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Karapetis CS, Stein B, Koczwara B, Harrup R, Milleshkin L, Parente P, Millward M, Haines I, Blinman P, Olver I. Medical Oncology Group of Australia position statement and membership survey on voluntary assisted dying. Intern Med J 2018; 48:774-779. [DOI: 10.1111/imj.13951] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 03/27/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Christos S. Karapetis
- Flinders Centre for Innovation in Cancer; Flinders University; Adelaide South Australia Australia
- Department of Medical Oncology; Flinders Medical Centre; Adelaide South Australia Australia
| | - Brian Stein
- Department of Medical Oncology; Royal Adelaide Hospital; Adelaide South Australia Australia
- Adelaide Cancer Centre; Adelaide South Australia Australia
| | - Bogda Koczwara
- Flinders Centre for Innovation in Cancer; Flinders University; Adelaide South Australia Australia
| | - Rosemary Harrup
- Department of Medical Oncology; Royal Hobart Hospital; Hobart Tasmania Australia
| | - Linda Milleshkin
- Department of Medical Oncology; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
| | - Phil Parente
- Department of Medical Oncology; Eastern Health; Melbourne Victoria Australia
- Department of Medical Oncology; Monash University; Melbourne Victoria Australia
| | - Michael Millward
- School of Medicine; University of Western Australia; Perth Western Australia Australia
- Department of Medical Oncology; Sir Charles Gairdner Hospital; Perth Western Australia Australia
| | - Ian Haines
- Department of Medical Oncology; Monash University; Melbourne Victoria Australia
- Department of Medical Oncology; Cabrini Health; Melbourne Victoria Australia
| | - Prunella Blinman
- Concord Repatriation General Hospital; Sydney New South Wales Australia
- Sydney Medical School; University of Sydney; Sydney New South Wales Australia
| | - Ian Olver
- University of South Australia Cancer Research Institute; Adelaide South Australia Australia
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Position paper of the Italian Association of Medical Oncology on early palliative care in oncology practice (Simultaneous Care). TUMORI JOURNAL 2016; 103:9-14. [PMID: 28009422 DOI: 10.5301/tj.5000593] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2016] [Indexed: 11/20/2022]
Abstract
One of the priorities of personalized medicine regards the role of early integration of palliative care with cancer-directed treatments, called simultaneous care. This article, written by the Italian Association of Medical Oncology (AIOM) Simultaneous and Continuous Care Task Force, represents the position of Italian medical oncologists about simultaneous care, and is the result of a 2-step project: a Web-based survey among medical oncologists and a consensus conference. We present the opinion of more than 600 oncologists who helped formulate these recommendations. This document covers 4 main aspects of simultaneous care: 1) ethical, cultural, and relational aspects of cancer and implications for patient communication; 2) training of medical oncologists in palliative medicine; 3) research on the integration between cancer treatments and palliative care; and 4) organizational and management models for the realization of simultaneous care. The resulting recommendations highlight the role of skills and competence in palliative care along with implementation of adequate organizational models to accomplish simultaneous care, which is considered a high priority of AIOM in order to grant the best quality of life for cancer patients and their families.
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Zagonel V, Torta R, Franciosi V, Brunello A, Biasco G, Cattaneo D, Cavanna L, Corsi D, Farina G, Fioretto L, Gamucci T, Lanzetta G, Magarotto R, Maltoni M, Mastromauro C, Melotti B, Meriggi F, Pavese I, Piva E, Sacco C, Tonini G, Trentin L, Ermacora P, Varetto A, Merlin F, Gori S, Cascinu S, Pinto C. Early Integration of Palliative Care in Oncology Practice: Results of the Italian Association of Medical Oncology (AIOM) Survey. J Cancer 2016; 7:1968-1978. [PMID: 27877212 PMCID: PMC5118660 DOI: 10.7150/jca.14634] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 05/21/2016] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Early integration of palliative care in oncology practice ("simultaneous care", SC) has been shown to provide better care resulting in improved quality-of-life and also survival. We evaluated the opinions of Italian Association of Medical Oncology (AIOM) members. PATIENTS AND METHODS A 37-item questionnaire was delivered to 1119 AIOM members. Main areas covered were: social, ethical, relational aspects of disease and communication, training, research, organizational and management models in SC. Three open questions explored the definition of Quality of Life, Medical Oncologist and Palliative Care. RESULTS Four hundred and forty-nine (40.1%) medical oncologists returned the questionnaires. Forty-nine percent stated they address non-curability when giving a diagnosis of metastatic tumor, and 43% give the information only to patients who clearly ask for it. Fifty-five percent say the main formative activity in palliative medicine came from attending meetings and 90% agree that specific palliative care training should be part of the core curriculum in oncology. Twenty-two percent stated they consulted guidelines for symptom management, 45% relied upon personal experience and 26% make a referral to a palliative care specialist. Seventy-four percent were in favor of more research in palliative medicine. An integration between Units of Oncology and Palliative Care Services early in the course of advanced disease was advocated by 86%. Diverse and multifaceted definitions were given for the concepts of Quality of Life, Palliative Care and Medical Oncologist. CONCLUSION SC is felt as an important task, as well as training of medical oncologists in symptom management and research in this field.
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Affiliation(s)
- Vittorina Zagonel
- Department of Clinical and Experimental Oncology, Medical Oncology Unit 1, Veneto Institute of Oncology IOV - IRCCS, Padova
| | - Riccardo Torta
- Clinical Psychology and Psycho-Oncology Unit, Department of Neuroscience, University of Turin, Turin
| | | | - Antonella Brunello
- Department of Clinical and Experimental Oncology, Medical Oncology Unit 1, Veneto Institute of Oncology IOV - IRCCS, Padova
| | - Guido Biasco
- "LA Seragnoli" Department of Hematology and Oncology Sciences, S. Orsola-Malpighi Hospital, Bologna
| | | | - Luigi Cavanna
- Department of Hematology and Oncology, Medical Oncology Unit, Piacenza Hospital, Piacenza
| | - Domenico Corsi
- Medical Oncology Unit, Fatebenefratelli - Isola Tiberina Hospital, Roma
| | | | - Luisa Fioretto
- Department of Oncology, S. Maria Annunziata Hospital - AUSL 10, Bagno a Ripoli (FI)
| | | | | | | | - Marco Maltoni
- Palliative Care Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori IRCCS, Meldola (FC)
| | | | | | - Fausto Meriggi
- Medical Oncology Unit, Fondazione Poliambulanza Hospital, Brescia
| | - Ida Pavese
- Department of Oncology, San Pietro Fatebenefratelli Hospital, Roma
| | - Erico Piva
- Medical Oncology Unit, S.Anna Hospital, Ferrara
| | - Cosimo Sacco
- Medical Oncology Unit, S. Maria Misericordia Hospital, Udine
| | | | - Leonardo Trentin
- Palliative Care Unit, Veneto Institute of Oncology IOV - IRCCS, Padova
| | - Paola Ermacora
- Medical Oncology Unit, S. Maria Misericordia Hospital, Udine
| | - Antonella Varetto
- Clinical Psychology and Psycho-Oncology Unit, Department of Neuroscience, University of Turin, Turin
| | - Federica Merlin
- Medical Oncology Unit, San Bonifacio Hospital, San Bonifacio (VR)
| | - Stefania Gori
- Oncology Department, Sacro Cuore-Don Calabria Hospital, Negrar (VR)
| | - Stefano Cascinu
- Department of Hematology and Oncology, University Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | - Carmine Pinto
- Department of Medical Oncology, IRCCS - Arcispedale S. Maria Nuova, Reggio Emilia, Italy
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Meñaca A, Evans N, Andrew EV, Toscani F, Finetti S, Gómez-Batiste X, Higginson IJ, Harding R, Pool R, Gysels M. End-of-life care across Southern Europe: A critical review of cultural similarities and differences between Italy, Spain and Portugal. Crit Rev Oncol Hematol 2012; 82:387-401. [DOI: 10.1016/j.critrevonc.2011.06.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Revised: 05/27/2011] [Accepted: 06/09/2011] [Indexed: 12/14/2022] Open
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Turillazzi E, Fineschi V. Advance directives in therapeutic intervention: a review of the Italian bioethical and juridical debate. MEDICINE, SCIENCE, AND THE LAW 2011; 51:76-80. [PMID: 21793468 DOI: 10.1258/msl.2010.010201] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The authors present a review of the Italian bioethical and juridical debate about advance directives. The relevant points of difference between desistence from therapy and euthanasia and of the definition of the concept of therapy are also examined. The Italian Senate has passed a bill in which the value of advance health-care directives is affirmed. However, it is also affirmed that in conditions of emergency or when the subject's life is at immediate risk, the advance health-care directives should not be applied and artificial nutrition and hydration cannot be included in advance directives. In fact, these practices are thought to be of vital support and physiologically aimed at alleviating suffering until the end of life. Therefore, they cannot be the object of advance health-care directives. It is the authors' view that it is not at all desirable to trust legislative choices about a subject which continually varies in relation to scientific and clinical knowledge, options and alternatives. The physician is rather asked for a behaviour inspired by the value of the dignity and autonomy of the persons involved, by the respect of wishes previously expressed or, in any case, objectively proved.
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Affiliation(s)
- Emanuela Turillazzi
- Department of Legal Medicine, University of Foggia, Ospedale Colonnello D'Avanzo, Via degli Aviatori 1, 71100 Foggia, Italy
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Clin B, Ophélie F. Law of 22 April 2005 on patients' rights and the end of life in France: setting the boundaries of euthanasia, with regard to current legislation in other European countries. MEDICINE, SCIENCE, AND THE LAW 2010; 50:183-188. [PMID: 21539283 DOI: 10.1258/msl.2010.010037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The term 'euthanasia' is not clearly defined. Euthanasia is evoked in many aspects of terminal care: interruption of curative treatment at the end of life, palliative care or the act of deliberately provoking death through compassion. A law on 'patients' rights and the end of life', promulgated in France on 22 April 2005, led to changes in the French Code of Public Health. In this work, we have first outlined the key provisions of this law and the changes it has brought, then we have compared current legislation on the subject throughout Europe, where a rapid overview of current practice in terminal patient care revealed four different types of legislation: the first authorizes euthanasia (in the sense of provoking death, if this choice is medically justified), the second legalizes 'assisted suicide', the third, which is sometimes referred to as 'passive euthanasia', consists of the non-administration of life-sustaining treatment and, finally, the fourth prohibits euthanasia in any form whatsoever. In the last section, we have attempted to clarify the as yet indistinct notion of 'euthanasia' in order to determine whether the conception of terminal care in the Law of 22 April 2005 was consistent with that put forward by the philosopher Francis Bacon, who claimed that, 'The physician's role is to relieve pain, not only when such relief can lead to healing, but also when it can proffer a calm and trouble-free death, thus putting an end to the suffering and the agony of death' (modern adaptation of the original quote).
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Affiliation(s)
- Bénédicte Clin
- Occupational Health Department, Cancers and Populations, ERI3 INSERM, Faculty of Medicine, Caen University Hospital, Caen, France.
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Andreoni B, Goldhirsch A, Orecchia R, Venturino M, Spirito R, Tadini L, Corbellini C, Bertani E, Veronesi U. Correlation between administered treatment and patient's living will. Ecancermedicalscience 2009; 3:158. [PMID: 22276019 PMCID: PMC3223999 DOI: 10.3332/ecancer.2009.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Indexed: 11/08/2022] Open
Abstract
Respecting the wishes of an adequately informed patient should be a priority in any health structure. A patient with advanced or terminal cancer should be allowed to express their will during the most important phases of their illness. Unfortunately, this is seldom the case, and in general instructions regarding an individual’s medical care preferences, i.e., their ‘living will’, expressed when healthy, often change with the onset of a serious illness. At the European Institute of Oncology (IEO), a clinical study is ongoing to verify whether, during clinical practice, the patient is adequately informed to sign an ‘informed consent’, in a fully aware manner, that will allow the patient and doctor to share in the decisions regarding complex treatment strategies (living will). A further aim of the study is to verify if health workers, both in hospital and at home, respect the patient’s will. The observational study ‘Respecting the patient’s wishes: Correlation between administered treatment and that accepted by the patient in their Living Will’ was approved by the IEO Ethical Committee in April 2008.
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Affiliation(s)
- B Andreoni
- Division General Surgery, European Institute of Oncology, 20141 Milan, Italy
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