scale. CONCLUSION The most common criteria, a hospitalization for acute exacerbation of COPD or supplemental oxygen use at home, both have the benefit of selecting patients who have a higher symptom burden or higher healthcare utilization who might therefore benefit more from palliative care. By describing the landscape and variability of previously used inclusion criteria, this article serves as a resource for clinicians and researchers. Developing a consistent set of inclusion criteria in the future would help generate generalizable results that can be translated into clinical practice to improve the lives of patients with COPD. PROSPERO REGISTRATION NUMBER CRD42022306752.
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Affiliation(s)
- Natalia Smirnova
- Division of Pulmonary, Allergy and Critical Care Medicine (N.S.), Emory University School of Medicine, Atlanta, Georgia, USA
| | - Allison V Lange
- Division of Pulmonary Sciences and Critical Care Medicine (A.V.L.), University of Colorado School of Medicine, Aurora, Colorado, USA.
| | - Amanda Glickman
- Division of General Internal Medicine (A.G., D.B.B.), University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Kristen Desanto
- Strauss Health Sciences Library (K.D.), University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Cara L McDermott
- Division of Geriatrics (C.L.M.), Duke University School of Medicine, Durham, North Carolina, USA
| | - Donald R Sullivan
- Division of Pulmonary, Allergy and Critical Care Medicine (D.R.S.), Oregon Health and Science University, Portland, Oregon, USA; Center to Improve Veteran Involvement in their Care (CIVIC) (D.R.S.), VA Portland Health Care System, Portland, Oregon, USA; Knight Cancer Institute (D.R.S.), Oregon Health and Science University, Portland, Oregon, USA
| | - David B Bekelman
- Division of General Internal Medicine (A.G., D.B.B.), University of Colorado School of Medicine, Aurora, Colorado, USA; Department of Medicine, Eastern Colorado Health Care System, Department of Veterans Affairs (D.B.B.), Denver, Aurora, Colorado, USA
| | - Dio Kavalieratos
- Division of Palliative Medicine (D.K.), Emory University School of Medicine, Atlanta, Georgia, USA; Rollins School of Public Health (D.K.), Emory University, Atlanta, Georgia, USA
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Wells M, Harding S, Dixon G, Buckley K, Russell AM, Barratt SL. Patient and caregiver shared experiences of pulmonary fibrosis (PF): A systematic literature review. Respir Med 2024; 227:107659. [PMID: 38729528 DOI: 10.1016/j.rmed.2024.107659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/30/2024] [Accepted: 05/03/2024] [Indexed: 05/12/2024]
Abstract
Pulmonary Fibrosis (PF) describes a group of lung diseases characterised by progressive scarring (fibrosis). Symptoms worsen over time and include breathlessness, tiredness, and cough, giving rise to psychological distress. Significant morbidity accompanies PF, so ensuring patients' care needs are well defined and provided for, represents an important treatment strategy. The purpose of this systematic review was to synthesise what is currently known about the psychosocial morbidity, illness experience and needs of people with pulmonary fibrosis and their informal caregivers. Eight databases (MEDLINE, EMBASE, PUBMED, Cochrane database of Systematic reviews (CDSR), Web of Science Social Sciences Citation Index, PsycINFO, PsycARTICLES and CINAHL) were used to identify studies exploring the supportive needs of adults with PF and/or their caregivers. Methodological quality was assessed using the Mixed Methods Appraisal Tool. 53 studies were included, the majority using qualitative methodology (79 %, 42/53), 6 as part of mixed methodological studies. Supportive care needs were mapped to eight domains using an a priori framework analysis. Findings highlight a lack of psychological support throughout the course of the illness, misconceptions about and barriers to, the provision of palliative care despite its potential positive impacts. Patients and caregivers express a desire for greater disease specific education and information provision throughout the illness. Trials of complex interventions are needed to address the unique set of challenges for patients and carers living with PF.
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Affiliation(s)
- Matthew Wells
- Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol, UK.
| | - Sam Harding
- Research and Development, North Bristol NHS Trust, Bristol, UK.
| | - Giles Dixon
- Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol, UK; Department of Clinical and Biomedical Sciences, University of Exeter, Exeter, UK.
| | - Kirsten Buckley
- Library and Knowledge Services, North Bristol NHS Trust, Bristol, UK
| | - Anne-Marie Russell
- Birmingham Regional Interstitial Lung Disease Service, University Hospitals Birmingham NHS Trust, Birmingham, UK; Faculty of Life Sciences, University of Exeter, Exeter, UK.
| | - Shaney L Barratt
- Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol, UK; Academic Respiratory Unit, Department of Clinical Sciences, University of Bristol, Bristol, UK.
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Obrero-Gaitán E, Chau-Cubero CY, Lomas-Vega R, Osuna-Pérez MC, García-López H, Cortés-Pérez I. Effectiveness of virtual reality-based therapy in pulmonary rehabilitation of chronic obstructive pulmonary disease. A systematic review with meta-analysis. Heart Lung 2024; 65:1-10. [PMID: 38330853 DOI: 10.1016/j.hrtlng.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 01/29/2024] [Accepted: 01/29/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND In addition to conventional pulmonary rehabilitation (PR) programs for the treatment of chronic obstructive pulmonary disease (COPD), the use of virtual reality-based therapy (VRBT) has been proposed as an effective complementary tool to be included in PR programs for COPD. OBJECTIVES To analyze the effectiveness of VRBT on functional capacity, pulmonary function, and functional mobility in patients with COPD. METHODS A meta-analysis was carried out through a bibliographic search in PubMed (Medline), WOS, PEDro, CINAHL, CENTRAL, and Scopus since inception up to June 2023. The risk of bias was assessed using the PEDro scale, and the effect was determined using the standardized mean difference (SMD) and its 95 % confidence interval (95 % CI) in a random effects model. RESULTS Five RCTs, providing data from 344 participants with a mean age 65.7 ± 5.3 years old, were included. The mean methodological quality of the studies included was good (6.8 ± 1.6 points). The meta-analysis showed that VRBT was effective in increasing functional capacity, assessed with the 6 Min Walking Test, (SMD=0.4, 95 % CI 0.07 to 0.71, p = 0.017); pulmonary function, assessed with FEV1 (SMD=0.33, 95 %CI 0.01 to 0.65, p = 0.048); and functional mobility, assessed with the Get Up and Go Test (SMD=0.77, 95 % CI 0.5 to 1.1, p<0.001) in patients with COPD. CONCLUSION VRBT is suggested to be effective in increasing functional capacity, pulmonary function, and functional mobility in patients with COPD. Non-immersive VRBT is the most used modality of VRBT in PR.
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Affiliation(s)
- Esteban Obrero-Gaitán
- Faculty of Health Sciences. University of Jaén. Campus Las Lagunillas s/n, 23071, Jaén Spain
| | - Celim Yem Chau-Cubero
- Faculty of Health Sciences. University of Jaén. Campus Las Lagunillas s/n, 23071, Jaén Spain
| | - Rafael Lomas-Vega
- Faculty of Health Sciences. University of Jaén. Campus Las Lagunillas s/n, 23071, Jaén Spain
| | | | - Héctor García-López
- Faculty of Nursing, Physiotherapy and Medicine. University of Almería. Ctra. Sacramento s/n, La Cañada, 04120, Almería Spain.
| | - Irene Cortés-Pérez
- Faculty of Health Sciences. University of Jaén. Campus Las Lagunillas s/n, 23071, Jaén Spain
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Gebresillassie BM, Attia JR, Mersha AG, Harris ML. Prognostic models and factors identifying end-of-life in non-cancer chronic diseases: a systematic review. BMJ Support Palliat Care 2024:spcare-2023-004656. [PMID: 38580395 DOI: 10.1136/spcare-2023-004656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/23/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND Precise prognostic information, if available, is very helpful for guiding treatment decisions and resource allocation in patients with non-cancer non-communicable chronic diseases (NCDs). This study aimed to systematically review the existing evidence, examining prognostic models and factors for identifying end-of-life non-cancer NCD patients. METHODS Electronic databases, including Medline, Embase, CINAHL, Cochrane Library, PsychINFO and other sources, were searched from the inception of these databases up until June 2023. Studies published in English with findings mentioning prognostic models or factors related to identifying end-of-life in non-cancer NCD patients were included. The quality of studies was assessed using the Quality in Prognosis Studies tool. RESULTS The analysis included data from 41 studies, with 16 focusing on chronic obstructive pulmonary diseases (COPD), 10 on dementia, 6 on heart failure and 9 on mixed NCDs. Traditional statistical modelling was predominantly used for the identified prognostic models. Common predictors in COPD models included dyspnoea, forced expiratory volume in 1 s, functional status, exacerbation history and body mass index. Models for dementia and heart failure frequently included comorbidity, age, gender, blood tests and nutritional status. Similarly, mixed NCD models commonly included functional status, age, dyspnoea, the presence of skin pressure ulcers, oral intake and level of consciousness. The identified prognostic models exhibited varying predictive accuracy, with the majority demonstrating weak to moderate discriminatory performance (area under the curve: 0.5-0.8). Additionally, most of these models lacked independent external validation, and only a few underwent internal validation. CONCLUSION Our review summarised the most relevant predictors for identifying end-of-life in non-cancer NCDs. However, the predictive accuracy of identified models was generally inconsistent and low, and lacked external validation. Although efforts to improve these prognostic models should continue, clinicians should recognise the possibility that disease heterogeneity may limit the utility of these models for individual prognostication; they may be more useful for population level health planning.
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Affiliation(s)
- Begashaw Melaku Gebresillassie
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia
- Centre for Women's Health Research, The University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
- School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - John Richard Attia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Amanual Getnet Mersha
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Melissa L Harris
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia
- Centre for Women's Health Research, The University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
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Rao-Newton A, Gallagher E, Mickelsen J, Sanchez C, Forby F, Andrews K, Hosie A, Sheehan C, DeNatale M, Agar M. Timely Assessment of Breathing-Related Distress in Community Palliative Care: A Multidisciplinary Collaborative Quality Improvement Project. J Palliat Med 2024; 27:324-334. [PMID: 37962858 DOI: 10.1089/jpm.2022.0576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023] Open
Abstract
Background: Breathlessness is a common symptom for palliative patients that can cause distress and decrease function and quality of life. Palliative care services in Australia aim to routinely assess patients for breathing-related distress, but timely reassessment is not always achieved. Objective: To improve the timeliness of breathlessness reassessment in a home-based community palliative care service in New South Wales for people with moderate-to-severe breathing-related distress. Breathing-related distress was defined as a Symptom Assessment Score for "breathing problems" of four or more. Methods: This collaborative quality improvement (QI) project between SPHERE Palliative Care CAG, Stanford University mentors, and a Sydney metropolitan specialist palliative care service included a: (1) retrospective chart audit; (2) cause and effect analyses using a fishbone diagram; (3) development and implementation of key drivers and interventions; and (4) a pre-and-post evaluation of the timeliness of reassessment of breathing-related distress and changes in Symptom Assessment Scale scores for "breathing problems." Results: Key interventions included multidisciplinary education sessions to facilitate buy-in, with nurses as case managers responsible for breathlessness reassessment and documentation of scores, access and training in electronic palliative care data entry software, fortnightly monitoring and reporting of breathing-related distress scores, and development of an educational flowchart. The proportion of patients reassessed within seven days of an initial nursing assessment of moderate-to-severe breathing-related distress increased from 34% at baseline to 92% at six months. Conclusion: A local QI project increased the proportion of patients with a timely reassessment of their breathing-related distress in a community palliative care service.
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Affiliation(s)
- Angela Rao-Newton
- School of Nursing, College of Health and Medicine, University of Tasmania, Lilyfield, New South Wales, Australia
- Improving Palliative Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Elaine Gallagher
- Calvary Health Care Kogarah, Beverley Park, New South Wales, Australia
| | - Jake Mickelsen
- Stanford University School of Medicine, Palo Alto, California, USA
| | - Carmen Sanchez
- Calvary Health Care Kogarah, Beverley Park, New South Wales, Australia
| | - Felicity Forby
- Calvary Health Care Kogarah, Beverley Park, New South Wales, Australia
| | - Kate Andrews
- Calvary Health Care Kogarah, Beverley Park, New South Wales, Australia
| | - Annmarie Hosie
- Improving Palliative Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
- University of Notre Dame, Sydney, New South Wales, Australia
- St Vincent's Health Network Sydney, New South Wales, Australia
| | - Caitlin Sheehan
- Improving Palliative Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
- Calvary Health Care Kogarah, Beverley Park, New South Wales, Australia
| | | | - Meera Agar
- Improving Palliative Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
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Shin J, Hammer M, Cooley ME, Cooper BA, Paul SM, Cartwright F, Kober KM, Conley YP, Levine JD, Miaskowski C. Common and distinct risk factors that influence more severe and distressing shortness of breath profiles in oncology outpatients. Cancer Med 2024; 13:e7013. [PMID: 38400684 PMCID: PMC10891479 DOI: 10.1002/cam4.7013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/05/2024] [Accepted: 01/31/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Shortness of breath occurs in 10%-70% of oncology patients. Very little is known about interindividual variability in its severity and distress and associated risk factors. Using latent profile analyses (LPAs), purpose was to identify subgroups of patients with distinct severity and distress profiles for shortness of breath as single symptom dimensions. In addition, a joint LPA was done using patients' severity AND distress ratings. For each of the three LPAs, differences among the shortness of breath classes in demographic, clinical, symptom, stress, and resilience characteristics were evaluated. METHODS Patients completed ratings of severity and distress from shortness of breath a total of six times over two cycles of chemotherapy. All of the other measures were completed at enrollment (i.e., prior to the second or third cycle of chemotherapy). Separate LPAs were done using ratings of severity and distress, as well as a joint analysis using severity AND distress ratings. Differences among the latent classes were evaluated using parametric and nonparametric tests. RESULTS For severity, two classes were identified (Slight to Moderate [91.6%] and Moderate to Severe [8.4%]). For distress, two classes were identified (A Little Bit to Somewhat [83.9%] and Somewhat to Quite a Bit [16.1%]). For the joint LPA, two classes were identified (Lower Severity and Distress [79.9%] and Higher Severity and Distress [20.1%]). While distinct risk factors were associated with each of the LPAs, across the three LPAs, the common risk factors associated with membership in the worse class included: a past or current history of smoking, poorer functional status, and higher comorbidity burden. In addition, these patients had a higher symptom burden and higher levels of cancer-specific stress. CONCLUSIONS Clinicians can use the information provided in this study to identify high-risk patients and develop individualized interventions.
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Affiliation(s)
- Joosun Shin
- Dana‐Farber Cancer InstituteBostonMassachusettsUSA
| | | | | | - Bruce A. Cooper
- School of NursingUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Steven M. Paul
- School of NursingUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | | | - Kord M. Kober
- School of NursingUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Yvette P. Conley
- School of NursingUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Jon D. Levine
- School of MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Christine Miaskowski
- School of NursingUniversity of CaliforniaSan FranciscoCaliforniaUSA
- School of MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
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Kao LT, Ko SC, Chen PJ, Wu YC, Liao KM, Liang YS, Ho CH, Liang FW. Trend Analysis of Palliative Care Utilization in Patients with Chronic Obstructive Pulmonary Disease During Hospitalization from 2007 to 2018 in Taiwan. Int J Chron Obstruct Pulmon Dis 2023; 18:3015-3026. [PMID: 38143921 PMCID: PMC10748865 DOI: 10.2147/copd.s435954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/10/2023] [Indexed: 12/26/2023] Open
Abstract
Purpose Palliative care utilization among hospitalized patients with advanced chronic obstructive pulmonary disease (COPD) in Taiwan remains low despite its costs making it eligible for reimbursement since 2009. Few studies have examined the trends of palliative care utilization. We analyzed the annual rate, associated factors, and timing of the inpatient palliative care utilization by hospitalized patients with COPD. Patients and Methods We conducted a cross-sectional observational study between 1 January 2007 and 31 December 2018. Population-based claims data were extracted from Taiwan's National Health Insurance Research Database to identify patients aged ≧40 years with COPD five years before the first instance of inpatient palliative care utilization. Results There were 24,502 patients with COPD receiving inpatient palliative care. Our results indicated that older age, concomitant chronic conditions-especially cancer-and severity of comorbidities were associated with a higher rate of palliative care utilization by hospitalized patients with chronic obstructive pulmonary disease. In our study, the proportion of hospitalized patients with COPD receiving inpatient palliative care and having a Charlson comorbidity index score of 1-2 was lower than that of patients with cancer and a Charlson comorbidity index score ≧3 during the 12-year study-observation period. In addition, approximately 50% of hospitalized patients with COPD received palliative care within 18 months after their initial admission for COPD during the study period. However, individuals with a CCI score of 1-2 exhibited a slower entry into palliative care, with nearly 50% initiating it within the first two years. Conclusion Inpatient palliative care utilization by hospitalized patients with advanced COPD remains low due to various causes. Our findings highlight that palliative care may be considered by professional care providers as routine care and as a way to manage problematic symptoms during hospitalization.
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Affiliation(s)
- Li-Ting Kao
- Department of Respiratory Therapy, Chi Mei Medical Center, Tainan, Taiwan
| | - Shian-Chin Ko
- Center for Palliative Care, Chi Mei Medical Center, Tainan, Taiwan
| | - Ping-Jen Chen
- Department of Family Medicine and Division of Geriatrics and Gerontology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yu-Cih Wu
- Department of Medical Research, Chi Mei Medical Center, Tainan City, Taiwan
| | - Kuang-Ming Liao
- Department of Internal Medicine, Chi Mei Medical Center, Chiali, Tainan, Taiwan
| | - Yi-Shan Liang
- Department of Respiratory Therapy, Chi Mei Medical Center, Tainan, Taiwan
| | - Chung-Han Ho
- Department of Medical Research, Chi Mei Medical Center, Tainan City, Taiwan
- Department of Information Management, Southern Taiwan University of Science and Technology, Tainan City, Taiwan
- Cancer Center, Taipei Municipal Wanfang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Fu-Wen Liang
- Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Center for Big Data Research, Kaohsiung Medical University, Kaohsiung, Taiwan
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9
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Gainza-Miranda D, Sanz-Peces EM, Varela Cerdeira M, Prados Sanchez C, Alonso-Babarro A. Effectiveness of the integration of a palliative care team in the follow-up of patients with advanced chronic obstructive pulmonary disease: The home obstructive lung disease study. Heart Lung 2023; 62:186-192. [PMID: 37556860 DOI: 10.1016/j.hrtlng.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Access to palliative care for patients with end-stage chronic obstructive pulmonary disease (COPD) is still very poor. OBJECTIVES Evaluate our palliative care program for patients with advanced COPD by assessing whether the referral criteria for advanced COPD patients were adequate in identifying patients in end-of-life care and determine the results of the palliative care team's intervention METHODS: This was a prospective observational study of patients admitted to a multidisciplinary unit for advanced COPD. Data on sociodemographic variables, survival, symptomatology, quality of life, ACP, and health resource utilization were analyzed. RESULTS Eighty-three patients were included in this study. By the end of the follow-up period, 69 (83%) patients had died, mainly due to respiratory failure (96%). The median duration of survival from the start of follow-up was 4.27 months (95% confidence interval, 1.97-16.07). Most patients (94%) had a dyspnea level of 4. Sixty (72%) patients required opioids for dyspnea control. There were no significant differences in the quality of life of the patients during follow-up. Thirty (43%) patients died at home, 26 (38%) in a palliative care unit, and 13 (19%) in an acute care hospital. ACP was performed for 50 (72%) patients. Forty (57%) patients required palliative sedation during follow-up. Dyspnea was the reason for sedation in 34 (85%) patients. Hospital admissions and emergency room visits decreased significantly (p = 0.01) during follow-up. CONCLUSIONS Our integrated model allows for adequate selection of patients, facilitates symptom control and ACP, reduces resource utilization, and favors death at home.
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Affiliation(s)
- D Gainza-Miranda
- Equipo de Soporte Paliativo Domiciliario Dirección Asistencial Norte de Madrid, Madrid, Spain.
| | - E M Sanz-Peces
- Equipo de Soporte Paliativo Domiciliario Dirección Asistencial Norte de Madrid, Madrid, Spain
| | - M Varela Cerdeira
- Unidad de Cuidados Paliativos Hospital Universitario de la Paz, Madrid, Spain
| | - C Prados Sanchez
- Servicio Neumología Hospital Universitario de la Paz, Madrid, Spain
| | - A Alonso-Babarro
- Unidad de Cuidados Paliativos Hospital Universitario de la Paz, Madrid, Spain
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10
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Shin J, Kober K, Yates P, Wong ML, Cooper BA, Paul SM, Hammer M, Conley Y, Levine JD, Wright F, Miaskowski C. Higher Lifetime Stress and Symptom Burden Contribute to the Occurrence of Shortness of Breath. Semin Oncol Nurs 2023; 39:151471. [PMID: 37500312 PMCID: PMC11446157 DOI: 10.1016/j.soncn.2023.151471] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 06/10/2023] [Accepted: 06/21/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVES Among four classes of patients with distinct shortness of breath profiles, evaluate for differences in levels of global, cancer-specific, and cumulative life stress, as well as resilience; evaluate for differences in the occurrence rates for various stressful life events, and evaluate for differences in the severity of common co-occurring symptoms. DATA SOURCES Outpatients (N = 1338) completed questionnaires six times over two cycles of chemotherapy. The occurrence of shortness of breath was assessed using the Memorial Symptom Assessment Scale. Latent class analysis was used to identify subgroups of patients with distinct shortness of breath profiles. Differences among the classes were evaluated using parametric and nonparametric tests. CONCLUSION Shortness of breath classes were labeled based on their distinct occurrence trajectories: None (70.5%), Decreasing (8.2%), Increasing (7.8%), and High (13.5%). Compared to None class, Decreasing and High classes had higher global and cancer-specific stress scores. The High class reported higher occurrence rates for several adverse childhood experiences. Compared to None class, Decreasing and High classes had higher depression, anxiety, and morning fatigue scores and lower morning energy and cognitive function scores. IMPLICATIONS FOR NURSING PRACTICE Given the additive or synergistic relationships between stress, co-occurring symptoms, and shortness of breath, multimodal interventions that include stress management, exercise training, and/or symptom management may decrease shortness of breath in oncology patients.
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Affiliation(s)
- Joosun Shin
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, California
| | - Kord Kober
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, California
| | - Patsy Yates
- Cancer & Palliative Outcomes Centre, Centre for Health Transformation, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Melisa L Wong
- Department of Medicine, School of Medicine, University of California, San Francisco, California
| | - Bruce A Cooper
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, California
| | - Steven M Paul
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, California
| | - Marilyn Hammer
- The Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Yvette Conley
- Department of Health Promotion and Development, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jon D Levine
- Department of Medicine, School of Medicine, University of California, San Francisco, California
| | - Fay Wright
- Rory Meyers College of Nursing, New York University, New York, New York
| | - Christine Miaskowski
- Departments of Physiological Nursing and Anesthesia, School of Nursing and School of Medicine, University of California, San Francisco, California.
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11
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Vestergaard AHS, Ehlers LH, Neergaard MA, Christiansen CF, Valentin JB, Johnsen SP. Healthcare Costs at the End of Life for Patients with Non-cancer Diseases and Cancer in Denmark. PHARMACOECONOMICS - OPEN 2023; 7:751-764. [PMID: 37552432 PMCID: PMC10471564 DOI: 10.1007/s41669-023-00430-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/06/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVES To examine costs of care from a healthcare sector perspective within 1 year before death in patients with non-cancer diseases and patients with cancer. METHODS This nationwide registry-based study identified all Danish citizens dying from major non-cancer diseases or cancer in 2010-2016. Applying the cost-of-illness method, we included costs of somatic hospitals, including hospital-based specialist palliative care, primary care, prescription medicine and hospice expressed in 2022 euros. Costs of patients with non-cancer diseases and cancer were compared using regression analyses adjusting for sex, age, comorbidity, residential region, marital/cohabitation status and income level. RESULTS Within 1 year before death, mean total healthcare costs were €27,185 [95% confidence interval (CI) €26,970-27,401] per patient with non-cancer disease (n = 109,723) and €51,348 (95% CI €51,098-51,597) per patient with cancer (n = 108,889). The adjusted relative total healthcare costs, i.e. the ratio of the mean costs, of patients with non-cancer diseases was 0.64 (95% CI 0.63-0.66) at 12 months before death and 0.91 (95% CI 0.90-0.92) within 30 days before death compared with patients with cancer. Mean costs of hospital-based specialist palliative care and hospice in the year leading up to death were €17 (95% CI €13-20) and €90 (95% CI €77-102) per patient with non-cancer disease but €1552 (95% CI €1506-1598) and €3411 (95% CI €3342-3480) per patient with cancer. CONCLUSIONS Within 1 year before death, total healthcare costs, mainly driven by hospital costs, were substantially lower for patients with non-cancer diseases compared with patients with cancer. Moreover, the costs of hospital-based specialist palliative care and hospice were minimal for patients with non-cancer diseases.
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Affiliation(s)
- Anne Høy Seemann Vestergaard
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus N, Denmark.
| | - Lars Holger Ehlers
- Danish Center for Healthcare Improvements, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Aalborg Ø, Denmark
- Nordic Institute of Health Economics, Aarhus, Denmark
| | - Mette Asbjoern Neergaard
- Palliative Care Unit, Department of Oncology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus N, Denmark
| | - Christian Fynbo Christiansen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus N, Denmark
| | - Jan Brink Valentin
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Aalborg Ø, Denmark
| | - Søren Paaske Johnsen
- Danish Center for Healthcare Improvements, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Aalborg Ø, Denmark
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Aalborg Ø, Denmark
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12
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Bugajski A, Morgan H, Wills W, Jacklin K, Alleyne S, Kolta B, Lengerich A, Rechenberg K. Anxiety and Depressive Symptoms in Patients with COPD: Modifiable Explanatory Factors. West J Nurs Res 2023; 45:316-326. [PMID: 36250352 DOI: 10.1177/01939459221129949] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
Anxiety and depressive symptoms affect up to 80% of people with chronic obstructive pulmonary disease (COPD). To reduce this symptom burden, clinicians should target modifiable explanatory factors while accounting for nonmodifiable explanatory factors of these symptoms. The purpose of this secondary data analysis was to examine which modifiable factors explain anxiety and depressive symptoms in COPD. This secondary data analysis of 1,760 COPD patients used multiple regression to explain anxiety and depressive symptoms from sets of modifiable patient characteristics and demographic controls. Clinically significant symptoms of anxiety or depression presented in 29.6% (n = 526) of participants, and 20.6% (n = 363) had both. Significant modifiable explanatory factors of both disorder symptoms were perceived functional status, functional capacity, psychosocial impact, symptom self-management, and significant symptoms for the other. Somatic symptom burden and dyspnea explained anxiety and depressive symptoms, respectively. Addressing these modifiable factors may reduce anxiety and depressive symptoms in patients with COPD.
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Affiliation(s)
- Andrew Bugajski
- Department of Research and Sponsored Studies, Lakeland Regional Health Medical Center, Lakeland, FL, USA
| | - Hailey Morgan
- College of Nursing, University of South Florida, Tampa, FL, USA
| | - Walter Wills
- Department of Research and Sponsored Studies, Lakeland Regional Health Medical Center, Lakeland, FL, USA.,College of Nursing, University of South Florida, Tampa, FL, USA
| | - Kellcee Jacklin
- Department of Research and Sponsored Studies, Lakeland Regional Health Medical Center, Lakeland, FL, USA
| | - Shirley Alleyne
- Department of Psychiatry, Lakeland Regional Health Medical Center, Lakeland, FL, USA
| | - Bishoy Kolta
- Department of Psychiatry, Lakeland Regional Health Medical Center, Lakeland, FL, USA
| | - Alexander Lengerich
- Eastern Colorado VA Health Care System, Rocky Mountain Regional Medical Center, Denver, CO, USA
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13
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Iyer AS, Wells RD, Dionne-Odom JN, Bechthold AC, Armstrong M, Byun JY, O'Hare L, Taylor R, Ford S, Coffee-Dunning J, Dransfield MT, Brown CJ, Bakitas MA. Project EPIC (Early Palliative Care In COPD): A Formative and Summative Evaluation of the EPIC Telehealth Intervention. J Pain Symptom Manage 2023; 65:335-347.e3. [PMID: 36496113 PMCID: PMC10023469 DOI: 10.1016/j.jpainsymman.2022.11.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022]
Abstract
CONTEXT Early, concurrent palliative care interventions in chronic obstructive pulmonary disease (COPD) are limited. Project EPIC (Early Palliative Care In COPD) is a multiphase mixed methods study working to fill this gap. OBJECTIVES To conduct a formative and summative evaluation of EPIC, a telephonic nurse coach-led early palliative care intervention for COPD adapted from the ENABLE© intervention in cancer. METHODS Phase I Formative Evaluation: Patients with moderate-to-very-severe COPD, family caregivers, and pulmonary and palliative care clinicians rated the acceptability and feasibility of EPIC (≥4 out of five on a Likert-scale survey). Phase II Summative Evaluation: Patients and family caregivers in Phase I participated in a pilot of the three month EPIC prototype to evaluate intervention and data collection feasibility (≥70% completion) and to seek qualitative feedback. RESULTS Phase I Formative Evaluation: Patients (n=10), family caregivers (n=10), pulmonary clinicians (n=6), and palliative care clinicians (n=6) found EPIC acceptable and feasible to support adaptation, while priority early palliative care needs in COPD from our prior research mapped well to the EPIC prototype. Phase II Summative Evaluation: Patients (n=5; ages 49-72, 40% moderate COPD, 40% Black) and their family caregivers (n=5; ages 51-73, 40% Black) completed 100% of EPIC prototype components, including weekly telephone sessions, a one month follow-up call, Advance Directive, palliative care clinic attendance, and 95% of monthly phone data collection sessions. Feedback from participants about EPIC was all positive. CONCLUSION EPIC was acceptable and feasible in patients with COPD and their family caregivers. Larger feasibility and effectiveness trials are warranted.
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Affiliation(s)
- Anand S Iyer
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine (A.S.I., L.O.H., M.T.D.), University of Alabama at Birmingham, Birmingham, Alabama; Center for Palliative and Supportive Care, Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine (A.S.I., R.D.W., J.N.D., J.C., M.A.B.), University of Alabama at Birmingham, Birmingham, Alabama; School of Nursing (A.S.I., R.D.W., J.N.D., J.C., M.A.B.), University of Alabama at Birmingham, Birmingham, Alabama.
| | - Rachel D Wells
- Center for Palliative and Supportive Care, Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine (A.S.I., R.D.W., J.N.D., J.C., M.A.B.), University of Alabama at Birmingham, Birmingham, Alabama; School of Nursing (A.S.I., R.D.W., J.N.D., J.C., M.A.B.), University of Alabama at Birmingham, Birmingham, Alabama
| | - J Nicholas Dionne-Odom
- Center for Palliative and Supportive Care, Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine (A.S.I., R.D.W., J.N.D., J.C., M.A.B.), University of Alabama at Birmingham, Birmingham, Alabama; School of Nursing (A.S.I., R.D.W., J.N.D., J.C., M.A.B.), University of Alabama at Birmingham, Birmingham, Alabama
| | - Avery C Bechthold
- School of Nursing (A.S.I., R.D.W., J.N.D., J.C., M.A.B.), University of Alabama at Birmingham, Birmingham, Alabama
| | - Margaret Armstrong
- School of Nursing (A.S.I., R.D.W., J.N.D., J.C., M.A.B.), University of Alabama at Birmingham, Birmingham, Alabama
| | - Jun Yeong Byun
- School of Nursing (A.S.I., R.D.W., J.N.D., J.C., M.A.B.), University of Alabama at Birmingham, Birmingham, Alabama
| | - Lanier O'Hare
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine (A.S.I., L.O.H., M.T.D.), University of Alabama at Birmingham, Birmingham, Alabama; School of Nursing (A.S.I., R.D.W., J.N.D., J.C., M.A.B.), University of Alabama at Birmingham, Birmingham, Alabama
| | - Richard Taylor
- School of Nursing (A.S.I., R.D.W., J.N.D., J.C., M.A.B.), University of Alabama at Birmingham, Birmingham, Alabama
| | - Stephanie Ford
- School of Nursing (A.S.I., R.D.W., J.N.D., J.C., M.A.B.), University of Alabama at Birmingham, Birmingham, Alabama
| | - Jazmine Coffee-Dunning
- Center for Palliative and Supportive Care, Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine (A.S.I., R.D.W., J.N.D., J.C., M.A.B.), University of Alabama at Birmingham, Birmingham, Alabama; School of Nursing (A.S.I., R.D.W., J.N.D., J.C., M.A.B.), University of Alabama at Birmingham, Birmingham, Alabama
| | - Mark T Dransfield
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine (A.S.I., L.O.H., M.T.D.), University of Alabama at Birmingham, Birmingham, Alabama; Birmingham Veterans Affairs Medical Center (M.T.D.), Birmingham, Alabama
| | - Cynthia J Brown
- Department of Internal Medicine(C.J.B.), Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Marie A Bakitas
- Center for Palliative and Supportive Care, Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine (A.S.I., R.D.W., J.N.D., J.C., M.A.B.), University of Alabama at Birmingham, Birmingham, Alabama; School of Nursing (A.S.I., R.D.W., J.N.D., J.C., M.A.B.), University of Alabama at Birmingham, Birmingham, Alabama
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Shin J, Kober K, Wong ML, Yates P, Miaskowski C. Systematic review of the literature on the occurrence and characteristics of dyspnea in oncology patients. Crit Rev Oncol Hematol 2023; 181:103870. [PMID: 36375635 DOI: 10.1016/j.critrevonc.2022.103870] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 10/31/2022] [Accepted: 11/10/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Dyspnea is a common and distressing symptom for oncology patients.However, dyspnea is not well-characterized and often underestimated by clinicians. This systematic review summarizes the prevalence, intensity, distress, and impact of dyspnea in oncology patients and identifies research gaps. METHODS A search of all of the relevant databases was done from 2009 to May 2022. A qualitative synthesis of the extant literature was performed using established guidelines. RESULTS One hundred-seventeen studies met inclusion criteria. Weighted grand mean prevalence of dyspnea in patients with advanced cancer was 58.0%. Intensity of dyspnea was most common dimension evaluated, followed by the impact and distress. Depression and anxiety were the most common symptoms that co-occurred with dyspnea. CONCLUSION Numerous methodologic challenges were evident across studies. Future studies need to use valid and reliable measures; evaluate the impact of dyspnea; and determine biomarkers for dyspnea.
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Affiliation(s)
- Joosun Shin
- School of Nursing, University of California, San Francisco, CA, USA.
| | - Kord Kober
- School of Nursing, University of California, San Francisco, CA, USA; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Melisa L Wong
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA; Division of Hematology/Oncology, Division of Geriatrics, University of California, San Francisco, CA, USA
| | - Patsy Yates
- Cancer & Palliative Outcomes Centre, Centre for Health Transformation, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia; School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Christine Miaskowski
- School of Nursing, University of California, San Francisco, CA, USA; School of Medicine, University of California, San Francisco, CA, USA; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
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15
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Mitzel H, Brown D, Thomas M, Curl B, Wild M, Kelsch A, Muskrat J, Hossain A, Ryan K, Babalola O, Burgard M, Mehedi M. Patient-Centered Discussion on End-of-Life Care for Patients with Advanced COPD. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:254. [PMID: 35208578 PMCID: PMC8878082 DOI: 10.3390/medicina58020254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 01/30/2022] [Accepted: 02/01/2022] [Indexed: 11/16/2022]
Abstract
Exacerbations of chronic obstructive pulmonary disease (COPD) may lead to a rapid decline in health and subsequent death, an unfortunate tyranny of having COPD-an irreversible health condition of 16 million individuals in the USA totaling 60 million in the world. While COPD is the third largest leading cause of death, causing 3.23 million deaths worldwide in 2019 (according to the WHO), most patients with COPD do not receive adequate treatment at the end stages of life. Although death is inevitable, the trajectory towards end-of-life is less predictable in severe COPD. Thus, clinician-patient discussion for end-of-life and palliative care could bring a meaningful life-prospective to patients with advanced COPD. Here, we summarized the current understanding and treatment of COPD. This review also highlights the importance of patient-centered discussion and summarizes current status of managing patients with advanced COPD.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Masfique Mehedi
- School of Medicine and Health Sciences, University of North Dakota, Grand Forks, ND 58202, USA; (H.M.); (D.B.); (M.T.); (B.C.); (M.W.); (A.K.); (J.M.); (A.H.); (K.R.); (O.B.); (M.B.)
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16
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Bigger SE, Haddad L, Glenn L. Cardiac and Pulmonary Diagnoses and Advance Care Planning in Home Health. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2022. [DOI: 10.1177/10848223211073711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Chronic cardiovascular and pulmonary diseases are prevalent in the US home health population. Heart failure and chronic obstructive pulmonary disease are both chronic and terminal, but they are not always perceived as serious illnesses with imminent death. Therefore, they provide a context for advance care planning that is distinct from the diagnostic contexts of cancer, end-stage renal disease, or dementia. Advance care planning is defined as a process that supports adults at any age or stage of health in understanding and sharing their goals, values, and preferences about future medical care, including the designation of a surrogate decision-maker. This study tests the hypothesis that US home health agencies with higher percentages of patients with chronic cardiovascular and pulmonary conditions have less robust advance care planning protocols. The Spearman correlation coefficient was r = 0.22 ( S = 74684, P = .025, 1-tailed), which was statistically significant and an unexpected finding. The greater percentage of patients with chronic cardiac and pulmonary diagnoses in an agency, the more robust the advance care planning protocol was. This supports our previous findings and existing literature indicating that agencies may be using exacerbation events marked by acute care use as opportunities to initiate or repeat advance care planning.
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Affiliation(s)
| | - Lisa Haddad
- East Tennessee State University, Johnson City, TN, USA
| | - Lee Glenn
- East Tennessee State University, Johnson City, TN, USA
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17
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Krajnik M, Hepgul N, Wilcock A, Jassem E, Bandurski T, Tanzi S, Simon ST, Higginson IJ, Jolley CJ. Do guidelines influence breathlessness management in advanced lung diseases? A multinational survey of respiratory medicine and palliative care physicians. BMC Pulm Med 2022; 22:41. [PMID: 35045847 PMCID: PMC8768441 DOI: 10.1186/s12890-022-01835-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 12/31/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Respiratory medicine (RM) and palliative care (PC) physicians' management of chronic breathlessness in advanced chronic obstructive pulmonary disease (COPD), fibrotic interstitial lung disease (fILD) and lung cancer (LC), and the influence of practice guidelines was explored via an online survey. METHODS A voluntary, online survey was distributed to RM and PC physicians via society newsletter mailing lists. RESULTS 450 evaluable questionnaires (348 (77%) RM and 102 (23%) PC) were analysed. Significantly more PC physicians indicated routine use (often/always) of opioids across conditions (COPD: 92% vs. 39%, fILD: 83% vs. 36%, LC: 95% vs. 76%; all p < 0.001) and significantly more PC physicians indicated routine use of benzodiazepines for COPD (33% vs. 10%) and fILD (25% vs. 12%) (both p < 0.001). Significantly more RM physicians reported routine use of a breathlessness score (62% vs. 13%, p < 0.001) and prioritised exercise training/rehabilitation for COPD (49% vs. 7%) and fILD (30% vs. 18%) (both p < 0.001). Overall, 40% of all respondents reported reading non-cancer palliative care guidelines (either carefully or looked at them briefly). Respondents who reported reading these guidelines were more likely to: routinely use a breathlessness score (χ2 = 13.8; p < 0.001), use opioids (χ2 = 12.58, p < 0.001) and refer to pulmonary rehabilitation (χ2 = 6.41, p = 0.011) in COPD; use antidepressants (χ2 = 6.25; p = 0.044) and refer to PC (χ2 = 5.83; p = 0.016) in fILD; and use a handheld fan in COPD (χ2 = 8.75, p = 0.003), fILD (χ2 = 4.85, p = 0.028) and LC (χ2 = 5.63; p = 0.018). CONCLUSIONS These findings suggest a need for improved dissemination and uptake of jointly developed breathlessness management guidelines in order to encourage appropriate use of existing, evidence-based therapies. The lack of opioid use by RM, and continued benzodiazepine use in PC, suggest that a wider range of acceptable therapies need to be developed and trialled.
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Affiliation(s)
- Małgorzata Krajnik
- Department of Palliative Care, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Skłodowskiej-Curie 9, 85-094, Bydgoszcz, Poland
| | - Nilay Hepgul
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Andrew Wilcock
- Palliative Medicine, Hayward House Specialist Palliative Care Unit, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK
| | - Ewa Jassem
- Department of Pneumonology, Medical University of Gdańsk, Gdańsk, Poland
| | - Tomasz Bandurski
- Department of Radiology, Informatics and Statistics, Medical University of Gdańsk, Gdańsk, Poland
| | - Silvia Tanzi
- Palliative Care Unit, Azienda USL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Steffen T Simon
- Department of Palliative Medicine and Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Caroline J Jolley
- Centre for Human & Applied Physiological Sciences, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, Shepherd's House, Rm 4.4, Guy's Campus, London, SE1 1UL, UK.
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18
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Courtright KR, Weissman GE. Administrative Data for Palliative Care Research: Friend or Foe? Ann Am Thorac Soc 2022; 19:5-7. [PMID: 34971355 PMCID: PMC8787795 DOI: 10.1513/annalsats.202109-1048ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Katherine R Courtright
- Palliative and Advanced Illness Research Center
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, and
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gary E Weissman
- Palliative and Advanced Illness Research Center
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, and
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
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Piamjariyakul U, Smothers A, Young S, Morrissey E, Petitte T, Wen S, Zulfikar R, Sangani R, Shafique S, Smith CE, Bosak K. Verifying intervention fidelity procedures for a palliative home care intervention with pilot study results. Res Nurs Health 2021; 44:854-863. [PMID: 34196013 PMCID: PMC8440457 DOI: 10.1002/nur.22166] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 06/05/2021] [Accepted: 06/10/2021] [Indexed: 11/06/2022]
Abstract
Fidelity (consistency of intervention implementation) is essential to rigorous research. Intervention fidelity maintains study internal validity, intervention reproducibility, and transparency in the research conduct. The purpose of this manuscript is to describe intervention fidelity strategies/procedures developed for a pilot study testing a new palliative care nursing intervention (FamPALcare) for families managing advanced lung disease. The procedures described herein are based on the fidelity best practices recommendations from the NIH Consortium. An evidence-based checklist guided observational ratings of the fidelity procedures used and the intervention content implemented in each intervention session. Descriptive data on how participants understood (received), enacted, or used the intervention information were summarized. The fidelity checklist observational scores found ≥93% of the planned intervention content was implemented, and the fidelity strategies were adhered to consistently during each intervention session. The small variation (7%) in implementation was expected and related to participants' varying experiences, input, and/or questions. The helpfulness scale items include participants' ability to use home care resources, to anticipate and manage end-of-life symptoms, and to use Advance Directive forms. The high ratings (M = 4.4) on the 1-5 (very helpful) Likert Helpfulness Scale verified participants utilized the information from the intervention. Furthermore, there was an improvement in patients' breathlessness scores and completion of Advance Directive forms at 3 months after baseline. It is essential to plan intervention fidelity strategies to use throughout a study and to report fidelity results.
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Affiliation(s)
| | | | | | - Elizabeth Morrissey
- West Virginia University, School of Nursing
- West Virginia University Hospital
| | | | - Sijin Wen
- West Virginia University, Department of Biostatistics School of Public Health
| | - Rafia Zulfikar
- West Virginia University, Section of Pulmonary, Critical Care, and Sleep Medicine, School of Medicine
| | - Rahul Sangani
- West Virginia University, Section of Pulmonary, Critical Care, and Sleep Medicine, School of Medicine
| | - Saima Shafique
- West Virginia University, Department of Epidemiology School of Public Health
| | - Carol E Smith
- University of Kansas Medical Center, School of Nursing
- University of Kansas Medical Center, School of Preventive Medicine
| | - Kelly Bosak
- University of Kansas Medical Center, School of Nursing
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Henoch I, Ekberg-Jansson A, Löfdahl CG, Strang P. Benefits, for patients with late stage chronic obstructive pulmonary disease, of being cared for in specialized palliative care compared to hospital. A nationwide register study. BMC Palliat Care 2021; 20:130. [PMID: 34429078 PMCID: PMC8386075 DOI: 10.1186/s12904-021-00826-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 08/06/2021] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND In early stage chronic obstructive pulmonary disease (COPD), dyspnea has been reported as the main symptom; but at the end of life, patients dying from COPD have a heavy symptom burden. Still, specialist palliative care is seldom offered to patients with COPD; they more often receive end of life care in hospitals. Furthermore, symptoms, symptom relief and care activities in the last week of life for COPD patients are rarely studied. The aim of this study was to compare patient and care characteristics in late stage COPD patients treated in specialized palliative care (SPC) versus hospital. METHODS Two nationwide registers were merged, the Swedish National Airway Register (SNAR) and the Swedish Register of Palliative Care (SRPC). Patients with COPD and < 50% of predicted forced expiratory volume in 1 s (FEV1), who had died in inpatient or outpatient SPC (n = 159) or in hospital (n = 439), were identified. Clinical COPD characteristics were extracted from the SNAR, and end of life (EOL) care characteristics from the SRPC. Descriptive statistics were used to describe the sample and the registered care and treatments. Independent samples t-test, Mantel-Haenszel chi-square test and Fisher's exact test was used to compare variables. To examine predictors of place of death, bivariate and multivariate logistic regression analyses were performed with a dependent variable with demographic and clinical variables used as independent variables. RESULTS The patients in hospitals were older and more likely to have heart failure or hypertension. Pain was more frequently reported and relieved in SPC than in hospitals (p = 0.001). Rattle, anxiety, delirium and nausea were reported at similar frequencies between the settings; but rattle, anxiety, delirium, and dyspnea were more frequently relieved in SPC (all p < 0.001). Compared to hospital, SPC was more often the preferred place of care (p < 0.001). In SPC, EOL discussions with patients and families were more frequently held than in hospital (p < 0.001). Heart failure increased the probability of dying in hospital while lung cancer increased the probability of dying in SPC. CONCLUSION This study provides evidence for referring more COPD patients to SPC, which is more focused on symptom management and psychosocial and existential support.
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Affiliation(s)
- Ingela Henoch
- Department of Research and Devlopment, Angered Hospital, Gothenburg, Sweden.
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30, Gothenburg, Sweden.
| | - Ann Ekberg-Jansson
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Claes-Göran Löfdahl
- University of Lund, Lund, Sweden
- COPD Center, Institute of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Peter Strang
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
- Research and Development Unit, Stockholms Sjukhem Foundation, Stockholm, Sweden
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21
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Matsunuma R, Yamaguchi T, Mori M, Ikari T, Suzuki K, Matsuda Y, Matsumoto Y, Watanabe H, Amano K, Kamura R, Kizawa Y. Predictive Factors for the Development of Dyspnea Within 7 Days After Admission Among Terminally Ill Cancer Patients. Am J Hosp Palliat Care 2021; 39:413-420. [PMID: 34235973 DOI: 10.1177/10499091211028817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Predictive factors for the development of dyspnea have not been reported among terminally ill cancer patients. OBJECTIVE This current study aimed to identify the predictive factors attributed to the development of dyspnea within 7 days after admission among patients with cancer. METHODS This was a secondary analysis of a multicenter prospective observational study on the dying process among patients admitted in inpatient hospices/palliative care units. Patients were divided into 2 groups: those who developed dyspnea (development group) and those who did not (non-development group). To determine independent predictive factors, univariate and multivariate analyses using the logistic regression model were performed. RESULTS From January 2017 to December 2017, 1159 patients were included in this analysis. Univariate analysis showed that male participants, those with primary lung cancer, ascites, and Karnofsky Performance Status score (KPS) of ≤40, smokers, and benzodiazepine users were significantly higher in the development group. Multivariate analysis revealed that primary lung cancer (odds ratio [OR]: 2.80, 95% confidence interval [95% CI]: 1.47-5.31; p = 0.002), KPS score (≤40) (OR: 1.84, 95% CI: 1.02-3.31; p = 0.044), and presence of ascites (OR: 2.34, 95% CI: 1.36-4.02; p = 0.002) were independent predictive factors for the development of dyspnea. CONCLUSIONS Lung cancer, poor performance status, and ascites may be predictive factors for the development of dyspnea among terminally ill cancer patients. However, further studies should be performed to validate these findings.
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Affiliation(s)
- Ryo Matsunuma
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takashi Yamaguchi
- Division of Palliative Care, Department of Medicine, Konan Medical Center, Kobe, Japan
| | - Masanori Mori
- Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Tomoo Ikari
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Kozue Suzuki
- Department of Palliative Care, Tokyo Metropolitan Cancer, and Infectious Disease Center, Komagome Hospital, Tokyo, Japan
| | - Yoshinobu Matsuda
- Department of Psychosomatic Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Yoshihisa Matsumoto
- Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwa, Japan
| | | | - Koji Amano
- Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan.,Department of Palliative and Supportive Medicine, Aichi Medical University, Graduate School of Medicine, Aichi, Japan
| | - Rena Kamura
- Yodogawa Christian Hospital, Hospice, Osaka, Japan
| | - Yoshiyuki Kizawa
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
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22
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Fairlamb HJ, Murtagh FEM. Health professionals' perceptions of palliative care for end-stage cardiac and respiratory conditions: a qualitative interview study. BMC Palliat Care 2021; 20:103. [PMID: 34233688 PMCID: PMC8265062 DOI: 10.1186/s12904-021-00805-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND End-stage cardiac and respiratory diseases are common in the UK. People with these end-stage conditions experience similar, or even worse, symptomatic suffering to cancer patients but are less likely to receive specialist palliative care services. The objective of this study is to explore health professional perceptions and current practices in relation to specialist palliative care for patients with end-stage cardiac and respiratory disease. METHODS Qualitative study using in-depth interviews with health professionals, audio recorded and transcribed verbatim for thematic analysis. The study was conducted with doctors and nurses from cardiology, respiratory, and palliative care specialities in the UK. The participants had to be involved clinically in providing care to people with end-stage cardiac or respiratory diseases. RESULTS A total of 16 health professionals participated (5 cardiology, 5 respiratory, and 6 palliative care). Participants reported variable disease trajectories in these diseases making deciding on timing of palliative care involvement difficult. This was complicated by lack of advance care planning discussions, attributed to poor communication, and lack of health professional time and confidence. Participants reported poor interdepartmental education and limited specialist palliative care involvement in multidisciplinary teams. CONCLUSIONS Palliative care for end-stage cardiac and respiratory diseases needs more attention in research and practice. Better integration of advance care planning discussions and early patient education/professional awareness are needed to enable timely referral to palliative care. Moreover, increased interdepartmental working for health professionals via joint educational and clinical meetings is perceived as likely to support earlier and increased referral to specialist palliative care services.
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Affiliation(s)
| | - Fliss E M Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
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23
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Costa AR, Lunet N, Martins-Branco D, Gomes B, Lopes S. Hospitalizations at the End of Life Among Chronic Obstructive Pulmonary Disease and Lung Cancer Patients: A Nationwide Study. J Pain Symptom Manage 2021; 62:48-57. [PMID: 33221384 DOI: 10.1016/j.jpainsymman.2020.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/08/2020] [Accepted: 11/11/2020] [Indexed: 11/29/2022]
Abstract
CONTEXT Patients with chronic obstructive pulmonary disease (COPD) and lung cancer report several symptoms at the end of life and may share palliative care needs. However, these disease groups have distinct health care use. OBJECTIVES To compare the frequency and length of hospitalizations during the last month of life between patients with COPD and lung cancer, assessing the main characteristics associated with these outcomes. METHODS Data were retrieved from the Portuguese Hospital Morbidity Database. Deceased patients in a public hospital from mainland Portugal (2010-2015), with COPD as the main diagnosis of the last hospitalization (n = 2942) were sex and age matched (1:1) with patients with lung cancer. The association of patients' main diagnosis, and individual, hospital and area of residence characteristics, on frequency (>1) and length (>14 days) of end-of-life hospitalizations were quantified through adjusted odds ratio (OR) and respective 95% confidence intervals (CIs). RESULTS Hospitalizations for >14 days during the last month of life were more likely for lung cancer patients than COPD patients (OR = 1.12; 95% CI = 1.00-1.25). Among patients with COPD, male sex (OR = 1.50; 95% CI = 1.25-1.80) and death in a large hospital (OR = 1.82; 95% CI = 1.41-2.35) were positively associated with longer hospitalizations; the occurrence of >1 hospitalization and hospitalizations for >14 days were less likely among those from rural areas (OR = 0.72, 95% CI = 0.55-0.94; OR = 0.67, 95% CI = 0.54-0.83, respectively). In patients with lung cancer, male sex was negatively associated with longer hospitalizations (OR = 0.82; 95% CI = 0.69-0.98). CONCLUSION At the end of life, patients with lung cancer had longer hospitalizations than patients with COPD, and the main characteristics associated with the frequency and length of hospitalizations differed according to the patients' main diagnosis.
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Affiliation(s)
- Ana Rute Costa
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.
| | - Nuno Lunet
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Diogo Martins-Branco
- Serviço de Oncologia Médica, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Lisbo, Portugal
| | - Barbara Gomes
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, United Kingdom; Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal
| | - Sílvia Lopes
- Escola Nacional de Saúde Pública, Centro de Investigação em Saúde Pública, Universidade NOVA de Lisboa, Lisboa, Portugal; Comprehensive Health Research Centre, Universidade NOVA de Lisboa, Lisboa, Portugal
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24
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High flow nasal therapy in the management of hypoxemic dyspnea at the end of life. Support Care Cancer 2021; 29:6179-6181. [PMID: 33990883 PMCID: PMC8121635 DOI: 10.1007/s00520-021-06279-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 05/05/2021] [Indexed: 11/07/2022]
Abstract
Refractory dyspnea is challenging for physicians treating patients near to the end of life. High-flow nasal therapy (HFNT). We report a case in which HFNS was effective in a patient in the last days of life to mitigate dyspnea allowing a minimal quality of life for some days before dying. HFNT may be helpful for severely hypoxemic patients who are unresponsive to common measured adopted in the last weeks–days of life of advanced cancer patients. Future studies should assess an early use of this device in combination with lower doses of opioids or as an alternative.
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25
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Reipas KM, Grossman DL, Lock K, Caraiscos VB. Examining the Characteristics of Patients With Non-Malignant Lung Disease at the Time of Referral to An Inter-Professional Supportive Care Clinic. Am J Hosp Palliat Care 2021; 38:1329-1335. [PMID: 33823617 DOI: 10.1177/10499091211005698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
CONTEXT Patients with non-malignant, advanced lung diseases (NMALD), such as chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD), experience a high symptom burden over a prolonged period. Involvement of palliative care has been shown to improve symptom management, reduce hospital visits and enhance psychosocial support; however, optimal timing of referral is unknown. OBJECTIVE The aim of this study was to identify the stage in the illness trajectory that patients with NMALD are referred to an ambulatory palliative care clinic. METHODS A retrospective chart review was conducted on all patients with NMALD who attended a Supportive Care Clinic (SCC) between March 1, 2017 and March 31, 2019. RESULTS Thirty patients attended the SCC during the study period. The most common diagnoses included COPD (36.7%), ILD (36.7%), and bronchiectasis (3.3%). At the time of initial consultation, the majority (89.4%) had Medical Research Council (MRC) class 4-5 dyspnea, however, only 1 patient had been prescribed opioids for management of breathlessness. Twenty-six patients had advance care planning discussions in the SCC. Phone appointments were a highly utilized feature of the program as patients had difficulty attending in-person appointments due to frailty and dyspnea. One-half of patients had at least 1 disease-related hospital admission in the previous year. Six patients were referred directly to home palliative care at their initial consultation. CONCLUSIONS Referral to palliative care often occurs at late stages in non-malignant lung disease. Further, opioids for the management of dyspnea are significantly underutilized by non-palliative providers.
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Affiliation(s)
- Kristen M Reipas
- Department of Family and Community Medicine, 7938University of Toronto, Toronto, Ontario, Canada
| | - Daphna L Grossman
- Department of Family and Community Medicine, 7938University of Toronto, Toronto, Ontario, Canada.,Department of Family and Community Medicine, 8613North York General Hospital, Toronto, Ontario, Canada
| | - Karen Lock
- Department of Medicine, 8613North York General Hospital, Toronto, Ontario, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Valerie B Caraiscos
- Department of Family and Community Medicine, 7938University of Toronto, Toronto, Ontario, Canada.,Department of Family and Community Medicine, 8613North York General Hospital, Toronto, Ontario, Canada
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26
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Barnes-Harris M, Allingham S, Morgan D, Ferreira D, Johnson MJ, Eagar K, Currow D. Comparing functional decline and distress from symptoms in people with thoracic life-limiting illnesses: lung cancers and non-malignant end-stage respiratory diseases. Thorax 2021; 76:989-995. [PMID: 33593929 DOI: 10.1136/thoraxjnl-2020-216039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 12/23/2020] [Accepted: 02/01/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND Malignant and non-malignant respiratory diseases account for >4.6 million deaths annually worldwide. Despite similar symptom burdens, serious inequities in access to palliative care persists for people with non-malignant respiratory diseases. AIM To compare functional decline and symptom distress in advanced malignant and non-malignant lung diseases using consecutive, routinely collected, point-of-care national data. SETTING/PARTICIPANTS The Australian national Palliative Care Outcomes Collaboration collects functional status (Australia-modified Karnofsky Performance Status (AKPS)) and symptom distress (patient-reported 0-10 numerical rating scale) in inpatient and community settings. Five years of data used Joinpoint and weighted scatterplot smoothing. RESULTS In lung cancers (89 904 observations; 18 586 patients) and non-malignant end-stage respiratory diseases (14 827 observations; 4279 patients), age at death was significantly lower in people with lung cancer (73 years; IQR 65-81) than non-malignant end-stage respiratory diseases (81 years; IQR 73-87 years; p<0.001). Four months before death, median AKPS was 40 in lung cancers and 30 in non-malignant end-stage respiratory diseases (p<0.001). Functional decline was similar in the two groups and accelerated in the last month of life. People with non-malignant diseases accessed palliative care later.Pain-related distress was greater with cancer and breathing-related distress with non-malignant disease. Breathing-related distress increased towards death in malignant, but decreased in non-malignant disease. Distress from fatigue and poor sleep were similar for both. CONCLUSIONS In this large dataset unlike previous datasets, the pattern of functional decline was similar as was overall symptom burden. Timely access to palliative care should be based on needs not diagnoses.
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Affiliation(s)
| | - Samuel Allingham
- Australian Health Services Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Deidre Morgan
- Research Centre for Palliative Care, Death and Dying, Flinders University, Adelaide, South Australia, Australia
| | - Diana Ferreira
- Research Centre for Palliative Care, Death and Dying, Flinders University, Adelaide, South Australia, Australia
| | - Miriam J Johnson
- Hull York Medical School, University of Hull, Hull, England.,Wolfson Palliative Care Research Centre, University of Hull, Hull, England
| | - Kathy Eagar
- Australian Health Services Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - David Currow
- Wolfson Palliative Care Research Centre, University of Hull, Hull, England .,IMPACCT, University of Technology Sydney, Sydney, New South Wales, Australia
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27
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Villalobos M, Kreuter M. Inadequate Palliative Care in Lung Disease. Respir Med 2021. [DOI: 10.1007/978-3-030-81788-6_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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28
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Luckett T, San Martin A, Currow DC, Johnson MJ, Barnes-Harris MM, Phillips JL. A systematic review and meta-analysis of studies comparing burden from lung cancer and chronic obstructive pulmonary disease. Palliat Med 2020; 34:1291-1304. [PMID: 32720568 DOI: 10.1177/0269216320940153] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease and lung cancer are both life-limiting diseases that confer burden in the form of symptoms and affect functioning and quality of life. Comparing burden between these diseases is of interest to determine whether people with chronic obstructive pulmonary disease require improved access to Specialist Palliative Care. Access should be based on needs rather than diagnosis or prognosis but is limited for people with chronic obstructive pulmonary disease compared to lung cancer. AIM The aim of this study was to synthesise research comparing burden from chronic obstructive pulmonary disease and lung cancer to estimate relative need for Specialist Palliative Care. DESIGN A systematic review was conducted of observational quantitative studies published in English peer-reviewed journals comparing burden from chronic obstructive pulmonary disease and lung cancer (PROSPERO CRD42018108819). No limits were placed on disease stage. Meta-analyses were performed where studies used the same measure; otherwise, synthesis used a narrative approach. Risk of bias was assessed using the Agency for Healthcare Research and Quality tool. DATA SOURCES Electronic databases were searched in September 2019. RESULTS Of 790 articles returned, 13 were included, reporting 11 studies. Risk of bias was generally moderate. Except for pain, burden tended to be at least as substantial from chronic obstructive pulmonary disease as from lung cancer, with breathlessness and impacts on functioning being significantly worse. Longitudinal studies suggest that people with chronic obstructive pulmonary disease live with burden for longer. CONCLUSION Efforts should be made to ensure that access to Specialist Palliative Care is commensurate with chronic obstructive pulmonary disease's substantial and long-lasting burden. Future research should clarify whether managing burden in chronic obstructive pulmonary disease and lung cancer requires different approaches.
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Affiliation(s)
- Tim Luckett
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | | | - David C Currow
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia.,Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Miriam J Johnson
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia.,Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | | | - Jane L Phillips
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
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29
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Begum M, Urquhart I, Lewison G, Fouad F, Sullivan R. Research on lung cancer and its funding, 2004-2018. Ecancermedicalscience 2020; 14:1132. [PMID: 33281924 PMCID: PMC7685768 DOI: 10.3332/ecancer.2020.1132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Indexed: 12/26/2022] Open
Abstract
Although smoking is declining in high-income countries, the relative burden from its most well-known consequence, lung cancer, continues to increase, especially in low-income countries. We examined the amount, types, geographical origins and funding of research on lung cancer as revealed by papers in the Web of Science over the 15 years, 2004–2018. The annual number of lung cancer research papers increased over the study period from 2,157 to 8,202, but as a percentage of all biomedical research in Western Europe and North America they only accounted for one-eighth of the percentage of the disease burden. Lung cancer increased its share of cancer research from 4.4% to 6.5%, mainly because of the greatly expanded output from China in 2014–2018 which published almost one-third of the world’s total on a fractional count basis. For almost all other countries, their lung cancer presence in cancer research has declined over the 15 years. However, only 15% of the Chinese papers were co-authored internationally and its research was focussed on treatment rather than prevention. Support for lung cancer research is primarily from the government rather than charity. There is therefore an urgent need to increase support for lung cancer research, and for more international collaboration, especially in low-income countries where the disease burden is growing rapidly, and in neglected domains, such as screening and palliative care.
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Affiliation(s)
- Mursheda Begum
- Queen Mary University of London, Business School, Mile End Road, London E1 4NS, UK.,King's College London, Institute of Cancer Policy, Guy's Hospital, London SE1 9RT, UK
| | - Isobel Urquhart
- University of Bristol, School of Geographical Sciences, University Road, Bristol BS8 1SS, UK
| | - Grant Lewison
- King's College London, Institute of Cancer Policy, Guy's Hospital, London SE1 9RT, UK
| | - Fouad Fouad
- Faculty of Health Science, American University of Beirut, Beirut, Lebanon
| | - Richard Sullivan
- King's College London, Institute of Cancer Policy, Guy's Hospital, London SE1 9RT, UK.,https://orcid.org/0000-0002-4493-1216
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30
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Weissinger GM, Carthon JMB, Brawner BM. Non-psychiatric hospitalization length-of-stay for patients with psychotic disorders: A mixed methods study. Gen Hosp Psychiatry 2020; 67:1-9. [PMID: 32866772 PMCID: PMC7722147 DOI: 10.1016/j.genhosppsych.2020.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 07/22/2020] [Accepted: 07/23/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Patients with psychotic disorders experience higher rates of chronic and acute non-psychotic diseases and have frequent non-psychiatric hospitalizations which result in both longer and more varied length-of-stay (LoS) than other patients. This study seeks to use a patient-centered perspective to examine LoS. METHODS This article reports Phase Two of a mixed methods, exploratory sequential study on non-psychiatric hospitalizations for individuals with psychotic disorders. Patients' experiences were used to guide a quantitative analysis of LoS using a general linear model. RESULTS Medical comorbidities were the patient characteristics which had the largest effect on LoS. Certain processes of care highlighted by patients from Phase One were also associated with longer LoS, including: physical restraints (105%), psychiatric consults (20%) and continuous observation (133%). Only recent in-system outpatient appointments were associated with shorter LoS. Data integration highlighted that factors which were important to patients such as partner support, were not always quantitatively significant, while others like medical comorbidities and use of physical restraints were points of congruence. CONCLUSIONS Medical comorbidities were highly associated with LoS but processes relating to longer LoS are those that are used to manage symptoms of acute psychosis. Clinicians should develop policies and procedures that address psychosis symptoms effectively during non-psychiatric hospitalizations. Further research is needed to understand which patients with psychotic disorders are at highest risk of extended length-of-stay.
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Affiliation(s)
- Guy M Weissinger
- Drexel University, College of Nursing and Health Professions, 3020 Market Street, Suite 510, Philadelphia, PA 19104, United States of America; University of Pennsylvania School of Nursing, 418 Curie Blvd., Philadelphia, PA 19104, United States of America.
| | - J Margo Brooks Carthon
- University of Pennsylvania School of Nursing, 418 Curie Blvd., Philadelphia, PA 19104, United States of America
| | - Bridgette M Brawner
- University of Pennsylvania School of Nursing, 418 Curie Blvd., Philadelphia, PA 19104, United States of America
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31
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Philip J, Wiseman R, Eastman P, Li C, Smallwood N. Mapping non-malignant respiratory palliative care services in Australia and New Zealand. AUST HEALTH REV 2020; 44:778-781. [PMID: 32943138 DOI: 10.1071/ah19206] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 12/13/2019] [Indexed: 11/23/2022]
Abstract
Objective Despite needs, people with advanced non-malignant respiratory disease are infrequently referred to palliative care services. Integrated models of palliative care and respiratory service delivery have been advocated to address this inequity of access. This study mapped current ambulatory palliative care service provision for patients with advanced non-malignant respiratory disease in Australia and New Zealand. Methods An online survey was distributed to the palliative care physician membership of the Australian and New Zealand Society of Palliative Medicine. Information was sought regarding access to specific breathlessness and integrated respiratory and palliative care services, and their operation. Data were described using descriptive statistics. Results In all, 133 respondents (93 from Australia, 40 from New Zealand; representing 55 Australian and 26 New Zealand discrete sites) with complete data were available for analysis. More than half the respondents reported seeing patients with advanced non-malignant respiratory disease frequently (56/97; 58%), and 18 of 81 services (22%) reported having breathlessness or integrated respiratory and palliative care services caring for this patient group. Such services were mostly staffed by respiratory and palliative care doctors and nurses and based in the clinic environment, with limited support available outside this setting. Of the 63 respondents without existing breathlessness or integrated services, 49 (78%) expressed interest in their establishment, with limited resources cited as the most common barrier. Conclusions There is limited availability of integrated respiratory and palliative care or specialised breathlessness services in Australia and New Zealand despite widespread support by palliative care physicians. This study provides a snapshot to inform strategic service development. What is known about the topic? People with advanced respiratory disease have very significant morbidity with complex needs equivalent to, and in many cases more intense than, people with end-stage lung cancer; they also have significant mortality. Yet, these people frequently do not access palliative care services. The establishment of integrated respiratory and palliative care services has been advocated as an effective means to overcome the barriers to palliative care access. Such services have demonstrated improved patient and family-reported outcomes, as well as service-level improvements. What does this paper add? This paper maps the availability of integrated respiratory palliative care services in Australia and New Zealand. We reveal that although most palliative care physicians report seeing patients with advanced respiratory disease in practice, just one-fifth of services report having an integrated service approach. There was high interest and enthusiasm for such services (78%), but resources limited their establishment. What are the implications for practitioners? Palliative care services recognise the needs of patients with advanced respiratory disease and the benefits of integrated respiratory and palliative care services to address these needs, but scarcity of resources limits the ability to respond accordingly. This study provides a snapshot of current service level to inform strategic development.
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Affiliation(s)
- Jennifer Philip
- Department of Medicine, The University of Melbourne, Eastern Hill Campus, Fitzroy, Vic. 3065, Australia; and Palliative Nexus Research Group, St Vincent's Hospital, Victoria Parade, Fitzroy, Vic. 3065, Australia; and Department of Palliative Care, Royal Melbourne Hospital, 300 Grattan Street, Parkville, Vic. 3050, Australia. ; and Corresponding author.
| | - Rachel Wiseman
- Christchurch Hospital, Canterbury District Health Board, Waitaha, PO Box 21212, Edgeware, Christchurch 8143, New Zealand.
| | - Peter Eastman
- Department of Palliative Care, Royal Melbourne Hospital, 300 Grattan Street, Parkville, Vic. 3050, Australia. ; and Barwon Health, Bellarine Street, Geelong, Vic. 3320, Australia
| | - Chi Li
- Albury Wodonga Health, PO Box 156, Wodonga, Vic. 3690, Australia. ; and Alfred Health, 55 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Natasha Smallwood
- Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, 300 Grattan Street, Parkville, Vic. 3050, Australia.
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Butler SJ, Ellerton L, Gershon AS, Goldstein RS, Brooks D. Comparison of end-of-life care in people with chronic obstructive pulmonary disease or lung cancer: A systematic review. Palliat Med 2020; 34:1030-1043. [PMID: 32484762 DOI: 10.1177/0269216320929556] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Palliative care has been widely implemented in clinical practice for patients with cancer but is not routinely provided to people with chronic obstructive pulmonary disease. AIM The study aims were to compare palliative care services, medications, life-sustaining interventions, place of death, symptom burden and health-related quality of life among chronic obstructive pulmonary disease and lung cancer populations. DESIGN Systematic review with meta-analysis (PROSPERO: CRD42019139425). DATA SOURCES MEDLINE, EMBASE, PubMed, CINAHL and PsycINFO were searched for studies comparing palliative care, symptom burden or health-related quality of life among chronic obstructive pulmonary disease, lung cancer or populations with both conditions. Quality scores were assigned using the QualSyst tool. RESULTS Nineteen studies were included. There was significant heterogeneity in study design and sample size. A random effects meta-analysis (n = 3-7) determined that people with lung cancer had higher odds of receiving hospital (odds ratio: 9.95, 95% confidence interval: 6.37-15.55, p < 0.001) or home-based palliative care (8.79, 6.76-11.43, p < 0.001), opioids (4.76, 1.87-12.11, p = 0.001), sedatives (2.03, 1.78-2.32, p < 0.001) and dying at home (1.47, 1.14-1.89, p = 0.003) compared to people with chronic obstructive pulmonary disease. People with lung cancer had lower odds of receiving invasive ventilation (0.26, 0.22-0.32, p < 0.001), non-invasive ventilation (0.63, 0.44-0.89, p = 0.009), cardiopulmonary resuscitation (0.29, 0.18-0.47, p < 0.001) or dying at a nursing home/long-term care facility (0.32, 0.16-0.64, p < 0.001) than people with chronic obstructive pulmonary disease. Symptom burden and health-related quality of life were relatively similar between the two populations. CONCLUSION People with chronic obstructive pulmonary disease receive less palliative measures at the end of life compared to people with lung cancer, despite a relatively similar symptom profile.
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Affiliation(s)
- Stacey J Butler
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada.,Sunnybrook Research Institute, Toronto, ON, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Lauren Ellerton
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada
| | - Andrea S Gershon
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada.,Sunnybrook Research Institute, Toronto, ON, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Roger S Goldstein
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Dina Brooks
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada.,School of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada
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Piamjariyakul U, Smothers A, Young S, Petitte T, Wen S, Morrissey E, Shafique S, Zulfikar R, Sangani R, Smith CE. Palliative care for rare advanced lung diseases in underserved Appalachia: Study protocol for a randomized controlled trial. J Adv Nurs 2020. [PMID: 32297352 DOI: 10.1111/jan.14395] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 03/27/2020] [Accepted: 04/06/2020] [Indexed: 01/07/2023]
Abstract
AIM To pilot test a home end-of-life and palliative care intervention for family caregivers and patients with rare advanced lung diseases and to estimate effect-size for the power analysis in a future clinical trial. DESIGN This study uses a parallel randomized control trial. Families are randomly assigned to the intervention group or the control group in a 1:1 fashion. METHODS The study population includes patients with rare advanced lung diseases and their family caregivers who are involved in patients' home care. The control group receives standard care through their hospital or outpatient clinics. The intervention group receives standard care plus 2-weekly home end-of-life and palliative care coaching by experienced community nurses. Primary outcome is breathlessness measured by shortness of breath scale. Secondary outcomes are: (a) caregivers' anxiety and depression measures; (b) the presence of patient's signed advance directives in the medical record or not; and (c) Helpfulness of intervention measured by self-report Helpfulness scale. The study was funded in October 2018 and received ethical Institutional Review Board approval in February 2019. DISCUSSION West Virginia has one of the highest incidence rates of lung disease deaths in the nation. However, there is inadequate home end-of-life and palliative care for this underserved population. This is an initial interventional study of nurse-led coaching home-based palliative care for rare advanced lung diseases in rural Appalachia. Developing research collaboration with clinicians is essential for enrolment. Enrolment was successful due to regular meetings with pulmonologists who screened patients per the study inclusion criteria in their specialty clinic and made direct referrals to the research assistants. Results of this study will be used in the future trial. IMPACT The findings will contribute to the evidence-based home nursing care, planning for family/patient preferences and supportive end-of-life palliative care for managing advanced lung diseases at home. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT03813667; registered January 23, 2019. https://clinicaltrials.gov/ct2/show/NCT03813667.
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Affiliation(s)
| | - Angel Smothers
- School of Nursing, West Virginia University, Morgantown, WV, USA
| | - Stephanie Young
- School of Nursing, West Virginia University, Morgantown, WV, USA
| | - Trisha Petitte
- School of Nursing, West Virginia University, Morgantown, WV, USA
| | - Sijin Wen
- Department of Biostatistics School of Public Health, West Virginia University, Morgantown, WV, USA
| | | | - Saima Shafique
- Department of Epidemiology School of Public Health, West Virginia University, Morgantown, WV, USA
| | - Rafia Zulfikar
- Section of Pulmonary, Critical Care, and Sleep Medicine, School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Rahul Sangani
- Section of Pulmonary, Critical Care, and Sleep Medicine, School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Carol E Smith
- School of Nursing and School of Preventive Medicine, University of Kansas Medical Center, Kansas City, KS, USA
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Pawlow PC, Doherty CL, Blumenthal NP, Matura LA, Christie JD, Ersek M. An Integrative Review of the Role of Palliative Care in Lung Transplantation. Prog Transplant 2020; 30:147-154. [DOI: 10.1177/1526924820913512] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Lung transplant patients experience significant physical symptoms and psychological stress that affect their quality of life. Palliative care is an interdisciplinary specialty associated with improved symptom management and enhanced quality of life. Little, however, is known about the palliative care needs of lung transplant patients and the role it plays in their care. Aim: The aim of this integrative review was to synthesize the literature describing the palliative care needs, the current role, and factors influencing the integration of palliative care in the care of lung transplant patients. Design/Data Sources: We searched PubMed, Scopus, CINAHL, and Embase to identify English-language, primary studies focused on palliative care in adult lung transplantation. Study quality was evaluated using Strengthening the Report of Observational studies in Epidemiology and Consolidated Criteria for Reporting Qualitative Research criteria. Results: Seven articles were included in the review. Most were single-center, descriptive studies. Two studies used qualitative and 5 used quantitative methodologies. Collectively, these studies suggest that palliative care is typically consulted for physical and psychological symptom management, although consultation is uncommon and often occurs late in the lung transplant process. We found no studies that systematically assessed palliative needs. Misperceptions about palliative care, communication challenges, and unrealistic patient/family expectations are identified barriers to the integration. While limited, evidence suggests that palliative care can be successfully integrated into lung transplant patient management. Conclusions: Empirical literature about palliative care in lung transplantation is sparse. Further research is needed to define the needs and opportunities for integration into the care of these patients.
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Affiliation(s)
| | | | | | - Lea Ann Matura
- University of Pennsylvania School of Nursing Philadelphia, PA, USA
| | - Jason D. Christie
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mary Ersek
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Veterans Affairs, Corporal Michael J. Crescenz VA Medical Center, PA, USA
- School of Nursing, Perelman School of Medicine, University of Pennsylvania, PA, USA
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35
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Lavesen M, Marsa KBM, Bove DG. A new way of organising palliative care for patients with severe chronic obstructive pulmonary disease. Int J Palliat Nurs 2019; 24:64-68. [PMID: 29469649 DOI: 10.12968/ijpn.2018.24.2.64] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Patients with chronic obstructive pulmonary disease (COPD) often live with unmet palliative needs and low quality of life, although several guidelines recommend that those with COPD should be offered early and integrated palliative care. However, none of the guidelines describe how these recommendations can be operationalised and the current literature offers little information about experiences with developing and implementing new palliative care services. This article offers insight into the experience of developing and implementing a new palliative outpatient structure for patients with severe COPD. All patients are assigned to a nurse who has overall responsibility for establishing and maintaining an individualised relationship with the patient and identifying their needs for care and treatment. Routine outpatient visits are replaced by ad hoc consultations, and patients are seen by pulmonary specialists only when there is a need for medical assessment and treatment or a planned advanced care planning dialogue. The new service was succesfully implemented; however, the changes required good multidisciplinary collaboration, dedicated health professionals and managerial support. This paper highlights the need for further studies to investigate the effectiveness of new palliative care interventions for patients with COPD.
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Affiliation(s)
- Marie Lavesen
- Registered Nurse, Department of Pulmonary and Infectious Diseases, Copenhagen University Hospital, Nordsjælland, Hillerød, Denmark
| | - Kristoffer Bastrup-Madsen Marsa
- Consultant, Department of Palliative Medicine, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Dorthe Gaby Bove
- Postdoctoral Researcher; Registered Nurse, Emergency Department, Copenhagen University Hospital, Nordsjælland, Hillerød, Denmark
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Akgün KM, Krishnan S, Feder SL, Tate J, Kutner JS, Crothers K. Polypharmacy Increases Risk of Dyspnea Among Adults With Serious, Life-Limiting Diseases. Am J Hosp Palliat Care 2019; 37:278-285. [PMID: 31550901 DOI: 10.1177/1049909119877512] [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: 12/29/2022] Open
Abstract
BACKGROUND Polypharmacy is associated with dyspnea in cross-sectional studies, but associations have not been determined in longitudinal analyses. Statins are commonly prescribed but their contribution to dyspnea is unknown. We determined whether polypharmacy was associated with dyspnea trajectory over time in adults with advanced illness enrolled in a statin discontinuation trial, overall, and in models stratified by statin discontinuation. METHODS Using data from a parallel-group unblinded pragmatic clinical trial (patients on statins ≥3 months with life expectancy of 1 month to 1 year, enrolled in the parent study between June 3, 2011, and May 2, 2013, n = 308/381 [81%]), we restricted analyses to patients with available baseline medication count and ≥1 dyspnea score. Polypharmacy was assessed by self-reported chronic medication count. Dyspnea trajectory group, our primary outcome, was determined over 24 weeks using the Edmonton Symptom Assessment System. RESULTS The mean age of the patients was 73.8 years (standard deviation [SD]: ±11.0) and the mean medication count was 11.6 (SD: ±5.0). We identified 3 dyspnea trajectory groups: none (n = 108), mild (n = 130), and moderate-severe (n = 70). Statins were discontinued in 51.8%, 48.5%, and 42.9% of patients, respectively. In multivariable models adjusting for age, sex, diagnosis, and statin discontinuation, each additional medication was associated with 8% (odds ratio [OR] = 1.08 [1.01-1.14]) and 16% (OR = 1.16 [1.08-1.25]) increased risk for mild and moderate-severe dyspnea, respectively. In stratified models, polypharmacy was associated with dyspnea in the statin continuation group only (mild OR = 1.12 [1.01-1.24], moderate-severe OR = 1.24 [1.11-1.39]) versus statin discontinuation (mild OR = 1.03 [0.95-1.12], and moderate-severe OR = 1.09 [0.98-1.22]). CONCLUSION Polypharmacy was strongly associated with dyspnea. Prospective interventions to decrease polypharmacy may impact dyspnea symptoms, especially for statins.
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Affiliation(s)
- Kathleen M Akgün
- Department of Internal Medicine, VA Connecticut Healthcare System, West Haven, CT, USA.,Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Supriya Krishnan
- Department of Internal Medicine, VA Connecticut Healthcare System, West Haven, CT, USA.,Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | | | - Janet Tate
- Department of Internal Medicine, VA Connecticut Healthcare System, West Haven, CT, USA.,Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Jean S Kutner
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Kristina Crothers
- Department of Medicine, VA Puget Sound Health Care System and University of Washington School of Medicine, Seattle, WA, USA
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Antoniu SA, Apostol A, Boiculese LV. Extra‐respiratory symptoms in patients hospitalized for a COPD exacerbation: Prevalence, clinical burden and their impact on functional status. CLINICAL RESPIRATORY JOURNAL 2019; 13:735-740. [DOI: 10.1111/crj.13083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 07/23/2019] [Accepted: 07/26/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Sabina Antonela Antoniu
- Department of Medicine II‐Nursing/Palliative Care University of Medicine and Pharmacy Grigore T Popa Iasi Romania
| | - Anca Apostol
- Faculty of Medicine University of Medicine and Pharmacy Grigore T Popa Iasi Romania
| | - Lucian Vasile Boiculese
- Department of Interdisciplinarity‐Biostatistics University of Medicine and Pharmacy Grigore T Popa Iasi Romania
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Sime C, Milligan S, Rooney KD. Improving the waiting times within a hospice breathlessness service. BMJ Open Qual 2019; 8:e000582. [PMID: 31206064 PMCID: PMC6542418 DOI: 10.1136/bmjoq-2018-000582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 11/20/2018] [Indexed: 12/03/2022] Open
Abstract
Background Breathlessness, a common symptom in advanced disease, is a distressing, complex symptom that can profoundly affect the quality of one’s life. Evidence suggests that specialist palliative care breathlessness intervention services can improve physical well-being, personal coping strategies and quality of life. In the UK, the use of quality improvement methods is well documented in the National Health Service. However, within the independent hospice sector there is a lack of published evidence of using such methods to improve service provision. Aim The aim of this project was to reduce the waiting time from referral to service commencement for a hospice breathlessness service by 40%—from a median of 19.5 to 11.5 working days. Methods Using a quality planning and systems thinking approach staff identified barriers and blockages in the current system and undertook plan-do-study-act cycles to test change ideas. The ideas tested included offering home visits to patients on long-term oxygen, using weekly team ‘huddles’, streamlining the internal referral process and reallocating staff resources. Results Using quality improvement methods enabled staff to proactively engage in positive changes to improve the service provided to people living with chronic breathlessness. Offering alternatives to morning appointments; using staff time more efficiently and introducing accurate data collection enabled staff to monitor waiting times in real time. The reduction achieved in the median waiting time from referral to service commencement exceeded the project aim. Conclusions This project demonstrates that quality improvement methodologies can be successfully used in a hospice setting to improve waiting times and meet the specific needs of people receiving specialist palliative care.
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Affiliation(s)
- Caroline Sime
- Institute for Research in Healthcare Policy & Practice, University of the West of Scotland, Hamilton, Scotland
| | - Stuart Milligan
- School of Health and Life Sciences, University of the West of Scotland, Paisley, Scotland
| | - Kevin Donal Rooney
- School of Health and Life Sciences, University of the West of Scotland, Paisley, Scotland.,Consultant in Anaesthesia and Intensive Care Medicine, Royal Alexandra Hospital, Paisley, Professor of Care Improvement, University of the West of Scotland, Hamilton, Scotland
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Mc Veigh C, Reid J, Larkin P, Porter S, Hudson P. Palliative care for people with non-malignant respiratory disease and their carers: a review of the current evidence. J Res Nurs 2019; 24:420-430. [PMID: 34394556 DOI: 10.1177/1744987119840066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Internationally, non-malignant respiratory disease is on the increase. However, although palliative care is recommended as an appropriate healthcare option for this client group, evidence suggests that these patients and their carers do not receive the same standards of palliative care as patients with a malignant lung condition. Aim The aim of this review was to provide a critical overview of the current evidence base in relation to the palliative service provision for people with non-malignant respiratory disease and their carers. Methods A review of the literature was conducted in July 2015 and updated in October 2017 and focused on the palliative care service provision for patients with interstitial lung disease, chronic obstructive pulmonary disease and bronchiectasis. Results In total, 71 empirical studies were included in the review and grouped into two main themes: patient and carer's bio-psychosocial symptom needs and management, and palliative care service provision for patients with non-malignant respiratory disease and their carers. Conclusion The majority of palliative research focuses on patients with a diagnosis of chronic obstructive pulmonary disease. A deeper insight is required into the palliative service provision experienced by those with other forms of non-malignant respiratory disease such as bronchiectasis and interstitial lung disease.
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Affiliation(s)
| | - Joanne Reid
- School of Nursing and Midwifery, Queen's University Belfast, UK
| | - Philip Larkin
- School of Nursing, Midwifery and Health Systems, University College Dublin, Ireland
| | - Sam Porter
- Department of Social Sciences and Social Work, Bournemouth University, UK
| | - Peter Hudson
- Centre for Palliative Care, Vincent's University Hospital, Melbourne, Australia
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40
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Gainza-Miranda D, Sanz-Peces EM, Alonso-Babarro A, Varela-Cerdeira M, Prados-Sánchez C, Vega-Aleman G, Rodriguez-Barrientos R, Polentinos-Castro E. Breaking Barriers: Prospective Study of a Cohort of Advanced Chronic Obstructive Pulmonary Disease Patients To Describe Their Survival and End-of-Life Palliative Care Requirements. J Palliat Med 2019; 22:290-296. [PMID: 30388050 PMCID: PMC6391614 DOI: 10.1089/jpm.2018.0363] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND AND AIM Consensus has been reached on the need to integrate palliative care in the follow-up examinations of chronic obstructive pulmonary disease (COPD) patients. We analyzed the survival from the initiation of follow-up by a palliative home care team (PHCT) and described the needs and end-of-life process. SETTING AND DESIGN This study was a prospective observational cohort study of advanced COPD patients referred to a PHCT. Sociodemographic variables, survival from the start date of follow-up using the Kaplan-Meier model, health resource consumption, perceived quality of life, main symptomatology, opioid use, and advanced care planning (ACP) were analyzed. RESULTS Sixty patients were included. The median survival was 8.3 months. Forty-two patients died at the end of the study (85% at home or in palliative care units). The most frequent cause of death was respiratory failure in 39 patients (93%), with 29 of these patients requiring sedation (69%). Dyspnea at rest, with an average of 5 (standard deviation [SD] 2) points, was the main symptom. Fifty-five patients (91%) required opioids for symptom control. The median score in the St. George's Respiratory Questionnaire was 72 (SD 13). The mean number of visits by the home team was 7 (SD 6.5). The mean number of admissions during the monitoring period was 1.5 (SD 0.15). CONCLUSIONS The characteristics of the cohort appear suitable for a PHCT. The follow-up care provided by our multidisciplinary unit decreased the number of hospitalizations, favored the development of ACP, and enabled death at home or in palliative care units.
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Affiliation(s)
- Daniel Gainza-Miranda
- Palliative Homecare Team Northern Area of Madrid, SERMAS, San Sebastian de los Reyes, Spain
| | - Eva Maria Sanz-Peces
- Palliative Homecare Team Northern Area of Madrid, SERMAS, San Sebastian de los Reyes, Spain
| | | | | | | | | | | | - Elena Polentinos-Castro
- Investigation Support Multidisciplinary Unit for Primary Care and Community North Area of Madrid, Madrid, Spain.
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Fusi-Schmidhauser T, Riglietti A, Froggatt K, Preston N. Palliative Care Provision for Patients with Advanced Chronic Obstructive Pulmonary Disease: A Systematic Integrative Literature Review. COPD 2019; 15:600-611. [PMID: 30714417 DOI: 10.1080/15412555.2019.1566893] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Although chronic obstructive pulmonary disease (COPD) is recognized as being a life-limiting condition with palliative care needs, palliative care provision is seldom implemented. The disease unpredictability, the misconceptions about palliative care being only for people with cancer, and only relevant in the last days of life, prevent a timely integrated care plan. This systematic review aimed to explore how palliative care is provided in advanced COPD and to identify elements defining integrated palliative care. Eight databases, including MEDLINE, EMBASE and CINAHL, were searched using a comprehensive search strategy to identify studies on palliative care provision in advanced COPD, published from January 1, 1960 to November 30, 2017. Citation tracking and evaluation of trial registers were also performed. Study quality was assessed with a critical appraisal tool for both qualitative and quantitative data. Of the 458 titles, 24 were eligible for inclusion. Experiences about advanced COPD, palliative care timing, service delivery and palliative care integration emerged as main themes, defining a developing taxonomy for palliative care provision in advanced COPD. This taxonomy involves different levels of care provision and integrated care is the last step of this dynamic process. Furthermore, palliative care involvement, holistic needs' assessment and management and advance care planning have been identified as elements of integrated care. This literature review identified elements that could be used to develop a taxonomy of palliative care delivery in advanced COPD. Further research is needed to improve our understanding on palliative care provision in advanced COPD.
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Affiliation(s)
- Tanja Fusi-Schmidhauser
- a Palliative and Supportive Care Clinic , Oncology Institute of Southern Switzerland and Ente Ospedaliero Cantonale , Lugano , Switzerland
| | - Alessia Riglietti
- b Respiratory Care Department , Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale , Lugano , Switzerland
| | - Katherine Froggatt
- c International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster , UK
| | - Nancy Preston
- c International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster , UK
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Janssens JP, Weber C, Herrmann FR, Cantero C, Pessina A, Matis C, Merlet Viollet R, Boiche-Brouillard L, Stirnemann J, Pautex S. Can Early Introduction of Palliative Care Limit Intensive Care, Emergency and Hospital Admissions in Patients with Severe Chronic Obstructive Pulmonary Disease? A Pilot Randomized Study. Respiration 2019; 97:406-415. [PMID: 30650418 DOI: 10.1159/000495312] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 11/09/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Despite their poor prognosis, patients with severe chronic obstructive pulmonary disease (COPD) have little access to palliative care and tend to have a high rate of hospital and intensive care unit (ICU) admissions during their last year of life. OBJECTIVES To determine the feasibility of a home palliative care intervention during 1 year versus usual care, and the possible impact of this intervention on emergency, hospital and ICU admissions, survival, mood, and health-related quality of life (HRQL). METHODS Prospective controlled study of patients with severe COPD (GOLD stage III or IV) and long-term oxygen therapy and/or home noninvasive ventilation and/or one or more hospital admissions in the previous year for acute exacerbation, randomized to usual care versus usual care with add-on monthly intervention by palliative care specialists at home for 12 months. RESULTS Of 315 patients screened, 49 (15.5%) were randomized (26 to early palliative care; 23 to the control group); aged (mean ± SD) 71 ± 8 years; FEV1 was 37 ± 14% predicted; 88% with a COPD assessment test score > 10; 69% on long-term oxygen therapy or home noninvasive ventilation. The patients accepted the intervention and completed the assessment scales. After 1 year, there was no difference between groups in symptoms, HRQL and mood, and there was a nonsignificant trend for higher admission rates to hospital and emergency wards in the intervention group. CONCLUSION Although this pilot study was underpowered to formally exclude a benefit from palliative care in severe COPD, it raises several questions as to patient selection, reluctance to palliative care in this group, and modalities of future trials.
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Affiliation(s)
- Jean-Paul Janssens
- Division of Pulmonary Diseases, Department of Medical Specialties, Geneva University Hospitals, Geneva, Switzerland,
| | - Catherine Weber
- Department of Community Medicine, Primary Care, and Emergency, Geneva University Hospitals, Geneva, Switzerland
| | - François R Herrmann
- Division of Geriatrics, Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Chloé Cantero
- Division of General Internal Medicine, Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland
| | - Aline Pessina
- Division of General Internal Medicine, Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland
| | - Caroline Matis
- Department of Palliative Care and Rehabilitation, Geneva University Hospitals, Geneva, Switzerland
| | - Roselyne Merlet Viollet
- Center for Clinical Research, Department of Anesthesiology, Pharmacology, and Intensive Care, Geneva University Hospitals, Geneva, Switzerland
| | | | - Jerôme Stirnemann
- Division of General Internal Medicine, Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland
| | - Sophie Pautex
- Department of Community Medicine, Primary Care, and Emergency, Geneva University Hospitals, Geneva, Switzerland
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Maddocks M, Reilly CC, Jolley C, Higginson IJ. What Next in Refractory Breathlessness? Breathlessness? Research Questions for Palliative Care. J Palliat Care 2018. [DOI: 10.1177/082585971403000405] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Matthew Maddocks
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, SE5 9PJ, UK
| | - Charles C. Reilly
- King's College Hospital NHS Foundation Trust, London, UK; Department of Respiratory Medicine, King's College London, London, UK; Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
| | - Caroline Jolley
- King's College Hospital NHS Foundation Trust, London, UK; Department of Respiratory Medicine, King's College London, London, UK; Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
| | - Irene J. Higginson
- King's College Hospital NHS Foundation Trust, London, UK; Department of Respiratory Medicine, King's College London, London, UK; Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
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Barratt SL, Morales M, Speirs T, Al Jboor K, Lamb H, Mulholland S, Edwards A, Gunary R, Meek P, Jordan N, Sharp C, Kendall C, Adamali HI. Specialist palliative care, psychology, interstitial lung disease (ILD) multidisciplinary team meeting: a novel model to address palliative care needs. BMJ Open Respir Res 2018; 5:e000360. [PMID: 30622718 PMCID: PMC6307575 DOI: 10.1136/bmjresp-2018-000360] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 10/19/2018] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Patients with progressive idiopathic fibrotic interstitial lung disease (ILD), such as those with idiopathic pulmonary fibrosis (IPF), can have an aggressive disease course, with a median survival of only 3-5 years from diagnosis. The palliative care needs of these patients are often unmet. There are calls for new models of care, whereby the patient's usual respiratory clinician remains central to the integration of palliative care principles and practices into their patient's management, but the optimal model of service delivery has yet to be determined. METHODS We developed a novel, collaborative, multidisciplinary team (MDT) meeting between our palliative care, psychology and ILD teams with the principal aim of integrating specialist care to ensure the needs of persons with ILD, and their caregivers were identified and met by referral to the appropriate service. The objective of this study was to assess the effectiveness of this novel MDT meeting on the assessment of a patient's palliative care needs. RESULTS Significant increases in advance care planning discussions were observed, in conjunction with increased referrals to community courses and teams, following introduction of this novel MDT. CONCLUSIONS Our results suggest that our collaborative MDT is an effective platform to address patients' unmet palliative care needs. Further work is required to explore the effect of our model on achieving the preferred place of death and reductions in unplanned hospital admissions.
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Affiliation(s)
- Shaney L Barratt
- Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol, UK
| | - Michelle Morales
- Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol, UK
| | - Toby Speirs
- Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol, UK
| | - Khaled Al Jboor
- Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol, UK
| | - Heather Lamb
- Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol, UK
| | - Sarah Mulholland
- Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol, UK
| | - Adrienne Edwards
- Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol, UK
| | - Rachel Gunary
- Department of Psychology, North Bristol NHS Trust, Bristol, UK
| | - Patricia Meek
- Department of Psychology, North Bristol NHS Trust, Bristol, UK
| | - Nikki Jordan
- Department of Palliative Care Medicine, North Bristol NHS Trust, Bristol, UK
| | - Charles Sharp
- Respiratory Medicine, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
| | - Clare Kendall
- Department of Palliative Care Medicine, North Bristol NHS Trust, Bristol, UK
| | - Huzaifa I Adamali
- Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol, UK
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Abstract
PURPOSE OF REVIEW To provide an update on recent studies about psychological interventions in palliative (mainly cancer) care with a focus on physical, psychological, spiritual, and social aspects. RECENT FINDINGS Some promising psychological interventions for physical challenges, such as fatigue, pain, dyspnea, and insomnia do exist, but further research is needed. Regarding psychological aspects, current reviews showed small to large effects in the reduction of depression and anxiety symptoms through cognitive behavioral-based interventions, mindfulness-based interventions, and meaning-based interventions. Meaning-based or dignity-based approaches were also used for targeting spiritual aspects or existential distress. Social aspects that play a crucial role in palliative care are addressed by social support interventions, end-of-life discussions, and advanced careplanning. All of these psychological interventions must meet the specific requirements of palliative care, namely abbreviated session time and flexibility concerning locality of interventions, a minimized questionnaire burden and a high attrition rate caused by patients' poor physical conditions or deaths. SUMMARY There is substantial research on psychological interventions in palliative care that shows promising results, but sample sizes were often small. Due to its high relevance for this growing patient group, there is a strong need for ongoing/further research.
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Wilcock A, Koon S, Manderson C, Taylor V, Maddocks M. Within and between day repeatability of the incremental shuttle walking test in patients with thoracic cancer. Respir Med 2018; 140:39-41. [PMID: 29957278 DOI: 10.1016/j.rmed.2018.05.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 05/18/2018] [Accepted: 05/19/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Breathlessness is common in patients with thoracic cancer but difficult to manage. The Incremental Shuttle Walking Test (ISWT) can help assess new treatments, but its repeatability has not been described in this group. AIM To examine within and between day repeatability of the ISWT in this setting. METHODS Patients with incurable thoracic cancer were recruited from outpatient clinics at a University Hospital. Two ISWTs were completed one hour apart on two consecutive days, with the first test for familiarization purposes only. Repeatability of distance walked was examined using Bland and Altman plots and assessed as the single determination (within subject) standard deviation of the difference between tests and its 95% range. RESULTS Forty-one patients participated and completed all tests. Mean (SD) distance walked was 333 (134), 349 (129) and 353 (130) m over the three tests, with the mean difference significantly different from zero between days (16 m, 95% CI 8-24 m, P = 0.043) but not within days (5 m, 95% CI -2 to 12 m, P = 0.47). Within and between day single determination SD and 95% ranges were 30 (-31 to 91) m and 36 (-37 to 109) m respectively. CONCLUSIONS These data help inform the design of studies making use of the ISWT and the interpretation of their findings.
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Affiliation(s)
- Andrew Wilcock
- Department of Clinical Oncology, Nottingham University Hospitals NHS Trust, Nottingham, NG5 1PB, UK.
| | - Sim Koon
- Department of Palliative Care, Nottingham University Hospitals NHS Trust, Nottingham, NG5 1PB, UK
| | - Cathann Manderson
- Department of Palliative Care, Nottingham University Hospitals NHS Trust, Nottingham, NG5 1PB, UK
| | - Vicky Taylor
- Department of Palliative Care, Nottingham University Hospitals NHS Trust, Nottingham, NG5 1PB, UK
| | - Matthew Maddocks
- Department of Palliative Care, Nottingham University Hospitals NHS Trust, Nottingham, NG5 1PB, UK
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Life-Sustaining Procedures, Palliative Care Consultation, and Do-Not Resuscitate Status in Dying Patients With COPD in US Hospitals. J Palliat Care 2018; 33:159-166. [DOI: 10.1177/0825859718777375] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Aim: Little is known regarding the extent to which dying patients with chronic obstructive pulmonary disease (COPD) receive life-sustaining procedures and palliative care in US hospitals. We examined temporal trends and the impact of palliative care on the use of life-sustaining procedures in this population. Materials and Methods: A retrospective nationwide cohort analysis was performed using weighted National Inpatient Sample (NIS) data obtained from 2010 to 2014. Decedents ≥18 years of age at the time of death and with a principal diagnosis of COPD were included. We examined the receipt of life-sustaining procedures, defined as1 ventilation (intubation, mechanical ventilation, and noninvasive ventilation),2 vasopressor use (infusion and intravascular monitoring),3 nutrition (enteral and parenteral infusion of concentrated nutrition),4 dialysis, and5 cardiopulmonary resuscitation as well as palliative care consultation and do not resuscitate (DNR). We used compound annual growth rates (CAGRs) and the Rao-Scott correction of the χ2 statistic to determine the statistical significance of temporal trends of life-sustaining procedures, palliative care utilization, and DNR status. Results: Among 37 312 324 hospitalizations, 38 425 patients were examined. The CAGRs of life-sustaining procedures were 6.61% and −9.73% among patients who underwent multiple procedures and patients who did not undergo any procedure, respectively (both P < .001). The CAGRs of palliative consultation and DNR were 5.25% and 36.62%, respectively (both P < .001). Conclusions: Among adults with COPD dying in US hospitals between 2010 and 2014, the utilization of life-sustaining procedures, palliative care, and DNR status increased.
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Abstract
PURPOSE OF REVIEW Chronic breathlessness is common in patients with advanced illness who require palliative care. Achieving good symptom control can be challenging. More people with advanced illness live in low and middle income than in high-income countries, but they are much less likely to receive palliative care. Most of the emerging evidence for the palliative management of chronic breathlessness is from high-income countries. This review explores the context of chronic breathlessness in low-income settings, how evidence for control of chronic breathlessness might relate to these settings and where further work should be focused. RECENT FINDINGS Systems for control of noncommunicable diseases (NCDs) in these low-income contexts are poorly developed and health services are often overwhelmed with high levels both of NCD and communicable disease. Multidisciplinary and holistic approaches to disease management are often lacking in these settings. Developing an integrated primary care approach to NCD management is increasingly recognized as a key strategy and this should include palliative care. Most evidence-based approaches to the control of chronic breathlessness could be adapted for use in these contexts SUMMARY: Hand held fans, breathing techniques, graded exercise and use of low-dose morphine can all be used in low-income settings particularly in the context of holistic care. Research is needed into the most effective ways of implementing such interventions and palliative care needs to be promoted as a fundamental aspect of NCD management.
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Winger JG, Rand KL, Hanna N, Jalal SI, Einhorn LH, Birdas TJ, Ceppa DP, Kesler KA, Champion VL, Mosher CE. Coping Skills Practice and Symptom Change: A Secondary Analysis of a Pilot Telephone Symptom Management Intervention for Lung Cancer Patients and Their Family Caregivers. J Pain Symptom Manage 2018; 55:1341-1349.e4. [PMID: 29366911 PMCID: PMC5899922 DOI: 10.1016/j.jpainsymman.2018.01.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 01/03/2018] [Accepted: 01/10/2018] [Indexed: 02/05/2023]
Abstract
CONTEXT Little research has explored coping skills practice in relation to symptom outcomes in psychosocial interventions for cancer patients and their family caregivers. OBJECTIVES To examine associations of coping skills practice to symptom change in a telephone symptom management (TSM) intervention delivered concurrently to lung cancer patients and their caregivers. METHODS This study was a secondary analysis of a randomized pilot trial. Data were examined from patient-caregiver dyads (n = 51 dyads) that were randomized to the TSM intervention. Guided by social cognitive theory, TSM involved four weekly sessions where dyads were taught coping skills including a mindfulness exercise, guided imagery, pursed lips breathing, cognitive restructuring, problem solving, emotion-focused coping, and assertive communication. Symptoms were assessed, including patients' and caregivers' psychological distress and patients' pain interference, fatigue interference, and distress related to breathlessness. Multiple regression analyses examined associations of coping skills practice during the intervention to symptoms at six weeks after the intervention. RESULTS For patients, greater practice of assertive communication was associated with less pain interference (β = -0.45, P = 0.02) and psychological distress (β = -0.36, P = 0.047); for caregivers, greater practice of guided imagery was associated with less psychological distress (β = -0.30, P = 0.01). Unexpectedly, for patients, greater practice of a mindfulness exercise was associated with higher pain (β = 0.47, P = 0.07) and fatigue interference (β = 0.49, P = 0.04); greater practice of problem solving was associated with higher distress related to breathlessness (β = 0.56, P = 0.01) and psychological distress (β = 0.36, P = 0.08). CONCLUSION Findings suggest that the effectiveness of TSM may have been reduced by competing effects of certain coping skills. Future interventions should consider focusing on assertive communication training for patients and guided imagery for caregivers.
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Affiliation(s)
- Joseph G Winger
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA.
| | - Kevin L Rand
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Nasser Hanna
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Shadia I Jalal
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA; Richard L. Roudebush VAMC, Indianapolis, Indiana, USA
| | - Lawrence H Einhorn
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Thomas J Birdas
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - DuyKhanh P Ceppa
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Kenneth A Kesler
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | - Catherine E Mosher
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA
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Strupp J, Hanke G, Schippel N, Pfaff H, Karbach U, Rietz C, Voltz R. Last Year of Life Study Cologne (LYOL-C): protocol for a cross-sectional mixed methods study to examine care trajectories and transitions in the last year of life until death. BMJ Open 2018; 8:e021211. [PMID: 29666139 PMCID: PMC5905737 DOI: 10.1136/bmjopen-2017-021211] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION The last year of life constitutes a particularly vulnerable phase for patients, involving nearly all health and social care structures. Yet, little scientific evidence is available that provides insight into the trajectories including the number and types of care setting transitions, transitions into palliative care and the dying phase. Only few studies have focused on difficulties associated with having to move between health and social care settings in the last year of life, although patients face a significant risk of adverse events. The Last Year of Life Study Cologne (LYOL-C) aims to fill this gap. METHODS AND ANALYSIS LYOL-C is a mixed-methods study composed of four steps: (1) Claims data collected by the statutory health insurance funds of deceased persons will be analysed with regard to patient care trajectories, health service transitions and costs in the last year of life. (2) Patient trajectories and transitions in healthcare will additionally be reconstructed by analysing the retrospective accounts of bereaved relatives (n=400) using a culturally adapted version of the Views of Informal Carers-Evaluation of Services Short Form questionnaire and the Patient Assessment of Care for Chronic Conditions Short Form questionnaire adapted for relatives. (3) Qualitative interviews with bereaved relatives (n=40-60) will provide in-depth insight into reasons for transitions and effects on patients' quality of life. (4) Focus groups (n=3-5) with Healthcare Professionals will be conducted to discuss challenges associated with transitions in the last year of life. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Ethics Commission of the Faculty of Medicine of Cologne University (#17-188). Results will be submitted for publication in peer-reviewed journals and presented at national and international conferences. TRIAL REGISTRATION NUMBER The study is registered in the German Clinical Trials Register (DRKS00011925) and in the Health Services Research Database (VfD_CoRe-Net_17_003806).
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Affiliation(s)
- Julia Strupp
- Department of Palliative Medicine, Medical Faculty, University of Cologne, Cologne, Germany
| | - Gloria Hanke
- Department of Palliative Medicine, Medical Faculty, University of Cologne, Cologne, Germany
| | - Nicolas Schippel
- Faculty of Human Sciences, Working Area Research Methodology, University of Cologne, Cologne, Germany
| | - Holger Pfaff
- Center for Health Services Research Cologne (ZVFK), University of Cologne, Cologne, Germany
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), University of Cologne, Cologne, Germany
| | - Ute Karbach
- Center for Health Services Research Cologne (ZVFK), University of Cologne, Cologne, Germany
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), University of Cologne, Cologne, Germany
| | - Christian Rietz
- Faculty of Human Sciences, Working Area Research Methodology, University of Cologne, Cologne, Germany
| | - Raymond Voltz
- Department of Palliative Medicine, Medical Faculty, University of Cologne, Cologne, Germany
- Center for Health Services Research Cologne (ZVFK), University of Cologne, Cologne, Germany
- Center for Integrated Oncology Cologne/Bonn (CIO), University of Cologne, Cologne, Germany
- Clinical Trials Center Cologne (ZKS), University of Cologne, Cologne, Germany
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