Association between unmet needs and quality of life in hospitalised cancer patients no longer receiving anti-cancer treatment

End-of-life care needs in cancer patients: a qualitative study of patient and family experiences

BACKGROUND

Cancer is a disease that transcends what is purely medical, profoundly affecting the day-to-day life of both patients and family members. Previous research has shown that the consequences of cancer are greatly aggravated in patients at the end of life, at a time when they must also grapple with numerous unmet needs. The main objective of this study was to obtain more in-depth insight into these needs, primarily in patients with end-stage cancer nearing death.

METHODS

Semi-structured interviews were conducted in Spain with cancer patients at the end of life (n = 3) and their family members (n = 12). The findings from the interviews were analyzed using qualitative thematic analysis and a grounded theory approach.

RESULTS

Four major themes emerged from the interviews that explored the needs and concerns of patients with cancer at the end of life: (1) physical well-being (2) emotional well-being (3) social well-being and (4), needs relating to information and autonomous decision-making. The interviews also shed light on the specific needs of family members during this period, namely the difficulties of managing increased caregiver burden and maintaining a healthy work-life balance.

CONCLUSIONS

A lack of support, information and transparency during a period of immense vulnerability makes the end-of-life experience even more difficult for patients with cancer. Our findings highlight the importance of developing a more in-depth understanding of the needs of this population, so that informed efforts can be made to improve palliative healthcare and implement more comprehensive care and support at the end of life.

Spiritual needs of older adults with cancer: A modified concept analysis

Objective

To clarify the concept of spiritual needs and explain its meaning to older adults with cancer.

Methods

Electronic databases (Web of Science, PubMed, EBSCOASU, CNKI, Wanfang, and VIP) were systematically searched and analyzed using "spiritual needs" as keywords. Rodgers' evolutionary method guided the concept analysis to identify attributes, antecedents, and consequences. Two rounds of Delphi expert consultations ensured accuracy, reliability, and feasibility for implementation.

Results

Spiritual needs express an individual's expectations of comfort and inner peace that satisfy his or her perception of the meaning and purpose of life, the ability to love and be loved, feelings of peace and gratitude, and a sense of belonging and hope. Spiritual needs have four dimensions: personal, communal, environmental, and transcendence or supreme. The attributes of spiritual needs include meaning and purpose of life, love and being loved, peace and gratitude, belonging, and hope. The antecedents include spiritual recognition and events that trigger spiritual needs and spiritual need thresholds. The outcomes of addressing and meeting the spiritual needs of older adults with cancer include promoting their spiritual health and enhancing their quality of life. After two rounds of Delphi experts' consultation, the expert authority coefficients (Cr) were 0.83 and 0.88, respectively. Experts agreed on the concept of spiritual needs.

Conclusions

Exploring antecedents of spiritual needs in older adults with cancer clarifies obstacles to spiritual practice, offering intervention strategies for spiritual care and well-being. Meeting their spiritual needs enhances spiritual health and quality of life, essential in humanistic nursing care.

Psychiatric Comorbidities and Outcomes in Palliative and End-of-Life Care: A Systematic Review

BACKGROUND

Although psychiatric comorbidities are common among individuals at end of life, their impact on outcomes is poorly understood.

METHODS

We conducted a systematic literature review of six databases following preferred reporting items for systematic reviews and meta-analyses guidelines and aimed at assessing the relationship between psychiatric comorbidities and outcomes in palliative and end-of-life care. Six databases were included in our search. This review is registered on PROSPERO (CRD42022335922).

RESULTS

Our search generated 7472 unique records. Eighty-eight full texts were reviewed for eligibility and 43 studies were included in the review. Clinically, psychiatric comorbidity was associated with poor quality of life, increased physical symptom burden, and low function. The impact of psychiatric comorbidity on health utilization varied, though many studies suggested that psychiatric comorbidity increased utilization of palliative care services. Quality of evidence was limited by lack of consistent approach to confounding variables as well as heterogeneity of the included studies.

CONCLUSION

Psychiatric comorbidity is associated with significant differences in care utilization and clinical outcome among patients at end of life. In particular, patients with psychiatric comorbidity and serious illness are at high risk of poor quality of life and high symptom burden. Our finding that psychiatric comorbidity is associated with increased utilization of palliative care likely reflects the complexity and clinical needs of patients with serious illness and mental health needs. These data suggest that greater integration of mental health and palliative care services may enhance quality-of-life among patients at end of life.

Unmet supportive care needs of people with advanced cancer and their caregivers: A systematic scoping review

Examining and addressing unmet care needs is integral to improving the provision and quality of cancer services. This review explored the prevalence of unmet supportive care needs, and factors associated with unmet need, in adults with advanced cancers (solid and hematological malignancies) and their caregivers. Electronic databases (PubMed, CINAHL, EMBASE) were searched, producing 85 papers representing 81 included studies. People with advanced cancer reported the highest unmet needs in financial, health system and information, psychological, and physical and daily living domains, whereas caregivers reported the highest unmet needs in psychological, and patient care and support domains. Distress, depression, and anxiety were associated with higher unmet needs across all unmet need domains for people with advanced cancer and their caregivers. Substantial heterogeneity in study populations and methods was observed. Findings from this review can inform targeted strategies and interventions to address these unmet needs in people with advanced cancer.

Spiritual Needs, Religious Coping and Mental Wellbeing: A Cross-Sectional Study among Migrants and Refugees in Germany

It has been widely proven that resettlement is associated with negative psychological effects (e.g., increased depression and symptoms of post-traumatic stress disorder) among refugees. Therefore, there is an urgent need to improve the psychosocial functioning of migrants. This study assessed associations between negative dysfunctional appraisal (perceiving experiences as stressful), spiritual needs, religious coping and wellbeing. Data from paper-and-pencil questionnaires were collected from 744 refugees (69.8% male) aged 18–67 years (M = 27.99) with diverse backgrounds (including from Mashreq countries) who were resettled in Germany. Bootstrapping mediation analysis revealed that the relationship of dysfunctional appraisal and wellbeing among refugees is mediated by spiritual needs (i.e., existential and religious needs). Additionally, negative religious coping mediates the relationship between spiritual needs and wellbeing. The data obtained suggest the need for practitioners to focus on psychological interventions that strengthen spiritual needs in order to improve mental health among refugees.

The Supportive Care Needs of Cancer Patients: a Systematic Review

Cancer, and the complex nature of treatment, has a profound impact on lives of patients and their families. Subsequently, cancer patients have a wide range of needs. This study aims to identify and synthesise cancer patients' views about areas where they need support throughout their care. A systematic  search of the literature from PsycInfo, Embase and Medline databases was conducted, and a narrative. Synthesis of results was carried out using the Corbin & Strauss "3 lines of work" framework. For each line of work, a group of key common needs were identified. For illness-work, the key needs idenitified were; understanding their illness and treatment options, knowing what to expect, communication with healthcare professionals, and staying well. In regards to everyday work, patients wanted to maintain a sense of normalcy and look after their loved ones. For biographical work, patients commonly struggled with the emotion impact of illness and a lack of control over their lives. Spiritual, sexual and financial problems were less universal. For some types of support, demographic factors influenced the level of need reported. While all patients are unique, there are a clear set of issues that are common to a majority of cancer journeys. To improve care, these needs should be prioritised by healthcare practitioners.

Quality of life in older survivors of non-Hodgkin's lymphoma who received chemotherapy and related factors

INTRODUCTION

Cancer and its treatment have a broad impact on patients' Quality of Life (QoL). Previous researches showed that many factors in Comprehensive Geriatric Assessment (CGA) affect QoL. CGA could predict toxicity, overall survival rate and can help adjust the choice and intensity of treatment in each patient. However, there has been no research explicitly exploring factors related to the QoL in older patients with Non-Hodgkin's Lymphoma (NHL). This research aims to explore the how factors in CGA relate to the QoL in older patients with NHL.

MATERIALS AND METHOD

The study design was cross-sectional in NHL patients aged ≥ 60 years, research was conducted in Integrated Geriatric Polyclinic and Hemato-Oncology Polyclinic of three public hospitals in Jakarta, during March-August 2019.

RESULTS

There were 62 subjects, with a median age of 66 years, 56.5% male. The result showed that most of the patients have a good QoL, based on each domain of SF-36 and EORTC QLQ-C30. In multivariate analysis, it was found that depression and frailty status were related to PCS SF-36 domain with PR 12.086 (95% CI 1.596-92.124) and PR 5.622 (95% CI 1.060-29.807), respectively. Multivariate analysis with SF-36's Mental Component Summary (MCS) showed a significant relationship with depression status with PR 24.400 (95% CI 2.961-140.539). While the results of multivariate analysis with the EORTC QLQ-C30 functional scale showed a significant relationship with the ECOG performance score with PR 171 (95% CI 8.470-3452.28).

DISCUSSIONS

After multivariate analysis, only frailty status, depression status and ECOG performance score have a statistically significant relationship.

Spiritual Experiences of Adults With Advanced Cancer in Outpatient Clinical Settings

CONTEXT

Adults who have advanced cancer experience distress, and many use religion and spirituality to cope. Research on the spiritual experiences of patients with advanced cancer will help guide the provision of high-quality spiritual care.

OBJECTIVES

To qualitatively describe advanced cancer patients' spiritual experiences of illness.

METHODS

We conducted semistructured qualitative interviews at a single cancer center with 21 patients with stage IV solid malignancies who had a prognosis of less than 12 months, as estimated by each patient's medical oncologist. Five investigators conducted a thematic analysis of the transcribed interviews.

RESULTS

We found 31 patients who were eligible for enrollment, and 21 (67.7%) participated in interviews to thematic saturation. Using a thematic-analysis approach, five major themes emerged. Relationships with family and friends was the most important theme among all 21 patients irrespective of their religious or spiritual identity. Relationship with God and faith community was frequently identified by those who considered themselves spiritually religious. Cancer often led to reflection about the meaning of life and the nature of existential suffering. Patients addressed the extent to which identity was changed or maintained through the cancer experience, and some expressed acceptance as a way of coping with illness.

CONCLUSIONS

Spiritual care for dying cancer patients should always include the exploration of relationships with family and friends, as well as God and faith community for some patients. Relationships with family, friends, and God can be a source of strength for many. Making meaning, addressing identity concerns, supporting acceptance as a resource for coping with illness, and acknowledging existential suffering will often arise for these patients.

Unmet care needs of advanced cancer patients and their informal caregivers: a systematic review

BACKGROUND

This systematic review aimed to identify the unmet care needs and their associated variables in patients with advanced cancer and informal caregivers, alongside summarizing the tools used for needs assessment.

METHODS

Ten electronic databases were searched systematically from inception of each database to December 2016 to determine eligible studies. Studies that considered the unmet care needs of either adult patients with advanced cancer or informal caregivers, regardless of the study design, were included. The Mixed Methods Appraisal Tool was utilized for quality appraisal of the included studies. Content analysis was used to identify unmet needs, and descriptive analysis was adopted to synthesize other outcomes.

RESULTS

Fifty studies were included, and their methodological quality was generally robust. The prevalence of unmet needs varied across studies. Twelve unmet need domains were identified in patients with advanced cancer, and seven among informal caregivers. The three most commonly reported domains for patients were psychological, physical, and healthcare service and information. The most prominent unmet items of these domains were emotional support (10.1-84.4%), fatigue (18-76.3%), and "being informed about benefits and side-effects of treatment" (4-66.7%). The most commonly identified  unmet needs for informal caregivers were information needs, including illness and treatment information (26-100%) and care-related information (21-100%). Unmet needs of patients with advanced cancer were associated with their physical symptoms, anxiety, and quality of life. The most commonly used instruments for needs assessment among patients with advanced cancer were the Supportive Care Needs Survey (N = 8) and Problems and Needs in Palliative Care questionnaire (N = 5). The majority of the included studies investigated unmet needs from the perspectives of either patients or caregivers with a cross-sectional study design using single time-point assessments. Moreover, significant heterogeneity, including differences in study contexts, assessment methods, instruments for measurement, need classifications, and reporting methods, were identified across studies.

CONCLUSION

Both advanced cancer patients and informal caregivers reported a wide range of context-bound unmet needs. Examining their unmet needs on the basis of viewing patients and their informal caregivers as a whole unit will be highly optimal. Unmet care needs should be comprehensively evaluated  from the perspectives of all stakeholders and interpreted by using rigorously designed mixed methods research and longitudinal studies within a given context.

Spiritual needs of patients with cancer in palliative care: an integrative review

PURPOSE OF REVIEW

The experience of a life crisis, such as the experience of end-of-life terminality whenever facing cancer can make the spiritual needs of patients clear. The goal of this revision was to synthesize the existing evidence regarding the spiritual needs of patients with cancer in palliative care.

RECENT FINDINGS

An integrated revision of the literature was conducted regarding the database sources from PubMed, CINAHL, EMBASE, LILACS and Scopus, without publishing year restrictions. There were 16 primary studies included. A total of 1469 patients have been evaluated, whereas eight groups of spiritual needs have been identified: finding the meaning and purpose of life; finding the meaning in experiencing the disease; being connected to other people, God and nature; having access to religious/spiritual practices; physical, psychological, social and spiritual wellbeing; talking about death and the experience of dying; making the best out of their time; being independent and being treated like a normal person.

SUMMARY

It is essential to pay attention to patients' spiritual dimensions regarding palliative care. Therefore, patients' spiritual needs must be identified and remedied or mitigated. It is necessary to develop studies that find specific strategies and interventions for the treatment of these needs.

Understanding Distress in the Hospital: A Qualitative Study Examining Adults With Cancer

PURPOSE

To measure the distress of hospitalized adults with cancer and identify strategies and behaviors to manage distress.
.

PARTICIPANTS & SETTING

185 adults with cancer hospitalized in a large tertiary hospital in the Midwest.
.

METHODOLOGIC APPROACH

This study involved a one-time assessment using the National Comprehensive Cancer Network's (NCCN's) Distress Thermometer and two open-ended questions. Demographic data were reviewed, and responses to open-ended questions were analyzed by content analysis. A team approach was used to develop and validate themes. 
.

FINDINGS

Strategies used by patients to manage distress were categorized as taking charge and embracing help. Helpful strategies were related to quality of life and relationship with care teams. 
.

IMPLICATIONS FOR NURSING

Understanding of distress in hospitalized adults with cancer is limited, which warrants the attention of healthcare professionals. Study results have implications to enhance patient care and to address nationally established psychosocial care objectives and NCCN distress screening standards.

Complex Problems, Care Demands, and Quality of Life Among People Living With HIV in the Antiretroviral Era in Indonesia

People living with HIV (PLWH) suffer from physical and psychological distress that palliative care could alleviate. Our cross-sectional study identified HIV-related problems and demands for palliative care at different disease stages, and their interactions with quality of life (QOL) in 215 PLWH from a referral hospital and an AIDS nongovernmental organization in Indonesia. A brief survey of demographic information, the Bahasa version of Problems and Needs of Palliative Care, and the World Health Organization Quality of Live in HIV-infected Persons instrument (WHOQOL-HIV BREF; Cronbach's alpha = .89) were used for data collection. Mean age was 33.5 years (SD = 4.7); 66% were male. Fatigue (67%) was the most prevalent symptom, and the symptom sleeping problems (54.9%) was the priority for palliative care. Higher spiritual and financial demands were found in PLWH with stage IV HIV. Multivariable analysis indicated negative associations between QOL and psychosocial problems, and demands for social and financial support. Interventions focused on psychosocial issues would improve the QOL for PLWH.

Predictors of Change in Quality of Life in Patients With End-Stage Disease During Hospitalization

BACKGROUND

Currently, there are no studies aimed at evaluating the quality of life (QoL) of patients with end-stage disease during hospitalization and the factors that influence it.

AIM

The aim of the research was to identify predictors of change in the QoL of patients hospitalized due to advanced stage of disease.

METHODS

The sample consisted of 140 patients with end-stage disease who were hospitalized on this account. For evaluation of QoL, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) was used. The Hospital Anxiety and Depression Scale and Karnofsky Performance Status questionnaires were used for the assessment of mental and functional status. For the evaluation of predictors of negative change in QoL, a logistic regression analysis was used.

RESULTS

During hospitalization, there was a significant deterioration in the scores given for all domains of the functional QLQ-C30 scale, but not the symptomatic scale. Predictors of change in overall QoL detected were marital status, improved functional status, and depression detected on admission to hospital. Gender and age were found to be protective factors against deterioration in overall QoL.

CONCLUSION

Sociodemographic characteristics and mental and functional status may be associated with change in QoL of patients with end-stage disease during hospitalization.

Assessing Patients’ Palliative Care Needs in the Final Stages of Illness During Hospitalization

This study aimed to explore the palliative care needs of inpatients in the final stages of illness and to analyze the factors that influence them. The survey comprised 349 inpatients in the terminal stage of disease. Needs were assessed with the Patient Needs Assessment in Palliative Care (PNAP) questionnaire; mental status was evaluated using the Hospital Anxiety and Depression Scale (HADS) questionnaire. The importance of needs varied with respect to patients’ diagnosis, age, gender, religion, and their levels of anxiety and depression. Most frequently, predictors of needs importance were lower age, poorer functional status, higher anxiety, and lower depression scores. Unmet needs were more likely to be indicated by nonreligious patients with better functional status and higher anxiety and depression scores.