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Lee W, Sheehan C, Chye R, Chang S, Bayes A, Loo C, Draper B, Agar MR, Currow DC. Subcutaneous ketamine infusion in palliative patients for major depressive disorder (SKIPMDD)-Phase II single-arm open-label feasibility study. PLoS One 2023; 18:e0290876. [PMID: 37963146 PMCID: PMC10645343 DOI: 10.1371/journal.pone.0290876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 08/17/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Ketamine at subanaesthetic dosages (≤0.5mg/kg) exhibits rapid onset (over hours to days) antidepressant effects against major depressive disorder in people who are otherwise well. However, its safety, tolerability and efficacy are not known for major depressive disorder in people with advanced life-limiting illnesses. OBJECTIVE To determine the feasibility, safety, tolerability, acceptability and any antidepressant signal/activity to justify and inform a fully powered study of subcutaneous ketamine infusions for major depressive disorder in the palliative setting. METHODS This was a single arm, open-label, phase II feasibility study (Australian New Zealand Clinical Trial Registry Number-ACTRN12618001586202). We recruited adults (≥ 18-years-old) with advanced life-limiting illnesses referred to four palliative care services in Sydney, Australia, diagnosed with major depressive disorder from any care setting. Participants received weekly subcutaneous ketamine infusion (0.1-0.4mg/kg) over two hours using individual dose-titration design. Outcomes assessed were feasibility, safety, tolerability and antidepressant activity. RESULTS Out of ninety-nine referrals, ten participants received ketamine and were analysed for responses. Accrual rate was 0.54 participants/month across sites with 50% of treated participants achieving ≥ 50% reduction in baseline Montgomery-Åsberg Depression Rating Scale, meeting feasibility criteria set a priori. There were no clinically relevant harms encountered. CONCLUSIONS A future definitive trial exploring the effectiveness of subcutaneous infusion of ketamine for major depressive disorder in the palliative care setting may be feasible by addressing identified study barriers. Individual dose-titration of subcutaneous ketamine infusions over two hours from 0.1mg/kg can be well-tolerated and appears to produce transient antidepressant signals over hours to days.
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Affiliation(s)
- Wei Lee
- University of Technology Sydney, Ultimo, NSW, Australia
- St. Vincent Health Australia, Sydney, NSW, Australia
- HammondCare, Royal North Shore Hospital, St. Leonards, NSW, Australia
- University of Sydney, Northern Clinical School, St. Leonards, NSW, Australia
| | | | - Richard Chye
- University of Technology Sydney, Ultimo, NSW, Australia
- St. Vincent Health Australia, Sydney, NSW, Australia
- University of Notre Dame Australia, Fremantle, NSW, Australia
- University of New South Wales, Randwick, NSW, Australia
| | - Sungwon Chang
- University of Technology Sydney, Ultimo, NSW, Australia
| | - Adam Bayes
- University of New South Wales, Randwick, NSW, Australia
- Blackdog Institute, Hospital Road, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Colleen Loo
- University of New South Wales, Randwick, NSW, Australia
- Blackdog Institute, Hospital Road, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Brian Draper
- University of New South Wales, Randwick, NSW, Australia
| | - Meera R. Agar
- University of Technology Sydney, Ultimo, NSW, Australia
- University of New South Wales, Randwick, NSW, Australia
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Nguyen JP, Gaillard H, Suarez A, Terzidis-Mallat É, Constant-David D, Van Langhenhove A, Evin A, Malineau C, Tan SVO, Mhalla A, Lefaucheur JP, Nizard J. Bicentre, randomized, parallel-arm, sham-controlled trial of transcranial direct-current stimulation (tDCS) in the treatment of palliative care patients with refractory cancer pain. BMC Palliat Care 2023; 22:15. [PMID: 36849977 PMCID: PMC9972710 DOI: 10.1186/s12904-023-01129-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 01/10/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Pain is a common symptom in palliative care cancer patients and is often insufficiently relieved. In recent years, transcranial direct-current stimulation (tDCS) of the motor cortex has been shown to be effective to treat chronic pain, essentially neuropathic pain. We propose to test the efficacy of tDCS in patients experiencing cancer pain in the palliative care setting. METHOD/DESIGN This article describes the protocol of a bicentre, randomized, parallel-arm, sham-controlled clinical trial evaluating tDCS in the treatment of palliative care patients with refractory cancer pain. Seventy patients between the ages of 18 and 80 years experiencing refractory pain with a pain score of 4/10 on a numerical rating scale (NRS) ranging from 0 to 10 will be enrolled in this trial. The main exclusion criteria are patients unable to fill in the various rating scales and life expectancy less than 3 weeks. Treatment consists of 5 consecutive tDCS sessions targeting the motor cortex (one daily session for 5 days) on the contralateral side to the pain. After randomization (1:1 ratio), 35 patients will receive active stimulation and 35 patients will receive sham stimulation. The primary endpoint is the NRS score and the primary objective is a significant improvement of this score between the baseline score recorded between D-3 and D-1 and the score recorded 4 days after stopping treatment (D8). The secondary objectives are to evaluate whether this improvement is maintained 16 days after stopping treatment (D21) and whether the following scores are improved on D14 and D21: Brief Pain Inventory, Edmonton Symptom Assessment System, Hospital Anxiety and Depression scale, State-Trait Anxiety Inventory and Medication Quantification Scale. DISCUSSION Positive results of this trial would indicate that tDCS can improve pain and quality of life of cancer patients in the palliative care setting. Reduction of analgesic consumption and improvement of activities of daily living should allow many patients to return home with a decreased workload for caregivers.
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Affiliation(s)
- Jean-Paul Nguyen
- Unité de Stimulation Transcrânienne, Clinique Bretéché, Groupe Elsan, Nantes, 44000 France ,grid.277151.70000 0004 0472 0371UIC22 et Service Douleur Soins Palliatifs et Soins de Support, Centre Hospitalo-Universitaire (CHU), Nantes, 44930 France
| | - Hélène Gaillard
- grid.277151.70000 0004 0472 0371UIC22 et Service Douleur Soins Palliatifs et Soins de Support, Centre Hospitalo-Universitaire (CHU), Nantes, 44930 France
| | - Alcira Suarez
- Unité de Stimulation Transcrânienne, Clinique Bretéché, Groupe Elsan, Nantes, 44000 France
| | | | - Diane Constant-David
- grid.277151.70000 0004 0472 0371UIC22 et Service Douleur Soins Palliatifs et Soins de Support, Centre Hospitalo-Universitaire (CHU), Nantes, 44930 France
| | - Aurélien Van Langhenhove
- grid.277151.70000 0004 0472 0371UIC22 et Service Douleur Soins Palliatifs et Soins de Support, Centre Hospitalo-Universitaire (CHU), Nantes, 44930 France
| | - Adrien Evin
- grid.277151.70000 0004 0472 0371UIC22 et Service Douleur Soins Palliatifs et Soins de Support, Centre Hospitalo-Universitaire (CHU), Nantes, 44930 France
| | - Catherine Malineau
- Unité de Stimulation Transcrânienne, Clinique Bretéché, Groupe Elsan, Nantes, 44000 France
| | - Son V. O. Tan
- Service de Neurochirurgie, University Hospital, Ho Chi Minh ville, Vietnam
| | - Alaa Mhalla
- grid.410511.00000 0001 2149 7878EA43910, Faculté de Médecine, Université Paris-Est, Créteil, 94000 France ,grid.50550.350000 0001 2175 4109Unité Douleur et Soins Palliatifs intégrés, DMU Cancer et spécialités, CHU Henri Mondor-Albert Chenevrier, APHP, Créteil, 94000 France
| | - Jean-Pascal Lefaucheur
- grid.410511.00000 0001 2149 7878EA43910, Faculté de Médecine, Université Paris-Est, Créteil, 94000 France ,grid.412116.10000 0004 1799 3934Unité de Neurophysiologie clinique, Hôpital Henri Mondor, APHP, Créteil, 94000 France
| | - Julien Nizard
- UIC22 et Service Douleur Soins Palliatifs et Soins de Support, Centre Hospitalo-Universitaire (CHU), Nantes, 44930, France. .,EA43910, Faculté de Médecine, Université Paris-Est, Créteil, 94000, France.
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Lee W, DiGiacomo M, Draper B, Agar MR, Currow DC. A Focus Group Study of Palliative Physician and Consultation-Liaison Psychiatrist Perceptions of Dealing with Depression in the Dying. J Palliat Care 2022; 37:535-544. [PMID: 36083631 PMCID: PMC9465534 DOI: 10.1177/08258597221121453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To ascertain palliative physicians’ and
consultation-liaison psychiatrists’ perceptions of depression care processes in
patients with very poor prognoses, exploring key challenges and postulating
solutions. Methods: A qualitative focus group study involving three
1-h online focus groups (2 palliative medicine and 1 psychiatry) were conducted
between November-December 2020. Fellows and trainees were recruited from
Australian and New Zealand Society of Palliative Medicine (n = 11) and Royal
Australian and New Zealand College of Psychiatrists (n = 4). Data underwent
conventional qualitative content analysis. Results: Participants
perceived depression care to be complex and challenging. Perceived barriers
included: inadequate palliative care psychiatry skills with variation in
clinical approaches; lack of supportive health infrastructure (poor access to
required interventions and suboptimal linkage between palliative care and
psychiatry); lack of research support; and societal stigma. Suggested solutions
included integrating care processes between palliative care and psychiatry to
improve clinician training, establish supportive health systems and promote
innovative research designs. Conclusions: Developing clinician
training, supportive health systems and innovative research strategies centering
on integrating palliative care and psychiatry care processes may be integral to
optimising depression care when providing care to people with very poor
prognoses.
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Affiliation(s)
- Wei Lee
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, 110561University of Technology Sydney, Ultimo, NSW 2007, Australia.,St Vicent's Clinical School, University of New South Wales, Sydney, Australia
| | - Michelle DiGiacomo
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, 110561University of Technology Sydney, Ultimo, NSW 2007, Australia
| | - Brian Draper
- School of Psychiatry, 7800University of New South Wales, Sydney, Australia
| | - Meera R Agar
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, 110561University of Technology Sydney, Ultimo, NSW 2007, Australia
| | - David C Currow
- Faculty of Science, Medicine and Health, 8691University of Wollongong, Wollongong, Australia
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Lee W, Chang S, DiGiacomo M, Draper B, Agar MR, Currow DC. Caring for depression in the dying is complex and challenging - survey of palliative physicians. BMC Palliat Care 2022; 21:11. [PMID: 35034640 PMCID: PMC8761382 DOI: 10.1186/s12904-022-00901-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 12/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Depression is prevalent in people with very poor prognoses (days to weeks). Clinical practices and perceptions of palliative physicians towards depression care have not been characterised in this setting. The objective of this study was to characterise current palliative clinicians' reported practices and perceptions in depression screening, assessment and management in the very poor prognosis setting. METHODS In this cross-sectional cohort study, 72 palliative physicians and 32 psychiatrists were recruited from Australian and New Zealand Society of Palliative Medicine and Royal Australian and New Zealand College of Psychiatrists between February and July 2020 using a 23-item anonymous online survey. RESULTS Only palliative physicians results were reported due to poor psychiatry representation. Palliative physicians perceived depression care in this setting to be complex and challenging. 40.0% reported screening for depression. All experienced uncertainty when assessing depression aetiology. Approaches to somatic symptom assessment varied. Physicians were generally less likely to intervene for depression than in the better prognosis setting. Most reported barriers to care included the perceived lack of rapidly effective therapeutic options (77.3%), concerns of patient burden and intolerance (71.2%), and the complexity in diagnostic differentiation (53.0%). 66.7% desired better collaboration between palliative care and psychiatry. CONCLUSIONS Palliative physicians perceived depression care in patients with very poor prognoses to be complex and challenging. The lack of screening, variations in assessment approaches, and the reduced likelihood of intervening in comparison to the better prognosis setting necessitate better collaboration between palliative care and psychiatry in service delivery, training and research.
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Affiliation(s)
- Wei Lee
- University of Technology Sydney, Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Ultimo, NSW, 2007, Australia.
- St Vincent's Clinical School, University of New South Wales, 390 Victoria St, Darlinghurst, NSW, 2010, Australia.
| | - Sungwon Chang
- University of Technology Sydney, Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Ultimo, NSW, 2007, Australia
| | - Michelle DiGiacomo
- University of Technology Sydney, Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Ultimo, NSW, 2007, Australia
| | - Brian Draper
- School of Psychiatry, University of New South Wales Sydney, Sydney, NSW, 2052, Australia
| | - Meera R Agar
- University of Technology Sydney, Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Ultimo, NSW, 2007, Australia
| | - David C Currow
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, 2522, Australia
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Lee W, Sheehan C, Chye R, Chang S, Loo C, Draper B, Agar M, Currow DC. Study protocol for SKIPMDD: subcutaneous ketamine infusion in palliative care patients with advanced life limiting illnesses for major depressive disorder (phase II pilot feasibility study). BMJ Open 2021; 11:e052312. [PMID: 34183351 PMCID: PMC8240583 DOI: 10.1136/bmjopen-2021-052312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/10/2021] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Major depressive disorder (MDD) in people with advanced life-limiting illnesses can have significant impact on the quality-of-life of those affected. The management of MDD in the palliative care setting can be challenging as typical antidepressants may not work in time nor be tolerated due to coexisting organ dysfunctions, symptom burden and frailty. Parenteral ketamine was found to exhibit effective and rapid-onset antidepressant effect even against treatment-resistant depression in the psychiatric population. However, there is currently neither feasibility study nor available prospective study available to inform of the safety, tolerability and efficacy of such for MDD in the palliative setting. METHODS AND ANALYSIS This is an open-labelled, single arm, phase II pilot feasibility study involving adult patients with advanced life-limiting illnesses and MDD across four palliative care services in Australia. It has an individual dose-titration design (0.1-0.4 mg/kg) with weekly treatments of subcutaneous ketamine infusion over 2 hours. The primary outcome is feasibility. The secondary outcomes are related to the safety, tolerability and antidepressant efficacy of ketamine, participants' satisfaction in relation to the trial process and the reasons for not completing the study at various stages. The feasibility data will be reported using descriptive statistics. Meanwhile, side effects, tolerability and efficacy data will be analysed using change of assessment scores from baseline. ETHICS AND DISSEMINATION Ethics approval was acquired (South Western Sydney Local Health District: HREC/18/LPOOL/466). The results of this study will be submitted for publication in peer-reviewed journals and presented at relevant conferences. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trial Registry Number: ACTRN12618001586202; Pre-results.
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Affiliation(s)
- Wei Lee
- Improving Care for Palliative Aged, and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
- St Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Richard Chye
- Palliative Care, St Vincent's Hospital Sydney, Darlinghurst, New South Wales, Australia
- University of Notre Dame, Darlinghurst, Sydney, Australia
| | - Sungwon Chang
- Improving Care for Palliative Aged, and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Colleen Loo
- Black Dog Institute, Randwick, New South Wales, Australia
- Department of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Brian Draper
- Department of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Meera Agar
- Improving Care for Palliative Aged, and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - David C Currow
- Improving Care for Palliative Aged, and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
- Cancer Institute New South Wales, St Leonards, New South Wales, Australia
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Lee W, Pulbrook M, Sheehan C, Kochovska S, Chang S, Hosie A, Lobb E, Parker D, Draper B, Agar MR, Currow DC. Clinically Significant Depressive Symptoms Are Prevalent in People With Extremely Short Prognoses-A Systematic Review. J Pain Symptom Manage 2021; 61:143-166.e2. [PMID: 32688012 DOI: 10.1016/j.jpainsymman.2020.07.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 07/09/2020] [Accepted: 07/13/2020] [Indexed: 12/13/2022]
Abstract
CONTEXT Currently, systematic evidence of the prevalence of clinically significant depressive symptoms in people with extremely short prognoses is not available to inform its global burden, assessment, and management. OBJECTIVES To determine the prevalence of clinically significant depressive symptoms in people with advanced life-limiting illnesses and extremely short prognoses (range of days to weeks). METHODS A systematic review and meta-analysis (random-effects model) were performed (PROSPERO: CRD42019125119). MEDLINE, Embase, PsycINFO, CINAHL, and CareSearch were searched for studies (1994-2019). Data were screened for the prevalence of clinically significant depressive symptoms (assessed using validated depression-specific screening tools or diagnostic criteria) of adults with advanced life-limiting illnesses and extremely short prognoses (defined by survival or functional status). Quality assessment was performed using the Joanna Briggs Institute Systematic Reviews Checklist for Prevalence Studies for individual studies and Grading of Recommendations Assessment, Development and Evaluation (GRADE) across studies. RESULTS Thirteen studies were included. The overall pooled prevalence of clinically significant depressive symptoms in adults with extremely short prognoses (n = 10 studies; extremely short prognoses: N = 905) using depression-specific screening tools was 50% (95% CI: 29%-70%; I2 = 97.6%). Prevalence of major and minor depression was 10% (95% CI: 4%-16%) and 5% (95% CI: 2%-8%), respectively. Major limitations included high heterogeneity, selection bias, and small sample sizes in individual studies. CONCLUSIONS Clinically, significant depressive symptoms were prevalent in people with advanced life-limiting illnesses and extremely short prognoses. Clinicians need to be proactive in the recognition and assessment of these symptoms to allow for timely intervention.
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Affiliation(s)
- Wei Lee
- University of Technology Sydney, Ultimo, New South Wales, Australia; St Vincent Hospital, Darlinghurst, New South Wales, Australia.
| | - Marley Pulbrook
- St Vincent Hospital, Darlinghurst, New South Wales, Australia
| | | | | | - Sungwon Chang
- University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Annmarie Hosie
- St Vincent Hospital, Darlinghurst, New South Wales, Australia; University of Notre Dame Australia, New South Wales, Australia
| | - Elizabeth Lobb
- Calvary Hospital, Kogarah, New South Wales, Australia; University of Notre Dame Australia, New South Wales, Australia
| | - Deborah Parker
- University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Brian Draper
- University of New South Wales, Randwick, New South Wales, Australia
| | - Meera R Agar
- University of Technology Sydney, Ultimo, New South Wales, Australia
| | - David C Currow
- University of Technology Sydney, Ultimo, New South Wales, Australia
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Soto-Rubio A, Perez-Marin M, Rudilla D, Galiana L, Oliver A, Fombuena M, Barreto P. Responding to the Spiritual Needs of Palliative Care Patients: A Randomized Controlled Trial to Test the Effectiveness of the Kibo Therapeutic Interview. Front Psychol 2020; 11:1979. [PMID: 32973614 PMCID: PMC7472743 DOI: 10.3389/fpsyg.2020.01979] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 07/16/2020] [Indexed: 11/13/2022] Open
Abstract
Context The WHO recognizes the need to attend to patients’ spiritual needs as being fundamental to comprehensive and high-quality end-of-life care. Spiritual needs must be attended to since the resolution of biological and psychosocial issues is insufficient to reduce patients’ suffering. Associations have been found between spiritual needs and other variables of importance for patients in palliative care. Despite the consensus that exists regarding the importance of assessing and attending to spiritual needs, professionals encounter many difficulties in attempting to do so. Objectives Our study aims to demonstrate the benefits that the Kibo therapeutic interview in palliative care patients can have for spirituality, demoralization, and resilience. Methods A parallel randomized controlled trial of two groups was undertaken. Information on 60 palliative care patients during pre- and post-intervention time points was gathered. Results ANOVAs showed a statistically significant effect of the intervention on the dimension of transpersonal spirituality. The ANCOVA for the effect of the intervention on resilience also pointed to its effectiveness. When the means of demoralization were examined, a higher decrease in the levels of demoralization for patients in the intervention group was observed, when compared to patients in the control group. Conclusion Our findings point to this interview as an effective means to attend to the spiritual needs of palliative patients, reducing demoralization and increasing resilience. Future research could focus on a broader sample and on the effects of this interview on family caregivers, mourners, and health care professionals. Clinical Trial Registration Number https://clinicaltrials.gov/ct2/show/ Identifier NCT03995095.
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Affiliation(s)
- Ana Soto-Rubio
- Department of Personality, Evaluation and Psychological Treatment, Faculty of Psychology, University of Valencia, Valencia, Spain
| | - Marian Perez-Marin
- Department of Personality, Evaluation and Psychological Treatment, Faculty of Psychology, University of Valencia, Valencia, Spain
| | | | - Laura Galiana
- Department of Methodology of Experimental and Social Sciences, University of Valencia, Valencia, Spain
| | - Amparo Oliver
- Department of Methodology of Experimental and Social Sciences, University of Valencia, Valencia, Spain
| | | | - Pilar Barreto
- Department of Personality, Evaluation and Psychological Treatment, Faculty of Psychology, University of Valencia, Valencia, Spain
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Santivasi WL, Partain DK, Whitford KJ. The role of geriatric palliative care in hospitalized older adults. Hosp Pract (1995) 2020; 48:37-47. [PMID: 31825689 DOI: 10.1080/21548331.2019.1703707] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 12/10/2019] [Indexed: 06/10/2023]
Abstract
Take-Away Points:1. Geriatric palliative care requires integrating the disciplines of hospital medicine and palliative care in pursuit of delivering comprehensive, whole-person care to aging patients with serious illnesses.2. Older adults have unique palliative care needs compared to the general population, different prevalence and intensity of symptoms, more frequent neuropsychiatric challenges, increased social needs, distinct spiritual, religious, and cultural considerations, and complex medicolegal and ethical issues.3. Hospital-based palliative care interdisciplinary teams can take many forms and provide high-quality, goal-concordant care to older adults and their families.
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Affiliation(s)
- Wil L Santivasi
- Center for Palliative Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Daniel K Partain
- Center for Palliative Medicine & Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kevin J Whitford
- Center for Palliative Medicine & Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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Comparing counseling and dignity therapies in home care patients: A pilot study. Palliat Support Care 2015; 14:321-9. [DOI: 10.1017/s1478951515001182] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:Several studies have successfully tested psychosocial interventions in palliative care patients. Counseling is the technique most often employed. Dignity therapy (DT) has recently emerged as a tool that can be utilized to address patients' needs at the end of life. The aims of our study were to examine the effects of DT and counseling and to offer useful information that could be put into practice to better meet patients' needs.Method:We developed a pilot randomized controlled trial at the Home Care Unit of the General University Hospital of Valencia (Spain). Some 70 patients were assigned to two therapy groups. The measurement instruments employed included the Patient Dignity Inventory (PDI), the Hospital Anxiety and Depression Scale (HADS), the Brief Resilient Coping Scale (BRCS), the GES Questionnaire, the Duke–UNC-11 Functional Social Support Questionnaire, and two items from the EORTC Quality of Life C30 Questionnaire (EORTC–QLQ–C30).Results:The results of repeated-measures t tests showed statistically significant differences with respect to the dimensions of dignity, anxiety, spirituality, and quality of life for both groups. However, depression increased in the DT group after the intervention, and there were no differences with respect to resilience. Therapy in the counseling group did not negatively affect depression, and resilience did improve. When post-intervention differences between groups were calculated, statistically significant differences in anxiety were found, with lower scores in the counseling group (t(68) = –2.341, p = 0.022, d = 0.560).Significance of Results:Our study provided evidence for the efficacy of dignity therapy and counseling in improving the well-being of palliative home care patients, and it found better results in the counseling therapy group with respect to depression, resilience, and anxiety.
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Plüddemann A, Wallace E, Bankhead C, Keogh C, Van der Windt D, Lasserson D, Galvin R, Moschetti I, Kearley K, O'Brien K, Sanders S, Mallett S, Malanda U, Thompson M, Fahey T, Stevens R. Clinical prediction rules in practice: review of clinical guidelines and survey of GPs. Br J Gen Pract 2014; 64:e233-42. [PMID: 24686888 PMCID: PMC3964449 DOI: 10.3399/bjgp14x677860] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 11/07/2013] [Accepted: 12/27/2013] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The publication of clinical prediction rules (CPRs) studies has risen significantly. It is unclear if this reflects increasing usage of these tools in clinical practice or how this may vary across clinical areas. AIM To review clinical guidelines in selected areas and survey GPs in order to explore CPR usefulness in the opinion of experts and use at the point of care. DESIGN AND SETTING A review of clinical guidelines and survey of UK GPs. METHOD Clinical guidelines in eight clinical domains with published CPRs were reviewed for recommendations to use CPRs including primary prevention of cardiovascular disease, transient ischaemic attack (TIA) and stroke, diabetes mellitus, fracture risk assessment in osteoporosis, lower limb fractures, breast cancer, depression, and acute infections in childhood. An online survey of 401 UK GPs was also conducted. RESULTS Guideline review: Of 7637 records screened by title and/or abstract, 243 clinical guidelines met inclusion criteria. CPRs were most commonly recommended in guidelines regarding primary prevention of cardiovascular disease (67%) and depression (67%). There was little consensus across various clinical guidelines as to which CPR to use preferentially. SURVEY Of 401 responders to the GP survey, most were aware of and applied named CPRs in the clinical areas of cardiovascular disease and depression. The commonest reasons for using CPRs were to guide management and conform to local policy requirements. CONCLUSION GPs use CPRs to guide management but also to comply with local policy requirements. Future research could focus on which clinical areas clinicians would most benefit from CPRs and promoting the use of robust, externally validated CPRs.
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Affiliation(s)
- Annette Plüddemann
- Department of Primary Care Health Sciences, University of Oxford, Oxford
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