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Vlachopoulos N, Kontogiannis G, Papageorgiou DI, Symvoulakis E, Haidich AB, Smyrnakis E. Effectiveness and Feasibility of Home-Based Palliative Care Interventions for Geriatric Oncology Patients: A Systematic Review Using Narrative Synthesis. Am J Hosp Palliat Care 2024:10499091241277882. [PMID: 39197821 DOI: 10.1177/10499091241277882] [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: 09/01/2024] Open
Abstract
BACKGROUND Due to an urgent need to develop palliative care services for geriatric patients with advanced cancer, an overview of available information regarding home-based palliative care interventions would be valuable. AIM To summarize current literature for interventions targeted to homebound, older patients with incurable cancer, and investigate whether these patients can be benefited from home-based palliative care and achieve improved outcomes. DESIGN A search strategy consisting of terms related to home care, palliation, oncology, and geriatrics was employed. A protocol following PRISMA guidelines was prospectively uploaded at PROSPERO (ID = CRD42023404675). DATA SOURCES Pubmed (MEDLINE), Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, and Epistemonikos.org databases were searched from inception until the present day. Eligibility criteria were selected based on the research question, the population of interest, and the research design. The Risk of Bias Assessment Tool version 2 (RoB-2) was used to appraise study quality. RESULTS A total of 10 articles including 871 patients (out of 1236 titles and 141 fully-reviewed texts) were selected. Four studies assessed exercise interventions, two evaluated multi-component home-care models, two focused on supervision services, and two had nutrition and activity components. Eight studies reported improved outcomes in either specified or mixed cancer geriatric populations. CONCLUSIONS There is a scarcity of clinical trials regarding home-based palliative care for geriatric oncology patients, resulting in poor information and a lack of evidence. At-home interventions seem feasible and have a positive effect on pain management and functional status, but more high-quality studies are required.
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Affiliation(s)
- Nikolaos Vlachopoulos
- Primary Health Care Research Network of the Aristotle University of Thessaloniki, Thessaloniki, Greece
- 251 Hellenic Air Force General Hospital, Athens, Greece
| | | | - Dimitra Iosifina Papageorgiou
- Primary Health Care Research Network of the Aristotle University of Thessaloniki, Thessaloniki, Greece
- Laboratory of Primary Health Care, General Practice and Health Services Research, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Emmanouil Symvoulakis
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Anna-Bettina Haidich
- Primary Health Care Research Network of the Aristotle University of Thessaloniki, Thessaloniki, Greece
- Laboratory of Hygiene, Social and Preventive Medicine, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Emmanouil Smyrnakis
- Primary Health Care Research Network of the Aristotle University of Thessaloniki, Thessaloniki, Greece
- Laboratory of Primary Health Care, General Practice and Health Services Research, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Wang A, Gonzaga K. Assistive Devices for Addressing Mobility Impairments Linked to Cancer and Cancer Treatment: An Expert Perspective. Semin Oncol Nurs 2024; 40:151683. [PMID: 38965022 DOI: 10.1016/j.soncn.2024.151683] [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: 03/01/2024] [Revised: 05/19/2024] [Accepted: 05/22/2024] [Indexed: 07/06/2024]
Abstract
OBJECTIVES Cancer survivors often experience mobility impairments that negatively impact their ability to engage in everyday activities. Healthcare providers working with patients in the continuum of cancer care play essential roles in identifying and addressing mobility impairments. The objective of this article is to present common assistive devices valuable in managing cancer and cancer treatment-related mobility impairments. METHODS Peer-reviewed scientific publications and expert opinions. RESULTS This article highlights assistive devices commonly used in various settings of cancer care and describes how they address different impairments faced by cancer survivors. The information presented can potentially serve as a resource when training clinical staff (eg, oncology nursing staff) on device provision across all settings. The information can also be useful for patients and caregivers to learn about potential functional impairments linked to cancer and treatments and assistive devices that can be useful to improve patients' functional capacity and reduce caregiver burden. CONCLUSION It is essential to involve different team members to identify and select the most appropriate assistive devices that match the patient's functional needs and physical capacity and to train them in device use so they can safely carry out their daily routine. IMPLICATIONS FOR NURSING PRACTICE Oncology nurses are one of the first providers to identify mobility impairments in cancer patients. This article will help increase their knowledge in common assistive devices valuable for addressing various mobility impairments associated with cancer and treatments. With additional training on device provision, oncology nurses will be more empowered to collaborate with rehabilitation to identify potential mobility impairments, initiate device provision, and encourage their patients to work with therapy services. Ultimately this could reduce injuries linked to mobility impairments and improve the patient's functional independence and overall quality of life.
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Affiliation(s)
- Allison Wang
- Staff Physical Therapist, Department of Neurology, Rehabilitation Services, Memorial Sloan Kettering Cancer Center, New York City, New York.
| | - Kimberley Gonzaga
- Senior Occupational Therapist, Department of Neurology, Rehabilitation Services, Memorial Sloan Kettering Cancer Center, New York City, New York
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Tang R, Zhang X, Yan S, Guan B, Li Y, Luo Q, Lai R, Wan H, Yang Y, Zeng L. Assistive device utilization among disabled elderly in China: A cross-sectional study. Public Health Nurs 2024; 41:653-663. [PMID: 38652371 DOI: 10.1111/phn.13329] [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: 12/18/2023] [Revised: 03/28/2024] [Accepted: 04/10/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE This study aimed to examine the characteristics of assistive device users and influencing factors among disabled elderly in China. METHODS A total of 13,510 disabled elderly in Sichuan Province were surveyed. Disability was assessed using the Barthel Activities of Daily Living Scale, mental status, sensory perception, and social engagement evaluation. Univariate analysis and logistic regression analysis were employed to identify the impact factors. RESULTS The prevalence of assistive device utilization among participants was 79.2% (10,700/13,510, 95% CI 78.5%-79.9%), with the wheelchair being the most commonly used device. Various factors were found to influence the usage of the device, including disability level, somatic disability, age, caregivers, income, caregiver fees, and living situation (p < .05). Additionally, several factors were identified associated with the frequency of device usage, such as somatic disability, education background, income, caregiver fees, living situation, access to acquire assistive devices, duration of assistive device usage, education on assistive devices, and satisfaction level (p < .05). CONCLUSIONS The use of assistive devices among elderly individuals in China is prevalent. There are many factors that affect the use of assistive devices, which can provide a reference for the formulation of policies in the field of assistive devices.
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Affiliation(s)
- Rong Tang
- Department of Nursing, Chengdu Fifth People's Hospital, Chengdu, Sichuan, China
| | - Xia Zhang
- Department of Geriatrics, Chengdu Fifth People's Hospital, Chengdu, Sichuan, China
| | - Shu Yan
- Medical Affairs Department, Chengdu Fifth People's Hospital, Chengdu, Sichuan, China
| | - Bi Guan
- Department of Nursing, Chengdu Fifth People's Hospital, Chengdu, Sichuan, China
- Department of Geriatrics, Chengdu Fifth People's Hospital, Chengdu, Sichuan, China
| | - Yan Li
- Department of Nursing, Chengdu Fifth People's Hospital, Chengdu, Sichuan, China
| | - Qing Luo
- Department of Geriatrics, Chengdu Fifth People's Hospital, Chengdu, Sichuan, China
| | - Rongmei Lai
- Department of Geriatrics, Chengdu Fifth People's Hospital, Chengdu, Sichuan, China
| | - Haiyan Wan
- Department of Nursing, Chengdu Fifth People's Hospital, Chengdu, Sichuan, China
| | - Yongxue Yang
- Department of Geriatrics, Chengdu Fifth People's Hospital, Chengdu, Sichuan, China
| | - Liangnan Zeng
- Department of Nursing, Chengdu Fifth People's Hospital, Chengdu, Sichuan, China
- Department of Geriatrics, Chengdu Fifth People's Hospital, Chengdu, Sichuan, China
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Wæhrens EE, Morgan DD, la Cour K, Lyons KD, Lozano ML, De Carlo MMP, Rezende G, Pilegaard MS. International consensus on occupational therapy interventions for people with palliative care needs: A European Association for Palliative Care Group Concept Mapping study. Palliat Med 2023; 37:1389-1401. [PMID: 37534430 DOI: 10.1177/02692163231188155] [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] [Indexed: 08/04/2023]
Abstract
BACKGROUND While evidence shows that occupational therapists can play a key role in the care of people with palliative care needs, more knowledge about effective occupational therapy interventions for this group is needed. AIM To identify, organise and prioritise intervention components considered to be effective within occupational therapy for people with palliative care needs from the perspective of occupational therapy clinicians, managers and researchers. DESIGN Group Concept Mapping utilising a mixed methods participatory approach. Using a focus prompt, participants brainstormed, sorted, labelled and rated generated statements about effective occupational therapy intervention components. Multidimensional scaling analysis and cluster analysis were conducted. SETTING/PARTICIPANTS Snowball recruitment was used to recruit participants. Participants included occupational therapists worldwide who were able to read and write in English and were working as clinicians, managers and/or researchers with occupational therapy interventions for people with palliative care needs. RESULTS Seventy-two occupational therapists from 15 countries participated in the study representing Asia (n = 3, 20%), Europe (n = 8, 53%), Oceania (n = 2, 13%) and North America (n = 2, 13%). A total of 117 statements were identified and organised into five clusters: (1) being client-centred, (2) promoting occupational engagement to optimise quality of life, (3) involving the social and relational environment, (4) enabling occupations and (5) facilitating occupational adaptation. CONCLUSIONS Five clusters of core occupational therapy intervention components were considered to be effective when supporting people with palliative care needs. Research should use this knowledge to inform future occupational therapy interventions for this group of people.
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Affiliation(s)
- Eva Ejlersen Wæhrens
- User Perspectives and Community-based Interventions, the Research Group for Occupational Science, Department of Public Health, University of Southern Denmark, Odense C, Denmark
- The ADL Unit, The Parker Institute, Copenhagen University Hospital, Denmark
| | - Deidre D Morgan
- Research Centre for Palliative Care, Death and Dying (RePaDD), Flinders University, Adelaide, SA, Australia
| | - Karen la Cour
- User Perspectives and Community-based Interventions, the Research Group for Occupational Science, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Kathleen Doyle Lyons
- The Department of Occupational Therapy, Massachusetts General Hospital Institute of Health Professions, Boston, MA, USA
| | - Mario Lozano Lozano
- The Department of Physical Therapy, University of Granada, Granada, Andalucía, Spain
- Instituto de Investigación Biosanitaria ibs, GRANADA, Granada, Andalucía, Spain
- The Sport and Health Joint University Institute (IMUDS), Granada, Andalucía, Spain
| | - Marysia Mr Prado De Carlo
- Division of Occupational Therapy, Department of Health Sciences, Ribeirão Preto Medical School of the University of São Paulo (FMRP-USP), Ribeirão Preto, São Paulo, Brazil
| | - Gabriela Rezende
- Division of Occupational Therapy, Department of Health Sciences, Ribeirão Preto Medical School of the University of São Paulo (FMRP-USP), Ribeirão Preto, São Paulo, Brazil
| | - Marc Sampedro Pilegaard
- DEFACTUM, Central Denmark Region, Aarhus, Denmark
- Department of Social Medicine and Rehabilitation, Gødstrup Hospital, Denmark
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Kelly R, Manning B, Broome K. Assistive technology in palliative medicine: equipment needs. BMJ Support Palliat Care 2023:bmjspcare-2022-003723. [PMID: 36604162 DOI: 10.1136/spcare-2022-003723] [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: 04/21/2022] [Accepted: 12/20/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Most people prefer to die at home. Timely and appropriate provision of assistive technology can support people to remain at home in the palliative phase. A state-wide palliative care equipment programme (PCEP) was established in Queensland, Australia, to support coordinated assistive technology provision. The objective of this study was to identify population-wide palliative care equipment needs and their relationship to primary diagnostic categories. METHOD A retrospective, cross-sectional analysis of equipment provided over a 19-month period was conducted. This included types of equipment provided and characteristics of the participants such as rurality, age and diagnostic category. RESULTS There were 13 764 approved equipment requests, with a median time between equipment application and death being around 35 days. There were significant differences in the types of equipment typically required across diagnostic categories. CONCLUSION The findings from the study can provide a benchmark for the development of population-wide PCEPs. For practitioners who are new to palliative care, typical trajectories of equipment needs by diagnostic group can help guide equipment planning.
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Affiliation(s)
- Renae Kelly
- Medical Aids Subsidy Scheme, Metro South Hospital and Health Service, Cannon Hill, Queensland, Australia
- School of Health & Rehabilitation Sciences, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Bridget Manning
- Medical Aids Subsidy Scheme, Metro South Hospital and Health Service, Cannon Hill, Queensland, Australia
| | - Kieran Broome
- Medical Aids Subsidy Scheme, Metro South Hospital and Health Service, Cannon Hill, Queensland, Australia
- School of Health & Behavioural Sciences, University of the Sunshine Coast, Maroochydore DC, Queensland, Australia
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The Complexities of Prescribing Assistive Equipment at the End of Life—Patient and Caregivers’ Perspectives. Healthcare (Basel) 2022; 10:healthcare10061005. [PMID: 35742056 PMCID: PMC9222988 DOI: 10.3390/healthcare10061005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/22/2022] [Accepted: 05/27/2022] [Indexed: 02/01/2023] Open
Abstract
Ongoing participation in valued and essential everyday activities remains a priority for people with advanced disease. This study sought to understand factors influencing patients with advanced disease and caregivers’ utilisation of assistive equipment that enable this participation. Employing a pragmatic approach, purposive sampling identified participants who were interviewed in their homes. A semi-structured interview guide was employed to elicit community dwelling patients’ and caregivers’ perspectives about assistive equipment utilisation. Recorded interviews were analysed inductively and themes were constructed from the data. Fourteen interviews were conducted with patients and caregivers. Patients had a range of cancers and COPD. Three empirically developed themes demonstrate the complexities associated with the use of assistive equipment at the end of life: 1. Enabling engagement in everyday activities; 2. Dependency—a two-way street; 3. The pragmatics of choosing, using or declining assistive equipment. Participants were motivated to use assistive equipment when it optimised their function, enabled participation and supported their values, roles and interests. Conversely, use of assistive equipment could be met with ambivalence as it represented deterioration or could cause conflict within relationships. Caregivers found assistive equipment made it easier for them to provide physical care. Skilled proactive assistive equipment prescription and training by allied health professionals enhanced patient and caregiver confidence and capacity to engage in everyday activities.
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